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Systematic Review March 27, 2025

Exercise Therapies for Fibromyalgia Pain Catastrophizing: A Systematic Review and Comparative Analysis

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Prim Care Companion CNS Disord 2025;27(2):24r03817

Abstract

Objective: To investigate the impact of various exercise modalities on the mitigation of pain catastrophizing in patients with fibromyalgia.

Data Sources: A systematic review with comparative analysis was conducted on May 22, 2024, utilizing Embase, PubMed, Scopus, Cochrane Library, and Web of Science.

Study Selection: The search resulted in 350 articles, of which 190 were duplicates. After duplicate removal, title and abstract appraisal was conducted followed by full-text appraisal. A total of 9 articles fit the inclusion/exclusion criteria.

Data Extraction: Usable statistics and relevant data points were extracted. Outcomes of interest were pain catastrophizing scores. The duration of treatment protocol and the number of exercise sessions per week were also extracted.

Results: Exercise intervention of any type showed a moderate impact on pain catastrophizing (d =0.58; 95% CI, 0.16–1.01; P < .01). Subgroup analysis showed varying effects. Yoga was not statistically significant but was the most clinically effective (d = 1.1; 95% CI, −0.48 to 2.69; P = .172). Pilates did not clinically or statistically reduce pain catastrophizing (d = 0.108; 95% CI, −0.522 to 0.738; P = .737). Resistance training, mixed aerobic-resistance exercise, aquatic therapy/exercise, and aerobic only all denoted a degree of clinically significant effectiveness (d = 0.559, 0.526, 0.548, and 0.226, respectively). Only mixed aerobic resistance training was significant (P = .046).

Conclusions: Exercise in general is a moderately effective treatment option to mitigate pain catastrophizing, although various treatment modalities may prove more practical than others due to their nature. High-effort, high intensity modalities may be less effective (Pilates) as lower-intensity modalities (aquatic therapy). Yoga, having the highest effect size, was the only modality which focuses on physical exercise as well as meditation and spirituality. More randomized trials are needed to further clarify the importance of mindfulness, spirituality, and meditation in combination with physical exercise for fibromyalgia patients who catastrophize.

Prim Care Companion CNS Disord 2025;27(2):24r03817

Author affiliations are listed at the end of this article.

