Six-month supervised telerehabilitation combining pilates-based therapeutic exercise and self-myofascial release in adults with fibromyalgia: a randomized controlled trial

Authors

  • Thomai Marantidou Department of Physical Education and Sport Science, Aristotle University of Thessaloniki, Thessaloniki, Greece
  • Evangelia I. Germanou Department of Physical Education and Sport Science, Aristotle University of Thessaloniki, Thessaloniki, Greece https://orcid.org/0000-0003-1811-0729
  • Vasiliki Manou Department of Physical Education and Sport Science, Aristotle University of Thessaloniki, Thessaloniki, Greece
  • Nikolaos Koutlianos Department of Physical Education and Sport Science, Aristotle University of Thessaloniki, Thessaloniki, Greece
  • Evangelos Sykaras Department of Physical Education and Sport Science, Aristotle University of Thessaloniki, Thessaloniki, Greece
  • Ioannis Terzidis Department of Physical Education and Sport Science, Aristotle University of Thessaloniki, Thessaloniki, Greece; TheMIS Orthopaedic Center, Thessaloniki, Greece https://orcid.org/0000-0001-6530-2833

DOI:

https://doi.org/10.2340/jrm.v58.46786

Keywords:

Fibromyalgia, Pilates, Rehabilitation, Self-Myofascial Release, Telerehabilitation, Therapeutic Exercise

Abstract

Objective: To evaluate the effects of a 6-month supervised multicomponent telerehabilitation programme combining Pilates-based therapeutic exercise and self-myofascial release on fibromyalgia impact, sleep quality, and psychological outcomes.

Design: Two-arm, parallel-group randomized controlled trial.

Subjects/Patients: 68 adults with fibromyalgia confirmed according to the 2016 ACR criteria.

Methods: Participants were randomized to a 6-month supervised home-based telerehabilitation programme (n = 35) or usual care (n = 33). The intervention comprised 3 live online sessions weekly combining Pilates-based therapeutic exercise, self-myofascial release, core stabilization, low-load resistance exercise, stretching, and relaxation. Outcomes were assessed at baseline, 3 months, and 6 months using validated patient-reported measures.

Results: Significant group-by-time interactions were observed for fibromyalgia impact (p < 0.001, partial η2 = 0.132), sleep quality (p < 0.001, partial η2 = 0.129), depressive symptoms (p = 0.002, partial η2 = 0.129), and perceived stress (p = 0.028, partial η2 = 0.065), but not for anxiety (p = 0.701). Mean intervention adherence was 87.5%, with no adverse or serious adverse events reported in either group.

Conclusion: 6 months of supervised multicomponent telerehabilitation produced favourable longitudinal changes in fibromyalgia impact, sleep quality, depressive symptoms, and perceived stress compared with usual care.

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Author Biography

Evangelos Sykaras, Department of Physical Education and Sport Science, Aristotle University of Thessaloniki, Thessaloniki, Greece

Retired Professor, Department of Physical Education and Sport Science, Aristotle University of Thessaloniki, Thessaloniki, Greece

References

Clauw DJ. From fibrositis to fibromyalgia to nociplastic pain: how rheumatology helped get us here and where do we go from here? Ann Rheum Dis 2024; 83: 1421–1427. DOI: https://doi.org/10.1136/ard-2023-225327

Alonso-Blanco C, Fernández-de-las-Peñas C, Morales-Cabezas M, Zarco-Moreno P, Ge HY, Florez-García M. Multiple active myofascial trigger points reproduce the overall spontaneous pain pattern in women with fibromyalgia and are related to widespread mechanical hypersensitivity. Clin J Pain 2011; 27: 405–413. DOI: https://doi.org/10.1097/AJP.0b013e318210110a

Choy EH. The role of sleep in pain and fibromyalgia. Nat Rev Rheumatol 2015; 11: 513–520. DOI: https://doi.org/10.1038/nrrheum.2015.56

Clauw DJ. Fibromyalgia: a clinical review. JAMA 2014; 311: 1547–1555. DOI: https://doi.org/10.1001/jama.2014.3266

Kleykamp BA, Ferguson MC, McNicol E, Bixho I, Arnold LM, Edwards RR, et al. The prevalence of psychiatric and chronic pain comorbidities in fibromyalgia: an ACTTION systematic review. Semin Arthritis Rheum 2021; 51: 166–174. DOI: https://doi.org/10.1016/j.semarthrit.2020.10.006

Macfarlane GJ, Kronisch C, Dean LE, Atzeni F, Häuser W, Fluß E, et al. EULAR revised recommendations for the management of fibromyalgia. Ann Rheum Dis 2017; 76: 318–328. DOI: https://doi.org/10.1136/annrheumdis-2016-209724

Altan L, Korkmaz N, Bingöl U, Günay B. Effect of Pilates training on people with fibromyalgia syndrome: a pilot study. Arch Phys Med Rehabil 2009; 90: 1983–1988. DOI: https://doi.org/10.1016/j.apmr.2009.06.021

