Exploring Adherence to Moderate to High-Intensity Exercises in Patients with Fibromyalgia: The Role of Physiological and Psychological Factors—A Narrative Literature Review

Fibromyalgia (FM) is a chronic condition characterized by widespread chronic pain, muscle tenderness, chronic fatigue, and sleep disturbances. Treatment of FM focuses on the management of symptoms, often using medications, cognitive behavioral therapy, or moderate-to-high-intensity exercises (MHIE). MHIE is highly recommended by the current guidelines from the American College of Sports Medicine and the American Heart Association for people with FM to decrease comorbidities due to sedentary lifestyles. MHIE has also been shown to improve FM symptoms in individuals who can tolerate MHIE. However, individuals with FM present with one of the poorest adherences to MHIE. Most individuals with FM report symptoms worsening at the beginning of an MHIE intervention program. Objectives: This literature review aims to estimate the adherence to MHIE using dropout and compliance rates in individuals with FM who participated in studies that applied MHIE as an intervention and to examine possible reasons for high dropout rates and low compliance with MHIE programs, including psychological and physiological factors. Understanding the scope of potential dropout and compliance rates to MHIE intervention and factors that impact MHIE adherence in people with FM may help researchers and clinicians better design clinical trial studies and develop tailored exercise interventions according to individual patient characteristics. Conclusion: FM is a multi-faceted syndrome that can vary significantly in its presentation from person to person due to the complex duality of psychological and physiological factors. Consequently, clinicians should consider both components when prescribing exercises to FM patients.