Liao, Zhongxin, Zhao, Suhong, Fang, Sitong et al. · iScience · 2025 · DOI
Researchers reviewed 25 studies testing different types of exercise for ME/CFS to see which worked best. Graded exercise therapy (GET)—where activity is slowly increased over time—showed the most short-term improvement in fatigue, mood, and anxiety compared to no treatment. Other exercises like yoga, qigong, and strength training showed smaller benefits that may not be meaningful for most patients.
This comprehensive comparison helps patients and clinicians understand which exercise approaches have evidence for symptom improvement in ME/CFS and which do not. The finding that most alternative exercises fall short of clinically meaningful benefits challenges common recommendations and highlights that GET, despite controversy, has the most robust short-term data—information critical for informed treatment decision-making.
This meta-analysis does not establish whether GET is safe or appropriate for all ME/CFS patients, particularly those with post-exertional malaise (PEM), as it examines symptom outcomes without fully addressing harm or patient heterogeneity. The short-term focus does not clarify long-term sustainability or whether benefits persist beyond the follow-up periods measured. Network meta-analysis compares efficacy within published trials but cannot prove causation or establish mechanisms.
About the PEM badge: “PEM required” means post-exertional malaise was an explicit required diagnostic criterion for participant inclusion in this study — not that PEM was studied, observed, or discussed. Studies using criteria that do not require PEM (e.g. Fukuda, Oxford) are tagged “PEM not required”. How the atlas works →
The first block is for the primary paper and is the citation you should use in research work. The atlas-snapshot line only applies if you are specifically referring to this atlas’s reading of the paper on the date shown.
Primary citation
Liao, Zhongxin, Zhao, Suhong, Fang, Sitong, Ren, Jun, Wang, Shoujian, Kong, Lingjun, et al. (2025). Comparative efficacy of various exercise therapies for chronic fatigue syndrome: A systematic review and network meta-analysis.. iScience. https://doi.org/10.1016/j.isci.2025.114178
BibTeX
@article{mecfsatlas-liao-2025-comparative-efficacy,
author = {Liao, Zhongxin and Zhao, Suhong and Fang, Sitong and Ren, Jun and Wang, Shoujian and Kong, Lingjun and Fang, Min},
title = {Comparative efficacy of various exercise therapies for chronic fatigue syndrome: A systematic review and network meta-analysis.},
journal = {iScience},
year = {2025},
doi = {10.1016/j.isci.2025.114178},
note = {PubMed: 41467182},
url = {https://www.mecfsatlas.com/evidence/liao-2025-comparative-efficacy},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-27. https://www.mecfsatlas.com/evidence/liao-2025-comparative-efficacy
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