E0 ConsensusModerate confidencePEM unclearSystematic-ReviewPeer-reviewedMachine draft
Effectiveness of Active Therapy-Based Training to Improve the Balance in Patients with Fibromyalgia: A Systematic Review with Meta-Analysis.
Del-Moral-García, María, Obrero-Gaitán, Esteban, Rodríguez-Almagro, Daniel et al. · Journal of clinical medicine · 2020 · DOI
Quick Summary
People with fibromyalgia often have trouble with balance, which increases their risk of falling and affects their ability to do daily activities. This review looked at 10 studies testing whether active exercise-based training programs could help improve balance in fibromyalgia patients. The results showed that these training programs did help people improve their balance and stability compared to other treatments or no treatment.
Why It Matters
Balance impairment is a common but understudied symptom in ME/CFS, similar to fibromyalgia. Understanding which physical interventions effectively improve balance without triggering post-exertional malaise is critical for developing safe rehabilitation protocols. This evidence synthesis provides a foundation for considering whether similar exercise-based approaches might benefit ME/CFS patients with balance dysfunction.
Observed Findings
- Ten randomized controlled trials involving 546 fibromyalgia patients (mean age 52.41 years, 98% female) were included in the meta-analysis.
- Active therapy-based training showed medium effect sizes for monopedal static balance (SMD=0.571, 95% CI 0.305–0.836), dynamic balance (SMD=0.618, 95% CI 0.348–0.888), and functional balance (SMD=0.409, 95% CI 0.044–0.774).
- No statistically significant differences were found for balance on unstable support surfaces.
- Moderate-quality evidence supported improvements in dynamic and functional balance; low-quality evidence supported monopedal static balance improvements.
Inferred Conclusions
- Active therapy-based training interventions produce clinically meaningful improvements in multiple balance domains in fibromyalgia patients compared to control conditions.
- Dynamic and functional balance improvements are more robustly supported by evidence than static balance improvements.
- The heterogeneity in training protocols and outcome measures suggests that various ATBT approaches may be effective, though standardization is needed.
Remaining Questions
- What are the optimal parameters (intensity, duration, type) of active therapy-based training for balance improvement in fibromyalgia?
- Do balance improvements achieved through ATBT reduce actual fall incidence and injury rates in real-world settings?
What This Study Does Not Prove
This study does not establish that ATBT is safe or effective for ME/CFS patients specifically, as fibromyalgia and ME/CFS have distinct pathophysiology and post-exertional responses. The review does not address whether improvements persist long-term or whether benefits extend to reducing fall-related injuries in real-world settings. Additionally, the study cannot determine optimal exercise intensity or duration, as this variation existed across the included trials.
Tags
Symptom:Pain
Method Flag:Weak Case Definition
Metadata
- DOI
- 10.3390/jcm9113771
- PMID
- 33266511
- Review status
- Machine draft
- Evidence level
- Established evidence from major reviews, guidelines, or evidence maps
- Last updated
- 8 April 2026
About the PEM badge: “PEM required” means post-exertional malaise was an explicit required diagnostic criterion for participant inclusion in this study — not that PEM was studied, observed, or discussed. Studies using criteria that do not require PEM (e.g. Fukuda, Oxford) are tagged “PEM not required”. How the atlas works →
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