Comparative Effectiveness of Exercise Modalities for Fibromyalgia: A Systematic Review and Bayesian Network Meta-Analysis

IF 3.4 2区医学 Q1 ANESTHESIOLOGY

European Journal of Pain Pub Date : 2025-09-01 DOI:10.1002/ejp.70109

Chuanzhi Wang, Jielin Sun, Zhide Liang, Yi Cai, Meng Zhang, Shudong Tian, Wenyi Yang, Shulin Cheng, Rui Duan, Xiuqiang Wang

{"title":"Comparative Effectiveness of Exercise Modalities for Fibromyalgia: A Systematic Review and Bayesian Network Meta-Analysis","authors":"Chuanzhi Wang, Jielin Sun, Zhide Liang, Yi Cai, Meng Zhang, Shudong Tian, Wenyi Yang, Shulin Cheng, Rui Duan, Xiuqiang Wang","doi":"10.1002/ejp.70109","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Objective</h3>\n \n <p>To synthesise existing evidence assessing the impact of exercise-based therapies on pain in patients with fibromyalgia syndrome (FM), determine the efficacy of various exercise modalities, and establish the optimal exercise dosage for pain management.</p>\n </section>\n \n <section>\n \n <h3> Design</h3>\n \n <p>Systematic review and network meta-analysis.</p>\n </section>\n \n <section>\n \n <h3> Data Sources</h3>\n \n <p>MEDLINE, Embase, Web of Science, Cochrane Library, Scopus and SPORT Discus were searched from inception to July 2024.</p>\n </section>\n \n <section>\n \n <h3> Eligibility Criteria</h3>\n \n <p>Randomised controlled trials (RCTs) that included adult patients with FM compared any exercise intervention with a non-exercise control group and reported pain-related outcomes.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>A total of 50 RCTs involving 3761 participants were included in this meta-analysis. Aerobic + flexibility training demonstrated the most significant intervention effect compared to controls (<i>g</i> = −0.82, 95% credible interval [CrI]: −1.07 to −0.58; five comparisons; surface under the cumulative ranking curve [SUCRA] = 0.91), followed by water-based exercise (<i>g</i> = −0.72, 95% CrI: −0.92 to −0.52; 11 comparisons; SUCRA = 0.87) and Pilates (<i>g</i> = −0.87, 95% CrI: −1.14 to −0.59; 11 comparisons; SUCRA = 0.60). A weekly exercise volume of 875 metabolic equivalent of task (MET) minutes was required to achieve minimal clinically important difference (MCID). The overall quality of evidence ranged from low to very low.</p>\n </section>\n \n <section>\n \n <h3> Conclusion</h3>\n \n <p>Aerobic + flexibility training and water-based exercises may be effective strategies for pain management in patients with FM. However, given the substantial heterogeneity, high risk of bias, and overall low quality of evidence, these findings should be interpreted with caution. The temporary nature of these benefits underscores the importance of maintaining a consistent, professionally guided and tailored exercise regimen.</p>\n </section>\n \n <section>\n \n <h3> Significance Statement</h3>\n \n <p>While acknowledging the overall low to very low quality of the available evidence, this study suggests that combining aerobic and flexibility training or engaging in water-based exercises may be effective for pain reduction in fibromyalgia. Our analysis indicates that a weekly exercise volume of approximately 875 METs-min, potentially achieved through 2–3 sessions per week, is associated with a minimal clinically important difference. These parameters should serve as a guide for clinicians rather than a strict prescription. Crucially, exercise programmes should start at a low intensity and be progressively tailored by professionals to the patient's individual tolerance and preference, as long-term adherence is key to sustaining benefits.</p>\n </section>\n \n <section>\n \n <h3> Trial Registration</h3>\n \n <p>PROSPERO number: CRD42024585864</p>\n </section>\n </div>","PeriodicalId":12021,"journal":{"name":"European Journal of Pain","volume":"29 9","pages":""},"PeriodicalIF":3.4000,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"European Journal of Pain","FirstCategoryId":"3","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1002/ejp.70109","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"ANESTHESIOLOGY","Score":null,"Total":0}

引用次数: 0

Abstract

Objective

To synthesise existing evidence assessing the impact of exercise-based therapies on pain in patients with fibromyalgia syndrome (FM), determine the efficacy of various exercise modalities, and establish the optimal exercise dosage for pain management.

Design

Systematic review and network meta-analysis.

Data Sources

MEDLINE, Embase, Web of Science, Cochrane Library, Scopus and SPORT Discus were searched from inception to July 2024.

Eligibility Criteria

Randomised controlled trials (RCTs) that included adult patients with FM compared any exercise intervention with a non-exercise control group and reported pain-related outcomes.

