title: Effects of muscle strengthening versus aerobic exercise program in fibromyalgia Controlled, cross-sectional, multi-center study of physical capacity and associated factors in women with fibromyalgia Cardiovascular autonomic modulation after acute resistance exercise in women with fibromyalgia. The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials Resistance exercise improves physical fatigue in women with fibromyalgia: a randomized controlled trial Resistance exercise improves muscle strength, health status and pain intensity in fibromyalgia—a randomized controlled trial Strengthening Exercises Improve Symptoms and Quality of Life but Do Not Change Autonomic Modulation in Fibromyalgia: A Randomized Clinical Trial Decrease of fear avoidance beliefs following person-centered progressive resistance exercise contributes to reduced pain disability in women with fibromyalgia: secondary exploratory analyses from a randomized controlled trial A randomized controlled trial of muscle strengthening versus flexibility training in fibromyalgia. Group exercise, education, and combination self-management in women with fibromyalgia: a randomized trial. Effects of resistance training and chiropractic treatment in women with fibromyalgia. Muscle hypertrophy, strength development, and serum hormones during strength training in elderly women with fibromyalgia The effects of a 12-week strength-training program on strength and functionality in women with fibromyalgia. The nuts and bolts of PROSPERO: an international prospective register of systematic reviews Strength training induced adaptations in neuromuscular function of premenopausal women with fibromyalgia: comparison with healthy women Effects of strength training on muscle strength, cross-sectional area, maximal electromyographic activity, and serum hormones in premenopausal women with fibromyalgia. Effectiveness of physical activity in reducing pain in patients with fibromyalgia: a blinded randomized clinical trial The effects of progressive strength training and aerobic exercise on muscle strength and cardiovascular fitness in women with fibromyalgia: a pilot study. Effects of strength vs aerobic exercise on pain severity in adults with fibromyalgia: A randomized equivalence trial Resistance exercise training improves heart rate variability in women with fibromyalgia Muscle stretching exercises and resistance training in fibromyalgia: which is better? A three-arm randomized controlled trial.
abstract: The purpose of this study was to compare the effects of aerobic training with a muscle-strengthening program in patients with fibromyalgia . Thirty women with fibromyalgia were r and omized to either an aerobic exercise ( AE ) program or a strengthening exercise ( SE ) program for 8 weeks . Outcome measures included the intensity of fibromyalgia-related symptoms , tender point count , fitness ( 6-min walk distance ) , hospital anxiety and depression ( HAD ) scale , and short-form health survey ( SF-36 ) . There were significant improvements in both groups regarding pain , sleep , fatigue , tender point count , and fitness after treatment . HAD-depression scores improved significantly in both groups while no significant change occurred in HAD-anxiety scores . Bodily pain subscale of SF-36 and physical component summary improved significantly in the AE group , whereas seven subscales of SF-36 , physical component summary , and mental component summary improved significantly in the SE group . When the groups were compared after treatment , there were no significant differences in pain , sleep , fatigue , tender point count , fitness , HAD scores , and SF-36 scores . AE and SE are similarly effective at improving symptoms , tender point count , fitness , depression , and quality of life in fibromyalgia Background Health and physical capacity are commonly associated with disease , age , and socioeconomic factors . The primary objective of this study was to investigate the degree to which physical capacity , defined as muscle strength and walking ability , is decreased in women with fibromyalgia ( FM ) , as compared to healthy women , who are matched for age and level of education . The secondary aim was to investigate whether muscle strength and walking ability are associated with age , symptom duration , activity limitations and , Body Mass Index ( BMI ) in women with FM and control subjects . Methods This controlled , cross-sectional , multi-center study comprised 118 women with FM and 93 age- and education-level-matched healthy women . The outcome measures were isometric knee-extension force , isometric elbow-flexion force , isometric h and -grip force , and walking ability . Differences between the groups were calculated , and for the women with FM analyses of correlations between the measures of physical capacity and variables were performed . Results The women with FM showed 20 % ( p < 0.001 ) lower isometric knee-extension force , 36 % ( p < 0.001 ) lower isometric elbow-flexion force , 34 % ( p < 0.001 ) lower isometric h and -grip force , and 16 % lower walking ability ( p < 0.001 ) , as compared to the healthy controls . All measures of muscle strength in women with FM showed significant weak to moderate relationship to symptom duration ( rs = − 0.23–0.32 ) and