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Aerobic\u2009+\u2009flexibility training demonstrated the most significant intervention effect compared to controls (\n                      <jats:italic>g<\/jats:italic>\n                      \u2009=\u2009\u22120.82, 95% credible interval [CrI]: \u22121.07 to \u22120.58; five comparisons; surface under the cumulative ranking curve [SUCRA]\u2009=\u20090.91), followed by water\u2010based exercise (\n                      <jats:italic>g<\/jats:italic>\n                      \u2009=\u2009\u22120.72, 95% CrI: \u22120.92 to \u22120.52; 11 comparisons; SUCRA\u2009=\u20090.87) and Pilates (\n                      <jats:italic>g<\/jats:italic>\n                      \u2009=\u2009\u22120.87, 95% CrI: \u22121.14 to \u22120.59; 11 comparisons; SUCRA\u2009=\u20090.60). A weekly exercise volume of 875 metabolic equivalent of task (MET) minutes was required to achieve minimal clinically important difference (MCID). The overall quality of evidence ranged from low to very low.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Aerobic\u2009+\u2009flexibility training and water\u2010based exercises may be effective strategies for pain management in patients with FM. However, given the substantial heterogeneity, high risk of bias, and overall low quality of evidence, these findings should be interpreted with caution. The temporary nature of these benefits underscores the importance of maintaining a consistent, professionally guided and tailored exercise regimen.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Significance Statement<\/jats:title>\n                    <jats:p>While acknowledging the overall low to very low quality of the available evidence, this study suggests that combining aerobic and flexibility training or engaging in water\u2010based exercises may be effective for pain reduction in fibromyalgia. Our analysis indicates that a weekly exercise volume of approximately 875 METs\u2010min, potentially achieved through 2\u20133 sessions per week, is associated with a minimal clinically important difference. These parameters should serve as a guide for clinicians rather than a strict prescription. Crucially, exercise programmes should start at a low intensity and be progressively tailored by professionals to the patient's individual tolerance and preference, as long\u2010term adherence is key to sustaining benefits.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial Registration<\/jats:title>\n                    <jats:p>PROSPERO number: CRD42024585864<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ejp.70109","type":"journal-article","created":{"date-parts":[[2025,9,1]],"date-time":"2025-09-01T14:00:20Z","timestamp":1756735220000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Comparative Effectiveness of Exercise Modalities for Fibromyalgia: A Systematic Review and Bayesian Network Meta\u2010Analysis"],"prefix":"10.1002","volume":"29","author":[{"given":"Chuanzhi","family":"Wang","sequence":"first","affiliation":[{"name":"National Center for Translational Medicine Shanghai Jiao Tong University  Shanghai China"},{"name":"Lab of Regenerative Medicine in Sports Science, School of Physical Education and Sports Science South China Normal University  Guangzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jielin","family":"Sun","sequence":"additional","affiliation":[{"name":"National Center for Translational Medicine Shanghai Jiao Tong University  Shanghai China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhide","family":"Liang","sequence":"additional","affiliation":[{"name":"Cancer Institute of the Affiliated Hospital of Qingdao University and Qingdao Cancer Institute  Qingdao China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yi","family":"Cai","sequence":"additional","affiliation":[{"name":"National Center for Translational Medicine Shanghai Jiao Tong University  Shanghai China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meng","family":"Zhang","sequence":"additional","affiliation":[{"name":"School of Exercise and Health Shanghai University of Sport  Shanghai China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shudong","family":"Tian","sequence":"additional","affiliation":[{"name":"School of Physical Education Shandong University  Jinan China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wenyi","family":"Yang","sequence":"additional","affiliation":[{"name":"National Center for Translational Medicine Shanghai Jiao Tong University  Shanghai China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shulin","family":"Cheng","sequence":"additional","affiliation":[{"name":"National Center for Translational Medicine Shanghai Jiao Tong University  Shanghai China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rui","family":"Duan","sequence":"additional","affiliation":[{"name":"Lab of Regenerative Medicine in Sports Science, School of Physical Education and Sports Science South China Normal University  Guangzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiuqiang","family":"Wang","sequence":"additional","affiliation":[{"name":"National Center for Translational Medicine Shanghai Jiao Tong University  Shanghai China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,9,1]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1214\/20\u2010BA1221"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1214\/06\u2010BA117A"},{"issue":"8","key":"e_1_2_6_4_1","first-page":"294","article-title":"A Study of Hydrotherapy and Its Health Benefits","volume":"1","author":"Bahadorfar M.","year":"2014","journal-title":"International Journal of Research"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajem.2019.158489"},{"key":"e_1_2_6_6_1","volume-title":"ACSM'S Exercise Testing and Prescription","author":"Bayles M. 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