Review Effectiveness of Exercise-Based Rehabilitation in Chronic Fatigue Syndrome: A Systematic Review and Meta-analysis, 2025, Martin et al

forestglip

forestglip

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Effectiveness of Exercise-Based Rehabilitation in Chronic Fatigue Syndrome: A Systematic Review and Meta-analysis

Antonio De Vera Martín, Alberto Díaz Salazar, Isidro Miguel Martín Pérez, Sebastián Eustaquio Martín Pérez

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Abstract
Chronic Fatigue Syndrome is a complex and debilitating disorder characterized by persistent fatigue, musculoskeletal pain, sleep disturbances, and cognitive impairments. The global prevalence is estimated between 0.2% and 0.4%, affecting over 17 million individuals worldwide, with an estimated burden exceeding 40,000 cases in Spain.

Despite the exploration of exercise-based rehabilitation as a therapeutic strategy, its clinical efficacy remains a subject of ongoing debate. This study aims to evaluate the effectiveness of exercise-based rehabilitation relative to conventional treatments in improving functional capacity and alleviating fatigue among adults with CFS

A systematic review and meta-analysis were conducted following PRISMA guidelines and registered in the PROSPERO database (CRD42024573955). Searches were systematically performed across MEDLINE, PEDro, CINAHL, Google Scholar, Scopus, and SportDiscus, covering studies published between January 2010 and January 2024. Methodological quality and risk of bias, assessed using the validated PEDro Scale and Cochrane tool, ranged from moderate to good, with bias levels varying from low to high. Inclusion criteria targeted studies investigating structured therapeutic exercise interventions, including aerobic training, resistance exercises, and mind-body therapies.

A total of 11 studies were included in the qualitative review, and with 7 randomized controlled trials (n = 2,276 participants) were finally incorporated in the meta-analysis.

Exercise-based interventions, including aerobic training, resistance exercises, graded exercise therapy (GET), mind-body therapies and multimodal programs, showed significantly significant reductions in fatigue in both the short term (n = 720) SMD = −0.50; 95% CI: [−0.75, -0.24]; Z = 3.81; p < 0.001) and medium term (n = 501; SMD = −0.53; 95% CI: [−0.95, -0.12]; Z = 2.52; p = 0.01).

Medium-term improvements in functionality were also significant (n = 685; SMD = 0.31; 95% CI: [0.11, 0.52]; Z = 2.96; p = 0.003), whereas short-term functionality outcomes were lesser compared to controls (n = 366; SMD = 0.10; 95% CI: [−0.05, 0.25]; Z = 1.29; p = 0.20).

Notably, the meta- analytic findings indicated that medium-term functional outcomes slightly favored control groups over exercise interventions, and no significant long-term benefits were observed in either fatigue reduction or functional capacity enhancement.

These findings underscore the selective efficacy of exercise-based rehabilitation for CFS, particularly in mitigating fatigue over the short to medium term. However, the transient nature of functional improvements highlights the need for further research to optimize exercise protocols, determine the most effective modalities, and develop strategies to sustain long-term therapeutic outcomes.

While the results support exercise as a potential adjunctive therapy for CFS, they also emphasize the necessity of rigorous, longitudinal investigations to establish its clinical applicability and long-term efficacy.

Link | PDF (International Journal of Exercise Science) [Open Access]
 
forestglip said:
Notably, the meta- analytic findings indicated that medium-term functional outcomes slightly favored control groups over exercise interventions, and no significant long-term benefits were observed in either fatigue reduction or functional capacity enhancement.

These findings underscore the selective efficacy of exercise-based rehabilitation for CFS, particularly in mitigating fatigue over the short to medium term. However, the transient nature of functional improvements highlights the need for further research to optimize exercise protocols, determine the most effective modalities, and develop strategies to sustain long-term therapeutic outcomes.

While the results support exercise as a potential adjunctive therapy for CFS, they also emphasize the necessity of rigorous, longitudinal investigations to establish its clinical applicability and long-term efficacy.
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I wish they had applied more critical thinking to this particular section.

Obviously there is an alternative explanation for the long term null or negative results: any short term results were pure bias caused by lack of blinding, subjective outcomes and a host of other methodological issues. Suggesting research to optimise the protocols assumes they have any effect at all. The measured differences could have been all bias.

(edited to clarify)
 
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I had an odd realization yesterday: there has never been an actual systematic review of rehabilitation for ME/CFS. They are all highly selective. Not a single one of them is "systematic". Here it's just 11 studies, and 7 R"C"Ts. Labeling them as controlled is just ridiculous, and only adds to the fact that there has never been an actual rigorous review of those treatments, because no such review would qualify them as being controlled.

Here it talks about "the exploration of exercise-based rehabilitation as a therapeutic strategy". But it hasn't been "explored". It has literally been the standard for at least two decades. There have been hundreds of such studies. Hundreds! Of course, they are all over the place and one major difficulty is in selecting those that actually reflect ME/CFS, but that's actually a huge part of the problem: the evidence base is a completely uninterpretable mess. The confusion, which should sink it, instead reinforces it, because it's slipperier than a greased eel. And despite this, this treatment approach has established itself as the standard, applied onto millions since, and de facto unchallengeable.

