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Referencias

Alentorn‐Geli 2008 {published data only}

Alentorn‐Geli E, Padilla J, Moras G, Lazaro Haro C, Fernandez‐Sola J. Six weeks of whole‐body vibration exercise improves pain and fatigue in women with fibromyalgia. Journal of Alternative & Complementary Medicine 2008;14(8):975‐81. CENTRAL
Alentorn‐Geli, E. PROTOCOL: Effects of Whole‐Body Vibration Exercise on Serum IGF‐1 in Fibromyalgia. ClinicalTrials.gov March 31, 2008; Vol. NCT00650715. CENTRAL

Gusi 2010 {published data only}

Adsuar JC, Del Pozo‐Cruz B, Parraca JA, Olivares PR, Gusi N. Whole body vibration improves the single‐leg stance static balance in women with fibromyalgia: a randomized controlled trial. Journal of Sports Medicine & Physical Fitness 2012;52(1):85‐91. CENTRAL
Gusi N, Parraca JA, Olivares PR, Leal A, Adsuar JC. Tilt vibratory exercise and the dynamic balance in fibromyalgia: a randomized controlled trial. Arthritis Care Research 2010;62(8):1072‐8. CENTRAL
Gusi, N. PROTOCOL: Prevention of Muscular Strength and Balance Loss and Osteoporosis Using Whole‐Body Vibration in Women with Fibromyalgia. Current Controlled Trials assigned: 12/02/2008; Vol. http://www.controlled‐trials.com/ISRCTN16950947:DOI: 10.1186/ISRCTN16950947. CENTRAL
Olivares PR, Gusi N, Parraca JA, Adsuar JC, Del Pozo‐Cruz B. Tilting whole body vibration improves quality of life in women with fibromyalgia: a randomized controlled trial. Journal of Alternative and Complementary Medicine 2011;17(8):723‐8. CENTRAL

Sañudo 2010 {published data only}

Sañudo B, de Hoyo M, Carrasco L, McVeigh JG, Corral J, Cabeza R, et al. The effect of 6‐week exercise programme and whole body vibration on strength and quality of life in women with fibromyalgia: a randomised study. Clinical & Experimental Rheumatology 2010;28(6 Suppl 63):S40‐5. CENTRAL
Sañudo B, de Hoyo M, Carrasco L, Rodriguez‐Blanco C, Oliva‐Pascual‐Vaca A, McVeigh JG. Effect of whole‐body vibration exercise on balance in women with fibromyalgia syndrome: a randomized controlled trial. Journal of Alternative and Complementary Medicine 2012;18(2):158‐64. CENTRAL

Sañudo 2013 {published data only}

Sañudo B, Carrasco L, de Hoyo M, Oliva‐Pascual‐Vaca Á, Rodríguez‐Blanco C. Changes in body balance and functional performance following whole‐body vibration training in patients with fibromyalgia syndrome: a randomized controlled trial. Journal of Rehabilitation Medicine2013; Vol. 45, issue 7:678‐84. CENTRAL

Ahlgren 2001 {published data only}

Ahlgren C, Waling K, Kadi F, Djupsjobacka M, Thornell L, Sundelin G. Effects on physical performance and pain from three dynamic training programs for women with work‐related trapezius myalgia. Journal of Rehabilitation Medicine 2001;33(4):162‐9. CENTRAL

Alentorn‐Geli 2009 {published data only}

Alentorn‐Geli E, Moras G, Padilla J, Fernandez Sola J, Bennett RM, Lazaro Haro C, et al. Effect of acute and chronic whole‐body vibration exercise on serum insulin‐like growth factor‐1 levels in women with fibromyalgia. Journal of Alternative & Complementary Medicine 2009;15(5):573‐8. CENTRAL

Altan 2004 {published data only}

Altan L, Bingol U, Aykac M, Koc Z, Yurtkuran M. Investigation of the effects of pool‐based exercise on fibromyalgia syndrome. Rheumatology International 2004;24(5):272‐7. CENTRAL

Altan 2009 {published data only}

Altan L, Korkmaz N, Bingol U, Gunay B. Effect of Pilates training on people with fibromyalgia syndrome: a pilot study. Archives of Physical Medicine and Rehabilitation 2009;90(12):1983‐8. CENTRAL

Amanollahi 2013 {published data only}

Amanollahi A, Naghizadeh J, Khatibi A, Hollisaz MT, Shamseddini AR, Saburi A. Comparison of impacts of friction massage, stretching exercises and analgesics on pain relief in primary fibromyalgia syndrome: a randomized clinical trial [Farsi]. Tehran University Medical Journal 2013;70(10):616‐22. CENTRAL

Andrade 2016 {published data only}

Andrade SC, Freitas RP, de Brito Vieira WH. Transcutaneous electrical nerve stimulation (TENS) and exercise: strategy in fibromyalgia treatment. Rheumatology International2016; Vol. 34, issue 4:577‐8. CENTRAL

Ang 2007 {published data only}

Ang D, Kesavalu R, Lydon JR, Lane KA, Bigatti S. Exercise‐based motivational interviewing for female patients with fibromyalgia: a case series. Clinincal Rheumatology 2007;26(0770‐3198 [Print], 11):1843‐9. CENTRAL

Aquino 2013 {published data only}

Aquino JK. Effect of group empowerment drumming on cognitive performance and mood in women with fibromyalgia. California State University, Fullerton (Dissertation). California State University, Fullerton, 2013; Vol. MPH:118. CENTRAL

Arcos‐Carmona 2011 {published data only}

Arcos‐Carmona IM, Castro‐Sánchez AM, Matarán‐Peñarrocha GA, Gutiérrez‐Rubio AB, Ramos‐González E, Moreno‐Lorenzo C. Effects of aerobic exercise program and relaxation techniques on anxiety, quality of sleep, depression, and quality of life in patients with fibromyalgia: a randomized controlled trial [Spanish] [Effectos de un programa de ejercicios aerobicos y tecnicas de relajacion sobre el estado de ansiedad, calidad del sueno, depresion y calidad de vida en pacientes con fibromialgia: ensayo clinico aleatorizado]. Medicina Clínica 2011;137(9):398‐401. CENTRAL

Assis 2006 {published data only}

Assis MR, Duardo Silva L, Martins Barros Alves A, Pessanha AP, Valim V, Feldman D, et al. A randomized controlled trial of deep water running: clinical effectiveness of aquatic exercise to treat fibromyalgia. Arthritis & Rheumatism 2006;55(1):57‐65. CENTRAL

Astin 2003 {published data only}

Astin JA, Berman BM, Bausel B, Lee WL, Hochberg M, Forys KL. The efficacy of mindfulness meditation plus Qigong movement therapy in the treatment of fibromyalgia: a randomized controlled trial. Journal of Rheumatology 2003;30(10):2257‐62. CENTRAL

Bailey 1999 {published data only}

Bailey A, Starr L, Alderson M, Moreland J. A comparative evaluation of a fibromyalgia rehabilitation program. Arthritis Care & Research 1999;12(5):336‐40. CENTRAL

Bakker 1995 {published data only}

Bakker C, Rutten M, van Santen‐Hoeufft M, Bolwijn P, van Doorslaer E, van der Linden S. Patient utilities in fibromyalgia and the association with other outcome measures. Journal of Rheumatology 1995;22:1536‐43. CENTRAL

Baniak 2015 {published data only}

Baniak LM, Pierce CS, Hiester E, McLeod KJ. Calf muscle pump stimulation as a means to reduce symptoms of fibromyalgia syndrome. Biological Research for Nursing2015; Vol. 17, issue 3:334‐9. CENTRAL

Baptista 2012 {published data only}

Baptista AS, Villela AL, Jones A, Natour J. Effectiveness of dance in patients with fibromyalgia: a randomized, single‐blind, controlled study. Clinical and Experimental Rheumatology 2012;30(6 Suppl 74):18‐23. CENTRAL

Bardal 2015 {published data only}

Bardal EM, Roeleveld K, Mork PJ. Aerobic and cardiovascular autonomic adaptations to moderate intensity endurance exercise in patients with fibromyalgia. Journal of Rehabilitation Medicine (Stiftelsen Rehabiliterings information)2015; Vol. 47, issue 7:639‐46. CENTRAL

Bircan 2008 {published data only}

Bircan C, Karasel SA, Akgun B, El O, Alper S. Effects of muscle strengthening versus aerobic exercise program in fibromyalgia. Rheumatology International 2008;28(6):527‐32. CENTRAL

Bojner‐Horwitz 2003 {published data only}

Bojner Horwitz E, Theorell T, Anderberg UM. Dance/movement therapy and changes in stress‐related hormones: a study of fibromyalgia patients with video interpretation. The Arts in Psychotherapy 2003;30(5):255‐64. CENTRAL

Bojner‐Horwitz 2006 {published data only}

Bojner Horwitz E, Kowalski J, Theorell T, Anderberg UM. Dance/movement therapy in fibromyalgia patients: changes in self‐figure drawings and their relation to verbal self‐rating scales. Arts in Psychotherapy 2006;33(1):11‐25. CENTRAL

Bote 2013 {published data only}

Bote ME, Garcia JJ, Hinchado MD, Otega E. Fibromyalgia: anti‐inflammatory and stress responses after acute moderate exercise. PLoS ONE 2013;8(9):e74524. CENTRAL

Bressan 2008 {published data only}

Bressan LR, Matsutani LA, Assumpção A, Marques AP, Cabral CMN. Effects of muscle stretching and physical conditioning as physical therapy treatment for patients with fibromyalgia [Portuguese] [Efeitos do alongamento muscular e condicionamento físico no tratamento fisioterápico de pacientes com fibromialgia]. Revista Brasileira de Fisioterapia 2008;12(2):88‐93. CENTRAL

Buckelew 1998 {published data only}

Buckelew SP, Conway R, Parker J, Deuser WE, Read J, Witty TE, et al. Biofeedback/relaxation training and exercise interventions for fibromyalgia: a prospective trial. Arthritis and Rheumatism 1998;11(3):196‐209. CENTRAL

Calandre 2010 {published data only}

Calandre EP, Rodriguez‐Claro ML, Rico‐Villademoros F, Vilchez JS, Hidalgo J, Delgado‐Rodriguez A. Effects of pool‐based exercise in fibromyalgia symptomatology and sleep quality: a prospective randomized comparison between stretching and Tai Chi. Clinical and Experimental Rheumatology 2009;27(5 Suppl 56):S21‐8. CENTRAL

Carbonell‐Baeza 2011 {published data only}

Carbonell‐Baeza A, Aparicio VA, Ortega FB, Cuevas AM, Alvarez IC, Ruiz JR, et al. Does a 3‐month multidisciplinary intervention improve pain, body composition and physical fitness in women with fibromyalgia?. British Journal of Sports Medicine 2011;45(15):1189‐95. CENTRAL

Carbonell‐Baeza 2011a {published data only}

Carbonell‐Baeza A, Romero A, Aparicio VA, Ortega FB, Tercedor P, Delgado‐Fernandez M, et al. Preliminary findings of a 4‐month Tai Chi intervention on tenderness, functional capacity, symptomatology, and quality of life in men with fibromyalgia. American Journal of Mens Health 2011;5(5):421‐9. CENTRAL

Carbonell‐Baeza 2012 {published data only}

Carbonell‐Baeza A, Ruiz JR, Ortega FB, Munguía‐Izquierdo D, Alvarez‐Gallardo IC, Segura‐Jiménez V, et al. Land‐ and water‐based exercise intervention in women with fibromyalgia: the al‐andalus physical activity randomised controlled trial [study protocol]. BMC Musculoskeletal Disorders 2012;13(18):1‐11. [DOI: 10.1186/1471‐2474‐13‐18]CENTRAL

Carson 2010 {published data only}

Carson JW, Carson KM, Jones KD, Bennett RM, Wright CL, Mist SD. A pilot randomized controlled trial of the Yoga of Awareness program in the management of fibromyalgia. Pain 2010;151(2):530‐9. CENTRAL

Carson 2012 {published data only}

Carson JW, Carson KM, Jones KD, Mist SD, Bennett RM. Follow‐up of Yoga of Awareness for fibromyalgia: results at 3 months and replication in the wait‐list group. Clinical Journal of Pain 2012;28(9):804‐13. CENTRAL

Casanueva‐Fernandez 2012 {published data only}

Casanueva‐Fernandez B, Llorca J, Rubio JBI, Rodero‐Fernandez B, Gonzalez‐Gay MA. Efficacy of a multidisciplinary treatment program in patients with severe fibromyalgia. Rheumatology International 2012;32(8):2497‐502. CENTRAL

Castel 2013 {published data only}

Castel A, Fontova R, Montull S, Perinan R, Poveda MJ, Miralles I, et al. Efficacy of a multidisciplinary fibromyalgia treatment adapted for women with low educational levels: a randomized controlled trial [with consumer summary]. Arthritis Care & Research 2013;65(3):421‐31. CENTRAL

Castro‐Sanchez 2011 {published data only}

Castro‐Sanchez AM, Mataran‐Penarrocha GA, Arroyo‐Morales M, Saavedra‐Hernandez M, Fernandez‐Sola C, Moreno‐Lorenzo C. Effects of myofascial release techniques on pain, physical function, and postural stability in patients with fibromyalgia: a randomized controlled trial. Clinical Rehabilitation 2011;25(9):800‐13. CENTRAL

Cedraschi 2004 {published data only}

Cedraschi C, Desmeules J, Rapiti E, Baumgartner E, Cohen P, Finckh A, et al. Fibromyalgia: a randomised, controlled trial of a treatment programme based on self management. Annals of the Rheumatic Diseases 2004;63(3):290‐6. CENTRAL

Cocke 2015 {published data only}

Cocke M. Altered Recovery Process after Fatiguing Exercise and Potential Benefits of Qigong in Patients with Fibromyalgia. University of Kansas (MS Dissertation). University of Kansas, 2015:96. CENTRAL

Da Costa 2005 {published data only}

Da Costa D, Abrahamowicz M, Lowensteyn I, Bernatsky S, Dritsa M, Fitzcharles MA, et al. A randomized clinical trial of an individualized home‐based exercise programme for women with fibromyalgia. Rheumatology 2005;44(11):1422‐7. CENTRAL

Dal 2011 {published data only}

Dal U, Cimen OB, Incel NA, Adim M, Dag F, Erdogan AT, et al. Fibromyalgia syndrome patients optimize the oxygen cost of walking by preferring a lower walking speed. Journal of Musculoskeletal Pain 2011;19(4):212‐7. CENTRAL

da Silva 2007 {published data only}

da Silva GD, Lorenzi‐Filho G, Lage LV. Effects of yoga and the addition of Tui Na in patients with fibromyalgia. Journal of Alternative & Complementary Medicine 2007;13(10):1107‐13. CENTRAL

da Silva 2015 {published data only}

da Silva MM, Albertini R, Leal‐Junior EC, de Tarso Camillo de Carvalho, Silva JA, Bussadori SK, et al. Effects of exercise training and photobiomodulation therapy (EXTRAPHOTO) on pain in women with fibromyalgia and temporomandibular disorder: study protocol for a randomized controlled trial. Trials 2015;16:252. CENTRAL

Dawson 2003 {published data only}

Dawson KA, Tiidus PM, Pierrynowski M, Crawford JP, Trotter J. Evaluation of a community‐based exercise program for diminishing symptoms of fibromyalgia. Physiotherapy Canada 2003;55:17‐22. CENTRAL

