Strength training and aerobic exercise have beneficial effects on pain in adults with fibromyalgia. However, the equivalence of strengthening and aerobic exercise has not been reported. The primary aim of this randomized equivalence trial involving patients with fibromyalgia admitted to an interdisciplinary pain treatment program was to test the hypothesis that strengthening (n = 36) and aerobic (n = 36) exercise have equivalent effects (95% confidence interval within an equivalence margin +/- 8) on pain, as measured by the pain severity subscale of the Multidimensional Pain Inventory. Secondary aims included determining the effects of strengthening and aerobic exercise on peak VO2 uptake, leg strength, and pressure pain thresholds. In an intent-to-treat analysis, the mean (+/- standard deviation) pain severity scores for the strength and aerobic groups at study completion were 34.4 +/- 11.5 and 37.6 +/- 11.9, respectively. The group difference was -3.2 (95% confidence interval, -8.7 to 2.3), which was within the equivalence margin of 8. Significant improvements in pain severity (p < 0.001), peak VO2 (p < 0.001), strength (p < 0.001), and pain thresholds (p < 0.001) were observed from baseline to week 3 in the intent-to-treat analysis; however, patients in the aerobic group (mean change 2.0 +/- 2.6mL/kg/min) experienced greater gains (p < 0.013) in peak VO2 compared to the strength group (mean change 0.4 +/- 2.6mL/kg/min). Knowledge of the equivalence and physiological effects of exercise have important clinical implications that could allow practitioners to target exercise recommendations on the basis of comorbid medical conditions or patient preference for a particular type of exercise. This study found that strength and aerobic exercise had equivalent effects on reducing pain severity among patients with fibromyalgia.

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