Comparative efficacy of various exercise therapies for chronic fatigue syndrome: A systematic review and network meta-analysis.

To systematically compare the effectiveness of different exercise therapies for chronic fatigue syndrome (CFS), we conducted a systematic review and network meta-analysis of randomized controlled trials based on searches of nine databases up to February 19, 2025. The review included 25 randomized controlled trials, with 20 trials (n = 2,831) eligible for network meta-analysis. Graded exercise therapy (GET) showed relatively superior short-term effects on fatigue (mean difference [MD]: -6.93, 95% confidence interval [CI]: -10.85 to -3.01; moderate certainty), depression (MD: -5.27, 95% CI: -7.38 to -3.16; low certainty), and anxiety (MD: -2.88, 95% CI: -5.10 to -0.66, low certainty) compared with waitlist at the end of treatments, with partial maintenance of effects at follow-up. Other modalities, including Qigong, Yoga, strength/resistance training, and running showed modest benefits but failed to surpass the minimally important difference with confidence, and were supported by low/very low certainty evidence. These findings support the short-term utility of GET in managing CFS symptoms. However, its broader clinical endorsement remains controversial, highlighting the need for further high-quality trials.