Zhao, Liping, Gou, Bo, Zhang, Meng · Journal of psychosomatic research · 2026 · DOI
A systematic review of 17 randomized controlled trials (involving 1,944 patients) found that exercise was associated with reported improvements in fatigue, sleep quality, quality of life, depression, and anxiety in ME/CFS patients. However, exercise did not show significant benefits for heart and lung function or overall physical capacity. The review noted no major differences in safety or tolerability between exercise and control groups, though individual responses vary and respecting personal energy limits is emphasized.
This systematic review summarises the largest evidence base to date (17 RCTs) on exercise in ME/CFS, providing clinicians and patients with quantified effect estimates for multiple symptom domains. The finding that exercise was associated with improvements in fatigue and quality of life, yet not in objective measures of cardiopulmonary or functional capacity, highlights the importance of distinguishing between symptom-focused and physiological outcomes in this condition.
This meta-analysis does not establish which exercise regimen is optimal for individual patients, nor does it confirm that exercise addresses underlying biological mechanisms in ME/CFS. The high heterogeneity between trials (I²=85.3% for fatigue) means results may not generalise equally to all ME/CFS presentations or subgroups. The review does not prove that exercise is safe or beneficial for all patients, particularly those with severe disease or prominent post-exertional malaise; individual supervision and response monitoring remain essential.
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
Zhao, Liping, Gou, Bo, & Zhang, Meng (2026). The efficacy of exercise in patients with myalgic encephalomyelitis/chronic fatigue syndrome: A systematic review and meta-analysis.. Journal of psychosomatic research. https://doi.org/10.1016/j.jpsychores.2026.112677
BibTeX
@article{mecfsatlas-zhao-2026-efficacy-exercise,
author = {Zhao, Liping and Gou, Bo and Zhang, Meng},
title = {The efficacy of exercise in patients with myalgic encephalomyelitis/chronic fatigue syndrome: A systematic review and meta-analysis.},
journal = {Journal of psychosomatic research},
year = {2026},
doi = {10.1016/j.jpsychores.2026.112677},
note = {PubMed: 42000527},
url = {https://www.mecfsatlas.com/evidence/zhao-2026-efficacy-exercise},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-06-07. https://www.mecfsatlas.com/evidence/zhao-2026-efficacy-exercise
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