Cognitive-Behavioral TherapyExerciseFibromyalgiaPain

Behavioral and exercise therapies for fibromyalgia

This review finds limited evidence of benefit from cognitive-behavioral therapy and exercise training programs.

First, the details.

  • Several databases were searched.
  • 30 studies of 2,446 patients were included.

And, the results on pain, disability, and mood.

Cognitive-behavioral therapy

  • 3 studies of educational programs reported no effect.
  • 2 of 3 studies of relaxation showed short-term positive effects for pain, but no benefit on disability or mood.
  • 3 of 5 studies of cognitive-behavioral therapy reported positive effects for at least one outcome, which was maintained at follow-up in 2 of the studies.


  • 7 of 10 studies of aerobic exercise alone reported improvement in at least 1 outcome.
    • But only 1 of 3 studies with long-term follow-up reported long-term improvements.
    • 1 also reported a negative effect on disability.
  • 2 of 3 studies of strength training reported positive effects on disability, but no effect on mood or pain.
  • All 5 studies of combined aerobic exercise with strength training reported positive treatment effects for pain and/or disability.
    • 2 of these reported long-term improvements.

Cognitive-behavioral therapy + exercise

  • 2 of 6 studies of education + exercise showed short-term improvement for at least 1 outcome
    • 2 also reported long-term improvements.
  • A study of relaxation + exercise reported benefits at follow-up for pain and disability vs the control group.
  • Both studies examining multi-method cognitive-behavioral therapy + exercise indicated improvements for all 3 outcomes post-treatment, with improvements maintained for pain at follow-up.

The bottom line?
The authors concluded, “The beneficial effects of non-pharmacological interventions appear limited.”

The Centre for Reviews and Dissemination takes an organized approach to reviewing the reviewers’ review and concludes, “It was not clear whether studies classified as showing a positive effect showed a statistically significant improvement in outcome measures or just an improvement. Sample sizes were small and dropout rates high in many of the studies. The analysis was further limited by methodological differences, including content and duration of the interventions, outcome measures and data analysis, and only 45% of the studies reported follow-up.”

9/7/08 19:09 JR

Hi, I’m JR

John Russo, Jr., PharmD, is president of The MedCom Resource, Inc. Previously, he was senior vice president of medical communications at, a complementary and alternative medicine website.