Efficacy of different exercises in women with fibromyalgia

syndrome: a randomised controlled trial

Ö. Şevgin1, B. Buğday2, R. Aydoğan Baykara3, G. Günendi4, B. Akkurt5, H. Atasoy1,
B. Dikmen Hoşbaş1, M.F. Akkurt6, B. Karamancıoğlu1
1
Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Uskudar University,
Istanbul; 2Department of Therapy and Rehabilitation, Vocational School of Health Services,
Inonu University, Malatya; 3Department of Physical Medicine and Rehabilitation, Malatya Turgut
Özal University, Training and Research Hospital, Malatya; 4Department of Physiotherapy and
Rehabilitation, Faculty of Health Sciences, Istanbul Yeniyüzyıl University, Istanbul;
5
Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Fenerbahce University,
Istanbul; 6Department of Occupational Therapy, Faculty of Health Sciences, Fenerbahce University,
Istanbul, Turkey.

Abstract
Objective
The objective of this study was to evaluate the impact of aerobic exercise, resistance exercise combined with aerobic
exercise, and yoga exercises combined with aerobic exercise on pain and disease activity in patients with fibromyalgia
syndrome (FM).

Methods
The study population comprised 60 individuals with FM who met the inclusion criteria. The participants were randomly
assigned to one of three groups. The first group underwent aerobic exercise (n=20), the second group combined aerobic
exercise with yoga (n=20), and the third group engaged in aerobic and resistance exercise (n=20). All exercise
interventions were conducted for a total of 12 weeks. Disease activity was evaluated using the Fibromyalgia Impact
Questionnaire (FIQ), while pain status was assessed with the Melzack-Melzack Pain Questionnaire (MMPQ).
All assessments were conducted before and following the completion of the exercise program. The clinical trial number
of this study is NCT06006494.

Results
The measurements of the aerobic exercise and yoga group were significantly lower than those of the aerobic and resistance
exercise group. A statistically significant difference was observed between the groups in terms of post-treatment MMPQ
scores. The measurements of the aerobic exercise and yoga group were significantly lower than those of the aerobic
exercise only and aerobic and resistance exercise groups. No statistically significant difference was observed between the
post-treatment MMPQ scores of the aerobic and aerobic resistance exercise groups.

Conclusion
The combination of aerobic exercise and yoga is more efficacious in the treatment of FM than aerobic exercise alone or a
combination of resistance exercises and aerobic exercise.

Key words
aerobic exercise, fibromyalgia, resistance training, pain, yoga

Clinical and Experimental Rheumatology Clinical

2022 and Experimental Rheumatology 2025.
Exercises in women with fibromyalgia syndrome / Ö. Şevgin et al.

