Table 2.
Summary of studies using water therapy for FMS treatment
| Author (year) | PEDro score | Design | Primary outcome | Groups (number in each group) | Water therapy protocol | Exercise Intensity | Water temperature | Main results | Effect sizes (reported for pain) | Secondary outcomes | Main results of Secondary outcomes | Effect sizes (reported for pain) |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Altan et al (2004)53 | 8 | RCT | Pain, tender points, fatigue, sleep, stiffness, health-related quality of life, muscle endurance, patient-rated disability, clinician-rated disability, depression |
2 groups: Aquatic exercise (n=24) Balneotherapy (n=22) |
35 min/session, 3×/week 12 weeks Protocol: Aquatic exercise – warm-up aerobics, muscle activation exercises, stretching, relaxation Balneotherapy – no exercise |
Aquatic exercise: not reported Balneotherapy: no exercise |
37 °C | Aquatic exercise: significant decrease in pain (VAS and 5-point scale), fatigue (VAS and 5-point scale), morning stiffness, number of tender points, myalgic score, FIQ, sleep disorder, patient’s and physician’s global evaluation, and BDI. Significant increase in algometric score Balneotherapy: significant decrease in pain (VAS and 5-point scale), fatigue (VAS and 5-point scale), number of tender points, myalgic score, patient’s and physician’s global evaluation. Significant increase in algometric score. Significant difference between groups after 12 and 24 weeks for BDI favoring aquatic exercise group |
Aquatic exercise after 12 weeks: ain (VAS)=1.06; ain (5-point scale)=0.99; number of tender points=2.11; myalgic score=1.62; FIQ=0.83; algometric score=0.62. Aquatic exercise after 24 weeks: pain (VAS)=1.01; pain (5-point scale)=1.18; number of tender points=1.97; myalgic score=1.32; FIQ=0.74; algometric score=0.78. Balneotherapy after 12 weeks: pain (VAS)=1.08; pain (5-point scale)=1.28; number of tender points=2.15; myalgic score=2.00; FIQ=0.62; algometric score=0.93. Balneotherapy after 24 weeks: pain (VAS)=0.54; pain (5-point scale)=0.82; number of tender points=1.18; myalgic score=0.91; FIQ=0.30; algometric score=0.60. |
NA | Aquatic exercises and balneotherapy significantly decreased pain. Aquatic exercises proved longer-lasting effects. There was no superiority of aquatic exercises over balneotherapy | NA |
| Andrade et al (2018)54 | 9 | RCT | Peak oxygen uptake, PPT, pain (VAS) | 2 groups: Aquatic exercise (n=27) No exercise control (n=27) |
45 min/session 2×/week 16 weeks Protocol: warm-up, stretching, aerobic exercises (30 min), resistance exercises of upper limbs using floats (5 min), relaxation (5 min) |
Aerobics: three HR percentages reached at VAT. Level 1: lower limb exercises sitting on floats (5 min) at 80% VAT HR; level 2: jumping on a trampoline (10 min) at 110% VAT HR; level 3: exercises in aquatic cycle with resistance adjustment at 100% VAT HR (10 min) | 30 °C (±2°C) | Aquatic exercise: significant increase in relative VO2, PPT, VAS well-being, and decrease in VAS pain and FIQ scores. No-exercise control group: did not present any significant improvement |
Aquatic exercise: PPT=0.31; VAS pain=−0.20. No-exercise control group: PPT=−0.33; VAS pain=0.43 |
NA | Aquatic exercise: PPT=0.31; VAS pain=−0.20. No-exercise control group: PPT=−0.33; VAS pain=0.43 |
Not reported |
| Arcos-Carmona et al (2011)55 | 8 | RCT | Sleep, pain, fatigue, health-related quality of life, self-rated physical function, mental health, anxiety, depression | 2 groups: Experimental (n=27) Placebo control (n=26) |
60 min/session 2×/week 10 weeks Protocol: Experimental –30 min of pool-based aerobic exercises and Jacobson relaxation Placebo control –20 min of sham magnet therapy applied at cervical (10 min) and lumbar (10 min) spine. |