De Andrade 2008 {published data only}

de Andrade SC, de Carvalho RFP, Soares AS, de Abreu Freitas RP, de Maderios Guerra LM, Vilar MJ. Thalassotherapy for fibromyalgia: a randomized controlled trial comparing aquatic exercises in sea water and water pool. Rheumatology International 2008;29:147‐52. [DOI: 10.1007/s00296‐008‐0644‐2]CENTRAL

de Araujo Farias 2013 {published data only}

de Araujo Farias D, Abrahao AA, Rossato M, Bezerra Ede S. Effects of two different training methods in women with fibromyalgia syndrome. Research in Sports Medicine 2013;21(3):280‐5. CENTRAL

Delgado 2011 {published data only}

Delgado M. Land‐ and Water‐Based Exercise Intervention in Women With Fibromyalgia: The Al‐Andalus Physical Activity Randomised Control Trial. Barcelona, 2011. CENTRAL

de Melo Vitorino 2006 {published data only}

Vitorino DF, de Carvalho LB, do Prado GF. Hydrotherapy and conventional physiotherapy improve total sleep time and quality of life of fibromyalgia patients: randomized clinical trial. Sleep Medicine 2006;7:293‐6. [DOI: 10.1016/j.sleep.2005.09.002]CENTRAL

Demir‐Gocmen 2013 {published data only}

Demir‐Gocmen D, Altan L, Korkmaz N, Arabaci R. Effect of supervised exercise program including balance exercises on the balance status and clinical signs in patients with fibromyalgia. Rheumatology International 2013;33(3):743‐50. CENTRAL

Duruturk 2015 {published data only}

Duruturk N, Tuzun EH, Culhaoglu B. Is balance exercise training as effective as aerobic exercise training in fibromyalgia syndrome?. Rheumatology International 2015;35(5):845‐54. CENTRAL

Ekici 2008 {published data only}

Ekici G, Yakut E, Akbayrak T. Effects of Pilates exercises and connective tissue manipulation on pain and depression in females with fibromyalgia: a randomized controlled trial [Turkish] [Fibromiyaljili kadinlarda Pilates egzersizleri ve konnektif doku manipulasyonunun aǧri ve depresyon üzerine etkileri Rastgele kontrollü çalişma]. Fizyoterapi Rehabilitasyon 2008;19(2):47‐54. CENTRAL

Etnier 2009 {published data only}

Etnier JL, Karper WB, Gapin JI, Barella LA, Chang YK, Murphy KJ. Exercise, fibromyalgia, and fibrofog: a pilot study. Journal of Physical Activity & Health 2009;6(2):239‐46. CENTRAL

Evcik 2008 {published data only}

Evcik D, Yugit I, Pusak H, Kavuncu V. Effectiveness of aquatic therapy in the treatment of fibromyalgia syndrome: a randomized controlled open study. Rheumatology International 2008;28(9):885‐90. [DOI: 10.1007/s00296‐008‐0538‐3]CENTRAL

Field 2003 {published data only}

Field T, Delage J, Hernandez Reif M. Movement and massage therapy reduce fibromyalgia pain. Journal of Bodywork and Movement Therapies 2003;7(1):49‐52. CENTRAL

Finset 2004 {published data only}

Finset A, Wigers SH, Gotestam KG. Depressed mood impedes pain treatment response in patients with fibromyalgia. Journal of Rheumatology 2004;31(5):976‐80. CENTRAL

Fioravanti 2015 {published data only}

Fioravanti A. Efficacy and Tolerability of Balneotherapy With Mineral Water Named "Debole of Vetriolo" in Fibromyalgia Syndrome (VET). ClinicalTrial.gov2015; Vol. NCT02548065. CENTRAL

Fontaine 2007 {published data only}

Fontaine KR, Haas S. Effects of lifestyle physical activity on health status, pain, and function in adults with fibromyalgia syndrome. Journal of Musculoskeletal Pain 2007;15(1):3‐9. CENTRAL

Fontaine 2010 {published data only}

Fontaine KR, Conn L, Clauw DJ. Effects of lifestyle physical activity on perceived symptoms and physical function in adults with fibromyalgia: results of a randomized trial. Arthritis Research & Therapy 2010;12(2):R55. CENTRAL

Fontaine 2011 {published data only}

Fontaine KR, Conn L, Clauw DJ. Effects of lifestyle physical activity in adults with fibromyalgia: results at follow‐up. Journal of Clinincal Rheumatology 2011;17(2):64‐8. CENTRAL

Gandhi 2000 {published data only}

Gandhi N. Effect of an exercise program on quality of life of women with fibromyalgia. Microform Publications. Eugene, Or: University of Oregon, 2000. CENTRAL

Garcia‐Martinez 2011 {published data only}

Garcia‐Martinez AM, De Paz JA, Marquez S. Effects of an exercise programme on self‐esteem, self‐concept and quality of life in women with fibromyalgia: a randomized controlled trial. Rheumatology International 2011;32(7):1869‐76. CENTRAL

Gavi 2014 {published data only}

Gavi MB, Vassalo DV, Amaral FT, Macedo DC, Gava PL, Dantas EM, et al. Strengthening exercises improve symptoms and quality of life but do not change autonomic modulation in fibromyalgia: a randomized clinical trial. PLoS One 2014;9(3):e90767. CENTRAL

Genc 2002 {published data only}

Genc A, Sagiroglu E. Comparison of two different exercise programs in fibromyalgia treatment [Turkish]. Fizyoterapi Rehabilitasyon 2002;13(2):90‐5. CENTRAL

Genc 2015 {published data only}

Genc A, Tur BS, Aytur YK, Oztuna D, Erdogan MF. Does aerobic exercise affect the hypothalamic‐pituitary‐adrenal hormonal response in patients with fibromyalgia syndrome?. Journal of Physical Therapy Science 2015;27(7):2225‐31. CENTRAL

Giannotti 2014 {published data only}

Giannotti E, Koutsikos K, Pigatto M, Rampudda ME, Doria A, Masiero S. Medium/long‐term effects of a specific exercise protocol combined with patient education on spine mobility, chronic fatigue, pain, aerobic fitness and level of disability in fibromyalgia. BioMed Research International 2014;20:9 pages. doi:10.1155/2014/474029. [DOI: 10.1155/2014/474029]CENTRAL

Gomes da Silva 2008 {published data only}

Gomes da Silva T, Suda EY, Marçulo CA, da Silva Paes FH, Pinheiro GT. Comparison of transcutaneous electrical nerve stimulation and hydrotherapy effects on pain, flexibility and quality of life in patients with fibromyalgia [Portuguese] [Comparação dos efeitos da estimulação elétrica nervosa transcutânea e da hidroterapia na dor, flexibilidade e qualidade de vida de pacientes com fibromialgia]. Fisioterapia e Pesquisa 2008;15(2):118‐24. CENTRAL

Gonzalez Gonzalez 2015 {published data only}

Gonzalez Gonzalez J, del Teso Rubio MDM, Walino Paniagua CN, Criado‐Alvarez JJ, Sanchez Holgado J. Symptomatic pain and fibromyalgia treatment through multidisciplinary approach for primary care [Spanish]. Reumatologia Clinica2015; Vol. 11, issue 2:22‐6. CENTRAL

Gowans 1999 {published data only}

Gowans SE, deHueck A, Voss S, Richardson M. A randomized, controlled trial of exercise and education for individuals with fibromyalgia. Arthritis Care and Research 1999;12(2):120‐8. CENTRAL

Gowans 2001 {published data only}

Gowans SE, deHueck A, Voss S, Silaj A, Abbey SE, Reynolds WJ. Effect of a randomized, controlled trial of exercise on mood and physical function in individuals with fibromyalgia. Arthritis Care and Research 2001;45:519‐29. CENTRAL

Gowans 2002 {published data only}

Gowans SE, deHueck A, Abbey SE. Measuring exercise‐induced mood changes in fibromyalgia: a comparison of several measures. Arthritis & Rheumatism 2002;47:603‐9. CENTRAL

Gowans 2004 {published data only}

Gowans SE, deHueck A, Voss S, Silaj A, Abbey SE. Six‐month and one‐year follow‐up of 23 weeks of aerobic exercise for individuals with fibromyalgia. Arthritis Care & Research 2004;51(6):890‐8. CENTRAL

Guarino 2001 {published data only}

Guarino P, Peduzzi P, Donta ST. A multicenter two by two factorial trial of cognitive behavioral therapy and aerobic exercise for Gulf War veterans' illnesses: design of a Veterans Affairs Cooperative Study (CSP #470). Controlled Clinical Trials 2001;22(3):310‐32. CENTRAL

Gusi 2006 {published data only}

Gusi N, Tomas‐Carus P, Häkkinen A, Häkkinen K, Ortega‐Alonso A. Exercise in waist‐high warm water decreases pain and improves health‐related quality of life and strength in the lower extremities in women with fibromyalgia. Arthritis and Rheumatism 2006;55(1):66‐73. CENTRAL

Gusi 2008 {published data only}

Gusi N, Tomas‐Carus P. Cost‐utility of an 8‐month aquatic training for women with fibromyalgia: a randomized controlled trial. Arthritis Research & Therapy 2008;10(1):R24. CENTRAL

Gusi Fuertes 2016 {published data only}

Gusi Fuertes N. Effects of a Virtual Reality‐Based Physical Exercise in Fibromyalgia Patients. A Randomized Controlled Trial. Australian New Zealand Clinical Trials Registry2016; Vol. ACTRN12615000836538. CENTRAL

Häkkinen 2001 {published data only}

Häkkinen A, Häkkinen K, Hannonen P, Alen M. Strength training induced adaptations in neuromuscular function of premenopausal women with fibromyalgia: comparison with healthy women. Annals of the Rheumatic Diseases 2001;60(1):21‐6. CENTRAL

Hakkinen 2002 {published data only}

Hakkinen K, Pakarinen A, Hannonen P, Hakkinen A, Airaksinen O, Valkeinen H, et al. Effects of strength training on muscle strength, cross‐sectional area, maximal electromyographic activity, and serum hormones in premenopausal women with fibromyalgia. Journal of Rheumatology 2002;29(6):1287‐95. CENTRAL

Häkkinen 2002 {published data only}

Häkkinen K, Pakarinen A, Hannonen P, Häkkinen A, Airaksinen O, Valkeinen H, et al. Effects of strength training on muscle strength, cross‐sectional area, maximal electromyographic activity, and serum hormones in premenopausal women with fibromyalgia. Journal of Rheumatology 2002;29(6):1287‐95. CENTRAL

Han 1998 {published data only}

Han SS. Effects of a self‐help program including stretching exercise on symptom reduction in patients with fibromyalgia. Taehan Kanho 1998;37:78‐80. CENTRAL

Hecker 2011 {published data only}

Hecker CD, Melo C, da Silva Tomazoni S, Brandão Lopes Martins RA, Pinto Leal Junior EC. Analysis of effects of kinesiotherapy and hydrokinesiotherapy on the quality of life of patients with fibromyalgia ‐ a randomized clinical trial [Portuguese] [Analise dos efeitos da cinesioterapia e da hidrocinesioterapia sobre a qualidade de vida de pacientes com fibromialgia ‐ um ensaio clinico randomizado]. Fisioterapia em Movimento 2011;24(1):57‐64. CENTRAL

Hoeger Bement 2011 {published data only}

Hoeger Bement MK, Weyer A, Hartley S, Drewek B, Harkins AL, Hunter SK. Pain perception after isometric exercise in women with fibromyalgia. Archives of Physical Medicine and Rehabilitation2011; Vol. 92, issue 1:89‐95. CENTRAL

Hoeger Bement 2014 {published data only}

Hoeger Bement MK, Weyer AD, Yoon T, Hunter SK. Corticomotor excitability during a noxious stimulus before and after exercise in women with fibromyalgia. Journal of Clinical Neurophysiology 2014;31(1):94‐8. CENTRAL

Hooten 2012 {published data only}

Hooten WM, Qu W, Townsend CO, Judd JW. Effects of strength vs aerobic exercise on pain severity in adults with fibromyalgia: a randomized equivalence trial. Pain 2012;153(4):915‐23. CENTRAL

Hsieh 2010 {published data only}

Hsieh LF, Chien HL, Chuang CC, Bai CH. Aerobic capacity is reduced in Chinese women with primary fibromyalgia syndrome. Journal of Musculoskeletal Pain 2010;18(3):216‐25. CENTRAL

Hunt 2000 {published data only}

Hunt J, Bogg J. An evaluation of the impact of a fibromyalgia self‐management programme on patient morbidity and coping. Advancing in Physiotherapy 2000;2(4):168‐75. CENTRAL

Huyser 1997 {published data only}

Huyser B, Buckelew SP, Hewett JE, Johnson JC. Factors affecting adherence to rehabilitation interventions for individuals with fibromyalgia. Rehabilitation Psychology 1997;42:75‐91. CENTRAL

Ide 2008 {published data only}

Ide MR, Laurindo LMM, Rodrigues‐Junior AL, Tanaka C. Effect of aquatic respiratory exercise‐based program in patients with fibromyalgia. International Journal of Rheumatic Diseases 2008;11(2):131‐40 doi: 10.1111/j.1756‐185X.2008.00348.x. CENTRAL

Ismael Martins 2014 {published data only}

Ismael Martins MR, Gritti CC, Dos Santos Junior R, De Araujo MCL, Dias LC, D'All Aglio Foss MH, et al. Randomized controlled trial of a therapeutic intervention group in patients with fibromyalgia syndrome. Revista Brasileira de Reumatologia 2014;54:179‐84. CENTRAL

Jentoft 2001 {published data only}

Jentoft ES, Kvalvik AG, Mengshoel AM. Effects of pool‐based and land‐based aerobic exercise on women with fibromyalgia/chronic widespread muscle pain. Arthritis and Rheumatism 2001;45:42‐7. CENTRAL

Jones 2002 {published data only}

Jones KD, Burckhardt CS, Clark SR, Bennett RM, Potempa KM. A randomized controlled trial of muscle strengthening versus flexibility training in fibromyalgia. Journal of Rheumatology 2002;29(5):1041‐8. CENTRAL

Jones 2007 {published data only}

Jones KD, Deodhar AA, Burckhardt CS, Perrin NA, Hanson GC, Bennett RM. A combination of 6 months of treatment with pyridostigmine and triweekly exercise fails to improve insulin‐like growth factor‐I levels in fibromyalgia, despite improvement in the acute growth hormone response to exercise. Journal of Rheumatology 2007;34(5):1103‐11. CENTRAL

Jones 2008 {published data only}

Jones KD, Burckhardt CS, Deodhar AA, Perrin NA, Hanson GC, Bennett RM. A six‐month randomized controlled trial of exercise and pyridostigmine in the treatment of fibromyalgia. Arthritis and Rheumatism 2008;58(2):612‐22. CENTRAL

Jones 2011 {published data only}

Jones KD. Nordic walking in fibromyalgia: a means of promoting fitness that is easy for busy clinicians to recommend. Arthritis Research & Therapy 2011;13(1):103. CENTRAL

Jones 2012 {published data only}

Jones K, Sherman C, Mist S, Carson J, Bennett R, Li F. A randomized controlled trial of 8‐form Tai Chi improves symptoms and functional mobility in fibromyalgia patients. BMC Complementary and Alternative Medicine 2012;12:1205‐14. CENTRAL

Joshi 2009 {published data only}

Joshi MN, Joshi R, Jain AP. Effect of amitriptyline vs. physiotherapy in management of fibromyalgia syndrome: what predicts a clinical benefit?. Journal of Postgraduate Medicine 2009;55(3):185‐9. CENTRAL

Kadetoff 2010 {published data only}

Kadetoff D, Kosek E. Evidence of reduced sympatho‐adrenal and hypothalamic‐pituitary activity during static muscular work in patients with fibromyalgia. Journal of Rehabilitation Medicine 2010;42(8):765‐72. CENTRAL

