Evidence browser

E1 ReplicatedCohortPEM unclearLongitudinal

"The effect of acupressure on fatigue in individuals with chronic fatigue syndrome".

Kurç, Doğukan, Şakul, Ayşe Arzu Sayin, Atilgan, Esra·Explore (New York, N.Y.)·2025

This study tested whether acupressure—a technique where pressure is applied to specific points on the body—could help reduce fatigue in people with ME/CFS who work in offices. Thirty-nine people received either 10 acupressure sessions over 4 weeks or no treatment. Those who received acupressure reported significantly less fatigue, better mood, and improved quality of life compared to those who received no treatment.

Six-year follow-up of participants in two clinical trials of rituximab or cyclophosphamide in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome.

Rekeland, Ingrid G, Sørland, Kari, Neteland, Lisbeth Lykke et al.·PloS one·2024

This study followed patients with ME/CFS for six years after they received either rituximab (an antibody treatment), cyclophosphamide (a chemotherapy drug), or placebo in two earlier clinical trials. The researchers tracked how much the patients could do in their daily lives using standard questionnaires. Cyclophosphamide showed the most improvement, with 44% of those patients reaching good functional levels after six years, but the rituximab and placebo groups showed smaller benefits.

Pain and SensitizationSleep

Efficacy of aquatic vs land-based therapy for pain management in women with fibromyalgia: a randomised controlled trial.

Rivas Neira, S, Pasqual Marques, A, Fernández Cervantes, R et al.·Physiotherapy·2024

This study compared two types of exercise therapy for women with fibromyalgia: exercising in a pool (aquatic therapy) versus exercising on land. Both groups did 60-minute exercise sessions three times a week for 12 weeks. Six weeks after the program ended, women who did aquatic therapy reported less pain and better sleep quality than those who exercised on land, suggesting that water-based exercise may be particularly helpful for fibromyalgia.

Impact of combined plant extracts on long COVID: An exploratory randomized controlled trial.

Lukkunaprasit, Thitiya, Satapornpong, Patompong, Kulchanawichien, Pongsiri et al.·Complementary therapies in medicine·2024

Researchers tested whether a supplement made from five plant extracts could help people with long COVID feel better. Over 7 days, people taking the supplement reported feeling less fatigued and had fewer severe symptoms like post-exertional malaise (worsening after activity) compared to those taking a placebo. The supplement was generally safe, though the study was small and longer research is needed to confirm these results.

Effects of Qiye Shen'an Pian Combined with Glutamate and Vitamin B1 on Fatigue State, Immune Function and Quality of Life in Patients with Chronic Fatigue Syndrome.

Liu, Jun, Liao, Junfeng, Lin, Fan et al.·Alternative therapies in health and medicine·2024

Researchers tested whether a traditional Chinese herbal supplement (Qiye Shen'an Pian) combined with glutathione and vitamin B1 could help ME/CFS patients feel less tired and improve their immune system. Over 8 weeks, patients receiving the herbal supplement along with the standard treatment showed greater improvements in fatigue levels, immune markers, and overall quality of life compared to those receiving only the standard treatment.

Immune System

Comparison of cognitive behaviour therapy versus activity management, both delivered remotely, to treat paediatric chronic fatigue syndrome/myalgic encephalomyelitis: the UK FITNET-NHS RCT.

Crawley, Esther, Anderson, Emma, Cochrane, Madeleine et al.·Health technology assessment (Winchester, England)·2024

This study compared two online treatments for teenagers with ME/CFS: a cognitive behavioural therapy programme called FITNET-NHS and activity management delivered by video calls. After 6 months, teenagers using FITNET-NHS showed better improvements in physical function and attended about half a day more school per week than those receiving activity management. However, FITNET-NHS was more expensive, and by 12 months both groups had improved similarly, making it unclear whether the extra cost was worth the temporary benefit.

Effectiveness of an online multicomponent program (FATIGUEWALK) for chronic fatigue syndrome: A randomized controlled trial.

Serrat, Mayte, Navarrete, Jaime, Ferrés, Sònia et al.·Health psychology : official journal of the Division of Health Psychology, American Psychological Association·2024

Researchers tested an online 12-week program called FATIGUEWALK that combines education about pain and fatigue, gentle exercise, cognitive techniques, and mindfulness training for people with ME/CFS. Compared to people who only received standard care, those who completed FATIGUEWALK showed meaningful improvements in fatigue, pain, mood, and daily functioning. About 1 in 5 participants improved with the program who wouldn't have with standard care alone.