Ömer Şevgin, PhD Introduction fibromyalgia is contingent upon the

Burak Buğday, PhD Fibromyalgia syndrome (FM) is de- specific characteristics of the exercise
Rabia Aydoğan Baykara, MD, PhD fined as a chronic rheumatological program, including its content and in-
Gizem Günendi, PhD
disease that causes sensory changes tensity. The combination of submaxi-
Burcu Akkurt, PhD
Hilal Atasoy and musculoskeletal pain. It is more mal aerobic exercise with strengthen-
Beyzanur Dikmen Hoşbaş prevalent in the female population (1, ing and stretching components has
Mustafa Ferit Akkurt, PhD 2). Regarding the underlying mecha- been demonstrated to elicit favourable
Berna Karamancıoğlu nism, one group of researchers posits outcomes in the reduction of symptoms
Please address correspondence to: that hyperexcitability of the central and hyperalgesic response (11, 12). In
Ömer Şevgin nervous system may be the cause. In individuals with fibromyalgia, a mini-
Department of Physiotherapy contrast, others suggest that an imbal- mum of moderate-intensity exercise
and Rehabilitation, ance of neurotransmitters may be the is deemed sufficient to elicit clinical
Faculty of Health Sciences,
underlying factor (3). Although nu- benefits, although low-intensity exer-
Üsküdar University,
34768 Istanbul, Turkey. merous symptoms are associated with cise also yields limited benefits. Given
E-mail: [Link]@[Link] FM, the primary symptoms have been the low exercise tolerance observed in
Received on October 29, 2024; accepted in identified as chronic pain, fatigue, and this cohort, the performance of high-in-
revised form February 3, 2025. muscle weakness (4, 5). tensity exercises is not a viable option
© Copyright Clinical and The management of this syndrome en- (13). In designing an exercise program
Experimental Rheumatology 2025. tails the alleviation of symptoms across for patients, it is essential to consider
various domains, including neurologi- the importance of initiating exercise at
cal and rheumatological manifestations a low intensity, gradually increasing
(6, 7). Advances in the comprehension the level of exertion, maintaining the
of FM have resulted in the emergence frequency of exercise, and reducing
of novel therapeutic avenues for pa- the intensity if the patient experiences
tients. Further studies are ongoing to adverse reactions. Additionally, incor-
examine the efficacy of new drugs and porating a diverse range of exercise
non-pharmacological interventions. modalities into the program is crucial
Nevertheless, no treatment has yet for ensuring patient safety and adher-
been identified that is suitable for all ence (13, 14).
patients with FM or for all symptoms Yoga can be considered as a discipline
experienced by a single patient (8). The that offers a multimodal treatment ap-
available clinical evidence indicates proach for fibromyalgia in both physi-
that a multifaceted treatment program cal (exercise) and psychological (cop-
is the most appropriate approach for ing skills) dimensions, aiming at mind-
fibromyalgia syndrome. In considering body integrity (12, 15). The fundamen-
non-drug treatments for fibromyalgia, tal elements of yoga can be distilled
there is compelling evidence to support into three core components: breathing
the efficacy of cardiovascular exercise, techniques, postures, and meditation
cognitive-behavioural therapy, patient (16). In the practice of yoga, the slow-
education, and combined treatments. ing of the respiratory rate and subse-
Additionally, there is moderate evi- quent reduction in heart rate result in
dence to suggest the efficacy of treat- the activation of the parasympathetic
ments such as strength training, acu- nervous system, which initiates the re-
puncture, hypnotherapy, biofeedback, laxation response (17). Asanas, another
and balneotherapy (9). component of yoga, have been reported
It is frequently observed that patients to reduce stress, improve mood, and
with fibromyalgia exhibit impaired raise cortisol levels (18). It has been
ORCID physical fitness. It is therefore recom- demonstrated that elevated cortisol lev-
Ö. Şevgin: 0000-0003-2145-5939 mended that physical fitness programs els are associated with enhanced men-
B. Buğday: 0000-0001-9806-291X be incorporated into the treatment plan tal endurance, elevated self-esteem,
R. Aydoğan Baykara: 0000-0003-0542-266X
(8). In general, exercise is regarded and greater mental stability (19). A
G. Günendi: 0009-0003-5397-4685
B. Akkurt: 0000-0001-8394-9702 as a transformative approach to the substantial body of evidence from sci-
H. Atasoy: 0009-0000-8451-1489 treatment of fibromyalgia, as well as a entific studies indicates that yoga can
B. Dikmen Hoşbaş: 0000-0003-2494-480X means of achieving holistic improve- lead to notable improvements in vari-
M.F. Akkurt: 0000-0002-0123-1287 ment in the health of individuals af- ous aspects of life for individuals with
B. Karamancıoğlu: 0000-0003-2561-4618 fected by this condition (10). The ef- FM. These include reductions in pain,
Competing interests: none declared. ficacy of exercise in the treatment of stiffness, and sleep disturbances, as

2 Clinical and Experimental Rheumatology 2025

 Exercises in women with fibromyalgia syndrome / Ö. Şevgin et al.