walking ability ( rs = 0.25–0.36 ) . Isometric knee-extension force correlated with activity limitations , as measured using the SF-36 Physical function subscale ( rs=0.23 , p = 0.011 ) . Conclusions Physical capacity was considerably decreased in the women with FM , as compared to the age- and education-level-matched control group . All measures of physical capacity showed a significant association with symptom duration . Knee-extension force and walking ability were significantly associated with activity limitations , age , and BMI . It seems important to address this problem and to target interventions to prevent decline in muscle strength . Assessment s of muscle strength and walking ability are easy to administer and should be routinely carried out in the clinical setting for women with FM.Trial registration Clinical Trials.gov identification number : NCT01226784 , Oct 21 , 2010 OBJECTIVE To test the hypothesis that autonomic modulation after resistance exercise ( RE ) would be reduced in women with fibromyalgia ( FM ) compared with controls . DESIGN Before-after trial . SETTING Testing occurred in a university setting . PARTICIPANTS Women with FM ( n=9 ) and healthy controls ( n=9 ) underwent testing before ( pre ) and 20 minutes after ( post ) RE . INTERVENTIONS Not applicable . MAIN OUTCOME MEASURES Normalized low-frequency ( LFnu ) and normalized high-frequency ( HFnu ) oscillations and the LFnu/HFnu ratio were indicative of sympathetic modulation , parasympathetic modulation , and sympathovagal balance , respectively . Baroreceptor reflex sensitivity ( BRS ) was also measured . RESULTS Variables were similar in both groups at rest . HFnu decreased in controls ( pre , 55.0+/-4.2 % ; post , 35.0+/-4.7 % ; P<.05 ) and increased in women with FM ( pre , 57.0+/-5.7 % ; post , 63.2+/-4.6 % ; P<.05 ) . LFnu increased in controls ( pre , 43.3+/-4.4 % ; post , 63.2+/-4.8 % ; P<.05 ) and decreased in women with FM ( pre , 41.8+/-5.6 % ; post , 35.6+/-4.7 % ; P<.05 ) . The LFnu/HFnu ratio increased in controls ( pre , 0.89+/-0.17 ; post , 2.43+/-0.64 ; P<.05 ) with no change in women with FM ( pre , 0.90+/-0.22 ; post , 0.64+/-0.13 ; P=.13 ) . BRS decreased in controls ( pre , 8.78+/-1.42 ms/mmHg ; post , 5.49+/-0.66 ms/mmHg ; P<.05 ) , but not in women with FM ( pre , 5.91+/-1.22 ms/mmHg ; post , 9.23+/-2.4 ms/mmHg ; P=.16 ) . CONCLUSIONS After acute RE , women with FM responded differently from controls , demonstrated by lower sympathetic and higher vagal modulation without altering BRS . These postexercise responses may be attributed to the altered autonomic responsiveness to physiologic stress that characterizes FM Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more Background Fibromyalgia ( FM ) affects approximately 1–3 % of the general population . Fatigue limits the work ability and social life of patients with FM . A few studies of physical exercise have included measures of fatigue in FM , indicating that exercise can decrease fatigue levels . There is limited knowledge about the effects of resistance exercise on multiple dimensions of fatigue in FM . The present study is a sub- study of a multicenter r and omized controlled trial in women with FM . The purpose of the present sub- study was to examine the effects of a person-centered progressive resistance exercise program on multiple dimensions of fatigue in women with FM , and to investigate predictors of the potential change in fatigue . Methods A total of 130 women with FM ( age 22–64 years ) were included in this assessor-blinded r and omized controlled multicenter trial examining the effects of person-centered progressive resistance exercise compared with an active control group . The intervention was performed twice a week for 15 weeks . Outcomes were five dimensions of fatigue measured with the Multidimensional Fatigue Inventory ( MFI-20 ) . Information about background was collected and the women also completed several health-related question naires . Multiple linear stepwise regression was used to analyze predictors of change in fatigue in the total population . Results A higher improvement was found at the post-treatment examination for change in the resistance exercise group , as compared to change in the active control group in the MFI-20 subscale of physical fatigue ( resistance group Δ –1.7 , SD 4.3 , controls Δ 0.0 , SD 2.7 , p = 0.013 ) , with an effect size of 0.33 . Sleep efficiency was the strongest predictor of change in the MFI-20 subscale general fatigue ( beta = −0.54 , p = 0.031 , R2 = 0.05 ) . Participating in resistance exercise ( beta = 1.90 , p = 0.010 ) and working fewer hours per week ( beta = 0.84 , p = 0.005 ) were independent significant predictors of change in physical fatigue ( R2 = 0.14 ) . Conclusions Person-centered progressive resistance exercise improved physical fatigue in women with FM when compared to an active control group . Trial registration Clinical Trials.gov NCT01226784 . Registered 21 October 2010 Introduction Fibromyalgia ( FM ) is characterized by persistent widespread pain , increased pain sensitivity and tenderness . Muscle strength in women with FM is reduced compared to healthy women . The aim of this study was to examine the effects of a progressive resistance exercise program on muscle strength , health status , and current pain intensity in women with FM . Methods A total of 130 women with FM ( age 22–64 years , symptom duration 0–35 years ) were included in this assessor-blinded r and omized controlled multi-center trial examining the effects of progressive resistance group exercise compared with an active control group . A person-centred model of exercise was used to support the participants ’ self-confidence for management of exercise because of known risks of activity-induced pain in FM . The intervention was performed twice a week for 15 weeks and was supervised by experienced physiotherapists . Primary outcome measure was isometric knee-extension force ( Steve Strong ® ) , secondary outcome measures were health status ( FIQ total score ) , current pain intensity ( VAS ) , 6MWT , isometric elbow-flexion force , h and -grip force , health related quality of life , pain disability , pain acceptance , fear avoidance beliefs , and patient global impression of change ( PGIC ) . Outcomes were assessed at baseline and immediately after the intervention . Long-term follow up comprised the self-reported question naires only and was conducted after 13–18 months . Between-group and within-group differences were calculated using non-parametric statistics . Results Significant improvements were found for isometric knee-extension force ( p = 0.010 ) , health status ( p = 0.038 ) , current pain intensity ( p = 0.033 ) , 6MWT ( p = 0.003 ) , isometric elbow flexion force ( p = 0.02 ) , pain disability ( p = 0.005 ) , and pain acceptance ( p = 0.043 ) in the resistance exercise group ( n = 56 ) when compared to the control group ( n = 49 ) . PGIC differed significantly ( p = 0.001 ) in favor of the resistance exercise group at post-treatment examinations . No significant differences between the resistance exercise group and the active control group were found regarding change in self-reported question naires from baseline to 13–18 months . Conclusions Person-centered progressive resistance exercise was found to be a feasible mode of exercise for women with FM , improving muscle strength , health status , and current pain intensity when assessed immediately after the intervention . Trial registration Clinical Trials.gov identification number : NCT01226784 , Oct 21 , 2010 Objective Autonomic dysfunction is an important mechanism that could explain many symptoms observed in fibromyalgia ( FM ) .  Exercise is an effective treatment , with benefits potentially mediated through changes in autonomic modulation . Strengthening is one of the less studied exercises in FM , and the acute and chronic effects of strengthening on the autonomic system remain unknown . The objective of this study was to assess the chronic effects of strengthening exercises ( STRE ) on autonomic modulation , pain perception and the quality of life ( QOL ) of FM patients . Methods Eighty sedentary women with FM ( ACR 1990 ) were r and omly selected to participate in STRE or flexibility ( FLEX ) exercises in a blinded controlled trial . The intensity of STRE was set at 45 % of the estimated load of 1 Repetition Maximum ( RM ) in 12 different exercises . Outcomes were Visual Analog Scale ( VAS ) for pain , Heart Rate Variability ( HRV ) analysis , treadmill test , the sit and reach test ( Wells and Dillon ’s Bench ) , maximal repetitions test and h and grip dynamometry ; and quality of life by the Fibromyalgia Impact Question naire ( FIQ ) , the Beck and I date Trait-State Inventory ( I DATE ) , a short-form health survey ( SF-36 ) . Results The STRE group was more effective to strength gain for all muscles and pain control after 4 and 16 weeks ( p<0.05 ) . The FLEX group showed higher improvements in anxiety ( p<0.05 ) . Both groups showed improvements in the QOL , and there was no significant difference observed between the groups . There was no change in the HRV of the STRE and FLEX groups . Conclusions Strengthening exercises show greater and more rapid improvements in pain and strength than flexibility exercises . Despite the benefits in fitness , pain , depression , anxiety and quality of life , no effect was observed on the autonomic modulation in both groups . This observation suggests that changes in autonomic modulation are not a target tobe clinical ly achieved in fibromyalgia . Trial Registration Clinical Trials.gov Background Fibromyalgia ( FM ) is characterized by persistent widespread pain , increased pain sensitivity and tenderness . Women with FM also report disability , in terms of negative consequences on activities of daily living . Our recent r and omized controlled trial ( RCT ) is the first study of resistance exercise to show positive effects on pain disability . The resistance exercise program of our RCT emphasized active involvement of participants in planning and progression of the exercise , using the principles of person-centeredness , to support each participant ’s ability to manage the exercise and the progress of it . The aim of this sub- study was to investigate explanatory factors for reduced pain disability in women with FM participating in a 15-week person-centered progressive resistance exercise program .  