Not reported | 28 ºC | Experimental group: SF-36 scores were lower after intervention Placebo control group: no significant differences from baseline |
Not reported | Not reported | Not reported | Not reported |
| Assis et al (2006)56 | 9 | RCT | Pain (VAS) | 2 groups: DWR (n=26) land-based exercises (n=26) |
60 min/session, 3×/week 15 weeks Protocol: a) stretching warm-up (10 min), DWR aerobic training (40 min), relaxation (10 min); b) land-based exercises – stretching warm-up (10 min), aerobic training on a treadmill (40 min), relaxation (10 min) |
DWR: first 2 weeks: low-intensity exercises for adaptation. Then, exercises performed at the anaerobic threshold level controlled by HR Land-based exercises: first 2 weeks: low-intensity exercises for adaptation. Then, exercises performed at the anaerobic threshold level controlled by HR |
28–31 °C | DWR: significant improvement in pain (VAS) Land-based exercises: significant improvement in pain (VAS) |
Not reported | Patient global assessment of response to therapy on a 5-point scale; SF-36; BDI; and FIQ | NA | NA |
| Avila et al (2017)28 | 5 | Single-arm clinical trial | Scapular three-dimensional motion measured with electromagnetic tracking device (Flock of Birds) | 1 group: (n = 20) |
45 min/session, 2×/week 16 weeks Protocol: stretching, warm-up, aerobics, muscle activation exercises, stretching, relaxation |
Patient determined | 31 °C (±2 °C) | No significant changes in scapular kinematics | NA | Pain, quality of life, function | Pain significantly decreased (lower NPRS and PPT), function (lower FIQ scores), and quality of life (greater SF-36 scores for most domains) significantly improved | PPT: 041–1.61 NPRS: −1.41 to −1.93 |
| Biezus et al (2006)57 | 5 | RCT | Pain (VAS) | 3 groups: GA – general aquatic exercises (n=5) GB –passive aquatic relaxation (n=5) GC –control (n=6) |
60 min/session, 2×/week 8 weeks Protocol: GA – warm-up, strengthening, stretching, and relaxation. Number of exercises in each therapy was approximately 13 GB – passive aquatic relaxation. TheExercises were done slowly and smoothly GC – no physical therapy intervention |
Not reported | 32 °C | Aquatic exercises and aquatic relaxation significantly decreased pain. However, aquatic exercises provided greater pain decrease than the aquatic relaxation program | GA – general aquatic exercises: d=0.55 GB – passive aquatic relaxation: d=1.26 GC – control group: d=0.20 |
NA | NA | NA |
| Bote et al (2014)58 | 7 | RCT | Neutrophil function | 2 groups: Aquatic exercise program (n=10) Control no exercise (n=10) |
60 min/session, 2×/week 32 weeks Protocol: stretching out of the water (5 min), aerobic warm-up in the water (5 min), passive stretching of the main muscle groups in the water (5 min), aerobic aquatic choreography (25 min), strength exercises involving the main muscle groups of the upper limbs (15 min), and cool-down (10 min) |
Parts (a), (b), (c), and (f) were performed at low exercise intensity (40–50% maximal HR). Part (d) was performed at low-to-moderate intensity (50–60% maximal HR) at the beginning of the program, and with increased intensity at the end of the program (65–75% maximal HR) | 32 °C | Aquatic exercise group had lower concentrations of IL-8 and noradrenaline together with reduced chemotaxis of neutrophils compared with the values determined in the same month in the control group of nonexercised FMS women | Not reported | Weight, body mass index, waist-to-hip ratio, body fat, flexibility, grip strength, balance, 6MWT, FIQ | Significant decrease of weight, body mass index, body fat and FIQ. Significant increase in grip strength | Not reported |
| Calandre et al (2009)59 | 7 | RCT | FIQ and PSQI | 2 groups: Stretching in water (n=39) Ai Chi–water Tai Chi (n=42) |
