Nutrición Hospitalaria

ISSN: 0212-1611
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Collado Mateo, Daniel; Pazzi, Francesco; Domínguez Muñoz, Francisco J.; Martín
Martínez, Juan Pedro; Olivares, Pedro R.; Gusi, Narcis; Adsuar, José C.
Ganoderma lucidum improves physical fitness in women with fibromyalgia
Nutrición Hospitalaria, vol. 32, núm. 5, 2015, pp. 2126-2135
Grupo Aula Médica
Madrid, España

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 Nutr Hosp. 2015;32(5):2126-2135
ISSN 0212-1611 • CODEN NUHOEQ
S.V.R. 318

Original / Alimentos funcionales
Ganoderma lucidum improves physical fitness in women with fibromyalgia
Daniel Collado Mateo1, Francesco Pazzi1, Francisco J. Domínguez Muñoz1,
Juan Pedro Martín Martínez1, Pedro R. Olivares2, Narcis Gusi1 and José C. Adsuar1
1
Faculty of Sport Science, University of Extremadura, Cáceres, Spain. 2Instituto  de Actividad Física y Salud, Universidad
Autónoma de Chile, Chile.

Abstract GANODERMA LUCIDUM MEJORA LA

CONDICIÓN FÍSICA EN MUJERES CON
Introduction: fibromyalgia is a chronic disease charac- FIBROMIALGIA
terized by generalized pain, stiffness, poor physical con-
ditioning, non-restorative sleep and poor health-related
quality of life. Ganoderma lucidum a type of mushroom Resumen
that has demonstrated several benefits in different po- Introducción: la fibromialgia es una enfermedad cróni-
pulations. Ceratonia siliqua is a natural therapy rich in ca caracterizada por dolor crónico general, rigidez, con-
antioxidants with potential benefits on health. dición física pobre, sueño no reparador y mala calidad
Objective: to evaluate the effects of 6-week treatment de vida relacionada con la salud. Ganoderma lucidum es
of Ganoderma lucidum and Ceratonia siliqua on physical un tipo de hongo que ha demostrado tener diferentes be-
fitness in patients suffering from fibromyalgia. neficios en diversas poblaciones. La harina de algarrobo
Methods: sixty-four women with fibromyalgia partici- (Ceratonia siliqua) es una fuente natural de antioxidantes
pated in the study. They took 6 g of Ganoderma lucidum con potenciales beneficios para la salud.
or Ceratonia siliqua per day for 6 weeks. Different fitness Objetivo: evaluar los efectos sobre la condición física
tests were selected in order to evaluate functional capa- en mujeres con fibromialgia de un tratamiento de seis se-
city. manas con Ganoderma lucidum y compararlos con los de
Results: after the 6-week treatment period, Ganoder- un tratamiento con Ceratonia siliqua.
ma lucidum significantly improved aerobic endurance, Métodos: sesenta y cuatro mujeres con fibromialgia
lower body flexibility, and velocity (p < .05). No signifi- participaron en el estudio. Se hicieron dos grupos, el
cant improvement in any physical test was observed in primer grupo tomó 6 g diarios de Ganoderma lucidum,
the Ceratonia siliqua group. mientras que el segundo tomó 6 g diarios de Ceratonia
Discussion and conclusion: Ganoderma lucidum may siliqua. Se evaluó la condición física mediante diferentes
improve physical fitness in women with fibromyalgia, test físicos validados.
whereas, Ceratonia siliqua seemed to be ineffective at in- Resultados: después de seis semanas de tratamiento,
creasing physical fitness. These results may indicate that Ganoderma lucidum mejoró significativamente la resis-
Ganoderma lucidum might be a useful dietary supple- tencia aeróbica, la flexibilidad del miembro inferior y la
ment to enhance physical performance of the patients velocidad (p < 0,05). Por otro lado, Ceratonia siliqua no
suffering from fibromyalgia. mejoró la condición física.
(Nutr Hosp. 2015;32:2126-2135) Discusión y conclusiones: Ganoderma lucidum puede
mejorar la condición física en mujeres con fibromialgia,
DOI:10.3305/nh.2015.32.5.9601 mientras que Ceratonia siliqua parece no ser efectivo
Key words: Chronic pain. Reishi. Ceratonia siliqua. Ga- para este propósito. Estos resultados pueden indicar que
noderma lucidum. Nutrition. Endurance. Velocity. 6 g diarios de Ganoderma lucidum podrían ser un suple-
mento útil para mejorar la condición física en esta po-
blación.
(Nutr Hosp. 2015;32:2126-2135)
DOI:10.3305/nh.2015.32.5.9601
Palabras clave: Dolor crónico. Reishi. Ceratonia siliqua.
Ganoderma lucidum. Nutrición. Resistencia. Velocidad.

Correspondence: Pedro R. Olivares.

Instituto de Actividad Física y Salud,
Universidad Autónoma de Chile, Chile.
E-mail: [email protected]
Recibido: 7-VII-2015.
Aceptado: 7-VIII-2015.