Methods A total of 67 women with FM were included in this sub- study of an RCT examining the effects of person-centered progressive resistance exercise performed twice a week for 15 weeks . Tests of physical capacity and health-related question naires were assessed at baseline and after the intervention period . Multivariable stepwise regression was used to analyze explanatory factors for improvements in pain disability . Results Reduced pain disability was explained by higher pain disability at baseline together with decreased fear avoidance beliefs about physical activity ( R2 = 28 , p = 0.005 ) . The improvements in the disability domains of recreation and social activity were explained by decreased fear avoidance beliefs about physical activity together with higher baseline values of each disability domain respectively ( R2 = 32 , p = 0.025 and R2 = 30 , p = 0.017 ) . The improvement in occupational disability was explained by higher baseline values of occupational disability ( R2 = 19 , p = 0.001 ) . Conclusion The person-centered resistance exercise intervention , based on principles of self-efficacy , had a positive effect on recreational , social and occupational disability . The reduced pain disability seemed to be mediated by decreased fear avoidance beliefs . Age , symptom duration , pain intensity , and muscle strength at baseline had no explanatory value for reduced pain disability , indicating that the person-centered resistance exercise program has the potential to work for anyone with FM who has interest in physical exercise . The trial was registered on October 21 , 2010 with Clinical Trials.gov identification number : NCT01226784 OBJECTIVE To determine the effectiveness of a muscle strengthening program compared to a stretching program in women with fibromyalgia ( FM ) . METHODS Sixty-eight women with FM were r and omly assigned to a 12 week , twice weekly exercise program consisting of either muscle strengthening or stretching . Outcome measures included muscle strength ( main outcome variable ) , flexibility , weight , body fat , tender point count , and disease and symptom severity scales . RESULTS No statistically significant differences between groups were found on independent t tests . Paired t tests revealed twice the number of significant improvements in the strengthening group compared to the stretching group . Effect size scores indicated that the magnitude of change was generally greater in the strengthening group than the stretching group . CONCLUSION Patients with FM can engage in a specially tailored muscle strengthening program and experience an improvement in overall disease activity , without a significant exercise induced flare in pain . Flexibility training alone also results in overall improvements , albeit of a lesser degree BACKGROUND Self-management has increasingly been recommended as part of st and ard care for fibromyalgia , a common , poorly understood condition with limited treatment options . Data that assess popular self-management recommendations are scarce . We evaluated and compared the effectiveness of 4 common self-management treatments on function , symptoms , and self-efficacy in women with fibromyalgia . METHODS A total of 207 women with confirmed fibromyalgia were recruited from September 16 , 2002 , through November 30 , 2004 , and r and omly assigned to 16 weeks of ( 1 ) aerobic and flexibility exercise ( AE ) ; ( 2 ) strength training , aerobic , and flexibility exercise ( ST ) ; ( 3 ) the Fibromyalgia Self-Help Course ( FSHC ) ; or ( 4 ) a combination of ST and FSHC ( ST-FSHC ) . The primary outcome was change in physical function from baseline to completion of the intervention . Secondary outcomes included social and emotional function , symptoms , and self-efficacy . RESULTS Improvements in the mean Fibromyalgia Impact Question naire score in the 4 groups were -12.7 for the ST-FSHC group , -8.2 for the AE group , -6.6 for the ST group , and -0.3 for the FSHC group . The ST-FSHC group demonstrated greater improvement than the FSHC group ( mean difference , -12.4 ; 95 % confidence interval [ CI ] , -23.1 to -1.7 ) . The ST-FSHC ( mean difference , 13.6 ; 95 % CI , 2.3 to 24.9 ) and AE ( mean difference , 13.1 ; 95 % CI , 1.6 to 25.6 ) groups had similar improvements in physical function scores on the 36-Item Short-Form Health Survey . Bodily pain scores on the 36-Item Short-Form Health Survey improved in the ST-FSHC ( 14.8 ) , AE ( 13.2 ) , and ST ( 5.7 ) groups . Social function , mental health , fatigue , depression , and self-efficacy also improved . The beneficial effect on physical function of exercise alone and in combination with education persisted at 6 months . CONCLUSIONS Progressive walking , simple strength training movements , and stretching activities improve functional status , key symptoms , and self-efficacy in women with fibromyalgia actively being treated with medication . The benefits of exercise are enhanced when combined with targeted self-management education . Our findings suggest that appropriate exercise and patient education be included in the treatment of fibromyalgia OBJECTIVE The objective of this study was to evaluate resistance training ( RES ) and RES combined with chiropractic treatment ( RES-C ) on fibromyalgia ( FM ) impact and functionality in women with FM . DESIGN The design of the study was a r and omized control trial . SETTING