Nithuthorn C, Chaipichit N, Jeeraaumponwat T, Maiprasert M, Dilokthornsakul P. Effect of Pilates on pain and health-related quality of life in fibromyalgia patients: a systematic review and meta-analysis. J Clin Med 2024; 13: 7447. DOI: https://doi.org/10.3390/jcm13237447

Rodríguez-Fuentes G, Bermúdez-Rodas A, Rodríguez-Otero H, Campo-Prieto P. The Pilates method as a therapeutic intervention in patients with fibromyalgia: a systematic review and meta-analysis. Appl Sci 2026; 16: 1324. DOI: https://doi.org/10.3390/app16031324

Ide FC, D’Oliveira A, Vieira EP, Martins TB, Andrade A, do Nascimento IB. What are the effects of connective tissue massage vs myofascial release on fibromyalgia pain? Systematic review with meta-analysis. Complement Ther Med 2026; 96: 103305. DOI: https://doi.org/10.1016/j.ctim.2025.103305

Beardsley C, Škarabot J. Effects of self-myofascial release: a systematic review. J Bodyw Mov Ther 2015; 19: 747–758. DOI: https://doi.org/10.1016/j.jbmt.2015.08.007

Cheatham SW, Kolber MJ, Cain M, Lee M. The effects of self-myofascial release using a foam roll or roller massager on joint range of motion, muscle recovery, and performance: a systematic review. Int J Sports Phys Ther 2015; 10: 827–838.

Castro-Sánchez AM, Matarán-Peñarrocha GA, Granero-Molina J, Aguilera-Manrique G, Quesada-Rubio JM, Moreno-Lorenzo C. Benefits of myofascial release therapy on pain, anxiety, quality of sleep, depression, and quality of life in patients with fibromyalgia. Evid Based Complement Alternat Med 2011; 2011: 561753. DOI: https://doi.org/10.1155/2011/561753

Ajimsha MS, Daniel B, Chithra S. Effectiveness of myofascial release in the management of fibromyalgia syndrome: a randomized controlled trial. J Bodyw Mov Ther 2014; 18: 390–395.

Ceca D, Elvira JLL, Guzmán JF, Pablos-Abella C. Effectiveness of self-myofascial release on pain, anxiety, depression, and sleep quality in patients with fibromyalgia. Complement Ther Clin Pract 2019; 35: 1–7.

Ceca D, Pablos A, Elvira L, López-Hernández L, Ortega AL. Effectiveness of a self-myofascial conditioning programme on pain, depression, anxiety and sleep quality in people with fibromyalgia. Cuad Psicol Deporte 2020; 20: 147–165. DOI: https://doi.org/10.6018/cpd.394361

Ughreja RA, Venkatesan P, Balebail Gopalakrishna D, Singh YP. Effectiveness of myofascial release on pain, sleep, and quality of life in patients with fibromyalgia syndrome: a systematic review. Complement Ther Clin Pract 2021; 45: 101477. DOI: https://doi.org/10.1016/j.ctcp.2021.101477

Wu YQ, Long Y, Peng WJ, Gong C, Liu YQ, Peng XM, et al. The efficacy and safety of telerehabilitation for fibromyalgia: systematic review and meta-analysis of randomized controlled trials. J Med Internet Res 2023; 25: e42090. DOI: https://doi.org/10.2196/42090

Sari F, Mirza Y, Yılmaz PD, Küçük A. The efficacy of a telerehabilitation-based clinical Pilates program on lumbopelvic muscle morphology and strength in female patients with fibromyalgia syndrome: a randomized controlled trial. Clin Rheumatol 2025; 44: 4689–4701. DOI: https://doi.org/10.1007/s10067-025-07712-5

Timurtaş E, Hüzmeli İ, Demirbüken İ, Polat MG. Clinical outcomes of asynchronous telerehabilitation through a mobile app are equivalent to synchronous telerehabilitation in patients with fibromyalgia: a randomized controlled study. BMC Musculoskelet Disord 2025; 26: 118. DOI: https://doi.org/10.1186/s12891-025-08377-6

Nicolas B, Leblong E, Fraudet B, Gallien P, Piette P. Telerehabilitation solutions in patient pathways: an overview of systematic reviews. Digit Health 2024; 10: 20552076241294110. DOI: https://doi.org/10.1177/20552076241294110

Wang C, Schmid CH, Fielding RA, Harvey WF, Reid KF, Price LL, et al. Effect of tai chi versus aerobic exercise for fibromyalgia: comparative effectiveness randomized controlled trial. BMJ 2018; 360: k851. DOI: https://doi.org/10.1136/bmj.k851

Wolfe F, Clauw DJ, Fitzcharles MA, Goldenberg DL, Häuser W, Katz RL, et al. 2016 revisions to the 2010/2011 fibromyalgia diagnostic criteria. Semin Arthritis Rheum 2016; 46: 319–329. DOI: https://doi.org/10.1016/j.semarthrit.2016.08.012

Bennett RM, Friend R, Jones KD, Ward R, Han BK, Ross RL. The Revised Fibromyalgia Impact Questionnaire (FIQR): validation and psychometric properties. Arthritis Res Ther 2009; 11: R120. DOI: https://doi.org/10.1186/ar2783

