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The objective of this study was to determine the effects of a 3-month Biodanza intervention in women with fibromyalgia (FM). This was a controlled trial. The study was conducted at a university research laboratory and social center. The study comprised 59 women with FM recruited from a local association of patients with FM. Participants were allocated to the Biodanza intervention group (n = 27) or usual-care group (n = 32). The Biodanza intervention was carried out once a week for 3 months. The outcome measures included the following: Pain threshold, body composition (body-mass index and estimated body fat percentage), physical fitness (30-second chair stand, handgrip strength, chair sit and reach, back scratch, blind flamingo, 8 feet up and go, and 6-minute walk test) and psychologic outcomes (Fibromyalgia Impact Questionnaire [FIQ], Short-Form Health Survey 36, Vanderbilt Pain Management Inventory, Hospital Anxiety and Depression Scale, General Self-Efficacy Scale, and Rosenberg Self-Esteem Scale). We observed a significant interaction effect (group*time) for pain threshold of several tender points (left [L] and right [R] side of the anterior cervical and supraspinatus, trapezius L and lateral epicondyle R, algometer score, tender points count), body fat percentage, and FIQ total score. In the intervention group, post hoc analysis revealed a significant improvement in pain threshold of the anterior cervical R and L and supraspinatus R and L tender points (all p < 0.05), algometer score (p = 0.008), tender point count (p = 0.002), body fat percentage (p = 0.001), and FIQ total score (p = 0.003). A 3-month (one session per week) Biodanza intervention shows improvements on pain, body composition, and FM impact in female patients.
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Efficacy of Biodanza for Treating Women
with Fibromyalgia
Ana Carbonell-Baeza, PhD,
Virginia A. Aparicio, BSc,
Clelia M. Martins-Pereira, BSc,
Claudia M. Gatto-Cardia, BSc,
Francisco B. Ortega, PhD,
Francisco J. Huertas, BSc,
Pablo Tercedor, PhD,
Jonatan R. Ruiz, PhD,
and Manuel Delgado-Fernandez, PhD
Objective: The objective of this study was to determine the effects of a 3-month Biodanza intervention in women
with fibromyalgia (FM).
Design: This was a controlled trial.
Setting/location: The study was conducted at a university research laboratory and social center.
Subjects: The study comprised 59 women with FM recruited from a local association of patients with FM.
Participants were allocated to the Biodanza intervention group (n¼27) or usual-care group (n¼32).
Intervention: The Biodanza intervention was carried out once a week for 3 months.
Outcome measures: The outcome measures included the following: Pain threshold, body composition (body–
mass index and estimated body fat percentage), physical fitness (30-second chair stand, handgrip strength, chair
sit and reach, back scratch, blind flamingo, 8 feet up and go, and 6-minute walk test) and psychologic outcomes
(Fibromyalgia Impact Questionnaire [FIQ], Short-Form Health Survey 36, Vanderbilt Pain Management In-
ventory, Hospital Anxiety and Depression Scale, General Self-Efficacy Scale, and Rosenberg Self-Esteem Scale).
Results: We observed a significant interaction effect (group*time) for pain threshold of several tender points (left
[L] and right [R] side of the anterior cervical and supraspinatus, trapezius L and lateral epicondyle R, algometer
score, tender points count), body fat percentage, and FIQ total score. In the intervention group, post hoc analysis
revealed a significant improvement in pain threshold of the anterior cervical R and L and supraspinatus R and L
tender points (all p<0.05), algometer score ( p¼0.008), tender point count ( p¼0.002), body fat percentage
(p¼0.001), and FIQ total score ( p¼0.003).
Conclusions: A 3-month (one session per week) Biodanza intervention shows improvements on pain, body
composition, and FM impact in female patients.
Fibromyalgia (FM) is a chronic diffuse pain condition that
probably results from abnormal central pain proces-
The symptoms most frequently associated are pain,
fatigue, stiffness, sleep disturbance, anxiety, depression, and
cognitive difficulties.
The level of psychologic distress is
higher in patients with FM compared to patients with other
pain syndromes.
Likewise, women with FM reported poorer
emotional and physical health and lower positive affect than
other patients with chronic pain.
Overall, patients with FM
report a high impact on their quality of life.
Diagnosis and treatment of FM is a complicated and con-
troversial process, but successful management of the disor-
der is possible.
The two most common nonpharmacological
FM treatments are physical exercise and educational–
psychologic programs, which are increasingly recommended
for the treatment of patients with FM.
During the last de-
cade, physical interventions such as water-based exercise,
aerobics, strength training, or a multidisciplinary approach
have been extensively used for the treatment of FM. Less is
known, however, about the efficacy of complementary and
alternative therapies. Patients with FM are prone to use
complementary and alternative therapies, despite the fact
Department of Physical Activity and Sports, School of Sport Sciences, University of Granada, Granada, Spain.
Department of Physiology, University of Granada, Granada, Spain.
Unit for Preventive Nutrition, Department of Biosciences and Nutrition, Karolinska Institutet, Huddinge, Sweden.
Universidade Federal De Paraı
´ba, Paraiba, Brazil.
Volume 16, Number 11, 2010, pp. 1191–1200
ªMary Ann Liebert, Inc.
DOI: 10.1089/acm.2010-0039
that there currently is no conclusive evidence about the ef-
fects of these therapies in FM.
‘Rolando Toro’s Biodanza’’ is a therapeutic strategy of
human development and growth that uses music, move-
ment, and emotions to induce integrative living experiences
or vivencias to group participants.
Vivencia is a concept
borrowed from the German Erlebnis meaning a vivid, in-
tensely felt moment in the ‘‘here-and-now.’’ Connections and
interactions with self, partners, and the group are also en-
couraged to improve participants’ health, well-being, vital-
ity, and joy.
Since Biodanza is an integrative dance therapy that com-
bines motor, sensory, and affective exercises performed at
low intensity/speed, it can be hypothesized that this com-
plementary approach may have positive effects in persons
with FM. The purpose of the present controlled trial was to
determine the effects of a 3-month Biodanza intervention,
carried out once a week, on pain, body composition, physical
fitness, and psychologic outcomes in women with FM.
Materials and Methods
Study participants
We contacted a total of 255 Spanish female members from
a local association of patients with FM (Granada, Spain).
Seventy-nine (79) potentially eligible patients responded,
and gave their written informed consent after receiving de-
tailed information about the aims and study procedures. The
inclusion criteria were (1) meeting the American College of
Rheumatology criteria: Widespread pain for more than 3
months, and pain with 4 kg/cm of pressure reported for 11
or more of 18 tender points
; (2) not to have other severe
somatic or psychiatric disorders, or other diseases that pre-
vent physical loading. A total of 7 patients were not included
in the study because they did not have 11 of the 18 tender
points. After the baseline measurements, 1 patient refused to
participate due to incompatibility with job schedule. There-
fore, a final sample of 71 women with FM participated in the
study. The study flow of patients is presented in Figure 1.
Patients were not engaged in regular physical activity >20
minutes on >3 days/week.
Study design
The present study was a controlled trial with participants
assigned to either the intervention (n¼37) or to the usual-
care (control) group (n¼34). For practical and ethical rea-
sons, it was not possible to randomize the patients. We had
an ethical obligation with the association of patients with FM
(Granada, Spain) to provide treatment to all patients willing
to participate in the study, but due to limitation of resources,
we created a waiting list. Patients from the waiting list
agreed to be part of the usual-care group (control group) and
were offered the intervention program at the end of the
follow-up period. Data collected only during the control
period were included in the current analysis.
FIG. 1. Flow of patients throughout the trial.
The research protocol was reviewed and approved by the
Ethics Committee of the Hospital Virgen de las Nieves (Gran-
ada, Spain). The study was developed between January 2008
and June 2009, following the ethical guidelines of the De-
claration of Helsinki, last modified in 2000.
