Comparative Effects of Supervised Exercise Regime, Education and Self-Management Techniques on Clinical Outcomes in Fibromyalgia

Abstract

Background: Fibromyalgia (FM) is a chronic disorder characterized by widespread musculoskeletal pain, fatigue, poor sleep, and psychological distress. Pharmacological therapies offer limited benefit, making non-pharmacological approaches such as exercise, education, and self-management essential in multimodal care. Objective: To compare the effects of supervised exercise versus education and self-management techniques on clinical outcomes in women with fibromyalgia. Methods: A randomized controlled trial was conducted at the University of Lahore Teaching Hospital from March to December 2024. Fifty-two women aged 20–45 years meeting ACR 2016 criteria for FM were randomized into supervised exercise (Group A, n=26) or education/self-management (Group B, n=26). Interventions lasted four weeks. Primary outcome was fibromyalgia impact (FIQ). Secondary outcomes included pain intensity (VAS), sleep quality (SQS), and patient satisfaction (PSQ-18). Data were analyzed using Wilcoxon signed-rank tests for within-group changes and ANCOVA/Mann–Whitney U tests for between-group comparisons. Effect sizes (r) and 95% confidence intervals (CI) were calculated. Results: Both groups improved significantly in FIQ and VAS. In Group A, FIQ decreased from 63 to 50 (Δ –13, Z=–4.21, p<0.001, r=0.65), and VAS from 7.1 to 5.4 (Δ –1.7, Z=–4.48, p<0.001, r=0.70). In Group B, FIQ decreased from 65 to 54 (Δ –11, Z=–3.92, p<0.001, r=0.60), and VAS from 7.3 to 5.6 (Δ –1.7, Z=–3.55, p=0.001, r=0.62). Sleep quality did not significantly change in either group (Group A: Δ –1, p=0.41; Group B: Δ –4, p=0.08). Patient satisfaction improved significantly in Group B (2.7→3.2, Δ +0.5, Z=–4.61, p<0.001, r=0.68) but not in Group A (2.8→3.0, p=0.06). Between-group comparisons showed no significant differences in FIQ (–2.1, 95% CI –6.0 to +1.8, p=0.28) or VAS (–0.3, 95% CI –0.7 to +0.2, p=0.23), but patient satisfaction favored Group B (–0.3, 95% CI –0.5 to –0.1, p=0.01). Adherence exceeded 85% in both groups with no adverse events. Conclusion: Both supervised exercise and education/self-management significantly improved pain and disease impact, but only education/self-management enhanced patient satisfaction. Integrating both approaches may provide optimal, patient-centered fibromyalgia care.