Purpose: The aim of this project was to present a case of an individual diagnosed with fibromyalgia (FM) and answers the following PICO question: In adult females with fibromyalgia, is aquatic-based therapy better than land-based therapy at improving symptomology and function?

Background: FM is a condition associated with chronic pain, tender points, fatigue, anxiety, depression, memory difficulty, gastrointestinal issues, sleep disturbances, muscle spasm, nerve pain, and sympathetic hyperactivity. Current literature shows positive effects of aerobic exercise programs on individuals with FM, but there is a lack of evidence-based review examining the effects of aquatic-based exercise programs on symptomology associated with FM.

Case Description: The subject was a 61-year-old female referred to outpatient physical therapy with a medical diagnosis of fibromyalgia and myofascial pain in her low back, abdominal region, bilateral lower extremities and groin.

Outcomes: This evidence-based review of the literature included eight studies, seven comparing land-based and aquatic-based exercise programs and one examining only aquatic-based therapy on various outcomes including pain by the visual analogue scale (VAS), Fibromyalgia Impact Questionnaire (FIQ), Six-Minute Walk Test (6MWT), Beck Depression Inventory (BID), SF-36, cortisol levels, and several others.

Discussion: Both aquatic and land-based exercise interventions are beneficial for treating women with fibromyalgia. Although land-based interventions demonstrated more significant strength increases and positive impacts on stress, aquatic-based exercise showed more significant improvements in psychological well-being including reducing depression and anxiety associated with fibromyalgia. Exercise programs should be tailored to the individual patient and implemented based on the clinician’s resources.



Document Type


Degree Name

Doctor of Physical Therapy (DPT)

Level of Degree


First Advisor

Deborah Doerfler, PT, PhD, DPT, OCS


fibromyalgia, aquatic, land, exercise, therapy, pool