Rheumatology · Medical Literature
What is known about fitness, physical activity, health-related quality of life and muscle-strengthening activities in adults with fibromyalgia? A scoping review
Abstract
Objective To map the current evidence on components of fitness, physical activity and health-related quality of life, in addition to common fitness and health-related quality of life outcomes and assessment tools, explore existing evidence on the design and effects of muscle-strengthening activities on health-related quality of life, and map the research on the barriers and facilitators to engagement in physical activities, specifically muscle-strengthening activities, in adults living with fibromyalgia. Design Scoping review of published articles. Data sources Electronic databases (PubMed, SPORTDiscus, SCOPUS, CINAHL, Cochrane Library, MedLine and Google Scholar) and reference searching were included from the earliest date to March 2025. Eligibility criteria Studies were included if they assessed components of fitness, physical activity, health-related quality of life and/or muscle-strengthening activities in relation to fibromyalgia and were published in English. Articles containing reviews, case reports, protocols, editorials or opinion pieces were excluded. Results 79 articles were included in the scoping review. Compared with healthy controls, individuals with fibromyalgia have decreased muscle strength, cardiovascular fitness, agility, balance and flexibility levels of physical activity and health-related quality of life. The fibromyalgia impact questionnaire, 36-item short-form health survey and visual analogue scale were predominant tools used to assess health-related quality of life, though methods varied considerably across studies. Muscle-strengthening activity intervention study designs were heterogeneous, although progressions during resistance-based strength exercise emerged as a promising modality to improve health-related quality of life. Currently, the barriers to and facilitators of muscle-strengthening activities are underexplored. Conclusion This scoping review highlights substantial heterogeneity in health-related quality of life assessment
Clinical relevance
Fibromyalgia affects approximately 2–4% of the global adult population and is associated with profound reductions in physical function, fitness, and health-related quality of life (HRQoL), yet there is no consensus on optimal non-pharmacological management strategies, particularly regarding resistance and muscle-strengthening exercise. This scoping review addresses a critical gap by comprehensively mapping the current evidence on fitness components, physical activity levels, HRQoL outcomes, and—crucially—the understudied role of muscle-strengthening activities in this population. Rheumatologists and multidisciplinary pain clinicians should take note given the growing emphasis on exercise-based therapies and the persistent lack of standardized outcome assessment frameworks to guide clinical decision-making.
Key findings
1. Compared to healthy controls, adults with fibromyalgia demonstrate decreased performance across all major fitness domains assessed: muscle strength, cardiovascular fitness, agility, balance, and flexibility—though the abstract does not report specific effect sizes or between-group differences with confidence intervals. 2. Physical activity levels and HRQoL are both significantly reduced in individuals with fibromyalgia relative to healthy controls, consistent across the 79 included studies spanning the earliest available dates to March 2025. 3. The Fibromyalgia Impact Questionnaire (FIQ), 36-Item Short-Form Health Survey (SF-36), and Visual Analogue Scale (VAS) were the predominant tools used to assess HRQoL; however, considerable methodological heterogeneity was identified across studies, limiting cross-study comparability. 4. A total of 79 articles met eligibility criteria after searching seven electronic databases (PubMed, SPORTDiscus, SCOPUS, CINAHL, Cochrane Library, MEDLINE, and Google Scholar), representing a broad synthesis of the available global literature. 5. Muscle-strengthening activity intervention study designs were highly heterogeneous; nonetheless, progressive resistance-based strength exercise emerged as a promising modality for improving HRQoL in adults with fibromyalgia, though quantitative pooled effect estimates were not reported in the abstract. 6. The barriers to and facilitators of engagement in muscle-strengthening activities specifically remain substantially underexplored in the fibromyalgia literature, representing a major evidence gap identified by this review. NOTE: Specific effect sizes, confidence intervals, p-values, and NNT/NNH were not reported in the provided abstract; figures above reflect the scope and qualitative findings of the review as stated.
Practice implications
Rheumatologists and allied health professionals should consider incorporating progressive resistance-based strength training into individualized exercise prescriptions for adults with fibromyalgia, given its emerging signal of benefit for HRQoL; however, clinicians should be aware that current evidence is heterogeneous and that no single standardized protocol has been validated. When evaluating treatment response, use of consistent, validated HRQoL instruments—preferably the FIQ or SF-36 in combination with a pain VAS—is advisable to enable comparability with the existing literature and to facilitate longitudinal monitoring. Future clinical management should proactively address patient-reported barriers to muscle-strengthening activity (e.g., pain-related fear, fatigue, exercise intolerance) and integrate facilitators such as graded exercise progression and multidisciplinary support, areas currently lacking sufficient evidence to guide specific protocols.