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Efficacy of different types of aerobic exercise in fibromyalgia syndrome: a systematic review and meta-analysis of randomised controlled trials

Winfried Häuser12*, Petra Klose3, Jost Langhorst3, Babak Moradi4, Mario Steinbach4, Marcus Schiltenwolf4 and Angela Busch5

Author Affiliations

1 Department of Internal Medicine I, Klinikum Saarbrücken, Winterberg 1, D-66119 Saarbrücken, Germany

2 Department of Psychosomatic Medicine, Technische Universität München, Langestr. 3, D-81675 München, Germany

3 Department of Internal Medicine V (Integrative Medicine), University of Duisburg-Essen, Kliniken Essen-Mitte, Am Deimelsberg 34a, D-45276 Essen, Germany

4 Orthopaedic Clinic, University of Heidelberg, Schlierbacher Landstraße 200, D-69118 Heidelberg, Germany

5 School of Physical Therapy, University of Saskatchewan, Saskatoon, 1121 College Drive, Saskatoon SK S7N OW3, Canada

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Arthritis Research & Therapy 2010, 12:R79  doi:10.1186/ar3002

Published: 10 May 2010



The efficacy and the optimal type and volume of aerobic exercise (AE) in fibromyalgia syndrome (FMS) are not established. We therefore assessed the efficacy of different types and volumes of AE in FMS.


The Cochrane Library, EMBASE, MEDLINE, PsychInfo and SPORTDISCUS (through April 2009) and the reference sections of original studies and systematic reviews on AE in FMS were systematically reviewed. Randomised controlled trials (RCTs) of AE compared with controls (treatment as usual, attention placebo, active therapy) and head-to-head comparisons of different types of AE were included. Two authors independently extracted articles using predefined data fields, including study quality indicators.


Twenty-eight RCTs comparing AE with controls and seven RCTs comparing different types of AE with a total of 2,494 patients were reviewed. Effects were summarised using standardised mean differences (95% confidence intervals) by random effect models. AE reduced pain (-0.31 (-0.46, -0.17); P < 0.001), fatigue (-0.22 (-0.38, -0.05); P = 0.009), depressed mood (-0.32 (-0.53, -0.12); P = 0.002) and limitations of health-related quality of life (HRQOL) (-0.40 (-0.60, -0.20); P < 0.001), and improved physical fitness (0.65 (0.38, 0.95); P < 0.001), post treatment. Pain was significantly reduced post treatment by land-based and water-based AE, exercises with slight to moderate intensity and frequency of two or three times per week. Positive effects on depressed mood, HRQOL and physical fitness could be maintained at follow-up. Continuing exercise was associated with positive outcomes at follow-up. Risks of bias analyses did not change the robustness of the results. Few studies reported a detailed exercise protocol, thus limiting subgroup analyses of different types of exercise.


An aerobic exercise programme for FMS patients should consist of land-based or water-based exercises with slight to moderate intensity two or three times per week for at least 4 weeks. The patient should be motivated to continue exercise after participating in an exercise programme.