Patient-friendly summary
If you read nothing else
Bottom line
Therapeutic exercise — particularly aerobic and muscle-strengthening, with combined programs best for mood — appears to reduce pain, FMS severity, and depressive symptoms and to improve quality of life, but small, heterogeneous, mostly-female studies mean the best exercise type remains uncertain.
Moderate evidencePublished
Evidence hierarchy
Study participants
Adults diagnosed with fibromyalgia syndrome without significant comorbidity, recruited across Norway, the UK, Brazil, Spain, the US, Sweden, and Turkey
Full research — for clinicians and curious readers
Study Summary
This systematic review and meta-analysis pooled randomized controlled trials of therapeutic exercise (aerobic, strengthening, stretching, and combined) for adults with fibromyalgia syndrome (FMS). Drawing on 16 RCTs (14 in the quantitative analysis; 715 participants, almost all women), it reports that exercise reduced pain, FMS severity, and symptoms of depression while improving both the physical and mental components of health-related quality of life. The authors describe aerobic and muscle-strengthening exercise as most effective for pain and FMS severity, stretching and aerobic exercise as most helpful for quality of life, and combined exercise as most effective for depressive symptoms. They caution that the included studies were small and heterogeneous, so firm conclusions about which exercise type is best could not be drawn.
Key Findings
| Finding | Detail | Impact |
|---|---|---|
| Exercise reduced overall pain with a large effect size | Pooled standardized mean difference (SMD) of −1.11 (95% CI −1.52 to −0.71; overall effect p < 0.001), described by the authors as strong evidence from both intention-to-treat and per-protocol analyses. Cohen's g indicated a large effect on pain. | High |
| Exercise reduced FMS severity (global well-being) with a medium effect | Pooled SMD of −0.67 (95% CI −0.89 to −0.45; p < 0.001) on FMS severity measured largely by the Fibromyalgia Impact Questionnaire; classified as a medium effect. | High |
| Exercise reduced symptoms of depression with a small effect | Pooled SMD of −0.40 (95% CI −0.55 to −0.24; p < 0.001); the authors note combined exercise produced the largest beneficial effect on depressive symptoms (SMD −0.47, medium effect). | Medium |
| Exercise improved both physical and mental components of health-related quality of life | Physical component SMD 0.77 (95% CI 0.47 to 1.08; p < 0.001) and mental component SMD 0.49 (95% CI 0.27 to 0.71; p < 0.001); medium effect sizes. Stretching produced the largest gain in the physical component of HRQOL. | High |
| Different exercise types appeared best for different outcomes | Aerobic and muscle-strengthening exercise were described as most effective for reducing pain and FMS severity; stretching and aerobic exercise for improving HRQOL; and combined programs for reducing depression. Stretching alone was not effective for pain or FMS severity in per-protocol analysis. | Medium |
| Heterogeneity was driven by two studies and removing them strengthened the pain effect | Excluding the studies by Kayo et al. and Jones et al. eliminated statistical heterogeneity for pain and FMS severity; the pain effect remained large (SMD −0.97, 95% CI −1.39 to −0.55; p < 0.001) and FMS severity strengthened (SMD −1.04). | Medium |
Strengths
- Conducted according to PRISMA and Cochrane Collaboration methodology with a prespecified protocol
- Comprehensive multi-database search (Cochrane Plus, PEDro, PubMed) plus manual journal searching in two languages
- Independent dual reviewers for study selection, data extraction, and quality assessment
- Methodological quality screened with CONSORT 2010 (inclusion threshold >15/25) and risk of bias assessed with the Cochrane tool
- Random-effects model (conservative) with Hedge's adjusted g to correct for small-study bias
- Subgroup analyses by exercise type and sensitivity analyses to identify sources of heterogeneity; funnel plot showed no evidence of publication bias
Limitations
- Small sample sizes in most included trials (typically fewer than 40 subjects per group)
- Almost all participants were women, so applicability to men with fibromyalgia is uncertain
- Exercise interventions cannot be blinded, so all studies were rated at high risk of bias for blinding of participants and personnel
- Substantial heterogeneity, primarily from the Kayo et al. and Jones et al. studies, which must be considered when interpreting results
- Each exercise type was studied in only a small number of trials, so the authors state they could not firmly conclude which type is most effective
- The meta-analysis treated post-treatment data as the experimental group and pre-treatment values as the control group, a within-study comparison approach
Key Takeaways for Patients
What This Means for You
Regular exercise may help reduce pain, lessen the overall impact of fibromyalgia, ease low mood, and improve quality of life — the review found benefits across all of these areas.
Aerobic activity (such as walking, cycling, or treadmill) and muscle-strengthening exercise appeared most helpful for pain and overall severity, while stretching and aerobic exercise helped most with quality of life.
Programs combining aerobic, strengthening, and stretching exercise seemed best for improving mood and depressive symptoms.
The reviewed programs were typically mild-to-moderate intensity, 2–3 sessions per week of about 30–45 minutes each.
Benefits tend to fade if you stop, so the authors emphasize keeping up regular activity over time; talk with your clinician about a program that fits you.
Because nearly all participants were women, it is not certain how well these results apply to men with fibromyalgia.
Read the Full Paper
Access the complete peer-reviewed study from BioMed Research International