During the 1950s and 60s, he won many titles and awards, including winning the Mr. Universe contest five times, and was named "World's Best-Built Man of the Century".

Even with his final Mr Universe win (at age 41), Pearl defeated Frank Zane, Reg Park, Dave Draper, and Sergio Oliva.

Though he was arguably the world's best bodybuilder in the mid-'60s, Pearl never competed in IFBB Mr. Olympia (which has been held annually beginning in 1965) but did the NABBA Pro Mr. Universe instead.

His strongman act included blowing up hot water bottles, bending tent spikes, breaking chains, and tearing up license plates.

[4] Pearl mentioned the benefits of vegetarian bodybuilding in his book Getting Stronger: Weight Training for Sports, published in 2005.

Pearl is the author of the exercise book, Getting Stronger: Weight Training for Men and Women, which has sold over 350,000 copies in the United States and has been translated into four other languages, including Chinese.

During the 1980s, Pearl served as a mentor, trainer, and training partner to many of the top professionals that were still competing, including Mr. Olympia, Chris Dickerson.

[6] In 2011 Pearl appeared in the documentary Challenging Impossibility describing when he hosted the 2004 strength exhibition by spiritual teacher and peace advocate Sri Chinmoy.