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Cited by 137Fibromyalgia and Chronic Fatigue Syndrome ResearchSleep and related disordersMusculoskeletal pain and rehabilitation

Effectiveness of Exercise on Fatigue and Sleep Quality in Fibromyalgia: A Systematic Review and Meta-analysis of Randomized Trials

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Estévez-López, Fernando, Maestre-Cascales, Cristina, Russell, Deborrah, Álvarez-Gallardo, Inmaculada C., Rodriguez-Ayllon, María, Hughes, Ciara M., Davison, Gareth W., Sañudo, Borja +1 more·2021·Archives of Physical Medicine and Rehabilitation
DOI 10.1016/j.apmr.2020.06.019
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Abstract

OBJECTIVES: To determine the effects of exercise on fatigue and sleep quality in fibromyalgia (primary aim) and to identify which type of exercise is the most effective in achieving these outcomes (secondary aim). DATA SOURCES: PubMed and Web of Science were searched from inception until October 18, 2018. STUDY SELECTION: Eligible studies contained information on population (fibromyalgia), intervention (exercise), and outcomes (fatigue or sleep). Randomized controlled trials (RCT) testing the effectiveness of exercise compared with usual care and randomized trials (RT) comparing the effectiveness of 2 different exercise interventions were included for the primary and secondary aims of the present review, respectively. Two independent researchers performed the search, screening, and final eligibility of the articles. Of 696 studies identified, 17 RCTs (n=1003) were included for fatigue and 12 RCTs (n=731) for sleep. Furthermore, 21 RTs compared the effectiveness of different exercise interventions (n=1254). DATA EXTRACTION: Two independent researchers extracted the key information from each eligible study. DATA SYNTHESIS: Separate random-effect meta-analyses were performed to examine the effects from RCTs and from RTs (primary and secondary aims). Standardized mean differences (SMD) effect sizes were calculated using Hedges' adjusted g. Effect sizes of 0.2, 0.4, and 0.8 were considered small, moderate, and large. Compared with usual care, exercise had moderate effects on fatigue and a small effect on sleep quality (SMD, -0.47; 95% confidence interval [CI], -0.67 to -0.27; P<.001 and SMD, -0.17; 95% CI, -0.32 to -0.01; P=.04). RTs in which fatigue was the primary outcome were the most beneficial for lowering fatigue. Additionally, meditative exercise programs were the most effective for improving sleep quality. CONCLUSIONS: Exercise is moderately effective for lowering fatigue and has small effects on enhancing sleep quality in fibromyalgia. Meditative exercise programs may be considered for improving sleep quality in fibromyalgia.

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  • Fibromyalgia is a disabling chronic pain syndrome characterized by multiple symptoms, including medically unexplained widespread pain, fatigue, cognitive, mood and sleep disorders.

    “Fibromyalgia (FM) is a disabling chronic pain syndrome characterized by multiple symptoms, including medically unexplained widespread pain, fatigue, cognitive, mood and sleep disorders.1–11”

    From A Review of Movement and Functional Impairments in Fibromyalgia: Implications for Targeted Treatment (2025) · cites this paper as [3]

    The opening passage labeled Abstract (page not provided) identifies fatigue and poor sleep quality as core fibromyalgia symptoms and discusses pain-related outcomes. The copy does not establish that the pain is medically unexplained or identify cognitive and mood disorders as characteristic symptoms; searches for those terms found no supporting passage. (LLM, conf=0.86)

    Experimental — accuracy not yet measured

  • Over 80% of FM patients report severe fatigue, which significantly impairs postural control and motor performance.

    “Over 80% of FM patients report severe fatigue, which significantly impairs postural control and motor performance.3,8,21”

    From A Review of Movement and Functional Impairments in Fibromyalgia: Implications for Targeted Treatment (2025) · cites this paper as [3]

    The opening passage (labelled Abstract in our copy; page unavailable) says that more than 80% of people with fibromyalgia experience severe fatigue or poor sleep quality. The paper does not say that fatigue significantly impairs postural control or motor performance, so that part of the claim is unsupported. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

  • More than 80% of people with fibromyalgia experience poor sleep quality with severe fatigue.