Results

A total of 50 RCTs involving 3761 participants were included in this meta-analysis. Aerobic + flexibility training demonstrated the most significant intervention effect compared to controls (g = −0.82, 95% credible interval [CrI]: −1.07 to −0.58; five comparisons; surface under the cumulative ranking curve [SUCRA] = 0.91), followed by water-based exercise (g = −0.72, 95% CrI: −0.92 to −0.52; 11 comparisons; SUCRA = 0.87) and Pilates (g = −0.87, 95% CrI: −1.14 to −0.59; 11 comparisons; SUCRA = 0.60). A weekly exercise volume of 875 metabolic equivalent of task (MET) minutes was required to achieve minimal clinically important difference (MCID). The overall quality of evidence ranged from low to very low.

Conclusion

Aerobic + flexibility training and water-based exercises may be effective strategies for pain management in patients with FM. However, given the substantial heterogeneity, high risk of bias, and overall low quality of evidence, these findings should be interpreted with caution. The temporary nature of these benefits underscores the importance of maintaining a consistent, professionally guided and tailored exercise regimen.

Significance Statement

While acknowledging the overall low to very low quality of the available evidence, this study suggests that combining aerobic and flexibility training or engaging in water-based exercises may be effective for pain reduction in fibromyalgia. Our analysis indicates that a weekly exercise volume of approximately 875 METs-min, potentially achieved through 2–3 sessions per week, is associated with a minimal clinically important difference. These parameters should serve as a guide for clinicians rather than a strict prescription. Crucially, exercise programmes should start at a low intensity and be progressively tailored by professionals to the patient's individual tolerance and preference, as long-term adherence is key to sustaining benefits.

Trial Registration

PROSPERO number: CRD42024585864

查看原文本刊更多论文

运动方式治疗纤维肌痛的比较效果：系统综述和贝叶斯网络meta分析

目的综合现有证据，评估运动疗法对纤维肌痛综合征（FM）患者疼痛的影响，确定各种运动方式的疗效，建立疼痛管理的最佳运动剂量。设计系统评价和网络荟萃分析。检索数据来源：MEDLINE、Embase、Web of Science、Cochrane Library、Scopus和SPORT Discus，检索时间从建校到2024年7月。纳入成年FM患者的随机对照试验（RCTs）比较了任何运动干预组与非运动对照组，并报告了与疼痛相关的结果。结果本meta分析共纳入50项随机对照试验，涉及3761名受试者。与对照组相比，有氧+柔韧性训练表现出最显著的干预效果（g = - 0.82, 95%可信区间[CrI]:−1.07至−0.58；5个比较；累积排名曲线下的表面[SUCRA] = 0.91），其次是水基运动（g = - 0.72, 95% CrI:−0.92至−0.52；11个比较；SUCRA = 0.87）和普拉提（g = - 0.87, 95% CrI:−1.14至−0.59；11个比较；SUCRA = 0.60）。达到最小临床重要差异（MCID）需要每周875代谢当量（MET）分钟的运动量。证据的总体质量从低到极低不等。结论有氧+柔韧性训练和水上运动可能是FM患者疼痛管理的有效策略。然而，考虑到大量的异质性、高偏倚风险和总体低质量的证据，这些发现应该谨慎解释。这些好处的暂时性强调了保持一致的、专业指导的、量身定制的锻炼方案的重要性。虽然承认现有证据的总体质量很低，但本研究表明，有氧和柔韧性训练相结合或从事水上运动可能对减轻纤维肌痛有效。我们的分析表明，每周约875 met -min的运动量，可能通过每周2-3次达到，与最小的临床重要差异相关。这些参数应作为临床医生的指南，而不是严格的处方。至关重要的是，锻炼计划应该从低强度开始，并逐步由专业人士根据患者的个人耐受性和偏好量身定制，因为长期坚持是保持益处的关键。试验注册号：CRD42024585864

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

European Journal of Pain 医学-临床神经学

CiteScore

7.50

自引率

5.60%

发文量

163

审稿时长

4-8 weeks

期刊介绍： European Journal of Pain (EJP) publishes clinical and basic science research papers relevant to all aspects of pain and its management, including specialties such as anaesthesia, dentistry, neurology and neurosurgery, orthopaedics, palliative care, pharmacology, physiology, psychiatry, psychology and rehabilitation; socio-economic aspects of pain are also covered. Regular sections in the journal are as follows: • Editorials and Commentaries • Position Papers and Guidelines • Reviews • Original Articles • Letters • Bookshelf The journal particularly welcomes clinical trials, which are published on an occasional basis. Research articles are published under the following subject headings: • Neurobiology • Neurology • Experimental Pharmacology • Clinical Pharmacology • Psychology • Behavioural Therapy • Epidemiology • Cancer Pain • Acute Pain • Clinical Trials.