A combination of thalassotherapy, exercise and patient education was studied in people with fibromyalgia. Patients with fibromyalgia, selected from a rheumatology outpatient department and from members of the Dutch fibromyalgia patient association, were pre-randomised to receive either 2½ weeks of treatment in a Tunisian spa resort, including thalassotherapy, supervised exercise and group education (active treatment), or treatment as usual (control treatment). Primary outcome measure was health-related quality of life, measured with the RAND-36 questionnaire. Secondary measures included the Fibromyalgia Impact Questionnaire, the McGill Pain Questionnaire, the Beck Depression Inventory, tender-point score and a 6-min treadmill walk test. Fifty-eight participants receiving the active treatment reported significant improvement on RAND-36 physical and mental component summary scales. For physical health, differences from the 76 controls were statistically significant after 3 months, but not after 6 and 12 months. A similar pattern of temporary improvement was seen in the self-reported secondary measures. Tender-point scores and treadmill walk tests improved more after active treatment, but did not reach significant between-group differences, except for walk tests after 12 months.