The most effective therapeutic exercises for pain intensity in women with fibromyalgia: A systematic review and network meta-analysis.
Álvaro-José Rodríguez-Domínguez, Manuel Rebollo-Salas, Raquel Chillón-Martínez and 3 others
PMID 40319533WHAT IT FOUND
Aquatic exercise eased fibromyalgia pain most in the short term and resistance training in the longer term, both by more than the 15 points out of 100 the review counts as a worthwhile change.
Resistance training worked at both time points.
Key findings
01In the short term (up to 3 months after the programme ended), aquatic exercise, Pilates, qigong, resistance training, virtual reality, mixed exercise and aerobic exercise each reduced pain significantly more than usual care or sham, and all of those improvements were large enough to count as clinically important. Aquatic exercise was ranked first.
02In the longer term, resistance training, dance, functional training, aquatic exercise, virtual reality and aerobic exercise all reduced pain significantly more than usual care. Only three approaches reached the review's threshold for a clinically important improvement (resistance training, dance and functional training), and resistance training alone reached the larger benchmark of 30 points out of 100, which the review calls a moderately important change. Resistance training was ranked first.
03Flexibility training was the one exercise that did significantly worse than the group it was compared with, both in the short and the longer term.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
Read the rest of this summary
You get three full summaries a month, free, and we do not ask for a card. Search, the TL;DRs and your library stay unlimited either way.
What it does not show
Only women were included, so this says nothing about exercise for men with fibromyalgia. Eighty per cent of the trials used the 1990 American College of Rheumatology diagnostic criteria, which were replaced in 2010 because they were no longer considered valid, so people in these trials may not all have had fibromyalgia as it is defined now. Exercise trials cannot be blinded. The women knew whether they were exercising and which kind, so expectations may have shaped the pain scores. The short-term comparisons, where most of the headline recommendations sit, were mostly rated low certainty, and the trials disagreed far more with each other than chance would explain, so a different set of trials could reorder the table. The authors describe the overall certainty as moderate, but their own grading gave that rating to only 22 of the 171 short-term comparisons. The review only looked at pain intensity. Pain intensity is one part of living with fibromyalgia, so a change in the score does not necessarily mean the illness as a whole has improved. Every league table rests partly on indirect comparisons, so some of the estimates of how two exercises compare come from how each performed against other treatments rather than from trials that tested the two against each other. Seven hundred and eight of the 3581 participants were in trials that could not be pooled, the average trial had 59 women, and the 15-point threshold for a worthwhile change was only applied to comparisons against usual care.
Declared interests
The authors declare no competing interests. The text provided carries no funding statement, so who paid for the review is not reported.
The easy way to misread this
Do not read the league table as a settled order of what works best. The short-term ranking that put aquatic exercise first rests mostly on low-certainty evidence, with 149 of the 171 comparisons graded low, and on trials that disagreed substantially with each other, so a different set of trials could reorder it. The firmer long-term evidence points to a different exercise (resistance training) than the short-term evidence does.
Summarised by AI from the full paper, without a clinician reviewing it. Check it against the source before it changes what you do. Read it on PubMed →