The program consisted of 12 sessions (one per week). Each
session lasted 120 minutes and was divided into two parts:
(1) a verbal phase of 35–45 minutes. In the first sessions,
theoretical information about the program was provided,
and from the third session on, participants (seated in circle)
were encouraged to express their feelings and to share with
the group their experiences from the previous sessions; (2)
the vivencia (living experience) itself (75–80 minutes), which
involves moving/dancing according both to the suggestion
given by the facilitator and the music played. The move-
ments should express the emotions elicited by the songs
(*12) as well as be a response to other peers’ presence,
proximity, and feedback. Dances were performed in three
different ways: (1) individually, (2) in pairs, (3) and with the
whole group. The exercises proposed in each living experi-
ence were chosen according to the objective of the session
and belong to five main groups: Vitality, sexuality, creativity,
affectivity, and transcendence. Intervention intensity was
controlled by the rate of perceived exertion (RPE) based on
Borg’s conventional (6–20-point) scale. The medium values
of RPE were 11 1. These RPE values correspond to a sub-
jective perceived exertion of ‘‘fairly light exertion,’’ that is,
low intensity.
The Biodanza intervention took place once a week due to
the fact that participants may feel these living experiences
(vivencias) so intensely that they need at least 1 week to as-
similate/integrate these experiences. Participants in the
usual-care group were asked not to change their activity
levels and medications during the 12-week intervention
Pre- and postintervention assessment were carried out on
2 separate days with at least 48 hours between each session.
This was done in order to prevent patients’ fatigue and flare-
ups (acute exacerbation of symptoms). The assessment of the
tender-points, blind flamingo test, chair stand test, and
psychologic outcomes were completed on the first visit. Body
composition and the chair sit and reach, back scratch, 8 feet
up & go, handgrip strength, and 6-minute walk tests were
done on the second day.
Tender points
We assessed 18 tender points according to the American
College of Rheumatology criteria for classification of FM
using a standard pressure algometer (EFFEGI, FPK 20,
The mean of two successive measurements at each
tender point was used for the analysis. Tender point scored
as positive when the patient noted pain at pressure of 4 kg/
or less. The total count of such positive tender points
was recorded for each participant. The algometer score was
calculated as the sum of the minimum pain-pressure values
obtained for each tender point.
Body composition
We performed a bioelectrical impedance analysis with an
eight-polar tactile-electrode impedanciometer (InBody 720,
Biospace). Weight (in kilograms) was measured, and body
fat percentage and skeletal muscle mass (kilograms) were
estimated. Validity of this instrument was reported else-
Height (in centimeters) was measured using a
stadiometer (Seca 22, Hamburg, Germany). Body–mass in-
dex was calculated as weight (in kilograms) divided by
height (in square meters).
Physical fitness
Fitness tests were part of the Functional Senior Fitness Test
Additionally, we also measured the handgrip
strength and the blind flamingo test, which have been used
in patients with FM.
Lower body muscular strength. The ‘‘30-second chair
stand test’’ involves counting the number of times within 30
seconds that an individual can rise to a full stand from a
seated position with back straight and feet flat on the floor,
without pushing off with the arms. The patients carried out 1
trial after familiarization.
Upper body muscular strength. ‘‘Handgrip strength’’ was
measured using a digital dynamometer (TKK 5101 Grip-
D;Takey, Tokyo, Japan) as described elsewhere.
The patient
performs (alternately with both hands) the test twice, al-
lowing a 1-minute rest period between measures. The best
value of two trials for each hand was chosen, and the aver-
age of both hands was used in the analysis.
Lower body flexibility. In the ‘‘chair sit and reach test,’
the patient is seated with one leg extended, and slowly
bends forward while sliding the hands down the extended
leg in an attempt to touch (or pass) the toes. The number of
centimeters short of reaching the toe (minus score) or
reaching beyond it (plus score) are recorded.
Two trials
with each leg were measured and the best value of each leg
was registered, being the average of both legs used in the
Upper body flexibility. The ‘‘back scratch test,’’ a mea-
sure of overall shoulder range of motion, involves mea-
suring the distance between (or overlap of ) the middle
fingers behind the back with a ruler.
This test was mea-
sured alternately with both hands twice, and the best value
was registered. The average of both hands was used in the
Static balance. This was assessed with the ‘‘blind fla-
mingo test.’’
The number of trials needed to complete 30
seconds of the static position is recorded, and the chronom-
eter is stopped whenever the patient does not comply with
the protocol conditions. One (1) trial was accomplished for
each leg, and the average of both values was selected for the
Motor agility/dynamic balance. The ‘‘8 feet up and go
test’’ involves standing up from a chair, walking 8 feet to and
around a cone, and returning to the chair in the shortest
possible time.
The best time of two trials was recorded and
used in the analysis.
Aerobic endurance. The ‘‘6-minute walk test’’ was as-
sessed. This test involves determining the maximum distance
(meters) that can be walked in 6 minutes along a 45.7-m
rectangular course.
Psychologic outcomes
Fibromyalgia Impact Questionnaire (FIQ). The original
version of the FIQ was designed by Burckhardt et al.
evaluate the severity of FM on daily activities. This is a self-
administered questionnaire, comprising 10 subscales of dis-
abilities and symptoms, and has been validated for the
Spanish FM population.
The total score, which is the mean
of the 10 subscales, and the subscales for physical function,
feel good, pain, fatigue, morning tiredness, stiffness, anxiety,
and depression were applied in the study. The questionnaire
is scored from 0 to 100, and a higher score indicates a greater
impact of the syndrome.
The Short-Form Health Survey 36 (SF-36). This is a
generic instrument assessing health-related quality of life. It
contains 36 items grouped into 8 subscales: physical func-
tioning, physical role, bodily pain, general health, vitality,
social functioning, emotional role, and mental health. The
range of scores is between 0 and 100 in every subscale, where
higher scores indicate better health. In this study, we used
the Spanish version of SF-36.
Hospital Anxiety and Depression Scale (HADS). This
contains 14 statements, ranging from 0 to 3, in which a
higher score indicates a higher degree of distress. The scores
build two subscales: anxiety (0–21) and depression (0–21).
Zigmond and Snaith
suggested subscale cutoffs of scores
higher than or equal to 8 to indicate the likely presence of
clinically significant levels of depression or anxiety at mild
intensity and cutoffs of scores higher than or equal to 11 to
indicate moderate to severe intensity. The Spanish version of
the scale was used in this study.
Vanderbilt Pain Management Inventory (VPMI). The
Vanderbilt Pain Management Inventory
adapted to the
Spanish version
was used to assess coping strategies.
The scale has 18 items divided into two subscales designed
to assess how often chronic pain sufferers use active and
passive coping. Active coping, when patients attempt to
function in spite of their pain; and passive coping, when
patients relinquish control of their pain to others, or allow
other areas of their life to be adversely affected by pain.
Rosenberg Self-Esteem Scale (RSES). It is a self-report
measure designed to assess the concept of global self-
The RSES comprises just 10 items scored on a 4-
point scale that are summed to produce a single index of
self-esteem. In this study we used the Spanish version.
General Self-Efficacy Scale. Self-efficacy was evaluated
with a Spanish version translated by Ba
¨ßler and Schwar-
This instrument contains 10 items scored on a 4-
point Likert scale from 1 (not at all true) to 4 (exactly true).
The scale assesses the individual’s beliefs in her/his own
capabilities to attain aims. In this case, higher scores indicate
a higher level of perceived general self-efficacy.
Table 1. Sociodemographic Characteristics of Women with Fibromyalgia by Group
Usual-care group (n¼32) Intervention group (n¼27) p
Age, years 51.4 (7.4) 54.2 (6.2) 0.126
Years since clinical diagnosis, n(%) 0.67
5 years 16 (50.0) 12 (44.4)
>5 years 16 (50.0) 15 (45.6)
Marital status, n(%) 0.527
Married 24 (75.0) 17 (63.0)
Unmarried 5 (15.6) 5 (18.5)
Separated/divorced/ widowed 3 (9.4) 5 (18.5)
Educational status, n(%)
Unfinished studies 2 (6.2) 2 (8.0)
Primary school 11 (34.4) 5 (20.0)
Secondary school 8 (25.0) 8 (32.0)
University degree 11 (34.4) 10 (40.0)
Occupational status, n(%)
Housewife 14 (46.7) 15 (65.2)
Working 11 (36.7) 5 (21.7)
Unemployed 2 (6.7) 1 (4.3)
Retired 3 (10.0) 2 (8.7)
Income, n(%) 0.407
<1200.00 e15 (46.9) 10 (37.0)
1201.00–1800.00 e7 (21.9) 4 (14.8)
>1800.00 e10 (31.2) 13 (48.1)
Two missing data in the intervention group.
