title: Effects of muscle strengthening versus aerobic exercise program in fibromyalgia A six-month randomized controlled trial of exercise and pyridostigmine in the treatment of fibromyalgia. Measuring exercise-induced mood changes in fibromyalgia: a comparison of several measures. Follow-up of Yoga of Awareness for Fibromyalgia: Results at 3 Months and Replication in the Wait-list Group Benefit of Qigong Exercise in Patients With Fibromyalgia: A Pilot Study The Effectiveness of Multidisciplinary Rehabilitation in the Treatment of Fibromyalgia: A Randomized Controlled Trial Evaluation of a Multimodal Treatment Program for Fibromyalgia Effectiveness of muscle stretching exercises with and without laser therapy at tender points for patients with fibromyalgia. Cardiovascular autonomic modulation after acute resistance exercise in women with fibromyalgia. 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A prospective randomized controlled trial A randomized controlled trial of 8-form Tai chi improves symptoms and functional mobility in fibromyalgia patients Treating fibromyalgia with mindfulness-based stress reduction: Results from a 3-armed randomized controlled trial Treating fibromyalgia with a brief interdisciplinary program: initial outcomes and predictors of response. Fibromyalgia: a randomised, controlled trial of a treatment programme based on self management Land- and water-based exercise intervention in women with fibromyalgia: the al-andalus physical activity randomised controlled trial A randomized trial of tai chi for fibromyalgia. Whole body vibration improves the single-leg stance static balance in women with fibromyalgia: a randomized controlled trial. Aerobic exercise versus combined exercise therapy in women with fibromyalgia syndrome: a randomized controlled trial. 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Cost-utility of an 8-month aquatic training for women with fibromyalgia: a randomized controlled trial Prescribed exercise in people with fibromyalgia: parallel group randomised controlled trial A pilot randomized controlled trial of the Yoga of Awareness program in the management of fibromyalgia Biofeedback/relaxation training and exercise interventions for fibromyalgia: a prospective trial. A randomized controlled trial of muscle strengthening versus flexibility training in fibromyalgia. Effects of short versus long bouts of aerobic exercise in sedentary women with fibromyalgia: a randomized controlled trial. Group exercise, education, and combination self-management in women with fibromyalgia: a randomized trial. Pool exercise combined with an education program for patients with fibromyalgia syndrome. A prospective, randomized study. Thalassotherapy for fibromyalgia: a randomized controlled trial comparing aquatic exercises in sea water and water pool Six-month and one-year followup of 23 weeks of aerobic exercise for individuals with fibromyalgia. Effects of yoga and the addition of Tui Na in patients with fibromyalgia. Assessment of the effects of aquatic therapy on global symptomatology in patients with fibromyalgia syndrome: a randomized controlled trial. Exercise, fibromyalgia, and fibrofog: a pilot study. A randomized, controlled trial of exercise and education for individuals with fibromyalgia. [Comparison between aquatic-biodanza and stretching for improving quality of life and pain in patients with fibromyalgia]. Effects of an exercise programme on self-esteem, self-concept and quality of life in women with fibromyalgia: a randomized controlled trial A controlled study of the effects of a supervised cardiovascular fitness training program on the manifestations of primary fibromyalgia. 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A combination of 6 months of treatment with pyridostigmine and triweekly exercise fails to improve insulin-like growth factor-I levels in fibromyalgia, despite improvement in the acute growth hormone response to exercise. Exercise in waist-high warm water decreases pain and improves health-related quality of life and strength in the lower extremities in women with fibromyalgia. Cognitive-educational treatment of fibromyalgia: a randomized clinical trial. I. Clinical effects. The effect of 6-week exercise programme and whole body vibration on strength and quality of life in women with fibromyalgia: a randomised study. Utilizing exercise to affect the symptomology of fibromyalgia: a pilot study. Fitness and perceived exertion in patients with fibromyalgia syndrome. Effect of acute and chronic whole-body vibration exercise on serum insulin-like growth factor-1 levels in women with fibromyalgia. Hydrotherapy and conventional physiotherapy improve total sleep time and quality of life of fibromyalgia patients: randomized clinical trial. A comparative evaluation of a fibromyalgia rehabilitation program. Patient utilities in fibromyalgia and the association with other outcome measures. A randomized, controlled clinical trial of education and physical training for women with fibromyalgia. Content and Criterion Validity of the Preliminary Core Dataset for Clinical Trials in Fibromyalgia Syndrome A randomized clinical trial comparing fitness and biofeedback training versus basic treatment in patients with fibromyalgia. 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. Exercise in warm water decreases pain and improves cognitive function in middle-aged women with fibromyalgia. A randomized controlled trial of deep water running: clinical effectiveness of aquatic exercise to treat 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. Moderate-intensity exercise and self-rated quality of sleep in older adults. A randomized controlled trial. Effect of a randomized, controlled trial of exercise on mood and physical function in individuals with fibromyalgia. Aquatic training and detraining on fitness and quality of life in fibromyalgia. Effects of a prolonged exercise program on key health outcomes in women with fibromyalgia: a randomized controlled trial. Effects of 2 physiotherapy programs on pain perception, muscular flexibility, and illness impact in women with fibromyalgia: a pilot study. An observer-blinded comparison of supervised and unsupervised aerobic exercise regimens in fibromyalgia. Effects of strength vs aerobic exercise on pain severity in adults with fibromyalgia: A randomized equivalence trial Depressed mood impedes pain treatment response in patients with fibromyalgia. Patients with Fibromyalgia Benefit from Aerobic Endurance Exercise A systematic review of the effectiveness of eccentric strength training in the prevention of hamstring muscle strains in otherwise healthy individuals. Resistance exercise training improves heart rate variability in women with fibromyalgia Tilting Whole Body Vibration improves quality of life in women with fibromyalgia: a randomized controlled trial. A pilot study of body awareness programs in the treatment of fibromyalgia syndrome. Effects of Lifestyle Physical Activity in Adults With Fibromyalgia: Results at Follow-Up Community patient education and exercise for people with fibromyalgia: a parallel group randomized controlled trial Effect of whole-body vibration exercise on balance in women with fibromyalgia syndrome: a 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 OBJECTIVE A subset of fibromyalgia ( FM ) patients have a dysfunctional hypothalamic-pituitary-insulin-like growth factor 1 ( IGF-1 ) axis , as evidence d by low serum levels of IGF-1 and a reduced growth hormone ( GH ) response to physiologic stimuli . There is evidence that pyridostigmine ( PYD ) improves the acute response of GH to exercise in FM patients . The purpose of this study was to evaluate the clinical effectiveness of 6 months of PYD and group exercise on FM symptoms . METHODS FM patients were r and omized to 1 of the following 4 groups : PYD plus exercise , PYD plus diet recall but no exercise , placebo plus exercise , and placebo plus diet recall but no exercise . The primary outcome measures were the visual analog scale ( VAS ) score for pain , tender point count , and total myalgic score . Secondary outcome measures were the total score on the Fibromyalgia Impact Question naire ( FIQ ) and FIQ VAS scores for individual symptoms ( fatigue , poor sleep , stiffness , and anxiety ) , as well as quality of life ( QOL ) and physical fitness ( lower body strength/endurance , upper and lower body flexibility , balance , and time on the treadmill ) . RESULTS A total of 165 FM patients completed baseline measurements ; 154 ( 93.3 % ) completed the study . The combination of PYD and exercise did not improve pain scores .  PYD groups showed a significant improvement in sleep and anxiety in those who completed the study and in QOL in those who complied with the therapeutic regimen as compared with the placebo groups . Compared with the nonexercise groups , the 2 exercise groups demonstrated improvement in fatigue and fitness .  PYD was generally well tolerated . CONCLUSION Neither the combination of PYD plus supervised exercise nor either treatment alone yielded improvement in most FM symptoms . However , PYD did improve anxiety and sleep , and exercise improved fatigue and fitness . We speculate that PYD may have improved vagal tone , thus benefiting sleep and anxiety ; this notion warrants further study OBJECTIVE To compare scales measuring exercise-induced changes in mood . METHODS Mood changes in a r and omized , 23-week controlled trial of exercise were assessed using the Beck Depression Inventory ( BDI ) , Center for Epidemiologic Studies Depression Scale ( CES-D ) , State Trait Anxiety Inventory ( STAI ) , Fibromyalgia Impact Question naire , and the Mental Health Inventory ( MHI ) . Effect sizes and t-tests were computed on 23-week change scores . Scales were deemed to be confounded if items addressed sleep disturbances , fatigue , or effort ( symptoms of both mood disturbances and fibromyalgia ) . RESULTS Efficacy ( 15 exercise subjects ) and intent-to-treat analyses ( 27 exercise subjects ) generated medium effects for BDI ( total , cognitive ) , MHI depression ( efficacy only ) , and CES-D ( intent-to-treat only ) scales . BDI ( total , cognitive ) , MHI ( depression , positive affect , total [ MHI-5 ] ) , and STAI scales distinguished exercise from control subjects at 23 weeks in all analyses . BDI somatic and CES-D scales were deemed to be confounded . CONCLUSION We recommend the BDI cognitive , STAI , and MHI-5 scales to measure depression , anxiety , and general mood , respectively , in patients with fibromyalgia Objectives : Published preliminary findings from a r and omized-controlled trial suggest that an 8-week Yoga of Awareness intervention may be effective for improving symptoms , functional deficits , and coping abilities in fibromyalgia . The primary aims of this study were to evaluate the same intervention ’s posttreatment effects in a wait-list group and to test the intervention ’s effects at 3-month follow-up in the immediate treatment group . Methods : Unpaired t tests were used to compare data from a per protocol sample of 21 women in the immediate treatment group who had completed treatment and 18 women in the wait-list group who had completed treatment . Within-group paired t tests were performed to compare posttreatment data with 3-month follow-up data in the immediate treatment group . The primary outcome measure was the Fibromyalgia Impact Question naire Revised ( FIQR ) . Multilevel r and om-effects models were also used to examine associations between yoga practice rates and outcomes . Results : Posttreatment results in the wait-list group largely mirrored results seen at posttreatment in the immediate treatment group , with the FIQR Total Score improving by 31.9 % across the 2 groups . Follow-up results showed that patients sustained most of their posttreatment gains , with the FIQR Total Score remaining 21.9 % improved at 3 months . Yoga practice rates were good , and more practice was associated with more benefit for a variety of outcomes . Discussion : These findings indicate that the benefits of Yoga of Awareness in fibromyalgia are replicable and can be maintained ABSTRACT Objective : Fibromyalgia ( FM ) patients present with widespread chronic pain and other symptoms . Some studies in the literature have reported inconsistent results after a Qigong exercise intervention in patients with FM . The purpose of this study was to test the feasibility of a home-based Qigong exercise in patients with FM . Methods : A total of 14 subjects were r and omly assigned into one of two groups . The experimental group went through a six-week Qigong exercise program involving meditation , deep breathing , and synchronized rhythmic body movements . The control group took part in a sham Qigong exercise program using the same body movements also for six weeks . Clinical assessment s at baseline and end of intervention used the Short-Form McGill Pain Question naire , Multidimensional Fatigue Inventory , Pittsburgh Sleep Quality Index , and Fibromyalgia Impact Question naire . Results : Group mean scores of four measurements were significantly ( p < .0125 ) reduced in the intervention group , but not in the control group . The percentage changes in the four measurements were 44.2 % , 24.8 % , 37.3 % , and 44.3 % in the intervention group , and 10.1 % , 6.3 % , 9.9 % , and 11.8 % in the control group . Conclusion : Qigong exercise may potentially be an effective self-management approach in controlling FM symptoms . In this pilot study , regular daily Qigong exercise , accumulated number of exercise sessions , and the specific form of Qigong exercise may all be important factors for the significant improvement in the study subjects . Future research is required to determine whether the same benefit can be obtained in a larger sample Objectives : To assess the effectiveness of multidisciplinary rehabilitation in the treatment of fibromyalgia in comparison to st and ard medical care . Methods : Seventy-nine men and women were r and omly assigned to one of two groups . The intervention group consisted of a rheumatologist and physical therapist intake and discharge , 18 group supervised exercise therapy sessions , 2 group pain and stress management lectures , 1 group education lecture , 1 group dietary lecture , and 2 massage therapy sessions . The control group consisted of st and ard medical care with the patients ' family physician . Outcome measures included self-perceived health status , pain-related disability , average pain intensity , depressed mood , days in pain , hours in pain , prescription and nonprescription medication usage , and work status . Outcomes were measured at the end of the 6-week intervention and at 15-month follow-up . Results : Thirty-five out of 43 patients from the intervention group and 36 out of 36 patients from the control group completed the study . There were no statistically significant differences between the 2 groups prior to intervention . Intention-to-treat analysis revealed that the intervention group , in comparison to the control group , experienced statistically significant changes at intervention completion in self-perceived health status , average pain intensity , pain related disability , depressed mood , days in pain , and hours in pain , but no significant differences in nonprescription drug use , prescription drug use , or work status . At 15 months , all health outcomes retained their significance except health status . Nonprescription and prescription drug use demonstrated significant reductions at 15 months . Binary logistic regression indicated that long-term changes in Pain Disability Index were influenced by long-term exercise adherence and income status . Conclusions : Positive health-related outcomes in this mostly unresponsive condition can be obtained with a low-cost , group multidisciplinary intervention in a community-based , non clinical setting A quasi-experimental design was used to assess a multimodal pain treatment program for female patients with fibromyalgia to ascertain immediate and long-term effects .  Laboratory  and self-report pain measures together with  psychological measures were obtained from patients who were tested up to 6 months after treatment . Comparison data were also obtained from fibromyalgia patients who failed to qualify for the treatment program because of insurance coverage . Immediate and long-term treatment effects were evident with the psychological measures and the subjective pain measures but not with the laboratory pain measures . Participants who attended the month-long multimodal program achieved significant and positive changes on most of the outcome measures . However , relapse prevention must be addressed OBJECTIVE To assess the efficiency of a treatment composed of muscle stretching exercises , associated or not to laser therapy at tender points , for patients with fibromyalgia ( FM ) , in view of bettering their quality of life . METHODS Twenty FM patients were r and omly assigned to two groups : one su bmi tted to laser therapy and stretching ( LSG , n=10 ) , and the other only to stretching exercises ( SG , n=10 ) . The visual analog scale of pain ( VAS ) and dolorimetry at tender points were used to assess pain ; life quality was evaluated by means of the Fibromyalgia Impact Question naire ( FIQ ) and the 36-item Short-Form Health Survey ( SF-36 ) . RESULTS After the treatment program , both in LSG and SG were detected pain reduction , higher pain threshold at tender points ( all p<0.01 ) , lower mean FIQ scores , and higher SF-36 mean scores ( all p<0.05 ) . No significant differences were found between both groups . CONCLUSION The stretching exercises program proposed is efficient to reduce pain and painful sensibility at tender points , thus enhancing patients ' quality of life .  