Effect of respiratory muscle training on symptoms of fibromyalgia: a systematic review with meta-analysis

This systematic review with meta-analysis aimed to investigate the effects of respiratory muscle training (RMT) on symptoms of fibromyalgia (FM). Searches were conducted in Medline/PubMed, EMBASE, Web of Science, SCOPUS, CINAHL, and PEDro for studies published up to November 2025. Randomized controlled trials comparing RMT to control conditions in individuals with FM were included. Risk of bias was assessed using the Cochrane tool, and the quality of evidence was analyzed using the GRADE. Mean differences (MD) and 95% confidence interval (CI) were calculated. Four studies were included; with meta-analyses conducted on two of them. RMT was superior to the control group at improving pain (MD: −2.98; 95% CI: −3.17 to −1.60), quality of life (MD: −1.09; 95% CI: −1.61 to −0.56), fatigue (MD: −1.16; 95% CI: −1.69 to −0.63), anxiety (MD: −0.60; 95% CI: −1.10 to −0.03), and sleep quality (MD: −3.93; 95% CI: −7.06 to −0.80), and maximal occlusion pressure (MD: 2.08; 95% CI: 1.58 to 2.58). However, the certainty of evidence for these findings was very low according to the GRADE approach. In conclusion, RMT may lead to improvements in several FM-related symptoms, but the current evidence is insufficient for clinical recommendations, and high-quality trials are urgently needed. Protocol registration:https://www.crd.york.ac.uk/prospero identifier is CRD42023445488. What is this article about? This article is about evaluating whether respiratory muscle training – a type of breathing exercise – can help relieve symptoms of fibromyalgia, such as pain, fatigue, anxiety, poor sleep, and reduced quality of life. The authors reviewed and combined data from previous studies to understand how effective this type of training is for people living with fibromyalgia. What do the results of the study mean? The results suggest that respiratory muscle training may offer benefits for people with fibromyalgia, including reduced pain, fatigue, anxiety, and improved sleep and quality of life. However, the scientific certainty of these findings is very low, meaning more and better-quality research is needed before this approach can be widely recommended.