60 min/session, 3×x/week 6 weeks Protocol: stretching performed over muscles of main body areas: cervical, upper, and lower extremities and trunk; Ai Chi: 16 movements which constitute the Tai Chi therapy |
Adjusted according to the degree of pain and fatigue Adjusted according to the degree of pain and fatigue |
36 °C | Significant reduction in the FIQ and PSQI scores observed in Ai Chi but not in stretching group, with longer effect duration on sleep measures | Stretching in water: FIQ total score (d=0.35), FIQ-VAS (d=0.26), PSQI total scores (d=0.28) Ai Chi–water Tai Chi: FIQ total score (d=0.53), FIQ-VAS (d=0.53), PSQI total scores (d=0.72) |
FIQ difficulty at work, fatigue, morning tenderness, stiffness, anxiety, and depression | BDI decreased in stretching but not in Ai Chi group. Trait-anxiety scores decreased in both groups | Stretching in water: FIQ difficulty at work (d=0.26), fatigue (d=0.21), morning tenderness (d=0.26), stiffness (d=0.17), anxiety (d=0.25). and depression (d=0.32) Ai Chi–water Tai Chi: FIQ difficulty at work (d=0.47), fatigue (d=0.64), morning tenderness (d=0.29), stiffness (d=0.58), anxiety (d=0.32), and depression (d=0.43) |
| Carbonel-Baeza et al (2010)60 | 6 | RCT | Tender points, blind flamingo test, chair stand test, body composition, chair sit and reach, back scratch, 8 feet up andgo, handgrip strength, and 6MWT | 2 groups: Intervention (n=27) Usual care (n=32) |
120 min/session, 1×/week 12 weeks Protocol: a) verbal phase (35–45 min); b) moving/dancing according both to the suggestion given by the facilitator and the music played (75–80 min) Usual care: asked not to change their activity levels and medications during the 12-week intervention period |
Adjusted according to the degree of pain and fatigue Intervention intensity was controlled by the RPE based on Borg’s conventional (6–20-point) scale. The medium values of RPE were 11±1. These RPE values correspond to a subjective perceived exertion of “fairly light exertion,” that is, low intensity |
Not reported | Biodanza intervention reduced pain and FM impact (measured by FIQ). There was significant decrease in body fat percentage. There was no significant improvement in physical fitness tests. The program was well tolerated and did not have any deleterious effects on the patients’ health | Not reported | NA | NA | NA |
| Cuesta-Vargas et al (2011)61 | 5 | Nonrandomised pilot clinical trial | FIQ | 2 groups: MMPP+DWR (n=22) Control (n=22) |
60 min/session, 3×/week 8 weeks Protocol: land-based exercises (stretching of tonic muscle and strengthening of phasic muscles combined with advice and education – 30 min) and DWR (30 min) Control: waiting list (no intervention) |
Exercise training at anaerobic threshold determined by a graded treadmill exercise test and DWR test with lactate and HR analyses | 28–31 °C | Significant decrease in FIQ | Not reported | SF-12: physical component, mental component, EuroQoL-5D, EuroQoL-VAS | Significant improvement in pain, physical function, sleep, fatigue, morning stiffness, quality of life, and psychological symptoms (depression and anxiety) |
Not reported |
| De Andrade et al (2008)62 | 9 | RCT | Pain intensity, fatigue, number of tender points, physical functional capacity, general health status, sleep quality and depression | 2 groups: Pool-based exercises (n=23) Thalassotherapy (n=23) |
60 min/session, 3×/week 12 weeks The program was composed of 10-min stretching, 40 min of various forms of low-impact aerobic exercise according to the desired intensity, and then a 10-min relaxation period |
Patients were monitored each for 10 min and were oriented to remain between levels 12 and 13 on BORG scale (from light to moderate). The first 2 weeks were used for familiarization, with light-intensity exercises only (between levels 10 and 11 on BORG scale) and learning the exercises. When pain occurred while they were exercising, patients were taught to decrease the intensity for a short time | Pool-based exercises (28–33 °C) Thalassotherapy (28–33 °C) |