Laser therapy has not shown advantages when added to muscle stretching exercises 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 OBJECTIVE To evaluate the feasibility of 8 months of supervised exercise therapy in warm water and its effects on the impact of fibromyalgia on physical and mental health and physical fitness in affected women . METHODS Thirty women with fibromyalgia were r and omly assigned to an exercise therapy group ( n = 15 ) or a control group ( inactive ) ( n = 15 ) . The impact of fibromyalgia on physical and mental health was assessed using the Fibromyalgia Impact Question naire and the anxiety state with State-Trait Anxiety Inventory . Physical fitness was measured using the following tests : Canadian Aerobic Fitness ; h and -grip dynamometry ; 10-metre walking ; 10-step stair-climbing and blind 1-leg stance . RESULTS After 8 months of training , the exercise therapy group improved compared with the control group in terms of physical function ( 20 % ) , pain ( 8 % ) , stiffness ( 53 % ) , anxiety ( 41 % ) , depression ( 27 % ) , Fibromyalgia Impact Question naire total scores ( 18 % ) , State-Trait Anxiety Inventory score ( 22 % ) , aerobic capacity ( 22 % ) , balance ( 30 % ) , functional capacity for walking ( 6 % ) , stair-climbing with no extra weight ( 14 % ) and stair-climbing 10 kg-weighted ( 25 % ) . CONCLUSION Eight months of supervised exercise in warm water was feasible and led to long-term improvements in physical and mental health in patients with fibromyalgia at a similar magnitude to those of shorter therapy programmes OBJECTIVE To evaluate the effects of pool exercise in patients with fibromyalgia and chronic widespread pain and to determine characteristics influencing the effects of treatment . METHODS A total of 134 women with fibromyalgia and 32 with chronic widespread pain were r and omized to a 20-session pool exercise and a 6-session education programme or to a control group undertaking the same education programme . The primary outcomes were the Fibromyalgia Impact Question naire ( FIQ ) total score and the 6-minute walk test ( 6MWT ) . FIQ Pain and other health variables were included . RESULTS The FIQ total ( p = 0.04 ) improved in the intervention group , with an effect size of 0.32 . Patients who had participated in at least 60 % of the exercise sessions improved in the FIQ total ( effect size 0.44 ) , the 6MWT ( effect size 0.43 ) and FIQ Pain ( effect size 0.69 ) compared with controls ( p < 0.05 ) . Long-term follow-up revealed lasting , but small , improvement ( effect size < 0.29 ) in the 6MWT among the active participants ( p < 0.05 ) . Analyses within the subgroups showed that patients with milder stress , pain or depression improved most by treatment on the FIQ total ( effect size > 0.50 , p < 0.05 ) compared with controls . CONCLUSION The exercise-education programme showed significant , but small , improvement in health status in patients with fibromyalgia and chronic widespread pain , compared with education only . Patients with milder symptoms improved most with this treatment We tested the hypothesis that exercise would improve subjective sleep quality and activity in depressed elders . A 10-week r and omized controlled trial was utilized . Participants consisted of a volunteer sample , aged > 60 with a diagnosis of major or minor depression or dysthymia . A total of 32 subjects aged 60 - 84 years with a mean age of 71.3 + /- 1.2 years was used . Intervention consisted of a supervised weight-training program three times a week or an attention-control group . Main outcome measures were Pittsburgh Subjective Sleep Quality Index ( PSQI ) , Likert Scale of Subjective Sleep Quality and Quantity . Paffenbarger Activity Index . Geriatric Depression Scale ( GDS ) . Beck Depression Inventory ( BDI ) , Hamilton Rating Scale of Depression ( HRSD ) , and the Medical Outcomes Survey Short Form 36 ( SF-36 ) . Results showed that exercise significantly improved all subjective sleep- quality and depression measures . Depression measures were reduced by approximately twice that of controls . Habitual activity was not significantly increased by exercise .  Quality of life subscales significantly improved . In a forward stepwise multiple regression , percent improvement in GDS and percent increase in strength remained significant predictors of the improvement in total PSQI score ( r = 0.71 , p = 0.0002 ) . In conclusion , weight lifting exercise was effective in improving subjective sleep quality , depression , strength , and quality of life without significantly changing habitual activity Introduction Although exercise is therapeutic for adults with fibromyalgia ( FM ) , its symptoms often create obstacles that discourage exercise . We evaluated the effects of accumulating at least 30 minutes of self-selected lifestyle physical activity ( LPA ) on perceived physical function , pain , fatigue , body mass index , depression , tenderness , and the six-minute walk test in adults with FM . Methods Eighty-four minimally active adults with FM were r and omized to either LPA or a FM education control ( FME ) group . LPA participants worked toward accumulating 30 minutes of self-selected moderate-intensity LPA , five to seven days per week , while the FME participants received information and support . Results Seventy-three of the 84 participants ( 87 % ) completed the 12-week trial . The LPA group increased their average daily steps by 54 % . Compared to FME , the LPA group reported significantly less perceived functional deficits ( P = .032 ) and less pain ( P = .006 ) . There were no differences between the groups on the six-minute walk test ( P = .067 ) , fatigue , depression , body mass index , or tenderness . Conclusions Accumulating 30 minutes of LPA throughout the day produces clinical ly relevant changes in perceived physical function and pain in previously minimally active adults with FM.Trial Registration clinical trials.gov UNLABELLED Altan L , Korkmaz N , Bingol U , Gunay B. Effect of Pilates training on people with fibromyalgia syndrome : a pilot study . OBJECTIVE To investigate the effects of Pilates on pain , functional status , and quality of life in fibromyalgia , which is known to be a chronic musculoskeletal disorder . DESIGN R and omized , prospect i ve , controlled , and single-blind trial . SETTING Physical medicine and rehabilitation department . PARTICIPANTS Women ( N=50 ) who had a diagnosis of fibromyalgia syndrome ( FMS ) according to the American College of Rheumatology criteria . INTERVENTION The participants were r and omly assigned into 2 groups . In group 1 , a Pilates exercise program of 1 hour was given by a certified trainer to 25 participants 3 times a week for 12 weeks . In group 2 , which was design ed as the control group , 25 participants were given a home exercise ( relaxation/stretching ) program . In both groups , pre- ( week 0 ) and posttreatment ( week 12 and week 24 ) evaluation was performed by one of the authors , who was blind to the group allocation . MAIN OUTCOME MEASURES Primary outcome measures were pain ( visual analog scale ) and Fibromyalgia Impact Question naire ( FIQ ) . Exploratory outcome measures were number of tender points , algometric score , chair test , and Nottingham Health Profile . RESULTS Twenty-five Pilates exercise and 24 relaxation/stretching exercise  participants completed the study . In group 1 , significant improvement was observed in both pain and FIQ at week 12 but only in FIQ at 24 weeks . In group 2 , no significant improvement was obtained in pain and FIQ at week 12 and week 24 . Comparison of the 2 groups showed significantly superior improvement in pain and FIQ in group 1 at week 12 but no difference between the 2 groups at week 24 . CONCLUSIONS We suggest Pilates as an effective and safe method for people with FMS . Our study is the first clinical study design ed to investigate the role of the Pilates method in FMS treatment . We believe that further research with more participants and longer follow-up periods could help assess the therapeutic value of this popular physical exercise method OBJECTIVE To determine the prevalence and characteristics of fibromyalgia in the general population . METHODS A r and om sample of 3,006 persons in Wichita , KS , were characterized according to the presence of no pain , non-widespread pain , and widespread pain . A sub sample of 391 persons , including 193 with widespread pain , were examined and interviewed in detail . RESULTS The prevalence of fibromyalgia was 2.0 % ( 95 % confidence interval [ 95 % CI ] 1.4 , 2.7 ) for both sexes , 3.4 % ( 95 % CI 2.3 , 4.6 ) for women , and 0.5 % ( 95 % CI 0.0 , 1.0 ) for men . The prevalence of the syndrome increased with age , with highest values attained between 60 and 79 years ( > 7.0 % in women ) . Demographic , psychological , dolorimetry , and symptom factors were associated with fibromyalgia . CONCLUSION Fibromyalgia is common in the population , and occurs often in older persons . Characteristic features of fibromyalgia -- pain threshold and symptoms -- are similar in community and clinic population s , but overall severity , pain , and functional disability are more severe in the clinic population OBJECTIVE To compare 2 exercise modalities , aerobic fitness training and stretching exercises , in patients with fibromyalgia ( FM ) in relation to function , pain , quality of life , depression , and anxiety , and to correlate the cardiorespiratory fitness gain with symptom improvement . METHODS Seventy-six women with FM between 18 and 60 years old were r and omized to either an aerobic program or stretching program , for 20 weeks . They were evaluated at the beginning of the program and after 10 and 20 weeks in relation to the improvement of aerobic fitness , flexibility , function , Fibromyalgia Impact Question naire ( FIQ ) , Short-form Health Survey ( SF-36 ) , and depression and anxiety levels . Ventilatory anaerobic threshold ( VT ) and maximum oxygen uptake ( VO2max ) were determined by expired gas analyses . RESULTS Aerobic exercise was superior to stretching in relation to VO2 max , VT , function , depression , pain , and the emotional aspects and mental health domains of SF-36 . Patients in the stretching group showed no improvement in depression , " role emotional , " and " mental health . " No association was noted between improvement in aerobic fitness as measured by VT and the improvement of pain , function , or scores in FIQ and SF-36 . CONCLUSION Our results confirm that aerobic exercise is beneficial to patients with FM , but the cardiorespiratory fitness gain is not related to improvement of FM symptoms OBJECTIVE To assess the utility of an exercise program , which included aerobic , flexibility and strengthening elements , in the treatment of fibromyalgia ( FM ) . FM is a chronic musculoskeletal condition characterized by diffuse musculoskeletal pain and aching . It has been suggested that aerobic exercise is helpful in its treatment . METHODS We studied 60 patients who met American College of Rheumatology criteria for FM and had no significant comorbidities . Measurements performed on each patient at the pre and post study assessment included the number of tender points ( TP ) , total myalgic scores ( TM ) , aerobic fitness ( AF ) , flexibility and isokinetic strength . After initial evaluation patients were r and omly assigned to either an exercise or a relaxation group . Each group met 3 times per week for 6 weeks for 1 h of supervised exercise or relaxation . All patients data were stored in a computerized data base and statistical analysis was performed on all pre and post study assessment s. RESULTS Thirty-eight patients ( 18 exercise and 20 relaxation ) completed the study . Analysis of our data showed no significant difference between the groups in their pre study assessment . Post study assessment s , however , showed a significant improvement between the exercise and relaxation groups in TP ( p < 0.05 ) , TM ( p < 0.05 ) , and AF ( p < 0.05 ) . Similar improvements were also found when the pre and post study assessment of the exercise group were compared . CONCLUSION Exercise is helpful in the management of FM in the short term . It also shows that FM patients can undertake an exercise program which includes aerobic , flexibility , and strength training exercises without adverse effects . The long term utility of this type of exercise requires further evaluation Introduction The objective of this study was to investigate the effects of moderate-to-high intensity Nordic walking ( NW ) on functional capacity and pain in fibromyalgia ( FM ) . Methods A total of 67 women with FM were recruited to the study and r and omized either to moderate-to-high intensity Nordic Walking ( n = 34 , age 48 ± 7.8 years ) or to a control group engaging in supervised low-intensity walking ( LIW , n = 33 , age 50 ± 7.6 years ) . Primary outcomes were the six-minute walk test ( 6MWT ) and the Fibromyalgia Impact Question naire Pain scale ( FIQ Pain ) . Secondary outcomes were : exercise heart rate in a submaximal ergometer bicycle test , the FIQ Physical ( activity limitations ) and the FIQ total score . Results A total of 58 patients completed the post-test . Significantly greater improvement in the 6MWT was found in the NW group ( P = 0.009 ) , as compared with the LIW group . No between-group difference was found for the FIQ Pain ( P = 0.626 ) . A significantly larger decrease in exercise heart rate ( P = 0.020 ) and significantly improved scores on the FIQ Physical ( P = 0.027 ) were found in the NW group as compared with the LIW group . No between-group difference was found for the change in the FIQ total . The effect sizes were moderate for the above mentioned outcomes . Conclusions Moderate-to-high intensity aerobic exercise by means of Nordic walking twice a week for 15 weeks was found to be a feasible mode of exercise , result ing in improved functional capacity and a decreased level of activity limitations . Pain severity did not change over time during the exercise period . Trial registration Clinical trials.gov identifier NCT00643006 Previous research ers have found that 10-form Tai chi yields symptomatic benefit in patients with fibromyalgia ( FM ) . The purpose of this study was to further investigate earlier findings and add a focus on functional mobility . We conducted a parallel-group r and omized controlled trial FM-modified 8-form Yang-style Tai chi program compared to an education control . Participants met in small groups twice weekly for 90 min over 12 weeks . The primary endpoint was symptom reduction and improvement in self-report physical function , as measured by the Fibromyalgia Impact Question naire ( FIQ ) , from baseline to 12 weeks . Secondary endpoints included pain severity and interference ( Brief Pain Inventory ( BPI ) , sleep ( Pittsburg sleep Inventory ) , self-efficacy , and functional mobility . Of the 101 r and omly assigned subjects ( mean age 54 years , 93 % female ) , those in the Tai chi condition compared with the education condition demonstrated clinical ly and statistically significant improvements in FIQ scores ( 16.5 vs. 3.1 , p = 0.0002 ) , BPI pain severity ( 1.2 vs. 0.4 , p = 0.0008 ) , BPI pain interference ( 2.1 vs. 0.6 , p = 0.0000 ) , sleep ( 2.0 vs. −0.03 , p = 0.0003 ) , and self-efficacy for pain control ( 9.2 vs. −1.5 , p = 0.0001 ) . Functional mobility variables including timed get up and go ( −.9 vs. −.3 , p = 0.0001 ) , static balance ( 7.5 vs. −0.3 , p = 0.0001 ) , and dynamic balance ( 1.6 vs. 0.3 , p = 0.0001 ) were significantly improved with Tai chi compared with education control . No adverse events were noted . Twelve weeks of Tai chi , practice twice weekly , provided worthwhile improvement in common FM symptoms including pain and physical function including mobility .  Tai chi appears to be a safe and an acceptable exercise modality that may be useful as adjunctive therapy in the management of FM patients . ( Clinical Trials.gov Identifier , NCT01311427 & NA ; Mindfulness‐based stress reduction ( MBSR ) is a structured 8‐week group program teaching mindfulness meditation and mindful yoga exercises . MBSR aims to help participants develop nonjudgmental awareness of moment‐to‐moment experience . Fibromyalgia is a clinical syndrome with chronic pain , fatigue , and insomnia as major symptoms . Efficacy of MBSR for enhanced well‐being of fibromyalgia patients was investigated in a 3‐armed trial , which was a follow‐up to an earlier quasi‐r and omized investigation . A total of 177 female patients were r and omized to one of the following : ( 1 ) MBSR , ( 2 ) an active control procedure controlling for nonspecific effects of MBSR , or ( 3 ) a  wait list  . The major outcome was health‐related quality of life ( HRQoL ) 2 months post‐treatment . Secondary outcomes were disorder‐specific quality of life , depression , pain , anxiety , somatic complaints , and a proposed index of mindfulness . Of the patients , 82 % completed the study . There were no significant differences between groups on primary outcome , but patients overall improved in HRQoL at short‐term follow‐up ( P = 0.004 ) . Post hoc analyses showed that only MBSR manifested a significant pre‐to‐post‐intervention improvement in HRQoL ( P = 0.02 ) . Furthermore , multivariate analysis of secondary measures indicated modest benefits for MBSR patients . MBSR yielded significant pre‐to‐post‐intervention improvements in 6 of 8 secondary outcome variables , the active control in 3 , and the wait list in 2 . In conclusion , primary outcome analyses did not support the efficacy of MBSR  in fibromyalgia , although patients in the MBSR arm appeared to benefit most . Effect sizes were small compared to the earlier , quasi‐r and omized investigation . Several method ological aspects are discussed , e.g. , patient burden , treatment preference and motivation , that may provide explanations for differences . In a 3‐armed r and omized controlled trial in female patients suffering from fibromyalgia , patients benefited modestly from a mindfulness‐based stress reduction intervention OBJECTIVES To evaluate the efficacy of a brief , intense treatment program for fibromyalgia and to determine which patient characteristics are associated with a better treatment response . PATIENTS AND METHODS Two self-report measures , the Fibromyalgia Impact Question naire ( FIQ ) and the Multidimensional Pain Inventory ( MPI ) , were administered before patients completed treatment and 1 month after participating in the program . The main outcome measure was the difference in FIQ score and MPI scale before and after program participation . RESULTS Of 139 patients who met the American College of Rheumatology criteria for fibromyalgia , 100 chose to participate in the 1 1/2-day Fibromyalgia Treatment Program at the Mayo Clinic , Rochester , Minn. Of these 100 patients , 74 completed the follow-up surveys . Patients were less affected by fibromyalgia after participation in the treatment program . This was demonstrated by a posttreatment improvement in the total FIQ score ( P<.001 ) , the MPI pain severity score ( P<.001 ) , and the MPI interference score ( P=.01 ) . The 1 patient characteristic found to be significantly associated ( P<.001 ) with a better response to treatment was a high pretreatment level of impairment from fibromyalgia , as measured by the pretreatment FIQ score . CONCLUSIONS A brief interdisciplinary program for treating fibromyalgia reduced some associated symptoms . Patients more severely affected by fibromyalgia may benefit most from this approach . Clinicians may apply these findings to develop beneficial and convenient treatment programs for patients with fibromyalgia Objective : To evaluate the efficacy of a treatment programme for patients with fibromyalgia ( FM ) based on self management , using pool exercises and education . Methods : R and omised controlled trial with a 6 month follow up to evaluate an outpatient multidisciplinary programme ; 164 patients with FM were allocated to an immediate 6 week programme ( n = 84 ) or to a waiting list control group ( n = 80 ) . The main outcomes were changes in quality of life , functional consequences , patient satisfaction and pain , using a combination of patient question naires and clinical examinations . The question naires included the Fibromyalgia Impact Question naire ( FIQ ) , Psychological General Well-Being ( PGWB ) index , regional pain score diagrams , and patient satisfaction measures . Results : 61 participants in the treatment group and 68 controls completed the programme and 6 month follow up examinations . Six months after programme completion , significant improvements in quality of life and functional consequences of FM were seen in the treatment group as compared with the controls and as measured by scores on both the FIQ ( total score p = 0.025 ; fatigue p = 0.003 ; depression p = 0.031 ) and PGWB ( total score p = 0.032 ; anxiety p = 0.011 ; vitality p = 0.013 , ) . All four major areas of patient satisfaction showed greater improvement in the treatment than the control groups ; between-group differences were statistically significant for “ control of symptoms ” , “ psychosocial factors ” , and “ physical therapy ” No change in pain was seen . Conclusion : A 6 week self management based programme of pool exercises and education can improve the quality of life of patients with FM and their satisfaction with treatment . These improvements are sustained for at least 6 months after programme completion Background The al- And alus physical activity intervention study is a r and omised control trial to investigate the effectiveness of a l and - and water-based exercise intervention for reducing the overall impact of fibromyalgia ( primary outcome ) , and for improving tenderness and pain-related measures , body composition , functional capacity , physical activity and sedentary behaviour , fatigue , sleep quality , health-related quality of life , and cognitive function ( secondary outcomes ) in women with fibromyalgia . Methods / Design One hundred eighty women with fibromyalgia ( age range : 35 - 65 years ) will be recruited from local associations of fibromyalgia patients in And alucía ( Southern Spain ) . Patients will be r and omly assigned to a usual care ( control ) group ( n = 60 ) , a water-based exercise intervention group ( n = 60 ) or a l and -based exercise intervention group ( n = 60 ) . Participants in the usual care group will receive general physical activity guidelines and participants allocated in the intervention groups will attend three non-consecutive training sessions ( 60 min each ) per week during 24 weeks . Both exercise interventions will consist of aerobic , muscular strength and flexibility exercises . We will also study the effect of a detraining period ( i.e. , 12 weeks with no exercise intervention ) on the studied variables . Discussion Our study attempts to reduce the impact of fibromyalgia and improve patients ' health status by implementing two types of exercise interventions . Results from this study will help to assess the efficacy of  exercise interventions for the treatment of fibromyalgia . If the interventions would be effective , this study will provide low-cost and feasible alternatives for health professionals in the management of fibromyalgia . Results from the al- And alus physical activity intervention will help to better underst and the potential of regular physical activity for improving the well-being of women with fibromyalgia . Trial registration Clinical Trials.gov ID : BACKGROUND Previous research has suggested that tai chi offers a therapeutic benefit in patients with fibromyalgia . METHODS We conducted a single-blind , r and omized trial of classic Yang-style tai chi as compared with a control intervention consisting of wellness education and stretching for the treatment of fibromyalgia ( defined by American College of Rheumatology 1990 criteria ) . Sessions lasted 60 minutes each and took place twice a week for 12 weeks for each of the study groups . The primary end point was a change in the Fibromyalgia Impact Question naire ( FIQ ) score ( ranging from 0 to 100 , with higher scores indicating more severe symptoms ) at the end of 12 weeks . Secondary end points included summary scores on the physical and mental components of the Medical Outcomes Study 36-Item Short-Form Health Survey ( SF-36 ) . All assessment s were repeated at 24 weeks to test the durability of the response . RESULTS Of the 66 r and omly assigned patients , the 33 in the tai chi group had clinical ly important improvements in the FIQ total score and quality of life . Mean ( + /-SD ) baseline and 12-week FIQ scores for the tai chi group were 62.9+/-15.5 and 35.1+/-18.8 , respectively , versus 68.0+/-11 and 58.6+/-17.6 , respectively , for the control group ( change from baseline in the tai chi group vs. change from baseline in the control group , -18.4 points ; P<0.001 ) . The corresponding SF-36 physical-component scores were 28.5+/-8.4 and 37.0+/-10.5 for the tai chi group versus 28.0+/-7.8 and 29.4+/-7.4 for the control group ( between-group difference , 7.1 points ; P=0.001 ) , and the mental-component scores were 42.6+/-12.2 and 50.3+/-10.2 for the tai chi group versus 37.8+/-10.5 and 39.4+/-11.9 for the control group ( between-group difference , 6.1 points ; P=0.03 ) . Improvements were maintained at 24 weeks ( between-group difference in the FIQ score , -18.3 points ; P<0.001 ) . No adverse events were observed . CONCLUSIONS Tai chi may be a useful treatment for  fibromyalgia  and merits long-term study in larger study population s. ( Funded by the National Center for Complementary and Alternative Medicine and others ; Clinical Trials.gov number , NCT00515008 . AIM Fibromyalgia ( FM ) is a chronic disorder characterized by widespread pain . Fibromyalgia is associated with balance problems and increased fall frequency . Whole-body vibration therapy had been used for improve balance in special population s but not in fibromyalgia . The main objective of this study was to analyze the effects of 12 weeks of tilting whole-body vibration therapy on static balance in fibromyalgia patients . METHODS Women with FM were r and omly and sequentially assigned to either the  vibration group ( N.=21 ) or the  control group ( N.=20 ) based on a r and omly generated number table , and a code number was assigned to each participant . All participants received st and ard care that included medical care through the public health system ( hospital and outpatient clinic , including primary care ) and social support through the local fibromyalgia association . Participants in the exercise group received whole-body vibration therapy ( 12 weeks , 12.5 Hz frequency and 3 mm amplitude ) . Outcome measure was determined using postural stability indices ( overall , anterior-posterior and medial-lateral ) assessed by the Biodex Balance System in a single dominant limb stance . RESULTS Treatment effect after 12-weeks of tilting whole body vibration therapy were 57.1 % on overall stability and 66.6 % on anterior-posterior stability . CONCLUSION Tilting whole-body vibration therapy effectively improves static balance in patients with FM OBJECTIVE To investigate the effects of supervised aerobic exercise ( AE ) and a combined program of supervised aerobic , muscle strengthening , and flexibility exercises ( combined exercise [ CE ] ) on important health outcomes in women with fibromyalgia syndrome ( FMS ) . DESIGN R and omized controlled trial . SETTING Community-based supervised intervention . PARTICIPANTS Women ( N=64 ) with a diagnosis of FMS according to the American College of Rheumatology criteria . INTERVENTION Participants were r and omly allocated to 1 of 3 groups : supervised AE , supervised CE , or usual-care control . Exercise sessions were performed twice weekly ( 45 - 60min/session ) for 24 weeks . MAIN OUTCOME MEASURES The primary outcome measure was the Fibromyalgia Impact Question naire ( FIQ ) . Exploratory outcome measures were the 36-Item Short-Form Health Survey , Beck Depression Inventory ( BDI ) , aerobic capacity ( 6-minute walk test ) , h and -grip strength , and range of motion in the shoulders and hips . RESULTS Compliance with both interventions was excellent , with women in the exercise groups attending more than 85 % of sessions . A 14 % to 15 % improvement from baseline in total FIQ score was observed in the exercise groups ( P≤.02 ) and was accompanied by decreases in BDI scores of 8.5 ( P<.001 ) and 6.4 ( P<.001 ) points in the AE and CE groups , respectively . Relative to nonexercising controls , CE evoked improvements in the SF-36 Physical Functioning ( P=.003 ) and Bodily Pain ( P=.003 ) domains and was more effective than AE for evoking improvements in the Vitality ( P=.002 ) and Mental Health ( P=.04 ) domains . Greater improvements also were observed in shoulder/hip range of motion and h and grip strength in the CE group . CONCLUSION Given the equivalent time commitment required for AE and CE , our results suggest that women with FMS can gain additional health benefits by engaging in a similar volume of CE OBJECTIVE To evaluate the effectiveness and tolerability of two pool-based physical therapies , stretching and Ai Chi , in fibromyalgia symptomatology and sleep quality . METHODS Eighty-one patients , r and omly assigned to stretching ( n=39 ) or Ai Chi ( n=42 ) , received 18 physiotherapy sessions  and were evaluated at baseline , at treatment termination , and after 4 and 12 weeks of follow-up . Main outcome measures were the Fibromyalgia Impact Question naire ( FIQ ) and the Pittsburgh Sleep Quality Index ( PSQI ) . Secondary outcome measures included the Beck Depression Inventory ( BDI ) , the State and Trait Anxiety Inventory ( STAI ) , and the SF-12 Health Survey ( SF-12 ) . Data analysis was done with repeated measures ANOVA and effect size estimation . RESULTS No differences were found between groups but significant reduction in the FIQ and the PSQI scores were observed in Ai Chi but not in stretching group , with larger effect sizes and longer effect duration on sleep measures . BDI scores decreased in stretching but not in Ai Chi group with small effect sizes . Trait-anxiety scores decreased in both groups also with small effect sizes . The mental component summary of the SF-12 increased only in stretching group with effect sizes moderate to large . CONCLUSIONS Although no global differences were found between groups , Ai Chi significantly improved fibromyalgia symptomatology and sleep quality , whereas stretching only improved subjects ' psychological well-being OBJECTIVE The aim of this study was to investigate the effectiveness of a 6-week traditional exercise program with supplementary whole-body vibration ( WBV ) in improving health status , physical functioning , and main symptoms of fibromyalgia ( FM ) in women with FM . METHODS Thirty-six ( 36 ) women with FM ( mean + /- st and ard error of the mean age 55.97 + /- 1.55 ) were r and omized into 3 treatment groups : exercise and vibration ( EVG ) , exercise ( EG ) , and control ( CG ) . Exercise therapy , consisting of aerobic activities , stretching , and relaxation techniques , was performed twice a week ( 90 min/day ) . Following each exercise session , the EVG underwent a protocol with WBV , whereas the EG performed the same protocol without vibratory stimulus . The Fibromyalgia Impact Question naire ( FIQ ) was administered at baseline and 6 weeks following the initiation of the treatments . Estimates of pain , fatigue , stiffness , and depression were also reported using the visual analogue scale . RESULTS A significant 3 x 2 ( group x time)-repeated measures analysis of variance interaction was found for pain ( p = 0.018 ) and fatigue ( p = 0.002 ) but not for FIQ ( p = 0.069 ) , stiffness ( p = 0.142 ) , or depression ( p = 0.654 ) . Pain and fatigue scores were significantly reduced from baseline in the EVG , but not in the EG or CG . In addition , the EVG showed significantly lower pain and fatigue scores at week 6 compared to the CG , whereas no significant differences were found between the EG and CG ( p > 0.05 ) . CONCLUSION Results suggest that a 6-week traditional exercise program with supplementary WBV safely reduces pain and fatigue , whereas exercise alone fails to induce improvements The Department of Veterans Affairs ( VA ) Cooperative Studies Program ( CSP ) Study # 470 is a 2 x 2 factorial trial design ed to evaluate the hypothesis that both cognitive behavioral therapy ( CBT ) and aerobic exercise will significantly improve physical function in participants with Gulf War veterans ' illnesses ( GWVI ) , and that adding CBT to aerobic exercise will provide further incremental benefit . One thous and three hundred fifty-six veterans will be r and omized to one of four treatment arms : CBT plus aerobic exercise plus usual and customary care , aerobic exercise plus usual and customary care , CBT plus usual and customary care , or usual and customary care alone . The study duration is 2.5 years with 1.5 years of intake and 1 year of follow-up . The primary outcome measure is the proportion of veterans improved more than seven units on the physical component summary ( PCS ) scale of the Short Form Health Survey for Veterans ( SF-36V ) measured 12 months after r and omization . This generic quality -of-life measure was chosen because there is no disease-specific measure for GWVI and the symptoms of GWVI span a wide range of physical manifestations that are related to the domains covered by the PCS scale . Sample size was determined to detect all six pairwise comparisons between the four treatment arms with 90 % power and a Bonferroni adjustment for an overall type I error of 0.05 or 0.05/6 = 0.0083 . CSP # 470 was initiated in May 1999 in 18 VA and two Department of Defense medical centers . To date this represents the largest r and omized trial design ed to evaluate treatments for individuals with unexplained physical symptoms . This paper will focus on the rationale and unique features of the study design . Control Clin Trials 2001;22:310 - The aim of this study was to investigate the results of a supervised exercise with transcutaneous electrical nerve stimulation ( TENS ) in an exercise controlled study in women with fibromyalgia . Sixty-six women with fibromyalgia who admitted to the outpatient clinic of our hospital were r and omized into two treatment groups . The patients in both groups participated in a supervised combined exercise program for 12 weeks . The women in first group had additional TENS in the first 3 weeks of the study . All subjects were analyzed at the baseline , at the end of the 3rd and 12th weeks . Outcome measures were tender point count ( TPC ) , myalgic pain score ( MPS ) , Fibromyalgia Impact Question naire ( FIQ ) and Short Form-36 ( SF-36 ) Health Survey .  Sixty women with fibromyalgia completed the study . The patients in both groups showed improvement in terms of TPC , MPS , FIQ , physical and mental summary scores and total scores of SF-36 at the end of the 3rd and 12th weeks . The improvement in MPS at the third week was higher in the first group ( p = 0.01 ) . But there was no difference in terms of the improvement in MPS between the groups at the end of the 12th week control ( p = 0.87 ) . There was no significant difference between the improvement in the other outcome parameters of the two groups . As a result , supervised exercise program was successful to improve the myalgic pain , functional status and quality of life in women with fibromyalgia .  Exercises combined with TENS might be useful due to quick myalgic pain relief in the treatment of fibromyalgia in everyday practice & NA ; Both pharmacological and non‐pharmacological interventions have demonstrated efficacy in the management of fibromyalgia ( FM ) .  Non‐pharmacological interventions however are far less likely to be used in clinical setting s , in part due to limited access . This manuscript presents the findings of a r and omized controlled trail of an Internet‐based exercise and behavioral self‐management program for FM design ed for use in the context of a routine clinical care . 118 individuals with FM were r and omly assigned to either ( a ) st and ard care or ( b ) st and ard care plus access to a Web‐Enhanced Behavioral Self‐Management program ( WEB‐SM ) grounded in cognitive and behavioral pain management principles . Individuals were assessed at baseline and again at 6 months for primary endpoints : reduction of pain and an improvement in physical functioning . Secondary outcomes included fatigue , sleep , anxiety and depressive symptoms , and a patient global impression of improvement . Individuals assigned to the WEB‐SM condition reported significantly greater improvement in pain , physical functioning , and overall global improvement . Exercise and relaxation techniques were the most commonly used skills throughout the 6 month period . A no‐contact , Internet‐based , self‐management intervention demonstrated efficacy on key outcomes for FM . While not everyone is expected to benefit from this approach , this study demonstrated that non‐pharmacological interventions can be efficiently integrated into routine clinical practice with positive outcomes OBJECTIVES The main objective was to assess the influence of resistance exercise on pain threshold and pain ratings . Secondary objectives included measuring state anxiety , body awareness , systolic blood pressure , diastolic blood pressure , and heart rate responses . METHODS Pressure ( 3 kg force ) was applied to the middle digit of the left h and for two minutes using a Forgione-Barber pain stimulator before and after ( five minute and 15 minutes ) resistance exercise and quiet rest . Resistance exercise consisted of 45 minutes of lifting three sets of 10 repetitions at 75 % of an individual 's one repetition maximum . Quiet rest consisted of sitting quietly in a room free from distractions . RESULTS Data were analysed by repeated measures analysis of variance for multifactor experiments . Pain threshold was significantly higher ( p<0.05 ) and pain ratings were significantly lower ( p<0.05 ) five minutes after resistance exercise . Changes in pain perception were accompanied by changes in heart rate , systolic blood pressure , and body awareness after exercise . CONCLUSION A single bout of resistance exercise is capable of modifying the sensation of experimentally induced pain Introduction Fibromyalgia is difficult to treat and requires the use of multiple approaches . This study is a r and omized controlled trial of qigong compared with a wait-list control group in fibromyalgia . Methods One hundred participants were r and omly assigned to  immediate or delayed practice groups , with the delayed group receiving training at the end of the control period . Qigong training ( level 1 Chaoyi Fanhuan Qigong , CFQ ) , given over three half-days , was followed by weekly review / practice sessions for eight weeks ; participants were also asked to practice at home for 45 to 60 minutes per day for this interval . Outcomes were pain , impact , sleep , physical function and mental function , and these were recorded at baseline , eight weeks , four months and six months . Immediate and delayed practice groups were analyzed individually compared to the control group , and as a combination group . Results In both the immediate and delayed treatment groups , CFQ demonstrated significant improvements in pain , impact , sleep , physical function and mental function when compared to the wait-list/usual care control group at eight weeks , with benefits extending beyond this time . Analysis of combined data indicated significant changes for all measures at all times for six months , with only one exception . Post-hoc analysis based on self-reported practice times indicated greater benefit with the per protocol group compared to minimal practice . Conclusions This study demonstrates that CFQ , a particular form of qigong , provides long-term benefits in several core domains in fibromyalgia . CFQ may be a useful adjuvant self-care treatment for fibromyalgia . Trial registration clinical trials.gov NCT00938834 To compare training programs for women with trapezius myalgia regarding physical performance and pain , 102 women were r and omized to strength , endurance , co-ordination and non-training groups . Before and after the intervention , static strength and dynamic muscular endurance in shoulder muscles were measured on a Cybex II dynamometer . Muscle activity in shoulder muscles was monitored via surface EMG . The signal amplitude ratio between the active and passive phase of repeated contractions indicated the ability to relax . Pain at present , pain in general and pain at worst were measured on visual analogue scales . After training , within group comparisons showed that the training groups rated less pain , and in the strength training group ratings of pain at worst differed from the non-training group . Using the non-training group as a reference , static strength increased in the strength and endurance training groups and muscular endurance in all training groups . The study indicates that regular exercises with strength , endurance or co-ordination training of neck/shoulder muscles might alleviate pain for women with work-related trapezius myalgia OBJECTIVE To determine the efficacy of a 12-week individualized home-based exercise programme on physical functioning , pain severity and psychological distress for women with fibromyalgia ( FM ) . METHODS Seventy-nine women with a primary diagnosis of FM were r and omized to a 12-week individualized home-based moderate-intensity exercise programme or to a usual care control group . Outcomes were functional capacity ( Fibromyalgia Impact Question naire ) , pain severity and psychological distress . Outcomes were measured at study entry , at the end of the 12-week intervention , and at 3 and 9 months following completion of the intervention . RESULTS On the basis of intention-to-treat analyses , a significant improvement in functional capacity at 3 and 9 months following treatment for participants in the exercise group who were more functionally disabled at study entry was observed . At both 3 and 9 months post-treatment , the mean estimated benefit of the intervention was more than 10 points [ -12.3 ( 95 % CI , -21.9 to -2.8 ) ; -10.8 ( 95 % CI , -21.5 to -0.2 ) ] . Compared with the control group , statistically significant improvements in upper body pain were evident in the exercise group at post-treatment . These between-group differences in upper body pain were maintained at 3 and 9 months post-treatment . No statistically significant group differences on lower body pain and psychological distress were found . CONCLUSIONS Home-based exercise , a relatively low-cost treatment modality , has the potential to improve important health outcomes in FM Introduction Physical therapy in warm water has been effective and highly recommended for persons with fibromyalgia , but its efficiency remains largely unknown . Should patients or health care managers invest in this therapy ? The aim of the current study was to assess the cost-utility of adding an aquatic exercise programme to the usual care of women with fibromyalgia . Methods Costs to the health care system and to society were considered in this study that included 33 participants , r and omly assigned to the experimental group ( n = 17 ) or a control group ( n = 16 ) . The intervention in the experimental group consisted of a 1-h , supervised , water-based exercise sessions , three times per week for 8 months . The main outcome measures were the health care costs and the number of quality -adjusted life-years ( QALYs ) using the time trade-off elicitation technique from the EuroQol EQ-5D instrument . Sensitivity analyses were performed for variations in staff salary , number of women attending sessions and time spent going to the pool . The cost effectiveness acceptability curves were created using a non-parametric bootstrap technique . Results The mean incremental treatment costs exceeded those for usual care per patient by € 517 for health care costs and € 1,032 for societal costs . The mean incremental QALY associated with the intervention was 0.131 ( 95 % CI : 0.011 to 0.290 ) . Each QALY gained in association with the exercise programme cost an additional € 3,947/QALY ( 95 % CI : 1,782 to 47,000 ) for a health care perspective and € 7,878/QALY ( 3,559 to 93,818 ) from a societal perspective . The curves showed a 95 % probability that the addition of the water-based programme is a cost-effective strategy if the ceiling of inversion is € 14,200/QALY from a health care perspective and € 28,300/QALY from a societal perspective . Conclusion The addition of an aquatic exercise programme to the usual care regime for fibromyalgia in women  is cost effective in terms of both health care costs and societal costs . However , the characteristics of facilities ( distance from the patients ' homes and number of patients that can be accommo date d per session ) are major determinants to consider before investing in such a programme . Trial registration Current controlled trials IS RCT N53367487 Abstract Objectives : To evaluate cardiovascular fitness exercise in people with fibromyalgia Design : R and omised controlled trial Setting : Hospital rheumatology out patients .  Group based classes took place at a “ healthy living centre . ” Participants : 132 patients with fibromyalgia . Interventions : Prescribed grade d aerobic exercise ( active treatment ) and relaxation and flexibility ( control treatment ) . Main outcome measures : Participants ' self assessment of improvement , tender point count , impact of condition measured by fibromyalgia impact question naire , and short form McGill pain question naire . Results : Compared with relaxation exercise led to significantly more participants rating themselves as much or very much better at three months : 24/69 ( 35 % ) v 12/67 ( 18 % ) , P=0.03 . Benefits were maintained or improved at one year follow up when fewer participants in the exercise group fulfilled the criteria for fibromyalgia ( 31/69 v 44/67 , P=0.01 ) . Peoplein the exercise group also had greater reductions in tender point counts ( 4.2 v 2.0 , P=0.02 ) and in scores on the fibromyalgia impact question naire ( 4.0 v 0.6 , P=0.07 ) . Conclusions : Prescribed grade d aerobic exercise is a simple , cheap , effective , and potentially widely available treatment for fibromyalgia & NA ; A mounting body of literature recommends that treatment for fibromyalgia ( FM ) encompass medications , exercise and improvement of coping skills . However , there is a significant gap in determining an effective counterpart to pharmacotherapy that incorporates both exercise and coping . The aim of this r and omized controlled trial was to evaluate the effects of a comprehensive yoga intervention on FM symptoms and coping . A sample of 53 female FM patients were r and omized to the 8‐week Yoga of Awareness program ( gentle poses , meditation , breathing exercises , yoga‐based coping instructions , group discussion s ) or to wait‐listed st and ard care . Data were analyzed by intention to treat . At post‐treatment , women assigned to the yoga program showed significantly greater improvements on st and ardized measures of FM symptoms and functioning , including pain , fatigue , and mood , and in pain catastrophizing , acceptance , and other coping strategies . This pilot study provides promising support for the potential benefits of a yoga program for women with FM OBJECTIVE To compare the effectiveness of biofeedback/relaxation , exercise , and a combined program for the treatment of  fibromyalgia . METHODS Subjects ( n = 119 ) were r and omly assigned to one of 4 groups : 1 ) biofeedback/relaxation training , 2 ) exercise training , 3 ) a combination treatment , or 4 ) an educational/attention control program . RESULTS All 3 treatment groups produced improvements in self-efficacy for function relative to the control condition . In addition , all treatment groups were significantly different from the control group on tender point index scores , reflecting a modest deterioration by the attention control group rather than improvements by the treatment groups . The exercise and combination groups also result ed in modest improvements on a physical activity measure . The combination group best maintained benefits across the 2-year period . CONCLUSION This study demonstrates that these 3 treatment interventions result in improved self-efficacy for physical function which was best maintained by the combination group 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 AND PURPOSE The purpose s of this study were : ( 1 ) to assess the effectiveness of a 16-week progressive program of home-based , videotape-based , low-impact aerobic exercise on physical function and signs and symptoms of fibromyalgia in previously sedentary women aged 20 to 55 years and ( 2 ) to compare the effects of 1 long exercise bout versus 2 short exercise bouts per training day ( fractionation ) on physical function , signs and symptoms of fibromyalgia , and exercise adherence . SUBJECTS One hundred forty-three sedentary women were r and omly assigned to 1 of 3 groups : a group who trained using a long bout of exercise ( LBE group , n=51 ) , a group who trained using short bouts of exercise ( SBE group , n=56 ) , and a group who performed no exercise ( NE group , n=36 ) . METHODS The SBE group exercised twice daily , and the LBE group worked out once daily . Both groups progressed in total daily training duration from 10 to 30 minutes , 3 to 5 times a week , for 16 weeks . Physical and psychological well-being , symptoms , and self-efficacy were evaluated using a multivariate analysis of variance . RESULTS Dropout rates for the NE , SBE , and LBE groups were 14 % , 38 % , and 29 % , respectively . The NE group differed from the LBE group in disease severity , self-efficacy , and psychological well-being ( midtest , efficacy analysis ) and from the SBE group in disease severity and self-efficacy ( posttest , efficacy analysis ) . Exercise adherence was greater for the LBE group than for the SBE group between weeks 5 and 8 of the training program . No other differences between exercise groups were found . DISCUSSION AND CONCLUSION Progressive , home-based , low-impact aerobics improved physical function and fibromyalgia symptoms minimally in participants who completed at least two thirds of the recommended exercise . Fractionation of exercise training provided no advantage in terms of exercise adherence , improvements in fibromyalgia symptoms or physical function . High attrition rates and problems with exercise adherence were experienced in both exercise groups 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 To evaluate the effects of 6 months of pool exercise combined with a 6 session education program for patients with fibromyalgia syndrome ( FM ) . METHODS The study population comprised 58 patients , r and omized to a treatment or a control group . Patients were instructed to match the pool exercises to their threshold of pain and fatigue . The education focused on strategies for coping with symptoms and encouragement of physical activity . The primary outcome measurements were the total score of the Fibromyalgia Impact Question naire ( FIQ ) and the 6 min walk test , recorded at study start and after 6 mo . Several other tests and instruments assessing functional limitations , severity of symptoms , disabilities , and quality of life were also applied . RESULTS Significant differences between the treatment group and the control group were found for the FIQ total score ( p = 0.017 ) and the 6 min walk test ( p < 0.0001 ) . Significant differences were also found for physical function , grip strength , pain severity , social functioning , psychological distress , and quality of life . CONCLUSION The results suggest that a 6 month program of exercises in a temperate pool combined with education will improve the consequences of FM The aim of this study was to evaluate the effectiveness of aerobic exercise in water pool compared with aerobic exercise performed in sea by women with fibromyalgia ( FM ) . A total of 46 patients were r and omly allocated into two groups : pool group ( 23 patients ) and sea group ( 23 patients ) that performed the same aerobic exercise program . Patients were evaluated baseline and after 12 weeks using : VAS , number of tender points , FIQ , SF-36 , PSQI , and BDI . Both groups improved significantly in post-treatment for all the evaluated variables . There were no significant differences between two groups , except for BDI ( F = 2.418 , P < 0.0001 ) . Aerobic exercise program performed in water ( pool or sea ) was effective for patients with FM . However , sea water exercises have been shown to bring more advantages related to emotional aspects . Then , exercise performed sea water ( thalassotherapy ) is an option for effective treatment with low cost for patients with FM OBJECTIVE To measure mood and physical function of individuals with fibromyalgia , 6 and 12 months following 23 weeks of supervised aerobic exercise . METHODS This is a followup report of individuals who were previously enrolled in 23 weeks of l and -based and water-based aerobic exercise classes .  Outcomes included the 6-minute walk test , Beck Depression Inventory ( BDI ) , State-Trait Anxiety Inventory , Arthritis Self-Efficacy Scale ( ASES ) , Fibromyalgia Impact Question naire ( FIQ ) , tender point count , patient global assessment score , and exercise compliance . Outcomes were measured at the start and end of the exercise classes and 6 and 12 months later . RESULTS Analyses were conducted on 29 ( intent-to-treat ) or 18 ( efficacy ) subjects .  Six-minute walk distances and BDI total scores were improved at followup ( all analyses ) . BDI cognitive/affective scores were improved at the end of 23 weeks of exercise ( both analyses ) and at the 12-month followup ( efficacy analysis only ) . BDI somatic scores were improved at 6-month ( both analyses ) and 12-month followup ( intent-to-treat only ) . FIQ and ASES function were improved at all followup points . ASES pain was improved in efficacy analyses only ( all followup points ) . Tender points were unchanged after 23 weeks of exercise and at followup . Exercise duration at followup ( total minutes of aerobic plus anaerobic exercise in the preceding week ) was related to gains in physical function ( 6- and 12-month followup ) and mood ( 6-month followup ) . CONCLUSION Exercise can improve physical function , mood , symptom severity , and aspects of self efficacy for at least 12 months . Exercising at followup was related to improvements in physical function and perhaps mood OBJECTIVES This study aim ed to verify whether techniques of yoga with and without the addition of Tui Na might improve pain and the negative impact of fibromyalgia ( FMS ) on patients ' daily life . DESIGN Forty ( 40 ) FMS women were r and omized into two groups , Relaxing Yoga ( RY ) and Relaxing Yoga plus Touch ( RYT ) , for eight weekly sessions of stretching , breathing , and relaxing yogic techniques . RYT patients were further su bmi tted to manipulative techniques of Tui Na . OUTCOME MEASURE Outcome measures comprised the Fibromyalgia Impact Question naire ( FIQ ) , pain threshold at the 18 FMS tender points , and a verbal graduation of pain assessed before treatment and on the followup . The visual analog scale ( VAS ) for pain was assessed before and after each session and on the follow-up . RESULTS Seventeen ( 17 ) RYT and 16 RY patients completed the study . Both RY and RYT groups showed improvement in the FIQ and VAS scores , which decreased on all sessions . The RYT group showed lower VAS and verbal scores for pain on the eighth session , but this difference was not maintained on the follow-up . Conversely , RY VAS and verbal scores were significantly lower just on the follow-up . CONCLUSIONS These study results showed that yogic techniques are valid therapeutic methods for FMS . Touch addition yielded greater improvement during the treatment . Over time , however , RY patients reported less pain than RYT . These results suggest that a passive therapy may possibly decrease control over FMS symptoms OBJECTIVES To evaluate the effects of a 16-week exercise therapy in a chest-high pool of warm water through applicable tests in the clinical practice on the global symptomatology of women with fibromyalgia ( FM ) and to determine exercise adherence levels . DESIGN A r and omized controlled trial . SETTING Testing and training were completed at the university . PARTICIPANTS Middle-aged women with FM ( n=60 ) and healthy women ( n=25 ) . INTERVENTION A 16-week aquatic training program , including strength training , aerobic training , and relaxation exercises . MAIN OUTCOME MEASURES Tender point count ( syringe calibrated ) , health status ( Fibromyalgia Impact Question naire ) ; sleep quality ( Pittsburgh Sleep Quality Index ) ; physical ( endurance strength to low loads tests ) , psychologic ( State Anxiety Inventory ) , and cognitive function ( Paced Auditory Serial Addition Task ) ; and adherence 12 months after the completion of the study . RESULTS For all the measurements , the patients showed significant deficiencies compared with the healthy subjects . Efficacy analysis ( n=29 ) and intent-to-treat analysis ( n=34 ) of the exercise therapy was effective in decreasing the tender point count and improving sleep quality , cognitive function , and physical function . Anxiety remained unchanged during the follow-up . The exercise group had a significant improvement of health status , not associated exclusively with the exercise intervention . There were no changes in the control group . Twenty-three patients in the exercise group were exercising regularly 12 months after completing the program . CONCLUSIONS An exercise therapy 3 times a week for 16 weeks in a warm pool could improve most of the symptoms of FM and cause a high adherence to exercise in unfit women with heightened FM symptomatology . The therapeutic intervention 's effects can be assessed through applicable tests in the clinical practice BACKGROUND This pilot study was design ed to test the efficacy of a physical activity program for improving psychological variables and fibromyalgia syndrome ( FMS ) symptoms and to provide preliminary evidence regarding the effects on perceived cognitive symptoms and objective ly measured cognitive performance by FMS patients . METHODS Sixteen women diagnosed with FMS were r and omly assigned to an 18-week physical activity program or to a control condition .  