Effectiveness of the SYNCHRONIZE + Brief Intervention in Improving Mediterranean Diet Adherence, Nutritional Quality and Intake Pattern in Persons with Fibromyalgia and Chronic Fatigue Syndrome.

Carrasco-Querol, Noèlia, Cabricano-Canga, Lorena, Bueno Hernández, Nerea et al.·Nutrients·2024

Researchers tested whether a Mediterranean diet program called SYNCHRONIZE + could help people with fibromyalgia and chronic fatigue syndrome eat better and feel healthier. Over one year, participants who received the intervention ate more vegetables, fruits, legumes, nuts, and fish, while eating fewer sweets and processed meats. People in the program also had better muscle mass and fewer nighttime eating habits.

E1 ReplicatedTrialPEM requiredRCT

Sijunzi decoction, a classical Chinese herbal formula, improves fatigue symptoms with changes in gut microbiota in chronic fatigue syndrome: A randomized, double-blind, placebo-controlled, multi-center clinical trial.

Dai, Liang, Liu, Zhidong, Zhou, Wenjuan et al.·Phytomedicine : international journal of phytotherapy and phytopharmacology·2024

This study tested whether Sijunzi decoction, a traditional Chinese herbal formula, could reduce fatigue in ME/CFS patients. Over 100 people with ME/CFS took either the herbal formula or a placebo for 2 months. The herbal treatment group showed slightly more improvement in fatigue symptoms and overall health than the placebo group, and the improvement may be linked to changes in gut bacteria.

Gut Microbiome

Videoconference-delivered group Cognitive Behavioral Stress Management for ME/CFS patients who present with severe PEM: A randomized controlled trial.

May, Marcella, Milrad, Sara F, Perdomo, Dolores M et al.·Fatigue : biomedicine, health & behavior·2024

This study tested whether a stress management program delivered by video could help ME/CFS patients who experience severe post-exertional malaise (PEM)—the worsening of symptoms after activity. Patients either received 10 weeks of cognitive behavioral stress management training or health information. For patients with severe PEM, the stress management program led to meaningful improvements in symptom frequency, symptom intensity, and fatigue-related problems, suggesting that managing stress may help reduce PEM severity.

E1 ReplicatedTrialPEM requiredRCT

Effects of a symptom-titrated exercise program on fatigue and quality of life in people with post-COVID condition - a randomized controlled trial.

Barz, Andreas, Berger, Joshua, Speicher, Marco et al.·Scientific reports·2024

This study tested whether a personalized exercise program that adjusts based on daily fatigue levels helps people with post-COVID condition. Over 10 weeks, 118 participants did exercise at commercial fitness facilities while a qualified trainer adjusted the intensity based on how they felt that day. The program significantly improved fatigue, quality of life, and physical strength without making symptoms worse.

Targeting persistent fatigue with tailored versus generic self-management strategies in adolescents and young adults with a fatigue syndrome or rheumatic condition: A randomized crossover trial.

Vroegindeweij, Anouk, Wulffraat, Nico M, Van De Putte, Elise M et al.·British journal of health psychology·2024

This study tested two different approaches to help young people (ages 12-29) with persistent fatigue manage their symptoms: personalized lifestyle advice tailored to each person, and generic dietary guidelines. Over 12 weeks each, both approaches similarly improved fatigue levels, confidence in managing their condition, and quality of life. The improvements were small but meaningful, suggesting these self-help strategies could be useful while waiting for other treatments like therapy.

Effectiveness of a brief multicomponent intervention to improve physical activity level and functional capacity in fibromyalgia and chronic fatigue syndrome (Synchronize+).

Martín-Borràs, Carme, González Serra, Gemma, Carrasco-Querol, Noèlia et al.·Frontiers in physiology·2024

Researchers tested a 12-hour program combining physical activity guidance, nutrition advice, and sleep/timing education for people with fibromyalgia and chronic fatigue syndrome. Participants who completed the program increased their weekly activity, reduced sitting time, slept better, and showed improvements in strength and aerobic fitness compared to those receiving standard care. These improvements appeared within 3 months of completing the brief intervention.

Sleep

RESTORE ME: a RCT of oxaloacetate for improving fatigue in patients with myalgic encephalomyelitis/chronic fatigue syndrome.

Cash, Alan, Vernon, Suzanne D, Rond, Candace et al.·Frontiers in neurology·2024

This study tested whether a supplement called oxaloacetate could help reduce fatigue in ME/CFS patients. Eighty-two people with ME/CFS took either 2,000 mg of oxaloacetate or a placebo daily for three months. The oxaloacetate group experienced a significant 25% reduction in fatigue, while the placebo group only improved by 10%, and the supplement was well tolerated with no safety concerns.

Energy Metabolism

Acupoint massage at Shenque (CV 8) for chronic fatigue syndrome: a randomized controlled trial.

Li, Zhijun, Ji, Rong, Yan, Chaoqun et al.·Zhongguo zhen jiu = Chinese acupuncture & moxibustion·2024

Researchers tested whether massaging a specific acupuncture point called Shenque (located on the abdomen) could help people with chronic fatigue syndrome. Patients in the treatment group received 10-minute massages three times a week for four weeks, while the control group received no treatment. The treatment group showed meaningful improvements in fatigue and sleep quality compared to the control group.

Sleep

E1 ReplicatedTrialPEM requiredRCT

Lower hair cortisol concentration in adolescent and young adult patients with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome and Q-Fever Fatigue Syndrome compared to controls.

Vroegindeweij, Anouk, Eijkelkamp, Niels, van den Berg, Sjoerd A A et al.·Psychoneuroendocrinology·2024

This study looked at cortisol (a stress hormone) levels in hair samples from young people with ME/CFS and other fatigue conditions. Researchers found that people with ME/CFS and Q-Fever Fatigue Syndrome had lower cortisol levels in their hair compared to healthy people, suggesting a long-term difference in how their bodies handle this hormone. Interestingly, baseline cortisol levels did not predict whether patients would improve with lifestyle and dietary changes.

Endocrine Disruption

Exercise does not cause post-exertional malaise in Veterans with Gulf War Illness: A randomized, controlled, dose-response, crossover study.

Boruch, Alexander E, Barhorst, Ellen E, Rayne, Tessa J et al.·Brain, behavior, and immunity·2024

This study tested whether exercise of different intensities causes post-exertional malaise (PEM)—a worsening of symptoms after physical activity—in veterans with Gulf War Illness, a condition similar to ME/CFS. Forty participants did light, moderate, or vigorous cycling for 20 minutes, or simply rested, while researchers measured their symptoms, pain sensitivity, thinking ability, and blood markers before and after. The study found that exercise did not cause greater symptom worsening or other problems than rest, even at higher intensities.

Herbal extract (Cervus elaphus Linnaeus, Angelica gigas Nakai, and Astragalus membranaceus Bunge) ameliorates chronic fatigue: A randomized, placebo-controlled, double-blind trial.

Ahn, SoYoung, Jamrasi, Parivash, Lim, Byunggul et al.·Integrative medicine research·2024

This study tested whether a herbal supplement made from deer antler, angelica root, and astragalus could reduce fatigue in people with chronic fatigue syndrome. Over 8 weeks, 80 patients took either the herbal mixture or a placebo, and researchers measured their fatigue levels and exercise capacity. The herbal supplement group showed meaningful improvements in fatigue symptoms and could exercise longer before exhaustion compared to the placebo group.

The effects of 3-month supplementation with synbiotic on patient-reported outcomes, exercise tolerance, and brain and muscle metabolism in adult patients with post-COVID-19 chronic fatigue syndrome (STOP-FATIGUE): a randomized Placebo-controlled clinical trial.

Ranisavljev, Marijana, Stajer, Valdemar, Todorovic, Nikola et al.·European journal of nutrition·2024

This study tested whether a special mixture of beneficial gut bacteria (probiotics) plus fiber and zinc could help people with post-COVID chronic fatigue syndrome (ME/CFS). Over three months, 26 patients took either the synbiotic mixture or a placebo, and researchers measured their fatigue, exercise recovery, and brain/muscle chemistry. The synbiotic group experienced better recovery after exercise and showed improvements in brain chemistry compared to the placebo group, though both groups felt less general fatigue.