Effects of rehabilitative exercise on quality of life in patients with fibromyalgia. Clinical trials review

doi: 10.56294/ri202223

SYSTEMATIC REVIEWS

Effects of rehabilitative exercise on quality of life in patients with fibromyalgia. Clinical trials review

Efectos del ejercicio de rehabilitación sobre la calidad de vida en pacientes con fibromialgia. Revisión de ensayos clínicos

Leandro Mendoza Rivas¹ *, Ismael Lázaro Armenta Alcocer¹

¹Universidad de Salamanca, Facultad De Enfermería y Fisioterapia. Salamanca, España.

Cite as: Mendoza Rivas L, Armenta Alcocer IL. Efectos del ejercicio de rehabilitación sobre la calidad de vida en pacientes con fibromialgia. Revisión de ensayos clínicos. Interdisciplinary Rehabilitation / Rehabilitación Interdisciplinaria. 2022;2:23. https://doi.org/10.56294/ri202223

Submitted: 01-09-2022 Revised: 29-10-2022 Accepted: 03-12-2022 Published: 04-12-2022

Editor: Prof. Dr. Carlos Oscar Lepez

ABSTRACT

Introduction: Fibromyalgia is a chronic disease characterized by widespread pain, fatigue and sleep disorders. Although there is no cure, multidisciplinary treatment, including lifestyle changes, cognitive-behavioral therapy and medications, can help control symptoms and improve quality of life.

Methods: a systematic review of clinical studies investigating the effectiveness of exercise in patients with fibromyalgia was conducted during the period from 2017 to 2021. A total of 29 relevant scientific articles that met the established inclusion criteria and filters were identified and evaluated.

Results: studies have shown that various physical activity interventions can have a positive impact on symptoms and quality of life in fibromyalgia patients, although efficacy may vary by modality. Obesity may moderate the benefits of treatment, and it is suggested that staying active may be an effective strategy in the management of fibromyalgia.

Conclusions: the most effective interventions were low-intensity physical exercise programs, such as resistance and coordination training; muscle stretching exercises and resistance training; core strengthening exercises and stretching exercises; and Tai Chi.

Keywords: Fibromyalgia; Exercise Therapy; Muscle Stretching Exercises.

RESUMEN

Introducción: la fibromialgia es una enfermedad crónica caracterizada por dolor generalizado, fatiga y trastornos del sueño. Aunque no existe cura, el tratamiento multidisciplinar, que incluye cambios en el estilo de vida, terapia cognitivo-conductual y medicamentos, puede ayudar a controlar los síntomas y mejorar la calidad de vida.

Métodos: se realizó una revisión sistemática de los estudios clínicos que investigaron la eficacia del ejercicio en pacientes con fibromialgia durante el período comprendido entre 2017 y 2021. Se identificaron y evaluaron un total de 29 artículos científicos relevantes que cumplieron con los criterios de inclusión y filtros establecidos.

Resultados: los estudios han demostrado que diversas intervenciones de actividad física pueden tener un impacto positivo en los síntomas y la calidad de vida de los pacientes con fibromialgia, aunque la eficacia puede variar según la modalidad. La obesidad puede moderar los beneficios del tratamiento, y se sugiere que mantenerse activo puede ser una estrategia eficaz en el tratamiento de la fibromialgia.

Conclusiones: las intervenciones más eficaces fueron los programas de ejercicio físico de baja intensidad, como entrenamiento de resistencia y coordinación; ejercicios de estiramiento muscular y entrenamiento de resistencia; ejercicios de fortalecimiento del core y ejercicios de estiramiento; y Tai Chi.

Palabras clave: Fibromialgia; Terapia De Ejercicio; Ejercicios De Estiramiento Muscular.

