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Review
. 2016 Oct;48(10):2003-12.
doi: 10.1249/MSS.0000000000000990.

Effect of Acute Exercise on Fatigue in People with ME/CFS/SEID: A Meta-analysis

Bryan D Loy  1 , Patrick J O'Connor, Rodney K Dishman
Affiliations
Review

Effect of Acute Exercise on Fatigue in People with ME/CFS/SEID: A Meta-analysis

Bryan D Loy et al. Med Sci Sports Exerc. 2016 Oct.

Abstract

Purpose: A prominent symptom of myalgic encephalomyelitis, chronic fatigue syndrome, or systemic exertion intolerance disease (ME/CFS/SEID) is persistent fatigue that is worsened by physical exertion. Here the population effect of a single bout of exercise on fatigue symptoms in people with ME/CFS/SEID was estimated and effect moderators were identified.

Methods: Google Scholar was systematically searched for peer-reviewed articles published between February 1991 and May 2015. Studies were included where people diagnosed with ME/CFS/SEID and matched control participants completed a single bout of exercise and fatigue self-reports were obtained before and after exercise. Fatigue means, standard deviations, and sample sizes were extracted to calculate effect sizes and the 95% confidence interval. Effects were pooled using a random-effects model and corrected for small sample bias to generate mean Δ. Multilevel regression modeling adjusted for nesting of effects within studies. Moderators identified a priori were diagnostic criteria, fibromyalgia comorbidity, exercise factors (intensity, duration, and type), and measurement factors.

Results: Seven studies examining 159 people with ME/CFS/SEID met inclusion criteria, and 47 fatigue effects were derived. The mean fatigue effect was Δ = 0.73 (95% confidence interval = 0.24-1.23). Fatigue increases were larger for people with ME/CFS/SEID when fatigue was measured 4 h or more after exercise ended rather than during or immediately after exercise ceased.

Conclusions: This preliminary evidence indicates that acute exercise increases fatigue in people with ME/CFS/SEID more than that in control groups, but effects were heterogeneous between studies. Future studies with no-exercise control groups of people with ME/CFS/SEID are needed to obtain a more precise estimate of the effect of exercise on fatigue in this population.

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Conflict of interest statement

The authors declare no conflicts of interest. The results of the present study do not constitute endorsement by The American College of Sports Medicine (ACSM).

Figures

Figure 1
Figure 1
Flow diagram of study selection. ME/CFS/SEID = Myalgic Encephalomyelitis/Chronic Fatigue Syndrome/Systemic Exertion Intolerance Disease.
Figure 2
Figure 2
Panel A. Forest plot of fatigue effect sizes. Negative values represent larger increases in post-exercise fatigue from baseline for the control group, and positive values represent larger fatigue increases for the ME/CFS/SEID group. Each lead author name corresponds to a single effect (listed to the right of the name) derived from that study. The dashed line indicates the mean effect size. Panel B. Forest plot of fatigue effect sizes for each individual study. Negative values represent larger increases in post-exercise fatigue from baseline for the control group, and positive values represent larger fatigue increases for the ME/CFS/SEID group. Each lead author name corresponds to an overall weighted mean effect size (listed to the right of the name) for the cited study. The dashed line indicates the mean effect size.
Figure 2
Figure 2
Panel A. Forest plot of fatigue effect sizes. Negative values represent larger increases in post-exercise fatigue from baseline for the control group, and positive values represent larger fatigue increases for the ME/CFS/SEID group. Each lead author name corresponds to a single effect (listed to the right of the name) derived from that study. The dashed line indicates the mean effect size. Panel B. Forest plot of fatigue effect sizes for each individual study. Negative values represent larger increases in post-exercise fatigue from baseline for the control group, and positive values represent larger fatigue increases for the ME/CFS/SEID group. Each lead author name corresponds to an overall weighted mean effect size (listed to the right of the name) for the cited study. The dashed line indicates the mean effect size.
Figure 3
Figure 3
Funnel plot of fatigue effect sizes. Effect size is on the x-axis and standard error is on the y-axis. Effects are expected to form a funnel shape in the absence of publication bias.
See this image and copyright information in PMC

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