First-Line Treatment of Fibromyalgia: Exercise and Movement-Based Therapies
Fibromyalgia presents with widespread musculoskeletal pain and reduced physical function. Structured physical activity forms the evidence-based foundation of first-line management, with strong guideline support for its role in improving both pain and function.
Treatment Approach
The first-line protocol is built around structured physical activity — aerobic or strengthening exercise — which may be combined with additional movement-based or physical therapy modalities selected to the individual's clinical picture. The complete regimen, including specific combinations, parameters, and sequencing, is available via the link below.
Clinical Goals
Improvement in fibromyalgia pain and physical function.
References
- We were unanimous in providing a 'strong for' recommendation for the use of exercise, particularly given its effect on pain, physical function and well-being, availability, relatively low cost and lack of safety concerns.
- The available evidence did not allow us to distinguish between the benefits of aerobic or strengthening.
- Exercise programmes lasting 2.5–24 weeks.
- We gave 'weak for' recommendations in relation to meditative movement therapies (which improved sleep, fatigue and quality of life) or mindfulness-based stress reduction (which improved pain and quality of life); the physical therapies acupuncture or hydrotherapy for which there was evidence that they improved pain/fatigue and pain/quality of life, respectively.
- Aerobic exercise was associated with improvements in pain (0.65; −0.09 to 1.39) and physical function (0.66; 0.41 to 0.92).
- Busch et al reviewed five trials with 219 participants and concluded that resistance training resulted in a significant improvement in pain (−3.3 cm on a 10 cm scale; −6.35 to −0.26) as well as function compared with control.
DOI: 10.1136/annrheumdis-2016-209724
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