Review Exercise interventions for physical function, psychological health, and quality of life in ME/CFS & fibromyalgia, 2026, Gao

[Dolphin]

https://www.sciencedirect.com/science/article/abs/pii/S0022399926001029

Review article​

Exercise interventions for physical function, psychological health, and quality of life in patients with myalgic encephalomyelitis/chronic fatigue syndrome and fibromyalgia: A systematic review and network meta-analysis​

Journal of Psychosomatic Research​

Available online 5 March 2026, 112618
In Press, Journal Pre-proofWhat’s this?

Review article​

Jiawen Gao a, Yunyang Liu a, Shun Wang a, Xiangwu Meng a, Zihan Bao a, Jidong Jing b, Yibo Chen c

https://doi.org/10.1016/j.jpsychores.2026.112618Get rights and content

Highlights​

• •
  This study conducted a network meta-analysis of 61 RCTs with 4204 participants.
• •
  Combined and HIIT exercises most effectively improved physical function and QoL.
• •
  Aerobic and combined exercise showed superior effects on anxiety and depression.
• •
  Aquatic exercise was most effective in reducing pain for sensitive FM/ME-CFS patients.
• •
  Findings support tailored, symptom-specific exercise prescriptions in ME/CFS and FM.

Abstract​

Background​

Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) and fibromyalgia (FM) are chronic, disabling conditions characterized by persistent fatigue, widespread pain, and psychological comorbidities that severely impair quality of life. Pharmacological options remain limited, and exercise is increasingly recommended as a core non-pharmacological strategy; however, the relative efficacy of different exercise modalities across physical, psychological, and quality-of-life outcomes remains unclear.

Objective​

To systematically evaluate the comparative effects of different types of exercise interventions on physical function, psychological health, and quality of life in patients with ME/CFS and FM, with the aim of identifying the most effective modalities to guide clinical rehabilitation. This analysis adopts a symptom-oriented perspective, focusing on shared outcome domains rather than diagnostic distinctions between ME/CFS and FM.

Methods​

A systematic search was conducted in PubMed, Embase, Web of Science, Cochrane Library, and the China National Knowledge Infrastructure (CNKI) for randomized controlled trials (RCTs) published from database inception to August 2025. Eligible studies included patients with ME/CFS or FM receiving exercise interventions compared with non-exercise control groups. A Bayesian network meta-analysis (NMA) was performed to evaluate the comparative efficacy of 13 exercise modalities across three outcome domains: physical function [6-Minute Walk Test (6MWT)], psychological health [depression: Beck Depression Inventory (BDI); anxiety: Hospital Anxiety and Depression Scale – Anxiety subscale (HADS-A)], and quality of life [disease impact: Fibromyalgia Impact Questionnaire (FIQ); health-related quality of life: 36-Item Short Form Health Survey (SF-36); pain: Visual Analog Scale (VAS)]. Meta-regression was used to explore the moderating effects of intervention parameters (session duration, intervention frequency, and intervention period). Surface under the cumulative ranking (SUCRA) values were calculated to rank the interventions.

Results​

A total of 57 studies (61 RCTs, 4204 participants) were included. Combined exercise (SUCRA: 79.0%) ranked highest for improving physical function (6MWT). For psychological health, aerobic exercise (SUCRA: 91.4%) and combined exercise (SUCRA: 92.6%) ranked highest in reducing anxiety (HADS-A) and depression (BDI), respectively. Within the quality-of-life domain, high-intensity interval training (HIIT) ranked highest on the SF-36 and FIQ (SUCRA: 94.6% and 98.9%), whereas aquatic exercise (SUCRA: 98.3%) ranked highest for pain reduction (VAS). Meta-regression analysis indicated that the type of intervention had a more substantial impact on treatment outcomes than frequency or duration.

Conclusion​

Different exercise modalities demonstrated domain-specific benefits. HIIT and combined exercise were most effective for improving physical function and quality of life, while aerobic and combined exercise were superior in alleviating anxiety and depression. Aquatic and other low-impact exercises demonstrated the greatest efficacy in reducing pain in patients with high pain sensitivity or poor tolerance to weight-bearing activities. These findings provide evidence-based insights to support the development of personalized, symptom-specific exercise prescriptions for ME/CFS and FM populations.

 

[rvallee]

conditions characterized by persistent fatigue, widespread pain, and psychological comorbidities that severely impair quality of life

In what way is this true? We keep seeing people say that, and yet there is literally no evidence of this, in fact it has been thoroughly debunked. They are not characterized by this, in fact it's constantly argued that the treatment approach is generic and should be acceptable precisely because it's also used in other 'serious' conditions, where the exact same problems are found, namely that being ill is terrible, and where they usually go away once the illness is treated, something not available here, and don't resolve when they can't, because none of those 'psychological comorbidities' are actually that, and rather are simply a consequence of being ill, for which the only resolution can ever be to treat the illness.

So how does that square with characterizing those illnesses? Because there is not a single such feature that isn't fully generic, all entirely non-specific, which the very same people argue means it can be handled generically. Which means that it's clearly not characteristic. This is such a blatant, insulting lie, how it's both generic and personalized, characteristic and holistic. What a total bunch of pseudoscientific crap.