Kaleth 2013 {published data only}

Kaleth AS, Saha CK, Jensen MP, Slaven JE, Ang DC. Effect of moderate to vigorous physical activity on long‐term clinical outcomes and pain severity in fibromyalgia. Arthritis Care & Research 2013;65(8):1211‐8. CENTRAL

Kaleth 2016 {published data only}

Kaleth AS, Slaven JE, Ang DC. Does increasing steps per day predict improvement in physical function and pain interference in adults with fibromyalgia?. Arthritis Care & Research2016; Vol. 66, issue 12:1887‐94. CENTRAL

Karolinska Institutet 2015 {published data only}

Karolinska Institutet. Internet‐based Exposure‐based Therapy for Fibromyalgia: A Randomized Controlled Trial. ClinicalTrials.gov2015; Vol. NCT02638636. CENTRAL

Karper 2001 {published data only}

Karper WB, Hopewell R, Hodge M. Exercise program effects on women with fibromyalgia syndrome. Clinical Nurse Specialist 2001;15:67‐75. CENTRAL

Kayo 2011 {published data only}

Kayo AH, Peccin MS, Sanches CM, Trevisani VF. Effectiveness of physical activity in reducing pain in patients with fibromyalgia: a blinded randomized clinical trial. Rheumatology International 2011;32(8):2285‐92. CENTRAL

Keel 1998 {published data only}

Keel PJ, Bodoky C, Gerhard U, Muller W. Comparison of integrated group therapy and group relaxation training for fibromyalgia. Clinical Journal of Pain 1998;14(3):232‐8. CENTRAL

Kendall 2000 {published data only}

Kendall SA, Brolin MK, Soren B, Gerdle B, Henriksson KG. A pilot study of body awareness programs in the treatment of fibromyalgia syndrome. Arthritis Care & Research 2000;13:304‐11. CENTRAL

Kesiktas 2011 {published data only}

Kesiktas N, Karagülle Z, Erdogan N, Yazicioglu K, Yilmaz H, Paker N. The efficacy of balneotherapy and physical modalities on the pulmonary system of patients with fibromyalgia. Journal of Back and Musculoskeletal Rehabilitation2011; Vol. 24, issue 1:57. CENTRAL

Khalsa 2009 {published data only}

Khalsa KPS. Bodywork for fibromyalgia: alternative therapies soothe the pain. Massage & Bodywork 2009;2009(May/June):80‐9. CENTRAL

Kibar 2015 {published data only}

Kibar S, Yildiz HE, Ay S, Evcik D, Ergin ES. New approach in fibromyalgia exercise program: a preliminary study regarding the effectiveness of balance training. Archives of Physical Medicine and Rehabilitation 2015;96(9):1576‐82. CENTRAL

King 2002 {published data only}

King SJ, Wessel J, Bhambhani Y, Sholter D, Maksymowych W. The effects of exercise and education, individually or combined, in women with fibromyalgia. Journal of Rheumatology 2002;29(12):2620‐7. CENTRAL

Kingsley 2005 {published data only}

Kingsley JD, Panton LB, Toole T, Sirithienthad P, Mathis R, McMillan V. The effects of a 12‐week strength‐training program on strength and functionality in women with fibromyalgia. Archives of Physical Medicine and Rehabilitation 2005;86(9):1713‐21. CENTRAL

Kingsley 2010 {published data only}

Kingsley JD, McMillan V, Figueroa A. The effects of 12 weeks of resistance exercise training on disease severity and autonomic modulation at rest and after acute leg resistance exercise in women with fibromyalgia. Archives of Physical Medicine and Rehabilitation 2010;91(10):1551‐7. CENTRAL

Klug 1989 {published data only}

Klug GA, McAuley E, Clark S. Factors influencing the development and maintenance of aerobic fitness: lessons applicable to the fibrositis syndrome. Journal of Rheumatology 1989;19 Suppl:30‐9. CENTRAL

Kroenke 2013 {published data only}

Kroenke K. Telephone‐based cognitive‐behavioural therapy and a structured exercise programme are effective for chronic widespread pain (fibromyalgia). Evidence Based Medicine 2013;18(1):23‐4. CENTRAL

Kurt 2016 {published data only}

Kurt EE, Kocak FA, Erdem HR, Tuncay F, Kelez F. Which non‐pharmacological treatment is more effective on clinical parameters in patients with fibromyalgia: balneotherapy or aerobic exercise?. Archives of Rheumatology2016; Vol. 31, issue 2:162‐9. CENTRAL

Lange 2011 {published data only}

Lange M, Krohn‐Grimberghe B, Petermann F. Medium‐term effects of a multimodal therapy on patients with fibromyalgia. Results of a controlled efficacy study [German] [Mittelfristige Effekte einer multimodalen Behandlung bei Patienten mit Fibromyalgiesyndrom]. Schmerz 2011;25(1):55‐61. CENTRAL

Larsson 2015 {published data only}

Larsson A, Palstam A, Lofgren M, Ernberg M, Bjersing J, Bileviciute‐Ljungar I, et al. Resistance exercise improves muscle strength, health status and pain intensity in fibromyalgia ‐ a randomized controlled trial. Arthritis Research & Therapy 2015;17:161. CENTRAL

Latorre 2013 {published data only}

Latorre PA, Santos MA, Heredia‐Jimenez JM, Delgado‐Fernandez M, Soto VM, Manas A, et al. Effect of a 24‐week physical training programme (in water and on land) on pain, functional capacity, body composition and quality of life in women with fibromyalgia. Clinical and Experimental Rheumatology 2013;31(6 Suppl 79):S72‐80. CENTRAL

Latorre Roman 2015 {published data only}

Latorre Roman PA, Santos E Campos MA, Garcia‐Pinillos F. Effects of functional training on pain, leg strength, and balance in women with fibromyalgia. Modern Rheumatology 2015;25(6):943‐7. CENTRAL

Lemstra 2005 {published data only}

Lemstra M, Olszynski WP. The effectiveness of multidisciplinary rehabilitation in the treatment of fibromyalgia: a randomized controlled trial. Clinical Journal of Pain 2005;21(2):166‐74. CENTRAL

Letieri 2013 {published data only}

Letieri RV, Furtado GE, Letieri M, Góes SM, Pinheiro CJ, Veronez SO, et al. Pain, quality of life, self perception of health and depression in patients with fibromyalgia, submitted to hydrocinesiotherapy [Portuguese] [Dor, qualidade de vida, autopercepção de saúde e depressão de pacientes com fibromialgia, tratados com hidrocinesioterapia]. Revista Brasileira de Reumatologia 2013;53(6):494‐500. CENTRAL

Liu 2012 {published data only}

Liu W, Zahner L, Cornell M, Le T, Ratner J, Wang Y, et al. Benefit of Qigong exercise in patients with fibromyalgia: a pilot study. International Journal of Neuroscience 2012;122(11):657‐64. CENTRAL

Lopez‐Pousa 2015 {published data only}

Lopez‐Pousa S, Bassets Pages G, Monserrat‐Vila S, de Gracia Blanco M, Hidalgo Colome J, Garre‐Olmo J. Sense of well‐being in patients with fibromyalgia: aerobic exercise program in a mature forest ‐ a pilot study. Evidence Based Complementary and Alternative Medicine 2015;2015:614783. CENTRAL

López‐Rodríguez 2012 {published data only}

López‐Rodríguez MM, Castro‐Sánchez AM, Fernández‐Martínez M, Matarán‐Peñarrocha GA, Rodríguez‐Ferrer ME. Comparison between aquatic‐biodanza and stretching for improving quality of life and pain in patients with fibromyalgia. Atencion Primaria 2012;44(11):641‐9. CENTRAL

Lorig 2008 {published data only}

Lorig KR, Ritter PL, Laurent DD, Plant K, Lorig KR, Ritter PL. The internet‐based arthritis self‐management program: a one‐year randomized trial for patients with arthritis or fibromyalgia. Arthritis & Rheumatism 2008;59(7):1009‐17. CENTRAL

Lynch 2012 {published data only}

Lynch M, Sawynok J, Hiew C, Marcon D. A randomized controlled trial of qigong for fibromyalgia. Arthritis Research & Therapy 2012;14(4):1‐11. CENTRAL

Mannerkorpi 2000 {published data only}

Mannerkorpi K, Nyberg B, Ahlmen M, Ekdahl C. Pool exercise combined with an education program for patients with fibromyalgia syndrome. A prospective, randomized study. Journal of Rheumatology 2000;27(10):2473‐81. CENTRAL

Mannerkorpi 2002 {published data only}

Mannerkorpi K, Ahlmen M, Ekdahl C. Six‐ and 24‐month follow‐up of pool exercise therapy and education for patients with fibromyalgia. Scandinavian Journal of Rheumatology 2002;31(5):306‐10. CENTRAL

Mannerkorpi 2009 {published data only}

Mannerkorpi K, Nodeman L, Eericsson A, Arndorw M, GAU Study Group. Pool exercise for patients with fibromyalgia or chronic widespread pain: a randomized controlled trial and subgroup analysis. Journal of Rehabilitation Medicine 2009;41:751‐60. CENTRAL

Mannerkorpi 2010 {published data only}

Mannerkorpi K, Nordeman L, Cider A, Jonsson G. Does moderate‐to‐high intensity Nordic walking improve functional capacity and pain in fibromyalgia? A prospective randomized controlled trial. Arthritis Research & Therapy 2010;12(5):R189. CENTRAL

Martin 1996 {published data only}

Martin L, Nutting A, MacIntosh BR, Edworthy SM, Butterwick D, Cook J. An exercise program in the treatment of fibromyalgia. Journal of Rheumatology 1996;23(6):1050‐3. CENTRAL

Martin 2014 {published data only}

Martin J, Torre F, Padierna A, Aguirre U, Gonzalez N, Matellanes B, et al. Impact of interdisciplinary treatment on physical and psychosocial parameters in patients with fibromyalgia: results of a randomised trial. International Journal of Clinical Practice 2014;68:618‐27. CENTRAL

Martin‐Nogueras 2012 {published data only}

Martin‐Nogueras AM, Calvo‐Arenillas JI. Efficacy of physiotherapy treatment on pain and quality of life in patients with fibromyalgia [Spanish] [Effectiveness of muscle stretching exercises with and without laser therapy at tender points for patients with fibromyalgia]. Rehabilitacion 2012;46(3):199‐206. CENTRAL

Mason 1998 {published data only}

Mason LW, Goolkasian P, McCain GA. Evaluation of multimodal treatment program for fibromyalgia. Journal of Behavioral Medicine 1998;21(2):163‐78. CENTRAL

Matsumoto 2011 {published data only}

Matsumoto S, Shimodozono M, Etoh S, Miyata R, Kawahira K. Effects of thermal therapy combining sauna therapy and underwater exercise in patients with fibromyalgia. Complementary Therapies in Clinical Practice 2011;17(3):162‐6. CENTRAL

Matsutani 2007 {published data only}

Matsutani LA, Marques AP, Ferreira EA, Assumpcao A, Lage LV, Casarotto RA, et al. Effectiveness of muscle stretching exercises with and without laser therapy at tender points for patients with fibromyalgia. Clinical and Experimental Rheumatology 2007;25(3):410‐5. CENTRAL

Matsutani 2012 {published data only}

Matsutani LA, Assumpcao A, Marques AP. Stretching and aerobic exercises in the treatment of fibromyalgia: pilot study [Portuguese] [Exercícios de alongamento muscular e aeróbico no tratamento da fibromialgia: estudo piloto]. Fisioterapia em Movimento 2012;25(2):411‐8. CENTRAL

McCain 1986 {published data only}

McCain GA. Role of physical fitness training in the fibrositis/fibromyalgia syndrome. American Journal of Medicine 1986;81(3A):73‐7. CENTRAL

McCain 1988 {published data only}

McCain GA, Bell DA, Mai FM, Halliday PD. A controlled study of the effects of a supervised cardiovascular fitness training program on the manifestations of primary fibromyalgia. Arthritis and Rheumatism 1988;31(9):1135‐41. CENTRAL

Meiworm 2000 {published data only}

Meiworm L, Jakob E, Walker UA, Peter HH, Keul J. Patients with fibromyalgia benefit from aerobic endurance exercise. Clinical Rheumatology 2000;19(4):253‐7. CENTRAL

Mendonca 2016 {published data only}

Mendonca ME, Simis M, Grecco LC, Battistella LR, Baptista AF, Fregni F. Transcranial direct current stimulation combined with aerobic exercise to optimize analgesic responses in fibromyalgia: a randomized placebo‐controlled clinical trial. Frontiers in Human Neuroscience 2016;10:68. CENTRAL

Mengshoel 1992 {published data only}

Mengshoel AM, Komnaes HB, Forre O. The effects of 20 weeks of physical fitness training in female patients with fibromyalgia. Clinical & Experimental Rheumatology 1992;10(4):345‐9. CENTRAL

Mengshoel 1993 {published data only}

Mengshoel AM, Forre O. Physical fitness training in patients with fibromyalgia. Musculoskeletal Pain 1993;1(4):267‐72. CENTRAL

Meyer 2000 {published data only}

Meyer BB, Lemley KJ. Utilizing exercise to affect the symptomology of fibromyalgia: a pilot study. Medicine and Science in Sports and Exercise 2000;32(10):1691‐7. CENTRAL

Mobily 2001 {published data only}

Mobily KE, Verburg MD. Aquatic therapy in community‐based therapeutic recreation: pain management in a case of fibromyalgia. Therapeutic Recreation Journal 2001;35:57‐69. CENTRAL

Munguia‐Izquierdo 2007 {published data only}

Munguía‐Izquierdo D, Legaz‐Arrese A. Exercise in warm water decreases pain and improves cognitive function in middle‐aged women with fibromyalgia. Clinical and Experimental Rheumatology 2007;25(6):823‐30. CENTRAL

Munguia‐Izquierdo 2008 {published data only}

Munguía‐Izquierdo D, Legaz‐Arrese A. Assessment of the effects of aquatic therapy on global symptomatology in patients with fibromyalgia syndrome: a randomized controlled trial. Archives of Physical Medicine and Rehabilitation 2008;89(12):2250‐7. CENTRAL

Mutlu 2013 {published data only}

Mutlu B, Paker N, Bugdayci D, Tekdos D, Kesiktas N. Efficacy of supervised exercise combined with transcutaneous electrical nerve stimulation in women with fibromyalgia: a prospective controlled study. Rheumatology International 2013;33(3):649‐55. CENTRAL

Newcomb 2011 {published data only}

Newcomb LW, Koltyn KF, Morgan WP, Cook DB. Influence of preferred versus prescribed exercise on pain in fibromyalgia. Medicine and Science in Sports and Exercise 2011;43(6):1106‐13. CENTRAL

Nichols 1994 {published data only}

Nichols DS, Glenn TM. Effects of aerobic exercise on pain perception, affect, and level of disability in individuals with fibromyalgia. Physical Therapy 1994;74:327‐32. CENTRAL

Nielens 2000 {published data only}

Nielens H, Boisset V, Masquelier E. Fitness and perceived exertion in patients with fibromyalgia syndrome. The Clinical Journal of Pain 2000;16(3):209‐13. CENTRAL

Norregaard 1997 {published data only}

Norregaard J, Lykkegaard JJ, Mehlsen J, Danneskiold Samsoe B. Exercise training in treatment of fibromyalgia. Journal of Musculoskeletal Pain 1997;5(1):71‐9. CENTRAL

Offenbacher 2000 {published data only}

Offenbächer M, Stucki G. Physical therapy in the treatment of fibromyalgia. Scandinavian Journal of Rheumatology 2000;113(Suppl 29):78‐85. CENTRAL

