{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T16:39:26Z","timestamp":1791909566378,"version":"4.3.4"},"reference-count":134,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2023,4,12]],"date-time":"2023-04-12T00:00:00Z","timestamp":1681257600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Physiol."],"abstract":"<jats:p>The aim of our meta-analysis was to compile the available evidence to evaluate the effect of physical exercise-based therapy (PEBT) on pain, impact of the disease, quality of life (QoL) and anxiety in patients with fibromyalgia syndrome (FMS), to determine the effect of different modes of physical exercise-based therapy, and the most effective dose of physical exercise-based therapy for improving each outcome. A systematic review and meta-analysis was carried out. The PubMed (MEDLINE), SCOPUS, Web of Science, CINAHL Complete and Physiotherapy Evidence Database (PEDro) databases were searched up to November 2022. Randomized controlled trials (RCTs) comparing the effects of physical exercise-based therapy and other treatments on pain, the impact of the disease, QoL and\/or anxiety in patients with FMS were included. The standardized mean difference (SMD) and a 95% CI were estimated for all the outcome measures using random effect models. Three reviewers independently extracted data and assessed the risk of bias using the PEDro scale. Sixty-eight RCTs involving 5,474 participants were included. Selection, detection and performance biases were the most identified. In comparison to other therapies, at immediate assessment, physical exercise-based therapy was effective at improving pain [SMD-0.62 (95%CI, \u22120.78 to \u22120.46)], the impact of the disease [SMD-0.52 (95%CI, \u22120.67 to \u22120.36)], the physical [SMD 0.51 (95%CI, 0.33 to 0.69)] and mental dimensions of QoL [SMD 0.48 (95%CI, 0.29 to 0.67)], and the anxiety [SMD-0.36 (95%CI, \u22120.49 to \u22120.25)]. The most effective dose of physical exercise-based therapy for reducing pain was 21\u201340 sessions [SMD-0.83 (95%CI, 1.1\u2013\u22120.56)], 3 sessions\/week [SMD-0.82 (95%CI, \u22121.2\u2013\u22120.48)] and 61\u201390\u00a0min per session [SMD-1.08 (95%CI, \u22121.55\u2013\u22120.62)]. The effect of PEBT on pain reduction was maintained up to 12\u00a0weeks [SMD-0.74 (95%CI, \u22121.03\u2013\u22120.45)]. Among patients with FMS, PEBT (including circuit-based exercises or exercise movement techniques) is effective at reducing pain, the impact of the disease and anxiety as well as increasing QoL.<\/jats:p><jats:p><jats:bold>Systematic Review Registration:<\/jats:bold> PROSPERO <jats:ext-link>https:\/\/www.crd.york.ac.uk\/<\/jats:ext-link>PROSPERO\/, identifier CRD42021232013.<\/jats:p>","DOI":"10.3389\/fphys.2023.1170621","type":"journal-article","created":{"date-parts":[[2023,4,12]],"date-time":"2023-04-12T05:55:10Z","timestamp":1681278910000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":29,"title":["Optimal dose and type of exercise to reduce pain, anxiety and increase quality of life in patients with fibromyalgia. A systematic review with meta-analysis"],"prefix":"10.3389","volume":"14","author":[{"given":"Daniel","family":"Rodr\u00edguez-Almagro","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mar\u00eda","family":"Del Moral-Garc\u00eda","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mar\u00eda del Carmen","family":"L\u00f3pez-Ruiz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Irene","family":"Cort\u00e9s-P\u00e9rez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Esteban","family":"Obrero-Gait\u00e1n","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rafael","family":"Lomas-Vega","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2023,4,12]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"934689","DOI":"10.3389\/fpain.2022.934689","article-title":"The pain outcomes comparing yoga vs. structured exercise (poyse) trial in veterans with fibromyalgia: Study design and methods","volume":"3","author":"Allsop","year":"2022","journal-title":"Front. Pain Res."},{"key":"B2","doi-asserted-by":"publisher","first-page":"79","DOI":"10.23736\/S1973-9087.18.05041-4","article-title":"Effects of aquatic training and detraining on women with fibromyalgia: Controlled randomized clinical trial","volume":"55","author":"Andrade","year":"2019","journal-title":"Eur. J. Phys. Rehabil. Med."},{"key":"B3","doi-asserted-by":"publisher","first-page":"69","DOI":"10.1186\/s13643-022-01944-1","article-title":"Effectiveness of multicomponent treatment in patients with fibromyalgia: Protocol for a systematic review and meta-analysis","volume":"11","author":"Araya-Quintanilla","year":"2022","journal-title":"Syst. Rev."},{"key":"B4","doi-asserted-by":"publisher","first-page":"398","DOI":"10.1016\/j.medcli.2010.09.045","article-title":"Effects of aerobic exercise program and relaxation techniques on anxiety, quality of sleep, depression, and quality of life in patients with fibromyalgia: A randomized controlled trial","volume":"137","author":"Arcos-Carmona","year":"2011","journal-title":"Med. Clin. Barc."},{"key":"B5","doi-asserted-by":"publisher","first-page":"1524","DOI":"10.1016\/j.apmr.2022.02.020","article-title":"Effectiveness of transcranial direct current stimulation combined with exercising in people with fibromyalgia: A randomized sham-controlled clinical trial","volume":"103","author":"Arroyo-Fern\u00e1ndez","year":"2022","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"B6","doi-asserted-by":"publisher","first-page":"663","DOI":"10.23736\/S1973-9087.17.04876-6","article-title":"Muscle stretching exercises and resistance training in fibromyalgia: Which is better? A three-arm randomized controlled trial","volume":"54","author":"Assump\u00e7\u00e3o","year":"2018","journal-title":"Eur. J. Phys. Rehabil. Med."