Effectiveness of Therapeutic Exercise in Fibromyalgia Syndrome: A Systematic Review and Meta-Analysis of Randomized Clinical Trials

Table 1

General characteristics of included studies.

Author/year	Design	Participants	Intervention/comparison	Outcomes	Conclusions
Wigers et al. 1996 [19]	RCT	AE: 18 women and 2 men; () with FMS; SMT: 18 women and 2 men; () with FMS; CG: 19 women and 1 man; () with FMS	Intervention: aerobic exercise (AE) and stress management treatment (SMT); Comparison: usual care (CG); Duration: AE: 3 days a week (45 minutes) for 14 weeks. SMT: 2 days a week (90 minutes) for 6 weeks and 1 day a week (90 minutes) for 8 weeks	(i) Pain; (ii) Symptoms of depression	Aerobic exercise was the overall most effective treatment.
Jones et al. 2001 [27]	RCT	EG: 28 women with FMS; CG: 28 women with FMS	Intervention: muscle strengthening (EG); Comparison: stretching exercises (CG); Duration: 2 days a week (60 minutes) for 12 weeks	(i) Pain; (ii) FMS impact	Muscle strengthening produces an improvement in overall disease activity.
Richards and Scott; 2002 [20]	RCT	EG: 62 women and 5 men; () with FMS; CG: 64 women and 5 men; () with FMS	Intervention: aerobic exercise (EG); Comparison: relaxation (CG); Duration: EG: 2 days a week (12–50 minutes) for 12 weeks. CG: 2 days a week (60 minute) for 12 weeks	(i) FMS impact	Aerobic exercise is an effective treatment for FMS.
Rooks et al. 2007 [28]	RCT	AE: 35 women with FMS; ST: 35 women with FMS; FSHC: 27 women with FMS; ST-FSHC: 38 women with; FMS	Interventions: aerobic exercise (AE), strength training, aerobic exercise and stretching (ST), fibromyalgia self-help course (FSHC), and a combination of ST and FSHC (ST-FSHC); Duration: AE and ST: 2 days a week (60 minutes) for 16 weeks. FSHC: 120 minutes every two weeks	(i) Pain; (ii) FMS impact	Progressive walking, simple strength training movements, and stretching activities improve functional status, key symptoms, and self-efficacy in women with FMS.
Bircan et al. 2008 [33]	RCT	AE: 13 women with FMS; SE: 13 women with FMS	Interventions: aerobic exercise (AE) and strengthening exercise (SE); Duration: 3 days a week (30–40 minutes) for 8 weeks	(i) Pain; (ii) Symptoms of depression	AE and SE are similarly effective at improving symptoms, depression, and quality of life in FMS.
García-Martínez et al. 2010 [23]	RCT	EG: 14 women with FMS; CG: 14 women with FMS	Intervention: exercise combined protocol; (aerobic, strengthening, and stretching exercises); (EG); Comparison: normal daily activities (CG); Duration: 3 days a week (60 minutes) for 12; weeks	(i) Pain; (ii) HRQOL; (iii) FMs impact	The GE improved quality of life, psychological state, and physical functioning.
Sañudo et al. 2010 [24]	RCT	EG1: 22 women with FMS; EG2: 21 women with FMS; CG: 20 women with FMS	Interventions: aerobic exercise and combined exercise (EG1 and EG2); Comparison: Normal daily activities (CG); Duration: GE1: 2 days a week (45–60 minutes); GE2: 2 days a week (35–45 minutes), 24 weeks	(i) FMS impact; (ii) HRQOL; (iii) Symptoms of depression; (iv) Pain	An improvement from baseline in total FIQ score was observed in the exercise groups and was accompanied by decreases in BDI scores. Relative to nonexercising controls, CE evoked improvements in the SF-36 physical functioning and bodily pain domains and was more effective than AE for evoking improvements in the vitality and mental health.
Mannerkorpi et al.; 2010 [30]	RCT	EG: 34 women with FMS; CG: 33 women with FMS	Intervention: Nordic walking moderate to high intensity (EG); Comparison: low intensity walking (CG); Duration: EG: 2 days a week (10–20 minutes), 15 weeks. CG: 1 day a week	(i) Pain; (ii) FMS impact	The Nordic walking group had better FIQ physical scores.
Sañudo et al. 2011 [25]	RCT	EG: 18 women with FMS; CG: 20 women with FMS	Intervention: combined exercise (aerobic, strength, and flexibility) (EG); Comparison: routine care (CG); Duration: 2 days a week (45–60 minutes) for 24; weeks	(i) HRQOL; (ii) FMS impact; (iii) Symptoms of depression	A combined program of long-term exercise improves psychological and health status by increasing the quality of life.
Kayo et al. 2012 [21]	RCT	WPG: 30 women with FMS; SMG: 30 women with FMS; GC: 30 women with FMS	Interventions: walking program (WPG) and muscle strengthening (SMG) exercises; Comparison: medication only or conventional treatment (CG); Duration: WPG and SMG: 3 days a week (60 minutes) for 16 weeks	(i) Pain; (ii) FMS impact; (iii) HRQOL; (iv) Use of drugs	Both modalities (WP and PSM) provided better pain relief for people with FMS than medication only or conventional treatment.
Hooten et al. 2012 [26]	RET	AE: 32 women and 4 men; () with FMS; SE: 33 women and 3 men; () with FMS	Intervention: aerobic exercise (AE) and strengthening exercise (SE); Duration: AE: 10–30 minutes each day for 3 weeks SE: 25–30 minutes each day for 3 weeks	(i) Pain severity	Strengthening exercises and aerobic exercise are similarly effective in reducing pain intensity.
Gavi et al. 2014 [22]	RCT	MSE: 35 women with FMS; SE: 31 women with FMS	Intervention: muscle strengthening exercise; (MSE) and stretching exercises (SE); Duration: 2 days a week (45 minutes) for 16 weeks	(i) Pain; (ii) HRQOL; (iii) FMS impact; (iv) Symptoms of depression	Both groups experienced a reduction in pain, which was more noticeable and had an earlier onset in the strengthening exercise group. Both groups experienced improvements in functionality, depression, and quality of life.
Duruturk et al. 2015 [32]	RCT	BE: 12 women with FMS; AE: 14 women with FMS	Intervention: balance exercise (BE) and aerobic exercise (AE); Duration: 3 days a week (20–45 minutes) for 6 weeks	(i) Pain; (ii) FMS impact	Both groups showed an improvement in pain intensity and FIQ functionality; there was no group difference on either measure.
Larsson et al. 2015 [29]	RCT	RE: 67 women with FMS; CG: 63 women with FMS	Intervention: resistance exercise (RE); Comparison: relaxation exercises (CG); Duration: RE: 2 days a week (60 minutes) for 15 weeks. CG: 2 days a week (25 minute) for 15 weeks	(i) HRQOL; (ii) Pain intensity; (iii) FMS impact	Resistance exercise group reduced pain intensity.
Ericsson et al. 2016 [31]	RCT	EG: 67 women with FMS; CG: 63 women with FMS	Intervention: resistance exercise (EG); Comparison: relaxation therapy (CG); Duration: 2 days a week (60 minutes) for 15; weeks	(i) Pain; (ii) Symptoms depression	Resistance exercise improves some symptoms in women with FMS.

RCT: randomized clinical trial; RET: randomized equivalence trial; EG: exercise group; CG: control group; FMS: Fibromyalgia Syndrome.