Rheumatology International

, Volume 33, Issue 1, pp 193–207 | Cite as

Efficacy and safety of meditative movement therapies in fibromyalgia syndrome: a systematic review and meta-analysis of randomized controlled trials

  • Jost LanghorstEmail author
  • Petra Klose
  • Gustav J. Dobos
  • Kathrin Bernardy
  • Winfried Häuser
Original Article


A systematic review with meta-analysis of the efficacy and safety of meditative movement therapies (Qigong, Tai Chi and Yoga) in fibromyalgia syndrome (FMS) was carried out. We screened Clinicaltrials.Gov, Cochrane Library, PsycINFO, PubMed and Scopus (through December 2010) and the reference sections of original studies for meditative movement therapies (MMT) in FMS. Randomized controlled trials (RCT) comparing MMT to controls were analysed. Outcomes of efficacy were pain, sleep, fatigue, depression and health-related quality of life (HRQOL). Effects were summarized using standardized mean differences (SMD [95% confidence interval]). Outcomes of safety were drop out because of adverse events and serious adverse events. A total of 7 out of 117 studies with 362 subjects and a median of 12 sessions (range 8–24) were included. MMT reduced sleep disturbances (−0.61 [−0.95, −0.27]; 0.0004), fatigue (−0.66 [−0.99, −0.34]; <0.0001), depression (−0.49 [−0.76, −0.22]; 0.0004) and limitations of HRQOL (−0.59 [−0.93, −0.24]; 0.0009), but not pain (−0.35 [−0.80, 0.11]; 0.14) compared to controls at final treatment. The significant effects on sleep disturbances (−0.52 [−0.97, −0.07]; 0.02) and HRQOL (−0.66 [−1.31, −0.01]; 0.05) could be maintained after a median of 4.5 (range 3–6) months. In subgroup analyses, only Yoga yielded significant effects on pain, fatigue, depression and HRQOL at final treatment. Drop out rate because of adverse events was 3.1%. No serious adverse events were reported. MMT are safe. Yoga had short-term beneficial effects on some key domains of FMS. There is a need for high-quality studies with larger sample sizes to confirm the results.


Fibromyalgia syndrome Meta-analysis Meditative movement therapies Yoga Taichi Qigong Efficacy Safety Randomized controlled trials CAM (complementary and alternative medicine) 



Fibromyalgia syndrome


Meditative movement therapies


Body awareness therapies


Complementary and alternative medicine


Randomized controlled trials


Health-related quality of life


Standardized mean differences



J.L. has received congress travel grant by Eli Lilly. K.B. has received congress travel grant by Pfizer. W.H. has received honoraria for educational lectures from Eli Lilly, Janssen-Cilag and Mundipharma, consulting fees from Eli Lilly and Pfizer, and a congress travel grant by Eli Lilly.


