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MSK Pain -CP – Improves general wellbeing

Evidence Summary (Updated 2022)
A systematic review with meta-analysis by Carnes et al looked at the effect of the physical activity components of self-management programmes on global wellbeing in those with chronic musculoskeletal pain. A moderate benefit was observed in the short and medium-term (7). One RCT of 21 patients included within a Cochrane review demonstrated an improvement of 40 on a self-reported 0-100 scale (4). Quality of life outcome measures were shown to improve with resistance training interventions in females with fibromyalgia (3).

Quality of Evidence
Grade B – moderate quality

Strength of recommendation
Grade 2 – weak recommendation

Regular physical activity may improve general wellbeing in those with chronic musculoskeletal pain. Many may report improvements due to the recognised benefit on their pain and function. Consider referring those with a significant psychosocial contribution to their presentation to group-based exercise intervention programmes with a psychological component.


  1. Busch AJ, Barber KAR, Overend TJ, Peloso PMJ, Schachter CL. Exercise for treating fibromyalgia syndrome. Cochrane Database Syst Rev [Internet]. 2007 [cited 2022 Aug 24];(4). Available from:
  2. Estévez-López F, Maestre-Cascales C, Russell D, Álvarez-Gallardo IC, Rodriguez-Ayllon M, Hughes CM, et al. Effectiveness of Exercise on Fatigue and Sleep Quality in Fibromyalgia: A Systematic Review and Meta-analysis of Randomized Trials. Arch Phys Med Rehabil [Internet]. 2021 Apr 1 [cited 2022 Jul 8];102(4):752–61. Available from:
  3. Andrade A, de Azevedo Klumb Steffens R, Sieczkowska SM, Peyré Tartaruga LA, Torres Vilarino G. A systematic review of the effects of strength training in patients with fibromyalgia: clinical outcomes and design considerations. Adv Rheumatol (London, England) [Internet]. 2018 Oct 22 [cited 2022 Jul 11];58(1):36. Available from:
  4. Busch AJ, Webber SC, Richards RS, Bidonde J, Schachter CL, Schafer LA, et al. Resistance exercise training for fibromyalgia. Cochrane database Syst Rev [Internet]. 2013 Dec 20 [cited 2022 Aug 24];2013(12). Available from:
  5. Vilarino GT, Andreato LV, de Souza LC, Branco JHL, Andrade A. Effects of resistance training on the mental health of patients with fibromyalgia: a systematic review. Clin Rheumatol [Internet]. 2021 Nov 1 [cited 2022 Jul 11];40(11):4417–25. Available from:
  6. Belavy DL, Van Oosterwijck J, Clarkson M, Dhondt E, Mundell NL, Miller CT, et al. Pain sensitivity is reduced by exercise training: Evidence from a systematic review and meta-analysis. Neurosci Biobehav Rev [Internet]. 2021 Jan 1 [cited 2022 Jul 8];120:100–8. Available from:
  7. Carnes D, Homer KE, Miles CL, Pincus T, Underwood M, Rahman A, et al. Effective delivery styles and content for self-management interventions for chronic musculoskeletal pain: a systematic literature review. Clin J Pain [Internet]. 2012 May [cited 2022 Aug 24];28(4):344–54. Available from:
  8. O’Connor SR, Tully MA, Ryan B, Bleakley CM, Baxter GD, Bradley JM, et al. Walking exercise for chronic musculoskeletal pain: systematic review and meta-analysis. Arch Phys Med Rehabil [Internet]. 2015 Apr 1 [cited 2022 Aug 24];96(4):724-734.E3. Available from:
  9. Ferro Moura Franco K, Lenoir D, dos Santos Franco YR, Jandre Reis FJ, Nunes Cabral CM, Meeus M. Prescription of exercises for the treatment of chronic pain along the continuum of nociplastic pain: A systematic review with meta-analysis. Eur J Pain [Internet]. 2021 Jan 1 [cited 2022 Jul 8];25(1):51–70. Available from:
  10. Macfarlane GJ, Kronisch C, Dean LE, Atzeni F, Häuser W, Flub E, et al. EULAR revised recommendations for the management of fibromyalgia. Ann Rheum Dis [Internet]. 2017 Feb 1 [cited 2022 Aug 24];76(2):318–28. Available from: