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Review
. 2022 Nov 22:15:3639-3656.
doi: 10.2147/JPR.S384215. eCollection 2022.

Effect of Exercise Interventions on Health-Related Quality of Life in Patients with Fibromyalgia Syndrome: A Systematic Review and Network Meta-Analysis

Kang-Da Zhang  1 , Lin-Yu Wang  1 , Zhi-Hua Zhang  1 , Dan-Xu Zhang  1 , Xiao-Wen Lin  2 , Tao Meng  1 , Feng Qi  1
Affiliations
Review

Effect of Exercise Interventions on Health-Related Quality of Life in Patients with Fibromyalgia Syndrome: A Systematic Review and Network Meta-Analysis

Kang-Da Zhang et al. J Pain Res. .

Abstract

Objective: Several guidelines highlight the beneficial impact of exercise on the management of symptoms and health-related quality of life (HRQOL) in patients with fibromyalgia syndrome (FMS). However, few analyses have compared different types of exercise. We, therefore, intent to compare the effects of different exercise types on improving the overall HRQOL and typical symptoms in patients with FMS.

Methods: Medline, Embase, the Cochrane Register of Clinical Trials, and NIH ClinicalTrials.gov were searched from inception to April 21, 2022. Randomized clinical trials (RCTs) were included to assess the impact of exercise intervention on health parameters in adult FMS patients. Data were extracted independently and a frequentist network meta-analyses (NMA) was performed to rank the effects of interventions according to P-scores. The NMA evidence certainty was assessed using the method recommended by Grading of Recommendations Assessment, Development, and Evaluation Working Group.

Results: A total of 57 RCTs were identified, including 3319 participants, involving 9 interventions (7 types of exercise, 2 controls). Of all treatments compared with usual care in efficacy outcomes, Mind-body exercise was associated with the best HRQOL (SMD, -12.12; 95% CI, -15.79 to -8.45). On the other characteristic symptom dimensions, based on moderate quality evidence, sensorimotor training was associated with minimal pain scores compared with usual care (SMD, -1.81; 95% CI, -2.81 to -0.82), whole body vibration therapy was most promising for improving sleep quality (SMD, -6.95; 95% CI, -10.03 to -3.87), pool-based aerobic exercise was most likely to ease anxiety (SMD, -4.83; 95% CI, -7.47 to -2.19), and whole body vibration was most likely to improve depression (SMD, -10.44; 95% CI, -22.00 to 1.12).

Conclusion: Mind-body exercise seems to be the most effective exercise to improve the overall HRQOL of patients with FMS. But at the same time, clinicians still need to develop individualized exercise plans for patients according to their symptoms and accessibility.

Keywords: exercise; fibromyalgia syndrome; network meta-analysis; quality of life; systematic review.

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Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Figure 1
Figure 1
Flow diagram of the literature search and study.
Figure 2
Figure 2
HRQOL. (A). Network plot of treatment comparisons. The width of the line represents the number of RCTs per pairwise comparison, and the size of each node is proportional to the number of sample size. (B). Network meta-analysis Estimates of HRQOL. Effect sizes presented on the upper triangle are direct comparisons (head-to-head studies) between the row and columns; the effect sizes on the lower triangle are network meta-analyses between the column and the row. Meta-analysis use SMD and 95% CI to assess the improvement in quality of life of the intervention. (C). Comparing-adjusted funnel plot.
Figure 3
Figure 3
Heat map of exercise interventions ranked according to improve Health-Related Quality of Life (HRQOL), pain, sleep, anxiety and depression.
Figure 4
Figure 4
Forest plot of network meta-analysis results. (A). Pain. (B). Sleep. (C). Anxiety. (D). Depression. Comparisons are based on SMD and 95% CI in all outcomes.
See this image and copyright information in PMC

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Grants and funding

This work was supported by the National Natural Science Foundation of China [grant numbers 81672250]; the National Natural Science Foundation of China [grant numbers 81900394]; Shandong Province Natural Science Foundation [grant numbers ZR2017BH022]; China Postdoctoral Science Foundation [grant numbers 2019M652395]; and the Fundamental Research Funding of Shandong University.