  1. 1.
    Wolfe F, Clauw DJ, Fitzcharles MA, Goldenberg DL, Katz RS, Mease P, Russell AS, Russell IJ, Winfield JB, Yunus MB (2010) The American College of Rheumatology preliminary diagnostic criteria for fibromyalgia and measurement of symptom severity. Arthritis Care Res 62:600–610CrossRefGoogle Scholar
  2. 2.
    Häuser W, Hayo S, Biewer W, Gesmann M, Kühn-Becker H, Petzke F, von Wilmoswky H, Langhorst J (2010) Diagnosis of fibromyalgia syndrome-a comparison of Association of the Medical Scientific Societies in Germany, survey, and American College of Rheumatology criteria. Clin J Pain 26:505–511PubMedCrossRefGoogle Scholar
  3. 3.
    Branco JC, Bannwarth B, Failde I, Abello Carbonell J, Blotman F, Spaeth M, Saraiva F, Nacci F, Thomas E, Caubère JP, Le Lay K, Taieb C, Matucci-Cerinic M (2009) Prevalence of fibromyalgia: a survey in five European countries. Semin Arthritis Rheum 39:448–453PubMedCrossRefGoogle Scholar
  4. 4.
    Häuser W, Schmutzer G, Glaesmer H, Brähler E (2009) Prevalence and predictors of pain in several body regions. Results of a representative German population survey. Schmerz 23(5):461–470. GermanGoogle Scholar
  5. 5.
    Berger A, Dukes E, Martin S, Edelsberg J, Oster G (2007) Characteristics and healthcare costs of patients with fibromyalgia syndrome. IntJ Clin Pract 61:1498–1508CrossRefGoogle Scholar
  6. 6.
    Bennett RM, Jones J, Turk DC, Russell IJ, Matallana L (2007) An internet survey of 2,596 people with fibromyalgia. BMC Musculoskelet Disord 8:27PubMedCrossRefGoogle Scholar
  7. 7.
    Larkey L, Jahnke R, Etnier J, Gonzalez J (2009) Meditative movement as a category of exercise: implications for research. J Phys Act Health 6(2):230–238PubMedGoogle Scholar
  8. 8.
    Wahbeh H, Elsas SM, Oken BS (2008) Mind-body interventions: applications in neurology. Neurology 70(24):2321–2328PubMedCrossRefGoogle Scholar
  9. 9.
    Burckhardt CS, Goldenberg D, Crofford L, Gerwin R, Gowans S, Jackson K et al (2005) Guideline for the management of fibromyalgia syndrome. Pain in adults and children. APS Clinical Practice Guideline Series No. 4. Glenview, IL: American Pain SocietyGoogle Scholar
  10. 10.
    Carville SF, Arendt-Nielsen S, Bliddal H, Blotman F, Branco JC, Buskila D et al (2008) EULAR evidence based recommendations for the management of fibromyalgia syndrome. Ann Rheum Dis 67:536–541PubMedCrossRefGoogle Scholar
  11. 11.
    Häuser W, Eich W, Herrmann M, Nutzinger DO, Schiltenwolf M, Henningsen P (2009) Fibromyalgia syndrome: classification, diagnosis, and treatment. Dtsch Arztebl Int 106:383–391PubMedGoogle Scholar
  12. 12.
    Lee MS, Pittler MH, Ernst E (2009) Internal qigong for pain conditions: a systematic review. J Pain 10(11):1121–1127PubMedCrossRefGoogle Scholar
  13. 13.
    Baranowsky J, Klose P, Musial F, Häuser W, Dobos G, Langhorst J (2009) Qualitative systemic review of randomized controlled trials on complementary and alternative medicine treatments in fibromyalgia. Rheumatol Int 30(1):23CrossRefGoogle Scholar
  14. 14.
    Moore RA, Eccleston C, Derry S, Wiffen P, Bell RF, Straube S, McQuay H (2010) ACTINPAIN writing group of the IASP special interest group on systematic reviews in pain relief; cochrane pain, palliative and supportive care systematic review group editors. “Evidence” in chronic pain–establishing best practice in the reporting of systematic reviews. Pain 150(3):386–389Google Scholar
  15. 15.
    Moher D, Liberati A, Teztlaff J, Altman G, The PRISMA Group (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med 51:1–7Google Scholar
  16. 16.