Psychological measures , FMS symptoms , perceived cognitive function , objective measures of cognition , and walking capacity were assessed at baseline and posttest . RESULTS At posttest , there were significant differences in fatigue ( effect size , ES=1.86 ) , depression ( ES=1.27 ) , FMS symptoms ( ES=1.56 ) , self-reported cognitive symptoms ( ES=1.19 ) , and delayed recall performance ( ES=1.16 ) between the physically active group and the control group , indicating that the FMS patients benefited from physical activity . Beneficial effects were also observed for 6 of the 7 objective measures of cognition and ranged from small to large ( ESs=0.26 to 1.06 ) . CONCLUSIONS Given that all FMS patients do not respond well to conventional treatments , these beneficial effects of physical activity are important . Future studies with larger sample s are warranted to test the reliability of the findings for the objective measures of cognition OBJECTIVE To evaluate the efficacy of a 6-week exercise and educational program for patients with fibromyalgia . METHODS Forty-one subjects were r and omly assigned to the program or served as waiting list controls . Program outcome was assessed with a 6-minute walk test , the Fibromyalgia Impact Question naire , a Self-Efficacy Scale , and a " knowledge " question naire ( based on information provided during the educational sessions ) . Waiting list control subjects subsequently completed the program . Program outcome was reassessed 3 or 6 months post-program . RESULTS The program produced significant improvements in 6-minute walk distance , well-being , fatigue , self-efficacy ( for controlling pain and other symptoms ) , and knowledge . At followup , immediate gains in walk distance , well-being , and self-efficacy were maintained , but gains in fatigue and knowledge were lost . CONCLUSION Short-term exercise and educational programs can produce immediate and sustained benefits for patients with fibromyalgia . The benefits of our program may be due to exercise or education since both interventions were given OBJECTIVE To determine the level of improvement , as regards pain , impact on fibromyalgia and depression , achieved by patients with fibromyalgia by comparing aquatic biodanza and stretching exercises . DESIGN R and omised controlled trial with two intervention groups . LOCATION Five health centres ( Almeria ) . PATIENTS A total of 82 fibromyalgia patients between 18 and 65 years old , diagnosed by American College of Rheumatology criteria , were included , with 12 patients declining to take part in the study . The 70 remaining patients were r and omly assigned to two groups of 35 patients each : aquatic biodanza and stretching exercises .  Those who did not attend in at least 14 sessions or changed their treatment during the studio were excluded . The final sample consisted of 19 patients in aquatic biodanza group and 20 in stretching group . The limitations of the study included , the open evaluation design and a sample size reduced by defaults . MAIN MEASURES The outcome measures were sociodemographic data , quality of life ( Fibromyalgia Impact Question naire ) , pain ( McGill-Melzack question naire ; and Visual Analogue Scale ) , pressure algometry ( Wagner FPI10 algometer ) and depression ( Beck Inventory ) . These were carried out before and after a 12-week therapy . RESULTS The mean age of the sample was 55.41 years . The mean period from diagnosis was 13.44 years . The sample consisted mainly of housewives . There were significant differences ( P<.05 ) between groups , in pain ( P<.01 ) , fibromyalgia impact ( P<.01 ) , and depression ( P<.04 ) after the treatment . CONCLUSIONS The biodanza aquatic exercises improve pain and quality of life in fibromyalgia patients This study was aim ed to investigate the effects of an exercise trial on self-esteem , self-concept and quality of life in patients with fibromyalgia and to evaluate whether improvements in psychological distress were related to changes in physical functioning . Twenty-eight women with a primary diagnosis of fibromyalgia were r and omized to a usual care control group or to a 12-week supervised training programme consisting of 3 weekly sessions of aerobic , strengthening and flexibility exercises . Outcomes were physical functioning ( Fibromyalgia Impact Question naire ( FIQ ) , lower-body strength and flexibility ) and psychological functioning ( SF-36 , Rosenberg self-esteem scale and Erdmann self-concept scale ) . Outcomes were measured at study entry and at the end of the intervention . Compared to the control group , statistically significant improvements in self-esteem , self-concept , FIQ , physical functioning , role physical , bodily pain , vitality , role emotional , social functioning , mental health , isometric strength , muscular endurance and flexibility were evident in the exercise group at the end of treatment . Self-esteem and self-concept scores were correlated positively with role emotional , mental health and the mental component summary of SF-36 and were negatively correlated to FIQ scores . No significant correlation existed between self-esteem or self-concept and isometric strength , muscular endurance or flexibility . Our results highlight the need for a broader array of physical and mental outcomes and the importance of examining patient ’s perceptions in future research therapies Forty-two patients with primary fibromyalgia were r and omized into a 20-week program consisting of either cardiovascular fitness ( CVR ) training or simple flexibility exercises ( FLEX ) that did not lead to enhanced cardiovascular fitness . Patients were supervised by the same medical fitness instructors . Patients in neither group had contact with members of the other group , and were blinded as to the exercise taught to the alternative group . Groups met for 60 minutes 3 times each week . The compliance rate was 90 % . Thirty-eight patients completed the study ( 18 with CVR training and 20 with FLEX ) . Blind assessment s ( st and ardized in preliminary trials to achieve acceptable inter-rater agreement ) were performed by the same 2 examiners . After 20 weeks , patients receiving CVR training showed significantly improved cardiovascular fitness scores compared with those receiving FLEX training ( t[35 ] = -4.22 , P less than 0.003 ) . Logistic regression analysis showed clinical ly and statistically significant improvements in pain threshold scores , which were measured directly over fibrositic tender points , in patients undergoing CVR ( t[35 ] = 2.21 , P less than 0.04 ) . There was also a trend toward improvement in pain scores ( visual analog scale ) in the CVR group , but this did not reach statistical significance . There was no improvement in the percentage of body area affected by fibrositic symptoms or the number of nights per week or hours per night of disturbed sleep ( self-report inventories ) . However , compared with the FLEX group , the CVR-trained patients improved significantly in both patient and physician global assessment scores . ( ABSTRACT TRUNCATED AT 250 WORDS OBJECTIVE To analyze the long-term efficacy of 2 interventions for female fibromyalgia ( FM ) patients : 1 ) cognitive-behavioral therapy ( CBT ) , and 2 ) a physical exercise (PE)-based strategy . METHODS We conducted a prospect i ve , long-term , r and omized , parallel clinical trial . The outcome variables are physical activity , aerobic capacity , and results of the Fibromyalgia Impact Question naire ( FIQ ) , Short Form 36 , Beck Anxiety and Depression Inventory , Chronic Pain Self-Efficacy Scale , and Chronic Pain Coping Inventory . All were measured at baseline , posttreatment , 6 months , and 1 year . The duration of both treatments was 8 weeks . RESULTS Some items of the FIQ and some strategies to cope with pain improved significantly in both groups after treatment . All variables measuring functional capacity improved significantly in the PE group , whereas only physical activity of the vertebral column improved in the CBT group . There were no differences in anxiety , depression , and self efficacy after treatment in either group . After 1 year of followup , most of the parameters had returned to baseline values in both groups . However , in the PE group , functional capacity remained significantly better . CONCLUSIONS PE and CBT improve clinical manifestations in FM patients only for short periods of time . Improvement in self efficacy and physical fitness are not associated with improvement in clinical manifestations OBJECTIVE To examine the effectiveness of concurrent strength and endurance training on muscle strength , aerobic and functional performance , and symptoms in postmenopausal women with fibromyalgia ( FM ) . DESIGN R and omized controlled trial . SETTING Local gym and university research laboratory . PARTICIPANTS Twenty-six women with FM . INTERVENTION Progressive and supervised 21-week concurrent strength and endurance training . MAIN OUTCOME MEASURES Muscle strength of leg extensors , upper extremities , and trunk ; peak oxygen uptake ( Vo(2)peak ) , maximal workload ( Wmax ) , and work time ; 10-m walking and 10-step stair-climbing time and self-reported functional capacity ( Health Assessment Question naire ) ; and symptoms of FM . RESULTS After concurrent strength and endurance training , the groups differed significantly in Wmax ( P=.001 ) , work time ( P=.001 ) , concentric leg extension force ( P=.043 ) , walking ( P=.001 ) and stair-climbing ( P<.001 ) time , and fatigue ( P=.038 ) . The training led to an increase of 10 % ( P=.004 ) in Wmax and 13 % ( P=.004 ) in work time on the bicycle but no change in Vo(2)peak . CONCLUSIONS Concurrent strength and endurance training in low to moderate volume improves the muscle strength of leg extensors , Wmax , work time , and functional performance as well as perceived symptoms , fatigue in particular . Concurrent strength and endurance training is beneficial to postmenopausal women with FM without adversities , but more extensive studies are needed to confirm the results OBJECTIVE To determine whether abnormalities of peripheral and central nociceptive sensory input processing exist outside areas of spontaneous pain in patients with fibromyalgia ( FM ) as compared with controls , by using quantitative sensory testing ( QST ) and a neurophysiologic paradigm independent from subjective reports . METHODS A total of 164 out patients with FM who were attending a self-management program were invited to participate in the study . Data for 85 patients were available and were compared with those for 40 non-FM controls matched for age and sex .  QST was performed using thermal , mechanical , and electrical stimuli at locations of nonspontaneous pain . Pain assessment was 2-fold and included use of subjective scales and the spinal nociceptive flexion reflex ( NFR ) , a specific physiologic correlate for the objective evaluation of central nociceptive pathways . Question naires regarding quality of life and the impact of FM were available . RESULTS Participants were mainly middle-aged women , with a mean disease duration of 8 years . Between-group differences were significant for neurophysiologic , clinical , and quality of life measures . In patients with FM , peripheral QST showed significantly altered cold and heat pain thresholds , and tolerance to cold pain was radically reduced . The median NFR threshold in patients with FM ( 22.7 mA [ range 17.5 - 31.7 ] ) was significantly decreased compared with that in controls ( 33 mA [ range 28.1 - 41 ] ) . A cutoff value of < 27.6 mA for NFR provided sensitivity of 73 % and specificity of 80 % for detecting central allodynia in the setting of FM . CONCLUSION Our results strongly , although indirectly , point to a state of central hyperexcitability of the nociceptive system in patients with FM . The NFR can be used to assess central allodynia in FM . It may also help discriminate patients who may benefit from use of central ly acting analgesics The purpose of this study was to evaluate the efficacy of a multidisciplinary treatment program in patients severely affected by fibromyalgia . Thirty-four fibromyalgia patients were r and omly divided into two groups . The control group : 17 women who continued their medical treatment and participated in four educational sessions  and the experimental group that included 17 patients who besides the former medical treatment  also underwent a weekly 1-h session program for 8 weeks including massage therapy , ischemic pressure on the 18 tender points , aerobic exercise and thermal therapy . At the beginning of the program , there were no significant differences between the two groups in any of the parameters . At the end of treatment , there was a significant improvement in the experimental group in the following items : vitality , social functioning , grip strength and the 6-min walk test . At 1 month after the end of treatment , the experimental group showed significant differences in overall health perception , social functioning , grip strength and the 6-min walk test . At that time , considering the threshold for clinical efficacy set at an improvement of 30 % or above for the analyzed variables , 25 % of the patients met the requirement for improvement of the following : number of symptoms : Visual Analogic Scale for fatigue , Fibromyalgia Impact Question naire and Beck Anxiety Inventory . In conclusion , patients with severe manifestations of fibromyalgia can obtain improvement with a short-term , low-cost and simple-delivery multidisciplinary program . However , additional studies including higher numbers of patients are needed to confirm the beneficial effect of this treatment program OBJECTIVES The aim of the present study was to assess the effectiveness of belly dance as a treatment option for patients with fibromyalgia . METHODS Eighty female patients with fibromyalgia between 18 to 65 years were r and omly allocated to a dance group ( n=40 ) and control group ( n=40 ) . Patients in the dance group underwent 16 weeks of belly dance twice a week , while the patients in the control group remained on a waiting list . The patients were evaluated with regard to pain ( VAS ) , function ( 6MWT ) , quality of life ( FIQ and SF-36 ) , depression ( Beck Inventory ) , anxiety ( STAI ) and self-image ( BDDE ) . Evaluations were carried out at baseline , 16 weeks and 32 weeks by a blinded assessor . RESULTS The dance group achieved significant improvements in VAS for pain ( p<0.001 ) , six-minute walk test ( p<0.001 ) , FIQ ( p=0.003 ) , BDDE ( p<0.009 ) as well as the pain ( p<0.001 ) , emotional aspects ( p<0.003 ) and mental health ( p<0.021 ) subscales on the SF-36 . CONCLUSIONS Belly dance can be used in the treatment of fibromyalgia to reduce pain and improve functional capacity , quality of life and self-image OBJECTIVE To determine the efficacy of training in fibromyalgia ( FM ) , we compared the effects of high intensity fitness training ( HIF ) and low intensity fitness training ( LIF ) . METHODS Thirty-seven female patients with FM were r and omly allocated to either a HIF group ( n = 19 ) or a LIF group ( n = 18 ) . Four patients ( 1 HIF group , 3 LIF group ) refused to participate after r and omization but before the start of the intervention . They were excluded from the analysis . Assessment s were performed at baseline and after 20 weeks of HIF or LIF . The primary outcome was patient 's global assessment [ on 100 mm visual analog scale ( VAS ) ] . Secondary endpoints were pain , number of tender points , total myalgic score , physical fitness , health status , and psychological distress . RESULTS One patient in the HIF group ( n = 18 ) and 2 in the LIF group ( n = 15 ) stopped training sessions during the course of the study . Nine of 18 patients in the HIF group compared to 8 of 15 patients in the LIF group achieved a participation rate of 67 % or more . Most important reasons for nonadherence were postexercise pain and fatigue , time consumption , and stress . The VAS for global well being improved slightly from 64 to 56 mm in the HIF group , and did not change in the LIF group ( 58 to 61 mm ) ( p = 0.07 ) . The Wmax ( physical fitness ) changed modestly from 110 to 123 watt in the HIF group , and from 97 to 103 watt in the LIF group ( p = 0.3 ) . VAS for pain increased from 53 to 64 mm in the HIF group and from 52 to 54 mm in the LIF group . The large st and ard deviations around mean change in global assessment s , number of tender points , total myalgic score , and psychological distress ( by SCL-90 ) severely influenced the power to detect within- and between-group differences . Analysis limited to those patients who accomplished a high attendance rate ( > 67 % ) showed similar results . CONCLUSION High intensity physical fitness training compared to low intensity physical fitness training leads to only modest improvements in physical fitness and general well being in patients with FM , and does not positively affect psychological status and general health OBJECTIVE To examine the effectiveness of a supervised aerobic exercise program , a self-management education program , and the combination of exercise and education for women with fibromyalgia ( FM ) . METHODS One hundred fifty-two women were r and omized into one of 4 groups : exercise-only , education-only , exercise and education , or control . The duration of the study was 12 weeks . All subjects were analyzed at 3 times : before study , immediately upon completion , and 3 months after completion of the intervention program on measures of disability , self-efficacy , fitness , tender point count , and tender point tenderness .  Of the 152 women , complete data were available for 95 and 69 who complied with the protocol . In order to determine the group time interaction , a 2 way analysis of variance with repeated measures was used for each measure . RESULTS The only significant group time interaction was reported with the compliance analysis for the Self-Efficacy Coping with Other Symptoms subscale and the Six Minute Walk . If the program was followed , the combination of a supervised exercise program and group education provided persons with FM with a better sense of control over their symptoms . Fitness improved in the 2 groups undergoing supervised aerobic exercise programs . However , the improvement in fitness was maintained at followup in the exercise-only group and not the combined group . Conclusion . Subjects receiving the combination of exercise and education and who complied with the treatment protocol improved their perceived ability to cope with other symptoms . In addition , a supervised exercise program increased walking distance at post-test , an increase that was maintained at followup in the exercise-only group . Results demonstrate the challenges with conducting exercise and education studies in persons with FM Objective . To follow patients with fibromyalgia six and 24 months after they finished a six-month treatment programme . The programme comprised pool exercise therapy , adjusted to the patients ' limitations , and education based on their health problems . Methods . Twenty-six patients were examined six and 24 months after the completion of the treatment programme  with the Fibromyalgia Impact Question naire ( FIQ ) , SF-36 , the 6-minute walk test , and the Grippit measure . The values obtained at the follow-up examinations were compared with the baseline and post-treatment values . Results . As compared with baseline , symptom severity ( FIQ , SF-36 ) , physical function ( FIQ , SF-36 , 6-minute walk test ) and quality of life ( SF-36 ) still showed improvements six months after the completion of treatment ( p<0.05 ) . Pain ( FIQ , SF-36 ) , fatigue ( FIQ , SF-36 ) , walking ability , and social function ( SF-36 ) still showed improvements 2 years after the completion of the programme as compared with the baseline values ( p<0.05 ) . No significant changes were found for these variables , when the values obtained at the two follow-up examinations were compared with those of the post-treatment examination . Conclusions . Improvements in symptom severity , physical function and social function were still found six and 24 months after the completed treatment programme OBJECTIVE To determine the efficacy of an Internet-based Arthritis Self-Management Program ( ASMP ) as a re source for arthritis patients unable or unwilling to attend small-group ASMPs , which have proven effective in changing health-related behaviors and improving health status measures . METHODS R and omized intervention participants were compared with usual care controls at 6 months and 1 year using repeated- measures analyses of variance . Patients with rheumatoid arthritis , osteoarthritis , or fibromyalgia and Internet and e-mail access ( n = 855 ) were r and omized to an intervention  ( n = 433 ) or  usual care control ( n = 422 ) group . Measures included 6 health status variables ( pain , fatigue , activity limitation , health distress , disability , and self-reported global health ) , 4 health behaviors ( aerobic exercise , stretching and strengthening exercise , practice of stress management , and communication with physicians ) , 5 utilization variables ( physician visits , emergency room visits , chiropractic visits , physical therapist visits , and nights in hospital ) , and self-efficacy . RESULTS At 1 year , the intervention group significantly improved in 4 of 6 health status measures and self-efficacy . No significant differences in health behaviors or health care utilization were found . CONCLUSION The Internet-based ASMP proved effective in improving health status measures at 1 year and is a viable alternative to the small-group ASMP To determine and compare short- and long-term effects of aerobic exercise ( AE ) , stress management treatment ( SMT ) , and treatment-as-usual ( TAU ) in fibromyalgia , 60 patients were r and omized to 14 weeks of treatment by either AE , SMT or TAU . Outcome measures at baseline , midway through treatment , at treatment completion , and at 4 year follow up included a patient made drawing of pain distribution , dolorimetry of tender points , ergometer cycle test , global subjective improvement , and VAS registration s of : pain , disturbed sleep , lack of energy , and depression . Both AE and SMT showed positive short-term effects .  