Beaton DE, Bombardier C, Guillemin F, Ferraz MB. Guidelines for the process of cross-cultural adaptation of self-report measures. Spine 2000; 25: 3186–3191. DOI: https://doi.org/10.1097/00007632-200012150-00014

Buysse DJ, Reynolds CF 3rd, Monk TH, Berman SR, Kupfer DJ. The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res 1989; 28: 193–213. DOI: https://doi.org/10.1016/0165-1781(89)90047-4

Lovibond PF, Lovibond SH. The structure of negative emotional states: comparison of the Depression Anxiety Stress Scales (DASS) with the Beck Depression and Anxiety Inventories. Behav Res Ther 1995; 33: 335–343. DOI: https://doi.org/10.1016/0005-7967(94)00075-U

Clauw DJ. Fibromyalgia and related conditions. Mayo Clin Proc 2015; 90: 680–692. DOI: https://doi.org/10.1016/j.mayocp.2015.03.014

Häuser W, Ablin J, Fitzcharles MA, Littlejohn G, Luciano JV, Usui C, et al. Fibromyalgia. Nat Rev Dis Primers 2015; 1: 15022. DOI: https://doi.org/10.1038/nrdp.2015.22

Surendran S, Mithun CB. Estimation of minimum clinically important difference in fibromyalgia for FIQR using BPI as the anchor measure. Ann Rheum Dis 2018; 77: 845. DOI: https://doi.org/10.1136/annrheumdis-2018-eular.5492

Sosa-Reina MD, Nunez-Nagy S, Gallego-Izquierdo T, Pecos-Martín D, Monserrat J, Álvarez-Mon M. Effectiveness of therapeutic exercise in fibromyalgia syndrome: a systematic review and meta-analysis of randomized clinical trials. Biomed Res Int 2017; 2017: 2356346. DOI: https://doi.org/10.1155/2017/2356346

Bidonde J, Fisher E, Perrot S, Moore RA, Bell RF, Makri S, et al. Effectiveness of non-pharmacological interventions for fibromyalgia and quality of review methods: an overview of Cochrane Reviews. Semin Arthritis Rheum 2023; 63: 152248. DOI: https://doi.org/10.1016/j.semarthrit.2023.152248

Wang JJ, Tam KW, Hsiao HY, Liou TH, Rau CL, Hsu TH. Effect of resistance exercises on function and pain in fibromyalgia: a systematic review and meta-analysis of randomized controlled trials. Am J Phys Med Rehabil 2024; 103: 275–283. DOI: https://doi.org/10.1097/PHM.0000000000002318

Araya-Quintanilla F, Cuyul-Vásquez I, Lizama-Lefno A, Jeria-Diaz A, Fuentes J, Serrat M, et al. Effectiveness of multicomponent treatment compared with other therapeutic interventions in patients with fibromyalgia: a systematic review with meta-analysis. J Back Musculoskelet Rehabil 2025; 38: 1209–1231. DOI: https://doi.org/10.1177/10538127251337393

Serrat M, Almirall M, Musté M, Sanabria-Mazo JP, Feliu-Soler A, Méndez-Ulrich JL, et al. Effectiveness of a multicomponent treatment for fibromyalgia based on pain neuroscience education, exercise therapy, psychological support, and nature exposure (NAT-FM): a pragmatic randomized controlled trial. J Clin Med 2020; 9: 3348. DOI: https://doi.org/10.3390/jcm9103348

Wang X, Luo H. Effects of traditional Chinese exercise therapy on pain scores, sleep quality, and anxiety-depression symptoms in fibromyalgia patients: a systematic review and meta-analysis. BMC Musculoskelet Disord 2024; 25: 99. DOI: https://doi.org/10.1186/s12891-024-07194-7

Ekici G, Ünal E, Akbayrak T, Vardar-Yağlı N, Yakut Y, Karabulut E. Effects of active/passive interventions on pain, anxiety, and quality of life in women with fibromyalgia: randomized controlled pilot trial. Women Health 2017; 57: 88–107. DOI: https://doi.org/10.1080/03630242.2016.1153017

Ceca D, Elvira L, Guzmán JF, Pablos A. Benefits of a self-myofascial release program on health-related quality of life in people with fibromyalgia: a randomized controlled trial. J Sports Med Phys Fitness 2017; 57: 993–1002. DOI: https://doi.org/10.23736/S0022-4707.17.07025-6

Vancampfort D, Van Damme T, Brunner E, McGrath RL, Hemmings L, Guimaraes ME, et al. Dropout from exercise interventions in adults with fibromyalgia: a systematic review and meta-analysis. Arch Phys Med Rehabil 2024; 105: 571–579. DOI: https://doi.org/10.1016/j.apmr.2023.06.002

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Published

2026-10-13

How to Cite

Marantidou, T., Germanou, E., Manou, V., Koutlianos, N., Sykaras, E., & Terzidis, I. (2026). Six-month supervised telerehabilitation combining pilates-based therapeutic exercise and self-myofascial release in adults with fibromyalgia: a randomized controlled trial. Journal of Rehabilitation Medicine, 58, jrm46786. https://doi.org/10.2340/jrm.v58.46786

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