band, body weight or other measures. Two meta-analyses on fibromyalgia have shown that resistance training can reduce anxiety and depression and one found that it improves quality of life. The dosage of resistance exercise for women with fibromyalgia was studied in a 2022 meta-analysis. Effective dosages were found when exercising twice a week, for at least eight weeks. Symptom improvement was found for even low dosages such as 1–2 sets of 4–20 repetitions. Most studies use moderate exercise intensity of 40% to 85% one-repetition maximum. This level of intensity was effective in reducing pain. Some treatment regimes increase the intensity over time (from 40% to 80%), whereas others increase it when the participant is able to perform 12 repetitions. High-intensity exercises may cause lower treatment adherence. Meditative A 2021 meta-analysis found that meditative exercise programs (tai chi, yoga, qigong) were superior to other forms of exercise (aerobic, flexibility, resistance) in improving sleep quality. Other meta-analyses also found positive effects of tai chi for sleep, fibromyalgia symptoms, and pain, fatigue, depression and quality of life. These tai chi interventions frequently included 1-hour sessions practiced 1-3 times a week for 12 weeks. Meditative exercises, as a whole, may achieve desired outcomes through biological mechanisms such as antioxidation, anti-inflammation, reduction in sympathetic activity and modulation of glucocorticoid receptor sensitivity. Aquatic Several reviews and meta-analyses suggest that aquatic training can improve symptoms and wellness in people with fibromyalgia. It is recommended to practice aquatic therapy at least twice a week using a low to moderate intensity. Other Limited evidence suggests vibration training in combination with exercise may improve pain, fatigue, and stiffness. Medications A few countries have published guidelines for the management and treatment of fibromyalgia. As of 2018, all of them emphasize that medications are not required. However, medications, though imperfect, continue to be a component of treatment strategy for fibromyalgia patients. The German guidelines outlined parameters for drug therapy termination and recommended considering drug holidays after six months. Approved medications Health Canada and the US Food and Drug Administration (FDA) have approved pregabalin and duloxetine for the management of fibromyalgia. The FDA also approved milnacipran, but the European Medicines Agency refused marketing authority. Antidepressants Antidepressants are one of the common drugs for fibromyalgia. A 2021 meta-analysis concluded that antidepressants can improve the quality of life for fibromyalgia patients in the medium-term. As of 2018, the only tricyclic antidepressant (TCA) that has sufficient