AE was the overall most effective treatment , despite being subject to the most sceptical patient attitude prior to the study . At follow up , there were no obvious group differences in symptom severity , which for AE seemed to be due to a considerable compliance problem BACKGROUND The management of persistent , unexplained physical symptoms is challenging and often unsatisfactory for patients and doctors . Aerobic exercise training has benefited patients referred to secondary care with symptoms of chronic fatigue and fibromyalgia . It is not known if this approach is either possible or beneficial for patients with the broader range of persistent , unexplained symptoms found in primary care . OBJECTIVES To examine the feasibility and effects of aerobic exercise training in primary care patients with unexplained physical symptoms persisting more than 12 months . METHODS R and omized comparison ( n = 228 ) of aerobic exercise with stretching as control among patients recruited from primary care . Training comprised 20 , one-hour , sessions led by NHS physiotherapists . Adherence to training was recorded along with two groups of outcome measures : ( i ) documented symptoms and health care use , monitored from six months before to six months after training ; and ( ii ) self-reported measures including emotional state and perceived disability , assessed before , during and six months after training . RESULTS Exercise training proved feasible : more than 70 % of referred patients attended for assessment and were r and omized to aerobic or control exercise ; 78 % of eligible patients attended the first session ; and median attendance was 11 sessions for both programmes . Primary care consultations and prescriptions were significantly reduced in the 6 months after training ; extent of reduction was related to attendance at training sessions , irrespective of type . Whilst self-reported measures improved similarly during both training programmes , improvements were unrelated to level of attendance . CONCLUSION For primary care patients with persistent , unexplained physical symptoms willing to be involved in exercise training , aerobic exercise offers no benefits over non-aerobic exercise . Whilst the observed reduction in primary health care use following exercise training is potentially of practical importance in a group of patients characterized by high consultation rates , improvement in patients ' subjective state was not clearly attributable to exercise training Objective The aim of this study was to compare pool-based exercise and balneotherapy in fibromyalgia syndrome ( FMS ) patients . Methods Fifty female patients diagnosed with FMS according to the American College of Rheumatism ( ACR ) criteria were r and omly assigned to two groups : group 1 ( n=25 ) with pool-based exercise , and in group 2 ( n=25 ) balneotherapy was applied in the same pool without any exercise for 35 min three times a week for 12 weeks . In both groups , pre- ( week 0 ) and post-treatment ( weeks 12 and 24 ) evaluation was performed by one of the authors , who was blind to the patient group . Evaluation parameters included pain , morning stiffness , sleep , tender points , global evaluation by the patient and the physician , fibromyalgia impact question naire , chair test , and Beck depression inventory . Statistical analysis was done on data collected from three evaluation stages . Results Twenty-four exercise and 22 balneotherapy patients completed the study . Pretreatment ( week 0 ) measurements did not show any difference between the groups . In group 1 , statistically significant improvement was observed in all parameters ( P<0.01 ) except for the chair test at both weeks 12 and 24 . In group 2 , week 12 measurements showed significant improvement in all parameters ( P<0.01 ) except for the chair test and Beck depression inventory . Week 24 evaluation results in group 2 showed significant improvements in pain and fatigue according to visual analogue scale ( VAS ) , 5-point scale , number of tender points , algometric and myalgic scores , and patient and physician global evaluation ( P<0.01 and P<0.05 , respectively ) , while improvements were nonsignificant in morning stiffness , sleep , fibromyalgia impact question naire ( FIQ ) , chair test , and Beck depression inventory parameters in this group . Comparison of the two groups based on the post-treatment ( weeks 12 and 24 ) percent changes and difference scores relative to pretreatment ( week 0 ) values failed to show a significant difference between the groups for any parameter except Beck depression inventory ( P<0.01 ) . Conclusion The results of our study showed that pool-based exercise had a longer-lasting effect on some of the FMS symptoms , but statistical analysis failed to show a significant superiority of pool-based exercise over balneotherapy without exercise . While we believe that exercise is a gold st and ard in FMS treatment , we also suggest in light of our results that balneotherapy is among the valid treatment options in FMS , and further research regarding the type and duration of the exercise programs is necessary 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 test the short and longterm benefits of an 8 week mind-body intervention that combined training in mindfulness meditation with Qigong movement therapy for individuals with fibromyalgia syndrome ( FM ) . METHODS A total of 128 individuals with FM were r and omly assigned to the mind-body training program or an education support group that served as the control . Outcome measures were pain , disability ( Fibromyalgia Impact Question naire ) , depression , myalgic score ( number and severity of tender points ) , 6 minute walk time , and coping strategies , which were assessed at baseline and at 8 , 16 , and 24 weeks . RESULTS Both groups registered statistically significant improvements across time for the Fibromyalgia Impact Question naire , Total Myalgic Score , Pain , and Depression , and no improvement in the number of feet traversed in the 6 minute walk . However , there was no difference in either the rate or magnitude of these changes between the mind-body training group and the education control group . Salutary changes occurring by the eighth week ( which corresponded to the end of the mind-body and education control group sessions ) were largely maintained by both groups throughout the 6 month followup period . CONCLUSION While both groups showed improvement on a number of outcome variables , there was no evidence that the multimodal mind-body intervention for FM was superior to education and support as a treatment option . Additional r and omized controlled trials are needed before interventions of this kind can be recommended for treatment of FM OBJECTIVE To evaluate the efficacy of operant pain treatment for fibromyalgia syndrome ( FMS ) in an inpatient setting . METHODS Sixty-one patients who fulfilled the American College of Rheumatology criteria for FMS were r and omly assigned to the operant pain treatment group ( OTG ; n = 40 ) or a st and ardized medical program with an emphasis on physical therapy ( PTG ; n = 21 ) . Pain assessment s were performed before , immediately after , 6 months after , and 15 months after treatment . RESULTS The OTG patients reported a significant and stable reduction in pain intensity , interference , solicitous behavior of the spouse , medication , pain behaviors , number of doctor visits , and days at a hospital as well as an increase in sleeping time . Sixty-five percent of the OTG compared with none of the patients in the PTG showed clinical ly significant improvement . CONCLUSION These results suggest that operant pain treatment provided in an inpatient setting is an effective treatment for FMS , whereas a purely somatically oriented program may lead to a deterioration of the pain problem 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 Cardiovascular fitness training has been suggested as a treatment for the fibrositis/fibromyalgia syndrome . Thirty-four patients with fibrositis/fibromyalgia who met Smythe 's original criteria were r and omly assigned to enter either a cardiovascular fitness training program or a program consisting only of flexibility exercises . Patients met in supervised groups three times weekly for a 20-week observation period . The cardiovascular fitness group underwent gradual heart rate-elevated training using a bicycle ergometer and achieved a 29.1 + /- 24.4 percent increase in peak work capacity at 170 beats per minute ( PWC-170 ) . Patients undergoing flexibility training had a net reduction in their PWC-170 scores of 4.3 + /- 9.4 percent . Patients in the cardiovascular fitness group had statistically significant improvements in the visual analogue pain scale of current pain intensity ; total myalgic scores in which pain thresholds at five fibrositic tender points selected for acceptable intra-rater and inter-rater reliability were measured using a dolorimeter ; percentage total body area affected as measured by self-administered pain diagrams ; and patients ' and physicians ' global assessment scores . Psychologic profiles as measured by Symptom Checklist-90R also improved in the cardiovascular fitness group compared with the flexibility training group . It is concluded that cardiovascular fitness training is feasible in patients with fibrositis/fibromyalgia and that such training improves subjective measurements of pain-reporting behavior . A theoretic basis for improvements in pain measurement scales and psychologic profiles is discussed in light of recent literature OBJECTIVE People with fibromyalgia ( FM ) often have low insulin-like growth factor-I ( IGF-I ) levels and a suboptimal growth hormone ( GH ) response to acute exercise . As previous work had demonstrated a normalization of the acute GH response to exercise with the use of pyridostigmine ( PYD ) , we tested the hypothesis that 6 months of PYD therapy plus supervised exercise would increase IGF-I levels . METHODS Subjects with primary FM were r and omized into 4 groups : ( 1 ) PYD/exercise ; ( 2 ) PYD/diet recall ; ( 3 ) placebo/exercise ; and ( 4 ) placebo/diet recall . The dosing of PYD was 60 mg tid for 6 months . Resting IGF-I levels were measured at baseline and after 6 months of treatment . In addition the acute GH response to exercise at VO2 max was measured at baseline and after treatment . RESULTS A total of 165 FM subjects ( mean age 49.5 yrs , 5 male ) were entered and 154 ( 93.3 % ) completed the study . Six months of therapy ( PYD plus exercise or exercise alone ) failed to improve the IGF-I levels . The use of PYD 1 hour prior to exercise improved the acute GH response ( 4.54 ng/dl ) compared to placebo ( 1.74 ng/dl ) ( p = 0.001 ) at the end of the 6-month trial . The acute GH response to exercise at baseline did not correlate with IGF-I , age , depression , medications , estrogen status , or obesity . CONCLUSION A combination of triweekly supervised exercise plus the daily use of PYD for 6 months failed to increase IGF-I levels in patients with FM , despite the confirmation that PYD normalizes the acute GH response to strenuous aerobic exercise OBJECTIVE To evaluate the short- and long-term efficacy of exercise therapy in a warm , waist-high pool in women with fibromyalgia . METHODS Thirty-four women ( mean + /- SD tender points 17 + /- 1 ) were r and omly assigned to either an exercise group ( n = 17 ) to perform 3 weekly sessions of training including aerobic , proprioceptive , and strengthening exercises during 12 weeks , or to a control group ( n = 17 ) . Maximal unilateral isokinetic strength was measured in the knee extensors and flexors in concentric and eccentric actions at 60 degrees /second and 210 degrees /second , and in the shoulder abductors and adductors in concentric contractions .  Health-related quality of life ( HRQOL ) was assessed using the EQ-5D question naire ; pain was assessed on a visual analog scale . All were measured at baseline , posttreatment , and after 6 months . RESULTS The strength of the knee extensors in concentric actions increased by 20 % in both limbs after the training period , and these improvements were maintained after the de-training period in the exercise group . The strength of other muscle actions measured did not change . HRQOL improved by 93 % ( P = 0.007 ) and pain was reduced by 29 % ( P = 0.012 ) in the exercise group during the training , but pain returned close to the pretraining level during the subsequent de-training . However , there were no changes in the control group during the entire period . CONCLUSION The therapy relieved pain and improved HRQOL and muscle strength in the lower limbs at low velocity in patients with initial low muscle strength and high number of tender points . Most of these improvements were maintained long term OBJECTIVE This r and omized controlled clinical trial evaluates the effectiveness of outpatient group cognitive/educational treatment for patients with the fibromyalgia ( FM ) syndrome . We hypothesized that the combination of group education with cognitive treatment aim ed at developing pain coping skills would be more effective than group education alone . METHODS 131 patients with FM were r and omly assigned to 3 conditions : an experimental condition , which was the combined cognitive/educational intervention ( ECO ) ; an attention control condition consisting of group education plus group discussion ( EDI ) ; and a waiting list control ( WLC ) . For the treatment conditions ECO and EDI , assessment s were made 2 weeks before treatment , at start of treatment , at post-treatment , and at 6 and 12 mo followup . WLC patients received only 3 assessment s. RESULTS There were no pretreatment differences between the groups , or between dropouts and patients who remained in the study . At post-treatment , and compared with the WLC , the ECO patients improved in knowledge about FM ( p = 0.007 ) and pain coping ( p < 0.001 ) . EDI patients improved on pain coping ( p = 0.005 ) and pain control ( p = 0.002 ) . EDI patients reported significantly less fear than ECO patients ( p = 0.005 ) . There were no other differential effects between ECO and EDI at post-treatment or 6 mo or 12 mo followup . Based on the reliability of change index for clinical significance , the relative short term success rates are 6.4 and 18.4 % for ECO and EDI , respectively . CONCLUSION The surplus value of a highly structured , 12 session group cognitive treatment added to group education can not be supported by our study . In EDI , fear reduction might have enhanced pain coping and pain control , while poor compliance , the difficulty of homework assignments , and lack of individual support may have limited the effectiveness of ECO OBJECTIVES The aim of this study was to investigate the effectiveness of a 6-week traditional exercise programme with supplementary whole-body vibration ( WBV ) in improving strength and health status in women with fibromyalgia ( FM ) . METHODS Thirty postmenopausal women with FM ( mean ( SD ) age : 59 ( 7.90 ) years ) were r and omised into one of two groups , one intervention group ( GEV n=15 ) , which combined exercise training ( two days a week ) with three days of WBV ( 3 sets of 45 s at 20 Hz-3 mm and four sets of unilateral static squats at 20 Hz-2 mm ) and another control group ( n=15 ) , that performed the same physical activity programme but without vibration training ( GEnV ) . The Fibromyalgia Impact Question naire ( FIQ ) and the global score of the SF-36 were used to assess functional capacity and quality of life . Two additional tests were employed to assess muscle strength . Baseline data and pre-test and post-test data were collected before and after the six-week intervention period . RESULTS Significant improvements in all outcomes measured were found from baseline in both groups . A 5 % improvement from baseline in total FIQ score was observed in the exercise groups ( p≤0.05 ) , and was accompanied by reductions in SF36 scores of 9.8 % ( p<0.001 ) and 7.9 % ( p<0.001 ) in the GEV and GEnV group , respectively . Improvements were also observed in muscle strength in both groups but greater in the GEV group . CONCLUSIONS The results suggest that women with FMS can gain additional health benefits by engaging in a 6-week traditional exercise programme with supplementary WBV UNLABELLED Fibromyalgia ( FM ) , a rheumatological disorder of unknown origin , is characterized by both physical and psychological symptoms . Although inconclusive results have been reported for most treatment modalities , exercise appears to have universal support for decreasing the myriad of symptoms associated with FM . Weaknesses in the literature , however , prevent conclusive statements regarding exercise prescription and concomitant impact on FM symptomology . PURPOSE The current pilot study attempted to examine the effect of a 24-wk walking program at predetermined intensities on FM . METHODS Initial design was a r and omized control trial with  high- and low-intensity exercise groups  , and a control group . Subsequent nonr and omized control trials were based on actual exercise behavior . RESULTS No differences between initial groups were identified . By collapsing groups , heart rate ( HR ) decreased ( P < 0.05 ) weeks 0 - 12 . Functional impairments were reduced 54 % weeks 0 - 24 , with exercise having a large impact ( omega2 = 0.30 ) on this decrease . By reassigning groups , impact of FM on current health status decreased in the low-intensity group ( P < 0.05 ) and increased in the high-intensity group ( P < 0.02 ) weeks 0 - 24 . Omega squared indicated strong influence of exercise on pain ( omega2 = 0.51 ) , with greater pain in the high-intensity group . CONCLUSIONS A larger number of subjects and direct supervision of the training program to increase compliance is necessary to clarify the effects of a walking program on the manifestations of FM . Results indicate that intensity of the walking program is an important consideration . Individuals with FM can adhere to low-intensity walking programs two to three times per week , possibly reducing FM impact on daily activities OBJECTIVE The aim of this study was to evaluate the cardiorespiratory fitness and perceived exertion of female patients with fibromyalgia syndrome ( FMS ) compared with that of healthy female subjects . DESIGN AND SUBJECTS This was design ed as a cross-sectional case-control study , with a consecutive sample of 30 female patients with FMS and an age-matched control group of 67 healthy female subjects . SETTING This study was conducted at the multidisciplinary pain center of a university hospital in a city of more than 1 million inhabitants . OUTCOME MEASURES A cardiorespiratory fitness index ( PWC65%/kg ) and an original perceived exertion index ( B65 % ) were obtained from the  heart rates and perceived exertions scored on a 10-point Borg scale during a submaximal cycle ergometer test .  