well as an improvement in psychologi-

cal symptoms. Furthermore, yoga has
been demonstrated to have beneficial
effects in numerous domains, including
flexibility, strength, balance, and over-
all quality of life (20). Yoga is widely
practiced among FM patients and is
beneficial by patients (21). In the con-
text of primary care for fibromyalgia,
yoga is regarded as a promising com-
plementary treatment approach, offer-
ing a low-cost and highly adaptable
solution (22).
A review of the literature revealed that
a combination of aerobic and resist-
ance exercise may be an efficacious ap-
proach for patients with FM (23). It is
plausible that all forms of exercise may
contribute to the alleviation of symp-
toms and the advancement of overall
well-being in patients diagnosed with
FM (10). Combined exercise programs
have been demonstrated to be an ef- Fig. 1. CONSORT flow chart.
fective approach for FM, with a strong
evidence base. However, further inves- power value as ß=0.80. However, to tive deficits that could affect the un-
tigation is required to ascertain the effi- account for potential drop-outs and to derstanding of the assessment tools or
cacy of different exercise types (9, 24). obtain more valid results, a total of 67 questionnaires, uncontrolled systemic
This study aimed to determine the ef- participants were included at baseline. diseases such as diabetes mellitus and
fects of aerobic exercise, combined arterial hypertension, neurological and
with either resistance training or yoga, Randomisation and blinding musculoskeletal disorders that could
on pain and disease activity in patients The trial was conducted according to affect the assessment procedures such
diagnosed with FM. the principles of a single-blind ran- as stroke, major sensory changes, ad-
domised controlled trial design. The vanced joint diseases (arthroplasty
Materials and methods evaluator was blinded to the study de- or osteoarthritis), infectious diseases,
Study design sign. Participants were randomly al- receiving pharmacological treatment,
This study is a prospective, randomized located to the study groups using a and pregnancy.
controlled study with a parallel group simple randomised method. To ensure
design conducted between September unbiased randomisation, the names of Intervention and procedure
and December 2023. Ethical approval volunteers who met the inclusion crite- Participants were randomly assigned
was obtained from Üsküdar University ria were listed on paper and placed in a to three groups. The first group was
Non-Interventional Research Ethics container. An assessor sorted the papers an aerobic exercise group, the second
Committee (61351342/May 2023). The into different groups using a random se- group was an aerobic exercise and
study complies with the Declaration of lection procedure. The 60 participants yoga group, and the third group was an
Helsinki and all participants signed in- were divided into three groups: aerobic aerobic and resistance exercise group.
formed consent. The clinical number of exercise, aerobic and resistance exer- All three groups started the program
the study is NCT06006494. cise, aerobic exercise and yoga groups. with warm-up exercises and ended
Each group had 20 participants. with cool-down exercises. The aerobic
Sample size calculation Informed consent for the experiment exercise was done 1 day a week, once a
G*Power [Link] software was used was obtained from a total of 67 par- day for 30-40 minutes in the beginning,
to determine the required number of ticipants, whose eligibility was guided and after the first week, it was done 3
participants (25). The total number of by an expert physician. Figure 1 shows days a week, once a day for 30-40 min-
participants was planned to be 60, with the flow of participants throughout the utes for a total of 12 weeks.
a minimum of 20 participants in each study. The study included women, aged Sociodemographic information was
group. In the power analysis, the alpha between 18 and 45 years, with a medi- obtained from participants who con-
significance level was taken as 0.05, cal diagnosis of FM; those who met sented to participate in the study. Dis-
the confidence interval as 95%, the ef- the 2016 ACR FM diagnostic criteria ease activity was assessed using the
fect size value as 0.45, and the desired (26) Exclusion criteria were cogni- Fibromyalgia Impact Questionnaire

Clinical and Experimental Rheumatology 2025 3

Exercises in women with fibromyalgia syndrome / Ö. Şevgin et al.