    Higgins JPT, Green S (2010) Cochrane handbook for systematic reviews of intervention. Version 5.01. Accessed June 8, 2010. Available from:
  17. 17.
    Bernardy K, Füber N, Köllner V, Häuser W (2010) Efficacy of cognitive behavioral therapies in fibromyalgie syndrome: a systematic review with meta-analysis. J Rheumatol 37(10):1991–2005PubMedCrossRefGoogle Scholar
  18. 18.
    Mease P, Arnold LM, Choy EH, Clauw DJ, Crofford LJ, Glass JM, Martin SA, Morea J, Simon L, Strand CV, Williams DA (2009) OMERACT fibromyalgia working group. Fibromyalgia syndrome module at OMERACT 9: domain construct. J Rheumatol 36(10):2318–2329PubMedCrossRefGoogle Scholar
  19. 19.
    The Nordic Cochrane Centre. Review Manager (RevMan) [Computer program]. Version 5.0 for Windows. Copenhagen: The Cochrane Collaboration, 2010Google Scholar
  20. 20.
    Laird NM, Mostellier F (1990) Some statistical methods for combining experimental results. In J Technol Assess Health Care 6:5–30CrossRefGoogle Scholar
  21. 21.
    Cohen J (1988) Statistical power analysis for the behavioral sciences. Lawrence Erlbaum Associates, HillsdaleGoogle Scholar
  22. 22.
    Egger M, Zellweger-Zahner T, Schneider M, Junker C, Lengeler C, Antes G (1997) Language bias in randomised controlled trials published in English and German. Lancet 350:326–329PubMedCrossRefGoogle Scholar
  23. 23.
    Begg CB, Mazumdar M (1994) Operating characteristics of a rank correlation test for publication bias. Biometrics 50(4):1088–1101PubMedCrossRefGoogle Scholar
  24. 24.
    Langhorst J, Musial F, Klose P, Häuser W (2009) Efficacy of hydrotherapy in fibromyalgia syndrome: a meta-analysis of randomized controlled clinical trials. Rheumatology (Oxford) 48(9):1155–1159CrossRefGoogle Scholar
  25. 25.
    Biostat. Comprehensive metaanalysis software. Version 2.0.Englewood:
  26. 26.
    Gustafsson M, Ekholm J, Broman L (2002) Effects of a multiprofessional rehabilitation programme for patients with fibromyalgia syndrome. J Rehabil Med 34(3):119–127PubMedCrossRefGoogle Scholar
  27. 27.
    Hammond A, Freeman K (2006) Community patient education and exercise for people with fibromyalgia: a parallel group randomized controlled trial. Clin Rehabil 20(10):835–846PubMedGoogle Scholar
  28. 28.
    Astin JA, Berman BM, Bausell B, Lee WL, Hochberg M, Forys KL (2003) The efficacy of mindfulness meditation plus Qigong movement therapy in the treatment of fibromyalgia: a randomized controlled trial. J Rheumatol 30(10):2257–2262PubMedGoogle Scholar
  29. 29.
    Grossman P, Tiefenthaler-Gilmer U, Raysz A, Kesper U (2007) Mindfulness training as an intervention for fibromyalgia: evidence of post intervention and 3-year follow-up benefits in well-being. Psychother Psychosom 76:226–233PubMedCrossRefGoogle Scholar
  30. 30.
    Schmidt S, Grossman P, Schwarzer B, Jena S, Naumann J, Walach H (2011) Treating fibromyalgia with mindfulness-based stress reduction: Results from a 3-armed randomized controlled trial. Pain 152(2):361–369PubMedCrossRefGoogle Scholar
  31. 31.
    da Silva GD, Lorenzi-Filho G, Lage LV (2007) Effects of yoga and the addition of Tui Na in patients with fibromyalgia. J Altern Complement Med 13(10):1107–1113PubMedCrossRefGoogle Scholar
  32. 32.
    Santana JS, Almeida AP, Brandão PM (2010) The effect of Ai Chi method in fibromyalgic patients. Cien Saude Colet 15(Suppl 1):1433–1438 PortuguesePubMedCrossRefGoogle Scholar
  33. 33.
    Kendall SA, Brolin-Magnusson K, Sören B, Gerdle B, Henriksson KG (2000) A pilot study of body awareness programs in the treatment of fibromyalgia syndrome. Arthritis Care Res 13(5):304–311PubMedCrossRefGoogle Scholar
