Effect of different types of exercise in fibromyalgia syndrome: a network meta-analysis

Patients with fibromyalgia syndrome (FMS) often exhibit poor health and reduced physical function. Exercise interventions can effectively alleviate symptoms and improve function. This study aims to systematically evaluate and compare the efficacy of different exercise interventions on the key clinical outcomes to identify the most effective modality and inform evidence-based exercise recommendations for patients with FMS.

This study conducted a systematic search of four databases: PubMed, Embase, the Cochrane Library, and Web of Science. The primary outcome measures included health status, pain intensity, the number of tender points (TP), and aerobic capacity. Stata 15.0 and R software were used for network meta-analysis (NMA), and the effect size and its 95% confidence interval were calculated using a random-effects model. The methodological quality of the included studies was assessed using the Cochrane RoB 2.0 tool and the TESTEX scale.

Stretching combined with balance training resulted in the greatest improvement in health status (MD = - 25.13; 95% CI [- 33.81, - 16.44]). For other symptom-related outcomes, aerobic exercise (AE) combined with strength and stretching showed the highest probability of alleviating pain intensity (MD = - 3.61; 95% CI [- 4.40, - 2.82]). AE alone was most effective in reducing the number of tender points (MD = - 2.28; 95% CI [- 3.57, - 1.00]), while whole-body vibration (WBV) produced the largest enhancement in aerobic capacity (MD = 55.0; 95% CI [26.14, 83.75]).

Stretching combined with balance training was found to be most effective in improving health status. AE combined with strength training and stretching demonstrated the greatest efficacy in reducing pain intensity, while AE was most effective in decreasing the number of tender points. WBV appeared to provide the largest improvement in aerobic capacity in patients with FMS. These findings suggest that healthcare providers should combine AE, strength, stretching, balance, WBV, and other exercises based on the individual circumstances of patients with FMS, while further high-quality RCTs are warranted to confirm these results and to standardize exercise protocols.

CRD420251036473.