The influence of balance, physical disability, strength, mechanosensitivity and spinal mobility on physical activity at home, work and leisure time in women with fibromyalgia


      • Women with fibromyalgia showed impaired balance, strength and mechanosensitivity.
      • Fibromyalgia sample had higher disability and activities dependence than controls.
      • Work physical activity was related to the impaired dynamic balance in this sample.
      • Leisure physical activity was associated with age and range of spinal inclination.



      Fibromyalgia syndrome is a chronic disease consisting of widespread pain, fatigue, sleep disturbances, and cognitive impairments, among other symptoms, which affect daily physical activity. However, the influence of functional status on physical activity involved in leisure, household and work activities has not been researched previously. The main objective was to evaluate balance, strength, spinal mobility, mechanosensitivity and function levels as related factors of physical activity in female with fibromyalgia.


      Thirty-four patients with Fibromyalgia and 22 matched controls were included in a cross-sectional study. Dynamic and static balance, general and daily activities disability, lumbosacral mechanosensitivity, spinal range of motion, lower limb strength, physical activity in leisure, household and work activities were registered. We tested for differences between groups by using independent sample t-tests. The influence of demographics, symptoms and physical outcomes on physical activity was statistically analyzed using bivariate and multivariate regression analyses.


      There was a significant association between leisure-time physical activity scores and age (r = 0.564), spinal flexion (r = 0.512), spinal extension (r = 0.421) and the total range of spinal inclination (r = 0.533). Fifty-eight percent of the variance of leisure-time physical activity was explained by age and range of spinal flexion-extension. Similarly, functional mobility was associated with physical activity at home and work scores (r = 0.459), explaining 21% of its variance.


      A higher time spent in leisure, household and work activities was related to higher age, spinal range of motion and lower functional mobility in women with Fibromyalgia. Rehabilitation intervention programs should promote physical activity at home, work and leisure time.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Clinical Biomechanics
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Akkaya N.
        • Akkaya S.
        • Atalay N.S.
        • Acar M.
        • Catalbas N.
        • Sahin F.
        Assessment of the relationship between postural stability and sleep quality in patients with fibromyalgia.
        Clin. Rheumatol. 2013; 32: 325-331
      1. American College of Rheumatology [Internet] 2016. Atlanta: The association; 1934–2016 [updated 2016; cited 2016 Nov 20]. Timed Up and Go (TUG). Available from:

        • Arnold C.M.
        • Faulkner R.A.
        The history of falls and the association of the timed up and go test to falls and near-falls in older adults with hip osteoarthritis.
        BMC Geriatr. 2007; 7: 17
        • Battaglia G.
        • Bellafiore M.
        • Caramazza G.
        • Paoli A.
        • Bianco A.
        • Palma A.
        Changes in spinal range of motion after a flexibility training program in elderly women.
        Clin. Interv. Aging. 2014; 9: 653
        • Bellato E.
        • Marini E.
        • Castoldi F.
        • Barbasetti N.
        • Mattei L.
        • Bonasia D.E.
        • Blonna D.
        Fibromyalgia syndrome: etiology, pathogenesis, diagnosis, and treatment.
        Pain Res. Treat. 2012; 2012: 1-17
        • Bennett R.M.
        • Jones J.
        • Turk D.C.
        • Russell I.J.
        • Matallana L.
        An internet survey of 2,596 people with fibromyalgia.
        BMC Musculoskelet. Disord. 2007; 8: 27
        • Bennett R.M.
        • Friend R.
        • Marcus D.
        • Bernstein C.
        • Han B.K.
        • Yachoui R.
        • Jones K.D.
        Criteria for the diagnosis of fibromyalgia: validation of the modified 2010 preliminary American College of Rheumatology criteria and the development of alternative criteria.
        Arthritis Care Res. 2014; 66: 1364-1373
        • Berg K.
        • Wood-Dauphine S.
        • Williams J.I.
        • Gayton D.
        Measuring balance in the elderly: preliminary development of an instrument.
        Physiother. Can. 1989; 41: 304-311
        • Cardiel M.H.
        • Abello-Banfi M.
        • Ruiz-Mercado R.
        • Alarcon-Segovia D.
        How to measure health status in rheumatoid arthritis in non-English speaking patients: validation of a Spanish version of the Health Assessment Questionnaire Disability Index (Spanish HAQ-DI).
        Clin. Exp. Rheumatol. 1993; 11: 117-121
        • Ekedahl K.H.
        • Jönsson B.
        • Frobell R.B.
        Validity of the fingertip-to-floor test and straight leg raising test in patients with acute and subacute low back pain: a comparison by sex and radicular pain.
        Arch. Phys. Med. Rehabil. 2010; 91: 1243-1247
        • Etnier J.L.
        • Karper W.B.
        • Gapin J.I.
        • Barella L.A.
        • Chang Y.K.
        • Murphy K.J.
        Exercise, fibromyalgia, and fibrofog: a pilot study.
        J. Phys. Act. Health. 2009; 6: 239-246
        • Giannotti E.
        • Koutsikos K.
        • Pigatto M.
        • Rampudda M.E.
        • Doria A.
        • Masiero S.
        Medium-/long-term effects of a specific exercise protocol combined with patient education on spine mobility, chronic fatigue, pain, aerobic fitness and level of disability in fibromyalgia.
        Biomed. Res. Int. 2014; 2014
        • Góes S.M.
        • Leite N.
        • Shay B.L.
        • Homann D.
        • Stefanello J.M.
        • Rodacki A.L.
        Functional capacity, muscle strength and falls in women with fibromyalgia.
        Clin. Biomech. 2012; 27: 578-583
        • Grodman I.
        • Buskila D.
        • Arnson Y.
        • Amital D.
        • Amital H.
        Understanding fibromyalgia and its resultant disability.
        Isr. Med. Assoc. J. 2011; 13: 769-771
        • Guermazi M.
        • Ghroubi S.
        • Kassis M.
        • Jaziri O.
        • Keskes H.
        • Kessomtini W.
        • Elleuch M.H.
        Validity and reliability of spinal mouse to assess lumbar flexion.
        Ann. Readapt. Med. Phys. 2006; 49: 172-177
        • Guymer E.K.
        • Littlejohn G.O.
        • Brand C.K.
        • Kwiatek R.A.
        Fibromyalgia onset has a high impact on work ability in Australians.
        Intern. Med. J. 2016; 46: 1069-1074
        • Horak F.B.
        Postural orientation and equilibrium: what do we need to know about neural control of balance to prevent falls?.
        Age Ageing. 2006; 35: ii7-ii11
        • Huijnen I.P.
        • Verbunt J.A.
        • Meeus M.
        • Smeets R.J.
        Energy expenditure during functional daily life performances in patients with fibromyalgia.
        Pain Pract. 2015; 15: 748-756
        • Jones K.D.
        • Horak F.B.
        • Winters K.S.
        • Morea J.M.
        • Bennett R.M.
        Fibromyalgia is associated with impaired balance and falls.
        J. Clin. Rheumatol. 2009; 15: 16
        • Jones K.D.
        • King L.A.
        • Mist S.D.
        • Bennett R.M.
        • Horak F.B.
        Postural control deficits in people with fibromyalgia: a pilot study.
        Arthritis Res. Ther. 2011; 13: R127
        • Jonsson E.
        • Seiger Å.
        • Hirschfeld H.
        One-leg stance in healthy young and elderly adults: a measure of postural steadiness?.
        Clin. Biomech. 2004; 19: 688-694
        • Kasukawa Y.
        • Miyakoshi N.
        • Hongo M.
        • Ishikawa Y.
        • Noguchi H.
        • Kamo K.
        • Shimada Y.
        Relationships between falls, spinal curvature, spinal mobility and back extensor strength in elderly people.
        J. Bone Miner. Metab. 2010; 28: 82
