[Effects of exercise interventions on anxiety and depressive symptoms in patients with fibromyalgia syndrome: a
Dongfei Liu1, Yuanhao Li2, Ping Chen3
1School of Physical Education, Yunnan Normal University, Kunming 650500, China. 871194394@qq.com.
Objectives:
To systematically evaluate the therapeutic effects of exercise interventions on anxiety and depressive symptoms in patients with fibromyalgia syndrome (FMS), compare the differential efficacy of various exercise modalities, and provide evidence-based guidance for optimizing individualized exercise prescriptions in clinical practice.
Methods:
A comprehensive literature search was conducted in CNKI, VIP, Wanfang Data, SinoMed, Web of Science, PubMed, Cochrane Library, and Embase from inception to August 25, 2025. Study selection followed the PICOS framework, and methodological quality was assessed using the Cochrane risk of bias tool. Conventional pairwise meta-analysis was performed to evaluate the overall effect of exercise interventions, with heterogeneity assessed via the I² statistic, and fixed-effect or random-effects models selected accordingly. Meta-regression analysis was employed to explore potential sources of hetero-geneity. Subgroup analyses were conducted to compare the efficacy of different assessment instruments and exercise prescription parameters. Network meta-analysis was used to compare the relative efficacy of different exercise modalities, with the surface under the cumulative ranking curve (SUCRA) to rank interventions. Adverse event reports were descriptively summarized. Sensitivity analyses were performed to test result robustness, and funnel plots were used to evaluate publication bias.
Results:
A total of 30 articles (comprising 33 studies) with 1844 participants were included. Pairwise meta-analysis showed that, compared with control groups, exercise interventions significantly improved anxiety symptoms (SMD=－0.407, 95%CI: －0.515-－0.298, P<0.01) and depressive symptoms (SMD=－0.526, 95%CI: －0.741-－0.312, P<0.01) in FMS patients. For anxiety symptoms, the largest pooled effect size was observed when assessed with the state-trait anxiety inventory (SMD=－0.651, 95%CI: －0.969-－0.333), with interventions lasting more than 17 weeks (SMD=－0.771, 95%CI: －1.207-－0.278), frequency 3-4 times per week (SMD=－0.588, 95%CI: －0.812-－0.364), and session duration less than 40 min (SMD=－0.556, 95%CI: －0.855-－0.257). For depressive symptoms, the largest pooled effect size was found when assessed with the Beck depression inventory (SMD=－0.758, 95%CI: －1.186-－0.329), with interventions lasting 9-12 weeks (SMD=－0.893, 95%CI: －1.484-－0.303), frequency 3-4 times per week (SMD=－1.199, 95%CI: －1.805-－0.593), and session duration no less than 60 min (SMD=－0.708, 95%CI: －1.080-－0.336). Network meta-analysis suggested that mind-body exercise had the highest potential for improving anxiety symptoms (SUCRA=88.8%), whereas aerobic exercise appeared most promising for depressive symptoms (SUCRA=94.0%). Safety outcomes were reported in eight studies, with no serious adverse events observed. Sensitivity analyses confirmed the robustness of the findings, and publication bias tests indicated no significant asymmetry.
Conclusions:
Exercise interventions are safe and effective in ameliorating anxiety and depressive symptoms in patients with FMS. Mind-body exercise and aerobic exercise may be the optimal choices for anxiety symptoms and depressive symptoms, respectively, and their efficacy is associated with exercise prescription parameters.