Brazilian Journal of Pain
https://brjp.org.br/article/doi/10.63231/2595-0118.202674-en
Brazilian Journal of Pain
Review Article

The effect of different exercise modalities on pain and quality of life in individuals with fibromyalgia: systematic review and meta-analysis

Efeito das diferentes modalidades de exercício na dor e qualidade de vida em indivíduos com fibromialgia: revisão sistemática e meta-análise

Ana Luiza Alves de Lima e Silva; Henrique Silva Sacramento

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Abstract

BACKGROUND AND OBJECTIVES: Fibromyalgia (FM) is a chronic rheumatic disease characterized by widespread pain. Common treatments for fibromyalgia include the use of drugs. However, pharmacological treatment alone is not sufficient. A multidimensional approach, including physical exercise, is recommended as a non-pharmacological method for treating fibromyalgia. The objective of this study was to identify evidence on the effects of different types of exercise commonly used in the treatment of FM (aerobic exercise, resistance exercise, stretching and Pilates) on the pain and quality of life of these individuals, with the intention of identifying the most appropriate type of exercise for managing the symptoms of this syndrome.

CONTENTS: A systematic literature search was conducted using the online Pubmed database. After eliminating duplicate articles and screening for inclusion criteria, a total of 12 studies were identified for review and data extraction. The findings of this study indicate that comparisons among different exercise modalities do not allow consistent conclusions regarding the superiority of one modality over another. Furthermore, the results highlight the gap in the literature regarding standardization and definition of the ideal type of exercise.

CONCLUSION: The results showed no significant evidence of superiority of any of the evaluated modalities in improving the outcomes analyzed. Despite this, physical exercise continues to be widely recommended as a non-pharmacological strategy in the management of fibromyalgia. Regular exercise, tailored to individual conditions, should be encouraged as part of an integrated and personalized therapeutic approach.

Keywords

Aerobic training; Fibromyalgia; Pain; Pilates; Quality of life; Resistance training; Stretching

Resumo

JUSTIFICATIVA E OBJETIVOS: A fibromialgia (FM) é uma doença reumática crônica caracterizada por dor generalizada. Os tratamentos comuns para fibromialgia incluem o uso de fármacos. No entanto, o tratamento farmacológico isolado não é suficiente. Uma abordagem multidimensional, incluindo exercícios físicos, é recomendada como um método não farmacológico para o tratamento da fibromialgia. O objetivo deste estudo foi identificar evidências sobre os efeitos de diferentes tipos de exercícios comumente utilizados no tratamento da FM (exercícios aeróbios, exercícios de resistência, alongamento e Pilates) na dor e na qualidade de vida desses indivíduos, com a intenção de identificar o tipo de exercício mais apropriado para o manejo dos sintomas dessa síndrome.

CONTEÚDO: Foi realizada uma revisão sistemática na literatura utilizando a base de dados online Pubmed. Após a eliminação de artigos duplicados e a verificação dos critérios de inclusão, um total de 12 estudos foram identificados para revisão e extração de dados. Os resultados deste estudo indicam que as comparações entre diferentes modalidades de exercício não permitem conclusões consistentes sobre a superioridade de uma modalidade em relação a outra. Além disso, os resultados destacam a lacuna na literatura no que diz respeito à padronização e definição do tipo ideal de exercício.

CONCLUSÃO: Os resultados não apresentaram evidência significativa de nenhuma das modalidades avaliadas na melhoria dos avanços desenvolvidos. Apesar disso, o exercício físico continua sendo amplamente recomendado como estratégia não farmacológica no tratamento da fibromialgia. A prática regular de exercícios, adaptada às condições individuais, deve ser incentivada como parte de uma abordagem terapêutica integrada e personalizada.

Palavras-chave

Alongamento; Dor; Exercício aeróbio; Exercício resistido; Fibromialgia; Pilates; Qualidade de vida

References

1 Eich W, Bär K-J, Bernateck M, Burgmer M, Dexl C, Petzke F, Sommer C, Winkelmann A, Häuser W. Definition, Klassifikation, klinische Diagnose und Prognose des Fibromyalgiesyndroms. Schmerz. 2017;31(3):231-8. https://doi.org/10.1007/s00482-017-0200-7. PMid:28421273.

2 Sarzi-Puttini P, Giorgi V, Marotto D, Atzeni F. Fibromyalgia: an update on clinical characteristics, aetiopathogenesis and treatment. Nat Rev Rheumatol. 2020;16(11):645-60. https://doi.org/10.1038/s41584-020-00506-w. PMid:33024295.

