Efﬁcacy of Biodanza for Treating Women
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
The level of psychologic distress is
higher in patients with FM compared to patients with other
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.
THE JOURNAL OF ALTERNATIVE AND COMPLEMENTARY MEDICINE
Volume 16, Number 11, 2010, pp. 1191–1200
ªMary Ann Liebert, Inc.
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
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.
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.
1192 CARBONELL-BAEZA ET AL.
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,
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.
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.
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).
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.
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.
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-
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
BIODANZA INTERVENTION IN FIBROMYALGIA 1193
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
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
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.
1194 CARBONELL-BAEZA ET AL.
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.,
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
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.
BIODANZA INTERVENTION IN FIBROMYALGIA 1195
(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.
Seventy-one (71) patients were included in the ITT anal-
ysis (intervention group, n¼37 and usual-care group,
n¼34). After adjusting for multiple comparisons,
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).
After adjusting for multiple comparisons,
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
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)
) 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
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.
1196 CARBONELL-BAEZA ET AL.
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
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.
BIODANZA INTERVENTION IN FIBROMYALGIA 1197
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
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
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.
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.
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
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.
No competing ﬁnancial interests exist.
1. Sarzi-Puttini P, Buskila D, Carrabba M, et al. Treatment
strategy in ﬁbromyalgia syndrome: Where are we now?
Semin Arthritis Rheum 2008;37:353–365.
2. Wolfe F, Smythe HA, Yunus MB, et al. The American Col-
lege of Rheumatology 1990 Criteria for the Classiﬁcation of
Fibromyalgia: Report of the Multicenter Criteria Committee.
Arthritis Rheum 1990;33:160–172.
3. Abeles AM, Pillinger MH, Solitar BM, et al. Narrative re-
view: The pathophysiology of ﬁbromyalgia. Ann Intern Med
4. Bennett RM, Jones J, Turk DC, et al. An Internet survey of
2,596 people with ﬁbromyalgia. BMC Musculoskelet Disord
1198 CARBONELL-BAEZA ET AL.
5. Verbunt JA, Pernot DH, Smeets RJ. Disability and quality of
life in patients with ﬁbromyalgia. Health Qual Life Out-
6. Davis MC, Zautra AJ, Reich JW. Vulnerability to stress
among women in chronic pain from ﬁbromyalgia and os-
teoarthritis. Ann Behav Med 2001;23:215–226.
7. Goldenberg DL. Multidisciplinary modalities in the treatment
of ﬁbromyalgia. J Clin Psychiatry 2008;69(suppl 2):30–34.
8. Mannerkorpi K, Henriksson C. Non-pharmacological treat-
ment of chronic widespread musculoskeletal pain. Best Pract
Res Clin Rheumatol 2007;21:513–534.
9. Goldenberg DL, Burckhardt C, Crofford L. Management of
ﬁbromyalgia syndrome. JAMA 2004;292:2388–2395.
10. Alvarez-Nemegyei J, Bautista-Botello A, Davila-Velazquez J.
Association of complementary or alternative medicine use
with quality of life, functional status or cumulated damage
in chronic rheumatic diseases. Clin Rheumatol 2009;28:547–
11. Baranowsky J, Klose P, Musial F, et al. Qualitative systemic
review of randomized controlled trials on complementary
and alternative medicine treatments in ﬁbromyalgia. Rheu-
matol Int 2009;30:1–21.
12. Toro R, ed. Biodanza Theory [in Portugese]. Fortaleza, Bra-
zil: ALAB, 1991.
13. D’Alencar BP, Mendes MM, Jorge MS, et al. Biodance as
process of existential renew for the elderly. Rev Bras Enferm
14. Lim JS, Hwang JS, Lee JA, et al. Cross-calibration of multi-
frequency bioelectrical impedance analysis with eight-point
tactile electrodes and dual-energy X-ray absorptiometry for
assessment of body composition in healthy children aged 6-
18 years. Pediatr Int 2009;51:263–268.
15. Malavolti M, Mussi C, Poli M, et al. Cross-calibration of
eight-polar bioelectrical impedance analysis versus dual-
energy X-ray absorptiometry for the assessment of total and
appendicular body composition in healthy subjects aged 21–
82 years. Ann Hum Biol 2003;30:380–391.
16. Rikli RE, Jones J. Development and validation of a functional
ﬁtness test for community residing older adults. J Aging
Physical Activity 1999;7:129–161.
17. Tomas-Carus P, Hakkinen A, Gusi N, et al. Aquatic training
and detraining on ﬁtness and quality of life in ﬁbromyalgia.
Med Sci Sports Exerc 2007;39:1044–1050.
18. Ruiz-Ruiz J, Mesa JL, Gutierrez A, et al. Hand size inﬂuences
optimal grip span in women but not in men. J Hand Surg
19. Rodriguez FA, Gusi N, Valenzuela A, et al. Evaluation of
health-related ﬁtness in adults (I): Background and protocols
of the AFISAL-INEFC Battery [in Spanish]. Apunts Educ
Fisica Deportes 1998;52:54–76.
20. Mannerkorpi K, Svantesson U, Carlsson J, et al. Tests of
functional limitations in ﬁbromyalgia syndrome: A reliabil-
ity study. Arthritis Care Res 1999;12:193–199.