INTRODUCTION

Fibromyalgia is a chronic disease characterized by widespread pain throughout the body, soft tissue tenderness, persistent fatigue and sleep disturbances. Although the exact cause of fibromyalgia is unknown, it is believed that it may be the result of a combination of factors, such as genetic predisposition, chemical imbalances in the brain, and environmental factors or emotional triggers.^(1,2)

One of the hallmarks of fibromyalgia is the presence of tender points in certain areas of the body, known as trigger points, which can cause intense pain when pressure is applied to them. In addition to widespread pain, symptoms of fibromyalgia can include muscle stiffness, difficulty concentrating, memory problems, depression, anxiety and mood disorders.^(3,4)

Fibromyalgia primarily affects middle-aged women, although it can also affect men and people of all ages, including adolescents and children. Symptoms can vary from person to person and can fluctuate in intensity over time. The disease can be debilitating and have a significant impact on patients' quality of life, limiting their ability to perform daily activities and participate in social activities.⁽⁵⁾

Diagnosing fibromyalgia can be complicated, as there are no specific laboratory tests or medical imaging to confirm its presence. Instead, physicians rely on symptoms and perform a physical examination to evaluate the presence of tender points in the body. Additional tests may also be performed to rule out other medical conditions that may be causing the symptoms.

Management of fibromyalgia is based on a multidisciplinary approach that combines different treatment strategies. This may include lifestyle changes, such as adopting a healthy diet, incorporating regular physical activity, and practicing relaxation and stress management techniques. In addition, medications, such as painkillers, antidepressants and muscle relaxants, may be prescribed to help control symptoms.^(1,6)

Patient education and cognitive behavioral therapy are also important components of fibromyalgia management. These interventions can help patients understand their disease, learn pain self-regulation techniques, and develop skills to manage stress and improve quality of life.^(6,7)

While there is no cure for fibromyalgia, many people with the disease can find relief and improve their quality of life through the right combination of treatments and management strategies. Continued research on fibromyalgia is critical to improve understanding of the disease and to develop better treatment options in the future.^(8,9,10)

In this context, several randomized controlled clinical trials have been conducted to evaluate the effectiveness of different therapeutic approaches in patients with fibromyalgia. These studies have investigated everything from low-intensity physical exercise programs, muscle stretching and resistance exercises, to cognitive-behavioral interventions and water-based physical therapy, among others.

The results of these studies have yielded promising findings. For example, it has been observed that physical exercise programs, whether in the form of resistance training, core strengthening exercises or physical activity in daily life, can improve physical fitness, reduce pain intensity and improve patients' quality of life. In addition, it has been shown that certain combined interventions, such as cognitive-behavioral therapy integrated with neuromuscular training, can be beneficial for adolescents with fibromyalgia.

However, factors that may influence treatment outcomes have also been identified. For example, obesity has been associated with less improvement in fibromyalgia symptoms in response to motivational interviewing-based therapy. In addition, it has been observed that different therapeutic approaches may have varying effects on different aspects of the disease, such as physical function, depression and pain perception.

In that sense the question arises: what is the effect of different physical exercise interventions in patients with fibromyalgia?

Fibromyalgia is a chronic and complex disease that affects many people worldwide. Despite numerous studies, there is still a need for continued research to better understand how physical exercise can impact the symptoms and quality of life of fibromyalgia patients.

The present study would provide valuable information on the effectiveness of different physical exercise interventions. By comparing and analyzing the results of these studies, the most effective interventions for reducing pain, improving physical function and quality of life in patients with fibromyalgia could be identified.

METHODS

A systematic review was conducted following the PRISMA workflow.⁽¹¹⁾ Scientific articles of clinical studies on the effectiveness of exercise in patients diagnosed with fibromyalgia were included. The study period ranged from 2017 to 2021.

The search was performed in the PubMed database. The search expression was constructed using the following MeSH terms: ((Fibromyalgia) AND (Exercise Therapy OR Muscle Stretching Exercises)). The following filters were applied: years 2017-2021, full-text available, clinical trial, English and Spanish language. Duplicate articles and those that did not fit the research topic were removed.

A total of 1027 articles were identified with the search expression, and the filters were applied. Twenty-nine articles were evaluated (figure 1).