Oncel 1994 {published data only}

Oncel A, Eskiyurt N, Leylabadi M. The results obtained by different therapeutic measures in the treatment of generalized fibromyalgia syndrome. Tip Fakultesi Mecmuasi 1994;57(4):45‐9. CENTRAL

Palekar 2014 {published data only}

Palekar TJ, Basu S. Comparative study of Pilates exercise verses yogasana in the treatment of fibromyalgia syndrome: a pilot study. International Journal of Pharma and Bio Sciences 2014;5:B410‐20. CENTRAL

Paolucci 2015 {published data only}

Paolucci T, Vetrano M, Zangrando F, Vulpiani MC, Grasso MR, Trifoglio D, et al. MMPI‐2 profiles and illness perception in fibromyalgia syndrome: the role of therapeutic exercise as adapted physical activity. Journal of Back and Musculoskeletal Rehabilitation 2015;28(1):101‐9. [DOI: http://dx.doi.org/10.3233/BMR‐140497]CENTRAL

Pastor 2014 {published data only}

Pastor MA, Lopez‐Roig S, Leido A, Peñacoba C, Velasco L, Schweiger‐Gallo I, et al. Combining motivational and volitional strategies to promote unsupervised walking in patients with fibromyalgia: study protocol for a randomized controlled trial. Trials2014; Vol. 120:1‐15. CENTRAL

Perez‐De la Cruz 2015 {published data only}

Perez‐De la Cruz S, Lambeck J. [Effects of a programme of aquatic Ai Chi exercise in patients with fibromyalgia. A pilot study]. Revista de Neurologia2015; Vol. 60, issue 2:59‐65. CENTRAL

Peters 2002 {published data only}

Peters S, Stanley I, Rose M, Kaney S, Salmon P. A randomized controlled trial of group aerobic exercise in primary care patients with persistent, unexplained physical symptoms. Family Practice 2002;19:665‐74. CENTRAL

Pfeiffer 2003 {published data only}

Pfeiffer AT. Effects of a 1.5‐day multidisciplinary outpatient treatment program for fibromyalgia: a pilot study. American Journal of Physical Medicine & Rehabilitation 2003;82:196‐201. CENTRAL

Piso 2001 {published data only}

Piso U, Kuther G, Gutenbrunner C, Gehrke A. Analgesic effects of sauna in fibromyalgia [German] [Analgetische Wirkungen der Sauna bei der Fibromyalgie]. Physikalische Medizin Rehabilitationsmedizin Kurortmedizin 2001;11(3):94‐9. CENTRAL

Ramsay 2000 {published data only}

Ramsay C, Moreland J, Ho M, Joyce S, Walker S, Pullar T. An observer‐blinded comparison of supervised and unsupervised aerobic exercise regimens in fibromyalgia. Rheumatology 2000;39(5):501‐5. CENTRAL

Richards 2002 {published data only}

Richards SC, Scott DL. Prescribed exercise in people with fibromyalgia: parallel group randomised controlled trial. BMJ 2002;325(7357):185‐9. CENTRAL

Rivera Redondo 2004 {published data only}

Rivera Redondo J, Moratalla Justo C, Valdepenas Moraleda F, Garcia Velayos Y, Oses Puche JJ, Ruiz Zubero J, et al. Long‐term efficacy of therapy in patients with fibromyalgia: a physical exercise‐based program and a cognitive‐behavioral approach. Arthritis and Rheumatism 2004;51(2):184‐92. CENTRAL

Rooks 2002 {published data only}

Rooks DS, Silverman CB, Kantrowitz FG. The effects of progressive strength training and aerobic exercise on muscle strength and cardiovascular fitness in women with fibromyalgia: a pilot study. Arthritis and Rheumatism 2002;47:22‐8. CENTRAL

Rooks 2007 {published data only}

Rooks DS, Gautam S, Romeling M, Cross ML, Stratigakis D, Evans B, et al. Group exercise, education, and combination self‐management in women with fibromyalgia: a randomized trial. Archives of Internal Medicine 2007;167(20):2192‐200. CENTRAL

Salek 2005 {published data only}

Salek AK, Khan MM, Ahmed SM, Rashid MI, Emran MA, Mamun MA. Effect of aerobic exercise on patients with primary fibromyalgia syndrome. Mymensingh Medical Journal 2005;14(2):141‐4. CENTRAL

Santana 2010 {published data only}

Santana JS, Almeida AP, Brandão PM. The effect of Ai Chi method in patients with fibromyalgia syndrome [Os efeitos do método Ai Chi em pacientes portadoras da síndrome fibromiálgica]. Ciencia & Saude Coletiva 2010;15 Suppl(1):1433‐8. CENTRAL

Sañudo 2010a {published data only}

Sañudo Corrales B, Galiano Orea D, Carrasco Páez L, Saxton J, de Hoyo Lora M. Autonomous nervous system response and quality of life on women with fibromyalgia after a long‐term intervention with physical exercise [Spanish] [Respuesta autónoma e influencia sobre la calidad de vida de mujeres con fibromialgia tras una intervención de ejercicio físico a largo plazo]. Rehabilitacion 2010;44(3):244‐9. CENTRAL

Sañudo 2010b {published data only}

Sañudo B, Galiano D, Carrasco L, Blagojevic M, de Hoyo M, Saxton J. Aerobic exercise versus combined exercise therapy in women with fibromyalgia syndrome: a randomized controlled trial. Archives of Physical Medicine and Rehabilitation 2010;91(12):1838‐43. CENTRAL

Sañudo 2011 {published data only}

Sañudo B, Galiano D, Carrasco L, De Hoyo M, McVeigh JG. Effects of a prolonged exercise program on key health outcomes in women with fibromyalgia: a randomized controlled trial. Journal of Rehabilitation Medicine 2011;43(6):521‐6. CENTRAL

Sañudo 2012a {published data only}

Sañudo B, Carrasco L, de Hoyo M, McVeigh JG. Effects of exercise training and detraining in patients with fibromyalgia syndrome: a 3‐yr longitudinal study. American Journal of Physical Medicine and Rehabilitation 2012;91(7):561‐73. CENTRAL

Sañudo 2015 {published data only}

Sañudo B, Carrasco L, de Hoyo M, Figueroa A, Saxton JM. Vagal modulation and symptomatology following a 6‐month aerobic exercise programme for women with fibromyalgia. Clinical and Experimental Rheumatology 2015;33(Suppl 88):S41‐S45. CENTRAL

Schachter 2003 {published data only}

Schachter CL, Busch AJ, Peloso P, Sheppard MS. The effects of short versus long bouts of aerobic exercise in sedentary women with fibromyalgia: a randomized controlled trial. Physical Therapy 2003;83(4):340‐58. CENTRAL

Schmidt 2011 {published data only}

Schmidt S, Grossman P, Schwarzer B, Jena S, Naumann J, Walach H. Treating fibromyalgia with mindfulness‐based stress reduction: results from a 3‐armed randomized controlled trial. Pain 2011;152(2):1838‐43. CENTRAL

Sencan 2004 {published data only}

Sencan S, Ak S, Karan A, Muslumanoglu L, Ozcan E, Berker E. A study to compare the therapeutic efficacy of aerobic exercise and paroxetine in fibromyalgia syndrome. Journal of Back & Musculoskeletal Rehabilitation 2004;17(2):57‐61. CENTRAL

Sigl‐Erkel 2011 {published data only}

Sigl‐Erkel T. A randomized trial of Tai Chi for fibromyalgia [German] [Studienbesprechung zu Tai Chi (taiji) bei fibromyalgie]. Chinesische Medizin 2011;26(2):112‐6. CENTRAL

Srikuea 2013 {published data only}

Srikuea R, Symons TB, Long DE, Lee JD, Shang Y, Chomentowski PJ, et al. Association of fibromyalgia with altered skeletal muscle characteristics which may contribute to postexertional fatigue in postmenopausal women. Arthritis and Rheumatism 2013;65(2):519‐28. CENTRAL

Steiner 2015 {published data only}

Steiner JL, Bigatti SM, Ang DC. Trajectory of change in pain, depression, and physical functioning after physical activity adoption in fibromyalgia. Journal of Health Psychology2015; Vol. 20, issue 7:931‐41. CENTRAL

Suman 2009 {published data only}

Suman AL, Biagi B, Biasi G, Carli G, Gradi M, Prati E, et al. One‐year efficacy of a 3‐week intensive multidisciplinary non‐pharmacological treatment program for fibromyalgia patients. Clinical & Experimental Rheumatology 2009;27(1):7‐14. CENTRAL

Thieme 2003 {published data only}

Thieme K, Gronica‐Ihle E, Flor H. Operant behavioral treatment of fibromyalgia: a controlled study. Arthritis Care & Research 2003;49:314‐20. CENTRAL

Thijssen 1992 {published data only}

Thijssen E, de Klerk E. Evaluation of a swimming program for patients with fibromyalgia [Dutch] [Evaluatie van een zwemprogramma voor patiёnten met fibromyalgie]. Ned Tijdschr Fysiother 1992;102(3):71‐5. CENTRAL

Tiidus 1997 {published data only}

Tiidus PM. Manual massage and recovery of muscle function following exercise: a literature review. Journal of Orthopaedic & Sports Physical Therapy 1997;25(2):107‐12. CENTRAL

Tomas‐Carus 2007a {published data only}

Tomás‐Carús P, Häkkinen A, Gusi N, Leal A, Häkkinen K, Ortega‐Alonso A. Aquatic training and detraining on fitness and quality of life in fibromyalgia. Medicine and Science in Sports and Exercise 2007;39(7):1044‐50. CENTRAL

Tomas‐Carus 2007b {published data only}

Tomás‐Carús P, Gusi N, Leal A, García Y, Ortega‐Alonso A. The fibromyalgia treatment with physical exercise in warm water reduces the impact of disease [El tratamiento para la fibromialgia con ejercicio físico en agua caliente reduce el impacto de la enfermedad en la salud física y mental de mujeres afectadas]. Reumatologia Clínica 2007;3(1):33‐7. CENTRAL

Tomas‐Carus 2007c {published data only}

Tomás‐Carús P, Raimundo A, Adsuar JC, Olivares P, Gusi N. Effects of aquatic training and subsequent detraining on the perception and intensity of pain and number of sensitive points in women with fibromyalgia [Efectos del entrenamiento acuatico y posterior desentrenamiento sobre la percepcion e intensidad del dolor y numero de puntos sensibles de mujeres con fibromialgia]. Apunts Medicina de l'Esport 2007;154(42):76‐81. CENTRAL

Tomas‐Carus 2007d {published data only}

Tomás‐Carús P, Raimundo A, Timon R, Gusi N. Exercise in warm water decreases pain but not the number of tender points in women with fibromyalgia: a randomized controlled trial [El ejercicio fisico en agua caliente reduce el dolor pero no el numero de puntos sensibles de mujeres con fibromialgia: un ensayo clinico randomizado]. Seleccion 2007;16(2):98‐102. CENTRAL

Tomas‐Carus 2008 {published data only}

Tomás‐Carús P, Gusi N, Häkkinen A, Häkkinen K, Leal A, Ortega‐Alonso A. Eight months of physical training in warm water improves physical and mental health in women with fibromyalgia: a randomized controlled trial. Journal of Rehabilitation Medicine 2008;40(4):248‐52. CENTRAL

Tomas‐Carus 2009 {published data only}

Tomás‐Carús P, Gusi N, Häkkinen A, Häkkinen K, Raimundo A, Ortega‐Alonso A. Improvements of muscle strength predicted benefits in HRQOL and postural balance in women in fibromyalgia: an 8‐month randomized controlled trial. Rheumatology 2009;48:1147‐51. CENTRAL

Torres 2015 {published data only}

Torres JR, Martos IC, Sanchez IT, Rubio AO, Pelegrina AD, Valenza MC. Results of an active neurodynamic mobilization program in patients with fibromyalgia syndrome: a randomized controlled trial. Archives of Physical Medicine Rehabilitation 2015;96(10):1771‐8. CENTRAL

Uhlemann 2007 {published data only}

Uhlemann C, Strobel I, Muller‐Ladner U, Lange U. Prospective clinical trial about physical activity in fibromyalgia [German] [Prospektive klinische pilotstudie zur wirksamkeit konditionierender massnahmen bei patienten mit fibromyalgie]. Aktuelle Rheumatologie 2007;32(1):27‐33. CENTRAL

Valencia 2009 {published data only}

Valencia M, Alonso B, Alvarez MJ, Barrientos MJ, Ayán C, Martín Sánchez V. Effects of 2 physiotherapy programs on pain perception, muscular flexibility, and illness impact in women with fibromyalgia: a pilot study. Journal of Manipulative and Physiological Therapeutics 2009;32(1):84‐92. CENTRAL

Valim 2003 {published data only}

Valim V, Oliveira L, Suda A, Silva L, de Assis M, Barros Neto T, et al. Aerobic fitness effects in fibromyalgia. Journal of Rheumatology 2003;30(5):1060‐9. CENTRAL

Valim 2013 {published data only}

Valim V, Natour J, Xiao Y, Pereira AF, Lopes BB, Pollak DF, et al. Effects of physical exercise on serum levels of serotonin and its metabolite in fibromyalgia: a randomized pilot study. Revista Brasileira de Reumatologia 2013;53(6):538‐41. CENTRAL

Valkeinen 2004 {published data only}

Valkeinen H, Alen M, Hannonen P, Häkkinen A, Airaksinen O, Häkkinen K. Changes in knee extension and flexion force, EMG and functional capacity during strength training in older females with fibromyalgia and healthy controls. Rheumatology 2004;43(2):225‐8. CENTRAL

Valkeinen 2005 {published data only}

Valkeinen H, Häkkinen K, Pakarinen A, Hannonen P, Häkkinen A, Airaksinen O, et al. Muscle hypertrophy, strength development, and serum hormones during strength training in elderly women with fibromyalgia. Scandinavian Journal of Rheumatology 2005;34(4):309‐14. CENTRAL

Valkeinen 2008 {published data only}

Valkeinen H, Alen M, Häkkinen A, Hannonen P, Kukkonen‐Harjula K, Häkkinen K. Effects of concurrent strength and endurance training on physical fitness and symptoms in postmenopausal women with fibromyalgia: a randomized controlled trial. Archives of Physical Medicine and Rehabilitation 2008;89(9):1660‐6. CENTRAL

van Eijk‐Hustings 2013 {published data only}

van E‐HY, Kroese M, Tan F, Boonen A, Bessems‐Beks M, Landewe R. Challenges in demonstrating the effectiveness of multidisciplinary treatment on quality of life, participation and health care utilisation in patients with fibromyalgia: a randomised controlled trial. Clinical Rheumatology 2013;32(2):199‐209. CENTRAL

van Koulil 2010 {published data only}

van Koulil S, van Lankveld W, Kraaimaat FW, van Helmond T, Vedder A, van Hoorn H, et al. Tailored cognitive‐behavioral therapy and exercise training for high‐risk patients with fibromyalgia. Arthritis Care and Research 2010;62(10):1377‐85. CENTRAL

VanRavenstein 2014 {published data only}

VanRavenstein KA. Physical Activity in Women with Fibromyalgia. Medical University of South Carolina (Dissertation). Medical University of South Carolina, 2014; Vol. PhD:120. CENTRAL

vanSanten 2002 {published data only}

vanSanten M, Bolwijn P, Landewe R, Verstappen F, Bakker C, Hidding A, et al. High or low intensity aerobic fitness training in fibromyalgia: does it matter?. Journal of Rheumatology 2002;29(3):582‐7. CENTRAL

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Characteristics of studies

Characteristics of included studies [ordered by study ID]

Alentorn‐Geli 2008

Methods

3 groups: mixed exercise (AE + FX + Relax) + WBV; mixed exercise (AE + FX + Relax) + placebo WBV; control (medication as usual)

