Home-based postural exercise as an adjunct to duloxetine improves sleep quality, physical quality of life, and trunk mobility in fibromyalgia: a randomized controlled trial

Clinical Snapshot

Key Findings

• P Value: Sleep quality p=0.002, trunk flexion p<0.001, trunk extension p=0.006

• Effect Size: Moderate to large effect sizes: sleep quality η²=0.184, trunk flexion η²=0.299, global trunk ROM η²=0.417

• Primary Outcome: Significant group × time interactions favoring exercise group for sleep quality (PSQI), physical QoL (SF-12), and trunk mobility

• Nnt Or Sensitivity: Not calculable from available data - no dichotomous outcomes or response rates reported

• Confidence Interval: Not reported

Clinical Application

High feasibility - home-based program requiring no equipment, 3 sessions weekly for 4 weeks Relevant to Australian practice. Duloxetine PBS-listed for fibromyalgia. Exercise therapy aligns with RACGP chronic pain guidelines and multidisciplinary approach recommended by Australian rheumatology societies Adults with fibromyalgia already receiving duloxetine therapy, particularly those with sleep disturbances and mobility limitations

Abstract

In fibromyalgia syndrome (FMS), current guidelines recommend combining pharmacological treatments such as duloxetine with exercise interventions. This randomized controlled trial aimed to evaluate the effectiveness of a home-based postural exercise program as an adjunct to pharmacological treatment in individuals with FMS. Fifty-one patients diagnosed with FMS according to the 2016 American College of Rheumatology criteria were randomly assigned to an exercise group (EG, n = 26) or a control group (CG, n = 25). Both groups received duloxetine therapy, while the EG additionally performed a home-based postural exercise program three times per week for four weeks. Outcomes included pain intensity, pressure pain threshold (PPT), sleep quality, anxiety and depression, quality of life, and trunk range of motion (ROM). Significant improvements over time were observed in pain intensity, psychological symptoms, sleep quality, quality of life, and PPT in both groups (p < 0.05). Significant group × time interactions favored the EG for sleep quality assessed using the Pittsburgh Sleep Quality Index (F = 11.07, p = 0.002, η²=0.184), the physical component of the Short Form-12 (F = 4.31, p = 0.043, η²=0.081), trunk flexion (F = 20.85, p < 0.001, η²=0.299), trunk extension (F = 8.34, p = 0.006, η²=0.146), and global trunk ROM (F = 35.10, p < 0.001, η²=0.417). No significant group × time interactions were observed for pain intensity, anxiety, depression, mental quality of life, or PPT (p > 0.05). Adding a home-based postural exercise program to pharmacological treatment may provide short-term additional benefits in sleep quality, physical quality of life, and spinal mobility in individuals with FMS; however, these findings should be interpreted cautiously due to the short intervention duration and absence of follow-up assessment.

References

1. 1.Demir, C., Özçelep, Ö. F., Okumuş, E. C., Canlı, M., & Alkan, H. (2026). Home-based postural exercise as an adjunct to duloxetine improves sleep quality, physical quality of life, and trunk mobility in fibromyalgia: a randomized controlled trial. Rheumatology International. https://doi.org/10.1002/art.1790070305