},{"key":"B7","first-page":"2257","article-title":"The efficacy of mindfulness meditation plus qigong movement therapy in the treatment of fibromyalgia: A randomized controlled trial","volume":"30","author":"Astin","year":"2003","journal-title":"J. Rheumatol."},{"key":"B8","doi-asserted-by":"publisher","first-page":"1865","DOI":"10.1016\/j.apmr.2020.05.022","article-title":"Effectiveness of high-intensity interval training vs moderate-intensity continuous training in patients with fibromyalgia: A pilot randomized controlled trial","volume":"101","author":"Atan","year":"2020","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"B9","doi-asserted-by":"publisher","first-page":"1490","DOI":"10.1136\/bmj.328.7454.1490","article-title":"Grading quality of evidence and strength of recommendations","volume":"328","author":"Atkins","year":"2004","journal-title":"BMJ"},{"key":"B10","doi-asserted-by":"publisher","first-page":"ITC33","DOI":"10.7326\/AITC202003030","volume":"172","author":"Bair","year":"2020","journal-title":"Fibromyalgia."},{"key":"B11","first-page":"18","article-title":"Effectiveness of dance in patients with fibromyalgia: A randomized, single-blind, controlled study","volume":"30","author":"Baptista","year":"2012","journal-title":"Clin. Exp. Rheumatol."},{"key":"B12","doi-asserted-by":"publisher","first-page":"1304","DOI":"10.3899\/jrheum.081090","article-title":"Minimal clinically important difference in the fibromyalgia impact questionnaire","volume":"36","author":"Bennett","year":"2009","journal-title":"J. Rheumatol."},{"key":"B13","doi-asserted-by":"publisher","first-page":"27","DOI":"10.1186\/1471-2474-8-27","article-title":"An internet survey of 2,596 people with fibromyalgia","volume":"8","author":"Bennett","year":"2007","journal-title":"BMC Musculoskelet. Disord."},{"key":"B14","doi-asserted-by":"publisher","first-page":"45","DOI":"10.2174\/1573403X10666140914155304","article-title":"Exercise for adults with fibromyalgia: An umbrella systematic review with synthesis of best evidence","volume":"10","author":"Bidonde","year":"","journal-title":"Curr. Rheumatol. Rev."},{"key":"B15","doi-asserted-by":"publisher","first-page":"CD011336","DOI":"10.1002\/14651858.CD011336","article-title":"Aquatic exercise training for fibromyalgia","author":"Bidonde","year":"","journal-title":"Cochrane Database Syst. Rev."},{"key":"B16","doi-asserted-by":"publisher","first-page":"919","DOI":"10.1080\/09593985.2018.1467520","article-title":"Basic body awareness therapy in patients suffering from fibromyalgia: A randomized clinical trial","volume":"35","author":"Bravo","year":"2019","journal-title":"Physiother. Theory Pract."},{"key":"B17","doi-asserted-by":"publisher","first-page":"530","DOI":"10.1016\/j.pain.2010.08.020","article-title":"A pilot randomized controlled trial of the Yoga of Awareness program in the management of fibromyalgia","volume":"151","author":"Carson","year":"2010","journal-title":"Pain"},{"key":"B18","doi-asserted-by":"publisher","first-page":"59","DOI":"10.1016\/j.jphys.2019.08.005","article-title":"Clinimetrics: Physiotherapy evidence database (PEDro) scale","volume":"66","author":"Cashin","year":"2020","journal-title":"J. Physiother."},{"key":"B19","doi-asserted-by":"publisher","first-page":"421","DOI":"10.1002\/acr.21818","article-title":"Efficacy of a multidisciplinary fibromyalgia treatment adapted for women with low educational levels: A randomized controlled trial","volume":"65","author":"Castel","year":"2013","journal-title":"Arthritis Care Res. Hob."},{"key":"B20","doi-asserted-by":"publisher","first-page":"290","DOI":"10.1136\/ard.2002.004945","article-title":"Fibromyalgia: A randomised, controlled trial of a treatment programme based on self management","volume":"63","author":"Cedraschi","year":"2004","journal-title":"Ann. Rheum. Dis."},{"key":"B21","doi-asserted-by":"publisher","first-page":"106048","DOI":"10.1155\/2014\/106048","article-title":"Qigong exercise alleviates fatigue, anxiety, and depressive symptoms, improves sleep quality, and shortens sleep latency in persons with chronic fatigue syndrome-like illness","volume":"2014","author":"Chan","year":"2014","journal-title":"Evidence-Based Complement. Altern. Med."},{"key":"B22","doi-asserted-by":"publisher","first-page":"493","DOI":"10.3727\/096368916X694238","article-title":"Adiponectin potentially contributes to the antidepressive effects of baduanjin qigong exercise in women with chronic fatigue syndrome-like illness","volume":"26","author":"Chan","year":"2017","journal-title":"Cell. Transpl."},{"key":"B23","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.ctim.2019.07.007","article-title":"Effectiveness of tai chi on fibromyalgia patients: A meta-analysis of randomized controlled trials","volume":"46","author":"Cheng","year":"2019","journal-title":"Complement. Ther. Med."},{"key":"B24","doi-asserted-by":"publisher","first-page":"676","DOI":"10.2340\/16501977-1819","article-title":"Effect of a fibromyalgia rehabilitation programme in warm versus cold climate: A randomized controlled study","volume":"46","author":"Clarke-Jenssen","year":"2014","journal-title":"J. Rehabil. Med."},{"key":"B25","volume-title":"Statistical power analysis for the behavioral sciences","author":"Cohen","year":"1977"},{"key":"B26","doi-asserted-by":"publisher","first-page":"1167","DOI":"10.3390\/JPM11111167","article-title":"Virtual reality-based therapy reduces the disabling impact of fibromyalgia syndrome in women: Systematic review with meta-analysis of randomized controlled trials","volume":"11","author":"Cort\u00e9s-P\u00e9rez","year":"2021","journal-title":"J. Pers. Med."