Effects of Mind-Body Exercise Therapies on Patients With Fibromyalgia: A Systematic Review and Meta-analysis

Fibromyalgia (FM) is a chronic condition characterized by widespread pain and functional impairment. While mind-body exercise (MBE) therapies are recommended, their comparative efficacy and optimal dosage remain unclear. This systematic review and meta-analysis aimed to evaluate the effects of different types, durations, and intensities of MBE on FM symptoms.

We conducted a systematic search of 7 electronic databases for randomized controlled trial of MBE (Tai Chi, Qigong, Yoga, Pilates) for adults with FM. The primary outcome was the Fibromyalgia Impact Questionnaire (FIQ). Secondary outcomes included pain (Visual Analogue Scale, Numeric Rating Scale), sleep quality (Pittsburgh Sleep Quality Index), and psychological status (Beck Depression Inventory, Hospital Anxiety and Depression Scale). A random effects meta-analysis was performed, with subgroup analyses based on intervention type, duration (<40, 40-80, >80 h), and intensity (low, medium).

Twenty-one randomized controlled trials involving 1155 patients were included. MBE was associated with significant improvements in quality of life (FIQ: mean difference [MD] = -11.44), pain (Visual Analogue Scale: MD = -1.33), sleep quality (Pittsburgh Sleep Quality Index: MD = -2.13), and depression (Beck Depression Inventory: MD = -3.67), though with substantial heterogeneity. Subgroup analyses suggested that Tai Chi may be associated with the broadest and most consistent benefits. A potential dose-response relationship was observed, with interventions lasting over 40 hours showing greater improvements in FIQ. Furthermore, exploratory analysis indicated that low-intensity exercise might be particularly effective for pain and sleep, whereas medium-intensity exercise appeared to have a stronger effect on depression and physical function (short form-36 Physical Component Summary). The overall effects on FIQ and pain appeared to be clinically meaningful.

The available evidence suggests that MBE is a beneficial adjunctive therapy for improving a range of symptoms in patients with FM. While limited by heterogeneity, our findings indicate that Tai Chi may be a particularly promising modality. To potentially optimize clinical outcomes, programs exceeding 40 hours in total duration could be considered. The choice of exercise intensity may also be a relevant factor to tailor to a patient's primary symptoms, a hypothesis that warrants further investigation.