2126

031_9601 El Ganoderma lucidum mejora.indd 2126 8/10/15 2:41

 Introduction Ceratonia siliqua (CS) is a natural therapy that has
been consumed in many Mediterranean countries in
Fibromyalgia (FM) is a chronic rheumatic disease culinary preparations of beverages and confectionery.
of unknown etiology. It is characterized by generalized It is also called carob tree and it is obtained from the
pain, stiffness, and tenderness in at least 11 of 18 spe- fruit of the CS tree. CS flour is rich in polyphenols
cific points1. In addition, FM is associated with a range and it acts as an antioxidant in the body25,26. Given its
of symptoms, such as muscular stiffness, depression, low prize, CS can be considered a “low cost” source
non-refreshing sleep, and cognitive impairments2,3. In of antioxidants. In mice, antidepressant effects were
European population, the estimated prevalence of FM also reported in previous studies27. However, to our
is around 3% to 5% of the general population4. knowledge, those results have not been studied in hu-
Differences in physical fitness between FM and man samples.
healthy women were compared in previous studies. Recent studies hypothesized that oxidative stress
FM patients showed worse results in upper and lower may have a relevant role in the pathophysiology of
limb strength, balance, flexibility, and aerobic endu- FM28. This, along with the effects of oxidative stress in
rance5,6. FM is also associated with high prevalence physical condition22, suggests that antioxidant sources
of overweight and obesity. In this regard, a recent could improve physical fitness in FM patients.
study reported that approximately 72% of women Given the potential effects of GL and CS, not only
with fibromyalgia are overweight or obese7. This an- as antioxidant sources (especially the GL, which may
thropometric difference could be given because FM have other benefits cited above), the aim of the pre-
patients are more prone to physical inactivity than sent study was to evaluate the effects of GL and CS
healthy people8. This sedentary tendency may be in- on physical fitness in patients suffering from FM. A
creased by FM symptoms like pain, fatigue, stiffness secondary objective was to evaluate the safety of GL
or depression, while at the same time some of these and CS treatments.
symptoms could be worsened by physical inactivity,
i.e. poor physical conditioning or depression9. All of
this can lead a reduction in health-related quality of Methods
life (HRQoL)10.
Recommended therapies in FM include pharmaco- Participants
logical and non-pharmacological therapies. Among
non-pharmacological treatments, physical therapies All participants were recruited from three FM as-
were reported to be effective at increasing well-being sociations. The following inclusion criteria were set:
and physical function11. Natural and nutritional the- 1) be diagnosed with FM by a rheumatologist; 2) be
rapies are currently being studied in this syndrome able to communicate effectively with study staff; 3)
because these could be helpful at improving different be older than 18 years old; 4) Give written-informed
symptoms12. consent. On the other hand, exclusion criteria were
Among those alternative therapies, Ganoderma lu- the following: 1) be pregnant; 2) change their daily
cidum (GL), also known as reishi or linghzi, has been activity during the 6 weeks of treatment; 3) be taking
widely used and studied in different populations. It is immunosuppressive; 4) be suffering from diabetes; 5)
a type of mushroom that has demonstrated his efficacy be participating in other investigations; 6) be taking C
at increasing vital energy, stimulating the immune sys- vitamin supplementation; 7) be taking anticoagulants,
tem, and promoting health13. Previous research investi- and 8) have taken GL and/or CS as a treatment be-
gated its effect as a treatment of different diseases, like fore. Additionally, an algometer (PainTest™ FPX 25
cancer14, diabetes15, Human Immuno Virus16, or hepa- Algometer. Wagner Instruments, Greenwich, USA)
titis17. Different properties and effects were also repor- was used in order to check FM diagnosis. Participants
ted, such as anti-inflammatory18, anti-oxidant15, antivi- without acute painful response in at least 11 of 18 spe-
ral19, neuroprotective20, and hypotensive21. Effects of cified tender points stimulated with a pressure of 4 kg/
GL on physical conditioning still remain unknown in cm2 were excluded.
humans. To our knowledge, only one investigation22 Figure 1 shows the flow diagram of participants. A
assessed the effects of GL on physical fitness, and total of 70 subjects were initially recruited. Sixty-se-
they concluded that the antioxidant effect of GL could ven of them were women and 3 were men. Five par-
protect endurance athletes from overtraining. Effec- ticipants were excluded because they did not meet the
tiveness in increasing antioxidant enzymes activities inclusion criteria and 1 declined to participate. A total
was also investigated in mice23. This study shown the of 64 women took part in the study. All of them signed
evidence that GL possessed protective effects against the informed consent in accordance with the updated
a strenuous exercise that could induce oxidative stress. Declaration of Helsinki.
Furthermore, relevant effects on physical condition This study was approved by the Biomedical Ethics
and fatigue were reported in breast cancer patients24. Committee of the University. The trial was registered
However, the mechanism under these improvements in the Australian New Zealand Clinical Trials, register
remains unknown. number: ACTRN12614001201662.

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031_9601 El Ganoderma lucidum mejora.indd 2127 8/10/15 2:41

 Enrollment Assessed for eligibility (n=70)

Excluded (n=6)
• Not meeting inclusion criteria (n=5)
• Declined to participate (n=1)

Randomized (n=64)

Allocation

Allocated to Ganoderma lucidum Group (n=32) Allocated to Ceratonia Siliqua Group (n=32)
• Received allocated intervention (n=32) • Received allocated intervention (n=31)
• Did not receive allocated intervention (n=0) • Did not receive allocated intervention
(decided not to start treatment) (n=1)

Follow-Up

Lost to follow-up (did not answer the calls) (n=1) Lost to follow-up (did not come the day when
Discontinued intervention (did not comply with the physical tests were performed) (n=1)
treatment for more than 80% of the dose) (n=5) Discontinued intervention (did not comply with the
treatment for more than 80% of the dose) (n=5)

Analysis

Analysed (n=25) Analysed (n=23)

• Excluded from analysis (severe back pain) (n=1) • Excluded from analysis (receiving other non usual
care therapies) (n=2)

Fig. 1.—Flow Diagram of participants.