Four missing data in the intervention group and two missing data in the usual-care group.
Data analysis
Analyses of data included the following: (1) Intention to
treat (ITT). A patient was considered a study participant if
she attended at least one treatment session. Participants
who dropped out before completion of the study were
asked to return for post-testing. When post-test data were
missing, baseline scores were considered post-test scores; (2)
The analysis was repeated using only those participants
with valid data at both baseline and post-test, and with an
attendance rate of 70% of the sessions (i.e., per-protocol
analysis). Independent tand w
tests were used to compare
demographic variables between groups. We used a two-
factor (group and time) analysis of covariance with
repeated measures to assess the training effects on the
outcome variables (pain, body composition, physical fitness,
and psychologic outcomes) after adjusting for age. For each
variable, we reported the p-value corresponding to the
group (between-subjects), time (within-subjects) and inter-
action (group*time) effects. We calculated the p-value for
within-group differences by group when a significant in-
teraction effect was present. Multiple comparisons (for a
priori statistics) were adjusted for mass significance.
Analyses were performed using the Statistical Package
for Social Sciences (SPSS, v. 16.0 for Windows; SPSS Inc.,
Chicago, IL).
Nine (9) women from the intervention group discontinued
the program due to family commitments, personal and
health problems, and another 1 was not included in the
analysis for attending less than 70% of the program (atten-
dance: 58.3%). Adherence to the intervention was 85.6%
Table 2. Effects of a 12-Week Intervention on Tender Points in Women with Fibromyalgia
Group Pre Post
pfor Group
pfor Time
pfor Interaction
Occiput R Control 2.81 (0.12) 2.40 (0.10) 0.958 0.931 0.042
Intervention 2.69 (0.13) 2.57 (0.11)
Occiput L Control 2.84 (0.12) 2.39 (0.11) 0.521 0.475 0.01
Intervention 2.70 (0.13) 2.72 (0.12)
Anterior cervical R Control*** 2.41 (0.13) 1.86 (0.11) 0.837 0.497 <0.001
Intervention* 2.00 (0.15) 2.33 (0.12)
Anterior cervical L Control** 2.25 (0.13) 1.89 (0.10) 0.331 0.291 <0.001
Intervention** 2.01 (0.14) 2.41 (0.11)
Trapezius R Control 3.02 (0.15) 2.66 (0.16) 0.713 0.499 0.091
Intervention 2.79 (0.16) 2.74 (0.17)
Trapezius L Control*** 3.21 (0.14) 2.76 (0.15) 0.573 0.161 0.001
Intervention 2.98 (0.15) 3.21 (0.17)
Supraspinatus R Control* 3.41 (0.14) 3.07 (0.16) 0.263 0.204 0.001
Intervention* 3.24 (0.16) 3.70 (0.18)
Supraspinatus L Control* 3.51 (0.14) 3.18 (0.16) 0.142 0.122 <0.001
Intervention*** 3.27 (0.15) 3.99 (0.17)
Second rib R Control 2.24 (0.11) 2.14 (0.13) 0.852 0.558 0.042
Intervention 2.08 (0.12) 2.35 (0.14)
Second rib L Control 2.28 (0.10) 2.06 (0.13) 0.089 0.171 0.006
Intervention 1.83 (0.10) 2.00 (0.13)
Lateral epicondyle R Control 2.28 (0.10) 2.05 (0.13) 0.335 0.401 <0.001
Intervention 2.10 (0.11) 2.53 (0.14)
Lateral epicondyle L Control 2.76 (0.13) 2.52 (0.14) 0.811 0.916 0.019
Intervention 2.54 (0.14) 2.81 (0.15)
Gluteal R Control 2.85 (0.16) 3.12 (0.18) 0.102 0.769 0.977
Intervention 3.22 (0.17) 3.49 (0.20)
Gluteal L Control 2.97 (0.17) 3.32 (0.17) 0.042 0.868 0.498
Intervention 3.34 (0.18) 3.86 (0.19)
Great trochanter R Control 2.86 (0.16) 2.93 (0.15) 0.313 0.68 0.359
Intervention 2.96 (0.17) 3.24 (0.16)
Great trochanter L Control 2.96 (0.14) 3.06 (0.17) 0.391 0.788 0.215
Intervention 2.97 (0.16) 3.39 (0.18)
Knee R Control 2.62 (0.16) 2.73 (0.16) 0.465 0.418 0.738
Intervention 2.43 (0.17) 2.61 (0.17)
Knee L Control 2.62 (0.16) 2.77 (0.17) 0.839 0.292 0.643
Intervention 2.52 (0.18) 2.78 (0.18)
Algometer score Control* 50.30 (1.77) 47.29 (1.91) 0.41 0.5 0.001
Intervention** 48.38 (1.94) 53.39 (2.08)
Total number of points Control 16.16 (0.38) 16.38 (0.46) 0.695 0.025 0.002
Intervention** 16.77 (0.42) 15.32 (0.50)
Data are means (standard error of the mean). Pvalues before adjustment for multiple comparisons.
*p<0.05, **p<0.01, ***p<0.001 for post hoc analysis pre versus post. R, right; L, left.
(range 70%–100%). A total of 27 (72.97%) women from the
intervention group and 32 (94.12%) from the usual-care
group completed the 3-month follow-up and were included
in the final analysis. Compliers and noncompliers were
similar in all the studied variables except on the subscales of
FIQ: feel good (8.0 2.1 versus 9.6 0.7; respectively,
p<0.05) and general self-efficacy (25.8 7.2 versus
17.1 10.0, respectively, p<0.01).
During the study period, no participant reported an ex-
acerbation of FM symptoms beyond normal flares, and there
were no serious adverse events. No women changed from the
control group to the intervention group or vice versa, and there
were no protocol deviations from the study, as planned.
Sociodemographic characteristics of women with FM by
group are shown in Table 1.
ITT analysis
Seventy-one (71) patients were included in the ITT anal-
ysis (intervention group, n¼37 and usual-care group,
n¼34). After adjusting for multiple comparisons,
we ob-
served interaction (group*time) effects in the following out-
comes: (1) Left (L) and right (R) side of the anterior cervical,
supraspinatus L, second rib L (all, p<0.001), supraspinatus
R and trapezius L (all, p¼0.001) and occiput L tender points
(p¼0.003). (2i) Algometer score ( p¼0.001) and tender-point
count ( p¼0.003). (3) Total score of FIQ ( p¼0.001).
Per-protocol analysis
After adjusting for multiple comparisons,
we observed
interaction group * time effects in the following measures:
1. Tender points. Left (L) and right (R) side of the anterior
cervical and supraspinatus tender point, left side of the
trapezius and right side of the lateral epicondyle tender
points. Post hoc analysis revealed that the pain threshold
in the control group significantly decreased (negative)
on the anterior cervical R ( p<0.001) and L ( p¼0.002),
trapezius L ( p¼0.002), supraspinatus R ( p¼0.045) and
L(p¼0.030) tender points. In the intervention group,
post hoc analysis revealed that the pain threshold sig-
nificantly increased (positive) on the anterior cervical R
(p¼0.025) and L ( p¼0.005) and supraspinatus R
(p¼0. 045) and L ( p<0.001) (Table 2).
