Role of Exercise in Fibromyalgia Management: A Narrative Review of Mechanisms, Modalities, and Clinical Evidence

Fibromyalgia (FM) is a chronic pain syndrome characterized by widespread pain, fatigue, sleep disturbance, cognitive symptoms, and mood comorbidity. This narrative review synthesizes mechanistic insights, randomized controlled trials (RCTs), and meta-analyses published primarily between 2005 and 2024 to evaluate exercise-based interventions as a primary therapeutic approach for FM. The objective was to synthesize mechanistic rationales, summarize RCTs and meta-analyses across exercise modalities, and provide practical prescription guidance. The results showed aerobic and resistance training consistently reduce pain and improve function and health-related quality of life (HRQoL). Mind-body and aquatic programs were effective and often well tolerated; combined programs frequently yielded the broadest benefits. Serious adverse events were rare. In conclusion, tailored, graded exercise represents an effective, low-risk strategy for FM care. Gaps include long-term durability, response prediction, and dose personalization.