Setting: not specified

Length: 6 weeks
Follow‐up: none

Study design: randomized clinical trial with parallel groups

Participants

Female:Male: 33:0

Age: 55.2 (SE 3.4); 53.7 (SE 2.7); 59.3 (SE 2.3) years, respectively

Duration of diagnosis (years): 9.8 (SE 0.8) to 10.5 (SE 0.8)

Inclusion: women with diagnosis of FM (ACR 1990) ≥ 3 years

Exclusion: any orthopedic limitation, or cardiovascular, pulmonary, or metabolic disease that would preclude exercise

Interventions

Mixed exercise, relaxation, vibration (n = 11): "The total duration (over 12 sessions) of aerobic exercise, stretching, and relaxation was 9 hours, 6 hours, and 4 hours, respectively" (page 977)

• exercise protocol ‐ total frequency: 2/wk: duration: 90' (warm‐up 15', AE 30', FX 25', Relax 20')

‐ AE intensity: moderate to vigorous (65%‐85% HR max); mode: AE primarily level ground walking with games dance

‐ FX to stop point: mode: FX 5 × 5 whole body stretches, 30 s hold, 30 s relax, involving hamstrings, calves, Achilles tendons, shoulders, arms, gluteals, cervical spine, low back, upper back, chest, hip adductors

• relaxation exercise ‐ mode: diaphragmatic respiration, progressive muscular relaxation, contraction – relaxation and imagery techniques, pharmacologic care as usual

• vibration protocol ‐ frequency: 2/wk; duration: 4‐5' sessions 1' and 2', 18' sessions 3‐12; intensity: body weight resistance; mode: six 30 s lower extremity exercises (static and dynamic), vibratory stimulus: vibration frequency 30 Hz with 2 mm amplitude

Mixed exercise, relaxation, placebo vibration (n = 12)

• exercise protocol ‐ as per mixed exercise, relaxation, vibration group

• relaxation exercise ‐ as per mixed exercise, relaxation, vibration group

• placebo vibration ‐ as per mixed exercise, relaxation, vibration group, but apparatus did not produce vibrations

Control (n = 10): pharmacologic care as usual

Outcomes

Health‐related quality of life (FIQ total), Pain intensity (FIQ VAS), Fatigue (FIQ VAS), Stiffness (FIQ VAS)

Other: depression (FIQ VAS).

Measurements at baseline and at 6 weeks post treatment

Adherence (monitoring, adherence criteria, adherence)

Monitoring methods: none stated; adherence criteria: "100% adherence = all sessions attended"; adherence in mixed exercise, relaxation, vibration group: attendance 93%; adherence in mixed exercise, relaxation, placebo vibration group: 92% (0% dropout)

Congruence of exercise protocol with ACSM criteria for aerobic, resistance or flexibility

Both intervention groups

AE ‐ exercise did not meet ACSM criteria based on frequency (only 2×/wk)

FX ‐ met criteria

Notes

Country: Spain

Language: English

Trial author contact: yes (no response to our email)

Data extraction: point estimates and variability estimates extrapolated from graphs

Funding sources: "no grant supported the investigation. ... There was no conflict of interest" (page 980)

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

Insufficient information to permit judgement: "Women were randomized into three treatment groups" (page 976)

Allocation concealment (selection bias)

Unclear risk

Insufficient information to permit judgement

Blinding of participants and personnel (performance bias)
All outcomes

Low risk

In addition to implementing a "sham" intervention (vibratory apparatus was turned on yet did not produce vibration (page 977), steps were taken to reduce contact between intervention groups

Blinding of self reported outcome (detection bias)

Low risk

All outcomes (HRQL, pain intensity, fatigue, stiffness) were self‐reported

"The administration and analysis of the questionnaires were performed by an investigator who was blind to the treatment group" (page 977)

Individuals not aware of placebo effect: "We informed both EVG and EG that they would receive a perceptible and imperceptible vibratory stimulus, respectively, thus maintaining the potential of a placebo effect consistent in both groups" (page 977)

Blinding of objectively measured outcome (detection bias)

Low risk

Not measured

Incomplete outcome data (attrition bias)
All outcomes

Low risk

Study has no dropouts. Attrition was attributed to "a no‐show on testing day" (page 978). Intention‐to‐treat not used; however, it is unlikely that attrition affected results

Selective reporting (reporting bias)

High risk

Trial authors used the FIQ but did not report all subscales. Assuming FIQ was used, outcomes physical function, anxiety, and sleep were not reported. Furthermore, we searched the protocol available on ClinicalTrials.gov (NCT00650715), but it does not provide further insight into selective reporting related to outcomes examined in this review. Trial authors specified their primary outcome only (serum IGT‐1); no other planned outcomes are available in the trial protocol

Other bias

Low risk

Study appears to be free of other sources of bias

Gusi 2010

Methods

2 groups: whole body vibration; control (standard care)

Setting: program implemented at the local fibromyalgia association (unclear whether group or individual)

Length of Intervention: 12 weeks
Follow‐up: none

Study design: randomized clinical trial, parallel groups

Participants

Female:Male: 41:0

Age: mean 52.4 (SD 10.8); mean 53 (SD 12) years, respectively

Duration of symptoms: 12.7 (6.7); 13.7 (6.2) years, respectively

Inclusion: participants in a local fibromyalgia association; condition diagnosed by a rheumatologist (ACR 1990 diagnostic criteria)

Exclusion: history of severe trauma, frequent migraines, peripheral nerve entrapment, inflammatory rheumatic disease, severe psychiatric illness, other diseases that prevent physical loading, pregnancy, participation in another psychological or physical therapy program, participation in regular physical exercise more often than 1×/wk for ≥ 30 minutes during any 2‐week period in past 5 years

Interventions

Whole body vibration (n = 21): frequency: 3×/wk; duration: 18‐21' per session. 10' warm‐up of slow walking and slight movement; total 6 reps of WBV at 12.5 Hz with 60 s rest interval; wk 1‐4 each rep was 30 s; wk 5‐8 each rep was 45 s; wk 9‐12 each rep was 60 s; at each repetition, the stance of the participant on the platform was alternated between stance 'A' (feet planted perpendicular to midline axis of the platform; right foot ahead of left; lift the toes of the platform; bend the knees and maintain a 45‐degree knee angle; keep back ahead straight) and 'B' (same as stance 'A' but left foot ahead). Intensity: not given. Mode: sustained squat on vibration platform

Control (n = 20): Participants received standard care that included medical attention and social support through the local fibromyalgia association: "Participants continue their daily activities which did not include any form of physical exercise that resembled the exercises performed by participants in the vibration group, and they not receive a weekly phone call" (page 1074)

Outcomes

Health‐related quality of life (FIQ total), Balance (Biodex Balance System dynamic and static balance ‐ degrees of tilt)

Other: HRQL (15D questionnaire), Number of falls in the past year (baseline only), Tender points (baseline only)

Measurements taken at baseline and at 12 weeks post treatment

Adherence (monitoring, adherence criteria, adherence)

Monitoring methods: logbooks and research assistance, 3‐minute weekly phone call; adherence criteria: none stated; adherence: program was completed by 85.7% of participants

Congruence of exercise protocol with ACSM criteria for aerobic, resistance or flexibility

Not applicable

Notes

Country: Spain,

Language: English

Trial author contact: no

Funding sources: not specified

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Low risk

Participants were "randomly and sequentially assigned to either the vibration group (n = 21) or the control group (n = 20) by a research assistant, according to a random number table" (page 1073)

Allocation concealment (selection bias)

Low risk

Participants were "allocated by research assistant, participants were blinded to allocation until after assignment, research team members were blinded to assignment" (page 1073)

Blinding of participants and personnel (performance bias)
All outcomes

High risk

"Participants were blinded to group assignment before baseline measurements, after which all participants were informed of their assignment" (page 1073)

Blinding of self reported outcome (detection bias)

High risk

Self‐reported outcome measures

Blinding of objectively measured outcome (detection bias)

Low risk

"Research team members (JAP and PRO) who were also blinded to the group assignments of the participants conducted the measurements of dynamic balance at baseline and 12 weeks. Different members of the research team (NG and JCA) administered the intervention and performed the statistical analysis" (page 1073)

Incomplete outcome data (attrition bias)
All outcomes

Low risk

ITT analysis and ITT data reported in Gusi 2010, but in Adsuar, analysis was based on "as treated" data (n = 18 per group)

Selective reporting (reporting bias)

High risk

Study protocol (www.controlled‐trials.com/ISRCTN16950947) states that FIQ was used at baseline and at 3 months, yet HRQL, physical function, and pain intensity were not reported

Other bias

Low risk

Study appears to be free of other sources of bias

Sañudo 2010

Methods

2 groups: mixed exercise (AE + RT + FX) + WBV; mixed exercise (AE + RT + FX)

Setting: group ‐ supervised

Length: 6 weeks

Follow‐up: none

Study design: randomized clinical trial with parallel groups

Participants

Female:Male: 30:0

Age: 57.89 (6.23); 60.13 (9.42) years, respectively

Duration of illness: not stated

Inclusion: postmenopausal women with diagnosis of fibromyalgia (ACR 1990)

Exclusion: inflammatory rheumatic disorders or degenerative joint disease, psychiatric disorders, respiratory or cardiovascular diseases that would preclude exercise. Individuals under psychiatrist care or performing structured physical activity ≥ 2 days a week or had psychological therapy during the 6 months before the study

Interventions

Mixed exercise (AE + RT + FX) + WBV (n = 15)

• exercise protocol: frequency 2×/wk

‐ AE intensity: 50%‐69% max HR, major muscle groups; mode: short intervals (4‐6 intervals of 2‐3', 1‐2' rest in between)

‐ RT intensity: 8 exercises: 1×1‐8 reps with 1‐3 kg; mode: not stated

‐ FX intensity: 8‐9 exercises: 1×3 reps, keeping the stretch position for 30 s; mode: not stated

• vibration protocol: frequency 3×/wk; duration 3 sets of 45 s with 120 s recovery (amplitude = 3 mm) and 4 sets of 15 s; intensity: frequency of 20 Hz and variable amplitude of 2‐3 mm; mode: using a platform (Novotec, Pforzheim, Germany), the first 3 sets were performed bilaterally for 45 s at a frequency of 20 Hz (amplitude 3 mm) after 120 s recovery between sets. Participants completed 4 sets of unilateral static squats at a frequency of 20 Hz (A = 2 mm) for 6 wk. Participants completed 15 s of exercise with right leg, then immediately completed 15 s on the left leg ‐ this was considered 1 set. During vibration session, participants stood with both knees in 120 isometric knee flexion (half‐squatting position) as measured by a goniometer

Mixed exercise (AE + ST + FX) (n = 15) performed as in Mixed exercise (AE + RT + FX) + WBV group, no vibration training. Frequency 2×/wk; duration 60 minutes

Outcomes

Health‐related quality of life (FIQ total), Muscle strength (newtons), Balance (Biodex Bal System – overall stability index, eyes closed, degree displacement 0‐20 scale)

Other: muscle endurance (number of squat reps in 60 s and fatigue index), power (maximum power; squats), HRQL (SF‐36)

Measurements at baseline and at 6 weeks post treatment

Adherence (monitoring, adherence criteria, adherence)

Monitoring methods: none stated; adherence criteria: none stated; adherence: none stated

Congruence of exercise protocol with ACSM criteria for aerobic, resistance or flexibility

Both intervention groups

AE ‐ did not meet ACSM criteria based on frequency (only 2×/wk for about 15')

RT ‐ met criteria

FX ‐ not enough info to judge; unclear which muscles were stretched

Notes

Country: Spain

Language: primary and companion articles in English

Funding sources: none stated

Trial author contact: yes, responses received (March 18, 2012) with regard to reasons for dropout, fatigue ratio calculation, sessions of vibration training, allocation concealment, and combined exercise sessions

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Low risk

"participants were randomized into one of two groups (by a computer generated random number table). Randomization was carried out by LC, who was not directly involved in the day‐to‐day running of the study…" (page S‐41)

Allocation concealment (selection bias)

Unclear risk

Insufficient information to permit judgment of "yes" or "no"

Blinding of participants and personnel (performance bias)
All outcomes

Unclear risk

No information provided to indicate measurements to blind study participants or personnel

Blinding of self reported outcome (detection bias)

Unclear risk

Self‐reported outcomes: head‐to‐head intervention; it is possible that both groups may have overestimated reporting of the outcome. No information about participant awareness of the intervention

Blinding of objectively measured outcome (detection bias)

Low risk

"Data were collected….by an outcome assessor who was blind to group allocation" (page S‐41)

Incomplete outcome data (attrition bias)
All outcomes

Low risk

No missing outcome data

Selective reporting (reporting bias)

Low risk

Study protocol is not available, but it is clear that published reports include all expected outcomes

Other bias

Low risk

Study appears to be free of other sources of bias

Sañudo 2013

Methods

3 groups: mixed exercise (AE + RT + FX) + WBV; mixed exercise (AE + RT + FX); control (usual care)

Setting: community based ‐ supervised

Length: 8 weeks

Follow‐up: none

Study design: randomized controlled trial, 3 parallel groups

Participants

Female:Male: 46:0

Age: 57.15 (SD 6.8); 62.3 (SD 9.8); 55.6 (SD 7.9) years, respectively

Duration of illness: not specified

Inclusion: participants in a local fibromyalgia support group (Seville, Spain) and physician practices; met ACR 1990 diagnosis criteria

Exclusion: no previous experience with vibratory training; ≥ 1 possible contraindications (acute hernia; thrombosis; diabetes; epilepsy; metabolic or neuromuscular disease; osteoporosis; osteoarthritis; orthopedic injuries and prosthesis); respiratory or cardiovascular disease that prevents physical exertion; taking drugs that could interfere with balance control; receiving psychological or physical therapy (to avoid possible interaction)

Interventions

Mixed exercise (AE + RT + FX) + WBV (n = 15)

• exercise protocol: duration: 45‐60 min (WU 10 min, AE 10‐15 min, RT 15‐20 min, FX 10 min)

‐ AE: frequency: 2×/wk; mode: AE ‐ walking mode not specified; intensity: moderate (65%‐70% HR max)

‐ RT: 1 set of 8‐10 reps for 8 different muscle groups; load 1‐3 kg

‐ FX: mode: 1 set of 3 reps for 8‐9 different exercises, maintained for 30 s; mode: focused on main areas of pain (deltoids, biceps, neck, hips, back, and chest)

• vibration protocol: frequency: 3×/wk progressive training (2‐leg stance with knees @120° of knee flexion), 30 Hz, peak to displacement 4 mm (71.1 m/s‐2˜7.2 g); duration: weeks 1‐2: 6 sets of 30 s, 45 s recovery between sets with participants standing with both feet on platform, and 4 sets of 30 s single leg (right and left immediately following each other); weeks 3‐4: 7 sets 30 s/45 s rest (bilateral squat), and 5 sets of 30 s/45 s rest (unilateral squat). Weeks 5‐6: 8 sets of 30 s/45 s rest (bilateral squat), and 6 sets of 30 s/45 s rest (unilateral squat), weeks 7‐8: 9 sets of 30 s/45 s rest (bilateral squat), and 7 sets of 30 s/45 s rest (unilateral squat)

Mixed exercise (AE + RT + FX) (n = 15)

Frequency: 2×/wk; duration: 45‐60 min (WU 10 min, AE 10‐15 min, RT 15‐20 min, FX 10 min)

• exercise protocol: performed as in Mixed exercise (AE + RT + FX) + WBV group

Usual care (n = 16): usual care, no additional information provided

Outcomes

Balance (Biodex F1C Stability System: overall stability index open eyes, overall stability index closed eyes)