2. Algometer score and tender-point count. Post hoc anal-
ysis revealed a significant increase in algometer score
(p¼0.008) and a decrease in tender-point count
(p¼0.002) in the intervention group, whereas in the
Table 3. Effects of a 12-Week Intervention on Body Composition in Women with Fibromyalgia
Group Pre Post
pfor Group
pfor Time
pfor Interaction
Weight (kg) Control 68.5 (2.1) 68.8 (2.0) 0.778 0.876 0.209
Intervention 68.1 (2.2) 67.5 (2.2)
Waist circumference (cm) Control 87.8 (1.9) 86.1 (1.9) 0.95 0.929 0.384
Intervention 87.1 (1.9) 86.5 (1.9)
BMI (kg/m
) Control 28.2 (0.9) 28.3 (0.9) 0.571 0.707 0.291
Intervention 27.5 (0.9) 27.4 (0.9)
Body fat percentage Control 38.6 (1.2) 37.2 (1.6) 0.036 0.372 0.003
Intervention* 37.2 (1.2) 31.4 (1.6)
Muscle mass (kg) Control 22.6 (0.5) 22.7 (1.4) 0.054 0.652 0.028
Intervention 23.3 (0.5) 27.2 (1.5)
BMI, body–mass index. Data are means (standard error of the mean). pValues before adjustment for multiple comparisons.
*p<0.01, for post hoc analysis pre versus post.
Table 4. Effects of a 12-Week Intervention on Physical Fitness in Women with Fibromyalgia
Group Pre Post
pfor Group
pfor Time
pfor Interaction
Chair sit and reach (cm) Control 13.2 (2.7) 15.7 (2.9) 0.114 0.46 0.064
Intervention 11.0 (2.8) 6.3 (3.0)
Back scratch test (cm) Control 7.3 (2.4) 9.3 (2.4) 0.522 0.578 0.198
Intervention 6.5 (2.4) 5.8 (2.5)
Handgrip strength (kg) Control 15.7 (1.0) 17.3 (1.0) 0.22 0.729 0.251
Intervention 18.1 (1.0) 18.4 (1.1)
Chair stand test (n) Control 7 (0.5) 8 (0.5) 0.024 0.897 0.114
Intervention 8 (0.5) 10 (0.5)
8 feet up & go (s) Control 8.3 (0.3) 7.8 (0.3) 0.048 0.318 0.44
Intervention 7.6 (0.3) 6.8 (0.3)
30-s blind flamingo (failures) Control 10 (1) 11 (1) 0.764 0.922 0.246
Intervention 10 (1) 9 (1)
6-minute walk (m) Control 456.6 (12.7) 457.0 (13.1) 0.649 0.764 0.041
Intervention 448.7 (13.5) 480.9 (13.8)
Data are means (standard error of the mean). pValues before adjustment for multiple comparisons.
control group, there was a significant decrease in alg-
ometer score ( p¼0.05).
3. Body fat percentage (Table 3). Post hoc analysis revealed
a significant decrease in body fat percentage ( p¼0.001)
in the intervention group. No significant improvement
attributed to the intervention was observed in physical
fitness (Table 4).
4. FIQ. Post hoc analysis revealed that there was an im-
provement in total score of FIQ in the intervention
group ( p¼0.003) (Table 5). We observed no significant
Table 5. Effects of a 12-Week Intervention on Psychologic Outcomes Assessed
in Women with Fibromyalgia
Group Pre Post
pfor Group
pfor Time
pfor Interaction
Total score Control 70.1 (2.1) 74.0 (2.8) 0.004 0.399 0.001
Intervention* 66.9 (2.9) 56.0 (3.1)
Physical function Control 4.3 (0.3) 4.8 (0.4) 0.247 0.703 0.005
Intervention 4.4 (0.4) 3.6 (0.4)
Feel good Control 8.3 (0.4) 8.8 (0.4) 0.002 0.347 0.01
Intervention 7.6 (0.4) 6.1 (0.5)
Pain Control 7.3 (0.3) 8.0 (0.3) 0.009 0.788 0.01
Intervention 6.9 (0.4) 6.1 (0.3)
Fatigue Control 8.2 (0.3) 8.5 (0.3) 0.001 0.539 0.009
Intervention 7.8 (0.4) 6.5 (0.3)
Sleep Control 8.0 (0.3) 8.11 (0.4) 0.149 0.687 0.004
Intervention 8.4 (0.3) 6.4 (0.4)
Stiffness Control 7.6 (0.4) 7.9 (0.4) 0.02 0.603 0.077
Intervention 6.6 (0.4) 6.0 (0.5)
Anxiety Control 7.4 (0.4) 7.9 (0.4) 0.002 0.075 0.016
Intervention 6.2 (0.5) 5.2 (0.5)
Depression Control 6.1 (0.5) 7.0 (0.5) 0.087 0.007 0.02
Intervention 5.7 (0.6) 4.9 (0.6)
Physical function Control 39.1 (3.5) 38.0 (3.0) 0.499 0.907 0.091
Intervention 38.1 (3.8) 44.8 (3.2)
Physical role Control 5.2 (3.3) 3.3 (2.6) 0.224 0.382 0.375
Intervention 6.8 (3.6) 10.0 (2.8)
Bodily pain Control 21.8 (2.8) 22.2 (2.2) 0.017 0.538 0.906
Intervention 30.1 (3.1) 30.9 (2.4)
General health Control 26.5 (3.0) 29.0 (3.1) 0.124 0.96 0.998
Intervention 33.0 (3.2) 35.6 (3.4)
Vitality Control 18.1 (2.8) 19.0 (2.9) 0.121 0.125 0.476
Intervention 22.6 (3.0) 26.4 (3.2)
Social functioning Control 44.4 (4.4) 36.7 (3.7) 0.029 0.888 0.024
Intervention 49.2 (4.8) 55.6 (4.0)
Emotional role Control 33.4 (8.0) 38.0 (8.1) 0.437 0.786 0.675
Intervention 39.4 (8.8) 48.8 (8.9)
Mental health Control 45.4 (3.6) 44.9 (4.2) 0.094 0.323 0.092
Intervention 50.8 (3.9) 57.9 (4.6)
Passive coping Control 24.7 (0.8) 24.2 (0.7) 0.017 0.669 0.063
Intervention 23.2 (0.9) 20.7 (0.7)
Active coping Control 16.1 (0.7) 16.1 (0.7) 0.868 0.756 0.602
Intervention 16.5 (0.7) 16.0 (0.7)
Anxiety Control 11.2 (0.8) 11.0 (0.8) 0.131 0.997 0.891
Intervention 9.4 (0.9) 9.1 (0.9)
Depression Control 9.3 (0.7) 9.0 (0.8) 0.105 0.554 0.902
Intervention 7.5 (0.8) 7.3 (0.9)
Self-Efficacy Control 25.0 (1.3) 25.5 (1.3) 0.248 0.363 0.624
Intervention 26.9 (1.4) 27.9 (1.4)
RSES Control 28.2 (1.1) 25.4 (1.2) 0.335 0.895 0.037
Intervention 28.4 (1.2) 28.3 (1.3)
Data are means (standard error of the mean). Pvalues before adjustment for multiple comparisons.
*p<0.01, for post hoc analysis pre versus post.
FIQ, Fibromyalgia Impact Questionnaire; SF-36, Short Form 36; VPMI, Vanderbilt Pain Management Inventory; HADS, Hospital Anxiety
and Depression Scale; RSES, Rosenberg Self-Esteem Scale.
interaction effect and hence no intervention-attributable
improvement for SF-36, VPMI, Hospital Anxiety and
Depression Scale, Rosenberg Self-Esteem Scale (RSES),
and general self-efficacy.
The main finding of the present study is that a 3-month
(one session per week) Biodanza intervention reduced pain
and FM impact (measured by FIQ) in female patients. We
also observed significant benefits in body fat percentage. We
did not observe a significant improvement on physical fit-
ness tests, yet the patients were able to walk *30 m more in
the 6-minute walk test after treatment. The program was
well tolerated and did not have any deleterious effects on the
patients’ health.
FM has a significant impact on a patient’s quality of life
and physical functioning.
The goals of the treatment in
patients with FM are relief of pain, which is the main
symptom, and increasing the level of functional cap-
We observed that the pain threshold increased by
several points in the intervention group, whereas the pain
threshold decreased in several tender points in the usual-care
group. In addition, there was an improvement in the alg-
ometer score and tender-point count after treatment.
