Although previous research has highlighted the benefits of exercise interventions on managing the symptoms in patients with fibromyalgia syndrome (FMS), mind-body exercise was shown to be the most effective exercise strategy to improve health-related quality of life (HRQoL) in this patient population, according to a study published in Dove Press.1 Individualized exercise plans, designed with symptoms and accessibility in mind, are encouraged.
“FMS can be lifelong, and medical therapy is of limited value due to the diversity of pathogenesis and concerns about side effects,” investigators emphasized. “In the long term, FMS is best managed as a chronic condition, with non-pharmacological therapies as the primary treatment and medications as an adjunct to symptom relief.”
Randomized clinical trials (RCTs) evaluating the impact of exercise on health parameters in adults with FMS were identified in databases such as the Cochrane Register of Clinical Trials, Embase, Medline, and National Institutes of Health (NIH) ClinicalTrials.gov. A frequentist network meta-analyses (NMA) was conducted to rank the effects of various interventions based on P-scores and the certainty of evidence was determined. The primary outcome was HRQoL after exercise intervention, measured by the Fibromyalgia Impact Questionnaire (FIQ). Secondary outcomes included anxiety, depression, sleep, and pain after intervention, using the Hospital Anxiety and Depression Scale (HADS), Beck Depression Inventory (BDI), Pittsburgh Sleep Quality Index (HSQI), and Visual Analogue Scale (VAS), respectively.
Eligible RCTs included adults with FMS, research focusing on either exercise and a control group or comparing 2 different treatments, and studies with comparable baseline data across groups with quantitative outcome data post-intervention. Physical exercise interventions were categorized as aerobic exercise, mind-body exercise, strength or resistance exercise, stretching exercise, sensorimotor training, and whole body vibration.
In total, 57 RCTs, comprised of 3319 participants (n = 2961 after loss of follow-up exclusion) and 9 interventions, were identified. Most (93.8%) of participants were women and the average age ranged from 35 to 59.3 years.
Mind-body exercise intervention was associated with the lowest FIQ score when compared with all included treatments (standardized mean difference [SMD], − 12.12; 95% CI, − 15.79 to − 8.45). Whole body vibration therapy was shown to improve sleep quality (SMD, − 6.95; 95% CI, − 10.03 to − 3.87) and improve depression (SMD, − 10.44; 95% CI, − 22.00 to 1.12), pool-based aerobic exercise effectively eased anxiety (SMD, − 4.83; 95% CI, − 7.47 to − 2.19), and sensorimotor training was linked to minimal pain scores when compared with usual care (SMD, − 1.81; 95% CI, − 2.81 to − 0.82).
Intensity, frequency, and duration of exercise, which varied among studies, were not analyzed, thus limiting the study. Additionally, only age and sex baseline characteristics were included. No consensus could be made on the optimal follow-up period post-interventions and the tools used to determine efficacy varied among studies.
“This study can be used as a reference for clinicians to prescribe personalized exercise for FMS patients, that is, the choice in terms of exercise recommendations should be informed by evidence, but other factors such as barriers to engagement and accessibility also have to be recognized,” investigators concluded. “In the future, further studies are needed to confirm the reliability of the conclusions of this study. In addition, it is important to determine the most appropriate exercise variables (intensity, frequency, and duration) to achieve the best results for quality of life.”
Zhang KD, Wang LY, Zhang ZH, et al. Effect of Exercise Interventions on Health-Related Quality of Life in Patients with Fibromyalgia Syndrome: A Systematic Review and Network Meta-Analysis. J Pain Res. 2022;15:3639-3656. Published 2022 Nov 22. doi:10.2147/JPR.S384215