Effectiveness of Virtual Reality-Based Active Exercise Interventions for Fibromyalgia: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Background and Objectives: Fibromyalgia is a chronic condition characterized by widespread pain, reduced quality of life, and impaired physical function. Given that physical activity is a primary treatment for musculoskeletal health and overall well-being, VR-based active exercise may offer an innovative way to engage individuals with fibromyalgia in therapeutic movement. Methods: A Systematic Review and meta-analysis were conducted following PRISMA guidelines. Randomized controlled trials including adult patients with fibromyalgia undergoing active VR-based exercise interventions were included. Databases searched were PubMed, Scopus, Web of Science, CENTRAL, and PEDro from inception up to 18 July 2025. Primary outcomes were pain intensity, fatigue, and symptom severity. Secondary outcomes included depression, anxiety, kinesiophobia, aerobic capacity, muscle strength, and balance. Risk of bias was assessed using Cochrane’s Risk of Bias 2 tool, and certainty of evidence was evaluated using GRADE. Results: Ten randomized controlled trials (203 participants) were included. Active VR interventions significantly reduced pain (SMD = −0.51), fatigue (SMD = −0.53), and symptom severity (MD = −8.41). Moderate effects were found for depression (SMD = −0.51) and anxiety (SMD = −0.41). Non-significant improvements were also observed in aerobic capacity (SMD = 0.28), and muscle strength (SMD = 0.33), while balance slightly favored control group (SMD = −0.19). The overall certainty of evidence for main outcomes was rated low. Subgroup analyses showed VR was superior to both no intervention and other isolated therapies. Conclusions: Active virtual reality-based exercise interventions appear effective for improving physical and psychological outcomes in fibromyalgia, although findings should be interpreted cautiously due to low certainty of evidence.