RESULTS AND DISCUSSION

Figure 1. Flowchart for the review of the state of the art according to PRISMA methodology

Table 1. Main characteristics of the included studies
No	Author (Year)	Country	Type of study	Treatment/ Intervention	Sample	Main outcomes
1	Izquierdo-Alventosa et al.⁽¹²⁾, 2020	Spain	Randomized controlled trial	Low-intensity physical exercise program (resistance and coordination training)	Women with fibromyalgia	Significant improvement in psychological variables, pain perception, quality of life and physical condition in women with fibromyalgia
2	Assumpção et al.⁽¹³⁾, 2018	Brazil	Randomized controlled trial	Muscle stretching and resistance training exercises	Women with fibromyalgia	Improvement in quality of life and fibromyalgia symptoms with both types of exercise. Muscle stretching exercise was more effective in improving physical function and resistance exercise in reducing depression
3	Park et al.⁽¹⁴⁾, 2021	Republic of Korea	Randomized controlled trial	Core muscle strengthening exercise and stretching exercises	Middle-aged women with fibromyalgia	Both types of exercise improved fibromyalgia symptoms, but there was no significant difference between them. The core muscle strengthening exercise showed improvements in balance function
4	Wang et al.⁽¹⁵⁾, 2018	United States of America	Randomized controlled trial	Tai Chi vs. aerobic exercise	Adults with fibromyalgia	Tai Chi showed similar or better results than aerobic exercise in improving fibromyalgia symptoms and quality of life. Duration and intensity of Tai Chi influenced the results
5	Andrade et al.⁽¹⁶⁾, 2019	Chile Brazil	Randomized controlled trial	Aquatic training and detraining	Women with fibromyalgia	Aquatic training improved aerobic functional capacity and clinical symptoms in women with fibromyalgia. However, these improvements were not maintained after the detraining period
6	Andersson et al.⁽¹⁷⁾, 2021	Sweden	Randomized crossover pilot study	Resistance exercise with heavy loads and low number of repetitions	Women with fibromyalgia	Exercise with heavy loads was more positive and produced lower lactate levels compared to exercise with light/moderate loads in women with fibromyalgia
7	Bjersing et al.⁽¹⁸⁾, 2017	Sweden	Randomized controlled trial	Strengthening exercises with Swiss ball vs. stretching exercises	Women with fibromyalgia	The Swiss ball exercise group showed a statistically significant improvement in pain, health status, quality of life and muscle strength compared to the stretching group
8	Hernando-Garijo et al. ⁽¹⁹⁾, 2021	Spain	Randomized controlled trial	Telerehabilitation program based on aerobic exercise	Women with fibromyalgia	The aerobic exercise-based telerehabilitation program produced immediate improvements in pain intensity, mechanical pain sensitivity, and psychological distress in women with fibromyalgia during confinement due to pandemic COVID-19
9	Arakaki et al.⁽²⁰⁾, 2021	Brazil	Randomized controlled trial	Strengthening exercises with Swiss ball vs. stretching exercises	Adults with fibromyalgia	Significant improvement in pain, health status, quality of life and muscle strength in the Swiss ball exercise group compared to the stretching group
10	Sauch-Valmaña et al.⁽²¹⁾, 2020	Spain	Randomized controlled trial	Physical activity program	Adults with fibromyalgia	No significant differences were found in the results after a 3-month physical activity program compared to the control group
11	Merriwether et al.⁽²²⁾, 2018	United States of America	Randomized controlled trial	Physical activity in daily life	Women with fibromyalgia	Physical activity was positively related to physical function and fatigue, but no relationship was found with pain in women with fibromyalgia
12	Haugmark et al.⁽²³⁾, 2021	Norway	Randomized controlled trial	Multidisciplinary rehabilitation program (mindfulness and acceptance-based group program followed by physical activity counseling)	Adults with fibromyalgia	No significant differences were found between the multidisciplinary rehabilitation program and treatment as usual in terms of improvement of the patient's overall impression of change and other related outcomes
13	Martínez-Rodríguez et al.⁽²⁴⁾, 2018	Spain	Randomized controlled trial	Physiotherapy treatment combined with a vegetarian-dairy dietary intervention	Women with fibromyalgia	The central stabilization exercise and lacto-vegetarian diet group showed pain reduction and improved body composition compared to the placebo and control groups
14	Ernberg et al.⁽²⁵⁾, 2018	Sweden	Randomized controlled trial	Progressive resistance exercise or relaxation therapy	Women with fibromyalgia	Changes in cytokine levels were found after both types of intervention, but no significant anti-inflammatory effects on fibromyalgia symptoms or on clinical and functional variables were observed