Procedures doReishi” provided the substances, and the Chair of

Mycology of the University of Valladolid (Spain) was
The current study is a randomized, double blind, responsible to analyze GL.
clinical trial. Participants were randomly assigned to
one of the following two groups: GL group (GLG) or
CS group (CSG). Subjects were informed about the Data collection
existence of both group, but they did not know which
group they were in. Randomization and allocation pro- In order to evaluate functional capacity and physical
cesses were conducted by one of the researchers using fitness, the following well-known tests were selected:
random code numbers. This researcher was not invol-
ved in data acquisition or statistical analysis. Thus, the –– Upper Body Muscular Strength: It was assessed
following people were blinded: a) people receiving the using two tests: the handgrip test and the arm
treatment; b) people administering the treatment; c) curl test. The handgrip strength was measured
people assessing the outcomes; and finally, d) people using a hand dynamometer (Takei TKK 5401
analyzing the results. Digital Handgrip Dynamometer, Tokyo Ja-
After initial measurement, participants took GL or pan). Patients had to squeeze the dynamometer
CS during a period of 6 weeks. GLG ingested 3g of GL with an optimal grip-span29. The better of two
dissolved in warm water twice a day (6g per day). The attempts for each hand was used in the analy-
first intake was at breakfast; whereas the second one ses. The second tool was the “Arm curl test”30.
was at dinner. CSG took 6 daily grams of CS with the It quantifies the number of repetitions that the
same administration indications. The company “Mun- patient is able to lift a hand weight (2.3 kg) in

2128 Nutr Hosp. 2015;32(5):2126-2135 Daniel Collado-Mateo et al.

031_9601 El Ganoderma lucidum mejora.indd 2128 8/10/15 2:41

 30 seconds. One trial with each hand was perfor- • Eyes open on unstable surface. In this test so-
med by the patients. matosensory capacity is compromised, thus vi-
–– Lower body muscular strength. The 30s-Chair sual and vestibular inputs are measured.
stand test was used. Participants started this test • Eyes closed on unstable surface. Only vesti-
seated on a chair with their hands over their bular information was estimated by compro-
shoulders. They should stand-up and sit-down as mising somatosensory information and visual
fast as possible within 30 seconds31. The number feedback.
of times they stand-up were recorded.
–– Upper Body Flexibility was assessed using the –– Trunk Endurance was evaluated by using the Ito,
back scratch test32. In this test, the distance be- Shirado method36. Flexor endurance was assessed
tween fingers behind the back is measured and at first. Patients started the test in supine position
the overlap is scored positively. and they should raise their lower extremities with
–– Lower Body Flexibility: it was measured using 90º flexion of the hip and knees joints. For ex-
the chair-sit-and-reach test30. In this test, partici- tensor muscles, participants should be in prone
pants were seated on a chair and they had to ex- position while holding their sternum off the floor.
tend their legs: first, the right leg, and second, the Subjects must maintain these positions as long as
other one. Then, they were instructed to reach the possible in both tests.
extended leg with the middle finger of the corres-
ponding hand and hold this position. Best score
was registered. Statistical analysis
–– Balance and agility: the 3 meters version of the
Timed-Up-and-Go Test (TUG)33 was used to as- Values of descriptive variables were calculated in
sess agility and dynamic balance. Participants order to characterize the two groups. Student’s t test
were asked to sit on a chair, placing their back for independent samples was used to compare the cha-
against the backrest of the chair. At the signal, racteristics of GLG and CSG at baseline. Distribution
they should walk to a line 3 meters away, turn of data was checked using the Kolmogorov-Smirnov
around, walk back to the chair and sit-down. Best test with Lilliefors significance.
score of two trials was used in the analyses. The analysis of variance (ANOVA) for repeated
–– Aerobic Endurance was measured using the measures was used to calculate the effects of the treat-
6-min walking test30. This test aims to determine ment on the physical fitness outcomes. Paired t test
the maximum distance that participants were able was calculated in order to estimate the changes of both
to walk in 6 minutes. It was performed around a groups comparing from baseline.
square measuring 20 meters each side. In addition to the efficacy analysis, which compri-
–– Velocity: Participants were asked to walk 20 me- ses the participants who took at least 80% of the do-
ters as fast as possible. Mean velocity was calcu- ses and completed the task, an intent-to-treat analysis
lated dividing the 20 meters by the time taken to was performed. It comprises the 64 initial participants.
complete this 20 meters34. Data of all participants that came to the post-treatment
–– Balance: it was measured using Biodex Balance measures were utilized, including data coming from
System (Shirley, NY, USA). This device objecti- the people who did not take at least 80% of the do-
vely measures the ability of a subject to stabilize ses (n=10). Post-treatment data of the remainder of
himself. It also quantifies the tilt about each axis the sample (n=6) was imputed according to the mean
during static and dynamic conditions. Clinical change of their group. The level of significance was
Test of Sensory Integration of Balance (CTSIB) set at p<.05. Analyses were performed using SPSS sof-
protocol was used. This test was performed with tware (version 21).
different devices by previous studies35. However,
it is the first time, to our knowledge, that this pro-
tocol is carried out with Biodex Balance System. Results
In all tests, patients maintained their feet on the
platform during 30 seconds with a rest of 10 se- Characteristics of participants at baseline are shown
conds between each test. The following tests were in table I. No statistically significant difference was
performed to quantify postural sway under four observed between GLG and CSG at baseline.
different sensory conditions according to the CT- Initially, 64 women were randomly allocated in 2
SIB: equal groups. However, final sample comprised 48
women: 25 belonging to GLG and 23 belonging to
• Eyes open on firm surface to measure somato- CSG. Starting from these 64 patients, a total of 5 par-
sensory, visual and vestibular sensory inputs. ticipants of each group did not took at least 80% of
• Eyes closed on firm surface to estimate somato- the dose and were excluded; 1 subject decided not to
sensory and vestibular inputs, since visual input start the treatment after the randomization was per-
is not available. formed; another woman did not answer the calls and

Ganoderma lucidum improves physical Nutr Hosp. 2015;32(5):2126-2135 2129

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 Table I
Characteristics at baseline of the two groups