There was a statistically significant improvement in pain, fatigue, tender points, FIQ, PSQI, and BDI in both groups. Improvement in BDI was greater in the thalassotherapy group | Not reported | NA | NA | NA |
| Evcik et al (2008)63 | 5 | RCT | Number of tender points, pain, depression, and functional capacity |
2 groups: Home-based exercise program (n=30) Aquatic exercise program (n=33) |
60 min/session 3×/week 5 weeks Protocol.: home-based exercise program: warm-up, ROM, relaxation, aerobic, stretching, and cool-down exercises. Aquatic exercise program: warm-up (20 min), aerobic exercises, active ROM, stretching, relaxation (35 min) and cool-down (5 min) |
Not reported | 33 °C | Both aquatic therapy and home-based aerobic exercise programs improved well-being, quality of life, and pain parameters in FMS. Aquatic therapy seems to have more advantage in long-term pain management | Not reported | NA | NA | NA |
| Fernandes et al (2016)64 | 9 | RCT | Pain (VAS) | 2 groups: Swimming (n=39) Walking (n=36) |
50 min/session 3×/week 12 weeks Protocol for both groups: warm-up (5 min), exercise (40 min), and cool-down (5 min) Swimming: freestyle swimming without floatation devices Walking: open-air walking |
Swimming group: HR was kept at 11 beats below the anaerobic threshold Walking group: HR was kept at the anaerobic threshold |
Not reported | Swimming, like walking, is an effective method for reducing pain in patients with FM | Not reported for intragroup comparisons. Effect size=0.168 for between-group comparison | Not reported | Swimming, like walking, is an effective method for improving both functional capacity and quality of life in patients with FM | Not reported |
| Gowans et al (2001)65 | 8 | RCT | BDI and 6MWT | 2 groups: Supervised exercise (n=15) Control (n=16) |
30 min/session 3×/week 23 weeks Protocol: stretching (5 min before and 5 min after exercise) and aerobic exercise (20 min) |
The aerobic component of the classes was designed to generate HRs equivalent to 60–75% of age-adjusted maximum HRs (210 – age [years]) | Not specified: “a warm therapeutic pool” |
There were significant improvements for exercise group subjects in 6MWT distances and BDI | Not reported | Anxiety, general mental health, number of tender points, isokinetic maximal voluntary strength, FIQ, and self-efficacy | There was a significant improvement in anxiety, FIQ, self-efficacy, and mental health | Not reported |
| Gusi et al (2006)66 | 6 | RCT | Pain, isokinetic muscle strength, health-related quality of life, spare time and work activities | 2 groups: Exercise (n=17) Control (n=17) |
60 min/session 3×/week 12 weeks Protocol: exercise – warm-up (10 min), aerobic exercises (10 min), overall mobility and lower-limb strength exercises (20 min), another set of aerobics (10 min), and cool-down (10 min) Control – follow normal daily activities, which did not include any form of exercise related to those in therapy |
Aerobic exercises were performed at 65–75% of maximal HR | 33 °C | Therapy relieved pain and improved HRQOL and muscle strength in the lower limbs at low velocity | Not reported | NA | NA | NA |
| Hecker et al (2011)67 | 9 | RCT | Quality of Life (SF-36) | 2 groups: Kinesiotherapy (n=12) Hydrokinesiotherapy (n=12) |
60 min/session 1×/week 23 weeks Protocol: muscle stretching exercises (15 min); passive and active movement of the lower limbs, upper limbs, trunk, and neck (30 min); and same stretching exercises performed at beginning of session (15 min) |