15	Park et al.⁽²⁶⁾, 2021	United States of America	Randomized controlled trial	Various methods of recruitment for an exercise clinical trial	Adults with fibromyalgia	Advertising in local newspapers was the most effective recruitment method, but also the costliest. Community-based strategies recruited a more racially diverse sample
16	Jablochkova et al.⁽²⁷⁾, 2019	Sweden	Randomized controlled trial	Progressive resistance exercise for 15 weeks	Women with fibromyalgia	Unchanged levels of nerve growth factor and high levels of brain-derived neurotrophic factor in plasma after progressive endurance exercise
17	Kashikar-Zuck et al.⁽²⁸⁾, 2018	United States of America	Randomized controlled trial	Integrated cognitive-behavioral therapy and neuromuscular training	Adolescents with fibromyalgia	Participants in the FIT Teens group showed a significant decrease in pain intensity compared to the cognitive-behavioral therapy-only group
18	Black et al.⁽²⁹⁾, 2021	United States of America	Randomized controlled trial	Fibromyalgia Integrated Training Program for Teens (FIT Teens)	Adolescents with fibromyalgia	The FIT Teens group showed improvements in hip strength and movement biomechanics compared to the cognitive-behavioral therapy-only group
19	Kim et al.⁽³⁰⁾, 2017	United States of America	Randomized controlled trial	Exercise-based motivational interviewing therapy	Adults with fibromyalgia	Exercise-based motivational interviewing therapy had sustained benefits on physical function, pain severity, and fibromyalgia symptom severity in nonopioid-using patients
20	Andrade et al.⁽³¹⁾, 2017	Brazil	Randomized controlled trial	Aquatic physical training	Women with fibromyalgia	Aquatic physical training did not produce significant changes in body composition, but increased maximal oxygen consumption during exercise in women with fibromyalgia
21	Mannerkorpi et al.⁽³²⁾, 2017	Sweden	Randomized controlled trial	Aerobic physical exercise	Women with fibromyalgia	Aerobic physical exercise for 15 minutes increased insulin-like growth factor levels in women with fibromyalgia, irrespective of exercise intensity
22	Tran et al.⁽³³⁾, 2017	United States of America	Randomized controlled trial	Cognitive-behavioral therapy and integrated neuromuscular training	Adolescents with fibromyalgia	Adolescents with fibromyalgia who participated in the FIT Teens program showed significant improvements in physical function and reduced fear of movement
23	de Carvalho et al.⁽³⁴⁾, 2021	Brazil	Randomized controlled trial	Wii group (virtual rehab) vs. control group (stretching exercises)	Women with fibromyalgia	The Wii group showed significant improvements in peak torque for dorsiflexion and plantarflexion movement in women with fibromyalgia. Both groups showed a significant decrease in tender point count. There was no significant improvement in static baropodometry.
24	Fussner et al.⁽³⁵⁾, 2019	United States of America	Randomized controlled trial	Cognitive-behavioral therapy (CBT) vs. CBT combined with neuromuscular exercise (FIT Teens)	Adolescents with fibromyalgia	The FIT Teens intervention (CBT combined with neuromuscular exercise) resulted in significant improvements on the Pediatric Pain Interference Scale (PPI) and Functional Disability Inventory (FDI) in adolescents with fibromyalgia
25	Serrat et al.⁽³⁶⁾, 2021	Spain	Randomized controlled trial	FIBROWALK + Standard Treatment Group vs. Standard Treatment alone	Adults with fibromyalgia	The FIBROWALK + Standard Treatment group showed significant improvements in functional disability and several secondary indicators in patients with fibromyalgia
26	Villafaina et al.⁽³⁷⁾, 2020	Spain	Randomized controlled trial	Exergames exercise group vs. control group	Womens with fibromyalgia	The exergames exercise group showed improvements in heart rate variability in women with fibromyalgia, indicating an improvement in autonomic control
27	Kaleth et al. ⁽³⁸⁾, 2018	United States of America	Analysis of secondary data from a clinical trial	Exercise-based Motivational Interviewing (MI) vs. Attention Control (AC) therapy	Adults with fibromyalgia	Obesity moderated the beneficial effects of treatment based on motivational interviewing (MI) therapy in patients with fibromyalgia. Obese patients showed less improvement in symptoms compared to non-obese patients
28	Mingorance et al.⁽³⁹⁾, 2021	Spain	Randomized controlled trial	Vertical vibration platform group vs. rotational vibration platform group vs. control group	Adults with fibromyalgia	Both types of vibration platforms showed benefits in fibromyalgia patients, but the rotational vibration platform was more effective in vibration thresholds and motor function and balance tasks
29	Jones et al.⁽⁴⁰⁾, 2019	United Kingdom	Randomized controlled trial	Remain active advisory group vs. rest advisory group vs. immediate treatment	Adults with fibromyalgia	Advice to remain active resulted in functional improvement at 26 weeks in patients with distal arm pain compared with advice to rest. Immediate physical therapy showed no additional benefit compared with physical therapy after a waiting time

