Strengthening exercises using swiss ball improve pain, health status, quality of life and muscle strength in patients with fibromyalgia: a randomized controlled trial

  • J.S. Arakaki | Universidade Federal de São Paulo - UNIFESP, São Paulo, Brazil.
  • F. Jennings Universidade Federal de São Paulo - UNIFESP, São Paulo, Brazil.
  • G.Q. Estrela Universidade Federal de São Paulo - UNIFESP, São Paulo, Brazil.
  • V.d.G. Cruz Martinelli Universidade Federal de São Paulo - UNIFESP, São Paulo, Brazil.
  • J. Natour Universidade Federal de São Paulo - UNIFESP, São Paulo, Brazil.


The aim was to evaluate the effectiveness of strengthening exercises using the Swiss ball in patients with fibromyalgia through a randomized controlled trial with intention to treat analyses. A total of 60 patients with fibromyalgia met the inclusion criteria and were randomly allocated to either the Swiss ball exercise group (n=30) or a stretching group (n=30). All patients participated in 40-minute training sessions 3 times per week for 12 weeks. Pain (Visual Analogue Scale 0-100); muscle strength (One Repetition Maximum test); health status (Fibromyalgia Impact Questionnaire Revised); quality of life (Short Form-36 questionnaire) were evaluated at baseline, and after 6 and 12 weeks of training. The Swiss ball group showed a statistically significant improvement in VAS (0-100) (p<0.001), SF-36 (p<0.05) and Fibromyalgia Impact Questionnaire (p<0.001) compared with the stretching group. The results of this study proved that the treatment for fibromyalgia with strengthening exercises and the use of the Swiss ball led to improvement of pain, quality of life, muscle strength and decreased the need for medications for this disease compared to stretching exercises, without negative effects.



PlumX Metrics


Download data is not yet available.


Puttini-Sarzi P, Giorgi V, Marotto D, Atzeni F. Fibromyalgia: an update on clinical characteristics, aetiopathogenesis and treatment. Nat Rev Rheumatol. 2020; 16: 645-60. DOI:

Macfarlane GJ, Kronisch C, Dean LE, et al. EULAR revised recommendations for the management of fibromyalgia. Ann Rheum Dis. 2017; 76; 318-28. DOI:

Busch AJ, Webber SC, Richards RS, et al. Resistance exercise training for fibromyalgia. Cochrane Database of Syst Rev. 2013; 12: 1-115. DOI:

Cazzola M, Atzeni F, Salaffi F, Stisi S, Cassisi G, Sarzi-Puttini P. Which kind of exercise is best in fibromyalgia therapeutic programmes? A practical review. Clin Exp Rheumatol. 2010; 28; 117-24.

Craig C. Pilates on the ball. 2th Ed. Phorte; 2005. pp 1-177.

Kim M-K .The effects of trunk stabilization exercise using a Swiss ball in the absence of visual stimulus on balance in the elderly. J Phys Ther Sci. 2016; 28: 2144-47. DOI:

Wolfe F, Smythe HA, Yunus MB, et al. The American College of Rheumatology Criteria for the Classification of Fibromyalgia. Report of the Multicenter Criteria Committee. Arthritis Rheum. 1990; 33: 160-72. DOI:

Hawker GA, Mian S, Kendzerska T, French M. Measures of adult pain: Visual Analog Scale for Pain (VAS Pain), Numeric Rating Scale for Pain (NRS Pain), McGill Pain Questionnaire (MPQ), Short-Form McGill Pain Questionnaire (SF-MPQ), Chronic Pain Grade Scale (CPGS), Short Form-36 Bodily Pain Scale (SF-36 BPS), and Measure of Intermittent and Constant Osteoarthritis Pain (ICOAP). Arthrits Care (Hoboken). 2011; 63: 240-52. DOI:

Paiva ES, Heymann RE, Rezende MC, et al. A Brazilian Portuguese version of the Revised Fibromyalgia Impact Questionnaire (FIQR): a validation study. Clin Rheumatol. 2013; 8; 199-206. DOI:

Fleck SJ, Kraemer JW. Designing resistance training programs. Human Kinetics 2004; 13-375.

Hoffman DL, Dukes E M. The health status burden of people with fibromyalgia: a review of studies that assessed health status with the SF-36 or the SF-12. Int J Clin Pract. 2008; 62: 115-26.

Santos E, Campos MA, Párraga-Montilla JA, et al. Effects of a functional training programme in patients with Fibromyalgia: A 9-years prospective longitudinal cohort study. Scand J Med Sci Sports. 2020; 10: 1111.