Other: power (number of reps of half squats in 1')

Measurements taken at baseline and at 8 weeks post treatment

Adherence (monitoring, adherence criteria, adherence)

Monitoring methods: not stated; adherence criteria: not stated; adherence: women in mixed plus whole body vibration group attended 77%, and in mixed exercise 79% of sessions

Congruence of exercise protocol with ACSM criteria for aerobic, resistance or flexibility

Both intervention groups

AE ‐ did not meet ACSM criteria for frequency and duration

RT ‐ not enough information to determine

FX ‐ met ACSM criteria

Notes

Country: Spain

Language: English

Funding sources: none stated

Trial author contact: email received March 17, 2014, provided clarification regard sample size (only 5 participants in CG dropped out, 11 participants were assessed at post‐test and assessor blinding)

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Low risk

"Participants were randomly assigned by using a computer generated random number sequence" (page 679)

Allocation concealment (selection bias)

Low risk

"Randomization was undertaken by a member of the research team not directly involved in the recruitment or assessment of patients" (page 679)

Blinding of participants and personnel (performance bias)
All outcomes

High risk

Unspecified blinding of participants or personnel

Blinding of self reported outcome (detection bias)

Low risk

Not measured

Blinding of objectively measured outcome (detection bias)

Low risk

Research team members (JAP and PRO) who were also blinded to group assignments of participants conducted measurements of dynamic balance at baseline and at 12 weeks. Different members of research team (NG and JCA) administered the intervention and performed statistical analysis (trial author communication)

Incomplete outcome data (attrition bias)
All outcomes

Low risk

ITT analysis, and ITT data reported

Selective reporting (reporting bias)

Low risk

Study protocol is not available, but results for all outcomes specified in the methods section of the paper were reported

Other bias

Unclear risk

Baselines differences in medial lateral mean defection (page 680)

Characteristics of excluded studies [ordered by study ID]

Study

Reason for exclusion

Ahlgren 2001

Diagnosis does not meet requirements

Alentorn‐Geli 2009

Outcomes were serum insulin‐like growth factor‐1 (IGF‐1) levels in women with fibromyalgia. None of the primary or secondary outcomes of the review were measured in this study

Altan 2004

Physical activity intervention did not meet requirements for vibration training

Altan 2009

Physical activity intervention did not meet requirements for vibration training

Amanollahi 2013

Physical activity intervention did not meet requirements for vibration training

Andrade 2016

Not an RCT

Ang 2007

Randomization does not allow analysis of effects of exercise

Aquino 2013

Exercise requirements not met

Arcos‐Carmona 2011

Physical activity intervention did not meet requirements for vibration training

Assis 2006

Physical activity intervention did not meet requirements for vibration training

Astin 2003

Physical activity intervention did not meet requirements for vibration training

Bailey 1999

Not an RCT

Bakker 1995

Designated outcomes not measured

Baniak 2015

Not an RCT

Baptista 2012

Physical activity intervention did not meet requirements for vibration training

Bardal 2015

Not an RCT

Bircan 2008

Physical activity intervention did not meet requirements for vibration training

Bojner‐Horwitz 2003

Physical activity intervention did not meet requirements for vibration training

Bojner‐Horwitz 2006

Physical activity intervention did not meet requirements for vibration training (companion)

Bote 2013

Not an RCT

Bressan 2008

Physical activity intervention did not meet requirements for vibration training

Buckelew 1998

Physical activity intervention did not meet requirements for vibration training

Calandre 2010

Physical activity intervention did not meet requirements for vibration training

Carbonell‐Baeza 2011

Physical activity intervention did not meet requirements for vibration training

Carbonell‐Baeza 2011a

RCT protocol (physical activity intervention did not meet requirements for vibration training)

Carbonell‐Baeza 2012

RCT protocol (physical activity intervention did not meet requirements for vibration training)

Carson 2010

Physical activity intervention did not meet requirements for vibration training

Carson 2012

Physical activity intervention did not meet requirements for vibration training (companion)

Casanueva‐Fernandez 2012

Exercise requirements not met

Castel 2013

Physical activity intervention did not meet requirements for vibration training

Castro‐Sanchez 2011

Exercise requirements not met

Cedraschi 2004

Physical activity intervention did not meet requirements for vibration training

Cocke 2015

Physical activity intervention did not meet requirements for vibration training

Da Costa 2005

Physical activity intervention did not meet requirements for vibration training

da Silva 2007

Physical activity intervention did not meet requirements for vibration training

da Silva 2015

RCT protocol (physical activity intervention did not meet requirements for vibration training)

Dal 2011

Not an RCT

Dawson 2003

Not an RCT

De Andrade 2008

Physical activity intervention did not meet requirements for vibration training

de Araujo Farias 2013

Physical activity intervention did not meet requirements for vibration training

de Melo Vitorino 2006

Physical activity intervention did not meet requirements for vibration training

Delgado 2011

RCT protocol (physical activity intervention did not meet requirements for vibration training)

Demir‐Gocmen 2013

Physical activity intervention did not meet requirements for vibration training

Duruturk 2015

Physical activity intervention did not meet requirements for vibration training

Ekici 2008

Physical activity intervention did not meet requirements for vibration training

Etnier 2009

Physical activity intervention did not meet requirements for vibration training

Evcik 2008

Physical activity intervention did not meet requirements for vibration training

Field 2003

Physical activity intervention did not meet requirements for vibration training

Finset 2004

Physical activity intervention did not meet requirements for vibration training (companion)

Fioravanti 2015

RCT protocol (physical activity intervention did not meet requirements for vibration training)

Fontaine 2007

Physical activity intervention did not meet requirements for vibration training

Fontaine 2010

Physical activity intervention did not meet requirements for vibration training

Fontaine 2011

Physical activity intervention did not meet requirements for vibration training (companion)

Gandhi 2000

Not an RCT

Garcia‐Martinez 2011

Physical activity intervention did not meet requirements for vibration training

Gavi 2014

Physical activity intervention did not meet requirements for vibration training

Genc 2002

Physical activity intervention did not meet requirements for vibration training

Genc 2015

Physical activity intervention did not meet requirements for vibration training

Giannotti 2014

Physical activity intervention did not meet requirements for vibration training

Gomes da Silva 2008

Physical activity intervention did not meet requirements for vibration training

Gonzalez Gonzalez 2015

Not an RCT

Gowans 1999

Physical activity intervention did not meet requirements for vibration training

Gowans 2001

Physical activity intervention did not meet requirements for vibration training

Gowans 2002

Physical activity intervention did not meet requirements for vibration training (companion)

Gowans 2004

Follow‐up study, randomization lost

Guarino 2001

Diagnosis did not meet requirements

Gusi 2006

Physical activity intervention did not meet requirements for vibration training

Gusi 2008

Physical activity intervention did not meet requirements for vibration training (companion)

Gusi Fuertes 2016

RCT protocol (physical activity intervention did not meet requirements for vibration training)

Hakkinen 2002

Physical activity intervention did not meet requirements for vibration training (companion)

Han 1998

Not an RCT

Hecker 2011

Physical activity intervention did not meet requirements for vibration training

Hoeger Bement 2011

Not an RCT

Hoeger Bement 2014

Not an RCT

Hooten 2012

Physical activity intervention did not meet requirements for vibration training

Hsieh 2010

Not an RCT

Hunt 2000

Physical activity intervention did not meet requirements for vibration training

Huyser 1997

Not an RCT

Häkkinen 2001

Physical activity intervention did not meet requirements for vibration training

Häkkinen 2002

Physical activity intervention did not meet requirements for vibration training

Ide 2008

Physical activity intervention did not meet requirements for vibration training

Ismael Martins 2014

Physical activity intervention did not meet requirements for vibration training

Jentoft 2001

Physical activity intervention did not meet requirements for vibration training

Jones 2002

Physical activity intervention did not meet requirements for vibration training

Jones 2007

Physical activity intervention did not meet requirements for vibration training (companion)

Jones 2008

Physical activity intervention did not meet requirements for vibration training

Jones 2011

Not an RCT

Jones 2012

Physical activity intervention did not meet requirements for vibration training

Joshi 2009

Physical activity intervention did not meet requirements for vibration training

Kadetoff 2010

Not an RCT

Kaleth 2013

Randomization does not allow analysis of effects of exercise

Kaleth 2016

Randomization does not allow analysis of effects of exercise

Karolinska Institutet 2015

RCT protocol (physical activity intervention did not meet requirements for vibration training)

Karper 2001

Not an RCT

Kayo 2011

Physical activity intervention did not meet requirements for vibration training

Keel 1998

Physical activity intervention did not meet requirements for vibration training

Kendall 2000

Exercise requirements not met

Kesiktas 2011

Not an RCT

Khalsa 2009

Not an RCT

Kibar 2015

Physical activity intervention did not meet requirements for vibration training

King 2002

Physical activity intervention did not meet requirements for vibration training

Kingsley 2005

Diagnosis did not meet requirements

Kingsley 2010

Not an RCT

Klug 1989

Not an RCT

Kroenke 2013

Diagnosis did not meet requirements

Kurt 2016

Physical activity intervention did not meet requirements for vibration training

Lange 2011

Not an RCT

Larsson 2015

Physical activity intervention did not meet requirements for vibration training

Latorre 2013

Not an RCT

Latorre Roman 2015

Physical activity intervention did not meet requirements for vibration training

Lemstra 2005

Physical activity intervention did not meet requirements for vibration training

Letieri 2013

Physical activity intervention did not meet requirements for vibration training

Liu 2012

Physical activity intervention did not meet requirements for vibration training

Lopez‐Pousa 2015

Study did not include exercise

Lorig 2008

Exercise requirements not met

Lynch 2012

Physical activity intervention did not meet requirements for vibration training

López‐Rodríguez 2012

Physical activity intervention did not meet requirements for vibration training

Mannerkorpi 2000

Physical activity intervention did not meet requirements for vibration training

Mannerkorpi 2002

Not an RCT

Mannerkorpi 2009

Physical activity intervention did not meet requirements for vibration training

Mannerkorpi 2010

Physical activity intervention did not meet requirements for vibration training

Martin 1996

Physical activity intervention did not meet requirements for vibration training

Martin 2014

Physical activity intervention did not meet requirements for vibration training

Martin‐Nogueras 2012

Physical activity intervention did not meet requirements for vibration training

Mason 1998

Not an RCT

Matsumoto 2011

Data for FM not isolated

Matsutani 2007

Physical activity intervention did not meet requirements for vibration training

Matsutani 2012

Physical activity intervention did not meet requirements for vibration training

McCain 1986

Physical activity intervention did not meet requirements for vibration training (companion)

McCain 1988

Physical activity intervention did not meet requirements for vibration training

Meiworm 2000

Not an RCT

Mendonca 2016

Physical activity intervention did not meet requirements for vibration training

Mengshoel 1992

Physical activity intervention did not meet requirements for vibration training

Mengshoel 1993

Physical activity intervention did not meet requirements for vibration training (companion)

Meyer 2000

Problem with implementation of study design ‐ randomization lost

Mobily 2001

Not an RCT

Munguia‐Izquierdo 2007

Physical activity intervention did not meet requirements for vibration training

Munguia‐Izquierdo 2008

Physical activity intervention did not meet requirements for vibration training (companion)

Mutlu 2013

Physical activity intervention did not meet requirements for vibration training

Newcomb 2011

Exercise requirements not met

Nichols 1994

Physical activity intervention did not meet requirements for vibration training

Nielens 2000

Not an RCT

Norregaard 1997

Physical activity intervention did not meet requirements for vibration training

Offenbacher 2000

Not an RCT

Oncel 1994

Exercise requirements not met

Palekar 2014

Physical activity intervention did not meet requirements for vibration training

Paolucci 2015

Physical activity intervention did not meet requirements for vibration training

Pastor 2014

RCT protocol (physical activity intervention did not meet requirements for vibration training)

Perez‐De la Cruz 2015

Study did not allow analysis of fibromyalgia only

Peters 2002

Diagnosis did not meet requirements

Pfeiffer 2003

Not an RCT

Piso 2001

Not an RCT

Ramsay 2000

Physical activity intervention did not meet requirements for vibration training

Richards 2002

Physical activity intervention did not meet requirements for vibration training

Rivera Redondo 2004

Physical activity intervention did not meet requirements for vibration training

Rooks 2002

Not an RCT

Rooks 2007

Physical activity intervention did not meet requirements for vibration training

Salek 2005

Not an RCT

Santana 2010

Diagnosis did not meet requirements

Sañudo 2010a

Physical activity intervention did not meet requirements for vibration training

Sañudo 2010b

Physical activity intervention did not meet requirements for vibration training

Sañudo 2011

Physical activity intervention did not meet requirements for vibration training

Sañudo 2012a

Physical activity intervention did not meet requirements for vibration training

Sañudo 2015

Physical activity intervention did not meet requirements for vibration training

Schachter 2003

Physical activity intervention did not meet requirements for vibration training

Schmidt 2011

Physical activity intervention did not meet requirements for vibration training

Sencan 2004

Physical activity intervention did not meet requirements for vibration training

Sigl‐Erkel 2011

Not an RCT

Srikuea 2013

Exercise requirements not met

Steiner 2015

Not a physical activity RCT; analysis did not isolate effects of exercise

Suman 2009

Not an RCT

Thieme 2003

Exercise requirements not met

Thijssen 1992

Not an RCT

Tiidus 1997

Not an RCT

Tomas‐Carus 2007a

Physical activity intervention did not meet requirements for vibration training (companion)

Tomas‐Carus 2007b

Physical activity intervention did not meet requirements for vibration training (companion)

Tomas‐Carus 2007c

Physical activity intervention did not meet requirements for vibration training (companion)

Tomas‐Carus 2007d

Physical activity intervention did not meet requirements for vibration training (companion)

Tomas‐Carus 2008

Physical activity intervention did not meet requirements for vibration training

Tomas‐Carus 2009

Not an RCT

Torres 2015

Study did not include exercise

Uhlemann 2007

Not an RCT

Valencia 2009

Physical activity intervention did not meet requirements for vibration training

Valim 2003

Physical activity intervention did not meet requirements for vibration training

Valim 2013

Physical activity intervention did not meet requirements for vibration training (companion)

Valkeinen 2004

Physical activity intervention did not meet requirements for vibration training

Valkeinen 2005

Physical activity intervention did not meet requirements for vibration training (companion)

Valkeinen 2008

Physical activity intervention did not meet requirements for vibration training

van Eijk‐Hustings 2013

Physical activity intervention did not meet requirements for vibration training

van Koulil 2010

Physical activity intervention did not meet requirements for vibration training

VanRavenstein 2014

Not an RCT

vanSanten 2002

Physical activity intervention did not meet requirements for vibration training

vanSanten 2002a

Physical activity intervention did not meet requirements for vibration training

Verstappen 1997

Physical activity intervention did not meet requirements for vibration training

Vlaeyen1996

Exercise requirements not met

Wang 2010

Physical activity intervention did not meet requirements for vibration training

Wang 2015

RCT protocol (physical activity intervention did not meet requirements for vibration training)

Westfall 1999

Diagnosis did not meet requirements

Wigers 1996

Physical activity intervention did not meet requirements for vibration training

Williams 2010

Exercise requirements not met

Worrel 2001

Not an RCT

Yuruk 2008

Physical activity intervention did not meet requirements for vibration training

Zijlstra 2005

Not an RCT

Data and analyses

Open in table viewer
Comparison 1. WBV vs C

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 HRQL, 1‐100 scale, lower means better HRQL Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

Analysis 1.1

Comparison 1 WBV vs C, Outcome 1 HRQL, 1‐100 scale, lower means better HRQL.

