Effectiveness of exercise on fatigue and sleep quality in fibromyalgia: a systematic review and meta-analysis of randomised trials

Fernando Estevez-Lopez, Christina Maestre Cascales, Deborrah Russell, Inmaculada Alvarez-Gallardo, Maria Rodriguez-Ayllon, Ciara Hughes, Gareth Davison, Borja Sanudo, Joseph McVeigh

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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 18th, 2018. Study selection: Eligible studies contained information on population (fibromyalgia), intervention (exercise) and outcomes (fatigue or sleep). Randomised controlled trials (RCTs) testing the effectiveness of exercise in comparison to usual care and randomised trials (RTs) comparing the effectiveness of two 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. From 696 identified studies, 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). Standardised 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. In comparison to usual care, exercise had moderate effects on fatigue and a small effect on sleep quality; SMD (95% confidence interval) = -0.47 (-0.67 to -0.27, p < 0.001) and -0.17 (-0.32 to -0.01, p = 0.04). 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.
Original languageEnglish
Pages (from-to)1-74
Number of pages74
JournalArchives of Physical Medicine and Rehabilitation
Early online date25 Jul 2020
Publication statusE-pub ahead of print - 25 Jul 2020


  • Chronic pain
  • sleeplessness
  • management
  • physical exercise
  • rehabilitation
  • training
  • vitality

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