and pain status was assessed using the exercise program commenced at 40% Turkish for female individuals with
McGill Pain Questionnaire Fatigue. All of one repetition maximum (RM) and FMS, consists of 10 items (32). The
assessments were made before and af- progressed to 80% of one repetition initial section comprises 11 Likert-type
ter the exercise program. maximum for 12 weeks. The progres- questions. The responses to these ques-
sion of loads was evaluated at three- to tions are graded on a scale of 0 to 3 and
Treatment groups four-week intervals and subsequently subsequently averaged. The second
Aerobic exercise group. All partici- adjusted on an individual basis (30). item inquires as to the number of days
pants in the study were included in in the previous week during which the
an aerobic exercise program that met Aerobic exercise and yoga group. In- patient reported feeling well. To ensure
the current guidelines for moderate- dividualised yoga programs were pro- consistency and comparability, the an-
intensity exercise recommended for vided to participants randomized to swer to this item is reverse scored, with
FM (27). Each aerobic exercise session the aerobic exercise and yoga groups a value of 7 assigned to 0 days and a
consisted of an active warm-up with for an average of 40 minutes, two days value of 0 assigned to 7 days. The third
low-intensity exercise and dynamic per week, in addition to the program item enquires as to the number of days
stretching, aerobic exercise gradually applied to the aerobic exercise group. in the previous seven-day period during
increasing from low to moderate in- These programs were supervised by a which the patient was unable to work.
tensity, and a cool-down with low-in- physiotherapist. The scores obtained from the first three
tensity exercise and dynamic and static The yoga program was equipped with items are then normalised. The score
stretching. For exercise intensity, heart a variety of supportive items, including obtained from the initial item is mul-
rate and perceived exertion rate were a mat, blankets, eye pillows, and sup- tiplied by 3.3, while the scores derived
recorded during each session (28). ports. The movements were performed from the subsequent two items are
Aerobic training was performed with in a fixed posture for a period of be- multiplied by 1.4. The remaining seven
a treadmill in the physiotherapy clinic. tween 15 seconds and two minutes. The items were designed to assess the se-
Participants completed a 10-minute yoga poses were presented in a single verity of symptoms, pain, fatigue, wak-
warm-up, 20 minutes of aerobic exer- sequence, with versions that could be ing without rest, stiffness, anxiety, and
cise (50-60% of estimated maximum performed in or out of a chair. Addi- depression, with respondents invited to
heart rate: perceived exertion ratio 11- tionally, the sequence included medita- indicate their level of discomfort on a
13 (6 (no effort) to 20 (maximal effort)) tion and breathing exercises, as well as 10-point Visual Analogue Scale. Re-
and a 10-minute cool-down during the yoga-based coping methods. The yoga sponses to these questions are used to
first week of the program. In subse- sequence comprised a variety of ele- calculate a score on a scale of 0 to 100
quent weeks, the intensity was gradual- ments, including preparatory exercises, (32). The mean score for a patient with
ly increased according to the patient’s self-massage, the mountain pose with fibromyalgia is 50, with a higher score
tolerance (29). In weeks 10 to 12 of the sun arms, the table pose, the warrior 1 indicating greater physical disability.
program, participants engaged in 40 flow, the breath of joy, the downward-
minutes of aerobic exercise at a level facing dog on the chair, the chair pose, McGill Melzack Pain Questionnaire
corresponding to 60-80% of their esti- the sphinx pose, the child’s pose, the (MPQ). The MPQ, developed by
mated maximum heart rate. The exer- modified locust pose, the supine core Melzak and Targerson in 1975, is a
cise program was individually tailored strengthening pose, the supine thoracic comprehensive tool comprising four
to each participant, and all sessions twist flow, the supine pigeon pose, the components designed to assess the pain
were conducted under the supervision bridge pose, the corpse pose and the experienced by the individual in ques-
and guidance of a physiotherapist. knees to chest pose (31). tion. The initial component of the as-
sessment entails the identification of the
Aerobic and resistance exercise group. Outcome measures specific locations on the body where the
Individuals allocated to the aerobic In this study, disease activity was subject is experiencing pain. The sec-
and resistance exercise groups were evaluated using the Fibromyalgia Im- ond part of the assessment entails the
subjected to a 40-minute resistance pact Questionnaire, while pain status selection of descriptive word groups
exercise program two days per week, was assessed with the McGill Pain that correspond to the pain being ex-
in addition to the program applied to Questionnaire. Additionally, sociode- perienced. The third section of the as-
the aerobic exercise group. This was mographic data, including age, height, sessment tool investigates the temporal
conducted under the supervision of a body weight, and marital status, were characteristics of pain. The fourth com-
physiotherapist. recorded. All assessments were con- ponent of the MPQ assesses the inten-
The resistance exercise program com- ducted before and after the completion sity of pain using a Likert-type scale
menced with a 10-minute warm-up of the exercise program. (33). The scale comprises unambiguous
period, followed by 50 minutes of re- questions that evaluate the intensity of
sistance training exercises targeting the Fibromyalgia Impact Questionnaire pain as follows: severe, moderate, mild,
major muscle groups in the four ex- (FIQ). The FIQ, which has been vali- and no pain (34). The scoring system
tremities and the trunk. The resistance dated and demonstrated reliability in ranges from 0 to 112. A higher score is

4 Clinical and Experimental Rheumatology 2025

 Exercises in women with fibromyalgia syndrome / Ö. Şevgin et al.

