The efficacy of exercise in patients with myalgic encephalomyelitis/chronic fatigue syndrome: A systematic review and meta-analysis.

OBJECTIVE

To evaluate the efficacy of exercise training for patients with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS).

METHODS

Seven databases were searched from inception to December 2025 for randomized controlled trials (RCTs) on exercise effects in ME/CFS. A random-effects model was employed to calculate the pooled effect size, with Q, I2 statistic, and τ2 assessing a heterogeneity. Additionally, we performed moderator analyses to explore stability of results.

RESULTS

A total of 17 RCTs (n = 1944) were included. Exercise interventions significantly improved fatigue (16 RCTs, n = 1673; standardized mean difference [SMD] = 0.85, 95% CI 0.65 to 1.06, I2 = 85.3%), sleep quality (5 RCTs, n = 806; SMD = 0.42, 95% CI 0.31 to 0.53, I2 = 41.2%), QoL (11 RCTs, n = 1171; SMD = 0.99, 95% CI 0.73 to 1.26, I2 = 89.7%), depression (9 RCTs, n = 1279; SMD = 0.56, 95% CI 0.43 to 0.69, I2 = 45.8%), and anxiety (9 RCTs, n = 1279; SMD = 0.14, 95% CI 0.04 to 0.24, I2 = 21.2%). However, the effects on cardiopulmonary function (3 RCTs, n = 150; SMD = 0.13, 95% CI -0.11 to 0.43, I2 = 0.0%) and functional capacity (4 RCTs, n = 459; SMD = 0.09, 95% CI -0.21 to 0.38, I2 = 47.4%) were not significant. These results may be influenced by potential moderators such as intervention length, frequency, session duration, and medication use. Crucially, there was no significant difference in acceptability or adverse events between two groups.

CONCLUSION

Exercise significantly improves fatigue, sleep, QoL, and depression in ME/CFS patients. However, exercise does not yield significant improvements in cardiopulmonary or functional capacity. While not a cure, exercise is an effective strategy for symptom management, provided that individual energy limits are strictly respected to prevent harm.