Effects of exercise interventions on anxiety and depressive symptoms in patients with fibromyalgia: a traditional and network meta-analysis

OBJECTIVES: To systematically evaluate the therapeutic effects of exercise interventions on anxiety and depressive symptoms in patients with fibromyalgia syndrome, compare the efficacy across different exercise modalities, and provide an evidence-based reference for individualized exercise prescription in clinical practice. METHODS: We searched CNKI, VIP, Wanfang Data, SinoMed, Web of Science, PubMed, Cochrane Library and Embase from inception to August 25, 2025. Literature screening followed the PICOS framework, and methodological quality was assessed using the Cochrane Risk of Bias tool. A traditional pairwise meta-analysis estimated the overall efficacy. Heterogeneity was evaluated using the I² statistic, and either a fixed- or random-effects model was selected accordingly. Subgroup analyses, meta-regression, and leave-one-out sensitivity analyses were performed to explore heterogeneity sources and verify the robustness of the results. A network meta-analysis compared the relative efficacy of different exercise modalities. Inconsistency was examined to ensure evidence consistency. League tables were constructed for pairwise comparisons, and the surface under the cumulative ranking curve (SUCRA) was used to rank the interventions. Publication bias was assessed via funnel plots. RESULTS: 0.01). For anxiety, the largest pooled effect was observed with the State-Trait Anxiety Inventory (SMD=－0.651, 95%CI: －0.969 to －0.333), interventions lasting ≥17 weeks (SMD=－0.771, 95%CI: －1.207 to －0.278), 3-4 sessions/week (SMD=－0.588, 95%CI: －0.812 to －0.364), and 40 min/session (SMD=－0.556, 95%CI: －0.855 to －0.257). For depression, the largest effect was found with the Beck Depression Inventory (SMD=－0.758, 95%CI: －1.186 to －0.329), interventions of 9-12 weeks (SMD=－0.893, 95%CI: －1.484 to －0.303), 3-4 sessions/week (SMD=－1.199, 95%CI: －1.805 to －0.593), and ≥60 min/session (SMD=－0.708, 95%CI: －1.080 to －0.336). Network meta-analysis indicated that mind-body exercise ranked highest for anxiety (SUCRA=88.8%), while aerobic exercise ranked highest for depression (SUCRA=94.0%). Eight studies reported safety outcomes, with no serious adverse events. Sensitivity analyses confirmed the stability of the results, and funnel plots showed no significant publication bias. CONCLUSIONS: Exercise interventions are safe and effective in ameliorating anxiety and depressive symptoms in patients with fibromyalgia syndrome. Mind-body exercise and aerobic exercise may be the optimal choices for anxiety and depression, respectively, and their efficacy is associated with exercise prescription parameters.