indicative of an increase in pain and as- Table I. Socio-demographic information of the participants.
sociated parameters (35, 36).
Variables
Aerobic exercise Aerobic and Aerobic exercise pa
group resistance exercise and Yoga group
Statistical analysis (n:20) group (n:20)
Once the findings of the study had (n:20)
been collated, the SPSS 24.0 (Statis-
X±SD X±SD X±SD
tical Package for the Social Sciences) Age (years) 25.4±1.7 25.1±3.6 24±2.9 0.253
program was employed for the purpose Height (cm) 165.2±3.1 162.4±3.6 166.8±6.2 0.360
of statistical analysis. In the process of Weight (kg) 63.4±3.8 62.2±7.9 64.2±5.2 0.771
BMI (kg/m2) 23.2±0.9 23.5±2.1 23.1±1.4 0.968
evaluating the study data, quantitative
n(%) n(%) n(%)
variables were presented with mean, Marital status Married 12(60) 12(60) 16(80)
standard deviation, median, minimum, Single 8(40) 8(40) 2(20)
and maximum values, while qualitative
*p<0.05.
variables were illustrated with descrip- a: Kruskal Wallis Test; X: mean; SD: standard deviation; n: number of individuals; cm: centimetre; kg:
tive statistical methods, such as fre- kilogram; m: meter; %: percentage; BMI: body mass index.
quency and percentage. The suitability
of the data for normal distribution was Table II. Results of Fibromyalgia Impact Questionnaire, McGill Melzack Pain Question-
evaluated using the Shapiro-Wilks test naire.
and box plot graphs. The Kruskal-Wal-
Variables Aerobic exercise Aerobic and Aerobic exercise
lis test was employed for the evaluation group resistance exercise and Yoga group
of variables exhibiting non-normal dis- (n:20) group (n:20)
tribution across three groups, while the (n:20)
Dunn test was utilized for post hoc as-
X±SD X±SD X±SD pb
sessments. Comparisons of postopera- (Min-Max) (Min-Max) (Min-Max)
tive scale scores according to preoper-
ative groups were evaluated using the FIQ BI 55.3±9.4 60.7±1.5 63.9±6.8 0.468
(44.5-66.2) (58.3-61.9) (57.7-71.8)
Wilcoxon signed-rank test. The Fisher-
AI 27.9±2.3 44.5±2.7 17.4±6.1 0.002**
Freeman-Halton test was employed for (24.1-30) (42.1-47.9) (10.8-26.4)
the evaluation of qualitative measure- pc 0.042* 0.034* 0.043*
ments. The results were evaluated at AI-BI 27.47±8.15 16.17±2.40 46.44±4.30
the 95% confidence interval and with a MMPQ BI 75.8±1.6 72.6±7.1 71.0±7.9 0.408
significance level of p<0.05. (74-78) (61-78) (57-76)
AI 54.4±2.7 61.6±6.1 34.8±3.1 0.004**
Results (52-59) (53-69) (30-38)
pc 0.042* 0.042* 0.041*
The variables of age, height, body AI-BI 21.40±1.52 11.00±6.08 36.20±5.16
weight, and body mass index, as well
as marital status, are presented in Ta- **p<0.01; b: Kruskal Wallis test, *p<0.05; X: Mean, c: Wilcoxon Signed Rank test.
ble I for each group. No statistically SD: standard deviation; n: number of people; Min: minimum; Max: maximum; BI: before interven-
tion; AI: after intervention; FIQ: Fibromyalgia Impact Questionnaire, MMPQ: McGill Melzack Pain
significant differences were observed Questionnaire.
between the age, height, body weight,
body mass index, and marital status
variables of the 60 participants includ- MMPQ pre-treatment measurements Discussion
ed in the study (p>0.05). did not show significant difference be- The objective of this study was to eval-
FIQ did not show a significant differ- tween the groups (p=0.408; p>0.05). uate the impact of aerobic exercise,
ence between the groups before treat- Post-treatment MMPQ scores were combined with or without resistance
ment (p=0.468; p>0.05). Post-treatment statistically significant between the training, and yoga, in conjunction with
FIQ scores were found to be statistically groups (p=0.004; p<0.01). The results or in addition to aerobic exercise, on
significant within (p<0.05) and between demonstrated that the measurements pain and disease activity in individuals
the groups (p=0.002; p<0.01). The of aerobic exercise and yoga groups diagnosed with FM. The findings in-
analysis of the significance revealed were significantly lower than those dicated that all three treatment groups
that the measurements of the aerobic of the aerobic exercise-only group demonstrated a reduction in pain and
exercise and yoga group were found to (p=0.040; p=0.001). However, no disease activity scores following the
be significantly lower than those of the significant difference was observed intervention. Furthermore, a compari-
aerobic and resistance exercise group between the post-treatment MMPQ son between the three groups revealed
(p=0.002; p<0.01). No significant dif- scores of the aerobic and aerobic and that the scores of the aerobic exercise
ference was found between the other resistance exercise groups (p>0.05) and yoga group exhibited a more pro-
groups (p>0.05) (Table II). (Table II). nounced improvement compared to the