21. King S, Wessel J, Bhambhani Y, et al. Validity and reliability
of the 6 minute walk in persons with ﬁbromyalgia. J Rheu-
22. Pankoff BA, Overend TJ, Lucy SD, et al. Reliability of the six-
minute walk test in people with ﬁbromyalgia. Arthritis Care
23. Burckhardt CS, Clark SR, Bennett RM. The ﬁbromyalgia
impact questionnaire: Development and validation. J Rheu-
24. Rivera J, Gonzalez T. The Fibromyalgia Impact Ques-
tionnaire: A validated Spanish version to assess the health
status in women with ﬁbromyalgia. Clin Exp Rheumatol
25. Alonso J, Prieto L, Anto JM. The Spanish version of the SF-36
Health Survey (the SF-36 health questionnaire): An instru-
ment for measuring clinical results [in Spanish]. Med Clin
26. Zigmond AS, Snaith RP. The Hospital Anxiety and De-
pression Scale. Acta Psychiatr Scand 1983;67:361–370.
27. Quintana JM, Padierna A, Esteban C, et al. Evaluation of the
psychometric characteristics of the Spanish version of the
Hospital Anxiety and Depression Scale. Acta Psychiatr
28. Brown GK, Nicassio PM. Development of a questionnaire
for the assessment of active and passive coping strategies in
chronic pain patients. Pain 1987;31:53–64.
29. Esteve R, Lopez AE, Ramirez-Maestre C. Assessment of
strategies for confronting chronic pain [in Spanish]. Rev
Psicol Salud 1999;11:77–102.
30. Rosenberg M. Society and the Adolescent Self-Image.
Princeton: Princeton University Press, 1965.
31. Vazquez AJ, Jimenez R, Vazquez-Morejon R. Rosenberg
Self-Esteem Scale: Reliability and validity in Spanish clinical
population [in Spanish]. Apuntes Psicol 2004;22:247–255.
32. Schwarzer R, Jerusalem M. Generalized Self-Efﬁcacy scale.
In: Weinman J, Wright S, Johnston M, eds. Measures in
Health Psychology: A User’s Portfolio Causal and Control
Beliefs. Windsor: NFER-Nelson, 1995:35–37.
¨ßler J, Schwarzer R. Measuring generalized self-beliefs: A
Spanish adaptation of the General Self-Efﬁcacy scale [in
Spanish]. Ansiedad Estre
34. Holm S. A simple sequentially rejective multiple test pro-
cedure. Scand J Statist 1979;6:65–70.
35. Mannerkorpi K, Burckhardt CS, Bjelle A. Physical perfor-
mance characteristics of women with ﬁbromyalgia. Arthritis
Care Res 1994;7:123–129.
36. de Andrade SC, de Carvalho RF, Soares AS, et al. Tha-
lassotherapy for ﬁbromyalgia: A randomized controlled trial
comparing aquatic exercises in sea water and water pool.
Rheumatol Int 2008;29:147–152.
37. Bertisch SM, Wee CC, Phillips RS, et al. Alternative mind–
body therapies used by adults with medical conditions. J
Psychosom Res 2009;66:511–519.
38. da Silva GD, Lorenzi-Filho G, Lage LV. Effects of yoga and
the addition of Tui Na in patients with ﬁbromyalgia. J Altern
Complement Med 2007;13:1107–1113.
39. Menzies V, Taylor AG, Bourguignon C. Effects of guided
imagery on outcomes of pain, functional status, and self-
efﬁcacy in persons diagnosed with ﬁbromyalgia. J Altern
Complement Med 2006;12:23–30.
40. Astin JA, Berman BM, Bausell B, et al. The efﬁcacy of
mindfulness meditation plus Qigong movement therapy in
the treatment of ﬁbromyalgia: A randomized controlled
trial. J Rheumatol 2003;30:2257–2262.
41. Hammond A, Freeman K. Community patient education
and exercise for people with ﬁbromyalgia: A parallel
group randomized controlled trial. Clin Rehabil 2006;20:
42. Taggart HM, Arslanian CL, Bae S, et al. Effects of T’ai Chi
exercise on ﬁbromyalgia symptoms and health-related
quality of life. Orthop Nurs 2003;22:353–360.
43. Sephton SE, Salmon P, Weissbecker I, et al. Mindfulness
meditation alleviates depressive symptoms in women with
ﬁbromyalgia: Results of a randomized clinical trial. Arthritis
BIODANZA INTERVENTION IN FIBROMYALGIA 1199
44. Asseﬁ N, Bogart A, Goldberg J, et al. Reiki for the treatment
of ﬁbromyalgia: A randomized controlled trial. J Altern
Complement Med 2008;14:1115–1122.
45. Mannerkorpi K, Arndorw M. Efﬁcacy and feasibility of a com-
bination of body awareness therapy and qigong in patients with
ﬁbromyalgia: A pilot study. J Rehabil Med 2004;36:279–281.
46. Rooks DS, Gautam S, Romeling M, et al. Group exercise,
education, and combination self-management in women
with ﬁbromyalgia: A randomized trial. Arch Intern Med
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
1200 CARBONELL-BAEZA ET AL.
Copyright of Journal of Alternative & Complementary Medicine is the property of Mary Ann Liebert, Inc. and
its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's
express written permission. However, users may print, download, or email articles for individual use.