Comparison 1 WBV vs C, Outcome 1 HRQL, 1‐100 scale, lower means better HRQL.

2 Balance, degrees of displacement, lower is best Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

Analysis 1.2

Comparison 1 WBV vs C, Outcome 2 Balance, degrees of displacement, lower is best.

Comparison 1 WBV vs C, Outcome 2 Balance, degrees of displacement, lower is best.

3 Withdrawal Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

Analysis 1.3

Comparison 1 WBV vs C, Outcome 3 Withdrawal.

Comparison 1 WBV vs C, Outcome 3 Withdrawal.

Open in table viewer
Comparison 2. WBV + MX vs C

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 WBV + MX vs C: HRQL, 0‐100 scale, lower is best Show forest plot

1

Mean Difference (IV, Random, 95% CI)

Totals not selected

Analysis 2.1

Comparison 2 WBV + MX vs C, Outcome 1 WBV + MX vs C: HRQL, 0‐100 scale, lower is best.

Comparison 2 WBV + MX vs C, Outcome 1 WBV + MX vs C: HRQL, 0‐100 scale, lower is best.

2 WBV + MX vs C: pain, 0‐100 scale, lower is best Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

Analysis 2.2

Comparison 2 WBV + MX vs C, Outcome 2 WBV + MX vs C: pain, 0‐100 scale, lower is best.

Comparison 2 WBV + MX vs C, Outcome 2 WBV + MX vs C: pain, 0‐100 scale, lower is best.

3 WBV + MX vs C: fatigue, 0‐100 scale, lower is best Show forest plot

1

Mean Difference (IV, Random, 95% CI)

Totals not selected

Analysis 2.3

Comparison 2 WBV + MX vs C, Outcome 3 WBV + MX vs C: fatigue, 0‐100 scale, lower is best.

Comparison 2 WBV + MX vs C, Outcome 3 WBV + MX vs C: fatigue, 0‐100 scale, lower is best.

4 WBV + MX vs C: stiffness, 0‐100 scale, lower is best Show forest plot

1

Mean Difference (IV, Random, 95% CI)

Totals not selected

Analysis 2.4

Comparison 2 WBV + MX vs C, Outcome 4 WBV + MX vs C: stiffness, 0‐100 scale, lower is best.

Comparison 2 WBV + MX vs C, Outcome 4 WBV + MX vs C: stiffness, 0‐100 scale, lower is best.

5 WBV + MX vs C: balance, overall stability index ‐ eyes closed (degrees of displacement 0 to 20 scale, lower is best) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

Analysis 2.5

Comparison 2 WBV + MX vs C, Outcome 5 WBV + MX vs C: balance, overall stability index ‐ eyes closed (degrees of displacement 0 to 20 scale, lower is best).

Comparison 2 WBV + MX vs C, Outcome 5 WBV + MX vs C: balance, overall stability index ‐ eyes closed (degrees of displacement 0 to 20 scale, lower is best).

6 Withdrawal Show forest plot

2

46

Risk Ratio (M‐H, Random, 95% CI)

0.25 [0.06, 1.12]

Analysis 2.6

Comparison 2 WBV + MX vs C, Outcome 6 Withdrawal.

Comparison 2 WBV + MX vs C, Outcome 6 Withdrawal.

Open in table viewer
Comparison 3. WBV + MX vs Other

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 WBV + MX vs Other: HRQL, 0‐100 scale, lower is best Show forest plot

2

49

Mean Difference (IV, Random, 95% CI)

‐6.67 [‐14.65, 1.31]

Analysis 3.1

Comparison 3 WBV + MX vs Other, Outcome 1 WBV + MX vs Other: HRQL, 0‐100 scale, lower is best.

Comparison 3 WBV + MX vs Other, Outcome 1 WBV + MX vs Other: HRQL, 0‐100 scale, lower is best.

2 WBV + MX vs Other: pain, 0‐100 scale, lower is best Show forest plot

1

Mean Difference (IV, Random, 95% CI)

Totals not selected

Analysis 3.2

Comparison 3 WBV + MX vs Other, Outcome 2 WBV + MX vs Other: pain, 0‐100 scale, lower is best.

Comparison 3 WBV + MX vs Other, Outcome 2 WBV + MX vs Other: pain, 0‐100 scale, lower is best.

3 WBV + MX vs Other: fatigue, 0‐100 scale, lower is best Show forest plot

1

Mean Difference (IV, Random, 95% CI)

Totals not selected

Analysis 3.3

Comparison 3 WBV + MX vs Other, Outcome 3 WBV + MX vs Other: fatigue, 0‐100 scale, lower is best.

Comparison 3 WBV + MX vs Other, Outcome 3 WBV + MX vs Other: fatigue, 0‐100 scale, lower is best.

4 WBV + MX vs Other: stiffness, 0‐100 scale, lower is best Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

Analysis 3.4

Comparison 3 WBV + MX vs Other, Outcome 4 WBV + MX vs Other: stiffness, 0‐100 scale, lower is best.

Comparison 3 WBV + MX vs Other, Outcome 4 WBV + MX vs Other: stiffness, 0‐100 scale, lower is best.

5 WBV + MX vs Other: strength, measured in newtons and number of reps, higher values are best Show forest plot

2

54

Std. Mean Difference (IV, Random, 95% CI)

0.77 [0.20, 1.35]

Analysis 3.5

Comparison 3 WBV + MX vs Other, Outcome 5 WBV + MX vs Other: strength, measured in newtons and number of reps, higher values are best.

Comparison 3 WBV + MX vs Other, Outcome 5 WBV + MX vs Other: strength, measured in newtons and number of reps, higher values are best.

6 WBV + MX vs Other: balance, overall stability index ‐ eyes closed (degrees of displacement 0 to 20 scale, lower is best) Show forest plot

2

54

Mean Difference (IV, Random, 95% CI)

‐0.22 [‐1.56, 1.11]

Analysis 3.6

Comparison 3 WBV + MX vs Other, Outcome 6 WBV + MX vs Other: balance, overall stability index ‐ eyes closed (degrees of displacement 0 to 20 scale, lower is best).

Comparison 3 WBV + MX vs Other, Outcome 6 WBV + MX vs Other: balance, overall stability index ‐ eyes closed (degrees of displacement 0 to 20 scale, lower is best).

7 Withdrawal Show forest plot

3

77

Risk Ratio (M‐H, Random, 95% CI)

0.72 [0.17, 3.11]

Analysis 3.7

Comparison 3 WBV + MX vs Other, Outcome 7 Withdrawal.

Comparison 3 WBV + MX vs Other, Outcome 7 Withdrawal.

Study flow diagram for vibration training interventions.
Figuras y tablas -
Figure 1

Study flow diagram for vibration training interventions.

Galileo Fitness Platform (Copyright © 2008‐2015 Novotec Medical GmbH; reproduced with permission)
Figuras y tablas -
Figure 2

Galileo Fitness Platform (Copyright © 2008‐2015 Novotec Medical GmbH; reproduced with permission)

Copyright © 2012 Wellsports GmbH Krefeld ‐ PowerPlate International B.V., The Netherlands ‐ awaiting response.Sept15
Figuras y tablas -
Figure 3

Copyright © 2012 Wellsports GmbH Krefeld ‐ PowerPlate International B.V., The Netherlands ‐ awaiting response.Sept15

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
Figuras y tablas -
Figure 4

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
Figuras y tablas -
Figure 5

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.

Comparison 1 WBV vs C, Outcome 1 HRQL, 1‐100 scale, lower means better HRQL.
Figuras y tablas -
Analysis 1.1

Comparison 1 WBV vs C, Outcome 1 HRQL, 1‐100 scale, lower means better HRQL.

Comparison 1 WBV vs C, Outcome 2 Balance, degrees of displacement, lower is best.
Figuras y tablas -
Analysis 1.2

Comparison 1 WBV vs C, Outcome 2 Balance, degrees of displacement, lower is best.

Comparison 1 WBV vs C, Outcome 3 Withdrawal.
Figuras y tablas -
Analysis 1.3

Comparison 1 WBV vs C, Outcome 3 Withdrawal.

Comparison 2 WBV + MX vs C, Outcome 1 WBV + MX vs C: HRQL, 0‐100 scale, lower is best.
Figuras y tablas -
Analysis 2.1

Comparison 2 WBV + MX vs C, Outcome 1 WBV + MX vs C: HRQL, 0‐100 scale, lower is best.

Comparison 2 WBV + MX vs C, Outcome 2 WBV + MX vs C: pain, 0‐100 scale, lower is best.
Figuras y tablas -
Analysis 2.2

Comparison 2 WBV + MX vs C, Outcome 2 WBV + MX vs C: pain, 0‐100 scale, lower is best.

Comparison 2 WBV + MX vs C, Outcome 3 WBV + MX vs C: fatigue, 0‐100 scale, lower is best.
Figuras y tablas -
Analysis 2.3

Comparison 2 WBV + MX vs C, Outcome 3 WBV + MX vs C: fatigue, 0‐100 scale, lower is best.

Comparison 2 WBV + MX vs C, Outcome 4 WBV + MX vs C: stiffness, 0‐100 scale, lower is best.
Figuras y tablas -
Analysis 2.4

Comparison 2 WBV + MX vs C, Outcome 4 WBV + MX vs C: stiffness, 0‐100 scale, lower is best.

Comparison 2 WBV + MX vs C, Outcome 5 WBV + MX vs C: balance, overall stability index ‐ eyes closed (degrees of displacement 0 to 20 scale, lower is best).
Figuras y tablas -
Analysis 2.5

Comparison 2 WBV + MX vs C, Outcome 5 WBV + MX vs C: balance, overall stability index ‐ eyes closed (degrees of displacement 0 to 20 scale, lower is best).

Comparison 2 WBV + MX vs C, Outcome 6 Withdrawal.
Figuras y tablas -
Analysis 2.6

Comparison 2 WBV + MX vs C, Outcome 6 Withdrawal.

Comparison 3 WBV + MX vs Other, Outcome 1 WBV + MX vs Other: HRQL, 0‐100 scale, lower is best.
Figuras y tablas -
Analysis 3.1

Comparison 3 WBV + MX vs Other, Outcome 1 WBV + MX vs Other: HRQL, 0‐100 scale, lower is best.

Comparison 3 WBV + MX vs Other, Outcome 2 WBV + MX vs Other: pain, 0‐100 scale, lower is best.
Figuras y tablas -
Analysis 3.2

Comparison 3 WBV + MX vs Other, Outcome 2 WBV + MX vs Other: pain, 0‐100 scale, lower is best.

Comparison 3 WBV + MX vs Other, Outcome 3 WBV + MX vs Other: fatigue, 0‐100 scale, lower is best.
Figuras y tablas -
Analysis 3.3

Comparison 3 WBV + MX vs Other, Outcome 3 WBV + MX vs Other: fatigue, 0‐100 scale, lower is best.

Comparison 3 WBV + MX vs Other, Outcome 4 WBV + MX vs Other: stiffness, 0‐100 scale, lower is best.
Figuras y tablas -
Analysis 3.4

Comparison 3 WBV + MX vs Other, Outcome 4 WBV + MX vs Other: stiffness, 0‐100 scale, lower is best.

Comparison 3 WBV + MX vs Other, Outcome 5 WBV + MX vs Other: strength, measured in newtons and number of reps, higher values are best.
Figuras y tablas -
Analysis 3.5

Comparison 3 WBV + MX vs Other, Outcome 5 WBV + MX vs Other: strength, measured in newtons and number of reps, higher values are best.

Comparison 3 WBV + MX vs Other, Outcome 6 WBV + MX vs Other: balance, overall stability index ‐ eyes closed (degrees of displacement 0 to 20 scale, lower is best).
Figuras y tablas -
Analysis 3.6

Comparison 3 WBV + MX vs Other, Outcome 6 WBV + MX vs Other: balance, overall stability index ‐ eyes closed (degrees of displacement 0 to 20 scale, lower is best).

Comparison 3 WBV + MX vs Other, Outcome 7 Withdrawal.
Figuras y tablas -
Analysis 3.7

Comparison 3 WBV + MX vs Other, Outcome 7 Withdrawal.

Summary of findings for the main comparison. Whole body vibration versus control

Whole body vibration versus control

Patient or population: individuals with fibromyalgia
Setting: community
Intervention: whole body vibration (WBV)
Comparison: control

Outcomes

Anticipated absolute effects* (95% CI)

Relative effect
(95% CI)

No. of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Risk with control

Risk with WBV

Health‐related quality of life
assessed by FIQ total scale, 0 to 100, 0 is best

Follow‐up: 12 weeks

Mean health‐related quality of life was 59 points

Mean health‐related quality of life in intervention group was 3.73 points lower (10.81 lower to 3.35 higher) at post‐test than in control group

41
(1 RCT)

♁◯◯◯
VERY LOWa,b

Absolute improvement: 4% (95% CI 11% better to 3% worse)

Relative change: 6.7% improvement (95% CI 19.6% improvement to 6.1% worse)

NNTB: n/ac

Pain intensity

Not measured

Not measured

Not measured

Not measured

Not measured

Fatigue

Not measured

Not measured

Not measured

Not measured

Not measured

Stiffness

Not measured

Not measured

Not measured

Not measured

Not measured

Physical function

Not measured

Not measured

Not measured

Not measured

Not measured

Adverse events
(narrative)

Gusi 2010: "The program was reasonably safe: only 5% of the participants (n = 1) dropped out of the program because of acute pain in the legs. The program was completed by 85% of the participants, without secondary adverse effects" (page 1076; 1 study)

All‐cause withdrawal
assessed by number of people who dropped out

Study population

RR 1.43 (0.27 to 7.67)

41
(1 RCT)

♁◯◯◯
VERY LOWa,b

Absolute risk difference: 4% more events (95% CI 16% fewer to 24% more)

Relative change: 43% more (73% fewer to 667% more)

NNTH: n/ac

10 per 100

(2 of 20)

14 per 100

(3 of 21)

*Risk in the intervention group (and its 95% confidence interval) is based on assumed risk in the comparison group and relative effect of the intervention (and its 95% CI)

CI: confidence interval; NNTB: number needed to treat for an additional beneficial outcome; NNTH: number needed to treat for an additional harmful outcome; OR: odds ratio; RR: risk ratio

GRADE Working Group grades of evidence
High quality: We are very confident that the true effect lies close to that of the estimate of the effect
Moderate quality: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different
Low quality: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect
Very low quality: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect

aImpresicion: number of participants lower than 400 rule of thumb; wide confidence interval (downgraded twice)

bHigh risk of biases including detection, performance, and reporting biases

cNumber needed to treat for an additional beneficial outcome (NNTB) or number needed to treat for an additional harmful outcome (NNTH) not applicable (n/a) when result is not statistically significant. NNT for dichotomous outcomes calculated with Cates NNT calculator (http://www.nntonline.net/visualrx/). NNT for continuous outcomes calculated with Wells calculator (CMSG Editorial Office)

Figuras y tablas -
Summary of findings for the main comparison. Whole body vibration versus control
Summary of findings 2. Whole body vibration plus mixed exercise versus control

Whole body vibration plus mixed exercise versus control

Patient or population: individuals with fibromyalgia
Setting: unspecified
Intervention: WBV + MX
Comparison: control

Outcomes

Anticipated absolute effects* (95% CI)

Relative effect
(95% CI)

No. of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Risk with control

Risk with WBV + MX

Health‐related quality of life
assessed by FIQ total scale, 0‐100, 0 is best

Mean health‐related quality of life was 59.64 points at the end of the study

Mean health‐related quality of life in the intervention group was 16.02 points lower (31.57 lower to 0.47 lower) at post‐test than in the control group