Not reported objectively (low intensity during the entire protocol) | 32–34 °C | No significant differences between groups after the intervention program. Both groups improved physical functioning, pain, social aspects, and mental health. Hydrokinesiotherapy group improved also emotional aspects, while the kinesiotherapy group improved physical aspects | Not reported | NA | NA | NA |
| Ide et al (2008)68 | 6 | RCT | PAIN (VAS – 10 cm, number of tender points) | 2 groups: ARG (n=18) CG (n=17) |
Both groups: 60 min/session, 1×/week, 4 weeks: supervised recreational activities (involved no exercises or health-related issues) ARG: 60 min/session, 4×/week; 4 weeks: warm-up, general exercises targeting specific breath patterns (45 min), and relaxation exercises |
Not specified | 32 °C | Decrease in pain (lower VAS scores); no difference in tender points count | Not reported | Dyspnea, function, quality of life, anxiety, sleep | Improvement in dyspnea (lower VAS scores), sleep quality (lower PSQI scores), anxiety (lower HAS scores), function (lower FIQ scores), and quality of life (greater SF-36 values) | NA |
| Jentoft et al (2001)69 | 5 | RCT | Function (FIQ) | 2 groups: PE (n=18) LE (n=16) |
60 min/session, 2×/week, 20 weeks. Both groups: body awareness training, ergonomics, warm-up, stretching, strengthening exercises, relaxation. Pool-based exercise group performed adapted protocol in water | 60–80% of maximum HR for age (during 40–50% of session) | 34 °C | No differences between groups for function; function equally improved for both groups (lower FIQ scores) | NA | Pain (FIQ pain subscore and VAS for local pain), self-efficacy, cardiovascular capacity, grip strength, walking time and endurance time of shoulder muscles | Improved grip strength (hand-held dynamometry) in LE group; within-group improvements in cardiovascular capacity (maximum O2 uptake), and walking time (s/100 m); within-group improvements in the PE group for several FIQ subscales including pain, anxiety, and depression |
Not reported |
| Kesiktas et al (2011)70 | 3 | Quasi-randomized trial | Pain (tender points count, VAS – 10 cm, and total PPTon tender points) | 2 groups: PTM+BT (n=16) PTM (n=20) PTM+HT (n=20) |
PTM: 36 min/session, 5×/week, 3 weeks: conventional TENS (15 min), ultrasound (6 min). and infrared (15min); PTM+BT: PTM added to 19 sessions of thermal pool bath (20 min of immersion/session); PTM+HT: PTM added to 20-min sessions of hydrotherapy (protocol not described) |
Not specified | Thermal pool bath: 37–38 °C Hydrotherapy: 37 °C |
Total PPT was lower for PTM+BT (compared to PTM+HT); improvement in pain symptoms (lower VAS, total PPTs and tender point count) was observed for all groups after treatment and only for PTM+BT and PTM+HT in the follow-up (after 6 months) |
Not reported | Depression, pulmonary function | Improvement in depressive symptoms (lower BDI and HDRS scores) for all groups after treatment; only PTM+BT maintained better scores at follow-up; pulmonary function only improved for PTM+BT and PTM+HT groups after treatment, but only PTM+BT maintained improved pulmonary function at follow-up | NA |
| Latorre et al (2013)30 | 5 | Nonrandomized clinical trial | Pain (tender point count, VAS – 10 cm, PPT over tender points) | 2 groups: EG (n=48) CG (n=37) |
CG: no activities or exercises other than usual, and none similar to EG protocol EG: 60 min/session, 3×/week (2×/week pool exercises and 1×/week land exercises), 24 weeks Protocol: warm-up, exercises of muscular strengthening, aerobic exercises, cool-down |
Not specified (controlled by Borg scale) | Not reported | EG significantly improved pain symptoms (lower VAS scores, greater PPT and reduced number of tender points) | Not reported | Functional capacity, body composition, and quality of life | EG improved functional capacity (greater hand-held grip dynamometry values, greater maximum O2 uptake, greater agility and balance indexes), quality of life (greater FIQ scores), and body composition (reduced fat percentage) | NA |
