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Bidonde J, Busch AJ, Schachter CL, et al. Aerobic exercise training for adults with fibromyalgia. Cochrane Database Syst Rev. 2017;6:CD012700. PMID 28636204

One-paragraph summary

Cochrane review of 13 RCTs (839 adults with fibromyalgia) of aerobic exercise training (submaximal, prolonged, 6–24 weeks) versus no-exercise control, other aerobic interventions, or non-exercise comparators — one review in the series that replaced the original 2002 "Exercise for treating fibromyalgia" review. Against control (8 trials, 456 participants), aerobic exercise improved health-related quality of life by MD −7.89 (95% CI −13.23 to −2.55) on a 0–100 scale (moderate quality), pain intensity by −11.06 (−18.34 to −3.77), physical function by −10.16 (−15.39 to −4.94), and stiffness by −7.96, with no clear effect on fatigue (−6.48, CI crossing zero) (low quality). HRQoL, function, and pain changes met the review's 15% relative-improvement threshold for clinical relevance. All-cause withdrawal was similar between arms (RR 1.25, 95% CI 0.89–1.77; ~20% vs 17%), and in three trials with 24–208 weeks of follow-up, pain and function benefits persisted while HRQoL and fatigue benefits did not.

Key findings

  • Pain: absolute improvement 11% (95% CI 4–18%), relative improvement 18% — comparable in magnitude to drug–placebo differences for approved drugs, without drug harms.
  • HRQoL (moderate quality) and physical function improvements are clinically relevant by the review's own threshold.
  • Tolerability: withdrawals no higher than control; adverse-event data sparse but no signal of harm.
  • Comparative questions (aerobic vs other exercise types, vs education, vs medication) rest on single small trials — low/very low certainty.

Limitations

  • Self-reported outcomes in unblindable interventions — performance/detection bias is intrinsic.
  • Small trials (total n=839 across 13 RCTs); dose, intensity, and supervision vary; adherence beyond the supervised period rarely tracked.
  • Adverse events poorly measured across the exercise literature.

Why it matters

This is the quantitative backbone of the single point on which all fibromyalgia guidelines agree: exercise first. EULAR's only "strong for" grade, the German S3 strong recommendation for endurance training, and NICE NG193's exercise-forward stance all trace to this evidence family. It also frames the field's implementation problem: the anchor therapy's effect is real but modest, benefits decay where supervision ends, and trials say little about maintaining the dose in real-world care.

Cited by wiki pages

  • non-pharmacologic-therapy
  • guidelines