Comparison of the Effects of Three Types of Exercise (Aerobic Exercise, Resistance Training, and Mind‐Body Exercise) on Fibromyalgia: A Systematic Review and Network Meta‐Analysis of Randomized Controlled Trials

BACKGROUND: Few studies have compared the effects of different types of exercise on the management of patients with fibromyalgia. Therefore, we conducted this systematic review with meta-analysis to evaluate the effects of three types of exercise on the treatment of fibromyalgia. METHODS: Search databases including PubMed, Cochrane, Embase, and Web of Science from their inception to October 15, 2022, for randomized controlled trials (RCTs) investigating the effects of exercise on people with fibromyalgia. RESULTS: A systematic analysis was conducted on 21 RCTs involving 1638 participants and five distinct interventions. Most participants were female, consistent with the epidemiological characteristics of fibromyalgia syndrome. Compared with routine healthcare, the results of FIQ showed that more significant relief of fatigue was associated with the combination of aerobic and mind-body exercises (SMD = -0.58 [95% CI: -1.14∼-0.01]), aerobic exercise (SMD = 0.79 [95% CI: 0.25∼1.33]), and mind-body exercise (SMD = 0.68 [95% CI: 1.05∼-0.32]). VAS results revealed that significant improvement in pain was associated with the combination of aerobic and mind-body exercises (SMD = -0.78 [95% CI: -1.54∼-0.02]), resistance training (SMD = -1.58 [95% CI: -2.67∼-0.49]), and mind-body exercise (SMD = -1.62 [95% CI: -2.35∼-0.90]). Analysis of the 6MWT results showed that patients to whom the mind-body exercise was delivered can walk farther (SMD = 33.03 [95% CI: 13.73∼52.34]), compared with those in the control group. A significant effect on 6-minute walk test (6MWT) performance was observed following aerobic exercise (SMD = -23.19 [95% CI: -38.78 to -7.60]); in contrast, no significant changes were found in the group that underwent combined aerobic and resistance exercise. CONCLUSIONS: This systematic review shows the effects of single or mixed exercise intervention for the management of fibromyalgia and suggests appropriate exercise as a highly effective nonpharmacological therapeutic strategy.