Testing and training were completed at the university and chiropractic treatment was completed at chiropractic clinics . PARTICIPANTS Participants ( 48 + /- 9 years ; mean + /- st and ard deviation ) were r and omly assigned to RES ( n = 10 ) or RES-C ( n = 11 ) . INTERVENTION Both groups completed 16 weeks of RES consisting of 10 exercises performed two times per week . RES-C received RES plus chiropractic treatment two times per week . OUTCOME MEASURES Strength was assessed using one repetition maximum for the chest press and leg extension . FM impact was measured using the FM impact question naire , myalgic score , and the number of active tender points . Functionality was assessed using the 10-item Continuous Scale Physical Functional Performance test . Analyses of variance with repeated measures compared groups before and after the intervention . RESULTS Six ( 6 ) participants discontinued the study : 5 from  RES  and 1 from RES-C.  Adherence to training was significantly higher in RES-C ( 92.0 + /- 7.5 % ) than in RES ( 82.8 + /- 7.5 % ) . Both groups increased ( p < or = 0.05 ) upper and lower body strength . There were similar improvements in FM impact in both groups . There were no group interactions for the functionality measures . Both groups improved in the strength domains ; however , only RES-C significantly improved in the pre- to postfunctional domains of flexibility , balance and coordination , and endurance . CONCLUSIONS In women with FM , resistance training improves strength , FM impact , and strength domains of functionality . The addition of chiropractic treatment improved adherence and dropout rates to the resistance training and facilitated greater improvements in the domains of functionality Objective : To examine the effects of strength training on maximal force , cross‐sectional area ( CSA ) , and electromyographic ( EMG ) activity of muscles and serum hormone concentrations in elderly females with fibromyalgia ( FM ) . Methods : Twenty‐six patients with FM were r and omly assigned to a  training ( FMT ; n = 13 ; mean age 60 years ) or a  control ( FMC ; n = 13 ; 59 years ) group . FMT performed progressive strength training twice a week for 21 weeks . The measurements included maximal isometric and concentric leg extension forces , EMG activity of the vastus lateralis and medialis , CSA of the quadriceps femoris , and serum concentrations of testosterone ( T ) , free testosterone ( FT ) , growth hormone ( GH ) , insulin‐like growth factor‐1 ( IGF‐1 ) , dehydroepi and rosterone sulfate ( DHEAS ) , and cortisol . Subjectively perceived symptoms of FM were also assessed . Results : All patients were able to complete the training . In FMT strength training led to increases of 36 % ( p<0.001 ) and 33 % ( p<0.001 ) in maximal isometric and concentric forces , respectively . The CSA increased by 5 % ( p<0.001 ) and the EMG activity in isometric action by 47 % ( p<0.001 ) and in concentric action by 57 % ( p<0.001 ) . Basal serum hormone concentrations remained unaltered during strength training . The subjective perceived symptoms showed a minor decreasing tendency ( ns ) . No statistically significant changes occurred in any of these parameters in FMC . Conclusion : Progressive strength training  increases strength , CSA , and voluntary activation of the trained muscles in elderly women with FM , while the measured basal serum hormone concentrations remain unaltered . Strength training benefits the overall physical fitness of the patients without adverse effects or any exacerbation of symptoms and should be included in the rehabilitation programmes of elderly patients with FM OBJECTIVE To determine whether women with fibromyalgia benefit from strength training . DESIGN R and omized controlled trial . SETTING Testing was completed at the university and training was completed at a local community wellness facility . PARTICIPANTS Twenty-nine women ( age range , 18 - 54 y ) with fibromyalgia participated . Subjects were r and omly assigned to a control ( n=14 ; wait-listed for exercise ) or strength ( n=15 ) group . After the first 4 weeks , 7 ( 47 % ) women dropped from the strength group . INTERVENTION Subjects underwent 12 weeks of training on 11 exercises , 2 times a week , performing 1 set of 8 to 12 repetitions at 40 % to 60 % of their maximal lifts and were progressed to 60 % to 80 % . MAIN OUTCOME MEASURES Subjects were measured for strength , functionality , tender point sensitivity , and fibromyalgia impact . RESULTS The strength group significantly ( P < or = .05 ) improved upper- ( strength , 39+/-11 to 42+/-12 kg ; control , 38+/-13 to 38+/-12 kg ) and lower- ( strength , 68+/-28 to 82+/-25 kg ; control , 61+/-25 to 61+/-26 kg ) body strength . Upper-body functionality measured by the Continuous-Scale Physical Functional Performance test improved significantly ( strength , 44+/-11 to 50+/-16U ; control , 51+/-11 to 49+/-13U ) after training . Tender point sensitivity and fibromyalgia impact did not change . CONCLUSIONS Strength training improved strength and some functionality in women with fibromyalgia . Interventions with resistance have important implication s on independence and quality of life issues for women with fibromyalgia Background Following publication of the PRISMA statement , the UK Centre for Review s and Dissemination ( CRD ) at the University of York in Engl and began to develop an international prospect i ve register of systematic review s with health-related outcomes . The objectives were to reduce unplanned duplication of review s and provide transparency in the review process , with the aim of minimizing reporting bias . Methods An international advisory group was formed and a consultation undertaken to establish the key items necessary for inclusion in the register and to gather views on various aspects of functionality . This article describes the development of the register , now called PROSPERO , and the process of registration . Results PROSPERO offers free registration and free public access to a unique prospect i ve register of systematic review s across all areas of health from all around the world . The dedicated web-based interface is electronically search able and available to all prospect i ve registrants . At the moment , inclusion in PROSPERO is restricted to systematic review s of the effects of interventions and strategies to prevent , diagnose , treat , and monitor health conditions , for which there is a health-related outcome .Ideally , registration should take place before the research ers have started formal screening against inclusion criteria but review s are eligible as long as they have not progressed beyond the point of completing data extraction .The required data set captures the key attributes of review design as well as the administrative details necessary for registration .Su bmi tted registration forms are checked against the scope for inclusion in PROSPERO and for clarity of content before being made publicly available on the register , rejected , or returned to the applicant for clarification . The public records include an audit trail of major changes to planned methods , details of when the review has been completed , and links to result ing publications when provided by the authors . Conclusions There has been international support and an enthusiastic response to the principle of prospect i ve registration of protocol s for systematic review s and to the development of PROSPERO .In October 2011 , PROSPERO contained 200 records of systematic review s being undertaken in 26 countries around the world on a diverse range of interventions OBJECTIVE To investigate the effects of 21 weeks ' progressive strength training on neuromuscular function and subjectively perceived symptoms in premenopausal women with fibromyalgia ( FM ) . METHODS Twenty one women with FM were r and omly assigned to experimental ( FMT ) or control ( FMC ) groups . Twelve healthy women served as training controls ( HT ) . The FMT and HT groups carried out progressive strength training twice a week for 21 weeks . The major outcome measures were muscle strength and electromyographic ( EMG ) recordings . Secondary outcome measures were pain , sleep , fatigue , physical function capacity ( Stanford Health Assessment Question naire ) , and mood ( short version of Beck 's depression index ) . RESULTS Female FMT subjects increased their maximal and explosive strength and EMG activity to the same extent as the HT group . Moreover , the progressive strength training showed immediate benefits on subjectively perceived fatigue , depression , and neck pain of training patients with FM . CONCLUSIONS The strength training data indicate comparable trainability of the neuromuscular system of women with FM and healthy women .  Progressive strength training can safely be used in the treatment of FM to decrease the impact of the syndrome on the neuromuscular system , perceived symptoms , and functional capacity . These results confirm the opinion that FM syndrome has a central rather than a peripheral or muscular basis OBJECTIVE To examine the effects of strength training on basal concentrations and acute responses of serum hormones , and their possible interrelationships with training induced muscle hypertrophy and strength gains of the knee extensor muscles in women with fibromyalgia ( FM ) and healthy controls . METHODS Twenty-one premenopausal women with FM were r and omized to 21 week strength training ( FMT ; n = 11 ) or control ( FMC ; n = 10 ) groups . Twelve premenopausal sedentary healthy women served as controls ( HC ) . Surface electromyographic ( EMG ) activity , maximal unilateral isometric force of the right knee extensors , and muscle cross-sectional area ( CSA ) of the quadriceps femoris throughout the lengths of 3/12 to 12/15 of the femur ( Lf ) were measured . Serum concentrations of total and free testosterone and growth hormone ( GH ) were analyzed at rest and in pre- and post-exercise conditions , while levels of insulin-like growth factor and dehydroepi and rosterone sulfate were measured at rest only . RESULTS Mean ( SD ) maximal force increased by 18 % ( 10 % ) ( p < 0.001 ) in the FMT group , and by 22 % ( 12 % ) ( p < 0.001 ) in the HC , while in the FMC it remained unchanged . Maximum integrated EMG of the agonists ( VL + VM/2 ) increased in HC by 22 % ( p < 0.05 ) and in the FMT by 19 % ( p < 0.05 ) . Significant increases in the CSA of the QF were observed at 5 to 12/15 Lf in FMT ( p < 0.05 - 0.01 ) and at 3 to 12/15 Lf in HC ( p < 0.05 - 0.001 ) , while in FMC the CSA remained unchanged . No training induced changes occurred in the basal concentrations of serum hormones examined . A significant acute increase took place in the mean concentration of GH at pre-training in HC ( p < 0.01 ) and in the FMT ( p < 0.05 ) , while at post-training the elevations after the loading ( p < 0.001 and 0.05 ) remained elevated up to 15 min ( p < 0.05 ) in HC and up to 30 min ( p < 0.01 ) post-loading in the FMT . CONCLUSION Both the magnitude and time course of adaptations of the neuromuscular system to resistance training in women with FM were completely comparable to those taking place in healthy women .  