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Network meta-analysis ranks exercise modalities for fibromyalgia impact in womenStudy compares exercise types for women with fibromyalgia, finds Pilates and aquatic exercise promising

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Key Takeaway
Consider exercise modality rankings for fibromyalgia with caution due to low-to-moderate certainty evidence.

This systematic review with network meta-analysis synthesized evidence from 59 randomized controlled trials involving 3256 women with fibromyalgia. It compared the effectiveness of 14 different therapeutic exercise modalities against seven comparison interventions for reducing fibromyalgia impact, measured by the Fibromyalgia Impact Questionnaire (FIQ/FIQR), over short-term (≤3 months) and long-term (>3 months) follow-up periods.

For short-term impact reduction, Pilates, Aquatic Exercise, and Resistance Exercise were ranked as the top three modalities. For long-term impact reduction, Dance and Mixed Exercise were ranked highest. The analysis did not report specific effect sizes, absolute numbers, p-values, or confidence intervals for these rankings. The certainty of evidence was assessed as mostly low to moderate, primarily limited by imprecision and heterogeneity.

Safety and tolerability data were not reported. Key limitations include substantial heterogeneity across studies and the low-to-moderate certainty of the evidence. The findings suggest associations rather than definitive causal effects and are specific to women with fibromyalgia. Clinicians should interpret these rankings cautiously when considering exercise prescriptions.

Researchers analyzed data from 59 previous studies involving 3,256 women with fibromyalgia. They wanted to see which types of therapeutic exercise might be most helpful for reducing the condition's impact on daily life, as measured by a standard questionnaire. They compared 14 different exercise approaches, including Pilates, swimming, resistance training, and dance.

The analysis found that for short-term relief (up to 3 months), Pilates, aquatic exercise (like water aerobics), and resistance exercise ranked as the most promising options. For longer-term relief (more than 3 months), dance and programs that mixed different types of exercise ranked highest. This means these forms of exercise showed the most consistent positive results in the studies reviewed.

It's important to be cautious about these results. The researchers noted the evidence was of 'mostly low-to-moderate certainty.' This means the studies varied a lot in how they were done, and the results aren't precise enough to be definitive. The findings only apply to women with fibromyalgia and don't tell us exactly how much benefit to expect.

Readers should see this as a helpful comparison of existing research, not a final guide. It suggests several exercise types are worth discussing with a doctor or physical therapist to find what might work best for an individual. The study did not report on safety or side effects of the exercises.

What this means for you:
Several exercises show promise for fibromyalgia, but evidence quality varies. Talk to your doctor about what's right for you.

Study Details

Study typeMeta analysis
EvidenceLevel 1
Follow-up3.0 mo
PublishedApr 2026
View Original Abstract ↓
BACKGROUND: Therapeutic exercise is the only intervention with strong evidence for fibromyalgia, yet the most effective modality remains uncertain. OBJECTIVE: To determine which modality of therapeutic exercise is the most effective in reducing the impact of fibromyalgia in women, as assessed by the Fibromyalgia Impact Questionnaire (FIQ/FIQR). DESIGN: Systematic review with a network meta-analysis of randomized controlled trials. METHODS: A comprehensive search was performed in MEDLINE, Cochrane Library, Scopus, Web of Science, and CINAHL from inception to March 2025. Eligible randomized controlled trials involved therapeutic exercise interventions reporting Fibromyalgia Impact Questionnaire outcomes. Data synthesis followed PRISMA-NMA guidelines, using a frequentist network meta-analysis to estimate effect sizes and clinically important differences in the short term (≤3 months) and long term (>3 months). Certainty of evidence was assessed with CINeMA. RESULTS: Sixty-four studies were identified, of which 59 were included in the quantitative synthesis (n = 3256). Fourteen modalities of therapeutic exercise and seven comparison interventions (comparators) were identified. In the short term, Pilates, Aquatic Exercise, and Resistance Exercise ranked highest. In the long term, Dance and Mixed Exercise ranked highest. Certainty of evidence was mostly low to moderate (CINeMA), mainly limited by imprecision and heterogeneity. CONCLUSIONS: Pilates, Aquatic Exercise, and Resistance Exercise ranked highest in the short term, while Dance and Mixed Exercise ranked highest in the long term. However, findings should be interpreted with caution due to substantial heterogeneity and mostly low-to-moderate certainty of evidence.
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