GLG (n=25) CSG (n=23) p

Age (years) 56.25 (8.05) 53.62 (11.75) .367
Height (cm) 157.16 (4.63) 156.13 (6.16) .514
Weight (kg) 64.21 (9.87) 61.50 (13.50) .429
Muscular mass (%) 62.00 (7.31) 64.76 (8.77) .245
Fat mass (%) 34.80 (7.67) 32.33 (7.92) .285
BMI 26.00 (3.82) 25.20 (4.83) .522
Date when fibromyalgia symptoms started 1993 (12.09) 1992 (12.76) .652
*Values expressed as mean (SD). BMI: Body Mass Index. GLG: Ganoderma lucidum group. CSG: Ceratonia siliqua group.

was lost; 2 women considerably changed their usual researches on the physiological effects of GL in the
therapies and were excluded too; 1 woman was not physical condition are needed.
able to complete physical fitness tests because she Although the current study is not able to precisely
had an acute musculoskeletal injury; 1 woman did not explain how physical condition is improved, the rele-
show up when measurements was performed (Fig. 1). vance of our findings is very large. To our knowledge,
Finally, 48 women were included in the efficacy this is the first study that investigates the effects of GL
analysis (GLG=25; CSG=23), whereas 64 (GLG=32; and/or CS on the physical fitness of a population with
CSG=32) were taken in consideration of intent to treat a specific disease. Therefore, this study lays the foun-
analysis. dation for future research focused on the GL effects on
Effects of GLG and CSG on physical fitness are physical fitness in pathologies characterized by poor
represented in table II. After the 6-week treatment physical conditioning. At the same time, findings from
period, a statistically significant difference in aerobic the previous study in cyclists are confirmed22. In this
endurance was observed between both groups (p<.05). way, the current study is also an important entry point
Furthermore, GLG obtained significant improvements for future studies on the effects of GL in sport perfor-
(p<.05) in lower body flexibility and velocity in effi- mance.
cacy analysis compared with CSG. However, only the The relevance of the physical condition in women
improvement in lower body flexibility was significant suffering from FM is widely known. In fact, it is clo-
in the intent to treat analysis (Table III). sely related with the satisfaction with life and wellbe-
ing40, because it is obviously related with the ability of
perform activities of daily living. Furthermore, aerobic
Discussion endurance and flexibility are extremely related with
HRQoL. The reported treatment effect in velocity is
The main finding of the current paper was that 6g/ higher than the minimal real change, which was calcu-
day of GL for 6 weeks improved the physical fitness of lated in patients with chronic pain (osteoarthritis) and
women suffering from FM. Specifically, we observed it was 0.07 m/s34.
improvements on aerobic endurance, walking veloci- Safety of both GL and CS were also demonstrated
ty, and lower limb flexibility. On the other hand, CS in the current paper. A total of 10 participants did not
seemed to be rather ineffective in improving physical complete the minimum 80% of the treatment. Of the-
fitness in FM patients. To our knowledge, this is the se, 5 belonged to the GLG and other 5 to the CSG,
first study that assesses the effects of CS and/or GL on which means a 15.63% of the total sample. The most
physical condition in FM patients. common complaint in those 10 participants were mild
Given the lack of studies about the potential mecha- nausea, diarrhea, discomfort, and nervousness. Some
nism of GL and CS in physical fitness, it is difficult participants opined that the reason of those reactions
to explain how GL may improve aerobic endurance, were the bad taste. In all cases the reactions were mild
velocity, or flexibility. The best explanation based on or moderate and the participants were asked to reduce
previous studies is the antioxidant effect37,38. In addi- the dose to 3 grams per day. However, no one of the
tion, the oxidative/antioxidative status was suggested patients that reduced the dose were able to continue the
to be a critical factor in physical and mental health of treatment and all of them ceased it. This could suggest
FM patients28,39. However, both GL and CS are antioxi- that the daily amount of GL and CS is not the cause of
dant sources. Therefore, based on our results, there can those complaints.
be no assurance that the reported improvements are The current study has several limitations. The most
caused by an antioxidant effect. In this context, further important limitation is the lack of previous studies that

2130 Nutr Hosp. 2015;32(5):2126-2135 Daniel Collado-Mateo et al.

031_9601 El Ganoderma lucidum mejora.indd 2130 8/10/15 2:41

 Table II
Effects of 6 weeks of GL vs CS treatment on physical conditioning

GLG CSG

Outcome measure Test Mean Mean Treatment Global

Mean (SD) Intra-Group Mean (SD) Intra-Group

031_9601 El Ganoderma lucidum mejora.indd 2131

(SD) after Pa (SD) after Pa F Pb effect Mean Effect
at baseline Effect Size at baseline Effect Size
treatment treatment (95% CI) Size
Right Handgrip (kg)
19.58 19.92 20.36 20.28 -0.42
GLG (n=25) .601 -0.072 .910 0.016 0.201 .656 0.132
(4.98) (4.33) (4.09) (5.68) (-1.47 to 2.32)

fitness in women with fibromyalgia

CSG (n=23)