We also observed a significant improvement in FIQ, which
concurs with the results obtained by other complementary
and alternative therapies in female patients with FM.
Silva et al.
observed significant decreases in FIQ scores but
not in pain threshold after 8-week Relaxing Yoga and Re-
laxing Yoga plus Touch treatment in patients with FM.
Menzies et al.
investigated the effects of a 6-week guided
imagery intervention on symptom management in patients
with FM. They observed a decrease in FIQ scores and an
increase in self-efficacy for managing pain in the intervention
group compared to the usual-care group.
Astin et al.
found improvements in FIQ, pain, and depression, but not in
the 6-minute walk test after 8 weeks of multimodal mind–
body intervention (mindfulness meditation plus qigong).
Septhon et al.
obtained improvements in depressive
symptoms after 8 weeks of a mindfulness-based stress re-
duction intervention. Hammond and Freeman
and Taggart
et al.
reported improvement in FIQ after treatments based
in t’ai chi exercises (2 times/week for 10 weeks and twice
weekly classes for 6 weeks, respectively). Taggart et al.
observed significant improvement in the dimensions of SF-36
physical functioning, bodily pain, general health, vitality,
and emotional role as well. However, they did not report the
total FIQ score or tender-point count and they did not es-
tablish as inclusion criteria the American College of Rheu-
matology diagnosis criteria for FM. Therefore, it is not
possible to know the level of severity in these patients.
In contrast with these positive results, other studies using
similar therapies did not find significant changes after
treatments. Assefi et al.
did not observe any improvement
in patients with FM after 8 weeks of Reiki (a form of energy
medicine) intervention on pain and SF-36. Mannerkorpi and
did not find improvement in the FIQ score, chair
test, and handgrip strength after 3 months of body aware-
ness therapy combined with qigong. In fact, a recent review
concluded that no positive evidence could be identified for
qigong and body awareness therapy in FM.
Although al-
ternative and complementary therapies have been used in
the management of FM, they are still in the ongoing process
of being evaluated by scientific research, and future research
is needed for better understanding of the potential efficacy of
these types of treatments.
11, 46
We observed no significant intervention-attributable im-
provement for SF36, VPMI, HADS, RSES, and general self-
efficacy. Whether increasing the number of sessions per
week, or increasing the time of the intervention (i.e., 6
months) may have a significant impact on these psychologic
outcomes remains to be elucidated.
The fact that we were not able to randomize the partici-
pants into the intervention and usual-care group is a limi-
tation of our study. Strengths include the assessment of body
composition and physical fitness measures, which are lim-
ited in others studies. We applied a correction for multiple
statistical tests
in order to avoid statistically significant ef-
fects by chance.
Biodanza is an intervention carried out once a week with
low intensity; therefore, a priori it is an appropriate option for
those patients who are sedentary and want to initiate a more
active lifestyle. In the light of the improvements observed in
this study, we believe that Biodanza may be an effective
complementary therapy in the management of FM.
A 3-month (one session per week) Biodanza intervention
reduces pain and FM impact in female patients. The results
also show that the Biodanza intervention may be, in the short
term, a very helpful resource for the management of FM.
Further studies should replicate these results and deepen
understanding of this therapy.
The study was supported by the Instituto Andaluz del
Deporte (IAD), the Center of Initiatives and Cooperation to
the Development (CICODE, University of Granada), the
Association of Fibromyalgia Patients of Granada (Spain), the
Spanish Ministry of Education (AP-2006-03676, EX-2007-
1124, EX-2008-0641), and the Science and Innovation Minis-
try (BES-2009-013442). The authors would like to thank the
researchers from the CTS-545 research group. We gratefully
acknowledge all participating patients for their collaboration.
Disclosure Statement
No competing financial interests exist.
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Address correspondence to:
Ana Carbonell Baeza, PhD
Department of Physical Activity and Sports
School of Sport Sciences
University of Granada
Carretera de Alfacar, s/n
Granada 18011
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... All these RCTs had assessed at least three outcomes in patients with fibromyalgia, pain and depression being primary and one either of sleep, fatigue, or quality of life was considered as secondary outcome. Thirteen studies [27][28][29][30][31][32][33][34][35][36][37][38][39] had passive control group (FMS group with only conventional treatment) while the other 12 studies [40][41][42][43][44][45][46][47][48][49][50][51] have involved an active control (comparison of different types of two or more intervention). Participants included in all these studies were predominantly females (>90%). ...
... Settings and participant's characteristics. Out of 25 studies, 6 each were conducted in Spain , 29,30,32,33,38,41 5 were done in Brazil, 34,37,43,44,47 4 were done in Turkey, 28,40,48,49 3 in USA, 42,45,48 2 in Italy 36,46 and one each in Germany, 51 Switzerland, 39 Egypt 50 and Canada. 27 However, the place of study conducted by Sanchez et al. 35 has not been mentioned. ...
... College of Rheumatology criteria for the classification of fibromyalgia of 1990 [27][28][29][30][31][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47][48]50,51 or 2010. 32,49 Bourgault et al., 27 Saral et al., 28 and Bravo et al. 30 included participants only after 6 months of diagnosis while Alventosa et al. 32 and Polat et al. 49 ...
Full-text available
Objectives The aim of this review was to (1) summarize evidence on the effectiveness of rehabilitation strategies in fibromyalgia syndrome (FMS) and (2) determine the most effective rehabilitation strategy for reducing pain and depression in people with FMS. Data Sources PubMed, Ovid (Sp), and Cochrane search engines were used for identifying relevant studies done up to 1st of July 2022. Study Selection Randomized control trials (RCTs) that have a passive control group and an active control group were included in this review for primary and secondary aim, respectively. The primary outcome measures were pain and depression. Secondary outcome was one from the sleep or fatigue or healthy related quality of life (HRQOL). Data Extraction Two researchers independently selected the studies and extracted the key information. Data Synthesis A total of 25 RCTs were included. Studies with passive control group showed moderate to large positive effects on pain (standard mean difference –0.65, 95% confidence interval −0.93 to −0.38; I ² = 72%) and HRQOL (MD −5.40, 95% CI −10.17 to −0.62; I ² = 74%) but were not statistically significant for sleep, fatigue, and depression. Furthermore, on subgroup analysis studies with a short term protocol showed significant effects on pain only, whereas studies with long term protocols showed positive effects on pain and HRQOL only, but no statistical significance at the time of post-trial follow-up. Studies with active control groups gave non-significant results except where there was mixed exercises, which showed a positive effect (mean difference −4.78, 95% CI −7.98 to −1.57; I ² = 0%) for HRQOL. Conclusion All rehabilitation strategies were effective for pain and HRQOL, and had a marginal effect on depression, sleep, and fatigue but efficacy was not maintained at the time of post-trial follow-up. However, in this review, we could not differentiate any rehabilitation strategies for the best among those used in the included studies.
... This review identified 27 quantitative studies, four qualitative studies [61][62][63][64], and three mixed-methods studies [65][66][67]. The quantitative studies consisted of 13 randomized controlled trials [68][69][70][71][72][73][74][75][76][77][78][79][80], 11 quasiexperimental studies [81][82][83][84][85][86][87][88][89][90][91], and three case series [92][93][94]. One randomized controlled trial produced two articles [70,71], and one quasi-experimental study produced two articles [82,90] with different measures reported. ...
... The quantitative studies consisted of 13 randomized controlled trials [68][69][70][71][72][73][74][75][76][77][78][79][80], 11 quasiexperimental studies [81][82][83][84][85][86][87][88][89][90][91], and three case series [92][93][94]. One randomized controlled trial produced two articles [70,71], and one quasi-experimental study produced two articles [82,90] with different measures reported. For qualitative studies, the theoretical framework was not specified, and data were collected via interviews [61,63,64] or focus groups [62]. ...