},{"key":"B27","doi-asserted-by":"publisher","first-page":"1169","DOI":"10.1097\/j.pain.0000000000001819","article-title":"A review of the incidence and risk factors for fibromyalgia and chronic widespread pain in population-based studies","volume":"161","author":"Creed","year":"2020","journal-title":"Pain"},{"key":"B28","doi-asserted-by":"publisher","first-page":"1422","DOI":"10.1093\/rheumatology\/kei032","article-title":"A randomized clinical trial of an individualized home-based exercise programme for women with fibromyalgia","volume":"44","author":"Da Costa","year":"2005","journal-title":"Rheumatology"},{"key":"B29","doi-asserted-by":"publisher","first-page":"495","DOI":"10.3233\/BMR-191820","article-title":"Effects of a physical self-care support program for patients with fibromyalgia: A randomized controlled trial","volume":"35","author":"de Lorena","year":"2022","journal-title":"J. Back Musculoskelet. Rehabil."},{"key":"B30","doi-asserted-by":"publisher","first-page":"3771","DOI":"10.3390\/jcm9113771","article-title":"Effectiveness of active therapy-based training to improve the balance in patients with fibromyalgia: A systematic review with meta-analysis","volume":"9","author":"Del-Moral-Garc\u00eda","year":"2020","journal-title":"J. Clin. Med."},{"key":"B31","doi-asserted-by":"publisher","first-page":"177","DOI":"10.1016\/0197-2456(86)90046-2","article-title":"Meta-analysis in clinical trials","volume":"7","author":"DerSimonian","year":"1986","journal-title":"Control. Clin. Trials"},{"key":"B32","doi-asserted-by":"publisher","first-page":"455","DOI":"10.1111\/j.0006-341X.2000.00455.x","article-title":"Trim and fill: A simple funnel-plot-based method of testing and adjusting for publication bias in meta-analysis","volume":"56","author":"Duval","year":"2000","journal-title":"Biometrics"},{"key":"B33","doi-asserted-by":"publisher","first-page":"629","DOI":"10.1136\/bmj.315.7109.629","article-title":"Bias in meta-analysis detected by a simple, graphical test","volume":"315","author":"Egger","year":"1997","journal-title":"Bmj"},{"key":"B34","doi-asserted-by":"publisher","first-page":"88","DOI":"10.1080\/03630242.2016.1153017","article-title":"Effects of active\/passive interventions on pain, anxiety, and quality of life in women with fibromyalgia: Randomized controlled pilot trial","volume":"57","author":"Ekici","year":"2017","journal-title":"Women Health"},{"key":"B35","doi-asserted-by":"publisher","first-page":"176","DOI":"10.1186\/s13075-016-1073-3","article-title":"Resistance exercise improves physical fatigue in women with fibromyalgia: A randomized controlled trial","volume":"18","author":"Ericsson","year":"2016","journal-title":"Arthritis Res. Ther."},{"key":"B36","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.ctim.2016.07.003","article-title":"Effect of low-impact aerobic exercise combined with music therapy on patients with fibromyalgia. A pilot study","volume":"28","author":"Esp\u00ed-L\u00f3pez","year":"2016","journal-title":"Complement. Ther. Med."},{"key":"B37","doi-asserted-by":"publisher","first-page":"752","DOI":"10.1016\/j.apmr.2020.06.019","article-title":"Effectiveness of exercise on fatigue and sleep quality in fibromyalgia: A systematic review and meta-analysis of randomized trials","volume":"102","author":"Est\u00e9vez-L\u00f3pez","year":"2021","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"B38","doi-asserted-by":"publisher","first-page":"2261","DOI":"10.3390\/ijerph20032261","article-title":"Can an aerobic exercise programme improve the response of the growth hormone in fibromyalgia patients? A randomised controlled trial","volume":"20","author":"Estrada-Marc\u00e9n","year":"2023","journal-title":"Int. J. Environ. Res. Public Health"},{"key":"B39","first-page":"700","article-title":"Interpreting estimates of treatment effects: Implications for managed care","volume":"33","author":"Faraone","year":"2008","journal-title":"P T"},{"key":"B40","doi-asserted-by":"publisher","first-page":"81","DOI":"10.1186\/s12906-016-1068-2","article-title":"Cost-utility and biological underpinnings of mindfulness-based stress reduction (MBSR) versus a psychoeducational programme (FibroQoL) for fibromyalgia: A 12-month randomised controlled trial (EUDAIMON study)","volume":"16","author":"Feliu-Soler","year":"2016","journal-title":"BMC Complement. Altern. Med."},{"key":"B41","doi-asserted-by":"publisher","first-page":"620","DOI":"10.1080\/09593985.2019.1639229","article-title":"Effects of aquatic physiotherapy or health education program in women with fibromyalgia: A randomized clinical trial","volume":"37","author":"Fonseca","year":"2021","journal-title":"Physiother. Theory Pract."},{"key":"B42","doi-asserted-by":"publisher","first-page":"R55","DOI":"10.1186\/ar2967","article-title":"Effects of lifestyle physical activity on perceived symptoms and physical function in adults with fibromyalgia: Results of a randomized trial","volume":"12","author":"Fontaine","year":"2010","journal-title":"Arthritis Res. Ther."},{"key":"B43","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1300\/J094v15n01_02","article-title":"Effects of lifestyle physical activity on health status, pain, and function in adults with fibromyalgia syndrome","volume":"15","author":"Fontaine","year":"2007","journal-title":"J. Musculoskelet. Pain"},{"key":"B44","doi-asserted-by":"publisher","first-page":"54","DOI":"10.1002\/ejp.2039","article-title":"Is Pilates more effective and cost\u2010effective than aerobic exercise in the treatment of patients with fibromyalgia syndrome? A randomized controlled trial with economic evaluation","volume":"27","author":"Franco","year":"2023","journal-title":"Eur. J. Pain"},{"key":"B45","doi-asserted-by":"publisher","first-page":"434","DOI":"10.1007\/s11916-014-0434-3","article-title":"Fibromyalgia and sleep in animal models: A current overview and future directions","volume":"18","author":"Frange","year":"2014","journal-title":"Curr. Pain Headache Rep."