Average indexes for the FMS patients and control subjects were compared . RESULTS The mean cardiorespiratory fitness index of the FMS patients was not significantly different from that of the controls . The mean perceived exertion index in the FMS patients was significantly greater than that of the controls , meaning that the FMS patients systematic ally reported higher ratings of perceived exertion during exercise . CONCLUSIONS Cardiorespiratory fitness , as expressed by a submaximal work capacity index , seems normal in female patients with FMS compared with age- and sex-matched healthy individuals . The fact that FMS patients overscore their perception of exertion may be due to a greater overlap of peripheral pain and perceived exertion perceptions during exercise . This observation should be noted when using perceived exertion scores to prescribe and monitor exercise in FMS patients OBJECTIVE The purpose of this study was to investigate the effect of acute and chronic whole-body vibration exercise on serum insulin-like growth factor-1 ( IGF-1 ) levels in women with fibromyalgia . METHODS A r and omized controlled two-factor mixed experimental design was used . Twenty-four women with fibromyalgia ( age + /- st and ard error of the mean , 54.95 + /- 2.03 ) were r and omized into the vibration group or the control group . The vibration group underwent a protocol of static and dynamic tasks with whole-body vibration exercise twice a week for a total of six weeks , whereas the control group performed the same protocol without vibratory stimulus . Both groups continued their usual pharmacological treatment .  Serum IGF-1 levels were determined using enzyme-linked immunosorbent assay ( ELISA ) . To test the effects of long-term whole-body vibration exercise , serum IGF-1 measurements were taken at baseline and at weeks 1 , 3 , and 6 of the intervention . To test the short-term effects , at week 1 , serum IGF-1 measurements were taken before and immediately following a session of whole-body vibration exercise . RESULTS Treatment adherence was 93 % in the vibration group and 92 % in the control group . None of the subjects dropped out of the study . There was an absence of change in IGF-1 at week 1 and week 6 of whole-body vibration exercise . CONCLUSION Results show no change in serum IGF-1 levels in women with fibromyalgia undergoing whole-body vibration exercise . Although high-intensity exercise and whole-body vibration exercise have been shown to increase serum IGF-1 in healthy individuals , the effectiveness of whole-body vibration exercise as a strategy to produce improvements in serum IGF-1 levels in women with fibromyalgia could not be demonstrated OBJECTIVE To compare hydrotherapy ( HT ) and conventional physiotherapy ( CP ) in the treatment of fibromyalgia ( FM ) , regarding quality of life ( QOL ) , total sleep time ( TST ) , and total nap time ( TNT ) . METHODS Fifty out patients , all female , 30 - 60 years old , diagnosed with FM , were r and omly assigned to two groups to carry out 3 weeks of treatment with HT or CP . In the beginning and in the end of treatment , patients were evaluated with the SF-36 question naire to measure QOL and the sleep diary for TST and TNT . Data analyses were blind . RESULTS All 24 HT patients increased 1h in TST compared to 19 CP patients . TNT decreased in the HT group . QOL improved for the two groups in all domains when pre- and post-intervention were compared , but there was no difference between groups . CONCLUSION HT is more effective than CP to improve TST and to decrease TNT in FM patients OBJECTIVE To compare an evidence -based clinical fibromyalgia program , referred to as Fibro-Fit , with results of controlled clinical trials . METHODS An interdisciplinary group education and exercise program with 36 sessions over 12 weeks was used . Demographic , clinical , and outcome variables were collected on 149 participants , of whom 71 % completed the program . Outcomes included measures of self-efficacy , pain , physical fitness , function , and coping skills . RESULTS Results of the prospect i ve before-after evaluation showed statistically significant ( P < 0.005 ) improvements in all outcomes except for grip strength . These results were comparable with controlled clinical trials found in the literature . Data suggest that smoking , fibromyalgia support groups , and medications may be important modifiable factors . CONCLUSIONS Results suggest that Fibro-Fit was effective in improving physical impairments and function . Further investigation is required to refine the effective components of these programs and determine how modifiable factors can be used to improve outcomes OBJECTIVE To compare in patients with fibromyalgia ( FM ) utilities derived by rating scale and st and ard gamble methods ; to gain insight into construct validity by relating utility values to other outcome measures ; to assess the sensitivity to change of utilities . METHODS A total of 73 patients with FM were r and omized into one of 3 groups : low impact fitness training , biofeedback , or controls . At baseline and after 6 mo the Maastricht Utility Measurement Question naire was applied . By means of both the rating scale and st and ard gamble method patients were asked to value their own health status . Construct validity of patient utility measurements was evaluated by Spearman correlation and multiple regression of baseline values with pain , stiffness , patient 's global assessment , Sickness Impact Profile ( SIP ) , modified Health Assessment Question naire and Arthritis Impact Measurement Scale ( AIMS ) . Sensitivity to change was assessed against changes in these outcomes . RESULTS Rating scale utilities correlated significantly ( p < 0.05 ) with patient 's global assessment ( rs = 0.53 ) , pain ( rs = -0.47 ) , SIP ( rs = -0.43 ) , and with 9 of 11 dimensions of the AIMS ( rs ranging from 0.23 to 0.62 ) . St and ard gamble utilities correlated significantly with mobility , pain , and arthritis impact of the AIMS scale ( rs from 0.22 to 0.36 ) and with pain by visual analog scale ( rs = -0.24 ) and patient 's global assessment ( rs = 0.32 ) . Multiple regression analysis showed that patient 's global assessment explained 41 % ( rating scale ) and 10 % ( st and ard gamble ) of total variance in baseline utilities . Also , 16 % of the variance in change in rating scale utility values was explained by changes in patient 's global assessment . In contrast , variance of changes in st and ard gamble utility values was not explained significantly by changes in other disease outcomes . CONCLUSION Rating scale utilities correlated more strongly with disease outcome measures than st and ard gamble utilities . Also , construct validity for the rating scale was better than for the st and ard gamble . In FM , utility measurement is sensitive to the method chosen to elicit patient priorities OBJECTIVE To determine the effectiveness of self-management education and physical training in decreasing fibromyalgia ( FMS ) symptoms and increasing physical and psychological well being . METHODS A pretest-posttest control group design was used . Ninety-nine women with FMS were r and omly assigned to 1 of 3 groups ; 86 completed the study . The education only group received a 6-week self-management course . The education plus physical training group received the course and 6 h of training design ed to assist them to exercise independently . The control group got treatment after 3 months . RESULTS The experimental programs had a significant positive impact on quality of life and self-efficacy . Helplessness , number of days feeling bad , physical dysfunction , and pain in the tender points decreased significantly in one or both of the treated groups when retested 6 weeks after the end of the program . Longterm followup of 67 treated subjects showed significant positive changes on the Fibromyalgia Impact Question naire primarily in the physical training group . Among all subjects , 87 % were exercising at least 3 times/week for 20 min or more ; 46 % said they had increased their exercise level since participating in the program ; 70 % were practicing relaxation strategies as needed ; 46 % were working at least half time as opposed to 37 % at pretest . CONCLUSION Self-efficacy of the treated groups was enhanced significantly by the program . Other changes were smaller and more delayed than had been expected . Recommendations for future trials include a longer education program , more vigorous physical training , and longterm followup Objective . Increasing research interest and emerging new therapies for treatment of fibromyalgia ( FM ) have led to a need to develop a consensus on a core set of outcome measures that should be assessed and reported in all clinical trials , to facilitate interpretation of the data and underst and ing of the disease . This aligns with the key objective of the Outcome Measures in Rheumatology ( OMERACT ) initiative to improve outcome measurement through a data driven , interactive consensus process . Methods . Through patient focus groups and Delphi processes , working groups at previous OMERACT meetings identified potential domains to be included in the core data set . A systematic review has shown that instruments measuring these domains are available and are at least moderately sensitive to change . Most instruments have been vali date d in multiple language s. This pooled analysis study aims to develop the core data set by analyzing data from 10 r and omized controlled trials ( RCT ) in FM . Results . Results from this study provide support for the inclusion of the following in the core data set : pain , tenderness , fatigue , sleep , patient global assessment , and multidimensional function/health related quality of life . Construct validity was demonstrated with outcome instruments showing convergent and divergent validity . Content and criterion validity were confirmed by multivariate analysis showing R square values between 0.4 and 0.6 . Low R square value is associated with studies in which one or more domains were not assessed . Conclusion . The core data set was supported by high consensus among attendees at OMERACT 9 . Establishing an international st and ard for RCT in FM should facilitate future metaanalyses and indirect comparisons OBJECTIVE To compare the therapeutic effects of physical fitness training or biofeedback training with the results of usual care in patients with fibromyalgia ( FM ) . METHODS One hundred forty-three female patients with FM ( American College of Rheumatology criteria ) were r and omized into 3 groups : a fitness program ( n = 58 ) , biofeedback training ( n = 56 ) , or controls ( n = 29 ) . Half the patients in the active treatment groups also received an educational program aim ed at improving compliance . Assessment s were done at baseline and after 24 weeks . The primary outcome was pain [ visual analog scale ( VAS ) ] . Other endpoints were the number of tender points , total myalgic score ( dolorimetry ) , physical fitness , functional ability ( Arthritis Impact Measurement Scale and Sickness Impact Profile ) , psychological distress ( Symptom Checklist-90-Revised ) , patient global assessment ( 5 point scale ) , and general fatigue ( VAS ) . RESULTS Baseline scores were similar in all 3 groups . Altogether 25 ( 17.5 % ) patients dropped out ; they were similarly distributed over all groups : 14 patients after r and omization and 11 ( 8 % ) during the study . A true high impact level for fitness training was not attained by any patient . After treatment , no significant differences in change scores of any outcome were found between the groups ( ANOVA , p > 0.05 ) . All outcome measures showed large variations intra- and interindividually . The educational program did not result in higher compliance with training sessions ( 62 % vs 71 % ) . Analysis of the subgroup of subjects with a high attendance rate ( > 67 % ) also showed no improvement . CONCLUSION In terms of training intensity and maximal heart rates , the high impact fitness intervention had a low impact benefit . Therefore effectiveness of high impact physical fitness training can not be demonstrated . Thus compared to usual care , the fitness training ( i.e. , low impact ) and biofeedback training had no clear beneficial effects on objective or subjective patient outcomes in patients with FM 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 OBJECTIVES To compare the cognitive function performance in patients with fibromyalgia ( FM ) with respect healthy controls and to evaluate the short-term efficacy of exercise therapy in a warm , chest-high pool on pain and cognitive function in women with FM . METHODS Sixty middle-aged women with FM were r and omly assigned to either an exercise training group ( n = 35 ) to perform 3 sessions per week of aquatic training ( 32 degrees C ) including mobility , aerobic , strengthening , and relaxation exercises for 16 weeks , or a control group ( n = 25 ) . Twenty-five healthy women matched for age , weight , body mass index , and educational and physical activity levels were recruited .  Pain was assessed in patients using a syringe calibrated like a pressure dolorimeter , and a visual analog scale . The severity of FM was evaluated using the Fibromyalgia Impact Question naire . Cognitive function was measured in healthy individuals and patients using several st and ardized neuropsychological tests . All patients were measured at baseline and post-treatment . RESULTS At baseline , the healthy group evidence d cognitive performance that was significantly superior to the group of patients with FM in all of the neuropsychological tests . The exercise group significantly improved their pain threshold , tender point count , self-reported pain , severity of FM , and cognitive function , while in the control group the differences were not significant . CONCLUSION An exercise therapy three times per week for 16 weeks in a warm-water pool is an adequate treatment to decrease the pain and severity of FM well as to improve cognitive function in previously unfit women with FM and heightened painful symptomatology OBJECTIVE To compare the clinical effectiveness of aerobic exercise in the water with walking/jogging for women with fibromyalgia ( FM ) . METHODS Sixty sedentary women with FM , ages 18 - 60 years , were r and omly assigned to either deep water running ( DWR ) or l and -based exercises ( LBE ) . Patients were trained for 15 weeks at their anaerobic threshold .  Visual analog scale of pain , Fibromyalgia Impact Question naire ( FIQ ) , Beck Depression Inventory , Short Form 36 Health Survey ( SF-36 ) , and a patient 's global assessment of response to therapy ( PGART ) were measured at baseline , week 8 , and week 15 . Statistical analysis included all patients . RESULTS Four patients dropped out from each group . Both groups improved significantly at week 15 compared with baseline , with an average 36 % reduction in pain intensity . For PGART , 40 % of the DWR group and 30 % of the LBE group answered " much better " at posttreatment . FIQ total score and FIQ depression improvements in the DWR group were faster ( week 8) than the LBE group and kept improving ( week 15 ; P < 0.05 ) . Only the DWR group showed improvements in SF-36 role emotional ( P = 0.006 ) . No significant between-group differences were observed for peak oxygen uptake and other outcomes . CONCLUSION DWR is a safe exercise that has been shown to be as effective as LBE regarding pain . However , it has been shown to bring more advantages related to emotional aspects . Aerobic gain was similar for both groups , regardless of symptom improvement . Therefore , DWR could be studied as an exercise option for patients with FM who have problems adapting to LBE or lower limbs limitations 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 OBJECTIVE To determine the effects of moderate-intensity exercise training on self-rated ( subjective ) sleep quality among healthy , sedentary older adults reporting moderate sleep complaints . DESIGN R and omized controlled trial of 16 weeks ' duration . SETTING General community . PARTICIPANTS Volunteer sample of 29 women and 14 men ( of 67 eligible subjects ) aged 50 to 76 years who were sedentary , free of cardiovascular disease , and reported moderate sleep complaints . No participant was withdrawn for adverse effects . INTERVENTION R and omized to 16 weeks of community-based , moderate-intensity exercise training or to a wait-listed control condition . Exercise consisted primarily of four 30- to 40-minute endurance training sessions ( low-impact aerobics ; brisk walking ) prescribed per week at 60 % to 75 % of heart rate reserve based on peak treadmill exercise heart rate . MAIN OUTCOME MEASURE Pittsburgh Sleep Quality Index ( PSQI ) . RESULTS Compared with controls ( C ) , subjects in the exercise training condition ( E ) showed significant improvement in the PSQI global sleep score at 16 weeks ( baseline and posttest values in mean [ SD ] for C=8.93 [ 3.1 ] and 8.8 [ 2.6 ] ; baseline and posttest values for E=8.7 [ 3.0 ] and 5.4 [ 2.8 ] ; mean posttest difference between conditions=3.4 ; P<.001 ; 95 % confidence interval , 1.9 - 5.4 ) , as well as in the sleep parameters of rated sleep quality , sleep-onset latency ( baseline and posttest values for C=26.1 [ 20.0 ] and 23.8 [ 15.3 ] ; for E=28.4 [ 20.2 ] and 14.6 [ 13.0 ] ; net improvement=11.5 minutes ) , and sleep duration baseline and posttest scores for C=5.8 [ 1.1 ] and 6.0 [ 1.0 ] ; for E=6.0 [ 1.1 ] and 6.8 [ 1.2 ] ; net improvement=42 minutes ) assessed via PSQI and sleep diaries ( P=.05 ) . CONCLUSIONS Older adults with moderate sleep complaints can improve self-rated sleep quality by initiating a regular moderate-intensity exercise program OBJECTIVE To evaluate the effect of exercise on mood and physical function in