  34. 34.
    Calandre EP, Rodriguez-Claro ML, Rico-Villademoros F, Vilchez JS, Hidalgo J, Delgado-Rodriguez A (2009) Effects of pool-based exercise in fibromyalgia symptomatology and sleep quality: a prospective randomised comparison between stretching and Ai Chi. Clin Exp Rheumatol 27(5 Suppl 56):S21–S28PubMedGoogle Scholar
  35. 35.
    Carson JW, Carson KM, Jones KD, Bennett RM, Wright CL, Mist SD (2010) A pilot randomized controlled trial of the Yoga of Awareness program in the management of fibromyalgia. Pain 151(2):530–539PubMedCrossRefGoogle Scholar
  36. 36.
    Ide MR, Laurindo IMM, Rodrigue AL, Tanaka C (2008) Efficacy of aquatic-respiratory exercise program on patients with fibromyalgia. In J Rheumat Dis 11:131–140CrossRefGoogle Scholar
  37. 37.
    Haak T, Scott B (2008) The effect of Qigong on fibromyalgia (FMS): a controlled randomized study. Disabil Rehabil 30(8):625–633PubMedCrossRefGoogle Scholar
  38. 38.
    Mannerkorpi K, Arndorw M (2004) Efficacy and feasibility of a combination of body awareness therapy and qigong in patients with fibromyalgia: a pilot study. J Rehabil Med 36(6):279–281PubMedCrossRefGoogle Scholar
  39. 39.
    Stephens S, Feldman BM, Bradley N, Schneiderman J, Wright V, Singh-Grewal D, Lefebvre A, Benseler SM, Cameron B, Laxer R, O’Brien C, Schneider R, Silverman E, Spiegel L, Stinson J, Tyrrell PN, Whitney K, Tse SM (2008) Feasibility and effectiveness of an aerobic exercise program in children with fibromyalgia: results of a randomized controlled pilot trial. Arthritis Rheum 59(10):1399–1406PubMedCrossRefGoogle Scholar
  40. 40.
    Wang C, Schmid CH, Rones R, Kalish R, Yinh J, Goldenberg DL, Lee Y, McAlindon T (2010) A randomized trial of tai chi for fibromyalgia. N Engl J Med 363(8):743–754PubMedCrossRefGoogle Scholar
  41. 41.
    Wolfe F, Smythe HA, Yunus MB, Bennett RM, Bombardier C, Goldenberg DL, Tugwell P, Campbell SM, Abeles M, Clark P et al (1990) The American College of Rheumatology 1990 criteria for the classification of fibromyalgia. Report of the multicenter criteria committee. Arthritis Rheum 33:160–172PubMedCrossRefGoogle Scholar
  42. 42.
    Yunus MB, Masi AT (1985) Juvenile primary fibromyalgia syndrome. A clinical study of thirty-three patients and matched normal controls. Arthritis Rheum 28:138–145PubMedCrossRefGoogle Scholar
  43. 43.
    Hall A, Maher C, Latimer J, Ferreira M (2009) The effectiveness of Tai Chi for chronic musculoskeletal pain conditions: a systematic review and meta-analysis. Arthritis Rheum 61(6):717–724PubMedCrossRefGoogle Scholar
  44. 44.
    Häuser W, Petzke F, Uçeyler N, Sommer C (2011) Comparative efficacy and acceptability of amitriptyline, duloxetine and milnacipran in fibromyalgia syndrome: a systematic review with meta-analysis. Rheumatology (Oxford) 50(3):532–543CrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • Jost Langhorst
    • 1
    Email author
  • Petra Klose
    • 1
  • Gustav J. Dobos
    • 1
  • Kathrin Bernardy
    • 2
    • 5
  • Winfried Häuser
    • 3
    • 4
  1. 1.Department of Internal and Integrative MedicineUniversity of Duisburg-EssenEssenGermany
  2. 2.Department of Anaesthesiology, Intensive Care and Pain TherapySaarland University HospitalHomburg/SaarGermany
  3. 3.Department of Internal Medicine IKlinikum SaarbrückenSaarbrückenGermany
  4. 4.Department of Psychosomatic Medicine and PsychotherapyTechnische Universität MünchenMunichGermany
  5. 5.Department of Pain Management, BG University Hospital Bergmannsheil GmbH, Ruhr University BochumBochumGermany

Personalised recommendations