},{"key":"B46","doi-asserted-by":"publisher","first-page":"904","DOI":"10.1080\/14397595.2020.1829339","article-title":"Pool-based exercise for amelioration of pain in adults with fibromyalgia syndrome: A systematic review and meta-analysis","volume":"31","author":"Galv\u00e3o-Moreira","year":"2021","journal-title":"Mod. Rheumatol."},{"key":"B47","doi-asserted-by":"publisher","first-page":"117","DOI":"10.2147\/PRBM.S178240","article-title":"Psychological impact of fibromyalgia: Current perspectives","volume":"12","author":"Galvez-S\u00e1nchez","year":"2019","journal-title":"Psychol. Res. Behav. Manag."},{"key":"B48","doi-asserted-by":"publisher","first-page":"1219","DOI":"10.3390\/jcm9041219","article-title":"Diagnostic criteria for fibromyalgia: Critical review and future perspectives","volume":"9","author":"Galvez-S\u00e1nchez","year":"2020","journal-title":"J. Clin. Med."},{"key":"B49","doi-asserted-by":"publisher","first-page":"1869","DOI":"10.1007\/s00296-011-1892-0","article-title":"Effects of an exercise programme on self-esteem, self-concept and quality of life in women with fibromyalgia: A randomized controlled trial","volume":"32","author":"Garc\u00eda-Mart\u00ednez","year":"2012","journal-title":"Rheumatol. Int."},{"key":"B50","doi-asserted-by":"publisher","first-page":"630","DOI":"10.1177\/0269215520911992","article-title":"Effectiveness of acupuncture vs. core stability training in balance and functional capacity of women with fibromyalgia: A randomized controlled trial","volume":"34","author":"Garrido-Ardila","year":"2020","journal-title":"Clin. Rehabil."},{"key":"B51","doi-asserted-by":"publisher","first-page":"e90767","DOI":"10.1371\/journal.pone.0090767","article-title":"Strengthening exercises improve symptoms and quality of life but do not change autonomic modulation in fibromyalgia: A randomized clinical trial","volume":"9","author":"Gavi","year":"2014","journal-title":"PLoS One"},{"key":"B52","doi-asserted-by":"publisher","first-page":"474029","DOI":"10.1155\/2014\/474029","article-title":"Medium-\/long-term effects of a specific exercise protocol combined with patient education on spine mobility, chronic fatigue, pain, aerobic fitness and level of disability in fibromyalgia","volume":"2014","author":"Giannotti","year":"2014","journal-title":"Biomed. Res. Int."},{"key":"B53","doi-asserted-by":"publisher","first-page":"613","DOI":"10.1002\/art.20063","article-title":"Evidence of augmented central pain processing in idiopathic chronic low back pain","volume":"50","author":"Giesecke","year":"2004","journal-title":"Arthritis Rheum."},{"key":"B54","doi-asserted-by":"publisher","first-page":"467","DOI":"10.1016\/j.rdc.2022.02.006","article-title":"Fibromyalgia: Recognition and management in the primary care office","volume":"48","author":"Gota","year":"2022","journal-title":"Fibromyalgia."},{"key":"B55","doi-asserted-by":"publisher","first-page":"1285","DOI":"10.1016\/j.spinee.2017.04.025","article-title":"Lumbar muscle structure and function in chronic versus recurrent low back pain: A cross-sectional study","volume":"17","author":"Goubert","year":"2017","journal-title":"Spine J."},{"key":"B56","doi-asserted-by":"publisher","first-page":"519","DOI":"10.1002\/1529-0131(200112)45:6<519:AID-ART377>3.0.CO;2-3","article-title":"Effect of a randomized, controlled trial of exercise on mood and physical function in individuals with fibromyalgia","volume":"45","author":"Gowans","year":"2001","journal-title":"Arthritis Rheum."},{"key":"B57","doi-asserted-by":"publisher","first-page":"185","DOI":"10.3233\/BMR-2008-21306","article-title":"The effect of a 4-week aerobic exercise program on muscle performance in patients with fibromyalgia","volume":"21","author":"G\u00fcnendi","year":"2008","journal-title":"J. Back Musculoskelet. Rehabil."},{"key":"B58","doi-asserted-by":"publisher","first-page":"66","DOI":"10.1002\/art.21718","article-title":"Exercise in waist-high warm water decreases pain and improves health-related quality of life and strength in the lower extremities in women with fibromyalgia","volume":"55","author":"Gusi","year":"2006","journal-title":"Arthritis Rheum."},{"key":"B59","doi-asserted-by":"publisher","first-page":"835","DOI":"10.1177\/0269215506072173","article-title":"Community patient education and exercise for people with fibromyalgia: A parallel group randomized controlled trial","volume":"20","author":"Hammond","year":"2006","journal-title":"Clin. Rehabil."},{"key":"B60","doi-asserted-by":"publisher","first-page":"e046943","DOI":"10.1136\/bmjopen-2020-046943","article-title":"Effects of a mindfulness-based and acceptance-based group programme followed by physical activity for patients with fibromyalgia: A randomised controlled trial","volume":"11","author":"Haugmark","year":"2021","journal-title":"a Open"},{"key":"B61","doi-asserted-by":"crossref","first-page":"15022","DOI":"10.1038\/nrdp.2015.22","article-title":"Fibromyalgia","volume":"1","author":"H\u00e4user","year":"2015","journal-title":"Nat. Rev. Dis. Prim."