Journal of Psychosomatic Research · Mar 5, 2026

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

By Gao J, Liu Y, Wang S et al.

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.

doi.org/10.1016/j.jpsychores.2026.112618PubMed 41861756Interventions