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Fibromyalgia management guidelines advocate exercise as a first-line treatment, yet the comparative potency of aerobic vs non-aerobic exercise remains unclear.
Aerobic and non-aerobic exercise produce comparable and significant improvements in fibromyalgia symptoms, while tDCS enhances pain modulation without adding clinical benefit.
Fibromyalgia management guidelines advocate exercise as a first-line treatment, yet the comparative potency of aerobic vs non-aerobic exercise remains unclear. Furthermore, transcranial direct current stimulation (tDCS) targeting the motor cortex has emerged as a valuable therapy to enhance descending pain modulation. This study determined the combined and independent effects of exercise modalities and tDCS on pain processing and clinical outcomes in fibromyalgia.
Adults diagnosed with fibromyalgia were allocated into four groups:
Volunteers completed 16 supervised sessions over 4 weeks, integrating exercise with concurrent tDCS. Non-aerobic exercise involved low-intensity treadmill walking (<40% Hrmax). In this randomized, double-blind clinical trial, the primary endpoints were conditioned pain modulation (CPM) and temporal summation of pain (TSP). Secondary outcomes were pain intensity, fatigue, sleep quality, quality of life, and depressive symptoms.
Among 116 participants (mean age 47.1 ± 11.9 years; 88.8% female), active tDCS remarkably improved CPM compared to sham (Cohen’s d = 0.66; p = 0.015), independent of exercise type. A small, non-significant improvement was noted in TSP (mean change −0.19).
All intervention groups illustrated moderate-to-large improvements in fatigue, pain, and quality of life (effect size d = 0.60–0.92), with no additional clinical benefit from tDCS. Aerobic and non-aerobic exercise showed comparable potency across outcomes. Lower body mass index (BMI) and greater age were linked with better response. Importantly, pain modulation improvements were not mediated by short-term clinical modifications.
Both aerobic and low-intensity non-aerobic exercise yielded short-term benefits in fibromyalgia, supporting their role as potent, accessible therapies. While motor cortex tDCS enhanced pain inhibition mechanisms, it did not translate into additional clinical improvement over exercise alone within 6 weeks.
The Lancet
A randomised, double-blind, sham-controlled, 2×2 factorial trial of aerobic vs. non-aerobic exercise and motor cortex transcranial direct current stimulation in fibromyalgia: effects on clinical outcomes and descending pain modulation
Felipe Fregni et al.
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