},{"key":"B62","doi-asserted-by":"publisher","first-page":"2075","DOI":"10.3390\/ijerph18042075","article-title":"Immediate effects of a telerehabilitation program based on aerobic exercise in women with fibromyalgia","volume":"18","author":"Hernando-Garijo","year":"2021","journal-title":"Int. J. Environ. Res. Public Health"},{"key":"B63","volume-title":"Cochrane Handbook for systematic reviews of interventions","author":"Higgins","year":"2020"},{"key":"B64","doi-asserted-by":"publisher","first-page":"557","DOI":"10.1136\/bmj.327.7414.557","article-title":"Measuring inconsistency in meta-analyses","volume":"327","author":"Higgins","year":"2003","journal-title":"BMJ"},{"key":"B65","doi-asserted-by":"publisher","first-page":"51","DOI":"10.1258\/1355819021927674","article-title":"Statistical heterogeneity in systematic reviews of clinical trials: A critical appraisal of guidelines and practice","volume":"7","author":"Higgins","year":"2002","journal-title":"J. Heal. Serv. Res. Policy"},{"key":"B66","doi-asserted-by":"publisher","first-page":"13","DOI":"10.1186\/1471-2288-5-13","article-title":"Estimating the mean and variance from the median, range, and the size of a sample","volume":"5","author":"Hozo","year":"2005","journal-title":"BMC Med. Res. Methodol."},{"key":"B67","doi-asserted-by":"publisher","first-page":"3634","DOI":"10.3390\/ijerph17103634","article-title":"Low-intensity physical exercise improves pain catastrophizing and other psychological and physical aspects in women with fibromyalgia: A randomized controlled trial","volume":"17","author":"Izquierdo-Alventosa","year":"2020","journal-title":"Int. J. Environ. Res. Public Health"},{"key":"B68","doi-asserted-by":"publisher","first-page":"pzab159","DOI":"10.1093\/ptj\/pzab159","article-title":"Effectiveness of high-frequency transcranial magnetic stimulation and physical exercise in women with fibromyalgia: A randomized controlled trial","volume":"101","author":"Izquierdo-Alventosa","year":"2021","journal-title":"Phys. Ther."},{"key":"B69","doi-asserted-by":"publisher","first-page":"1205","DOI":"10.1007\/s10067-012-1996-2","article-title":"A randomized controlled trial of 8-form Tai chi improves symptoms and functional mobility in fibromyalgia patients","volume":"31","author":"Jones","year":"2012","journal-title":"Clin. Rheumatol."},{"key":"B70","doi-asserted-by":"publisher","first-page":"1049","DOI":"10.1016\/j.jpain.2018.04.003","article-title":"Pilot randomized trial of integrated cognitive-behavioral therapy and neuromuscular training for juvenile fibromyalgia: The FIT teens program","volume":"19","author":"Kashikar-Zuck","year":"2018","journal-title":"J. Pain"},{"key":"B71","doi-asserted-by":"publisher","first-page":"2285","DOI":"10.1007\/s00296-011-1958-z","article-title":"Effectiveness of physical activity in reducing pain in patients with fibromyalgia: A blinded randomized clinical trial","volume":"32","author":"Kayo","year":"2012","journal-title":"Rheumatol. Int."},{"key":"B72","doi-asserted-by":"publisher","first-page":"CD013419","DOI":"10.1002\/14651858.CD013419","article-title":"Flexibility exercise training for adults with fibromyalgia","volume":"9","author":"Kim","year":"2019","journal-title":"Cochrane Database Syst. Rev."},{"key":"B73","first-page":"2620","article-title":"The effects of exercise and education, individually or combined, in women with fibromyalgia","volume":"29","author":"King","year":"2002","journal-title":"J. Rheumatol."},{"key":"B74","doi-asserted-by":"publisher","first-page":"1713","DOI":"10.1016\/j.apmr.2005.04.014","article-title":"The effects of a 12-week strength-training program on strength and functionality in women with fibromyalgia","volume":"86","author":"Kingsley","year":"2005","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"B75","doi-asserted-by":"publisher","first-page":"162","DOI":"10.5606\/ArchRheumatol.2016.5751","article-title":"Which non-pharmacological treatment is more effective on clinical parameters in patients with fibromyalgia: Balneotherapy or aerobic exercise?","volume":"31","author":"Kurt","year":"2016","journal-title":"Arch. Rheumatol."},{"key":"B76","doi-asserted-by":"publisher","first-page":"161","DOI":"10.1186\/s13075-015-0679-1","article-title":"Resistance exercise improves muscle strength, health status and pain intensity in fibromyalgia\u2014A randomized controlled trial","volume":"17","author":"Larsson","year":"2015","journal-title":"Arthritis Res. Ther."},{"key":"B77","doi-asserted-by":"publisher","first-page":"943","DOI":"10.3109\/14397595.2015.1040614","article-title":"Effects of functional training on pain, leg strength, and balance in women with fibromyalgia","volume":"25","author":"Latorre Rom\u00e1n","year":"2015","journal-title":"Mod. Rheumatol."},{"key":"B78","doi-asserted-by":"publisher","first-page":"2915","DOI":"10.2147\/JPR.S210653","article-title":"Impact of daily yoga-based exercise on pain, catastrophizing, and sleep amongst individuals with fibromyalgia","volume":"12","author":"Lazaridou","year":"2019","journal-title":"J. Pain Res."},{"key":"B79","doi-asserted-by":"publisher","first-page":"920","DOI":"10.1016\/j.jclinepi.2009.10.005","article-title":"There was evidence of convergent and construct validity of Physiotherapy Evidence Database quality scale for physiotherapy trials","volume":"63","author":"Macedo","year":"2010","journal-title":"J. Clin. Epidemiol."},{"key":"B80","doi-asserted-by":"publisher","first-page":"318","DOI":"10.1136\/annrheumdis-2016-209724","article-title":"EULAR revised recommendations for the management of fibromyalgia","volume":"76","author":"Macfarlane","year":"2017","journal-title":"Ann. Rheum. Dis."},{"key":"B81","doi-asserted-by":"publisher","first-page":"109","DOI":"10.1016\/j.ctcp.2016.05.010","article-title":"Efficacy of rehabilitation with tai ji quan in an Italian cohort of patients with fibromyalgia syndrome","volume":"24","author":"Maddali Bongi","year":"2016","journal-title":"Complement. Ther. Clin. Pract."