Aquatic Exercise Improves Physical, Psychosocial Outcomes in People With ME/CFS

A self-paced aquatic exercise program improved physical and psychosocial outcomes in people with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), according to new findings from a randomized controlled trial (RCT).1

“Appropriate modes of physical activity are uncertain, given the risk of symptom exacerbation, yet remaining sedentary may also increase the risk of developing conditions, such as type 2 diabetes, cardiovascular disease and cancer. ME/CFS is also compounded by the high percentage of patients who suffer from concurrent fibromyalgia syndrome (FMS), which includes muscular pain in specific areas, pain amplification and allodynia2,” lead investigator Suzanne Broadbent, PhD, Associate Professor, Clinical Exercise Physiology, School of Health, University of the Sunshine Coast, Australia, and colleagues wrote.1

Broadbent and colleagues conducted the trial to investigate the efficacy of a 6-month self-paced, low–moderate-intensity aquatic exercise program on physical function, symptoms and psychosocial measures in people with ME/CFS. The trial included 32 participants with a mean age of 55 years (standard deviation [SD], 13.9) randomized to the intervention group (INT; n = 17) or control group (CON; n = 15). The intervention consisted of 2 20-min sessions per week of self-paced aquatic movements and stretches. Investigators assessed physiological measures, 6-min walk test, hand-grip strength, Sit-to-Stand, Apley’s shoulder test, Sit–Reach test, perceived exertion, fatigue (FACIT), anxiety/depression (HADS) questionnaires, and tiredness and pain scores (VAS 0–10 scale) pre- and post-intervention.

The investigators found that the INT grou ahd significantly increased walk test distance (13.7%; P <.001), Sit-to-Stand scores (33.7%; P <.001) and peak expiratory pulmonary flow (12.9%; P = .028) post-intervention, as well as significantly improved fatigue (29.5%; P = .005), depression (21.7%; P = .010), combined anxiety/depression scores (16.9%; P = .047) and resting diastolic blood pressure (4.8%; P <.001). Notably, the INT group had significantly lower Sit-Reach scores (− 4.0 cm; SD, 10.4) than the CON group post-intervention (+4.3 cm; SD, 10.7; P = .034). No participants in the trial experienced any adverse events or symptom worsening during the trial.

“Six months of self-paced, low-moderate aquatic exercise significantly improved fatigue, depression, walk distance, lower limb strength and peak expiratory flow," Broadbent and colleagues wrote.1 "PEM was not worsened by the intervention, which is extremely important for ME/CFS management. This mode of physical activity may be safe, effective in improving functional capacity, and manageable for individuals with ME/CFS."

The investigators noted that the improvements in fatigue and depression, via the FACIT and HADS scores, respectively, were important findings, as patients with ME/CFS have high rates of depression and post-exercise malaise is a primary concern. Although no changes were seen in Sit–Reach scores or Apley Shoulder Test scores, there was large variability within and without the groups. Broadbent and colleagues also noted limitations of the study including a small sample size and considerable variance.

“Since there are few recent robust controlled physical activity intervention studies, the impact of different modes of exercise rehabilitation on individuals with ME/CFS is somewhat uncertain,” Broadbent and colleagues concluded.1 "This RCT provides evidence of efficacy and safety for low-intensity aquatic exercise rehabilitation."

REFERENCES

1. Broadbent S, Coetzee S, Calder A, Beavers R. Physical function and psychosocial outcomes after a 6-month self-paced aquatic exercise program for individuals with myalgic encephalomyelitis/chronic fatigue syndrome. Eur. J. Appl. Physiol. Published online April 5, 2025. doi: 10.1007/s00421-025-05759-5

2. Siracusa R, Di Paola R, Cuzzocrea S, Impellizzeri D (2021) Fibromyalgia: pathogenesis, mechanisms, diagnosis and treatment options update. Int J Mol Sci 22:3891–3922. doi: 10.3390/ijms22083891