Ganoderma lucidum improves physical

Left Handgrip (kg)
18.33 18.91 18.73 19.39 0.07
GLG (n=24) .482 -0.131 .420 -0.143 0.005 .946 0.021
(4.92) (3.85) (3.99) (5.11) (-2.37 to 2.21)
Upper Body Stren- CSG (n=23)
gth Arm Curl Right (reps)
10.20 13.36 10.09 12.91 -0.34
GLG (n=25) <.001 -0.830 .001 -0.877 0.145 .705 0.112
(3.55) (4.04) (2.99) (3.42) (-1.43 to 2.09)
CSG (n=23)
Arm Curl Left (reps)
10.48 13.81 10.41 12.67 -1.07
GLG (n=24) <.001 -0.782 .001 0.681 1.784 .188 0.398
(4.11) (4.40) (3.64) (2.96) (-0.54 to 2.68)
CSG (n=23)
Back Scratch (cm)
Upper Body -4.12 -3.80 -5.36 -5.86 -0.82
GLG (n=25) .761 -0.029 .754 0.058 0.197 .659 0.133
Flexibility (10.99) (10.63) (8.71) (8.35) (-2.90 to 4.54)
CSG (n=22)
Chair Sit and Reach (cm)
Lower body -0.20 4.00 -0.35 -.22 -4.06
GLG (n=25) <.001 -0.452 .893 -0.014 9.060 .004 0.887
flexibility (8.69) (9.85) (9.39) (8.98) (1.38 to 6.75)
CSG (n=23)

Nutr Hosp. 2015;32(5):2126-2135

Timed-Up-Go (s)
7.29 6.85 7.31 7.00 0.13
Balance and agility GLG (n=25) .007 0.378 .329 0.257 0.144 .706 0.113
(1.29) (1.02) (1.10) (1.30) (-0.80 to 0.54)
CSG (n=22)
6 m Walking (m)
507.00 528.97 477.73 469.49 -30.19
Aerobic endurance GLG (n=25) .006 -0.301 .643 0.080 4.260 .045 0.497
(73.88) (72.08) (79.69) (120.45) (-6.33 to 66.75)
CSG (n=22)
Chair stand Test (reps)
10.26 11.14 10.22 10.86 -0.25
Lower body strength GLG (n=25) .005 -0.462 .051 -0.279 0.343 .561 0.175
(1.71) (2.08) (2.03) (2.52) (-0.59 to 1.08)
CSG (n=22)
20-m walk test (m/s)
3.35 3.54 3.26 3.24 0.30
Velocity GLG (n=25) .002 0.254 .883 -0.059 4.491 .040 0.625
(0.52) (0.54) (0.42) (0.52) (-0.72 to .11)
CSG (n=23)

2131

8/10/15 2:41
 2132
Table II (cont.)
Effects of 6 weeks of GL vs CS treatment on physical conditioning

GLG CSG

031_9601 El Ganoderma lucidum mejora.indd 2132

Outcome measure Test Mean Mean Treatment Global
Mean (SD) Intra-Group Mean (SD) Intra-Group
(SD) after Pa (SD) after Pa F Pb effect Mean Effect
at baseline Effect Size at baseline Effect Size
treatment treatment (95% CI) Size
Balance. Eyes Open
4.63 4.77 4.72 4.32 -0.54
Firm Surface Stability Index (º) .478 -0.090 .238 0.203 2.066 .157 0.424
(1.68) (1.42) (1.62) (2.26) (-0.21 to 1.30)
GLG (n=25)
0.78 0.51 0.73 0.62 0.16
CSG (n=23) Swing Index (º) .021 0.599 .255 0.247 1.239 .271 0.329
(0.59) (0.24) (0.44) (0.45) (-0.43 to 0.12)
Balance Eyes Closed
4.83 4.70 4.66 4.20 -0.33
Firm Surface Stability Index (º) .591 0.083 .205 0.245 0.657 .422 0.239
(1.50) (1.61) (1.66) (2.06) (-0.49 to 1.15)
GLG (n=25)
1.19 0.99 1.01 0.90 0.08
.136 0.216 0.348 .558 0.174

Nutr Hosp. 2015;32(5):2126-2135

CSG (n=23) Swing Index (º) .080 0.355
(0.62) (0.50) (0.56) (0.45) (-0.34 to 0.18)
Balance Eyes Open
4.02 4.14 3.97 4.38 0.28
Unstable Surface Stability Index (º) .635 -0.078 .210 -0.243 0.483 .490 0.205
(1.65) (1.41) (1.52) (1.83) (-1.09 to 0.53)
GLG (n=25)
1.42 1.26 1.22 1.05 -0.01
CSG (n=23) Swing Index (º) .218 0.249 .001 0.418 0.008 .931 0.026
(0.63) (0.65) (0.44) (0.37) (-0.26 to 0.29)
Eyes Closed on
4.90 4.92 4.57 4.89 0.29
Unstable Surface Stability Index (º) .933 -0.013 .279 -0.147 0.469 .497 0.202
(1.37) (1.50) (1.85) (2.45) (-1.14 to 0.56)
GLG (n=25)
3.22 3.22 2.93 2.82 -0.10
CSG (n=23) Swing Index (º) .997 0.000 .562 0.106 0.157 .693 0.117
(0.97) (1.24) (1.07) (.99) (-0.43 to 0.65)
46.18 54.55 39.45 41.49 -6.33 (-18.19
Trunk Endurance Abdominal (s) .321 -0.211 .817 -0.056 0.272 .605 0.242
(39.47) (39.80) (34.69) (37.74) to 30.87)
GLG (n=25)
CSG (n=19) 54.01 59.36 49.73 46.41 -8.66 (-25.58
Lumbar (s) .666 -0.123 .777 0.081 0.261 .612 0.168
(40.84) (45.81) (41.22) (40.75) to 42.92)
GLG: ganoderma lucidum group; CSG: ceratonia siliqua group; ap of t-test; bp-values of analysis of variance for repeated measures to compare differences between groups after treatment; CI: confidence
interval.

Daniel Collado-Mateo et al.