},{"key":"B82","doi-asserted-by":"publisher","first-page":"751","DOI":"10.2340\/16501977-0409","article-title":"Pool exercise for patients with fibromyalgia or chronic widespread pain: A randomized controlled trial and subgroup analyses","volume":"41","author":"Mannerkorpi","year":"2009","journal-title":"J. Rehabil. Med."},{"key":"B83","first-page":"2473","article-title":"Pool exercise combined with an education program for patients with fibromyalgia syndrome. A prospective, randomized study","volume":"27","author":"Mannerkorpi","year":"2000","journal-title":"J. Rheumatol."},{"key":"B84","doi-asserted-by":"publisher","first-page":"618","DOI":"10.1111\/ijcp.12365","article-title":"Impact of interdisciplinary treatment on physical and psychosocial parameters in patients with fibromyalgia: Results of a randomised trial","volume":"68","author":"Mart\u00edn","year":"2014","journal-title":"Int. J. Clin. Pract."},{"key":"B85","doi-asserted-by":"publisher","first-page":"481","DOI":"10.1093\/pm\/pnaa331","article-title":"Intervention therapies to reduce pain-related fear in fibromyalgia syndrome: A systematic review of randomized clinical trials","volume":"22","author":"Martinez-Calderon","year":"2021","journal-title":"Pain Med."},{"key":"B86","doi-asserted-by":"publisher","first-page":"82","DOI":"10.1186\/2046-4053-3-82","article-title":"A checklist designed to aid consistency and reproducibility of GRADE assessments: Development and pilot validation","volume":"3","author":"Meader","year":"2014","journal-title":"Syst. Rev."},{"key":"B87","doi-asserted-by":"publisher","first-page":"821","DOI":"10.1002\/acr.20449","article-title":"Estimation of minimum clinically important difference for pain in fibromyalgia","volume":"63","author":"Mease","year":"2011","journal-title":"Arthritis Care Res. Hob."},{"key":"B88","first-page":"823","article-title":"Exercise in warm water decreases pain and improves cognitive function in middle-aged women with fibromyalgia","volume":"25","author":"Mungu\u00eda-Izquierdo","year":"2007","journal-title":"Clin. Exp. Rheumatol."},{"key":"B89","doi-asserted-by":"publisher","first-page":"101577","DOI":"10.1016\/j.ctcp.2022.101577","article-title":"Creative versus repetitive dance therapies to reduce the impact of fibromyalgia and pain: A systematic review and meta-analysis","volume":"47","author":"Murillo-Garcia","year":"2022","journal-title":"Complement. Ther. Clin. Pract."},{"key":"B90","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/S13075-014-0425-0\/METRICS","article-title":"What has functional connectivity and chemical neuroimaging in fibromyalgia taught us about the mechanisms and management of \u201ccentralized\u201d pain?","volume":"16","author":"Napadow","year":"2014","journal-title":"Arthritis Res. Ther."},{"key":"B91","doi-asserted-by":"publisher","first-page":"955","DOI":"10.1136\/annrheumdis-2011-201249","article-title":"Comparative efficacy of pharmacological and non-pharmacological interventions in fibromyalgia syndrome: Network meta-analysis","volume":"72","author":"N\u00fcesch","year":"2013","journal-title":"Ann. Rheum. Dis."},{"key":"B92","doi-asserted-by":"publisher","first-page":"381","DOI":"10.1007\/s10067-010-1677-y","article-title":"Health-related quality of life in patients with chronic fatigue syndrome: Group cognitive behavioural therapy and graded exercise versus usual treatment. A randomised controlled trial with 1 year of follow-up","volume":"30","author":"N\u00fa\u00f1ez","year":"2011","journal-title":"Clin. Rheumatol."},{"key":"B93","doi-asserted-by":"publisher","first-page":"127","DOI":"10.3390\/diagnostics11010127","article-title":"Alteration of postural balance in patients with fibromyalgia syndrome\u2014A systematic review and meta-analysis","volume":"11","author":"N\u00fa\u00f1ez-Fuentes","year":"2021","journal-title":"Diagnostics"},{"key":"B94","doi-asserted-by":"publisher","first-page":"819","DOI":"10.1016\/j.jpain.2018.01.010","article-title":"Defective endogenous pain modulation in fibromyalgia: A meta-analysis of temporal summation and conditioned pain modulation paradigms","volume":"19","author":"O\u2019Brien","year":"2018","journal-title":"J. Pain"},{"key":"B95","doi-asserted-by":"publisher","first-page":"125","DOI":"10.1097\/j.pain.0000000000002319","article-title":"Central pain modulatory mechanisms of attentional analgesia are preserved in fibromyalgia","volume":"163","author":"Oliva","year":"2022","journal-title":"Pain"},{"key":"B96","doi-asserted-by":"publisher","first-page":"n71","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 statement: An updated guideline for reporting systematic reviews","volume":"372","author":"Page","year":"2021","journal-title":"BMJ"},{"key":"B97","doi-asserted-by":"publisher","first-page":"3160","DOI":"10.3390\/ijerph17093160","article-title":"Impaired balance in patients with fibromyalgia syndrome: Predictors of the impact of this disorder and balance confidence","volume":"17","author":"Peinado-Rubia","year":"2020","journal-title":"Int. J. Environ. Res. Public Health"},{"key":"B98","doi-asserted-by":"publisher","first-page":"356","DOI":"10.1007\/s11916-013-0356-5","article-title":"Worldwide epidemiology of fibromyalgia","volume":"17","author":"Queiroz","year":"2013","journal-title":"Curr. Pain Headache Rep."},{"key":"B99","doi-asserted-by":"publisher","first-page":"184","DOI":"10.1002\/art.20252","article-title":"Long-term efficacy of therapy in patients with fibromyalgia: A physical exercise-based program and a cognitive-behavioral approach","volume":"51","author":"Redondo","year":"2004","journal-title":"Arthritis Care Res. Hob."