... Of the six studies using the visual analog scale, the average decrease in score was two points on a 10-point scale [68,75,76,79,85,90]. There were 18 studies that used multidimensional measures, such as specific questionnaires that have a pain component, with the majority of these using a 36-Item Short-Form Survey (SF-36) [68,[81][82][83][84][85]93] or 12-Item Short-Form Survey (SF-12) [73,86], from which bodily pain data were extracted. One study did not report bodily pain [86] in their SF-12. ...
Full-text available
Objectives: Globally, 20-25% of people will experience chronic pain in their lifetime. Dance is a physical activity with psychosocial benefits which may positively impact pain. This review aimed to investigate the effect of dance interventions on the experience of pain, by quantitative measures and qualitative themes. Methods: Seven major databases were searched from inception to January 2021. Two independent reviewers screened articles at each stage. Qualitative and quantitative studies were included if the dance interventions lasted over 6 weeks, participants reported pain longer than 3 months, and pain was an outcome of the study. All articles were critically appraised using appropriate Joanna Briggs Institute tools and data were collated using results-based convergent synthesis. Results: From 23,628 articles 34 full papers were included, with a total of 1254 participants (75.2% female). Studies predominantly investigated individuals with Fibromyalgia (26%) and generalised chronic pain (14%), with aerobic dance (20.7%) and Biodanza (20.7%) the most common dance genres investigated. Overall, 74% of studies noted either reduced pain through quantitative pain measures or qualitative themes of improved pain experience (88% for chronic primary pain and 80% for chronic secondary musculoskeletal pain). Discussion: There were positive effects of dance on chronic primary and secondary musculoskeletal pain across diverse populations. A variety of study designs and interventions noted improved pain measures and themes around pain coping and acceptance, with all dance therapies showing improvements, particularly when performed for 60-150 minutes duration weekly. Dance should be considered as an effective adjunct in the management of chronic pain.
... Dado que el estudio de las propiedades de la Biodanza parece haber estado concentrado en los pacientes de fibromialgia, buena parte de sus resultados constatables están ligados al manejo del dolor y el impacto de la enfermedad en la calidad de vida de las pacientes. En este sentido, la práctica de Biodanza mejora el índice de dolor, reduce el impacto de la fibromialgia en las actividades de la vida cotidiana e igualmente el de la depresión (Carbonell-Baeza et al., 2010;López, Fernández, Matarán, Rodriguez y Ferrándiz, 2013). Produce una reducción acumulada de la gravedad del dolor (Segura et al, 2017) y mejora la composición corporal (Carbonell-Baeza et al, 2010). ...
... En este sentido, la práctica de Biodanza mejora el índice de dolor, reduce el impacto de la fibromialgia en las actividades de la vida cotidiana e igualmente el de la depresión (Carbonell-Baeza et al., 2010;López, Fernández, Matarán, Rodriguez y Ferrándiz, 2013). Produce una reducción acumulada de la gravedad del dolor (Segura et al, 2017) y mejora la composición corporal (Carbonell-Baeza et al, 2010). También favorece una mejora significativa en algunos de los principales síntomas de los pacientes de fibromialgia, ya que aporta a la recuperación de la calidad del sueño, reduce el estado de ansiedad y promueve una disminución de la sintomatología y una mayor autonomía, lo cual propicia un aumento de la calidad de vida (López, Castro, Fernández, Matarán y Rodríguez, 2012). ...
Full-text available
La Biodanza es una disciplina emergente que parece estar relacionada con la salud y el bienestar. Basada en un sistema integrador de disciplinas como la danza, la música y sobre todo la expresión corporal, que permite a los participantes adaptar su nivel inicial y sus capacidades. Para conocer los beneficios que aporta la práctica de biodanza se hace necesario la revisión sistemática de la literatura científica. El objetivo fue realizar una revisión sistemática de la literatura científica sobre biodanza y su relación con la salud. Método: se identificaron los estudios en las bases de datos Web of Science y Scopus hasta enero de 2020. Se seleccionaron las investigaciones de diseño cuantitativo, publicadas en inglés o castellano. Tras el cribado, se identificaron nueve artículos que cumplían los criterios de inclusión. Resultados: la biodanza muestra resultados positivos sobre la salud de mujeres con fibromialgia, así como en población general y niños. Las variables analizadas fundamentalmente fueron depresión, ansiedad, calidad del sueño, manejo del dolor, o inteligencia emocional. Conclusiones: los estudios muestran una relación positiva entre los practicantes de biodanza y algunos parámetros de salud, especialmente variables referidas al bienestar, así como una clara utilidad en el trabajo comunitario y la promoción de la salud. Los estudios son escasos y las muestras no son aleatorias, por lo que no se pueden generalizar fácilmente los resultados. Abstract. Biodanza is an emerging discipline apparently related to health and well-being. It is based on an system integrating disciplines such as dance, music, and, particularly, body expression, which allows participants to adapt their initial level and abilities. In order to know the benefits of the practice of biodanza, it is necessary to systematically review the scientific literature related to it. Objective: this article aims to systematically review the benefits of biodanza on health. Method: the studies were identified in the databases until December 2018. Quantitative design research, published both in English and Spanish, were selected. Nine articles meeting the inclusion criteria were identified. Results: biodanza shows positive results on the health of women with fibromyalgia, as well as in the general population and children. Depression, anxiety, quality of sleep, or emotional intelligence were among the health variables analyzed. Conclusions: the studies show a positive relationship between biodanza practitioners and some health parameters, especially wellbeing variables. Biodanza seems to have also a clear utility in community work and health promotion. The studies are still scarce and the samples are not random, so the results cannot be easily generalized.
... Body Awareness Therapies have shown positive outcomes in several pathologies such as cancer 15 in terms of physical, psychological and immune function 16 , quality of life and bone density 17 . European movement approaches such as dance therapy, Feldenkrais and Alexander Technique 18 and integrative dance therapies such as biodance and aquatic biodance have shown efficacy in the rehabilitation programmes for fibromyalgia 19 . Although the effectiveness of body awareness therapies have been assessed by several authors 12,13,20 this updated systematic review and meta-analysis intends to provide a summary of Movement and Body Awareness Therapies in patients COPYRIGHT© EDIZIONI MINERVA MEDICA This document is protected by international copyright laws. ...
... It is not permitted to frame or use framing techniques to enclose any trademark, logo, or other proprietary information of the Publisher. Therapy 29 , biodance 19 and aquatic biodance 37 also led to improvement in pain and the best results were obtained after 32 weeks (p < 0.022). ...
Introduction: Fibromyalgia is a long-term condition that is associated with widespread pain and is recognized as one of the major common causes of disability. The standard clinical guidance for fibromyalgia includes both pharmacological and non-pharmacological interventions. In the latter, different interventions are implemented such as aerobic exercises, flexibility exercises, strength training, stretching and body awareness (BA) therapies. The aims of this review were to provide a summary of movement and BA therapies in patients with fibromyalgia and to compare the different therapies in relation to outcomes. Evidence acquisition: The search strategy was undertaken using the following databases from inception to October 2018: PubMed, Cinahl, PEDro, PsychoInfo and The Cochrane Library. Articles were eligible if they were randomized controlled trials (RCTs) comparing movement and BA therapies with another intervention. Evidence synthesis: Two authors independently extracted data and assessed trial quality; 418 studies were found, twenty-two of which met the inclusion criteria. Pain symptom was improved with movement and BA therapies such as, affective self-awareness, t'ai chi, yoga, belly dance, strengthening program and Resseguier method. Forest plot analysis in short term confirms positive trend in favor of BA; however, a great heterogeneity was found between trials. Conclusions: This systematic review and meta-analysis shows positive results in favor of movement and BA therapies as adjunct treatment to usual care in patients who suffer from fibromyalgia. Further work in identifying the mechanism of action by which BA therapies benefit outcomes should be undertaken.
... The current study does not provide enough information to draw solid conclusions about the effects of exergames on depression symptoms in people with fibromyalgia. Nevertheless, previous studies with artistic expression-based interventions presented benefits on anxiety and depression (Baptista, Villela, Jones, & Natour, 2012;Carbonell-Baeza et al., 2010;López-Rodríguez et al., 2013). This reduction may be related to the artistic expression of creative arts therapies (Martin et al., 2018). ...