8/10/15 2:41
 Table III
Effects of 6 weeks of GL or CS treatments on physical conditioning. Intent-to-treat analysis

GLG (n=32) CSG (n=32)

Outcome measure Test Mean Mean Treatment Global

Mean (SD) Intra-Group Mean (SD) Intra-Group
(SD) after Pa (SD) after pa F Pb effect Mean Effect
at base line Effect Size at base line Effect Size
treatment treatment (95% CI) Size

031_9601 El Ganoderma lucidum mejora.indd 2133

19.81 18.17 19.98 18.51 0.28
Right Handgrip (kg) .885 0.338 .571 0.346 0.042 .838 0.052
(4.87) (4.82) (4.33) (4.16) (-1.92 to 1.37)
18.17 18.56 18.51 19.47 0.56
Left Handgrip (kg) .535 -0.084 .147 -0.215 0.399 .530 0.160

fitness in women with fibromyalgia

Upper Body (4.82) (4.37) (4.16) (4.72) (-2.35 to 1.22)
Strength

Ganoderma lucidum improves physical

9.76 12.82 9.06 12.45 0.32
Right arm curl (reps) .000 -0.826 .000 -0.909 0.182 .672 0.108
(3.44) (3.95) (3.34) (4.08) (-1.83 to 1.19)
10.36 13.65 9.92 12.65 -0.56
Left arm curl (reps) .000 -0.811 .000 -0.707 0.674 .415 0.209
(3.87) (4.23) (3.83) (3.89) (-0.80 to 1.93)
Upper Body -4.00 -3.50 -5.00 -6.25 -1.74
Back Scratch (cm) .560 -0.045 .282 0.119 1.514 .223 0.313
Flexibility (11.02) (10.87) (10.39) (10.55) (-1.09 to 4.58)
Lower body -0.28 3.02 -0.34 0.43 -2.53
Chair Sit and Reach (cm) .000 -0.375 .397 -0.070 4.312 .044 0.527
flexibility (8.38) (9.20) (11.62) (10.16) (0.06 to 4.99)
7.25 6.89 7.43 7.18 0.09
Balance and agility Timed-Up-Go (s) .010 0.322 .288 0.160 0.163 .688 0.103
(1.18) (1.05) (1.49) (1.62) (-0.64 to 0.42)
Six minutes walking test 505.59 524.76 484.46 474.79 -28.84
Aerobic endurance .008 -0.269 .478 0.096 3.661 .060 0.486
(m) (71.40) (70.89) (80.52) (117.4) (-1.29 to 58.99)
10.29 11.04 10.03 10.75 -0.02
Lower Body strength Chair stand test (reps) .007 -0.398 .003 -0.275 0.006 .940 0.020
(1.72) (2.03) (2.40) (2.81) (-0.65 to 0.70)
3.36 3.51 3.27 3.25 -0.15
Velocity 20-m walk test (m/s) .006 -0.282 .808 0.037 3.581 .063 0.481
(0.50) (0.56) (0.47) (0.58) (-0.01 to 0.33)

Nutr Hosp. 2015;32(5):2126-2135

4.60 4.82 4.60 4.49 -0.33
Balance Eyes Open Stability Index(º) .318 -0.133 .726 0.055 0.740 .393 0.218
(1.78) (1.51) (1.56) (2.32) (-0.43 to 1.09)
Firm Surface
0.79 0.53 0.80 0.68 0.14
Swing Index(º) .005 0.533 .087 0.219 1.628 .207 0.324
(0.62) (0.30) (0.51) (0.58) (-0.35 to 0.07)
4.93 4.84 4.64 4.37 -0.17
Balance Eyes Closed Stability Index(º) .660 0.052 .330 0.149 0.268 .607 0.131
(1.65) (1.77) (1.65) (1.94) (-0.50 to 0.86)
Firm Surface
1.19 0.96 1.08 0.93 0.07
Swing Index(º) .037 0.388 .029 0.252 0.306 .582 0.141
(0.68) (0.49) (0.60) (0.59) (-0.31 to 0.17)
4.18 4.41 3.93 4.35 0.18
Balance Eyes Open Stability Index(º) .311 -0.148 .117 -0.264 0.279 .599 0.134
(1.59) (1.50) (1.42) (1.74) (-0.88 to 0.51)
Unstable Surface
1.42 1.25 1.30 1.16 0.03
Swing Index(º) .105 0.285 .029 0.231 0.078 .781 0.078
(0.59) (0.60) (0.53) (0.67) (-0.27 to 0.20)

2133

8/10/15 2:41
 could explain the mechanisms under the differences

GLG: ganoderma lucidum group; CSG: ceratonia siliqua group; ap of t-test; bp-values of analysis of variance for repeated measures to compare differences between groups after treatment; CI: confidence
Global
Effect

0.210

0.029

0.123

0.071
Size
observed. In addition, given that the two treatments
were antioxidant sources, it is impossible to conclu-
de whether the changes are based on the antioxidant

(-0.96 to 0.40)

(-0.42 to 0.48)
-4.09 (-12.78

-3.54 (-21.71
effect Mean
Treatment

(95% CI)
effects or not. The second is the lack of knowledge

to 20.96)

to 28.80)
-0.02
0.28
about the most adequate dose of both GL and CS in
adult women. Furthermore, the dose and indications of
both treatments had to be the same in order to keep the
double-blind. Third, duration of the treatment could be
0.681 .413

0.013 .910

0.235 .630

0.079 .780
Pb

insufficient to increase some physical fitness variables.

Finally, although no statistically significant differences
F

in many physical tests were observed, treatment effects

could not be discarded due to the small sample size.
Intra-Group
Effect Size

Despite all these limitations, it can be concluded that

-0.169

-0.037
-0.119
0.028

GL may be effective in improving endurance, lower

Effects of 6 weeks of GL or CS treatments on physical conditioning. Intent-to-treat analysis

body flexibility, and velocity. On the other hand, CS

seemed to be ineffective in improving physical fitness
in women suffering from FM. However, more studies
.171

.870

.434

.858
pa

with longer intervention periods and different doses

CSG (n=32)

of GL and CS are required. Similarly, further studies

(SD) after
treatment

(37.16)

(41.05)

focused on the mechanisms under the reported impro-

(2.18)

(1.13)
Mean

40.62

49.17
4.93

2.95

vements are needed.