Several studies demonstrated significant improvements in the conditions of fibromyalgia patients through various physical treatment methods. These treatments included low-intensity exercise, stretching and resistance, core strengthening, Tai Chi, aquatic training, heavy weight exercise, Swiss ball exercise, telerehabilitation with aerobic exercise, physical activity programs, integrated physical training and cognitive-behavioral therapy, aquatic physical training, aerobic exercise, and vibration platform training.^{(12,13,14,15,16,17,18,19,20,24,30,31,32,34,36,37,39)}

In contrast, Sauch-Valmaña et al.⁽²¹⁾, Merriwether et al.⁽²²⁾ and Haugmark et al.⁽²³⁾ found no significant differences in outcomes after physical activity programs and a multidisciplinary rehabilitation program. The Ernberg et al.⁽²⁵⁾ study found no significant anti-inflammatory effects on fibromyalgia symptoms or clinical and functional variables after progressive resistance exercise or relaxation therapy.

The Jablochkova et al.⁽²⁷⁾ study also showed unchanged results in nerve growth factor levels and high plasma brain-derived neurotrophic factor levels after progressive resistance exercise.

Studies by Kashikar-Zuck et al.⁽²⁸⁾, Black et al.⁽²⁹⁾, Tran et al.⁽³³⁾, Fussner et al.⁽³⁵⁾, demonstrated significant improvements in pain, physical function, and pain interference in adolescents with fibromyalgia who participated in the FIT Teens program, a program that integrates cognitive-behavioral therapy and neuromuscular training.

Park et al.⁽²⁶⁾, meanwhile, showed that advertising in local newspapers was the most effective, but also the most expensive recruitment method for an exercise clinical trial.

Kaleth et al.⁽³⁸⁾found that obesity moderated the beneficial effects of motivational interviewing-based treatment in fibromyalgia patients, with obese patients showing less improvement in symptoms compared to non-obese patients.

Jones et al.⁽⁴⁰⁾ found that advice to stay active resulted in functional improvement at 26 weeks in patients with distal arm pain compared with advice to rest.

The results show the diversity of physical activity interventions that can have a positive impact on symptoms and quality of life in patients with fibromyalgia. These findings align with existing literature supporting the role of physical activity and exercise in the management of fibromyalgia.⁽⁴⁰⁾

Several studies demonstrated the efficacy of interventions such as resistance and coordination exercises,⁽¹²⁾ stretching and endurance,⁽¹³⁾ core strengthening,⁽²⁶⁾ Tai Chi,⁽¹⁵⁾ and aquatic training.⁽¹⁶⁾

Although physical activity and exercise have a positive effect on fibromyalgia symptoms in general, the type of activity and modality may vary in terms of efficacy. For example, Wang et al.⁽¹⁵⁾ found that Tai Chi provided similar or better results than aerobic exercise in improving fibromyalgia symptoms and quality of life.

Obesity may moderate the beneficial effects of treatment in fibromyalgia patients, suggesting the need to address obesity as a concurrent condition in the management of fibromyalgia.⁽³⁸⁾

Finally, the Jones et al.⁽⁴⁰⁾ suggests that advice to stay active may be an effective strategy in the management of fibromyalgia. This emphasizes the importance of promoting regular physical activity in this population, although the type and intensity of activity may need to be individualized depending on patient characteristics and preferences.

