Women With Fibromyalgia Prefer Two or Three Training Sets

Key Takeaways

• Among women with fibromyalgia who completed crossover resistance-training sessions, 0% preferred one set, while 50% preferred two sets and 50% preferred three sets.
• Pain did not differ significantly between set-count protocols; a statistically significant decline within the two-set session fell short of clinical importance.
• Preintervention expectancy and measured exercise execution time did not differ significantly across protocols.
• No serious adverse events occurred during the resistance-training sessions.

For women with fibromyalgia, the number of sets in a resistance-training session may matter to how acceptable the workout feels. Pain and exercise tolerance can complicate that choice, even when the exercises themselves remain familiar. Whether a shorter session is preferable to a higher-volume session is not necessarily apparent from the prescribed workload alone. Set count varied across sessions while the other workout elements remained steady.

Investigators conducted a randomized crossover trial in Physiotherapy Research International. All 38 enrolled women, aged 18–65 and diagnosed under the 2016 American College of Rheumatology fibromyalgia criteria, completed every session and assessment without withdrawal. None had performed resistance training in the preceding six months, although 87% were classified as active or very active at baseline. Opaque sealed envelopes assigned the order of one-, two-, and three-set sessions, separated by seven-day washouts. Each woman served as her own control. Participants performed barbell bench press, front lat pulldown, 45° leg press, and seated leg curl in that order, with 10 repetitions per set at approximately 60% of estimated one-repetition maximum. Set count was the only intervention change. Blinded evaluators assessed outcomes, but participants and therapists were unblinded. The primary endpoint was preferred volume, reported one week after the final session. Expectancy was measured before intervention, and pain at baseline, immediately before and after sessions, and 24 hours afterward.

Preferred set count differed significantly (p < 0.001; Cohen's w = 0.71), an effect the authors classified as large. Pretreatment expectancy did not differ significantly among protocols.

Pain did not differ significantly between protocols at the assessed time points. Within the two-set session, pain immediately after exercise declined relative to baseline and immediately before the session (time effect p = 0.015). The mean change did not reach the prespecified clinically important decrease of at least 2 points on the 0–10 Numeric Pain Rating Scale, and the within-session result did not establish an advantage over other set counts. Exercise execution time did not differ significantly for the analyzed exercises. No serious adverse events requiring medical intervention or withdrawal occurred.

Brief exposure to each training volume, followed by a later preference choice, cannot establish whether preferences persist, support adherence, or correspond to longer-term symptom benefit. The investigators cautioned that the modest, age-restricted sample, composed mostly of habitually active women, may not represent older or less active people with fibromyalgia. Randomizing session order also cannot rule out order or recency effects on the eventual choice. The isolated pain decline within the two-set session remains exploratory, not evidence of superior analgesia. The authors viewed preference as potentially informative for individualized training, rather than proof of an optimal therapeutic dose.

The authors concluded that acute preference favored the higher set counts, while no detected difference in expectancy or between-protocol pain established an optimal long-term training dose. They proposed examining whether those preferences persist and relate to subsequent adherence or clinical outcomes.

Clinician Questions

What did exercise execution time measure during resistance training in women with fibromyalgia?

In the fibromyalgia crossover comparison of set counts, stopwatch-based execution time ran from the first through the last repetition of each exercise set, including lifting and lowering phases. It did not measure total training-session duration.

Did investigators ask women with fibromyalgia why they preferred a particular resistance-training set count?

Women with fibromyalgia identified a preferred one-, two-, or three-set resistance-training protocol after completing all options, but investigators did not collect their reasons for those choices.