Effect Size at base line
Intra-Group Mean (SD)

Acknowledgments
(34.10)

(39.08)
(1.68)

(1.00)
36.36

47.66
4.60

2.98

The authors acknowledge Juan Andrés Oria de Rue-

Table III (cont.)

da for the support in the study protocol design. The

company “MundoReishi” provided the Ganoderma lu-
-0.033

-0.227

-0.121

cidum and Ceratonia siliqua utilized in the study. The

0.000

author DCM was supported by a Predoctoral Fellows-

hip from the “Fundación Tatiana Pérez de Guzmán el
Bueno”. The authors acknowledge the assistance of
.845

.995

.209

.598
Pa

the local associations of Palencia, Salamanca and Chi-

GLG (n=32)

piona.
(SD) after
treatment

(36.98)

(44.09)
(1.54)

(1.24)
Mean

53.90

58.86
5.02

3.32

Conflict of Interest

The authors declare there are not competing finan-

at base line
Mean (SD)

(36.52)

(38.69)

cial interests existing.

(1.48)

(1.02)
45.55

53.82
4.97

3.32

References
Stability Index(º)

1. Wolfe F, Smythe HA, Yunus MB, et al. The american-colle-

Swing Index(º)

Abdominal(s)

ge-of-rheumatology 1990 criteria for the classification of fi-

Lumbar(s)

bromyalgia - report of the multicenter criteria committee. Ar-

Test

thritis and rheumatism 1990; 33(2): 160-72.

2. Bennett RM, Jones J, Turk DC, Russell IJ, Matallana L. An
internet survey of 2,596 people with fibromyalgia. Bmc Mus-
culoskeletal Disorders 2007; 8.
3. Wilson HD, Robinson JP, Turk DC. Toward the Identification
of Symptom Patterns in People With Fibromyalgia. Arthritis &
Outcome measure

Rheumatism-Arthritis Care & Research 2009; 61(4): 527-34.

Trunk Endurance

4. Branco JC, Bannwarth B, Failde I, et al. Prevalence of Fibrom-

Unstable Surface
Eyes Closed on

yalgia: A Survey in Five European Countries. Seminars in ar-

thritis and rheumatism 2010; 39(6): 448-53.
5. Aparicio VA, Segura-Jimenez V, Alvarez-Gallardo IC, et al.
interval.

Fitness Testing in the Fibromyalgia Diagnosis: The al-Anda-

lus Project. Medicine and science in sports and exercise 2015;
47(3): 451-9.