And still this selective review talks about how "they also emphasize the necessity of rigorous, longitudinal investigations to establish its clinical applicability and long-term efficacy". It's been decades since this has been asserted to be effective and implemented into standard practice. This is longitudinal enough. And yet this never happens. Even the latest "stock take" from the UK government couldn't even take stock of things, because no one is actually keeping track of anything. They can't, it would expose how fraudulent it all is.

Meanwhile it's widely known that there are no treatments for Long Covid. It's repeated constantly, in almost every article about it. What they mean about this is mostly ME/CFS and other already-discriminated chronic illnesses, for which it's also widely known that there are no treatments for. Because when patients state that there are no treatments, they explicitly include this pseudoscientific mess.

And yet if you ask most physicians, who would agree that there are no treatments for this, most would also assert that rehabilitation is an effective treatment. A sign of a world completely mad, where two mutually exclusive truths are both "correct", where what has been tried for decades has never been tried, but also has been used extensively for decades, as evidence that it works. There are no treatments for this illness, also here's the treatment for it. With seemingly zero self-awareness, but since those are all smart people, it's obvious that they know, they just lie about it.

The only systematic evaluation of the literature was the 2015 IOM report, which did not evaluate treatments. It found that there is no basis to the common belief that this is a psychiatric disorder, and it still changed nothing at all, that belief remains generally "common knowledge". In large part because there has never been a true systematic review of this treatment approach, only very selective ones. Like this one.

Eleven out of several hundred, probably North of 1,000 by now, is a single digit % of the whole of it. This is not systematic at all. Words in medicine seem to have no true, fixed, meaning outside of discussions of biology. And even then. And yet it moves.
 
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Actually this review seems to find that exercise therapy is pretty hopeless for CFS.
abstract said:
Medium-term improvements in functionality were also significant (n = 685; SMD = 0.31; 95% CI: [0.11, 0.52]; Z = 2.96; p = 0.003), whereas short-term functionality outcomes were lesser compared to controls (n = 366; SMD = 0.10; 95% CI: [−0.05, 0.25]; Z = 1.29; p = 0.20).

Notably, the meta- analytic findings indicated that medium-term functional outcomes slightly favored control groups over exercise interventions, and no significant long-term benefits were observed in either fatigue reduction or functional capacity enhancement.

These findings underscore the selective efficacy of exercise-based rehabilitation for CFS, particularly in mitigating fatigue over the short to medium term. However, the transient nature of functional improvements highlights the need for further research to optimize exercise protocols, determine the most effective modalities, and develop strategies to sustain long-term therapeutic outcomes.
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Just from the abstract:

Short term functionality outcomes were less than controls.
Medium term functionality outcomes were less than controls. (even though both treatment groups also improved)
There were no long term benefits in 'functional capacity enhancement'.

They talk about the 'transient nature of functional improvements' - but they were less than the controls.

The wording of the abstract obfuscates.
 
(Actually I'm a bit confused about what groups are being compared in the standard mean differences (SMD) reported (differences between baseline and later time points, or differences in changes as compared to controls?). I think we will need to read the paper to find out exactly what they are saying. The comment about obfuscation still certainly applies.)
 
Hutan said:
Actually this review seems to find that exercise therapy is pretty hopeless for CFS.

Just from the abstract:

Short term functionality outcomes were less than controls.
Medium term functionality outcomes were less than controls. (even though both treatment groups also improved)
There were no long term benefits in 'functional capacity enhancement'.

They talk about the 'transient nature of functional improvements' - but they were less than the controls.

The wording of the abstract obfuscates.
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That first sentence above the abstract says it all. Spot on!! :thumbup:
 
Sean said:
"Chronic Fatigue Syndrome"

Not a good start.

Summary: Exercise doesn't deliver meaningful sustained benefits, therefore we must do more research into exercise.
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I'm still not clear what this means. It keeps being repeated about the general woo stuff, mind-body and all that, and I still have no idea what it means because 1) I've never seen any actual research of this, only 'pragmatic' trials and 2) there have been hundreds of pragmatic trials already, and they're all basically copies of one another, but also 3) this has been a standard treatment literally for decades, how can it even be in both states at once?

But, hey, it's a universal excuse I guess.
 
rvallee said:
I'm still not clear what this means. It keeps being repeated about the general woo stuff, mind-body and all that, and I still have no idea what it means because 1) I've never seen any actual research of this, only 'pragmatic' trials and 2) there have been hundreds of pragmatic trials already, and they're all basically copies of one another, but also 3) this has been a standard treatment literally for decades, how can it even be in both states at once?

But, hey, it's a universal excuse I guess.
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Basically they have decided on the treatments in advance, but even with such a bias ridden experimental design they don’t get the results they want, but the recommend their preferred treatment anyway, throwing in lots of buzz words like mind body, etc to justify still recommending what they have shown not to work.
 
From the abstract:
The global prevalence is estimated between 0.2% and 0.4%, affecting over 17 million individuals worldwide, with an estimated burden exceeding 40,000 cases in Spain.
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From the introduction:
CFS exhibits significant clinical overlap with fibromyalgia, with a global prevalence estimate ranging from 0.5% to 2%, affecting over 17 million individuals worldwide. 7,8 In Spain, the epidemiological landscape remains poorly delineated, though estimates suggest that more than 40,000 individuals may be afflicted. 9,10
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The population of Spain was 48 million in 2023. The percentages and numbers stated make no sense.
 
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