Manual Diaphragmatic Release on Exercise Capacity and Quality of Life in Women With Fibromyalgia

Sixty women diagnosed with fibromyalgia will be recruited from outpatient rheumatology and physical therapy clinics. Following clinical screening, patients will be randomly assigned into two parallel groups:

The Study Group: Will include 30 women participating in manual diaphragmatic release plus aerobic training for 8 weeks.

The Control Group: Will include 30 women participating in aerobic training only for 8 weeks.

At baseline and post-study (after 8 weeks), outcomes will be comprehensively assessed. The primary focus is to determine whether manual release of the diaphragm improves exercise capacity, minimizes the overall impact of fibromyalgia symptoms, improves health-related quality of life metrics, and enhances respiratory muscles strength.

• Manual Diaphragmatic Release (Other): Thrice a week for 8 weeks, the participant will assume a supine position with relaxed limbs. The therapist will position themselves at the head of the participant and make manual contact with the pisiform, hypothenar region, and the last three fingers on both sides, underneath the seventh to tenth rib costal cartilages. During the inspiratory phase, the therapist gently pulls the contact points toward the head and slightly laterally, progressively deepening contact within the costal margin over successive respiratory cycles to release restriction.
• Aerobic Training (Other): 3 sessions per week consisting of 30-45 minutes of cycling at low-to-moderate intensity on a cycle ergometer. Intensity will be managed at a workout heart rate ranging between 60% to 70% of the maximal heart rate, accompanied by a brief warm-up and cool-down phase.

Primary outcomes

• Exercise Capacity [Baseline and after 8 weeks]: Maximal Oxygen Consumption via Cardiopulmonary Exercise Testing

Secondary outcomes

• Health-Related Quality of Life [Baseline and after 8 weeks]: Health-related quality of life will be assessed using the 12-Item Short Form Health Survey. The survey provides scores for physical and mental health status, with scores ranging from 0 to 100, where higher scores indicate better health-related quality of life.
• Fibromyalgia Symptom Severity [Baseline and after 8 weeks]: Symptoms will be assessed using the Revised Fibromyalgia Impact Questionnaire. The total score ranges from 0 to 100, with higher scores indicating greater symptom severity and a greater impact of fibromyalgia on daily functioning and quality of life.
• Respiratory Muscle Strength [Baseline and after 8 weeks]: Maximal Inspiratory Pressure and Maximal Expiratory Pressure will be tested

Sex: Female, ages: 18 Years to 55 Years

Inclusion Criteria:

* Confirmed clinical diagnosis of fibromyalgia fulfilling the American College of Rheumatology diagnostic criteria.
* Sedentary or low physical activity status (not participating in structured exercise programs within the past 3 months).

Exclusion Criteria:

* Severe psychiatric comorbidities (e.g., major depressive disorder with active suicidal ideation) or cognitive impairments.
* Presence of comorbid rheumatologic or autoimmune conditions that overlap with muscle/joint symptoms (e.g., severe rheumatoid arthritis, systemic lupus erythematosus).
* Primary chronic respiratory/chest diseases (e.g., severe COPD or active asthma).
* Cardiovascular disorders or uncontrolled hypertension.
* Pregnancy.