3 O’Brien AT, Deitos A, Triñanes Pego Y, Fregni F, Carrillo-de-la-Peña MT. Defective endogenous pain modulation in fibromyalgia: a meta-analysis of temporal summation and conditioned pain modulation paradigms. J Pain. 2018;19(8):819-36. https://doi.org/10.1016/j.jpain.2018.01.010. PMid:29454976.

4 Silva HJA, Lins CAA, Nobre TTX, de Sousa VPS, Caldas RTJ, de Souza MC. Mat Pilates and aquatic aerobic exercises for women with fibromyalgia: a protocol for a randomised controlled blind study. BMJ Open. 2019;9(2):e022306. https://doi.org/10.1136/bmjopen-2018-022306. PMid:30782866.

5 García Rodríguez DF, Abud Mendoza C. Physiopathology of fibromyalgia. Fisiopatología de la fibromialgia. Reumatol Clin. 2020;16(3):191-4. https://doi.org/10.1016/j.reumae.2020.02.004. PMid:32279983.

6 Sanz-Baños Y, Pastor-Mira MÁ, Lledó A, López-Roig S, Peñacoba C, Sánchez-Meca J. Do women with fibromyalgia adhere to walking for exercise programs to improve their health? Systematic review and meta-analysis. Disabil Rehabil. 2018;40(21):2475-87. https://doi.org/10.1080/09638288.2017.1347722. PMid:28687050.

7 Bidonde J, Busch AJ, Schachter CL, Webber SC, Musselman KE, Overend TJ, Góes SM, Dal Bello-Haas V, Boden C. Mixed exercise training for adults with fibromyalgia. Cochrane Database Syst Rev. 2019;5(5):CD013340. https://doi.org/10.1002/14651858.CD013340. PMid:31124142.

8 Wang C, Schmid CH, Fielding RA, Harvey WF, Reid KF, Price LL, Driban JB, Kalish R, Rones R, McAlindon T. Effect of tai chi versus aerobic exercise for fibromyalgia: comparative effectiveness randomized controlled trial. BMJ. 2018;360:k851. https://doi.org/10.1136/bmj.k851. PMid:29563100.

9 Saracoglu I, Akin E, Aydin Dincer GB. Efficacy of adding pain neuroscience education to a multimodal treatment in fibromyalgia: A systematic review and meta-analysis. Int J Rheum Dis. 2022;25(4):394-404. https://doi.org/10.1111/1756-185X.14293. PMid:35061337.

10 Macfarlane GJ, Kronisch C, Dean LE, Atzeni F, Häuser W, Fluß E, Choy E, Kosek E, Amris K, Branco J, Dincer F, Leino-Arjas P, Longley K, McCarthy GM, Makri S, Perrot S, Sarzi-Puttini P, Taylor A, Jones GT. EULAR revised recommendations for the management of fibromyalgia. Ann Rheum Dis. 2017;76(2):318-28. https://doi.org/10.1136/annrheumdis-2016-209724. PMid:27377815.

11 Chinn S, Caldwell W, Gritsenko K. Fibromyalgia pathogenesis and treatment options update. Curr Pain Headache Rep. 2016;20(4):25. https://doi.org/10.1007/s11916-016-0556-x. PMid:26922414.

12 Antunes MD, Couto LA, Gomes Bertolini SMM, da Rocha Loures FCN, Basso Schmitt AC, Marques AP. Effectiveness of interdisciplinary health education programs for individuals with fibromyalgia: A systematic review. J Educ Health Promot. 2021;10(1):64. https://doi.org/10.4103/jehp.jehp_592_20. PMid:34084811.

13 García-Ríos MC, Navarro-Ledesma S, Tapia-Haro RM, Toledano-Moreno S, Casas-Barragán A, Correa-Rodríguez M, Aguilar-Ferrándiz ME. Effectiveness of health education in patients with fibromyalgia: a systematic review. Eur J Phys Rehabil Med. 2019;55(2):301-13. https://doi.org/10.23736/S1973-9087.19.05524-2. PMid:30698402.

14 Mendoza-Muñoz M, Morenas-Martín J, Rodal M, García-Matador J, García-Gordillo MÁ, Calzada-Rodríguez JI. Knowledge about Fibromyalgia in Fibromyalgia Patients and Its Relation to HRQoL and Physical Activity. Biology (Basel). 2021;10(7):673. https://doi.org/10.3390/biology10070673. PMid:34356528.