| Latorre Román et al (2015)71 | 6 | RCT | Pain (tender point count, VAS – 10 cm, PPT over tender points) | 2 groups: EG (n=20) CG (n=16) |
CG: no activities or exercises other than usual, and none similar to EG protocol EG: 60 min/session, 3×/week (2×/week pool exercises and 1×/week land exercises), 18 weeks Protocol: warm-up, exercises of muscular strengthening and balance, cool-down |
Patient determined | 30 °C | EG significantly improved pain symptoms (lower VAS scores, greater PPT and reduced number of tender points) | Not reported | Impact of fibromyalgia, strength, and balance | EG significantly improved: lower impact of fibromyalgia (lower FIQ scores), greater strength (leg and handgrip) and balance (agility dynamic and balance) | NA |
| Letieri et al (2013)72 | 6 | RCT | Pain (VAS – 10 cm) | 2 groups: HG (n=33) CG (n=33) |
45 min/session, 2×/week, 15 weeks. Protocol: warm-up, strengthening, balance, coordination and agility exercises, stretching, and relaxation |
Moderate according to the perceived effort modified scale | 33 °C | Decrease in pain (lower VAS scores) | Not reported | Quality of life, depressive symptoms | Improved quality of life (lower FIQ scores) and depressive symptoms (lower BDI scores) | NA |
| López-Rodríguez et al (2013)73 | 6 | RCT | Pain (VAS – 10 cm, MPQ, PPT) | 2 groups: ABD (n=29) CG (n=30) |
60 min/session, 2×/week; 12 weeks. Protocol: ABD – flexibility and breathing exercises, rhythmic dancing movements, and mild exercises; CG – stretching exercises for different body parts |
Not specified | 29 °C (preceded by a bath of 33–35 °C) | Decrease in pain (lower VAS and MPQ scores and lower number of active tender points for PPT) | Not reported | Sleep, anxiety, depression, function | Improvement in sleep quality (lower PSQI scores), anxiety (lower SAI scores), function (lower FIQ scores) for ABD | NA |
| Mannerkorpi et al (2000)74 | 4 | Quasi-randomized clinical trial | Impact of fibromyalgia (FIQ – total score), physical capacity (6MWT) | 2 groups: TG (n=37) CG (n=32) |
35 min/session, 1×/week, 24 weeks. Protocol: exercises for endurance, flexibility, coordination, and relaxation along with education sessions (6 sessions, 1 h/session) |
Patient determined | Not reported | Decreased fibromyalgia impact (lower FIQ total scores) and improved physical capacity (better scores in the 6MWT) | NA | FIQ subscores (including pain), pain, quality of life, self-efficacy, functional limitations | TG significantly improved physical functioning (lower FIQ subscores), anxiety (lower FIQ and AIMS subscores), depression (lower AIMS subscores), strength (greater grip strength), general health (greater SF-36 scores), social functioning (greater SF-36 scores), and pain (lower scores for pain severity and affective distress for the MPI-S) | Not reported |
| Mannerkorpi et al (2009)75 | 8 | RCT | Impact of fibromyalgia (FIQ – total score), physical capacity (6MWT) | 2 groups: Ex-Edu (n=81) Edu (n=85) |
45 min/session, 1×/week, 20 weeks. Protocol: exercises for endurance, flexibility, coordination, and relaxation along with education sessions (6 sessions, 1 h/session) |
48–65% of maximum HR (light to moderate intensity) | 33 °C | Decreased fibromyalgia impact (lower FIQ total scores) and improved physical capacity (better scores in the 6MWT) | NA | FIQ subscores (including pain), pain, quality of life, anxiety and depression, leisure-time physical activity, stress, fatigue | Significant improvement for change in pain (lower FIQ pain subscores) and for leisure time (decreased LTPAI scores) | 0.69 (0.45 for the intention-to-treat analysis) |