CONCLUSIONS

· Various types of exercise can improve symptoms and quality of life in people with fibromyalgia.

· Tai Chi and aquatic exercise are effective in relieving fibromyalgia symptoms.

· Multidisciplinary rehabilitation programs have similar results to standard treatment in patients with fibromyalgia.

· Interventions combining cognitive-behavioral therapy with neuromuscular training are beneficial for adolescents with fibromyalgia.

· The most effective interventions were low-intensity physical exercise programs, such as resistance and coordination training; muscle stretching exercises and resistance training; core strengthening exercises and stretching exercises; and Tai Chi.

REFERENCES

1. Bair MJ, Krebs EE. Fibromyalgia. Ann Intern Med. 3 de marzo de 2020;172(5):ITC33-48.

2. Maffei ME. Fibromyalgia: Recent Advances in Diagnosis, Classification, Pharmacotherapy and Alternative Remedies. Int J Mol Sci. 23 de octubre de 2020;21(21):7877.

3. Kaltsas G, Tsiveriotis K. Fibromyalgia. En: Feingold KR, Anawalt B, Blackman MR, Boyce A, Chrousos G, Corpas E, et al., editores. Endotext [Internet]. South Dartmouth (MA): MDText.com, Inc.; 2000 [citado 16 de julio de 2023]. Disponible en: http://www.ncbi.nlm.nih.gov/books/NBK279092/

4. Neumeister MW, Neumeister EL. Fibromyalgia. Clin Plast Surg. abril de 2020;47(2):203-13.

5. Tzadok R, Ablin JN. Current and Emerging Pharmacotherapy for Fibromyalgia. Pain Res Manag. 2020;2020:6541798.

6. Clauw DJ. Fibromyalgia: a clinical review. JAMA. 16 de abril de 2014;311(15):1547-55.

7. Borisovskaya A, Chmelik E, Karnik A. Exercise and Chronic Pain. Adv Exp Med Biol. 2020;1228:233-53.

8. Siracusa R, Paola RD, Cuzzocrea S, Impellizzeri D. Fibromyalgia: Pathogenesis, Mechanisms, Diagnosis and Treatment Options Update. Int J Mol Sci. 9 de abril de 2021;22(8):3891.

9. Chinn S, Caldwell W, Gritsenko K. Fibromyalgia Pathogenesis and Treatment Options Update. Curr Pain Headache Rep. abril de 2016;20(4):25.

10. Tomaino L, Serra-Majem L, Martini S, Ingenito MR, Rossi P, La Vecchia C, et al. Fibromyalgia and Nutrition: An Updated Review. J Am Coll Nutr. 2021;40(7):665-78.

11. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. Declaración PRISMA 2020: una guía actualizada para la publicación de revisiones sistemáticas. Revista Española de Cardiología. septiembre de 2021;74(9):790-9.

12. Izquierdo-Alventosa R, Inglés M, Cortés-Amador S, Gimeno-Mallench L, Chirivella-Garrido J, Kropotov J, et al. Low-Intensity Physical Exercise Improves Pain Catastrophizing and Other Psychological and Physical Aspects in Women with Fibromyalgia: A Randomized Controlled Trial. Int J Environ Res Public Health. 21 de mayo de 2020;17(10):3634.

13. Assumpção A, Matsutani LA, Yuan SL, Santo AS, Sauer J, Mango P, et al. Muscle stretching exercises and resistance training in fibromyalgia: which is better? A three-arm randomized controlled trial. Eur J Phys Rehabil Med. octubre de 2018;54(5):663-70.

14. Park HK, Song MK, Kim DJ, Choi IS, Han JY. Comparison of core muscle strengthening exercise and stretching exercise in middle-aged women with fibromyalgia: A randomized, single-blind, controlled study. Medicine (Baltimore). 17 de diciembre de 2021;100(50):e27854.

15. Wang C, Schmid CH, Fielding RA, Harvey WF, Reid KF, Price LL, et al. Effect of tai chi versus aerobic exercise for fibromyalgia: comparative effectiveness randomized controlled trial. BMJ. 21 de marzo de 2018;360:k851.