But of course it's just a foundational lie, it can be repeated despite not being true simply because it has been asserted to be true and accepted as such, against evidence, and it would be shameful to admit that it was false all along. Meanwhile the same people will literally entirely ignore the actual foundational characteristic of ME/CFS, PEM. What the hell is this clown fake science?

A total of 57 studies (61 RCTs, 4204 participants) were included

published from database inception to August 2025

This is obviously a lie. There have been literally hundreds of those. Why are the vast majority excluded? How is this an acceptable way of doing things? When over 90% of what is produced is deemed as garbage by the same people who produce it?

Our strongest argument in general remains that the quality of what has been done about those illnesses is of atrocious quality, and even in terms of quantity it's especially bad, is excessively biased to the point of being functionally worthless. This is all our position should really be: this is garbage, stop producing garbage, in fact throw the damn garbage away and let adults handle this.

 

[Utsikt]

No mention of the quality of the trials or the risk of bias in the abstract. Never a good sign..

 

[SNT Gatchaman]

Two investigators applied the revised Cochrane Risk of Bias tool for randomized trials (Risk of Bias 2, RoB 2)[31] to assess the methodological quality of the included studies across five domains: (1) bias arising from the randomization process; (2) bias due to deviations from intended interventions; (3) bias due to missing outcome data; (4) bias in measurement of the outcome; and (5) bias in selection of the reported result. The assessments were independently conducted by two reviewers (GJW and LYY), with disagreements resolved through consultation with a third reviewer (WS). This process ensured the rigor, reliability, and reproducibility of the findings.

The risk-of-bias judgments are summarized in Supplementary Figure S1. Across the bias domains, most studies showed a low risk in the randomization process and measurement of outcomes, while some exhibited concerns or high risk in deviations from intended interventions and missing outcome data. In total, 19 studies were rated as low risk of bias, 30 as having some concerns, and 10 as high risk. Based on the overall risk of bias assessment, 19 studies (34.5%) were categorized as relatively high quality, 30 (54.5%) as moderate quality, and 10 (18.2%) as low quality. Publication bias was assessed using funnel plots, which appeared approximately symmetrical, suggesting a low risk of publication bias; however, the possibility of insufficient statistical power due to small sample sizes cannot be excluded.

Supplementary data don't seem to be available / published.

The evidence base for cognitive behavioral therapy (CBT) and GET in ME/CFS has been the subject of substantial methodological debate. Key concerns include frequent reliance on unblinded designs with predominantly self-reported outcomes, heterogeneity in case definitions and eligibility criteria, limited transparency regarding prespecified outcomes and analytic decisions, and insufficient reporting of harms and PEM, all of which may bias effect estimates and complicate interpretation [20]. The updated National Institute for Health and Care Excellence (NICE) guidance reflects this evolving evidence landscape and emphasizes caution in recommending graded exercise approaches that may exacerbate symptoms in some patients[115]. Moreover, GET trials have varied considerably in implementation (e.g., progression rules, individualization strategies, and levels of education/support), which may contribute to inconsistent effects across studies [93].

Accordingly, while our NMA synthesizes available randomized evidence across modalities, pooled estimates for interventions influenced by this controversy should be interpreted cautiously, with particular attention to risk-of-bias assessments, outcome type (objective vs subjective), and the completeness of safety/PEM reporting. These considerations further reinforce the priority of rigorously designed RCTs to establish both efficacy and safety in ME/CFS and related symptom profiles.

follow-up was typically short and adverse-event reporting was often limited, restricting inference about long-term effectiveness and safety—particularly important for ME/CFS given the potential for delayed post-exertional symptom exacerbation. Finally, for modalities subject to ongoing methodological controversy in ME/CFS (e.g., GET/CBT-related trials), reliance on unblinded designs and subjective outcomes may increase risk of bias; therefore, these estimates should be interpreted cautiously and should not be viewed as definitive endorsement of any contentious approach.

 

[Utsikt]

@SNT Gatchaman so no available data for the individual studies?

I strongly doubt that any of these studies were of even moderate quality. Even the ones with «objective» outcomes are flawed because they essentially measure adherence to the exercise protocol. Of course someone exercising will get a bit fitter. But rehab has this idea that simple exercise tests are good proxies for overall functional capacity, so getting a bit fitter in one test supposedly means that you’ve gotten healthier.

 

[SNT Gatchaman]

so no available data for the individual studies?

Not that I can find. The paper itself is in pre-proof. Presumably all the supplementary files containing this data will be available when finalised. Eg:

The primary outcome measures were the FIQ, VAS, SF-36, 6MWT, BDI, and HADS-A, as shown in Supplementary Table S2.

Global heterogeneity across outcomes was low to moderate, with τ² ranging from 0.00 for BDI to 0.44 for 6MWT(Supplementary Table S3).

To enhance transparency, the number of studies contributing to each pooled estimate (k) for each outcome and intervention is summarized in Supplementary Table S8.