Aquatic Exercise, Resistance Training Most Beneficial for Reducing Fibromyalgia Pain

Aquatic exercise for the short term, and then resistance training for the long term, were the most effective therapeutic exercises (TE) for reducing pain intensity in women with fibromyalgia, according to a new network meta-analysis (NMA).1

“To date, we have not found any publications that compares all TE approaches with each other for the treatment of pain in fibromyalgia. Because the disease affects mainly women and the response to treatment is influenced by a multitude of factors, including gender, the objective of this study was to analyze the efficacy of different TE approaches in pain intensity in women with fibromyalgia and to identify which exercise approach is the most effective through an NMA of randomized clinical trials (RCTs),” lead investigator Álvaro-José Rodríguez-Domínguez, Department of Health and Sports, Pablo de Olavide University, Seville, Spain, and colleagues wrote.1

Rodríguez-Domínguez and colleagues performed an NMA of RCTs evaluating the effects of TE on pain intensity for women with fibromyalgia from 6 databases. They assessed methodological quality using the Physiotherapy Evidence Database scale and determined the size of the effect and the clinically important difference in both the short-term (≤3 months) and long-term (>3 months).

The investigators identified 61 studies and included 51in the quantitative synthesis (n = 2873). Finally, 15 TE interventions and 8 comparison interventions (comparators) were identified. They found that aquatic exercise (p-score, 0.8713) provided the best benefits in the short-term and resistance training provided the best benefits in the long-term (p-score, 0.9749). They also found statistically significant differences in favor of aquatic exercise, Pilates, qigong, resistance training, virtual reality, mixed exercise, and aerobic exercise in the short-term; and in favor of resistance training, dance, functional training, aquatic exercise, virtual reality, and aerobic exercise in the long-term compared to usual care.1

“Our findings have significant clinical implications for several reasons. Most importantly, [they] can serve as a valuable guide for selecting the most appropriate TE approaches to reduce pain intensity in women with fibromyalgia. This decision should also be made based on the patient's characteristics and preferences, as this is a key factor in improving adherence to treatment. These findings could also contribute to a change in the current paradigm regarding TE prescription in fibromyalgia, because the "gold standard" recommendation of aerobic exercise should be replaced by other more effective approaches,” Rodríguez-Domínguez and colleagues concluded.1

Other recent research focused on benefits of exercise in people with fibromyalgia found that aquatic exercise and other forms of exercise helped with sleep problems. Specifically, investigators found that land-based aerobic exercise training in combination with flexibility training showed a standardized mean difference (SMD) of −4.69 (95% CI, -8.14 to -1.28) and aquatic-based aerobic exercise training showed a SMD of-2.63 (95% CI, -4.74 to -0.58) compared to placebo or sham. The investigators also found some suggesting that electrotherapy, weight loss, dental splints, antipsychotics, tricyclics, land-based strengthening exercise, and psychological and behavioral therapy with a focus on sleep, may moderately affect sleep.2

REFERENCES

1. Rodríguez-Domínguez ÁJ, Rebollo-Salas M, Chillón-Martínez R, Rosales-Tristancho A, Villa-Del-Pino I, Jiménez-Rejano JJ. The most effective therapeutic exercises for pain intensity in women with fibromyalgia: A systematic review and network meta-analysis. Braz J Phys Ther. Published online May 3, 2025. doi:10.1016/j.bjpt.2025.101226

2. Hudson J, Imamura M, Robertson C, et al. Effects of Pharmacologic and Nonpharmacologic Interventions for the Management of Sleep Problems in People With Fibromyalgia: Systematic Review and Network Meta-Analysis of Randomized Controlled Trials. Arth. Care. Res. Pubished online February 10, 2025. Accessed April 25, 2025. doi: 10.1002/acr.25505