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#396 Fit for Fibro: Does exercise help pain or function in Fibromyalgia?


CLINICAL QUESTION
QUESTION CLINIQUE
 Does exercise in patients with fibromyalgia improve pain, quality of life or fatigue?

BOTTOM LINE
RÉSULTAT FINAL
 The benefits of exercise in fibromyalgia remain unclear due to limited high-quality evidence. While improvements from baseline are seen, clinically meaningful changes versus control are rare, and responder analysis— a more reliable measure of improvement—has not been assessed. However, exercise offers several ancillary benefits.


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EVIDENCE
DONNÉES PROBANTES
  • Systematic Reviews comparing exercise with non-active control. Statistically significant unless indicated. Patients >90% women, age ~51. Pain intensity, Fibromyalgia Impact Scale (FIQ) and Fatigue scales all 0-100, higher=worse. Minimally clinically important difference considered 15/100.1
  • Aquatic (2 Systematic Reviews, 6-16 Randomized Controlled Trials (RCTs), 271-881 patients).2,3 From most comprehensive review:2 1-4 sessions/week for 4-32 weeks.
    • Pain: Baseline ~70 reduced to ~61 versus ~68 (control).
    • FIQ: Baseline ~64 reduced to 58 versus 63 (control).
    • Fatigue: No difference.
    • Other systematic review similar.3
  • Aerobic (3 Systematic Reviews, 4-17 RCTs, 202-1095 patients).1,4,5 Baseline scores not reported. Most 2-3 sessions/week for 45-60 minutes, for 6-24 weeks.
    • Pain:1,4,5 Aerobic ~11 points better than control.
    • FIQ:4 Aerobic 8 better than control.
    • Fatigue,4,5 Aerobic 6 better than control.
  • Resistance/Strength (3 Systematic Reviews, 9-11 RCTs, 443-839 patients).5-7 Baseline scores not reported. ~2 sessions/week, 8-21 weeks.
    • Pain:6 Resistance ~10 better than control.
    • FIQ:6Resistance 19 better than control.
    • Fatigue: 6 Standard mean difference reported, results uninterpretable.
  • Combined exercise (minimum two of aerobic/aquatic/resistance/stretching) (2 Systematic Reviews5,8 11-29 RCTs 523-2088 patients). Baseline not reported. 2-3 sessions/week, 45-60 minutes/session, ~12 weeks.
    • Pain: 8 Combined 53 versus 59.
    • FIQ:8 Combined 49 versus 56.
    • Fatigue:8 Combined 59 versus 72.
  • Adverse events: Rarely reported.
  • Limitations: No studies reported responder analysis (number of participants achieving clinically meaningful pain reduction), small study sizes, blinding inconsistent, varying interventions/controls.
CONTEXT
CONTEXTE
  • Canadian guideline9 recommends patient’s choice of graduated exercise programme
  • Indirectly, improvements in mean pain scores (~8%) similar for duloxetine.10
  • Exercise reduces cardiovascular risk,11 osteoarthritis and back pain,12 and depression.13

Frank Foley September 1, 2025

good review – thanks

Sukhwinder Randhawa September 3, 2025

patients choice of graduated exercise programme is good

raj vijayaraghavan September 25, 2025

Not clear abou. Exercise benefit less than 15 /100

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Author(s)
Auteur(s)
  • Jess Kirkwood MD CCFP (AM)
  • Jennifer Young MD CCFP-EM

1. Casanova-Rodríguez D, Ranchal-Sánchez A, Rodríguez RB, et al. Eur J Pain. 2025 Feb;29(2):e4783.

2. Bidonde J, Busch AJ, Webber SC, et al. Cochrane Database Syst Rev. 2014 Oct 28;2014(10):CD011336.

3. Correyero-León M, Medrano-de-la-Fuente R, Hernando-Garijo I, et al. Explore (NY). 2024 Jan-Feb;20(1):27-38.

4. Bidonde J, Busch AJ, Schachter CL, et al. Cochrane Database Syst Rev. 2017 Jun 21;6(6):CD012700.

5. Albuquerque MLL, Monteiro D, Marinho DA, et al. Rheumatol Int. 2022 Nov;42(11):1893-1908.

6. Vilarino, G.T., Branco, J.H.L., de Souza, L.C. et al. Ir J Med Sci. 2023 Aug;192: 2001–2014.

7. da Silva JM, de Barros BS, Almeida GJ et al. Rheumatol Int. 2022 Mar;42(3):413-429.

8. Bidonde J, Busch AJ, Schachter CL, et al. Cochrane Database Syst Rev. 2019 May 24;5(5):CD013340

9. Fitzcharles MA, Ste-Marie PA, Goldenberg DL et al. Pain Res Manag. 2013 May-Jun;18(3):119-26.

10. Lunn MP, Hughes RA, Wiffen PJ. Cochrane Database Syst Rev. 2014 Jan 3; 2014(1):CD007115.

11. Kolber M R., Klarenbach S, Cauchon M, et al. Can Fam Physician. 2023 Oct;69(10), 675-686.

12. Korownyk CS, Montgomery L, Young J, et al. Can Fam Physician. 2022 Mar;68(3):179-190

13. Lindblad A, Klein D, Dhawan S. Tools for Practice #130: Working out depression: Is exercise effective for depression? Published January 19, 2015. Available at https://cfpclearn.ca/tfp130/ Accessed April 29, 2025.

Authors do not have any conflicts of interest to declare.