Beyond pain: Impact of movement-based mindful exercises in fibromyalgia. A systematic review with meta-analysis

<h2>Abstract:</h2><h3>Background and Objective</h3> Current literature supports exercise for the management of fibromyalgia (FM), although the optimal type of exercise remains unclear. This systematic review aims to summarize the effectiveness of qigong, yoga, and tai chi for FM-related symptoms beyond pain. <h3>Methods</h3> Searches were conducted in CINAHL (via EBSCOhost), Embase, PubMed, SPORTDiscus (via EBSCOhost), and the Cochrane Library from inception to September 2023 (updated in February 2026). Randomized controlled trials (RCTs) including measures of fatigue, anxiety, depression, health status, sleep quality, and overall quality of life were included. The Cochrane Risk of Bias tool 2 (ROB-2) was used to assess the risk of bias in primary studies. The Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach judged the certainty of the evidence. Sensitivity analyses and meta-regressions were performed. <h3>Results</h3> Twenty-three RCTs with 1,734 participants were included. Meta-analyses showed that mindful exercises were more effective than control interventions (active and inactive) across all measures, i.e., fatigue (standard mean difference [SMD]: 0.63, 95% confidence interval [CI]: 0.08 to 1.17; P=0.04), except for sleep quality and overall quality of life. Subgroup analyses demonstrated that the type of intervention may influence the results. Most RCTs had a high risk of bias, and the certainty of the evidence was low or very low. <h3>Discussion</h3> Qigong, tai chi, and yoga positively impact FM-related symptoms beyond pain, including fatigue, mental health, and health status. However, given the very low certainty of the evidence, these findings should be interpreted with considerable caution in clinical practice.