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Comparative Effectiveness of Exercise Modalities for Fibromyalgia: A Systematic Review and Bayesian Network

Chuanzhi Wang1,2, Jielin Sun1, Zhide Liang3

  • 1National Center for Translational Medicine, Shanghai Jiao Tong University, Shanghai, China.

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Exercise combining aerobic and flexibility training, or water-based exercises, show promise for fibromyalgia pain relief. A weekly volume of 875 MET-minutes is suggested for meaningful pain reduction, though evidence quality is low.

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Area of Science:

  • Rheumatology
  • Exercise Science
  • Pain Management

Background:

  • Fibromyalgia syndrome (FM) is a chronic condition characterized by widespread pain and fatigue.
  • Exercise-based therapies are increasingly explored for managing FM symptoms.
  • Existing evidence on the efficacy of different exercise modalities and optimal dosages for pain relief in FM requires synthesis.

Purpose of the Study:

  • To systematically review and meta-analyze the impact of exercise therapies on pain in fibromyalgia patients.
  • To compare the effectiveness of various exercise modalities for pain management.
  • To determine the optimal exercise volume for achieving clinically meaningful pain reduction.

Main Methods:

  • Systematic review and network meta-analysis of randomized controlled trials (RCTs).
  • Searched multiple databases (MEDLINE, Embase, Web of Science, Cochrane Library, Scopus, SPORTDiscus) up to July 2024.
  • Included RCTs comparing exercise interventions with non-exercise controls in adult FM patients reporting pain outcomes.

Main Results:

  • 50 RCTs with 3761 participants were analyzed.
  • Aerobic + flexibility training (SUCRA=0.91) and water-based exercise (SUCRA=0.87) showed the most significant pain reduction effects.
  • A weekly volume of 875 MET-minutes was associated with minimal clinically important difference (MCID).
  • Overall evidence quality was rated as low to very low.

Conclusions:

  • Combined aerobic and flexibility training, and water-based exercises, may effectively reduce pain in fibromyalgia.
  • Findings should be interpreted cautiously due to heterogeneity, bias, and low evidence quality.
  • Consistent, professionally guided, and tailored exercise regimens are crucial for sustained pain management benefits.