16. Andrade CP, Zamunér AR, Forti M, Tamburús NY, Silva E. Effects of aquatic training and detraining on women with fibromyalgia: controlled randomized clinical trial. Eur J Phys Rehabil Med. febrero de 2019;55(1):79-88.

17. Andersson UM, Åberg AC, von Koch L, Palstam A. Women with Fibromyalgia Prefer Resistance Exercise with Heavy Loads-A Randomized Crossover Pilot Study. Int J Environ Res Public Health. 10 de junio de 2021;18(12):6276.

18. Bjersing JL, Larsson A, Palstam A, Ernberg M, Bileviciute-Ljungar I, Löfgren M, et al. Benefits of resistance exercise in lean women with fibromyalgia: involvement of IGF-1 and leptin. BMC Musculoskelet Disord. 14 de marzo de 2017;18(1):106.

19. Hernando-Garijo I, Ceballos-Laita L, Mingo-Gómez MT, Medrano-de-la-Fuente R, Estébanez-de-Miguel E, Martínez-Pérez MN, et al. Immediate Effects of a Telerehabilitation Program Based on Aerobic Exercise in Women with Fibromyalgia. Int J Environ Res Public Health. 20 de febrero de 2021;18(4):2075.

20. Arakaki JS, Jennings F, Estrela GQ, Cruz Martinelli VDG, Natour J. Strengthening exercises using swiss ball improve pain, health status, quality of life and muscle strength in patients with fibromyalgia: a randomized controlled trial. Reumatismo. 19 de abril de 2021;73(1):15-23.

21. Sauch Valmaña G, Vidal-Alaball J, Poch PR, Peña JM, Panadés Zafra R, Cantero Gómez FX, et al. Effects of a Physical Exercise Program on Patients Affected with Fibromyalgia. J Prim Care Community Health. 2020;11:2150132720965071.

22. Merriwether EN, Frey-Law LA, Rakel BA, Zimmerman MB, Dailey DL, Vance CGT, et al. Physical activity is related to function and fatigue but not pain in women with fibromyalgia: baseline analyses from the Fibromyalgia Activity Study with TENS (FAST). Arthritis Res Ther. 29 de agosto de 2018;20(1):199.

23. Haugmark T, Hagen KB, Provan SA, Smedslund G, Zangi HA. Effects of a mindfulness-based and acceptance-based group programme followed by physical activity for patients with fibromyalgia: a randomised controlled trial. BMJ Open. 29 de junio de 2021;11(6):e046943.

24. Martínez-Rodríguez A, Leyva-Vela B, Martínez-García A, Nadal-Nicolás Y. [Effects of lacto-vegetarian diet and stabilization core exercises on body composition and pain in women with fibromyalgia: randomized controlled trial]. Nutr Hosp. 1 de marzo de 2018;35(2):392-9.

25. Ernberg M, Christidis N, Ghafouri B, Bileviciute-Ljungar I, Löfgren M, Bjersing J, et al. Plasma Cytokine Levels in Fibromyalgia and Their Response to 15 Weeks of Progressive Resistance Exercise or Relaxation Therapy. Mediators Inflamm. 2018;2018:3985154.

26. Park M, Bannuru RR, Price LL, Harvey WF, Driban JB, Wang C. Effective recruitment strategies in an exercise trial for patients with fibromyalgia. Trials. 21 de agosto de 2021;22(1):557.

27. Jablochkova A, Bäckryd E, Kosek E, Mannerkorpi K, Ernberg M, Gerdle B, et al. Unaltered low nerve growth factor and high brain-derived neurotrophic factor levels in plasma from patients with fibromyalgia after a 15-week progressive resistance exercise. J Rehabil Med. 29 de octubre de 2019;51(10):779-87.

28. Kashikar-Zuck S, Black WR, Pfeiffer M, Peugh J, Williams SE, Ting TV, et al. Pilot Randomized Trial of Integrated Cognitive-Behavioral Therapy and Neuromuscular Training for Juvenile Fibromyalgia: The FIT Teens Program. J Pain. septiembre de 2018;19(9):1049-62.