2134 Nutr Hosp. 2015;32(5):2126-2135 Daniel Collado-Mateo et al.

031_9601 El Ganoderma lucidum mejora.indd 2134 8/10/15 2:41

 6. Aparicio VA, Carbonell-Baeza A, Ruiz JR, et al. Fitness testing 22. Rossi P, Buonocore D, Altobelli E, et al. Improving Training
as a discriminative tool for the diagnosis and monitoring of Condition Assessment in Endurance Cyclists: Effects of Gano-
fibromyalgia. Scandinavian journal of medicine & science in derma lucidum and Ophiocordyceps sinensis Dietary Supple-
sports 2013; 23(4): 415-23. mentation. Evidence-based complementary and alternative
7. Segura-Jimenez V, Aparicio VA, Alvarez-Gallardo IC, Car- medicine : eCAM 2014; 2014: 979613.
bonell-Baeza A, Tornero-Quinones I, Delgado-Fernandez M. 23. Zhonghui Z, Xiaowei Z, Fang F. Ganoderma lucidum polysac-
Does body composition differ between fibromyalgia patients charides supplementation attenuates exercise-induced oxidati-
and controls? The al-Andalus project. Clinical and experimen- ve stress in skeletal muscle of mice. Saudi journal of biological
tal rheumatology 2015; 33(1 Suppl 88): 25-32. sciences 2014; 21(2): 119-23.
8. Rusu C, Gee ME, Lagace C, Parlor M. Chronic fatigue syndro- 24. Zhao H, Zhang Q, Zhao L, Huang X, Wang J, Kang X. Spore
me and fibromyalgia in Canada: prevalence and associations Powder of Ganoderma lucidum Improves Cancer-Related Fati-
with six health status indicators. Health promotion and chronic gue in Breast Cancer Patients Undergoing Endocrine Therapy:
disease prevention in Canada 2015; 35(1): 3-11. A Pilot Clinical Trial. Evidence-based complementary and al-
9. Everson-Hock ES, Green MA, Goyder EC, et al. Reducing the ternative medicine : eCAM 2012; 2012: 809614.
impact of physical inactivity: evidence to support the case for 25. El Hajaji H, Lachkar N, Alaoui K, et al. Antioxidant activity,
targeting people with chronic mental and physical conditions. phytochemical screening, and total phenolic content of extracts
Journal of public health 2015. from three genders of carob tree barks growing in Morocco.
10. Gusi N, Tomas-Carus P, Hakkinen A, Hakkinen K, Orte- Arabian Journal of Chemistry 2011; 4(3): 321-4.
ga-Alons A. Exercise in waist-high warm water decreases pain 26. Yousif AK, Alghzawi HM. Processing and characterization of
and improves health-related quality of life and strength in the carob powder. Food chemistry 2000; 69(3): 283-7.
lower extremities in women with fibromyalgia. Arthritis & 27. Agrawal A, Mohan M, Kasture S, et al. Antidepressant activity
Rheumatism-Arthritis Care & Research 2006; 55(1): 66-73. of Ceratonia siliqua L. fruit extract, a source of polyphenols.
11. Busch AJ, Schachter CL, Overend TJ, Peloso PM, Barber Natural product research 2011; 25(4): 450-6.
KAR. Exercise for fibromyalgia: A systematic review. Journal 28. Rossi A, Di Lollo AC, Guzzo MP, et al. Fibromyalgia and nu-
of Rheumatology 2008; 35(6): 1130-44. trition: what news? Clinical and experimental rheumatology
12. Shaver JL, Wilbur J, Lee H, Robinson FP, Wang E. Self-Re- 2015; 33(1 Suppl 88): S117-25.
ported Medication and Herb/Supplement Use by Women with 29. Ruiz-Ruiz J, Mesa JLM, Gutierrez A, Castillo MJ. Hand size
and without Fibromyalgia. Journal of Womens Health 2009; influences optimal grip span in women but not in men. Journal
18(5): 709-16. of Hand Surgery-American Volume 2002; 27A(5): 897-901.
13. Batra P, Sharma AK, Khajuria R. Probing Lingzhi or Reishi 30. Rikli RE, Jones CJ. Development and validation of a functio-
Medicinal Mushroom Ganoderma lucidum (Higher Basi- nal fitness test for community-residing older adults. Journal of
diomycetes): A Bitter Mushroom with Amazing Health Be- Aging and Physical Activity 1999; 7(2): 129-61.
nefits. International journal of medicinal mushrooms 2013; 31. Park DC, Glass JM, Minear M, Crofford LJ. Cognitive func-
15(2): 127-43. tion in fibromyalgia patients. Arthritis and rheumatism 2001;
14. Liang Z, Yi Y, Guo Y, Wang R, Hu Q, Xiong X. Chemical 44(9): 2125-33.
characterization and antitumor activities of polysaccharide 32. Rikli RE, Jones CJ. Senior fitness test manual: Human Ki-
extracted from Ganoderma lucidum. International journal of netics; 2013.
molecular sciences 2014; 15(5): 9103-16. 33. Podsiadlo D, Richardson S. The timed up and go - a test of
15. Pan D, Zhang D, Wu J, et al. Antidiabetic, antihyperlipidemic basic functional mobility for frail elderly persons. Journal of
and antioxidant activities of a novel proteoglycan from gano- the American Geriatrics Society 1991; 39(2): 142-8.
derma lucidum fruiting bodies on db/db mice and the possible 34. Motyl JM, Driban JB, McAdams E, Price LL, McAlindon TE.
mechanism. PloS one 2013; 8(7): e68332. Test-retest reliability and sensitivity of the 20-meter walk test
16. Akbar R, Yam WK. Interaction of ganoderic acid on HIV re- among patients with knee osteoarthritis. BMC musculoskeletal
lated target: molecular docking studies. Bioinformation 2011; disorders 2013; 14: 166.
7(8): 413-7. 35. Alias HA, Justine M. The impact of a submaximal level of
17. Li Y, Yang Y, Fang L, Zhang Z, Jin J, Zhang K. Anti-hepatitis exercise on balance performance in older persons. TheScienti-
activities in the broth of Ganoderma lucidum supplemented ficWorldJournal 2014; 2014: 986252-.
with a Chinese herbal medicine. The American journal of Chi- 36. Ito T, Shirado O, Suzuki H, Takahashi M, Kaneda K, Strax
nese medicine 2006; 34(2): 341-9. TE. Lumbar trunk muscle endurance testing: An inexpensive
18. Yoon HM, Jang KJ, Han MS, et al. Ganoderma lucidum etha- alternative to a machine for evaluation. Archives of Physical
nol extract inhibits the inflammatory response by suppressing Medicine and Rehabilitation 1996; 77(1): 75-9.
the NF-kappaB and toll-like receptor pathways in lipopolysac- 37. Lamprecht M, Hofmann P, Greilberger JF, Schwaberger G.
charide-stimulated BV2 microglial cells. Experimental and Increased lipid peroxidation in trained men after 2 weeks of
therapeutic medicine 2013; 5(3): 957-63. antioxidant supplementation. International journal of sport nu-
19. Zhang W, Tao J, Yang X, et al. Antiviral effects of two Gano- trition and exercise metabolism 2009; 19(4): 385-99.
derma lucidum triterpenoids against enterovirus 71 infection. 38. Gomez-Cabrera MC, Borras C, Pallardo FV, Sastre J, Ji LL,
Biochemical and biophysical research communications 2014; Vina J. Decreasing xanthine oxidase-mediated oxidative stress
449(3): 307-12. prevents useful cellular adaptations to exercise in rats. The
20. Zhang W, Zhang Q, Deng W, et al. Neuroprotective effect of Journal of physiology 2005; 567(Pt 1): 113-20.
pretreatment with ganoderma lucidum in cerebral ischemia/ 39. La Rubia M, Rus A, Molina F, Del Moral ML. Is fibromyal-
reperfusion injury in rat hippocampus. Neural regeneration gia-related oxidative stress implicated in the decline of physi-
research 2014; 9(15): 1446-52. cal and mental health status? Clinical and experimental rheu-
21. Tran HB, Yamamoto A, Matsumoto S, et al. Hypotensive matology 2013; 31(6 Suppl 79): S121-7.
effects and angiotensin-converting enzyme inhibitory peptides 40. Juuso P, Skar L, Olsson M, Soderberg S. Meanings of feeling
of reishi (Ganoderma lingzhi) auto-digested extract. Molecules well for women with fibromyalgia. Health care for women in-
2014; 19(9): 13473-85. ternational 2013; 34(8): 694-706.

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fitness in women with fibromyalgia

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