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: The impact of muscle-training treatment on quality of life and functional outcomes in people with pelvic floor dysfunction may be related to adherence rates. Methods: Nine electronic databases were searched for studies published up to 15 October 2024. A qualitative synthesis was used to describe the relationship between adherence or compliance with treatment, quality of life, and symptomatic severity. A meta-analysis of data from selected studies was performed that assessed quality of life and symptomatic severity in the short term. Results: Seven studies with 2190 participants were included. Of these studies, 42% showed rates greater than 80% in terms of adherence. A beneficial effect was found in terms of urinary incontinence severity without statistical differences between the groups (p = 0.813), while quality of life showed statistically significant improvements favoring the experimental group (p = 0.036). The quality of the evidence was collected or measured from low to high. Conclusions: People with pelvic floor disorders show high rates of adherence to pelvic floor muscle exercise and experience an improved quality of life in the short term, but more research is needed on the design of homogeneous systems to measure compliance and adherence to exercise-based treatments.

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

Background: Internet and social media addiction have become a health problem due to their negative impact on health and well-being. Internet use time is also frequently examined as an outcome, offering complementary insight into usage patterns. Health education is a key tool during adolescence to promote healthy behaviours, supporting self-regulation and fostering healthier patterns of Internet and social media use. The aim of this study is to evaluate the effectiveness of health education interventions for reducing Internet addiction, Internet use time, and social media addiction among adolescents. Methods: We conducted a systematic review with meta-analysis following PRISMA guidelines. Eligible studies were experimental or quasi-experimental designs involving adolescents and evaluating health education interventions, with outcomes on Internet addiction, Internet use time, or social media addiction. A search was conducted in Medline, WoS, Scopus, CINAHL, PsycINFO and PubMed Central. Study selection, data extraction, and synthesis were performed independently by pairs of researchers. To evaluate risk of bias, the Cochrane Collaboration’s tool was used for randomised studies, and ROBINS-I for non-randomised studies. Certainty of evidence was assessed with GRADE. Results: Sixteen studies with 13,562 participants were included in the systematic review. Six were included in the meta-analysis for Internet addiction. Most interventions were conducted in educational settings, with participants showing variability in their Internet use patterns across studies. Across studies, observed characteristics included group delivery and participatory approaches, parental involvement, promotion of healthier Internet use, and inclusion of broader educational content addressing health-promotion topics. The review found generally favourable effects on Internet addiction and Internet use time. Evidence on social media addiction was limited. The meta-analysis for Internet addiction showed a statistically significant difference in favour of the intervention, with a large effect size (SMD = − 1.88; 95% CI [− 2.64, − 1.11], p < 0.00001). Subgroup analysis showed a large and significant effect in adolescent only interventions (SMD = − 1.93; 95% CI [− 2.84, − 1.02], p < 0.0001) and in parent involved interventions (SMD = − 1.81; 95% CI [− 2.95, − 0.68], p = 0.002). Conclusions: Health education shows promise for reducing Internet addiction and Internet use time among adolescents. Evidence on social media addiction remains limited. Trial registration: The study protocol was registered in PROSPERO (CRD42024568029).

Objective: The objective was to compare the effectiveness of a combined pain neuroscience education and resistance training program (PNE + RT) with that of a combined aerobic and flexibility exercise program (AE + FE). Design: A randomized pilot study was conducted in women with fibromyalgia. Methods: Thirty‐one women with fibromyalgia were randomized into the experimental group (PNE + RT, n = 15) and the usual care group (AE + FE, n = 16). Both groups carried out the intervention 3 days a week for 12 weeks. Primary outcomes were pain intensity, disability, and symptoms related to central sensitization (CS). Among them, pain intensity was considered the main primary endpoint for statistical analysis and interpretation. Secondary outcomes were pressure pain threshold (PPT), maximum handgrip strength (MHS), and stiffness. Results: Statistically significant between‐group differences were found in favor of PNE + RT group for short‐term pain intensity ( p < 0.05) and PPT trapezius ( p < 0.05). PNE + RT also showed statistically significant within‐group improvements in pain intensity ( p < 0.01), CS‐related symptoms ( p < 0.01), PPT quadriceps ( p < 0.01), and MHS of the left hand ( p < 0.01). Disability improved significantly in both groups ( p < 0.01). There were no significant changes in stiffness. Conclusion: The PNE + RT program is more effective than the AE + FE program in improving pain intensity in the short term and PPT in the trapezius muscle in the long term. PNE + RT is also effective in improving disability, pain intensity, CS‐related symptoms (short and long term), and left MHS and PPT in the quadriceps muscle (long term), although it is not more effective than AE + FE. The AE + FE program is only effective in improving disability. These findings are preliminary, and larger studies are needed to confirm the results. Trial Registration: ClinicalTrials.gov identifier: NCT04855851