individuals with fibromyalgia . METHODS Subjects were r and omly assigned to an exercise ( EX ) or control ( CTL ) group . EX subjects participated in 3 30-minute exercise classes per week for 23 weeks . Subjects were tested at entry and at 6 , 12 , and 23 weeks . Tests included the Beck Depression Inventory ( BDI ) , 6-minute walk , State-Trait Anxiety Inventory ( STAI ) , Mental Health Inventory ( MHI ) , Fibromyalgia Impact Question naire ( FIQ ) , Arthritis Self-Efficacy Scale ( ASES ) , and a measure of tender points and knee strength . RESULTS Fifty subjects ( 27 EX , 23 CTL ) completed the study , and 31 ( 15 EX , 16 CTL ) met criteria for efficacy analyses . In efficacy analyses , significant improvements were seen for EX subjects in 6-minute walk distances , BDI ( total , cognitive/ affective ) , STAI , FIQ , ASES , and MHI ( 3 of 5 subscales ) scores . These effects were reduced but remained during intent-to-treat analyses . CONCLUSION Exercise can improve the mood and physical function of individuals with fibromyalgia PURPOSE To evaluate the effects of a 12-wk period of aquatic training and subsequent detraining on health-related quality of life ( HRQOL ) and physical fitness in females with fibromyalgia . METHODS Thirty-four females with fibromyalgia were r and omly assigned into two groups : an exercise group , who exercised for 60 min in warm water , three times a week ( N = 17 ) ; and a control group , who continued their habitual leisure-time activities ( N = 17 ) . HRQOL was assessed using the Short Form 36 question naire and the Fibromyalgia Impact Question naire . Physical fitness was measured using the following tests : Canadian Aerobic Fitness , h and grip dynamometry , 10-m walking , 10-step stair climbing , and blind one-leg stance . Outcomes were measured at baseline , after treatment , and after 3 months of detraining . RESULTS After 12 wk of aquatic exercise , significant positive effects of aquatic training were found in physical function , body pain , general health perception , vitality , social function , role emotional problems and mental health , balance , and stair climbing . After the detraining period , only the improvements in body pain and role emotional problems were maintained . CONCLUSION The present water exercise protocol improved some components of HRQOL , balance , and stair climbing in females with fibromyalgia , but regular exercise and higher intensities may be required to preserve most of these gains OBJECTIVE To assess the impact of a long-term exercise programme vs usual care on perceived health status , functional capacity and depression in patients with fibromyalgia . DESIGN R and omized controlled trial . SUBJECTS Forty-two women with fibromyalgia were allocated r and omly to 1 of 2 groups : an experimental group that carried out aerobic , strength and flexibility exercises for 24 weeks and a usual care control group . METHODS Health status and functional capacity were evaluated using the Fibromyalgia Impact Question naire and the Short Form Health Survey 36 . Depression was evaluated with the Beck Depression Inventory . RESULTS Significant improvements were observed in health status and functional capacity for the exercise group over the control group . The magnitude of the effect size of these improvements , expressed as Cohen 's d , was medium . The effect size ( 95 % confidence interval ) for the Fibromyalgia Impact Question naire was 0.58 ( -14.12 , -2.35 ) , for the Short Form Health Survey 36 . global score 0.54 ( 1.28 , 14.52 ) , and in the mental health domain of the Short Form Health Survey 36 . 0.51 ( 1.20 , 16.26 ) . There was a large effect size in vitality . All the aforementioned improvements can be considered as clinical ly important changes . CONCLUSION Results confirm that a long-term combination of aerobic exercise , strengthening and flexibility improves psychological health status and health-related quality of life in patients with fibromyalgia OBJECTIVE This study assessed the effect of 2 physiotherapy programs design ed to improve flexibility and to reduce the impact of the illness and pain perception in women with the fibromyalgia syndrome ( FMS ) , and compared the effects of the 2 programs in the short and intermediate term . METHODS Twenty FMS patients were r and omly assigned to 2 training groups , one following a program of kinesiotherapy and active muscular stretching and one using techniques of Global Myofascial Physiotherapy , according to the Mézières method . Both groups met twice a week for 12 weeks , for a total of 150 minutes each week . Flexibility and illness impact were measured by means of a st and ard test , whereas pain was assessed by means of thumb palpation . Measurements were taken at the beginning and end of the program and 24 weeks after its end . RESULTS Patients had achieved a statistically significant reduction in the severity of the disease and improved their flexibility level by the end of the program , but had returned to initial values after follow-up . Significant differences were not observed between the 2 treatment groups in the initial values or in the results at the end of the program or after the follow-up , so neither program proved better than the other . CONCLUSION The FMS patients in this study improved their flexibility level and general well-being using both kinesiotherapy and stretching exercises techniques OBJECTIVE To compare a supervised 12-week aerobic exercise class with unsupervised home aerobic exercises in the treatment of patients with fibromyalgia . METHODS This was a 48-week r and omized single ( observer ) blind study in a teaching hospital rheumatology and physiotherapy department . The subjects were 74 patients who fulfilled the American College of Rheumatology criteria for fibromyalgia . Results and conclusions . A 12-week exercise class programme with home exercises demonstrated no benefit over a single physiotherapy session with home exercises in the treatment of pain in patients with fibromyalgia . Neither group ( nor the groups combined ) showed an improvement in pain compared with baseline . There was some significant benefit in psychological well-being in the exercise class group and perhaps a slowing of functional deterioration in this group 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 OBJECTIVE To investigate prognostic factors in the course of the fibromyalgia syndrome ( FM ) from baseline to post-treatment . METHODS Fifty-seven patients with FM were examined in a r and omized intervention study . Pre-treatment variables were entered into linear regression analyses : gender , age , duration of disease , allocation to treatment , pain distribution ( based on a patient-made drawing ) , fatigue , sleep disturbance , and depressed mood ( based on visual analog scores ) , with pain distribution at treatment completion as the dependent variable . RESULTS Depressed mood at baseline was a significant predictor of sustained widespread pain at treatment completion . CONCLUSION The findings indicate a role for depressed mood as a predictive factor for treatment response Abstract : Fibromyalgia ( FM ) is a disorder characterised by diffuse widespread musculoskeletal aching and stiffness and multiple tender points [ 1 ] . Its pathophysiology is poorly understood . The influence of aerobic endurance exercise on pain in patients with FM was investigated . Twenty-seven patients ( 25 female , 2 male ) participated in a controlled clinical study and performed 12 weeks of jogging , walking , cycling or swimming following a given schedule .  Twelve sedentary FM patients ( 11 female , 1 male ) served as controls . Before and after training both the study and the control groups were evaluated spiroergometrically .  Tender point pain was quantified by dolorimetry . The painful body surface was estimated by a pain body diagram , and its intensity by a visual analogue scale and a ranking scale . Patients trained for an average of 25 min two to three times a week , with an average intensity of 50 % of maximal oxygen uptake ( VO2max ) . Unlike the control group , the training group exhibited a decrease in heart rate and VO2 and an increase in respiratory quotient during submaximal workload . Maximal performance capacity and VO2max remained unchanged , whereas the wattpulse ( watt/heart rate ) improved at maximal workload . Pain parameters remained unchanged in the control group , but in the training group the mean number of positive tender points ( 15.4/12.7 ) , the mean pain threshold of the gluteal tender point ( 2.89 kp/3.50 kp ) and the painful body surface ( 18%/15 % body surface ) decreased significantly . Subjective general pain condition deteriorated in two patients but improved in 17 . Our results suggest a positive effect of aerobic endurance exercise on fitness and well-being in patients with FM BACKGROUND Hamstring strains are the most common soft-tissue injury observed in recreational and athletic activities , yet no consensus exists regarding appropriate primary and secondary strategies to prevent these strains . Eccentric exercise has been reported to reduce the incidence of ham-string strains but its role has not been clearly defined . OBJECTIVE The objective of this systematic review was to determine the effectiveness of eccentric exercise in preventing hamstring strains . DATA SOURCES Online data bases , including MED-LINE , PubMed , CINAHL , PEDro , SPORTD iscus , EMBASE , Cochrane Data base of Systematic Review s , Cochrane Central Register of Controlled Trials , and Web of Science were search ed for relevant articles . Each data base was search ed from the earliest date to July 2007 . STUDY SELECTION Selection criteria included diagnosis of hamstring strain , otherwise healthy individuals , and at least one group receiving an eccentric exercise intervention . Seven articles { three r and omized controlled trials ( RCTs ) and four cohort studies } met the inclusion criteria . DATA EXTRACTION Data were extracted using a customized form . Method ological rigor of included studies was assessed using the PEDro scale and Oxford Centre for Evidence -based Medicine Levels of Evidence . DATA SYNTHESIS STUDIES WERE GROUPED BY ECCENTRIC EXERCISE INTERVENTION PROTOCOL : hamstring lowers , isokinetic strengthening , and other strengthening . A best- evidence synthesis of pooled data was qualitatively summarized . CONCLUSIONS Findings suggest that eccentric training is effective in primary and secondary prevention of hamstring strains . Study heterogeneity and poor method ological rigor limit the ability to provide clinical recommendations . Further RCTs are needed to support the use of eccentric training protocol s in the prevention of hamstring strains 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 OBJECTIVES The aim of this study was to analyze the effect of 12-week tilting Whole Body Vibration therapy ( WBV ) on Health Related Quality of Life ( HRQoL ) in fibromylagia ( FM ) within the context of a r and omized control trial ( IS RCT N16950947 ) . SUBJECTS AND METHODS Thirty-six ( 36 ) women with FM were r and omly allocated to either an exercise or a control group . The women in the exercise group were assigned to a 12-week course of tilting WBV ( 12.5-Hz frequency ; 3-mm amplitude ) . HRQoL was assessed using the Fibromyalgia Impact Question naire ( FIQ ) and a 15D question naire . RESULTS A 12-week course of tilting WBV therapy was associated with improvements in FIQ scores ( 12 % ) but not in the 15D question naire . CONCLUSIONS Tilting WBV was a feasible intervention that prevented the loss of HRQoL in previously physically untrained women with FM OBJECTIVE To compare in a pilot study the effect of two physical therapies , the Mensendieck system ( MS ) and body awareness therapy ( BAT ) according to Roxendal , in fibromyalgia patients and to investigate differences in effect between the two interventions . METHODS Twenty female patients were r and omized to either MS or BAT in a program lasting 20 weeks . Evaluations were tender point examination and question naires , including visual analog scales ( pain intensity at worst site , muscular stiffness , evening fatigue , and global health ) , Fibromyalgia Impact Question naire ( FIQ ) , Coping Strategies Question naire , Quality of Life Scales , Arthritis Self-Efficacy Scale ( ASES ) , and disability before , immediately after , and at 6 and 18 months follow-up . RESULTS The BAT group had improved global health at 18 months follow-up , but lower results than the MS group . The MS group had improved FIQ , ASES other symptoms , and pain at worst site at 18 months follow-up . CONCLUSION In the present pilot study , MS was associated with more positive changes than BAT Background : In a 12-week r and omized controlled trial of the effects of lifestyle physical activity ( LPA ) on symptoms and function among adults with fibromyalgia , we found that  LPA participants increased their average daily step count by 54 % , improved their self-reported functioning by 18 % , and reduced their pain by 35 % . Objectives : The objective of the study was to evaluate the intermediate ( 6 months ) and long-term ( 12 months ) effects of the LPA intervention on outcomes . Methods : Participants completed follow-up assessment s of physical activity , pain , fibromyalgia-related function , fatigue , depression , number of tender points , 6-minute walk test , and perceived improvement at 6 and 12 months after intervention . Results : Of the 73 participants who completed the 12-week trial , 53 ( 73 % ) completed both the 6- and 12-month follow-up . Although the LPA participants reported greater perceived improvement at each follow-up , they did not differ from controls on pain , physical activity , tenderness , fatigue , depression , or the 6-minute walk test . Self-reported functioning declined markedly at follow-up for the LPA participants . Conclusions : Although participants reported greater perceived improvement at each assessment , the beneficial effects of LPA on physical activity , function , and pain found after the 12-week intervention were not sustained over time . This recidivism is seen in studies of activity and exercise in nearly any condition , and innovative methods that may prevent this are a focus of future studies Objective : To evaluate the effects of a community patient education -exercise programme , using a cognitive-behavioural approach , for people with fibromyalgia . Design : A r and omized , parallel group trial with assessment s at 0 , 4 and 8 months . Setting : Community leisure centres . Subjects : People with fibromyalgia ( n=183 ) attending a rheumatology outpatient department at a large district general hospital . Interventions : Participants were r and omized to a patient education-exercise group ( n=97 ) or relaxation ( attention control ) group ( n=86 ) . Main measures : The Fibromyalgia Impact Question naire ( 0 - 80 ; lower score means better health ) . Secondary outcomes included : the Arthritis Self-Efficacy Scale(pain and other symptoms subscales : 1 -10 scale ; higher scores mean greater self-efficacy ) and self-reported improvement . Results : Fifty participants withdrew or were unable to attend and 133 completed and returned baseline question naires : patient education group  ( n=71 ) ; relaxation group ( n=62 ) ; 120/133 participants were women . Average age was 48 . 53 ( SD 10.89 ) years . Follow-up ranged between 73 and 82 % of question naires returned . At four months , there was a difference in average changes in total Fibromyalgia Impact Question naire scores between the two groups : patient education group -3.38 ( SD 9.35 ) ; relaxation group 0.3 ( SD 8.85 ) ; P=0.02 . Arthritis Self-Efficacy Scale scores were significantly higher in the patient education group : pain 0.59 ( SD 1.45)compared to the relaxation group ’s -0.12 ( SD 1.22 ) ; P=0.003 ; other symptoms ( patient education group 0.72 ( SD 1.33 ) ; relaxation group 0.03 ( SD 1.16 ) ; P=0.002 ) . At eight months these differences were no longer apparent . Forty-seven per cent in the patient education group self-reported improvement compared with 13 % in the relaxation group ( ϰ=13.65 ; P=0.0001 ) . Conclusion : Short-term improvements result ed from the education -exercise programme but were not sustained . Appropriate selection may improve efficacy OBJECTIVES This study evaluated the effectiveness of a 6-week " usual care " exercise program supplemented with whole-body vibration ( WBV ) to improve balance and strength in women with fibromyalgia ( FM ) . DESIGN This was a r and omized controlled study . SETTING S The setting was a physical therapy department in an academic setting . SUBJECTS The subjects were 30 postmenopausal women with FM ( age : 59±7.90 years ) . INTERVENTIONS Subjects were r and omized into one of two groups : an experimental group ( EG : n=15 ) , which combined exercise training ( 2 days a week ) with 3 days of WBV , and a control group ( CG : n=15 ) , who performed the same exercise training program ( 2 days a week ) but without WBV . OUTCOME MEASURES Balance and muscle strength were measured at baseline and after the 6-week intervention . RESULTS Significant differences were found ( p<0.05 ) between the study groups for the Medio-Lateral Stability Index ( MLSI ) , when patients were assessed with their eyes open and closed . The effect size of the improvement was large with eyes closed ( R2=0.260 ) and moderate when the eyes were open ( R2=0.047 ) . However , no significant differences were found ( p>0.05 ) between the study groups for other outcomes . CONCLUSIONS Women with FM may increase their MLSI by engaging in a 6-week traditional exercise program with supplementary WBV . This may have implication s for falls prevention in this patient group
target: There were no statistically significant differences in attrition rates between the interventions .
  In general , adverse effects were poorly recorded , but no serious adverse effects were reported .
  The evidence ( rated as low quality ) suggested that moderate- and moderate- to high-intensity resistance training improves multidimensional function , pain , tenderness , and muscle strength in women with fibromyalgia .
  The evidence ( rated as low quality ) also suggested that eight weeks of aerobic exercise was superior to moderate-intensity resistance training for improving pain in women with fibromyalgia .
  There was low- quality evidence that 12 weeks of low-intensity resistance training was superior to flexibility exercise training in women with fibromyalgia for improvements in pain and multidimensional function .
  There was low- quality evidence that women with fibromyalgia can safely perform moderate- to high-resistance training
background: BACKGROUND Fibromyalgia is characterized by chronic widespread pain that leads to reduced physical function .
  Exercise training is commonly recommended as a treatment for management of symptoms .
  We examined the literature on resistance training for individuals with fibromyalgia .
  Resistance training is exercise performed against a progressive resistance with the intention of improving muscle strength , muscle endurance , muscle power , or a combination of these .
  OBJECTIVES To evaluate the benefits and harms of resistance exercise training in adults with fibromyalgia .
  We compared resistance training versus control and versus other types of exercise training .