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

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

Research output: Contribution to journalReview articlepeer-review

38 Citations (Scopus)
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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 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.

Original languageEnglish
Pages (from-to)752-761
Number of pages10
JournalArchives of Physical Medicine and Rehabilitation
Issue number4
Early online date25 Jul 2020
Publication statusPublished (in print/issue) - 1 Apr 2021

Bibliographical note

Funding Information:
Supported by the Health and Social Care Public Health Agency , Northern Ireland (STL/5268/16 to C.H. and J.G.M.). F.E.-L. received funding from the European Union’s Horizon 2020 research and innovation program under the Marie Skłodowska-Curie grant (agreement no. 707404). The funders of the present study did not have any role in the study design, data collection and analyses, decision to publish, or preparation of the manuscript. F.E.-L. is the guarantor of the review.

Publisher Copyright:
© 2020 American Congress of Rehabilitation Medicine

Copyright 2020 Elsevier B.V., All rights reserved.


  • Chronic pain
  • Management
  • Physical exercise
  • Rehabilitation
  • Training
  • Vitality
  • Humans
  • Fibromyalgia/therapy
  • Randomized Controlled Trials as Topic
  • Exercise Movement Techniques/methods
  • Exercise Therapy/methods
  • Sleep Wake Disorders/therapy
  • Fatigue/therapy


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