},{"key":"B100","doi-asserted-by":"publisher","first-page":"185","DOI":"10.1136\/bmj.325.7357.185","article-title":"Prescribed exercise in people with fibromyalgia: Parallel group randomised controlled trial","volume":"325","author":"Richards","year":"2002","journal-title":"BMJ"},{"key":"B101","doi-asserted-by":"publisher","first-page":"e574","DOI":"10.1097\/RHU.0000000000001758","article-title":"Impact of fibromyalgia syndrome on female sexual function","volume":"28","author":"Ricoy-Cano","year":"2021","journal-title":"JCR J. Clin. Rheumatol."},{"key":"B102","doi-asserted-by":"publisher","first-page":"2192","DOI":"10.1001\/archinte.167.20.2192","article-title":"Group exercise, education, and combination self-management in women with fibromyalgia. A randomized trial","volume":"167","author":"Rooks","year":"2007","journal-title":"Arch. Intern. Med."},{"key":"B103","volume-title":"Modern epidemiology","author":"Rothman","year":"2008"},{"key":"B104","doi-asserted-by":"publisher","first-page":"13","DOI":"10.1002\/jrsm.1410","article-title":"Beyond the forest plot: The drapery plot","volume":"12","author":"R\u00fccker","year":"2020","journal-title":"Res. Synth. Methods."},{"key":"B105","first-page":"620","article-title":"Depression and anxiety disorders: Benefits of exercise, yoga, and meditation","volume":"99","author":"Saeed","year":"2019","journal-title":"Am. Fam. Physician"},{"key":"B106","first-page":"S41","article-title":"Vagal modulation and symptomatology following a 6-month aerobic exercise program for women with fibromyalgia","volume":"33","author":"Sa\u00f1udo","year":"2015","journal-title":"Clin. Exp. Rheumatol."},{"key":"B107","doi-asserted-by":"publisher","first-page":"521","DOI":"10.2340\/16501977-0814","article-title":"Effects of a prolonged exercise program on key health outcomes in women with fibromyalgia: A randomized controlled trial","volume":"43","author":"Sa\u00f1udo","year":"2011","journal-title":"J. Rehabil. Med."},{"key":"B108","doi-asserted-by":"publisher","first-page":"244","DOI":"10.1016\/j.rh.2009.11.008","article-title":"Respuesta aut\u00f3noma e influencia sobre la calidad de vida de mujeres con fibromialgia tras una intervenci\u00f3n de ejercicio f\u00edsico a largo plazo","volume":"44","author":"Sa\u00f1udo Corrales","year":"2010","journal-title":"Rehabilitaci\u00f3n"},{"key":"B109","doi-asserted-by":"publisher","first-page":"394","DOI":"10.1111\/1756-185X.14293","article-title":"Efficacy of adding pain neuroscience education to a multimodal treatment in fibromyalgia: A systematic review and meta\u2010analysis","volume":"25","author":"Saracoglu","year":"2022","journal-title":"Int. J. Rheum. Dis."},{"key":"B110","doi-asserted-by":"publisher","first-page":"645","DOI":"10.1038\/s41584-020-00506-w","article-title":"Fibromyalgia: An update on clinical characteristics, aetiopathogenesis and treatment","volume":"16","author":"Sarzi-Puttini","year":"2020","journal-title":"Nat. Rev. Rheumatol."},{"key":"B111","doi-asserted-by":"publisher","first-page":"2150132720965071","DOI":"10.1177\/2150132720965071","article-title":"Effects of a physical exercise program on patients affected with fibromyalgia","volume":"11","author":"Sauch Valma\u00f1a","year":"2020","journal-title":"J. Prim. Care Community Health"},{"key":"B112","doi-asserted-by":"publisher","first-page":"340","DOI":"10.1093\/ptj\/83.4.340","article-title":"Effects of short versus long bouts of aerobic exercise in sedentary women with fibromyalgia: A randomized controlled trial","volume":"83","author":"Schachter","year":"2003","journal-title":"Phys. Ther."},{"key":"B113","doi-asserted-by":"publisher","first-page":"71","DOI":"10.1186\/1477-7525-9-71","article-title":"The comparative burden of mild, moderate and severe fibromyalgia: Results from a cross-sectional survey in the United States","volume":"9","author":"Schaefer","year":"2011","journal-title":"Health Qual. Life Outcomes"},{"key":"B114","doi-asserted-by":"publisher","first-page":"22","DOI":"10.3390\/biomedicines5020022","article-title":"New insights into the pathophysiology and treatment of fibromyalgia","volume":"5","author":"Schmidt-Wilcke","year":"2017","journal-title":"Biomedicines"},{"key":"B115","doi-asserted-by":"publisher","first-page":"57","DOI":"10.3233\/bmr-2004-17204","article-title":"A study to compare the therapeutic efficacy of aerobic exercise and paroxetine in fibromyalgia syndrome","volume":"17","author":"Sencan","year":"2004","journal-title":"J. Back Musculoskelet. Rehabil."},{"key":"B116","doi-asserted-by":"publisher","first-page":"104188","DOI":"10.1016\/j.brat.2022.104188","article-title":"Effectiveness of two video-based multicomponent treatments for fibromyalgia: The added value of cognitive restructuring and mindfulness in a three-arm randomised controlled trial","volume":"158","author":"Serrat","year":"2022","journal-title":"Behav. Res. Ther."},{"key":"B117","doi-asserted-by":"publisher","first-page":"3348","DOI":"10.3390\/jcm9103348","article-title":"Effectiveness of a multicomponent treatment for fibromyalgia based on pain neuroscience education, exercise therapy, psychological support, and nature exposure (NAT-FM): A pragmatic randomized controlled trial","volume":"9","author":"Serrat","year":"2020","journal-title":"J. Clin. Med."},{"key":"B118","doi-asserted-by":"publisher","first-page":"10300","DOI":"10.3390\/ijerph181910300","article-title":"Efficacy of the fibrowalk multicomponent program moved to a virtual setting for patients with fibromyalgia during the COVID-19 pandemic: A proof-of-concept rct performed alongside the state of alarm in Spain","volume":"18","author":"Serrat","year":"","journal-title":"Int. J. Environ. Res. Public Health"},{"key":"B119","doi-asserted-by":"publisher","first-page":"pzab200","DOI":"10.1093\/ptj\/pzab200","article-title":"Effectiveness of a multicomponent treatment based on pain neuroscience education, therapeutic exercise, cognitive behavioral therapy, and mindfulness in patients with fibromyalgia (fibrowalk study): A randomized controlled trial","volume":"101","author":"Serrat","year":"","journal-title":"Phys. Ther."