Effects of Physical Exercise on Anxiety and Depression of People with Fibromyalgia: Umbrella Review of Systematic Reviews and Meta-Analyses

Background: Fibromyalgia is a chronic nociplastic pain condition often accompanied by mental health comorbidities, with anxiety and depression being the most prevalent. The objective of this umbrella review is to analyze the effects of physical exercise on anxiety and depression symptoms in individuals with fibromyalgia. Methods: Following Cochrane and PRIOR guidelines, a systematic search was conducted in PubMed, Web of Science, Scopus, and CINAHL Complete up to 28 August 2025. Systematic reviews with or without meta-analyses that evaluated physical exercise interventions in adults with fibromyalgia and reported anxiety or depressive symptom outcomes were included. Risk of bias was assessed with AMSTAR-2; overlap was evaluated using MOoR and CCA. Results: Fourteen reviews (eight meta-analyses, three systematic reviews, two meta-analyses treated as descriptive, and one network meta-analysis) were included, synthesizing 98 randomized controlled trials (RCTs) with 4325 participants (in the 12 reviews that provided data). The majority of the patients were women and people aged between 10 and 65. Regarding anxiety, five of seven reviews reported significant improvements. Aquatic exercise showed the greatest effect (SMD = −1.14). Regarding depression, eight of 11 reviews reported significant benefits. Aquatic exercise again stood out with the highest effect (SMD = −1.18). Adherence varied between 64% and 97%. Methodological quality according to AMSTAR-2 showed considerable heterogeneity. Conclusions: Physical exercise, especially aerobic and aquatic modalities, may support the reduction of symptoms of anxiety and depression in people with fibromyalgia. These findings support its inclusion in rehabilitation programs, although methodological and prescription variability suggests caution in interpreting optimal parameters. PROSPERO-ID: CRD42024590799.