Hagen KB, Dagfinrud H, Moe RH, et al. Exercise therapy for bone and muscle health: an overview of systematic reviews. BMC Med. 2012; 10: 1-11. DOI:

D'Souza RS, Lin G, Oh T, et al. Fibromyalgia Symptom Severity and Psychosocial Outcomes in Fibromyalgia Patients with Hypovitaminosis D: A Prospective Questionnaire Study. Pain Med. 2020; 21: 3470-8. DOI:

Correa-Rodríguez M, Jamal E, Mansouri-Yachou, et al. The Association of Body Mass Index and Body Composition with Pain, Disease Activity, Fatigue, Sleep and Anxiety in Women with Fibromyalgia. Nutrients 2019; 27: 1193. DOI:

Valkeinen H, Alén M, Häkkinen A, et al. Effects of concurrent strength and endurance training on physical fitness and symptoms in postmenopausal women with fibromyalgia: a randomized controlled trial. Arch Phys Med Rehabil 2008; 89: 1660-6. DOI:

Jones KD, Burckhardt CS, Clark SR, et al. A randomized controlled trial of muscle strengthening versus flexibility training in fibromyalgia. J Rheumatol. 2002; 29: 1041-8.

Sosa-Reina MD, Nunez-Nagy S, Gallego-Izquierdo T, et al. Effectiveness of Therapeutic Exercise in Fibromyalgia Syndrome: A Systematic Review and Meta-Analysis of Randomized Clinical Trials. Biomed Res Int. 2017; 2356346; 1-4. DOI:

Kingsley JD, McMillan V, Figueroa A. The effects of 12 weeks of resistance exercise training on disease severity and autonomic modulation at rest and after acute leg resistance exercise in women with fibromyalgia. Arch Phys Med Rehabil. 2010; 91; 1551-7. DOI:

Häkkinen K, Pakarinen A, Hannonen P, et al. Effects of strength training on muscle strength, cross-sectional area, maximal electromyographic activity, and serum hormones in premenopausal women with fibromyalgia. J Rheumatol. 2002; 29: 1287-95.

Kingsley JD, Panton LB, Toole T, et al. The effects of a 12-week strength-training program on strength and functionality in women with fibromyalgia. Arch Phys Med Rehabil. 2005; 86: 1713-21. DOI:

Bircan C, Karasel SA, Akgün B, et al. Effects of muscle strengthening versus aerobic execise program in fibromyalgia. Rheumatol Int. 2008; 28: 527-32. DOI:

Haskell WL, Lee IM, Pate RR, et al. Physical activity and public health: updated recommendation for adults from the American College of Sports Medicine and the American Heart Association. Med Sci Sports Exerc. 2007; 39: 1423-34. DOI:

American College of Sports Medicine. American College of Sports Medicine position stand. Progression models in resistance training for healthy adults. Med Sci Sports Exerc. 2009; 41: 687-08. DOI:

Lehman GJ, Gordon T, Langley J, et al. Replacing a Swiss ball for an exercise bench causes variable changes in trunk muscle activity during upper limb strength exercises. Dyn Med. 2005; 3: 4-6. DOI:

Sekendiz B, Cuğ M, Korkusuz F. Effects of Swiss-ball core strength training on strength, endurance, flexibility, and balance in sedentary women. J Strength Cond Res. 2010; 24: 3032-40. DOI:

Escamilla RF, Lewis C, Bell D, et al. Core muscle activation during Swiss ball and traditional abdominal exercises. J Orthop Sports Phys Ther. 2010; 40: 265-76. DOI:

Rooks DS, Silverman CB, Kantrowitz FG. The effects of progressive strength training and aerobic exercise on muscle strength and cardiovascular fitness in women with fibromyalgia: A pilot Study. Arthritis Rheum. 2002; 47: 22-8. DOI:

Hoeger Bement MK, Weyer A, Hartley S, et al. Pain perception after isometric exercise in women with fibromyalgia. Arch Phys Med Rehabil. 2011; 92: 89-95. DOI:

Swiss ball, strengthening exercise, stretching exercise, non pharmacological therapy.
  • Abstract views: 326

  • PDF: 275
How to Cite
Arakaki, J., Jennings, F., Estrela, G., Cruz Martinelli, V., & Natour, J. (2021). Strengthening exercises using swiss ball improve pain, health status, quality of life and muscle strength in patients with fibromyalgia: a randomized controlled trial. Reumatismo, 73(1), 15-23.