15 Menten LA, Franco KFM, Franco YRS, Miyamoto GC, Reis FJJ, Cabral CMN. Do patients with fibromyalgia have body image and tactile acuity distortion? Pain Pract. 2022;22(8):678-87. https://doi.org/10.1111/papr.13153. PMid:36345889.

16 Hernando-Garijo I, Ceballos-Laita L, Mingo-Gómez MT, Medrano-de-la-Fuente R, Estébanez-de-Miguel E, Martínez-Pérez MN, Jiménez-Del-Barrio S. Immediate effects of a telerehabilitation program based on aerobic exercise in women with fibromyalgia. Int J Environ Res Public Health. 2021;18(4):2075. https://doi.org/10.3390/ijerph18042075. PMid:33672691.

17 Häuser W, Klose P, Langhorst J, Moradi B, Steinbach M, Schiltenwolf M, Busch A. Efficacy of different types of aerobic exercise in fibromyalgia syndrome: a systematic review and meta-analysis of randomised controlled trials. Arthritis Res Ther. 2010;12(3):R79. https://doi.org/10.1186/ar3002. PMid:20459730.

18 Bidonde J, Busch AJ, Schachter CL, Overend TJ, Kim SY, Góes SM, Boden C, Foulds HJ. Aerobic exercise training for adults with fibromyalgia. Cochrane Database Syst Rev. 2017;6(6):CD012700. https://doi.org/10.1002/14651858.CD012700. PMid:28636204.

19 Bidonde J, Busch AJ, Bath B, Milosavljevic S. Exercise for adults with fibromyalgia: an umbrella systematic review with synthesis of best evidence. Curr Rheumatol Rev. 2014;10(1):45-79. https://doi.org/10.2174/1573403X10666140914155304. PMid:25229499.

20 Álvarez-Gallardo IC, Bidonde J, Busch A, Westby M, Kenny GP, Delgado-Fernández M, Carbonell-Baeza A, Rahman P, De Angelis G, Brosseau L. Therapeutic validity of exercise interventions in the management of fibromyalgia. J Sports Med Phys Fitness. 2019;59(5):828-38. https://doi.org/10.23736/S0022-4707.18.08897-7. PMid:30293405.

21 Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, Shamseer L, Tetzlaff JM, Akl EA, Brennan SE, Chou R, Glanville J, Grimshaw JM, Hróbjartsson A, Lalu MM, Li T, Loder EW, Mayo-Wilson E, McDonald S, McGuinness LA, Stewart LA, Thomas J, Tricco AC, Welch VA, Whiting P, Moher D. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372(71):n71. https://doi.org/10.1136/bmj.n71. PMid:33782057.

22 de Morton NA. The PEDro scale is a valid measure of the methodological quality of clinical trials: a demographic study. Aust J Physiother. 2009;55(2):129-33. https://doi.org/10.1016/S0004-9514(09)70043-1. PMid:19463084.

23 Borenstein M, Hedges LV, Higgins JPT, Rothstein HR. Introduction to meta-analysis. Chichester, UK: John Wiley & Sons; 2009. https://doi.org/10.1002/9780470743386.

24 Park HK, Song MK, Kim DJ, Choi IS, Han JY. Comparison of core muscle strengthening exercise and stretching exercise in middle-aged women with fibromyalgia: A randomized, single-blind, controlled study. Medicine (Baltimore). 2021;100(50):e27854. https://doi.org/10.1097/MD.0000000000027854. PMid:34918634.

25 Caglayan BC, Basakci Calik B, Gur Kabul E, Karasu U. Investigation of effectiveness of reformer pilates in individuals with fibromyalgia: A randomized controlled trial. Reumatol Clin (Engl Ed). 2023;19(1):18-25. https://doi.org/10.1016/j.reumae.2022.01.003. PMid:36603963.

26 Eseoğlu İ, Yılmaz AK, Anıl B, Korkmaz E, Akdemir E, Yılmaz C, Kehribar L, Aydın NG, Ermiş E, Yoldaş B, İmamoğlu O. Effects of electro-muscle stimulation exercise combined with mat pilates on pain, anxiety, and strength in sedentary females with fibromyalgia: a single-blind randomized controlled trial. J Pers Med. 2024;14(7):697. https://doi.org/10.3390/jpm14070697. PMid:39063951.

27 Berardi G, Senefeld JW, Hunter SK, Bement MKH. Impact of isometric and concentric resistance exercise on pain and fatigue in fibromyalgia. Eur J Appl Physiol. 2021;121(5):1389-404. https://doi.org/10.1007/s00421-021-04600-z. PMid:33616753.