Clinical and Experimental Rheumatology 2025 5

Exercises in women with fibromyalgia syndrome / Ö. Şevgin et al.

aerobic exercise only and aerobic and tions that increase muscle strength and duration and frequency of the yoga
resistance exercise groups. decrease muscle loss and regular par- exercise program was similar to previ-
Previous studies have revealed several ticipation in exercise in all groups. The ous studies in the literature. Bravo et
advantages of exercise therapy for pa- acquisition of strength represents an ef- al. found positive results in the treat-
tients with FM (37, 38). Such benefits ficacious strategy for the management ment of FM symptoms with exercise
include enhanced cardiovascular fit- of pain in patients with FM (46). More- and body awareness therapies, find-
ness, augmented muscle strength, im- over, exercise has been demonstrated to ing significant improvements in pain
proved flexibility, and superior overall stimulate the production of endogenous levels immediately after testing and
physical functioning (39). It is widely opioids and β-endorphins, which have functional limitation on the FIQ score
acknowledged that aerobic exercises been shown to activate decreased noci- six weeks after treatment (51). Exer-
play an integral role in maintaining ceptive inhibitory mechanisms, thereby cises based on movement and body
optimal cardiovascular health. Simi- resulting in hypoalgesia (47). awareness have been reported to have
larly, resistance training has been dem- A comprehensive indicator such as the a moderate to high effect size in reduc-
onstrated to enhance muscle strength FIQ encompasses a range of secondary ing pain (52). Meditative movement
and flexibility, while improving range symptoms, including physical func- therapy had a positive effect on sleep
of movement (40, 41). These develop- tion, occupational status, depression, disturbance, fatigue, depression and
ments collectively facilitate more ef- anxiety, stiffness, fatigue, pain, and health-related quality of life, and these
ficacious FM management, aligning happiness (48). The results of our study effects were maintained for 4.5 months
with the recommendations set forth by demonstrated a statistically significant (53). There was a significant improve-
the American College of Sports Medi- improvement in the FIQ, which as- ment in pain, quality of life and physi-
cine (ACSM) (42). The efficacy of ex- sesses secondary symptoms, following cal condition with stretching (54). In
ercise therapy in the treatment of FM treatment in all exercise groups. Each our study, the aerobic exercise + yoga
has been extensively investigated and type of exercise exerts a therapeutic ef- group was superior to the aerobic exer-
endorsed due to its convenient admin- fect on FM. Our findings are consistent cise + resistance exercise group in re-
istration, low cost, and long-term ef- with those of previous meta-analyses ducing disease activity and superior to
ficacy (43). Nevertheless, the level of of randomised controlled trials, includ- both groups in reducing pain. This may
exertion can influence the efficacy of ing those that have analysed a large be explained by both the proven effec-
treatment and the optimal methodol- number of studies and demonstrated tiveness of aerobic exercise in patients
ogy for exercise remains undetermined the efficacy of aerobic exercise (44). with this diagnosis and the relaxation
(44). The findings of our study corroborate response produced by the movement
It can be posited that exercise plays a the notion that various forms of exer- and body awareness, flexibility and
role in the comprehensive treatment of cise, including aerobic, combined aero- meditation components of yoga in peo-
FM. Moreover, there is currently no cur bic and resistance, and yoga programs ple with FM.
for FM; rather, the objective of treat- incorporating both aerobic and flexibil- When analysing the trials conducted
ment is to provide long-term relief of ity components, can exert beneficial in people with FM, the frequency and
symptoms (42). It can be reasonably therapeutic effects on the disease activ- duration of aerobic exercise varied be-
deduced that patients with FM will ity associated with FM. tween 3-5 sessions per week and 6-24
require long-term treatment. Among Trials investigating the effects of ex- weeks (49). Exercise interventions
the numerous treatment options avail- ercise and body awareness therapies have been reported to have positive ef-
able, exercise is notable for its lack of (flexibility exercises, tai chi, yoga, fects on pain, multidimensional func-
adverse effects and its capacity to en- Pilates) in people with FM have gen- tion, and self-reported physical func-
hance patients’ physical fitness while erally been conducted in female popu- tion (55).
providing more enduring symptom al- lations. The proportion of female par- The most frequently analysed com-
leviation. Pain is the primary symptom ticipants in these studies varies from bined exercise modalities were aerobic
of FM and is identified as the main di- 73% to 100% (49). However, the total and resistance training, as reported by
agnostic criterion. The prevailing view duration of treatment varied from 1 to Andrade et al. The findings indicated
attributes the pain associated with FM 32 weeks and the frequency of treat- that moderate to high-intensity aerobic
primarily to the central nervous sys- ment was reported as a minimum of exercise twice a week increased heart
tem (44). It has been demonstrated that one day per week and a maximum of rate and reduced autonomic dysfunc-
exercise can exert a central analgesic three days per week (49). The range of tion. Conversely, resistance training
effect, thereby providing relief from treatment duration varied from 1 week was associated with an increase in
chronic pain (45). The findings of our (50) to 32 weeks, with the minimum muscle strength as well as a reduc-
study indicate that post-treatment pain and maximum treatment frequency be- tion in symptoms of anxiety and de-
reduction was observed in all exercise ing one day per week and three days pression. However, the results did not
groups. It is hypothesised that this im- per week, respectively (49). The sam- demonstrate a reduction in autonomic
provement in pain reduction can be at- ple of the present study consisted en- dysfunction in the short or long term
tributed to movement-based interven- tirely of female participants and the (56). This conclusion is supported by

