Fibromyalgia is a chronic condition that most often affects young to middle-aged women. According to the American College of Rheumatology, it is diagnosed by the presence of widespread musculoskeletal pain for at least 3 months and excessive tenderness in at least 11 out of 18 defined tender points. Currently there are no definitive diagnostic laboratory tests or imaging for fibromyalgia. Its cause is still unknown. The purpose of this appraisal was to evaluate the effectiveness of aerobic training- based exercise programs compared with other types of physical activity on the symptomatology of fibromyalgia. Searches on PubMed/MEDLINE databases using the key words pool exercise, fibromyalgia, aerobic fitness, and home-based exercise, were performed to identify articles comparing different exercise regimens. A treatment protocol was developed based on the articles identified. Background and Etiology: There is no known cause of fibromyalgia, however, some theories exist. Many sufferers of fibromyalgia have been through physical or emotional trauma, which is thought to be a possible trigger. There is also thought to be a physiologic cause; the area in the brain that is responsible for pain may not function the same in patients who have fibromyalgia, or they may have a decrease in certain neurotransmitters responsible for detection of pain. Some researchers also believe that fibromyalgia patients could have contracted a virus preceding their symptoms and diagnosis of fibromyalgia. Chronic widespread pain is the hallmark symptom of fibromyalgia. Also, fibromyalgia patients tend to have a lower pain threshold than healthy people. Another typical finding in patients with fibromyalgia is extreme fatigue. About 90% of patients suffer from lack of restorative sleep (1), especially stage four sleep, which is markedly deficient in fibromyalgia patients. This acts to further exacerbate their pain levels. Another common symptom for these patients is commonly called fibro fog: Patients will have trouble with memory and impaired cognition, and will function similarly to subjects nearly 20 years their senior. Fibromyalgia is a disorder that is characterized by an increased sensitivity to pain. According to the International Association for the Study of Pain, "pain" is described as "an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage."2 Pain receptors of the body are known as nociceptors, which, when stimulated, send signals to multiple regions of the brain through the spinal cord. These regions are the emotional, autonomic, discriminative, and motor/reflex centers. During the pain response, the hypothalamic-pituitary-adrenocortical (HPA) axis and the sympathetic nervous system are also activated. These specific stress responses in patients with chronic pain syndromes, such as fibromyalgia, may be maladaptive. Since the perception of pain travels through the emotional centers of the brain, patients with fibromyalgia should be counseled on certain cognitive aspects due to the constant stressors placed on the system. These negative emotions on the system have been shown to lead to self-sustaining neuroendocrine cascades that can lead to the patient developing flu-like symptoms, depression, and fatigue. Serotonin has been associated with fibromyalgia. In patients with fibromyalgia, the levels of serotonin have been shown to be lower than normal. These low levels are thought to be the result of low levels of tryptophan and 5-hydroxyindole acetic acid in the CSF. Substance P, a neurotransmitter located in the nervous system, increases when there is sensitivity of nerves to pain or heightened awareness of pain. In patients with fibromyalgia, Substance P levels have been found to be 2-3 times higher than normal in the CSF. Clinical Question: In middle-aged women with fibromyalgia, does a comprehensive workout designed to increase strength, build aerobic capacity, and provide stimulation for the brain have a greater impact on the symptoms of fibromyalgia over a 12-week span than current treatments of cognitive behavioral therapy coupled with aerobic activities and pharmacological therapy? Methods: The database used was PubMed/MEDLINE. After deciding on our topic of fibromyalgia, we chose to take a broader stance toward exercise intervention. We chose to research multiple exercise topics, including pool exercises, aerobic exercise, and home-based exercise. To obtain articles pertaining to fibromyalgia and our exercise topics, we used the key words pool exercise, fibromyalgia, aerobic fitness, and home-based exercise for fibromyalgia. The results of this search yielded 82 articles. The articles that were selected were "Pool exercise for patients with fibromyalgia or chronic widespread pain: a randomized controlled trial and subgroup analyses" by Mannerkorpi et al.; "Aerobic fitness effects in fibromyalgia" by Valim et al.; and "A randomized clinical trial of an individualized home-based exercise program for women with fibromyalgia" by Da Costa et al. Results: A summary of the three identified articles follows.