28 de Medeiros SA, de Almeida Silva HJ, do Nascimento RM, da Silva Maia JB, de Almeida Lins CA, de Souza MC. Mat Pilates is as effective as aquatic aerobic exercise in treating women with fibromyalgia: a clinical, randomized and blind trial. Adv Rheumatol. 2020;60(1):21. https://doi.org/10.1186/s42358-020-0124-2. PMid:32252822.

29 Assumpção A, Matsutani LA, Yuan SL, Santo AS, Sauer J, Mango P, Marques AP. Muscle stretching exercises and resistance training in fibromyalgia: which is better? A three-arm randomized controlled trial. Eur J Phys Rehabil Med. 2018;54(5):663-70. https://doi.org/10.23736/S1973-9087.17.04876-6. PMid:29185675.

30 Larsson A, Palstam A, Löfgren M, Ernberg M, Bjersing J, Bileviciute-Ljungar I, Gerdle B, Kosek E, Mannerkorpi K. Resistance exercise improves muscle strength, health status and pain intensity in fibromyalgia--a randomized controlled trial. Arthritis Res Ther. 2015;17(1):161. https://doi.org/10.1186/s13075-015-0679-1. PMid:26084281.

31 Glasgow A, Stone TM, Kingsley JD. Resistance exercise training on disease impact, pain catastrophizing and autonomic modulation in women with fibromyalgia. Int J Exerc Sci. 2017;10(8):1184-95. https://doi.org/10.70252/LAZD6794. PMid:29399247.

32 Sevimli D, Kozanoglu E, Guzel R, Doganay A. The effects of aquatic, isometric strength-stretching and aerobic exercise on physical and psychological parameters of female patients with fibromyalgia syndrome. J Phys Ther Sci. 2015;27(6):1781-6. https://doi.org/10.1589/jpts.27.1781. PMid:26180320.

33 Norouzi E, Hosseini F, Vaezmosavi M, Gerber M, Pühse U, Brand S. Zumba dancing and aerobic exercise can improve working memory, motor function, and depressive symptoms in female patients with Fibromyalgia. Eur J Sport Sci. 2020;20(7):981-91. https://doi.org/10.1080/17461391.2019.1683610. PMid:31630663.

34 Franco KFM, Miyamoto GC, Franco YRDS, Salvador EMES, do Nascimento BCB, Menten LA, Cabral CMN. Is Pilates more effective and cost-effective than aerobic exercise in the treatment of patients with fibromyalgia syndrome? A randomized controlled trial with economic evaluation. Eur J Pain. 2023;27(1):54-71. https://doi.org/10.1002/ejp.2039. PMid:36097826.

35 Jones GT, Atzeni F, Beasley M, Flüß E, Sarzi-Puttini P, Macfarlane GJ. The prevalence of fibromyalgia in the general population: a comparison of the American College of Rheumatology 1990, 2010, and modified 2010 classification criteria. Arthritis Rheumatol. 2015;67(2):568-75. https://doi.org/10.1002/art.38905. PMid:25323744.

36 Prados G, Miró E, Martínez MP, Sánchez AI, López S, Sáez G. Fibromyalgia: gender differences and sleep-disordered breathing. Clin Exp Rheumatol. 2013;31(6 Suppl 79):S102-10. PMid:24373368.

37 Sosa-Reina MD, Nunez-Nagy S, Gallego-Izquierdo T, Pecos-Martín D, Monserrat J, Álvarez-Mon M. Effectiveness of therapeutic exercise in fibromyalgia syndrome: a systematic review and meta-analysis of randomized clinical trials. BioMed Res Int. 2017;2017:2356346. https://doi.org/10.1155/2017/2356346. PMid:29291206.

38 Nithuthorn C, Chaipichit N, Jeeraaumponwat T, Maiprasert M, Dilokthornsakul P. Effect of pilates on pain and health-related quality of life in fibromyalgia patients: a systematic review and meta-analysis. J Clin Med. 2024;13(23):7447. https://doi.org/10.3390/jcm13237447. PMid:39685905.

39 Beato M. Recommendations for the design of randomized controlled trials in strength and conditioning. Common design and data interpretation. Front Sports Act Living. 2022;4:981836. https://doi.org/10.3389/fspor.2022.981836. PMid:36157898.


Submitted date:
09/29/2025

Accepted date:
03/26/2026

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