    “More than 80% of people with FM experience poor sleep quality with severe fatigue impacting depression,3 pain perception, physical functioning10 and exercise adherence.2,17,21”

    From A Review of Movement and Functional Impairments in Fibromyalgia: Implications for Targeted Treatment (2025) · cites this paper as [3]

    The supplied passage labeled Abstract says that more than 80% of people with fibromyalgia experience severe fatigue or poor sleep quality. The citing claim changes “or” to “with,” implying that more than 80% experience both together; the passage does not support that joint prevalence. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

  • Severe fatigue impacts depression, pain perception, physical functioning, and exercise adherence in fibromyalgia.

    “More than 80% of people with FM experience poor sleep quality with severe fatigue impacting depression,3 pain perception, physical functioning10 and exercise adherence.2,17,21”

    From A Review of Movement and Functional Impairments in Fibromyalgia: Implications for Targeted Treatment (2025) · cites this paper as [3]

    The Abstract reports that more than 80% of people with fibromyalgia experience severe fatigue or poor sleep quality. However, the Synthesis of the data discusses adherence only as a criterion used in exercise studies; it does not establish that severe fatigue affects exercise adherence. The cited passages also do not establish effects of fatigue on depression, pain perception, or physical functioning. (LLM, conf=0.82)

    Experimental — accuracy not yet measured

  • Nonpharmacological therapies, including exercise, have been advocated as a first-line treatment for patients with fibromyalgia.

    “Nonpharmacological therapies have been advocated as a first-line treatment for patients suffering from FM, including exercise, which is the only strong therapy-based recommendation.3,5”

    From A Review of Movement and Functional Impairments in Fibromyalgia: Implications for Targeted Treatment (2025) · cites this paper as [3]

    The Clinical applications section (page not provided) says European League Against Rheumatism recommendations highlight exercise as the only therapy with a strong level of evidence for managing fibromyalgia. Our copy does not say that nonpharmacological therapies generally are advocated as first-line treatment, so that broader part of the citing sentence is unsupported. (LLM, conf=0.86)

    Experimental — accuracy not yet measured

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Cites

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Authors
Estévez-López, F., Maestre-Cascales, C., Russell, D., Álvarez-Gallardo, I. C., Rodriguez-Ayllon, M., Hughes, C. M., Davison, G. W., Sañudo, B., & McVeigh, J. G.
Affiliations
  • Universidad Politécnica de Madrid (ES)
  • University of Ulster (GB)
  • Universidad de Sevilla (ES)
  • University College Cork (IE)
ORCID
Venue
Archives of Physical Medicine and Rehabilitation
Publisher
Elsevier BV
Published
2021-04
Volume
102
Issue
4
Pages
752-761
ISSN
0003-9993 (ISSN-L)
DOI
10.1016/j.apmr.2020.06.019
OpenAlex
W3040540998
Cited by
137
References
7
Citations by year
2026: 13 · 2025: 19 · 2024: 24 · 2023: 39 · 2022: 24 · 2021: 15 · 2020: 3
FWCI
3.37
Type
journal article
Language
en
Open access
Licence
Locations
  • Archives of Physical Medicine and Rehabilitation (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • EUR Research Repository (Erasmus University Rotterdam) (publishedVersion, cc-by)
  • Ulster University Research Portal (Ulster University) (acceptedVersion, cc-by)
  • Deposito de Investigacion Universidad de Sevilla (University of Seville) (submittedVersion, cc-by-nc-nd)
  • EUR Research Repository (Erasmus University Rotterdam) (submittedVersion, other-oa)
  • Institutional Repository of the University of Granada (University of Granada) (submittedVersion, cc-by)
  • LA Referencia (Red Federada de Repositorios Institucionales de Publicaciones Científicas) (submittedVersion, cc-by)
  • RODIN (Universidad de Cádiz) (submittedVersion, cc-by)
Funders
  • H2020 Marie Skłodowska-Curie Actions (707404)
  • Horizon 2020
  • Department for Employment and Learning, Northern Ireland (STL/5268/16)
  • Horizon 2020 Framework Programme
Topics
  • Health Sciences › Medicine › Psychiatry and Mental health › Fibromyalgia and Chronic Fatigue Syndrome Research
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
  • Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
Keywords
fibromyalgia, exercise therapy, fatigue, sleep quality, exercise type comparison, usual care comparison
MeSH terms
Exercise Therapy, Fatigue, Fibromyalgia, Humans, Sleep Wake Disorders, Randomized Controlled Trials as Topic, Exercise Movement Techniques

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