        • Latorre Román P.A.
        • Santos E Campos M.A.
        • García-Pinillos F.
        Effects of functional training on pain, leg strength, and balance in women with fibromyalgia.
        Mod. Rheumatol. 2015; 25: 943-947
        • Lobo A.
        • Ezquerra J.
        • Gómez-Burgada F.
        • Sala J.M.
        El Mini-Examen Cognoscitivo: Un test sencillo, práctico, para detectar alteraciones intelectuales en pacientes médicos.
        in: Actas Luso-españolas de Neurología, Psiquiatría y Ciencias Afines. 7. 1979: 189-201 (Spanish)
        • López R.S.
        • Pastor M.Á.
        • Peñacoba C.
        • Lledó A.
        • Sanz Y.
        • Velasco L.
        Prevalence and predictors of unsupervised walking and physical activity in a community population of women with fibromyalgia.
        Rheumatol. Int. 2016; 36: 1127-1133
        • Luciano J.V.
        • Bertsch J.
        • Salvador-Carulla L.
        • Tomás J.M.
        • Fernández A.
        • Pinto-Meza A.
        • Serrano-Blanco A.
        Factor structure, internal consistency and construct validity of the Sheehan disability scale in a Spanish primary care sample.
        J. Eval. Clin. Pract. 2010; 16: 895-901
        • Luzilaurie M.U.T.O.
        • Mango P.
        • Sauer J.
        • Susan Y.U.A.N.
        • Sousa A.
        • Marques A.
        Postural control and balance self-efficacy in women with fibromyalgia: are there differences?.
        Eur. J. Phys. Rehabil. Med. 2014; 51: 149-154
        • Mannerkorpi K.
        • Hernelid C.
        Leisure time physical activity instrument and physical activity at home and work instrument. Development, face validity, construct validity and test-retest reliability for subjects with fibromyalgia.
        Disabil. Rehabil. 2005; 27: 695-701
        • Mhatre B.S.
        • Singh Y.L.
        • Tembhekar J.Y.
        • Mehta A.
        Which is the better method to improve “perceived hamstrings tightness”–exercises targeting neural tissue mobility or exercises targeting hamstrings muscle extensibility?.
        Int. J. Osteopath. Med. 2013; 16: 153-162
        • Norén A.M.
        • Bogren U.
        • Bolin J.
        • Stenström C.
        Balance assessment in patients with peripheral arthritis: applicability and reliability of some clinical assessments.
        Physiother. Res. Int. 2001; 6: 193-204
        • O'Hoski S.
        • Winship B.
        • Herridge L.
        • Agha T.
        • Brooks D.
        • Beauchamp M.K.
        • Sibley K.M.
        Increasing the clinical utility of the BESTest, mini-BESTest, and brief-BESTest: normative values in Canadian adults who are healthy and aged 50 years or older.
        Phys. Ther. 2014; 94: 334-342
        • O'Shea S.D.
        • Taylor N.F.
        • Paratz J.D.
        Measuring muscle strength for people with chronic obstructive pulmonary disease: retest reliability of hand-held dynamometry.
        Arch. Phys. Med. Rehabil. 2007; 88: 32-36
        • Oude Voshaar M.A.
        • ten Klooster P.M.
        • Taal E.
        • Wolfe F.
        • Vonkeman H.
        • Glas C.A.
        • de Laar M.A.
        Linking physical function outcomes in rheumatology: performance of a crosswalk for converting Health Assessment Questionnaire scores to short form 36 physical functioning scale scores.
        Arthritis Care Res. 2014; 66: 1754-1758
        • Philip K.
        • Lew P.
        • Matyas T.A.
        The inter-therapist reliability of the slump test.
        Aust. J. Phys. 1989; 35: 89-94
        • Post R.B.
        • Leferink V.J.M.
        Spinal mobility: sagittal range of motion measured with the SpinalMouse, a new non-invasive device.
        Arch. Orthop. Trauma Surg. 2004; 124: 187-192
        • Salgueiro M.
        • García-Leiva J.M.
        • Ballesteros J.
        • Hidalgo J.
        • Molina R.
        • Calandre E.P.
        Validation of a Spanish version of the revised fibromyalgia impact questionnaire (FIQR).
        Health Qual. Life Outcomes. 2013; 11: 132
        • Salminen J.J.
        • Oksanen A.
        • Mäki P.
        • Pentti J.
        • Kujala U.M.
        Leisure time physical activity in the young. Correlation with low-back pain, spinal mobility and trunk muscle strength in 15-year-old school children.
        Int. J. Sports Med. 1993; 14: 406-410
        • Segura-Jiménez V.
        • Borges-Cosic M.
        • Soriano-Maldonado A.
        • Estévez-López F.
        • Álvarez-Gallardo I.C.
        • Herrador-Colmenero M.
        • Ruiz J.R.
        Association of sedentary time and physical activity with pain, fatigue, and impact of fibromyalgia: the al-Ándalus study.
        Scand. J. Med. Sci. Sports. 2017; 27: 83-92
        • Shumway-Cook A.
        • Baldwin M.
        • Polissar N.L.
        • Gruber W.
        Predicting the probability for falls in community-dwelling older adults.
        Phys. Ther. 1997; 77: 812-819
        • Waddell G.
        • Somerville D.
        • Henderson I.
        • Newton M.
        Objective clinical evaluation of physical impairment in chronic low back pain.
        Spine. 1992; 17: 617-628