Exercise Therapies for Fibromyalgia Pain Catastrophizing: A Systematic Review and Comparative Analysis

Objective: To investigate the impact of various exercise modalities on the mitigation of pain catastrophizing in patients with fibromyalgia.

Data Sources: A systematic review with comparative analysis was conducted on May 22, 2024, utilizing Embase, PubMed, Scopus, Cochrane Library, and Web of Science.

Study Selection: The search resulted in 350 articles, of which 190 were duplicates. After duplicate removal, title and abstract appraisal was conducted followed by full-text appraisal. A total of 9 articles fit the inclusion/exclusion criteria.

Data Extraction: Usable statistics and relevant data points were extracted. Outcomes of interest were pain catastrophizing scores. The duration of treatment protocol and the number of exercise sessions per week were also extracted.

Results: Exercise intervention of any type showed a moderate impact on pain catastrophizing (d =0.58; 95% CI, 0.16-1.01; P < .01). Subgroup analysis showed varying effects. Yoga was not statistically significant but was the most clinically effective (d = 1.1; 95% CI, -0.48 to 2.69; P = .172). Pilates did not clinically or statistically reduce pain catastrophizing (d = 0.108; 95% CI, -0.522 to 0.738; P = .737). Resistance training, mixed aerobic-resistance exercise, aquatic therapy/exercise, and aerobic only all denoted a degree of clinically significant effectiveness (d = 0.559, 0.526, 0.548, and 0.226, respectively). Only mixed aerobic resistance training was significant (P = .046).

Conclusions: Exercise in general is a moderately effective treatment option to mitigate pain catastrophizing, although various treatment modalities may prove more practical than others due to their nature. High-effort, high intensity modalities may be less effective (Pilates) as lower-intensity modalities (aquatic therapy). Yoga, having the highest effect size, was the only modality which focuses on physical exercise as well as meditation and spirituality. More randomized trials are needed to further clarify the importance of mindfulness, spirituality, and meditation in combination with physical exercise for fibromyalgia patients who catastrophize.

Prim Care Companion CNS Disord 2025;27(2):24r03817.

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