},{"key":"B120","doi-asserted-by":"publisher","first-page":"382","DOI":"10.1016\/j.jbmt.2018.02.005","article-title":"Sophrology versus resistance training for treatment of women with fibromyalgia: A randomized controlled trial","volume":"23","author":"Silva","year":"2019","journal-title":"J. Bodyw. Mov. Ther."},{"key":"B121","doi-asserted-by":"publisher","first-page":"457","DOI":"10.1007\/s40273-014-0137-y","article-title":"Fibromyalgia: Disease synopsis, medication cost effectiveness and economic burden","volume":"32","author":"Skaer","year":"2014","journal-title":"Pharmacoeconomics"},{"key":"B122","doi-asserted-by":"publisher","first-page":"2356346","DOI":"10.1155\/2017\/2356346","article-title":"Effectiveness of therapeutic exercise in fibromyalgia syndrome: A systematic review and meta-analysis of randomized clinical trials","volume":"2017","author":"Sosa-Reina","year":"2017","journal-title":"Biomed. Res. Int."},{"key":"B123","doi-asserted-by":"publisher","first-page":"177","DOI":"10.1016\/j.pain.2007.03.015","article-title":"Spatial summation of mechanically evoked muscle pain and painful aftersensations in normal subjects and fibromyalgia patients","volume":"130","author":"Staud","year":"2007","journal-title":"Pain"},{"key":"B124","doi-asserted-by":"publisher","first-page":"1046","DOI":"10.1016\/S0895-4356(01)00377-8","article-title":"Funnel plots for detecting bias in meta-analysis: Guidelines on choice of axis","volume":"54","author":"Sterne","year":"2001","journal-title":"J. Clin. Epidemiol."},{"key":"B125","doi-asserted-by":"publisher","first-page":"113","DOI":"10.1186\/s12891-022-05047-9","article-title":"Does aerobic exercise effect pain sensitisation in individuals with musculoskeletal pain? A systematic review","volume":"23","author":"Tan","year":"2022","journal-title":"BMC Musculoskelet. Disord."},{"key":"B126","doi-asserted-by":"publisher","first-page":"1119","DOI":"10.55563\/clinexprheumatol\/0v55nh","article-title":"Effects of respiratory muscle training on respiratory efficiency and health-related quality of life in sedentary women with fibromyalgia: A randomised controlled trial","volume":"40","author":"Tomas-Carus","year":"2021","journal-title":"Clin. Exp. Rheumatol."},{"key":"B127","doi-asserted-by":"publisher","first-page":"825","DOI":"10.1089\/acm.2017.0335","article-title":"Breathing exercises must be a real and effective intervention to consider in women with fibromyalgia: A pilot randomized controlled trial","volume":"24","author":"Tomas-Carus","year":"2018","journal-title":"J. Altern. Complement. Med."},{"key":"B128","doi-asserted-by":"publisher","first-page":"1147","DOI":"10.1093\/rheumatology\/kep208","article-title":"Improvements of muscle strength predicted benefits in HRQOL and postural balance in women with fibromyalgia: An 8-month randomized controlled trial","volume":"48","author":"Tomas-Carus","year":"2009","journal-title":"Rheumatology"},{"key":"B129","doi-asserted-by":"publisher","first-page":"1044","DOI":"10.1249\/01.mss.0b0138059aec4","article-title":"Aquatic training and detraining on fitness and quality of life in fibromyalgia","volume":"39","author":"Tomas-Carus","year":"2007","journal-title":"Med. Sci. Sport. Exerc."},{"key":"B130","doi-asserted-by":"publisher","first-page":"4417","DOI":"10.1007\/s10067-021-05738-z","article-title":"Effects of resistance training on the mental health of patients with fibromyalgia: A systematic review","volume":"40","author":"Vilarino","year":"2021","journal-title":"Clin. Rheumatol."},{"key":"B131","doi-asserted-by":"publisher","first-page":"77","DOI":"10.3109\/03009749609069212","article-title":"Effects of aerobic exercise versus stress management treatment in fibromyalgia. A 4.5 year prospective study","volume":"25","author":"Wigers","year":"1996","journal-title":"Scand. J. Rheumatol."},{"key":"B132","doi-asserted-by":"publisher","first-page":"6","DOI":"10.1016\/j.jpsychores.2016.11.014","article-title":"Heart rate variability biofeedback therapy and graded exercise training in management of chronic fatigue syndrome: An exploratory pilot study","volume":"93","author":"Windthorst","year":"2017","journal-title":"J. Psychosom. Res."},{"key":"B133","doi-asserted-by":"publisher","first-page":"214","DOI":"10.1123\/japa.2017-0038","article-title":"Effectiveness of tai chi on cardiac autonomic function and symptomatology in women with fibromyalgia: A randomized controlled trial","volume":"26","author":"Wong","year":"2018","journal-title":"J. Aging Phys. Act."},{"key":"B134","doi-asserted-by":"publisher","first-page":"539","DOI":"10.1093\/rheumatology\/keh537","article-title":"Spa treatment for primary fibromyalgia syndrome: A combination of thalassotherapy, exercise and patient education improves symptoms and quality of life","volume":"44","author":"Zijlstra","year":"2005","journal-title":"Rheumatology"}],"container-title":["Frontiers in Physiology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fphys.2023.1170621\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,4,12]],"date-time":"2023-04-12T05:55:20Z","timestamp":1681278920000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fphys.2023.1170621\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,4,12]]},"references-count":134,"alternative-id":["10.3389\/fphys.2023.1170621"],"URL":"https:\/\/doi.org\/10.3389\/fphys.2023.1170621","relation":{},"ISSN":["1664-042X"],"issn-type":[{"value":"1664-042X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,4,12]]},"article-number":"1170621"}}