... After a thorough literature search, 347 studies were initially found. After the removal of duplicates and application of inclusion criteria, 14 studies were included in our final analysis with a total number of 886 participants [36][37][38][39][40][41][42][43][44][45][46][47][48][49]. The meta-analysis flowchart can be seen in Fig. 1. ...
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Fibromyalgia is a chronic medical condition of unclear etiopathology that diminished patients’ quality of life; chronic pain is the main symptom, yet patients with fibromyalgia struggle also with depression, anxiety, and insomnia. For many years, pharmaceutical management of pain was the mainstay of treatment. In the latest decade, conventional low-impact aerobic exercise and complementary and alternative medical (CAM) exercise have become important when structuring a personalized therapeutic plan, since side effects are practically inexistent. Heterogenous studies with different methodological approaches have failed to display a clear clinical effect. We conducted a systematic review with meta-analysis of clinical trials putting emphasis on standardized measurable outcomes (Fibromyalgia Impact Questionnaire, FIQ) in our effort to draw a safe conclusion on CAM exercise’s effect. After analyzing 14 studies, including 886 patients, meta analysis showed CAM exercise had a beneficial effect on patients’ FIQ score reports: standardized mean difference (SMD) 1.330 (95% CI 0.733–1.928). Among them, dance and Tai chi, had a more profound effect: SMD 1.969 (95% CI 0.575–3.364) and SMD 1.852 (95% CI 0.119–3.584), respectively. However, the risk of bias was overall medium to high and statistical heterogeneity was very high. Our meta-regression analysis failed to identify any variable that could account for high heterogeneity. Even though more experimental studies should be done on this subject, CAM exercise seems beneficial for patients with Fibromyalgia.
... For girls aged 8 to 12 years, multicomponent interventions including dance can lead to improvements in psychological well-being, perceived self-efficacy, and physical self-confidence [43]. Although more research is needed, dance has also been proven to help decrease pain, both for young people [44] and adult women [45][46][47]. ...
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Background Functional abdominal pain disorders (FAPDs) affect many children worldwide, predominantly girls, and cause considerable long-term negative consequences for individuals and society. Evidence-based and cost-effective treatments are therefore strongly needed. Physical activity has shown promising effects in the practical management of FAPDs. Dance and yoga are both popular activities that have been shown to provide significant psychological and pain-related benefits with minimal risk. The activities complement each other, in that dance involves dynamic, rhythmic physical activity, while yoga enhances relaxation and focus. Objective This study aims to evaluate the effects of a dance and yoga intervention among girls aged 9 to 13 years with FAPDs. Methods The study is a prospective randomized controlled trial among girls aged 9 to 13 years with functional abdominal pain, irritable bowel syndrome, or both. The target sample size was 150 girls randomized into 2 arms: an intervention arm that receives dance and yoga sessions twice weekly for 8 months and a control arm that receives standard care. Outcomes will be measured at baseline and after 4, 8, 12, and 24 months, and long-term follow-up will be conducted 5 years from baseline. Questionnaires, interviews, and biomarker measures, such as cortisol in saliva and fecal microbiota, will be used. The primary outcome is the proportion of girls in each group with reduced pain, as measured by the faces pain scale-revised in a pain diary, immediately after the intervention. Secondary outcomes are gastrointestinal symptoms, general health, mental health, stress, and physical activity. The study also includes qualitative evaluations and health economic analyses. This study was approved by the Regional Ethical Review Board in Uppsala (No. 2016/082 1-2). Results Data collection began in October 2016. The intervention has been performed in 3 periods from 2016 through 2019. The final 5-year follow-up is anticipated to be completed by fall 2023. Conclusions Cost-effective and easily accessible interventions are warranted to reduce the negative consequences arising from FAPDs in young girls. Physical activity is an effective strategy, but intervention studies are needed to better understand what types of activities facilitate regular participation in this target group. The Just in TIME (Try, Identify, Move, and Enjoy) study will provide insights regarding the effectiveness of dance and yoga and is anticipated to contribute to the challenging work of reducing the burden of FAPDs for young girls. Trial Registration (NCT02920268); International Registered Report Identifier (IRRID) DERR1-10.2196/19748
... Two studies evaluated 139 subjects (age: 16 to 65) [49,50]. After 12 weeks, no adverse effects were observed, but a decrease in pain and improvements in walking, mental health and quality of life were observed. ...
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Introduction: Physical inactivity often accompanies chronic pathologies. This induces a sedentariness that favors complications and patient isolation. There is a growing scientific interest in the practice of art, for such activities leave the usual healthcare framework and include the World Health Organization (WHO)'s three dimensions of health. Dance is a universal activity that has been identified as healthy. This scoping review's aim is to study the benefits, modalities and risks of dance for persons with a chronic pathology. Method: The literature research was conducted in English and French, using PubMed and Kinedoc's databases, and keywords related to dance and chronic pathologies. Dance activities that did not involve a dance instructor or a trained health professional were excluded. Studies' location and design, the chosen type of dance, pathologies, the number of subjects, modalities, intended effects and adverse effects were then studied. Results: 51 studies were included in this work. 47.5% were RCTs and 47% originate from North America. The number of published studies is strongly increasing. Sixteen different pathologies were studied, with a large predominance of neurology diseases. Targeted effects were the impacts on mental health, quality of life, physical and motor capacities and pathology-specific symptoms. Dance activities are deemed feasible, and no adverse effects were identified. Discussion: In the event of chronic pathologies, practicing dance is possible; it is stimulating and effective against sedentariness and its adverse effects. Patient adherence is good, and dance seems to respond to the multidimensional component of chronic diseases, while offering unlimited adaptation to patients' physical and cognitive impairments. There are few studies yet, and their methodological quality is moderate, which is why further research work must confirm dance's interest regarding chronic pathologies.
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As a form of art, dance comes to us pointed in several studies with benefits in terms of health and well-being in all kinds of population and applied in several contexts of health This study provides the therapeutic intervention with Dance at the level of Psychosocial Rehabilitation, in adult contexts classified with intellectual disabilities and adolescents classified with mental illness. Therefore, Dance is proposed as an intervention of social therapeutic nature, framed within the powers of the nurse specialist in mental health and psychiatry nursing. It is intended, with this work, to do na evaluation of the effects of a dance program, structured on the basis of the Biodanza System, in these populations through observation of models, based on body language and on a set of sensory and bodily representations that dance provides, in a perspective of research-action. To carry on the evaluation of the intervention program, we selected a methodology for quantitative analysis through the use and application of the scale of assessment LMA Adapted "Freedom to move" (Dunphy & Scott, 2003) and NOC observation grids (Nursing Classification Results, 2010) adapted, and in a qualitative analysis of the dance program, from the perspective of the participants and the therapist's perspective. Main conclusions: with this study we noticed the potencial of Dance in psychosocial rehabilitation, in inducing the feeling of pleasure and well-being in connection with the here and now, connection and communication with others, body notion, range of motion, physical ability and coordinative, connection between thought, imagination and the body (verified by applying the LMA Adapted scale of assessment "Freedom to move") and in favoring self-esteem, social interaction skills, communication: expression and coordinated movement (verified by applying the grids of observation of the Nursing Classification Results). Keywords: Dance, Body, Motion, Mental Health, Nursing
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Antonio Roberto Zamunér,1 Carolina Pieroni Andrade,2 Eduardo Aguilar Arca,3 Mariana Arias Avila41Departamento de Kinesiología, Universidad Católica del Maule, Talca, Maule, Chile; 2Secretaria de Saúde do Município de Guareí, Guareí, São Paulo, Brasil; 3Departamento de Fisioterapia, Universidade do Sagrado Coração, Bauru, São Paulo, Brasil; 4Departamento de Fisioterapia e Programa de Pós-Graduação em Fisioterapia, Universidade Federal de São Carlos, São Carlos, São Paulo, BrasilAbstract: Exercise-related interventions have been recommended as one of the main components in the management of fibromyalgia syndrome (FMS). Water therapy, which combines water’s physical properties and exercise benefits, has proven effective in improving the clinical symptoms of FMS, especially pain, considered the hallmark of this syndrome. However, to our knowledge, the mechanisms underlying water therapy effects on pain are still scarcely explored in the literature. Therefore, this narrative review aimed to present the current perspectives on water therapy and the physiological basis for the mechanisms supporting its use for pain management in patients with FMS. Furthermore, the effects of water therapy on the musculoskeletal, neuromuscular, cardiovascular, respiratory, and neuroendocrine systems and inflammation are also addressed. Taking into account the aspects reviewed herein, water therapy is recommended as a nonpharmacologic therapeutic approach in the management of FMS patients, improving pain, fatigue, and quality of life. Future studies should focus on clarifying whether mechanisms and long-lasting effects are superior to other types of nonpharmacological interventions, as well as the economic and societal impacts that this intervention may present.Keywords: hydrotherapy, exercise, pain management, chronic pain, physical therapy, aquatic therapy
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Health-related fitness evaluation can be used in exercise testing and prescription for health, and can also be a very useful tool for research in physical activity, fitness, and health. In this article we describe the antecedents, the justification and the protocols of application of a series of tests which constitute the AFISAL-INEFC health-related fitness test battery for adults (Rodrfguez et al. 1995a-c). The purpose of this battery is to evaluate in a simple, rapid, and economical manner some of the main factors of health-related fitness. The main criteria for the design of the test battery have been validity, reliability, pertinence, safety, feasibility, and economy Tests and items usually used to evaluate different components and factors of health-related fitness were reviewed and discussed, and then went on to the design of a battery of tests that would meet as much as possible the established criteria . The battery includes eight tests for the evaluation of the following health-related factors: health status (physical activity readiness), body composition, flexibility (trunk), maximal strength (hand grip), strength endurance (abdominals), explosive strength (Iower limbs), balance (static), and cardiorespiratory endurance Evaluation of health-related fitness in adults (I): Background and protocols of the AFISAL-INEFC Battery [in Spanish]. Available from: [accessed Feb 25, 2016].