| Munguía-Izquierdo and Legaz-Arrese (2007)76 | 7 | RCT | Tender point count, PPT on the tender points, and FIQ pain subscore (VAS – 100 mm) | 3 groups: Ex (n=35) CG (n=25) Healthy group (n=25) |
60 min/session, 3×/week, 16 weeks Protocol: warm-up with slow walks and mobility exercises, strength exercises, aerobic exercises, and cool-down |
50–80% of predicted maximum HR according to age | 32 °C | Decreased pain (reduced number of tender points, increased PPT over all tender points, and reduction in FIQ pain subscore) compared to control group | Not reported | Severity of FM and cognitive function | Improvement of FM severity (lower FIQ scores) and in cognitive function (improvement in neuropsychological tests) | NA |
| Munguía-Izquierdo and Legaz-Arrese (2008)77 | 8 | RCT | Tender point count, PPT over tender points, health status (FIQ) | 3 groups: Ex (n=35) CG (n=25) Healthy group (n=25) |
60 min/session, 3×/week, 16 weeks Protocol: warm-up with slow walks and mobility exercises, strength exercises, aerobic exercises, and cool-down |
50–80% of predicted maximum HR according to age | 32 °C | Decreased pain (reduced number of tender points, increased PPT over all tender points) compared to control group, Improvement in health status (lower FIQ scores) | Not reported | Anxiety, sleep quality, cognitive function, physical function | Improvement in sleep quality (lower PSQI scores), cognitive function (greater PASAT scores) and physical function (increased muscle endurance for upper and lower limbs) | NA |
| Pérez de la Cruz and Lambeck (2016)78 | 3 | Pilot study | VAS (10 cm) for pain | 1 group: FMS (n=20) |
45 min/session, 2/week, 10 weeks Protocol: warm-up, Ai Chi program, cool-down |
Not reported | 33 °C±0.5 °C | Significant improvement in pain (lower VAS scores) | Not reported | Health-related quality of life | Improved quality of life (increased scores in all domains of SF-36 except role physical and role emotional) | NA |
| Piso et al (2001)54 | 4 | Case–control study | PPT over tender points | 2 groups: Sauna (n=9) HT (n=9) |
30 min/session, 2×/week, 6 weeks. Protocol: bodily awareness exercises, low-impact strength exercises |
Patient determined | Sauna: 90 ºC HT: 35 °C |
No significant differences comparing groups; significant improvement in PPT only for sauna group | Not reported | Previous treatment | Out of 18, 12 patients consider HT as first-choice treatment | NA |
| Santana et al (2010)53 | 1 | Analytical clinical trial | FM impact and pain over tender points | 2 groups: Ai Chi (n=5) CG (n=5) |
40 min/session, 10 sessions (number of weeks not specified) Protocol: Ai Chi program (sequence of slow and wide movements with upper limbs, lower limbs, and trunk, emphasizing deep breathing during the exercises) |
Not reported | 34–36 °C | No significant improvement was observed for intervention group compared to CG | Not reported | NA | NA | NA |
| Segura-Jiménez et al (2013)79 | 2 | Uncontrolled clinical trial | Tender point count and immediate pain (VAS – 10 cm) | 1 group: FMS (n=33) |
45 min/session, 2×/week, 12 weeks Protocol: warm-up, general exercises (on Mondays: strength; on Wednesdays: balance), stretching, and relaxation |
RPE (Borg): 12±2 points | 34 °C | Improvement in immediate pain (decreased VAS scores) | Not reported | Body composition | No differences were observed in body composition | NA |
| Sevimli et al (2015)80 | 5 | RCT | Pain (VAS – 100 mm) | 3 groups: ISSEP (n=25) AEP (n=25) AAEP (n=25) |
ISSEP: 15 min/day (3 months) of home-based stretching and strength exercises AEP and AAEP: 40–50 min/session, 2×/week, 12 weeks Protocol not described for AEP and AAEP |
