Muscle stretching exercises and resistance training in fibromyalgia: which is better? A three-arm randomized controlled trial

BACKGROUND: Exercise therapy is an effective component of fibromyalgia (FM) treatment. However, it is important to know the effects and specificities of the different types of exercise: muscle stretching and resistance training. AIM: To verify and compare the effectiveness of muscle stretching exercise and resistance training for symptoms and quality of life in FM patients. DESIGN: Randomized controlled trial. SETTING: Physical therapy service, FM outpatient clinic. POPULATION: Forty-four women with FM (79 screened). METHODS: Patients were randomly allocated into a stretching group (N.=14), resistance group (N.=16), and control group (N.=14). Pain was assessed using the visual analog scale, pain threshold using a Fischer dolorimeter. FM symptoms using the Fibromyalgia Impact Questionnaire (FIQ), and quality of life using the Medical Outcomes Study 36-item Short-Form Health Survey (SF-36). The three intervention groups continued with usual medical treatment. In addition, the stretching and resistance groups performed two different exercise programs twice a week for 12 weeks. RESULTS: After treatment, the stretching group showed the highest SF-36 physical functioning score (P=0.01) and the lowest bodily pain score (P=0.01). The resistance group had the lowest FIQ depression score (P=0.02). The control group had the highest score for FIQ morning tiredness and stiffness, and the lowest score for SF-36 vitality. In clinical analyses, the stretching group had significant improvement in quality of life for all SF-36 domains, and the resistance group had significant improvement in FM symptoms and in quality of life for SF-36 domains of physical functioning, vitality, social function, emotional role, and mental health. CONCLUSIONS: Muscle stretching exercise was the most effective modality in improving quality of life, especially with regard to physical functioning and pain, and resistance training was the most effective modality in reducing depression. CLINICAL REHABILITATION IMPACT: The trial included a control group and two intervention groups, both of which received exercise programs created specifically for patients with FM. In clinical practice, we suggest including both modalities in an exercise therapy program for FM.