Therapeutic exercise (TE) is the only intervention with strong recommendation for fibromyalgia. However, there is controversy as to which type of exercise is the most beneficial. To determine which TE approach is the most effective in reducing pain intensity in women with fibromyalgia. A systematic review was performed with a network meta-analysis (NMA). Six databases were searched from inception until January 2024. Randomized controlled trials (RCTs) evaluating the effects of TE on pain intensity were included in women with fibromyalgia. Methodological quality was assessed using the Physiotherapy Evidence Database scale. The size of the effect and the clinically important difference were determined in the short-term (≤3 months) and long-term (>3 months). Sixty-one studies were identified, of which 51 were included in the quantitative synthesis (n = 2873). Fifteen TE interventions and eight comparison interventions (comparators) were identified. Aquatic exercise (p-score: 0.8713) was found to provide best benefits in the short-term and resistance training in the long-term (p-score: 0.9749). Statistically significant differences were found in favor of aquatic exercise, Pilates, qigong, resistance training, virtual reality, mixed exercise, and aerobic exercise (in the short-term) and in favor of resistance training, dance, functional training, aquatic exercise, virtual reality, and aerobic exercise (in the long-term) compared to usual care. With a moderate level of evidence, our NMA shows that, in the short-term, aquatic exercise is the most effective TE intervention to reduce pain intensity in women with fibromyalgia, while resistance training is the most effective in the long-term. More RCTs are needed to strengthen these findings.

Background and Objective: There has been an increase in the number of papers assessing the effects of resistance training (RT) in patients with fibromyalgia. Therefore, the objective of our study was to evaluate the clinical relevance and effectiveness of RT for pain intensity, functionality and severity of the disease specifically in women with fibromyalgia through a systematic review with meta‐analysis.Databases and Data Treatment: Seven databases were searched. Randomized controlled trials conducted in women over 18 years of age with fibromyalgia were included. Fifteen trials were included in the systematic review and 14 of these studies were included in the three meta‐analyses performed. Study quality assessment was performed using the PEDro scale. In addition, the GRADE recommendations were used.Results: The global meta‐analysis revealed statistically significant differences in the RT group versus the control group on pain intensity (SMD = −0.49; 95% CI [−0.74, −0.24],p = 0.0001), functionality (SMD = −0.23; 95% CI [0.01, 0.45],p = 0.04) and on severity of the disease (SMD = −0.58; 95% CI [−0.90, −0.26],p = 0.0005). Clinically relevant improvements in the overall outcome of the three variables studied in favour of RT were obtained.Conclusions: RT is effective to improve pain intensity, functionality and severity of the disease in women with fibromyalgia. These improvements are clinically relevant. More clinical trials of RT are needed in women with fibromyalgia to support our results due to the low strength of evidence.Significance: This systematic review with meta‐analysis provides evidence that RT produces clinically relevant improvements in women with fibromyalgia. The absence of immediate benefit is often a major barrier to adherence to treatment. Our findings will help clinicians to empower patients that if they continue treatment, they will achieve improvement in their disease.

Background and Objective: Guidelines recommend combining physical and psychological programmes for chronic low back pain (CLBP); however, exercise therapy (ET) and manual therapy (MT) are often delivered separately. This systematic review with meta‐analysis and meta‐regression of randomised controlled trials (RCTs) aimed to compare the efficacy of ET with MT in terms of pain intensity, disability and physical function in people with CLBP. Databases and Data Treatment: MEDLINE, Web of Science, PEDro, Cochrane Library and Scopus were searched July–August 2024 for RCTs comparing ET with MT in participants aged 18–54 years. Outcomes were extracted for the short‐, medium‐ and long‐term follow‐up periods. Risk of bias (RoB 2.0 Cochrane Tool) and certainty of evidence (GRADE) were appraised. Results: Six RCTs (743 patients) were included. Meta‐analyses showed, albeit non‐clinically relevant, a significant difference for long‐term in favour of ET for disability (SMD = −0.25, 95% CI [−0.43, −0.07], p = 0.007). Meta‐regression showed that the female–male ratio, treatment duration and mean age explain variability in pain intensity and disability. Conclusions: ET had a small beneficial effect on long‐term disability in people with CLBP. Nevertheless, evidence does not provide conclusive differences between both the treatments overall, influenced by heterogeneity and the number of studies included. Biopsychosocial factors may moderate the differences in outcomes. The GRADE assessment revealed very low certainty across all outcomes, highlighting the lack of high‐quality research. Significance Statement: ET may offer small long‐term benefits over MT for disability in people with CLBP. Differences seem to be influenced by sex, age and treatment duration. The choice of ET over MT, or vice versa, as a stand‐alone treatment does not appear to be supported by current evidence. PROSPERO Registration Number: CRD42024569120

Purpose: Fibromyalgia is a chronic disease that mainly affects women, deteriorating the quality of life of these patients. Resistance exercise (RE) has been shown to be beneficial in this disease. The objective of this study is to evaluate the effectiveness of RE for depression, fatigue, and sleep quality in women with fibromyalgia.Design and Methods: A systematic review with meta‐analysis was conducted until September 1, 2024. Seven databases were searched as follows: PubMed, Cochrane Library, Web of Science, Scopus, Physiotherapy Evidence Database, Dialnet, and Cumulative Index to Nursing and Allied Health Literature. Randomized clinical trials were conducted in women with a diagnosis of fibromyalgia, including RE as the only intervention in any of the groups and to assess depression, fatigue, and sleep quality. For meta‐analyses, we calculated the standardized difference of means and its standard error. A random‐effects model was used. The risk of bias was assessed using the Cochrane risk‐of‐bias tool for randomized trials (RoB 2). PROSPERO Registration: CRD42021256162.Findings: Eleven trials were included in the systematic review and eight in the meta‐analysis (n = 664). RE showed statistically significant improvements in depression (SMD = −0.54; 95% CI [−0.92, −0.16], p = 0.005) and fatigue (SMD = −0.83; 95% CI [−1.41–0.25], p = 0.005). No significant differences were found in sleep quality (SMD = −0.99; 95% CI [−2.40, 0.43], p = 0.17). In general, the methodological quality of the included trials was good.Practice Implication: RE is an effective tool to improve depression and fatigue in women with fibromyalgia, achieving clinically relevant improvements of more than 50% in symptoms related to depression. RE did not show benefits for sleep quality, although this finding may be due to a lack of studies. More studies are needed to determine the effectiveness of RE on sleep quality.

Therapeutic exercise is the only intervention with strong evidence for fibromyalgia, yet the most effective modality remains uncertain. 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). Systematic review with a network meta-analysis of randomized controlled trials. 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. 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. 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.