Positive outcomes were reported for pain , health-status and tender point count .
There is strong evidence for the use of hydrotherapy in the management of FMS
Hydrotherapy is often used in the treatment of  fibromyalgia syndrome ( FMS ) , however there has been limited evaluation of its effectiveness .
The aim of this systematic review was therefore to examine the effectiveness of hydrotherapy in the management of FMS .
A randomized clinical trial comparing fitness and biofeedback training versus basic treatment in patients with fibromyalgia.
OBJECTIVE To compare the therapeutic effects of physical fitness training or biofeedback training with the results of usual care in patients with fibromyalgia ( FM ) . METHODS One hundred forty-three female patients with FM ( American College of Rheumatology criteria ) were r and omized into 3 groups : a fitness program ( n = 58 ) , biofeedback training ( n = 56 ) , or controls ( n = 29 ) . Half the patients in the active treatment groups also received an educational program aim ed at improving compliance . Assessment s were done at baseline and after 24 weeks . The primary outcome was pain [ visual analog scale ( VAS ) ] . Other endpoints were the number of tender points , total myalgic score ( dolorimetry ) , physical fitness , functional ability ( Arthritis Impact Measurement Scale and Sickness Impact Profile ) , psychological distress ( Symptom Checklist-90-Revised ) , patient global assessment ( 5 point scale ) , and general fatigue ( VAS ) . RESULTS Baseline scores were similar in all 3 groups . Altogether 25 ( 17.5 % ) patients dropped out ; they were similarly distributed over all groups : 14 patients after r and omization and 11 ( 8 % ) during the study . A true high impact level for fitness training was not attained by any patient . After treatment , no significant differences in change scores of any outcome were found between the groups ( ANOVA , p > 0.05 ) . All outcome measures showed large variations intra- and interindividually . The educational program did not result in higher compliance with training sessions ( 62 % vs 71 % ) . Analysis of the subgroup of subjects with a high attendance rate ( > 67 % ) also showed no improvement . CONCLUSION In terms of training intensity and maximal heart rates , the high impact fitness intervention had a low impact benefit . Therefore effectiveness of high impact physical fitness training can not be demonstrated . Thus compared to usual care , the fitness training ( i.e. , low impact ) and biofeedback training had no clear beneficial effects on objective or subjective patient outcomes in patients with FM
Positive outcomes were reported for pain , health-status and tender point count .
There is strong evidence for the use of hydrotherapy in the management of FMS
Hydrotherapy is often used in the treatment of  fibromyalgia syndrome ( FMS ) , however there has been limited evaluation of its effectiveness .
The aim of this systematic review was therefore to examine the effectiveness of hydrotherapy in the management of FMS .