# Role of Exercise in Fibromyalgia Management: A Narrative Review of Mechanisms, Modalities, and Clinical Evidence

## TL;DR

This review explores how exercise helps manage fibromyalgia, showing that it reduces pain and improves quality of life with few risks.

## Contribution

The paper provides updated synthesis of exercise interventions for fibromyalgia, emphasizing tailored and graded approaches.

## Key findings

- Aerobic and resistance training consistently reduce pain and improve function and HRQoL in fibromyalgia patients.
- Mind-body and aquatic exercises are effective and well tolerated, with combined programs offering broader benefits.
- Serious adverse events from exercise are rare, supporting its use as a low-risk therapeutic strategy.

## Abstract

Fibromyalgia (FM) is a chronic pain syndrome characterized by widespread pain, fatigue, sleep disturbance, cognitive symptoms, and mood comorbidity. This narrative review synthesizes mechanistic insights, randomized controlled trials (RCTs), and meta-analyses published primarily between 2005 and 2024 to evaluate exercise-based interventions as a primary therapeutic approach for FM. The objective was to synthesize mechanistic rationales, summarize RCTs and meta-analyses across exercise modalities, and provide practical prescription guidance. The results showed aerobic and resistance training consistently reduce pain and improve function and health-related quality of life (HRQoL). Mind-body and aquatic programs were effective and often well tolerated; combined programs frequently yielded the broadest benefits. Serious adverse events were rare. In conclusion, tailored, graded exercise represents an effective, low-risk strategy for FM care. Gaps include long-term durability, response prediction, and dose personalization.