  1. Maffei ME. Fibromyalgia: recent advances in diagnosis, classification, pharmacotherapy and alternative remedies. Int J Mol Sci. 2020;21(21):7877.
  2. Wolfe F, Clauw DJ, Fitzcharles MA, et al. The American College of Rheumatology preliminary diagnostic criteria for fibromyalgia and measurement of symptom severity. Arthritis Care Res (Hoboken). 2010;62(5):600–610. PubMed CrossRef
  3. Bhargava J, Hurley JA. Fibromyalgia. In: StatPearls. StatPearls Publishing; 2023.
  4. Vincent A, Lahr BD, Wolfe F, et al. Prevalence of fibromyalgia: a population-based study in Olmsted County, Minnesota, utilizing the Rochester Epidemiology Project. Arthritis Care Res (Hoboken). 2013;65(5):786–792. PubMed CrossRef
  5. Offenbaecher M, Kohls N, Ewert T, et al. Pain is not the major determinant of quality of life in fibromyalgia: results from a retrospective “real world” data analysis of fibromyalgia patients. Rheumatol Int. 2021;41(11):1995–2006.
  6. Ablin JN, Buskila D. Update on the genetics of the fibromyalgia syndrome. Best Pract Res Clin Rheumatol. 2015;29(1):20–28.
  7. Gota CE. Fibromyalgia: recognition and management in the primary care office. Med Clin North Am. 2021;105(2):285–296.
  8. Millea PJ, Holloway RL. Treating fibromyalgia. Am Fam Physician. 2000;62(7):1575–1587.
  9. Catalá P, Gutiérrez L, Écija C, et al. How to generate self-efficacy despite pain: the role of catastrophizing and avoidance in women with fibromyalgia. Biomedicines. 2023;12(1):47.
  10. Droppert KM, Knowles SR. The role of pain acceptance, pain catastrophizing, and coping strategies: a validation of the common sense model in females living with fibromyalgia. J Clin Psychol Med Settings. 2023;30(2):445–452.
  11. Varallo G, Scarpina F, Giusti EM, et al. The role of pain catastrophizing and pain acceptance in performance-based and self-reported physical functioning in individuals with fibromyalgia and obesity. J Pers Med. 2021;11(8):810.
  12. López-Gómez I, Velasco L, Gutiérrez L, et al. Symptoms in women with fibromyalgia after performing physical activity: the role of pain catastrophizing and disease impact. Clin Rheumatol. 2023;42(1):225–232.
  13. Lima LV, Abner TS, Sluka KA. Does exercise increase or decrease pain? Central mechanisms underlying these two phenomena. J Physiol. 2017;595(13):4141–4150. PubMed CrossRef
  14. Neelapala YV, Mercuri D, Macedo L, et al. Mechanisms hypothesized for pain relieving effects of exercise in fibromyalgia: a scoping review. Ther Adv Musculoskelet Dis. 2023;15:1759720X231182894.
  15. Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372:n71.
  16. Sullivan M, Bishop S, Pivik J. The Pain Catastrophizing Scale: Development and validation. Psychol Assessment. 1995;7(4):524–532. In press.
  17. Sarda J, Nicholas MK, Pereira IA, et al. Validation of the Pain-Related Catastrophizing Thoughts Scale. Acta Fisiatr. 2008;15(1):31–36. In press.
  18. Schünemann H, Brożek J, Guyatt G, et al, eds. GRADE Handbook for Grading Quality of Evidence and Strength of Recommendations. The GRADE Working Group; 2013. https://guidelinedevelopment.org/handbook
  19. GRADEpro GDT: GRADEpro Guideline Development Tool [Software]. McMaster University and Evidence Prime; 2024. https://gradepro.org
  20. Sterne JAC, Savović J, Page MJ, et al. RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ. 2019;366:l4898. PubMed CrossRef
  21. McGuinness LA, Higgins JPT. Risk-of-bias VISualization (robvis): an R package and Shiny web app for visualizing risk-of-bias assessments. Res Syn Meth. 2021;12:55–61.
  22. Carson JW, Carson KM, Jones KD, et al. A pilot randomized controlled trial of the Yoga of Awareness program in the management of fibromyalgia. Pain. 2010;151(2):530–539. PubMed CrossRef
  23. Glasgow A, Stone TM, Kingsley JD. Resistance exercise training on disease impact, pain catastrophizing and autonomic modulation in women with fibromyalgia. Int J Exerc Sci. 2017;10(8):1184–1195.
  24. Merriwether EN, Frey-Law LA, Rakel BA, et al. Physical activity is related to function and fatigue but not pain in women with fibromyalgia: baseline analyses from the Fibromyalgia Activity Study with TENS (FAST). Arthritis Res Ther. 2018;20(1):199. PubMed CrossRef
  25. Ceballos-Laita L, Mingo-Gómez MT, Navas-Cámara F, et al. Therapeutic exercise and pain neurophysiology education in female patients with fibromyalgia syndrome: a feasibility study. J Clin Med. 2020;9(11):3564.
  26. Izquierdo-Alventosa R, Inglés M, Cortés-Amador S, et al. Low-intensity physical exercise improves pain catastrophizing and other psychological and physical aspects in women with fibromyalgia: a randomized controlled trial. Int J Environ Res Public Health. 2020;17(10):3634.
  27. de Medeiros SA, de Almeida Silva HJ, do Nascimento RM, et al. Mat Pilates is as effective as aquatic aerobic exercise in treating women with fibromyalgia: a clinical, randomized and blind trial. Adv Rheumatol. 2020;60(1):21. PubMed CrossRef
  28. Hernando-Garijo I, Ceballos-Laita L, Mingo-Gómez MT, et al. Immediate effects of a telerehabilitation program based on aerobic exercise in women with fibromyalgia. Int J Environ Res Public Health. 2021;18(4):2075.
  29. Lazaridou A, Koulouris A, Devine JK, et al. Impact of daily yoga-based exercise on pain, catastrophizing, and sleep amongst individuals with fibromyalgia. J Pain Res. 2019;12:2915–2923. PubMed CrossRef
  30. Kumar A, Yadav RK, Venkataraman S, et al. Exploring pain status and flexibility in fibromyalgia patients: effect of 20 sessions of yoga therapy. Indian J Physiol Pharmacol. 2023;67:262–269.
  31. Chopra D, Stern E, Bushell WC, et al. Yoga and pain: a mind-body complex system. Front Pain Res. 2023;4:1075866.
  32. Kloubec J. Pilates: how does it work and who needs it? Muscles Ligaments Tendons J. 2011;1(2):61–66. PubMed
  33. Rodríguez-Domínguez ÁJ, Rebollo-Salas M, Chillón-Martínez R, et al. Clinical relevance of resistance training in women with fibromyalgia: a systematic review and meta-analysis. Eur J Pain. 2024;28(1):21–36.
  34. Bidonde J, Busch AJ, Schachter CL, et al. Mixed exercise training for adults with fibromyalgia. Cochrane Database Syst Rev. 2019;5(5):CD013340. PubMed CrossRef
  35. Zamunér AR, Andrade CP, Arca EA, et al. Impact of water therapy on pain management in patients with fibromyalgia: current perspectives. J Pain Res. 2019;12:1971–2007.
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