Effects of exercise on pain, fatigue, and quality of life in people with fibromyalgia: a systematic review and meta-analysis of randomized controlled trials

Background An increasing number of studies have explored the effects of exercise on pain, fatigue, and quality of life (QOL) in fibromyalgia patients, yet the available results remain inconsistent. This study aimed to examine the effects of exercise on pain, fatigue, and QOL in fibromyalgia patients. Methods A comprehensive literature search, restricted to studies published up to 30 July 2025, was conducted across five databases: Embase, PubMed, Cochrane Library, Web of Science, and Scopus. The search utilized the following keywords: exercise, fibromyalgia, pain, fatigue, and quality of life. A meta-analysis was performed to calculate the standardized mean difference (SMD) and 95% confidence interval. Results Twenty-four studies were included in this meta-analysis. Exercise had a positive effect on alleviating pain (SMD, −0.77; p 0.00001), fatigue (SMD, −0.39; p = 0.03), and QOL (SMD, 0.53; p 0.00001) in fibromyalgia patients. Subgroup analyses showed that aerobic exercise (SMD, −0.83; p = 0.0002) conducted for ≥8 weeks (SMD, −0.73; p = 0.006), 3 times per week (SMD, −1.12; p = 0.0009), 60–90 min per session (SMD, −1.35; p = 0.0001), and 180 min per week (SMD, −0.96; p = 0.001) were more effective in alleviating pain. Conclusion Exercise significantly improved pain, fatigue, and QOL in fibromyalgia patients. To alleviate pain, fibromyalgia patients are recommended to engage in aerobic exercise for at least 8 weeks, 60–90 min per session, twice weekly, without exceeding 180 min weekly. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/view/CRD42023493753 .