Basal levels of the anabolic hormones seem to be similar in women with FM compared to age matched healthy women . Observations recorded during the acute loading conditions might be considered an indication of the training induced adaptation of the endocrine system , showing that the acute GH response may become systematic after strength training in both women with FM and controls The purpose of this study was to evaluate and compare the effectiveness of muscle-strengthening exercises ( MS ) and a walking program ( WA ) in reducing pain in patients with fibromyalgia . Ninety women , 30–55 years of age , diagnosed with fibromyalgia according to the American College of Rheumatology 1990 criteria , were r and omized into 3 groups : WA Group , MS Group , and control group . Pain ( visual analog scale ) was evaluated as the primary outcome . Physical functioning ( Fibromyalgia Impact Question naire , FIQ ) , health-related quality of life ( Short-Form 36 Health Survey , SF-36 ) , and use of medication were evaluated as secondary outcomes . Assessment s were performed at baseline , 8 , 16 , and 28 weeks . Intention-to-treat and efficacy analyses were conducted . Sixty-eight patients completed the treatment protocol . All 3 groups showed improvement after the 16-week treatment compared to baseline . At the 28-week follow-up , pain reduction was similar for the WA and MS groups ( P = 0.39 ) , but different from the control group ( P = 0.01 ) . At the end of the treatment , 80 % of subjects in the control group took pain medication , but only 46.7 % in the WA and 41.4 % in the MS  groups . Mean FIQ total scores were lower for the WA and MS groups ( P = 0.96 ) compared with the control group ( P < 0.01 ) . Patients in the WA and MS groups reported higher scores ( better health status ) than controls in almost all SF-36 subscales . MS was as effective as WA in reducing pain regarding all study variables ; however , symptoms management during the follow-up period was more efficient in the WA group OBJECTIVE To determine the safety , feasibility and consequences of a program of progressive strength training and cardiovascular exercise in women with fibromyalgia syndrome ( FMS ) . METHODS Fifteen women with confirmed FMS were monitored for injury and exercise compliance , and assessed for muscle strength ( 1-repetition maximum technique ) , cardiovascular endurance ( 6-minute walk test ) , and functional status ( Fibromyalgia Impact Question naire [ FIQ ] ) before and after a 20-week exercise intervention . RESULTS Zero injuries and an 81 % compliance rate occurred during training . Improvement was seen in muscle strength of the lower ( 191 + /- 75 to 265 + /- 67 pounds ; P < 0.001 ) and upper ( 61 + /- 18 to 76 + /- 18 pounds ; P < 0.001 ) body , 6-minute walk distance ( 530 + /- 80 to 629 + /- 74 meters ; P < 0.001 ) , and in FIQ score ( 44 + /- 9 to 32 + /- 14 ; P < 0.01 ) . CONCLUSION A program of progressive strength training and cardiovascular exercise can be safe , well tolerated , and effective at improving muscle strength , cardiovascular endurance and functional status in women with FMS without exacerbating symptoms . This program may also contribute to a reduction in the severity of several symptoms Summary Strengthening and aerobic exercise had equivalent effects on reducing pain severity in patients with fibromyalgia .  Abstract Strength training and aerobic exercise have beneficial effects on pain in adults with fibromyalgia . However , the equivalence of strengthening and aerobic exercise has not been reported . The primary aim of this r and omized equivalence trial involving patients with fibromyalgia admitted to an interdisciplinary pain treatment program was to test the hypothesis that strengthening ( n = 36 ) and aerobic ( n = 36 ) exercise have equivalent effects ( 95 % confidence interval within an equivalence margin ±8 ) on pain , as measured by the pain severity subscale of the Multidimensional Pain Inventory . Secondary aims included determining the effects of strengthening and aerobic exercise  on peak Vo2 uptake , leg strength , and pressure pain thresholds . In an intent‐to‐treat analysis , the mean ( ± st and ard deviation ) pain severity scores for the strength and aerobic groups at study completion were 34.4 ± 11.5 and 37.6 ± 11.9 , respectively . The group difference was −3.2 ( 95 % confidence interval , −8.7 to 2.3 ) , which was within the equivalence margin of Δ8 . Significant improvements in pain severity ( P < .001 ) , peak Vo2 ( P < .001 ) , strength ( P < .001 ) , and pain thresholds ( P < .001 ) were observed from baseline to week 3 in the intent‐to‐treat analysis ; however , patients in the aerobic group ( mean change 2.0 ± 2.6 mL/kg/min ) experienced greater gains ( P < .013 ) in peak Vo2 compared to the strength group ( mean change 0.4 ± 2.6 mL/kg/min ) . Knowledge of the equivalence and physiological effects of exercise have important clinical implication s that could allow practitioners to target exercise recommendations on the basis of comorbid medical conditions or patient preference for a particular type of exercise . This study found that strength and aerobic exercise had equivalent effects on reducing pain severity among patients with fibromyalgia Fibromyalgia ( FM ) is characterized by generalized muscle pain , low muscle strength and autonomic dysfunction . Heart rate ( HR ) variability ( HRV ) is reduced in individuals with FM increasing their risk for cardiovascular morbidity and mortality . We tested the hypothesis that resistance exercise training ( RET ) improves HRV , baroreflex sensitivity ( BRS ) and muscle strength in women with FM . Women with FM ( n = 10 ) and healthy controls ( n = 9 ) , aged 27–60 years , were compared at baseline . Only women with FM underwent supervised RET 2 days per week for 16 weeks . Baseline and post‐training measurements included HRV and spontaneous baroreflex sensitivity ( BRS , alpha index ) from continuous electrocardiogram and blood pressure ( BP ) recorded with finger plethysmography during 5 min in the supine position . RR interval , total power , log transformed ( Ln ) squared root of the st and ard deviation of RR interval ( RMSSD ) , low‐frequency power and BRS were lower ( P<0·05 ) , and HR and pulse pressure were higher ( P<0·05 ) in women with FM than in healthy controls . After RET , mean ( SEM ) total power increased ( 387 ± 170 ms2 , P<0·05 ) , RMSSD increased ( 0·18 ± 0·08 Ln ms , P<0·05 ) and Ln of high‐frequency power increased ( 0·54 ± 0·27 Ln ms2 , P = 0·08 ) in women with FM . Upper and lower body muscle strength increased by 63 % and 49 % ( P<0·001 ) , and pain perception decreased by 39 % in women with FM . There were no changes in BRS , HR and BP after RET . Our study demonstrates that RET  improves total power , cardiac parasympathetic tone , pain perception and muscle strength in women with FM who had autonomic dysfunction before the exercise programme BACKGROUND Exercise therapy is an effective component of fibromyalgia ( FM ) treatment . However , it is important to know the effects and specificities of the different types of exercise : muscle stretching and resistance training . AIM To verify and compare the effectiveness of muscle stretching exercise and resistance training for symptoms and quality of life in FM patients . DESIGN R and omized controlled trial . SETTING Physical therapy service , FM outpatient clinic . POPULATION Forty-four women with FM ( 79 screened ) . METHODS Patients were r and omly allocated into a stretching group ( N.=14 ) , resistance group ( N.=16 ) , and control group ( N.=14 ) . Pain was assessed using the visual analog scale , pain threshold using a Fischer dolorimeter , FM symptoms using the Fibromyalgia Impact Question naire ( FIQ ) , and quality of life using the Medical Outcomes Study 36-item Short-Form Health Survey ( SF-36 ) . The three intervention groups continued with usual medical treatment . In addition , the stretching and resistance groups performed two different exercise programs twice a week for 12 weeks . RESULTS After treatment , the stretching group showed the highest SF-36 physical functioning score ( P=0.01 ) and the lowest bodily pain score ( P=0.01 ) . The resistance group had the lowest FIQ depression score ( P=0.02 ) . The control group had the highest score for FIQ morning tiredness and stiffness , and the lowest score for SF-36 vitality . In clinical analyses , the stretching group had significant improvement in quality of life for all SF-36 domains , and the resistance group had significant improvement in FM symptoms and in quality of life for SF-36 domains of physical functioning , vitality , social function , emotional role , and mental health . CONCLUSIONS Muscle stretching exercise was the most effective modality in improving quality of life , especially with regard to physical functioning and pain , and resistance training was the most effective modality in reducing depression . CLINICAL REHABILITATION IMPACT The trial included a control group and two intervention groups , both of which received exercise programs created specifically for patients with FM . In clinical practice , we suggest including both modalities in an exercise therapy program for FM
target: Conclusion The main results included reduction in pain , fatigue , number of tender points , depression , and anxiety , with increased functional capacity and quality of life .
background: Background Fibromyalgia ( FM ) is characterized by chronic and generalized musculoskeletal pain .
  There is currently no cure for FM , but palliative treatments are available .
  One type of treatment is strength training ( ST ) .
  However , there is a need for more information on optimal training protocol s , intensity , and volume needed to improve symptoms .
  The aim of this study was to analyze the effects of ST in the treatment of FM through a systematic review of experimental research .