21
(1 RCT)

♁◯◯◯
VERY LOWa,b

Absolute difference: 16% improvement (95% CI 32% to 0.5% improvement). Relative change: 24% (47% to 0.7%)c

NNTBd: 3 (2 to 237)

Pain Intensity
assessed by FIQ scale, 0 to 100 mm, 0 is no pain

Mean pain intensity was 69.38 mm in the control group at the end of the study

Mean pain Intensity in the intervention group was 28.22 mm lower (43.26 lower to 13.18 lower) at post‐test than in the control group

21
(1 RCT)

♁◯◯◯
VERY LOWa,b

Absolute difference: 28% (95% CI 43% to 13%). Relative difference: 39% (95% CI 18% to 60%)

NNTBd: 2 (1 to 4)

Fatigue
assessed by FIQ scale, 0 to 100 mm, 0 is best

Mean fatigue was 75.17 mm at the end of the study

Mean fatigue in the intervention group was 32.84 mm lower (49.2 lower to 16.48 lower) at post‐test than in the control group

21
(1 RCT)

♁◯◯◯
VERY LOWa,b

Absolute difference: 33% (95% CI 49% to 16%). Relative difference: 47% (95% CI 23% to 70%)

NNTBd: 2 (1 to 4)

Stiffness
assessed by FIQ scale, 0 to 100 mm scale, 0 is best

Mean stiffness was 68.71 mm at the end of the study

Mean stiffness in the intervention group was 26.27 mm lower (42.96 lower to 9.58 lower) at post‐test than in the control group

21
(1 RCT)

♁◯◯◯
VERY LOWa,b

Absolute difference 26% (95% CI 43% to 10%). Relative difference: 36.5% (95% CI 60% to 23%)

NNTBd: 2 (1 to 6)

Physical function

Not measured

Not measured

Not measured

Not measured

Not measured

Adverse events (narrative)

Alentorn‐Geli 2008: "This program neither exacerbated FM‐related symptoms nor resulted in musculoskeletal injuries; however, 1 patient exhibited a mild anxiety attack on the first session of WBV" (page 978)

Sañudo 2013: "This study, however, demonstrated that WBV training is safe (no adverse events)..." (page 683)

All‐cause withdrawal
assessed by number of people who dropped out

33 per 100

(7 of 21)

8 per 100
(2 of 25)

RR 0.25, 95% CI 0.06 to 1.12

46
(2 RCTs)

♁◯◯◯
VERY LOWa,b

Absolute risk difference: 24% (95% CI 3 to 51)

NNTHd: n/a

*Risk in the intervention group (and its 95% confidence interval) is based on assumed risk in the comparison group and relative effect of the intervention (and its 95% CI)

CI: confidence interval; NNTB: number needed to treat for an additional beneficial outcome; NNTH: number needed to treat for an additional harmful outcome; OR: odds ratio; RR: risk ratio

GRADE Working Group grades of evidence
High quality: We are very confident that the true effect lies close to that of the estimate of the effect
Moderate quality: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different
Low quality: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect
Very low quality: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect

aImprecision: Number of participants lower than 400 rule of thumb; wide confidence interval. Need for more studies with more participants to reach optimal information size (downgraded twice)

bHigh risk of biases including reporting and selection biases. Need for methodologically better designed and executed studies

cBaseline control group mean (SD) = 67 (15.81), n = 10

dNumber needed to treat for an additional beneficial outcome (NNTB) or number needed to treat for an additional harmful outcome (NNTH) not applicable (n/a) when result is not statistically significant. NNT for dichotomous outcomes calculated with Cates NNT calculator (http://www.nntonline.net/visualrx/). NNT for continuous outcomes calculated with Wells calculator (CMSG Editorial Office)

Figuras y tablas -
Summary of findings 2. Whole body vibration plus mixed exercise versus control
Table 1. Glossary of terms

Term

Definition

Allodynia

Pain resulting from a stimulus that would not normally provoke pain

Amplitude

Absolute value of maximum displacement from a zero value during 1 period of an oscillation

Damping

Energy dissipation properties of a material or system under cyclic stress

Endurance

Two forms of endurance that refer to health‐related physical fitness include cardiorespiratory endurance (also known as cardiovascular endurance, aerobic fitness, aerobic endurance, exercise tolerance), which "relates to the ability of the circulatory and respiratory systems to supply fuel during sustained physical activity and to eliminate waste products after supplying fuel," and muscle endurance, which "relates to the ability of muscle groups to exert external force for many repetitions" (Caspersen 1985)

Frequency

Number of cycles or completed alternations per unit time of a wave or oscillation

Hertz

One hertz is 1 cycle per second; therefore, when an individual is exposed to a vibration of 30 Hz, targeted muscles receive 30 cycles of vibration per second, which makes muscles contract and relax 30 times in the same period

Hyperalgesia

Increased pain from a stimulus that normally provokes pain

Natural frequency

Frequency at which a system oscillates when not subjected to continuous or repeated external forces

Paresthesia

Abnormal sensation that is spontaneous or is evoked by a stimulus (eg, numbness)

Phase angle

Particular stage or point of advancement in a cycle; fractional part of the period through which time has advanced, measured from some arbitrary origin often expressed as an angle (phase angle); the entire period being taken is 360°

Figuras y tablas -
Table 1. Glossary of terms
Table 2. List of Abbreviations

Abbreviation

Description

A

amplitude

ACR

American College of Rheumatology

ACSM

American College of Sports Medicine

AE

aerobic exercise

EMG

electromyography

f

frequency

FIQ

Fibromyalgia Impact Questionnaire

FX

flexibility

g

gravitational load (G‐force) = 1 cm/s2

HR

heart rate

HRQL

health‐related quality of life

hz

Hertz

ITT

intention‐to‐treat

kg

kilogram

m/s2

unit of acceleration: 1 Gal = 0.01 m/s2

MCID

minimal clinically important difference

MD

mean difference

MX

mixed intervention (includes more than 1 mode of physical activity)

n

number of studies

N

number of individuals

RD

risk difference

Relax

relaxation

RT

resistance training

s

seconds

SD

standard deviation

SE

standard error

SMD

standardized mean difference

sTNFR1 and sTNFR2

soluble tumor necrosis factor receptor 1 and 2

VAS

visual analogue scale

WBV

whole body vibration

wk

week(s)

WU

warm‐up

Figuras y tablas -
Table 2. List of Abbreviations
Table 3. Mixed exercise FITT (frequency, intensity, time, and type) parameters

Vibration + Mixed vs Mixed + Placebo vs Control

Author, year

Intervention

Frequency (times per week | length in weeks)

Total duration

Supervised or home program

Aerobic component

Resistance component

Flexibility Component

Other

I (intensity): ACSM classification and physiological measure; M (mode): mode of exercise; T (time): duration of aerobic component in minutes

M (muscle groups, joints or areas of body); I (intensity resistance, repetitions, sets); T (type), T (time)

M (muscle groups, joints or areas of body); T (type of stretch, repetition, set), T (time)

Alentorn‐Geli 2008

AE + FX + Relax

2 times/wk

6 weeks

90’

Not specified

I: moderate to vigorous (65%‐85% HR max), T: primarily level ground walking with games and dance, T: 30'

Not applicable

M: 5 whole body stretches involving lower and upper limbs, neck, back; T: dynamic, 5 reps held for 30 s with 30 s rests, T: 25'

Relaxation

Vibration + Mixed vs Mixed

Sañudo 2010

AE + RT + FX

2 times/wk

6 weeks

60’

Supervised

I: light to moderate (50%‐69% HR max), M: not specified, T: 4‐6 intervals of 2‐3’, 1‐2’ rest between intervals

M: major muscle groups, I: 8 exercises, 1 × 8‐10 reps with 1‐3 kg, T: not specified

M: not specified, I: 1x 3 reps holding for 30s, T: not specified

Sañudo 2013

AE + RT + FX

2 times/wk

8 weeks

45‐60’

Supervised

I: moderate (65%‐70% HR max), M: not specified, T: 10‐15’

M: deltoids, biceps, neck, hips, back, and chest, I: 1 set of 8‐10 reps for 8 different muscle groups against 1‐3 kg, T: 15‐20’

M: deltoids, biceps, neck, hips, back, and chest

I: 1 set of 3 reps for 8‐9 different ex, maintained for 30 s, T: 10’

Figuras y tablas -
Table 3. Mixed exercise FITT (frequency, intensity, time, and type) parameters
Table 4. Vibration specifications

Study name/year

Name of device

Vibration frequency and amplitude

Position of participant

Stabilizing support

Footwear

Static/Dynamic; unilateral/bilateral

Alentorn‐Geli 2008

PowerPlate

(PowerPlate International B.V., Badhoevendorp,

The Netherlands)

30 Hz; 2 mm vertical amplitude

The following 6 exercises were performed for 30 s each during whole body vibration (WBV) and were repeated 6 times with recovery of 3 minutes between repetitions

(a) static squat at 100° of knee flexion

(b) dynamic squat between 90° and 130° of knee flexion

(c) maintained ankle plantar‐flexion with legs in extension

(d) flexion‐extension of right leg between 100° and 130° of knee flexion

(e) flexion‐extension of left leg between 100° and 130° of knee flexion

(f) squat at 100° of knee flexion shifting body weight from 1 leg to the other

For adaptation purposes, only tasks (a), (b), and (c) (repeated 3 times) were performed during first 2 sessions

Yes ‐ for all tasks, individuals held onto the supporting bar

Does not state

Static bilateral

Gusi 2010

Galileo Fitness Platform

(Novotec Medical, Pforzheim, Germany)

12.5 Hz; 3 mm vertical amplitude

Participants alternated between 2 stances for each repetition

Stance A: feet perpendicular to midline axis of the platform with right foot placed slightly ahead of left foot. Toes of right foot and heel of left foot lifted 4 mm above surface of the platform. Knees bent to 45° angle. Back and head kept straight

Stance B: as per Stance A, except with left foot placed slightly ahead of right foot

Not reported and not pictured in Figure 2

Balance testing was performed barefoot. Does not specify that exercise was done barefoot, but Figure 2 indicates this

Static and dynamic both unilateral and bilateral

Sañudo 2010

Galileo Fitness Platform

(Novotec Medical, Pforzheim, Germany)

20 Hz; variable amplitude of 2‐3 mm

Three sets of 45 s of bilateral static squat with 120 s recovery between sets (amplitude = 3 mm) followed by 4 sets of 15 s of unilateral static squat on each leg (amplitude = 2 mm).

During WBV, participants stood with both knees in 120° isometric knee flexion (half‐squatting position) as measured by a goniometer

Does not state

Does not state

Static unilateral and bilateral

Sañudo 2013

PowerPlate,

North America Inc.,

Northbrook, IL,

United States

30 Hz; vertical displacement of 4 mm (71.1 m/s‐2 ≈ 7.2 g)

Standing on the platform, with knees in 120º isometric knee flexion (measured by a goniometer) and trunk upright

Bilateral static squat: 6 sets of 30 s, with 45‐s recovery between sets

Unilateral static squat: 4 sets of 30 s each leg

Does not state

All participants wore sport shoes for vibration exercises

Static unilateral and bilateral

Figuras y tablas -
Table 4. Vibration specifications
Table 5. Quality of evidence. GRADE assessment for WBV + MX vs Other

Quality assessment

No. of participants

Quality

Importance

No. of studies

Study design

Risk of bias

Inconsistency

Indirectness

Imprecision

Other considerations

Aerobic exercise (AE) intervention

AE control

Health‐related quality of life (HRQL), 0‐100, lower is best

2

Randomized trial

Very serious1

Not serious

Not serious

Serious2

23

26

⊕⊝⊝⊝
very low

CRITICAL

Pain intensity, 0‐100, lower is best

1

Randomized trial

Serious3

Not serious

Not serious

Serious2

One very small study

11

12

⊕⊝⊝⊝
very low

CRITICAL

Fatigue, 0‐100, lower is best

1

Randomized trial

Serious1

Not serious

Not serious

Serious2

One very small study

11

12

⊕⊝⊝⊝
very low

IMPORTANT

Stiffness, 0‐100, lower is best

1

Randomized trial

Serious1

Not serious

Not serious

Serious2

One very small study

11

12

⊕⊝⊝⊝
very low

IMPORTANT

Physical function, not reported

Withdrawals

3

Randomized trial

Very serious4

Not serious

Not serious

Serious2

3/39 (7.69%)

4/38 (10.52%)

⊕⊝⊝⊝
very low

IMPORTANT

Adverse events:Alentorn‐Geli 2008: "This program neither exacerbated FM‐related symptoms nor resulted in musculoskeletal injuries; however, one patient exhibited a mild anxiety attack on the first session of WBV" (page 978); Sañudo 2010: Trial authors clarified that one person in the comparison group ("other exercise group") dropped out owing to an injury that was not an injury related to the program (participant fell down on the street); Sañudo 2013: "This study, however, demonstrated that WBV training is a safe (no adverse effects), suitable (no dropouts due to the intervention), and effective (increased lower limb muscle strength) way to exercise the musculoskeletal system, and potentially a feasible intervention for those patients who cannot participate in conventional strength training" (page 683)

Figuras y tablas -
Table 5. Quality of evidence. GRADE assessment for WBV + MX vs Other
Comparison 1. WBV vs C

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 HRQL, 1‐100 scale, lower means better HRQL Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

2 Balance, degrees of displacement, lower is best Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

3 Withdrawal Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

Figuras y tablas -
Comparison 1. WBV vs C
Comparison 2. WBV + MX vs C

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 WBV + MX vs C: HRQL, 0‐100 scale, lower is best Show forest plot

1

Mean Difference (IV, Random, 95% CI)

Totals not selected

2 WBV + MX vs C: pain, 0‐100 scale, lower is best Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

3 WBV + MX vs C: fatigue, 0‐100 scale, lower is best Show forest plot

1

Mean Difference (IV, Random, 95% CI)

Totals not selected

4 WBV + MX vs C: stiffness, 0‐100 scale, lower is best Show forest plot

1

Mean Difference (IV, Random, 95% CI)

Totals not selected

5 WBV + MX vs C: balance, overall stability index ‐ eyes closed (degrees of displacement 0 to 20 scale, lower is best) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

6 Withdrawal Show forest plot

2

46

Risk Ratio (M‐H, Random, 95% CI)

0.25 [0.06, 1.12]

Figuras y tablas -
Comparison 2. WBV + MX vs C
Comparison 3. WBV + MX vs Other

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 WBV + MX vs Other: HRQL, 0‐100 scale, lower is best Show forest plot

2

49

Mean Difference (IV, Random, 95% CI)

‐6.67 [‐14.65, 1.31]

2 WBV + MX vs Other: pain, 0‐100 scale, lower is best Show forest plot

1

Mean Difference (IV, Random, 95% CI)

Totals not selected

3 WBV + MX vs Other: fatigue, 0‐100 scale, lower is best Show forest plot

1

Mean Difference (IV, Random, 95% CI)

Totals not selected

4 WBV + MX vs Other: stiffness, 0‐100 scale, lower is best Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

5 WBV + MX vs Other: strength, measured in newtons and number of reps, higher values are best Show forest plot

2

54

Std. Mean Difference (IV, Random, 95% CI)

0.77 [0.20, 1.35]

6 WBV + MX vs Other: balance, overall stability index ‐ eyes closed (degrees of displacement 0 to 20 scale, lower is best) Show forest plot

2

54

Mean Difference (IV, Random, 95% CI)

‐0.22 [‐1.56, 1.11]

7 Withdrawal Show forest plot

3

77

Risk Ratio (M‐H, Random, 95% CI)

0.72 [0.17, 3.11]

Figuras y tablas -
Comparison 3. WBV + MX vs Other