60–80% maximal HR | Not reported | Pain improved for AEP and AAEP (lower VAS after treatment) | Not reported | Health status, endurance, quality of life, depression | Improvement in quality of life (greater SF-36 scores), depression (lower BDI scores), health status (lower FIQ scores) and endurance (greater scores for 6MWT) for AAEP and AEP | NA |
| Tomas-Carus et al (2007)81 | 7 | RCT | FM impact (FIQ total score) | 2 groups: EG (n=17) CG (n=17) |
60 min/session, 3×/week, 12 weeks Protocol: warm-up, mobility exercises, aerobic exercises, lower limb exercises, cool-down exercises, and relaxation |
60–65% maximal hear rate | 33 °C | Improvement of FM impact (lower FIQ scores) | NA | FIQ subscores (including pain) | Improvement of all FIQ subscores (lower scores for all, including pain) | Not reported |
| Tomas-Carus et al (2009)82 | 7 | RCT | FM impact (FIQ total score and subscores, including pain) and anxiety state (STAI) | 2 groups: EG (n=15) CG (n=15) |
60 min/session, 3×/week, 24 weeks Protocol: warm-up, mobility exercises, aerobic exercises, lower limb exercises, cool-down exercises |
60–65% maximal hear rate | 33 °C | Significant reduction of FM impact (lower FIQ total scores, and FIQ pain subscores) | Treatment effect of −0.5 (−1.8 to 0.7) for the FIQ pain subscore | Physical fitness | Improvement of physical fitness (increase in maximal oxygen uptake, and increased scores for mobility and balance tests) | NA |
| Trevisan et al, (2015)31 | 1 | Single-arm study | Postural control (center of pressure sway) | 1 group: FMS (n=17) |
45 min/session, 2×/week, 16 weeks. Protocol: familiarization, warm- up, exercises (aerobic and strength exercises for upper and lower limbs and trunk), cool-down stretching, and relaxation |
Patient determined | 30 °C ±2 °C | Improvement in postural sway (lower center of pressure sway in different situations) | NA | Pain (VAS – 100 mm during rest and movement) and function (FIQ) | Improvement in pain (lower VAS scores) and function (lower FIQ scores) | VAS: Rest: −2.12 (−2.90 to −1.23) Movement: –1.94 (−2.70 to −1.08) |
Abbreviations: 6MWT, 6-min walking test; AAEP, pool-based aquatic aerobic exercise program; ABD, aquatic biodance; AEP, gymnastic-based aerobic exercise program; AIMS, Arthritis Impact Measurement Scales; ARG, aquatic respiratory exercise-based program; BDI, Beck Depression Inventory; CG, control group; DWR, deep water running; Edu, education group; EG, exercise group; EuroQoL-5D, EuroQol Research Foundation Quality of Life Questionnaire; EuroQoL-VAS, EuroQol Research Foundation Quality of Life Questionnaire Visual Analog Scale; Ex, exercise group; Ex-Edu, exercise and education group; FIQ, Fibromyalgia Impact Questionnaire; FMS, fibromyalgia syndrome; HAS, Hamilton Anxiety Scale; HDRS, Hamilton Depression Rank Scale; HG, hydrotherapy group; HR, heart rate; HRQOL, health-related quality of life; HT, hydrotherapy; ISSEP, home-based isometric strength and stretching exercise program; LE, land-based exercise group; LTPAI, leisure-time physical activity instrument; MMPP+DWR, multimodal physiotherapy program+deep water running; MPI-S, Multidimensional Pain Inventory – Swedish Version; MPQ, McGill Pain Questionnaire; NA, not applicable; NPRS, numerical pain rating scale; PASAT, Paced Auditory Serial Addition Task; PE, pool-based exercise group; PPT, pressure pain threshold; PSQI, Pittsburgh Sleep Quality Index; PTM, physical therapy modalities; PTM+BT, photobiomodulation+balneotherapy; PTM+HT, photobiomodulation+hydrotherapy; RCT, randomized controlled trial; ROM, range of motion; RPE, rate of perceived exertion; SAI, State Anxiety Inventory; SF-36, Medical Outcomes Study 36-item Short Form Health Survey; STAI, State-Trait Anxiety Inventory; TENS, transcutaneous electrical nerve stimulation; TG, training group; VAS, visual analog scale; VAT, ventilatory anaerobic threshold; VO2, oxygen uptake.