6 Clinical and Experimental Rheumatology 2025

 Exercises in women with fibromyalgia syndrome / Ö. Şevgin et al.

the analysis of Cerrillo Urbina et al., effects associated with these therapeu- other sociodemographic information
who found that exercise programs have tic modalities renders them a relatively (including education, employment sta-
a positive effect on FMS symptoms in low-risk option for the management of tus, marital status, race/ethnicity, as
perimenopausal women (57). The re- FM (52). The combination of exercises well as clinical conditions such as year
sults of the meta-analysis indicated that was found to have a beneficial effect since diagnosis, medications, and other
combined exercise and aquatic exercise on several health-related outcomes, in- medical histories) was not collected in
programs had a moderate and small ef- cluding symptoms, physical function, this study. Furthermore, post-exercise
fect on global functional well-being pain, fatigue, and quality of life (49). follow-up is recommended for future
respectively. It can be posited that A high level of adherence to an exercise studies. In the majority of studies,
short-term interventions may prove program has been linked to enhanced various combined treatment programs
efficacious in the alleviation of symp- physical health outcomes, thereby un- were excluded to maintain the integrity
toms experienced by perimenopausal derscoring the significance of adhering of the exercise therapy (44). To the best
women with fibromyalgia. Bidonde et to structured exercise guidelines (60). of our knowledge, this is the first study
al. conducted a comparative analysis of The classification system provides a to investigate the efficacy of aerobic
combined exercise interventions with a framework for the assessment of the exercise in conjunction with resistance
non-exercise control group and other efficacy of exercise programs that are training and aerobic exercise in con-
exercise interventions. The findings designed to align with the specific junction with a yoga program on pain
indicated that combined exercise re- capabilities and constraints of the in- and disease activity in individuals with
sulted in improved outcomes, reduced dividual (60). In order to gain a more FM. It is crucial to gain insight into the
pain, fatigue, stiffness, and enhanced comprehensive understanding of the impact of diverse exercise modalities
physical function when compared to role of exercise therapy in the manage- and combinations on FM, as this will
the control group (58). In the design of ment of FM, it is essential to consider facilitate the diversification of treat-
the present study, combined exercises the therapeutic benefits of different ex- ment approaches and the individualisa-
were evaluated as a comparison group ercise modalities in accordance with tion of treatments. The findings of our
against aerobic exercise. The findings the guidelines set forth by the American study may contribute to the develop-
demonstrated that the effectiveness of College of Sports Medicine (ACSM) ment of more effective and holistic ap-
yoga exercises combined with aerobic (60). It is proposed that adherence to proaches to FM.
exercise was superior. These findings these guidelines will optimise the vari-
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