The most effective therapeutic exercises for pain intensity in women with fibromyalgia: A systematic review and network meta-analysis
Álvaro‐José Rodríguez‐Domínguez, Manuel Rebollo‐Salas, Raquel Chillón‐Martínez, Abel Rosales‐Tristancho, Inmaculada Villa-Del-Pino, José‐Jesús Jiménez‐Rejano
Abstract
• Resistance training was the only therapeutic exercise (TE) approach that showed clinical relevance, in the short and long term, to reduce pain intensity in women with fibromyalgia, showing a moderately important improvement (>30 %). • In the short term, aquatic exercise was the most effective approach to reduce pain intensity, so it could be an appropriate option to start a TE program in women with fibromyalgia. • These findings could contribute to a change in the current paradigm on TE prescription in fibromyalgia, because the “gold standard” recommendation of aerobic exercise should be replaced by other more effective approaches. • The results provide a valuable tool for decision making when choosing the most appropriate TE approach according to the patient's characteristics and preferences, because it is a key factor in improving adherence to treatment. Therapeutic exercise (TE) is the only intervention with strong recommendation for fibromyalgia. However, there is controversy as to which type of exercise is the most beneficial. To determine which TE approach is the most effective in reducing pain intensity in women with fibromyalgia. A systematic review was performed with a network meta-analysis (NMA). Six databases were searched from inception until January 2024. Randomized controlled trials (RCTs) evaluating the effects of TE on pain intensity were included in women with fibromyalgia. Methodological quality was assessed using the Physiotherapy Evidence Database scale. The size of the effect and the clinically important difference were determined in the short-term (≤3 months) and long-term (>3 months). Sixty-one studies were identified, of which 51 were included in the quantitative synthesis ( n = 2873). Fifteen TE interventions and eight comparison interventions (comparators) were identified. Aquatic exercise (p-score: 0.8713) was found to provide best benefits in the short-term and resistance training in the long-term (p-score: 0.9749). Statistically significant differences were found 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. With a moderate level of evidence, our NMA shows that, in the short-term, aquatic exercise is the most effective TE intervention to reduce pain intensity in women with fibromyalgia, while resistance training is the most effective in the long-term. More RCTs are needed to strengthen these findings.