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Preventing or delaying the onset of physical frailty is an increasingly important goal because more individuals are living well into their 8th and 9th decades. We describe the development and validation of a functional fitness test battery that can assess the physiologic parameters that support physical mobility in older adults. The procedures involved in the test development were (a) developing a theoretical framework for the test items, (b) establishing an advisory panel of experts, (c) determining test selection criteria, (d) selecting the test items, and (e) establishing test reliability and validity: The complete battery consists of 6 items (and one alternative) designed to assess the physiologic parameters associated with independent functioning-lower and upper body strength, aerobic endurance, lower and upper body flexibility, and agility/dynamic balance. We also assessed body mass index as an estimate of body composition. We concluded that the tests met the established criteria for scientific rigor and feasibility for use in common community settings.
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En este estudio se busca, a partir del método etnográfico, identificar los efectos de la biodanza en los adultos mayores que la experimentan. El estudio fué realizado con 8 adultos mayores que integran el grupo de biodanza de la SESC de la ciudad de Fortaleza, Ceará, Brasil. Los datos recolectados a traves de la entrevista semiestructurada y de la observación participante, fueron analizados por el método del análisis narrativo. En la busqueda del segnificado de la biodanza para las personas mayores de edad, se evidenció que ella constituye un mecanismo de enfrentamiento hacia las dificultades en su salud, estimulandolos a los cambios de comportamiento en relación a las condiciones de salud, aumentar su impetu vital y la voluntad de vivir. En este sentido, la biodanza promueve el rescate de la salud de las personas que envejecen.
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In two investigations, we studied vulnerability to the negative effects of stress among women in chronic pain from 2 types of musculoskeletal illnesses, fibromyalgia syndrome (FMS) and osteoarthritis (OA). In Study 1, there were 101 female participants 50 to 78 years old: 50 had FMS, 29 had OA knee pain and were scheduled for knee surgery, and 22 had OA but were not planning surgery. Cross-sectional analyses showed that the three groups were comparable on demographic variables, personality attributes, negative affect, active coping, and perceived social support. As expected, FMS and OA surgery women reported similar levels of bodily pain, and both groups scored higher than OA nonsurgery women. However, women with FMS reported poorer emotional and physical health, lower positive affect, a poorer quality social milieu, and more frequent use of avoidant coping with pain than did both groups of women with OA. Moreover, the perception and use of social support were closely tied to perceived social stress only among the FMS group. In Study 2, we experimentally manipulated negative mood and stress in 41 women 37 to 74 years old: 20 women had FMS, and 21 women had OA. Participants from each group were randomly assigned to either a negative mood induction or a neutral mood (control) condition, and then all participants discussed a stressful interpersonal event for 30 min. Stress-related increases in pain were exacerbated by negative mood induction among women with FMS but not women with OA, and pain during stress was associated with decreases in positive affect in women with FMS but not women with OA. These findings suggest that among women with chronic pain, those with FMS may be particularly vulnerable to the negative effects of social stress. They have fewer positive affective resources, use less effective pain-coping strategies, and have more constrained social networks than their counterparts with OA, particularly those who experience similar levels of pain. They also seem to experience more prolonged stress-related increases in pain under certain circumstances, all of which may contribute to a lowering of positive affect and increased stress reactivity over time.
Primary fibromyalgia is a common yet poorly understood syndrome characterized by diffuse chronic pain accompanied by other somatic symptoms, including poor sleep, fatigue, and stiffness, in the absence of disease. Fibromyalgia does not have a distinct cause or pathology. Nevertheless, in the past decade, the study of chronic pain has yielded new insights into the pathophysiology of fibromyalgia and related chronic pain disorders. Accruing evidence shows that patients with fibromyalgia experience pain differently from the general population because of dysfunctional pain processing in the central nervous system. Aberrant pain processing, which can result in chronic pain and associated symptoms, may be the result of several interplaying mechanisms, including central sensitization, blunting of inhibitory pain pathways, alterations in neurotransmitters, and psychiatric comorbid conditions. This review provides an overview of the mechanisms currently thought to be partly responsible for the chronic diffuse pain typical of fibromyalgia.
To develop criteria for the classification of fibromyalgia, we studied 558 consecutive patients: 293 patients with fibromyalgia and 265 control patients. Interviews and examinations were performed by trained, blinded assessors. Control patients for the group with primary fibromyalgia were matched for age and sex, and limited to patients with disorders that could be confused with primary fibromyalgia. Control patients for the group with secondary-concomitant fibromyalgia were matched for age, sex, and concomitant rheumatic disorders. Widespread pain (axial plus upper and lower segment plus left- and right-sided pain) was found in 97.6% of all patients with fibromyalgia and in 69.1% of all control patients. The combination of widespread pain and mild or greater tenderness in ⩾ 11 of 18 tender point sites yielded a sensitivity of 88.4% and a specificity of 81.1%. Primary fibromyalgia patients and secondary-concomitant fibromyalgia patients did not differ statistically in any major study variable, and the criteria performed equally well in patients with and those without concomitant rheumatic conditions. The newly proposed criteria for the classification of fibromyalgia are 1) widespread pain in combination with 2) tenderness at 11 or more of the 18 specific tender point sites. No exclusions are made for the presence of concomitant radiographic or laboratory abnormalities. At the diagnostic or classification level, the distinction between primary fibromyalgia and secondary-concomitant fibromyalgia (as defined in the text) is abandoned.
ABSTRACT– A self-assessment scale has been developed and found to be a reliable instrument for detecting states of depression and anxiety in the setting of an hospital medical outpatient clinic. The anxiety and depressive subscales are also valid measures of severity of the emotional disorder. It is suggested that the introduction of the scales into general hospital practice would facilitate the large task of detection and management of emotional disorder in patients under investigation and treatment in medical and surgical departments.
This paper presents a simple and widely ap- plicable multiple test procedure of the sequentially rejective type, i.e. hypotheses are rejected one at a tine until no further rejections can be done. It is shown that the test has a prescribed level of significance protection against error of the first kind for any combination of true hypotheses. The power properties of the test and a number of possible applications are also discussed.