Fibromyalgia is a common chronic rheumatic condition associated with widespread musculoskeletal pain and fatigue which impact on mood and health-related quality of life (HRQoL). Low-moderate quality evidence to date has not investigated the efficacy of different types of exercise training. This systematic review aimed to estimate the effects of exercise (aerobic, resistance or stretching) compared to usual care on pain, depression and HRQoL in people with fibromyalgia.
The protocol was prospectively registered. Two databases were searched for randomised controlled trials published in English with no date restriction. Eligible studies included adult participants with fibromyalgia. The intervention was land-based exercise training (aerobic, resistance or stretching). Usual care participants received an alternative exercise type (e.g., aerobic training versus strength training), another type of intervention (e.g., relaxation, chiropractic) or non-exercise usual care. Self-reported pain, depression and HRQoL were the outcomes of interest. Title and abstract, full-text screening for eligibility, data extraction and assessment of methodological quality (using the Cochrane Collaboration Risk of Bias tool) were performed by two authors independently, with disagreements resolved by a third author. A meta-analysis (random effects model) pooled the trials, with forest plots used to summarise and compare trials. Subgroup analyses investigated differences between types of exercise training. Evidence certainty was rated using the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) approach.
Eighteen trials, involving 1,184 (97.5% female) participants were included. Nine trials included aerobic exercise, 10 resistance and five stretching. The intervention parameters varied widely with session duration ranging from 20-60 minutes, frequency from 2-7 days/week and program duration of between three-24 weeks. Risk of bias due to lack of blinding of participants and personnel, blinding of outcomes or incomplete outcomes was high in 14, 2 and 3 trials, respectively.
Four questionnaires were used to report pain, two reported HRQoL and another two depression meaning results were combined as standardised mean differences (SMD) and 95% confidence intervals (CI). All three types of exercise showed significant reductions in pain compared to usual care (SMD=-1.34, 95% CI -1.69 to -0.99, I2 85%, no significant differences between exercise types). Overall exercise showed significant reductions in depression compared to usual care (SMD=-0.78, 95% CI -1.28 to -0.28, I2 85%), subgroup analysis revealed significant effects for aerobic exercise (SMD -0.55 (95% CI -0.97 to -0.12) but not resistance or stretching). Overall exercise showed significant lower impact of fibromyalgia on HRQoL compared to usual care (SMD=-0.95, 95% CI -1.34 to -0.56, I2 82%) and improvements in mental (SMD=0.54 (95% CI 0.23 to 0.84), I2 55%) and physical (SMD=0.80 (95% CI 0.46 to 1.14), I2=62%) components of HRQoL. Adverse events were not reported.
Exercise training for people with fibromyalgia reduces pain and depression and improves HRQoL, although the certainty of available evidence was very low. Further higher-quality evidence is required.
Couto N, Monteiro D, Cid L, Bento T. Effect of different types of exercise in adult subjects with fibromyalgia: a systematic review and meta-analysis of randomised clinical trials. Sci Rep. 2022 Jun 20;12(1):10391. doi: 10.1038/s41598-022-14213-x.
PEDro acknowledges Dr Lara Edbrooke and Laura Crowe-Owen for preparing this summary.