The evidence base for physiotherapy in myalgic encephalomyelitis/chronic fatigue syndrome when considering post-exertional malaise: a systematic review and narrative synthesis

Review written by Dr Xiaoqi Chen info

Key Points

  1. Myalgic Encephalomyelitis / Chronic Fatigue Syndrome (ME/CFS) is characterized by debilitating fatigue that is exacerbated by physical and mental exertion that impacts multi-system function and is not relieved by rest.
All key points available for members only


Myalgic Encephalomyelitis / Chronic Fatigue Syndrome (ME/CFS) is a chronic condition characterised by debilitating fatigue affecting multi-systems. At present, ME/CFS is diagnosed via exclusion after a person has had symptoms continually for six months. People with ME/CFS include those with mild disability (50% reduction of premorbid activity level), moderate disability (mostly homebound), to very severe disability (completely dependent and bedridden).

Unfortunately, unhelpful misconceptions around ME/CFS exist, implying that these patients are “just being tired”, anxious or mental health cases, hypochondriacs, or that they should “just push through”. These false beliefs are harmful and can often cause those with ME/CFS to push beyond their limits causing severe relapses, and sometimes permanent disability.

The hallmark feature of ME/CFS is “post-exertional malaise” (PEM), which can be aggravated by not only physical tasks, but also cognitive and emotional exertion. PEM may occur at a disproportionate level to the original level of exertion and is not relieved with rest, resulting in what patients would call a “crash” that can occur for hours up to a month post-exertion.

The ME/CFS community is supported by a large body of patient, scientific and clinician advocates, and lately the subject of physical therapy has been greatly contentious within this community. The objective of this review was to summarize results from a systematic review of current evidence on the effects of physical therapy interventions on ME/CFS in view of the significance of PEM in the applied diagnostic criteria.

The hallmark feature of Myalgic Encephalomyelitis / Chronic Fatigue Syndrome is “post-exertional malaise”.
Small doses of gentle physical activity that do not trigger PEMs can still be tolerated, but this is very dependent on the individual.


The study was a systematic review of randomized controlled trials (RCTs) from the year 2000 using the search databases PubMed, CINAHL and PEDro between February and April 2020. Articles were included if the population was of those diagnosed with ME/CFS,

to unlock full access to this review and 989 more