29. Black WR, DiCesare CA, Thomas S, Pfeiffer M, Williams SE, Kitchen K, et al. Preliminary Evidence for the Fibromyalgia Integrative Training Program (FIT Teens) Improving Strength and Movement Biomechanics in Juvenile Fibromyalgia: Secondary Analysis and Results from a Pilot Randomized Clinical Trial. Clin J Pain. enero de 2021;37(1):51-60.

30. Kim S, Slaven JE, Ang DC. Sustained Benefits of Exercise-based Motivational Interviewing, but Only among Nonusers of Opioids in Patients with Fibromyalgia. J Rheumatol. abril de 2017;44(4):505-11.

31. Andrade CP, Zamunér AR, Forti M, França TF, Tamburús NY, Silva E. Oxygen uptake and body composition after aquatic physical training in women with fibromyalgia: a randomized controlled trial. Eur J Phys Rehabil Med. octubre de 2017;53(5):751-8.

32. Mannerkorpi K, Landin-Wilhelmsen K, Larsson A, Cider Å, Arodell O, Bjersing JL. Acute effects of physical exercise on the serum insulin-like growth factor system in women with fibromyalgia. BMC Musculoskelet Disord. 25 de enero de 2017;18(1):37.

33. Tran ST, Guite JW, Pantaleao A, Pfeiffer M, Myer GD, Sil S, et al. Preliminary Outcomes of a Cross-Site Cognitive-Behavioral and Neuromuscular Integrative Training Intervention for Juvenile Fibromyalgia. Arthritis Care Res (Hoboken). marzo de 2017;69(3):413-20.

34. de Carvalho MS, Carvalho LC, Alves R da S, Menezes F da S, Gomes E da C, Frazin A, et al. Analysis of the Muscular Activity, Peak Torque in the Lower Limbs, and Static Balance after Virtual Rehabilitation in Women with Fibromyalgia: A Randomized Controlled Study. Games Health J. junio de 2021;10(3):190-7.

35. Fussner LM, Black WR, Lynch-Jordan A, Morgan EM, Ting TV, Kashikar-Zuck S. Utility of the PROMIS Pediatric Pain Interference Scale in Juvenile Fibromyalgia. J Pediatr Psychol. 1 de mayo de 2019;44(4):436-41.

36. Serrat M, Coll-Omaña M, Albajes K, Solé S, Almirall M, Luciano JV, et al. 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. Int J Environ Res Public Health. 30 de septiembre de 2021;18(19):10300.

37. Villafaina S, Collado-Mateo D, Domínguez-Muñoz FJ, Gusi N, Fuentes-Garcia JP. Effects of exergames on heart rate variability of women with fibromyalgia: A randomized controlled trial. Sci Rep. 20 de marzo de 2020;10(1):5168.

38. Kaleth AS, Slaven JE, Ang DC. Obesity Moderates the Effects of Motivational Interviewing Treatment Outcomes in Fibromyalgia. Clin J Pain. enero de 2018;34(1):76-81.

39. Mingorance JA, Montoya P, Vivas Miranda JG, Riquelme I. A Comparison of the Effect of Two Types of Whole Body Vibration Platforms on Fibromyalgia. A Randomized Controlled Trial. Int J Environ Res Public Health. 15 de marzo de 2021;18(6):3007.

40. Jones GT, Macfarlane GJ, Walker-Bone K, Burton K, Heine P, McCabe C, et al. Maintained physical activity and physiotherapy in the management of distal arm pain: a randomised controlled trial. RMD Open. 2019;5(1):e000810.

FINANCING

No financing.

CONFLICT OF INTEREST

The authors declare that there are no conflicts of interest.

AUTHORSHIP CONTRIBUTION

Conceptualization: Leandro Mendoza Rivas, Ismael Lázaro Armenta Alcocer.

Investigation: Leandro Mendoza Rivas, Ismael Lázaro Armenta Alcocer.

Methodology: Leandro Mendoza Rivas, Ismael Lázaro Armenta Alcocer.

Writing-original draft: Leandro Mendoza Rivas, Ismael Lázaro Armenta Alcocer.

Writing-review and editing: Leandro Mendoza Rivas, Ismael Lázaro Armenta Alcocer.