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Author(s): Álvaro-José Rodríguez-Domínguez [1]; Manuel Rebollo-Salas (corresponding author) [2]; Raquel Chillón-Martínez [1]; Abel Rosales-Tristancho [3]; Andrés Arana-Rodríguez [4]; José-Jesús Jiménez-Rejano [2] 1. Introduction Fibromyalgia is a chronic disease that causes [...], Purpose: Fibromyalgia is a chronic disease that mainly affects women, deteriorating the quality of life of these patients. Resistance exercise (RE) has been shown to be beneficial in this disease. The objective of this study is to evaluate the effectiveness of RE for depression, fatigue, and sleep quality in women with fibromyalgia. Design and Methods: A systematic review with meta-analysis was conducted until September 1, 2024. Seven databases were searched as follows: PubMed, Cochrane Library, Web of Science, Scopus, Physiotherapy Evidence Database, Dialnet, and Cumulative Index to Nursing and Allied Health Literature. Randomized clinical trials were conducted in women with a diagnosis of fibromyalgia, including RE as the only intervention in any of the groups and to assess depression, fatigue, and sleep quality. For meta-analyses, we calculated the standardized difference of means and its standard error. A random-effects model was used. The risk of bias was assessed using the Cochrane risk-of-bias tool for randomized trials (RoB 2). PROSPERO Registration: CRD42021256162. Findings: Eleven trials were included in the systematic review and eight in the meta-analysis (n=664). RE showed statistically significant improvements in depression (SMD=-0.54; 95% CI [-0.92, -0.16], p=0.005) and fatigue (SMD=-0.83; 95% CI [-1.41-0.25], p=0.005). No significant differences were found in sleep quality (SMD=-0.99; 95% CI [-2.40, 0.43], p=0.17). In general, the methodological quality of the included trials was good. Practice Implication: RE is an effective tool to improve depression and fatigue in women with fibromyalgia, achieving clinically relevant improvements of more than 50% in symptoms related to depression. RE did not show benefits for sleep quality, although this finding may be due to a lack of studies. More studies are needed to determine the effectiveness of RE on sleep quality.