Daily Walking
Steady walks built into the day; the easiest place to start.
Get-fit guides / Fibromyalgia and chronic fatigue
Exercise for fibromyalgia and chronic fatigue
By the Exercise Explorer team. Last updated 13 November 2026.
Fibromyalgia and ME/CFS (chronic fatigue syndrome) can look similar, but the advice on exercise is different. For fibromyalgia, gentle, gradual exercise has some research support. For ME/CFS, NICE advises against graded exercise therapy and general exercise programmes outside specialist care.
Read this first. If you have ME/CFS, please read the ME/CFS section below before doing anything. NICE advises that exercise should not be offered as a cure or as a graded programme, and that exercise advice should come from a specialist ME/CFS team, because it may worsen symptoms. This is general information, not medical advice.
The short answer
- For fibromyalgia, a Cochrane review of 13 trials (839 people) found low-quality evidence that aerobic exercise improved quality of life, pain and physical function, and it appeared well tolerated.
- Another 2017 review concluded that aerobic and strengthening exercise were the most effective ways of reducing pain and improving well-being in fibromyalgia.
- Start very low and go slowly. A flare after exercise is a sign to reduce, not to push on.
- For ME/CFS, NICE (2021) does not recommend graded exercise therapy. Ask your ME/CFS team about pacing and energy management instead.
Gentle exercise for fibromyalgia
Aqua Aerobics
Group exercise to music in a pool.
Tai Chi
Slow, flowing movements for balance and calm.
Hatha Yoga
Slow poses with breathing and stillness.
Resistance Band Training
Full-body workouts with elastic bands.
Water Walking
Walking in chest-deep water for gentle resistance.
Chair Yoga
Seated and supported yoga for limited mobility.
Stationary Bike
Seated cycling at the gym or at home.
How each one helps
Evidence at a glance How much good research supports each option
StrongModerateLimited
- 1Daily WalkingStrong evidence
Start with very short walks and build up very slowly.
30 min × 5/wkEffort ●○○○○Free - 2Aqua AerobicsModerate evidence
Gentle, supported movement in a pool.
45 min × 2/wkEffort ●●○○○Low cost - 3
- 4Hatha YogaModerate evidence
A gentle class, with the teacher aware of your condition.
60 min × 2/wkEffort ●●○○○Low cost - 5Resistance Band TrainingModerate evidence
Very light strength work, progressed slowly.
30 min × 3/wkEffort ●●○○○Low cost - 6Water WalkingLimited evidence
Warm water supports the body and is gentle on tender muscles.
30 min × 3/wkEffort ●○○○○Low cost - 7
- 8
What to avoid or go slowly with
- Pushing through a flare. Boom-and-bust patterns, doing too much on a good day then crashing, make things worse.
- Starting at a level that leaves you unwell the next day or two. Halve it.
- Graded exercise programmes if you have ME/CFS. NICE advises against them.
- High-intensity workouts at the start.
- Comparing yourself with others. Progress is slow and uneven.
How to start gently with fibromyalgia: a first week
This is an example to adapt, not a prescription. If a day feels too much, do less.
- Day1A 5-minute gentle walk, or a few minutes of gentle stretching.
- Day2Rest.
- Day3A 5-minute walk or water walking.
- Day4Rest.
- Day55 minutes of gentle seated movement.
- Day6Rest, or a short walk if you feel well.
- Day7Rest. Only add time if the week was comfortable, and by a minute or two.
- My notes: how did you feel the day after?
When to see a doctor
Stop exercising and get medical advice if any of these apply to you.
Get urgent help now
- Chest pain or tightness
- Severe breathlessness, or fainting
Call 999 or go to A&E. Do not wait for a GP appointment.
Speak to a GP or call NHS 111 if you have
- Symptoms that are getting worse after exercise and not settling within a day or two.
- New or unexplained symptoms, weight loss, fever or swollen joints.
- Low mood, which is common with long-term pain and fatigue.
- You think you may have ME/CFS and have not been assessed.
What the research says
A 2017 Cochrane review of aerobic exercise for fibromyalgia included 13 trials (839 people). Compared with no exercise, aerobic exercise probably improved health-related quality of life and, with low-quality evidence, pain intensity and physical function. Effects on fatigue and stiffness were less clear. Withdrawal rates were similar in both groups, so it appeared well tolerated, but evidence on safety was scarce. Benefits for pain and function in long-term follow-up were uncertain.
A 2017 meta-analysis of therapeutic exercise in fibromyalgia concluded that aerobic and muscle-strengthening exercise were the most effective ways of reducing pain and improving global well-being, and that combined exercise gave the biggest benefit for symptoms of depression.
For ME/CFS, the 2021 NICE guideline recommends that people should not be offered physical activity or exercise as a treatment or cure, generalised exercise programmes, or programmes based on fixed incremental increases such as graded exercise therapy. Any exercise or activity programme should be overseen by a physiotherapist in an ME/CFS specialist team.
We did not find trials we had read in full on exercise for ME/CFS or on yoga or tai chi for fibromyalgia, so those are included for gentleness, not because of results.
Full references are listed under Sources below. Evidence ratings are our own plain-English summary of the research we found, not a medical opinion.
Frequently asked questions
Is exercise good for fibromyalgia?
A Cochrane review found low-quality evidence that aerobic exercise improved quality of life, pain and physical function. It needs to be gentle and gradual, and individual responses vary.
What is the best exercise for fibromyalgia?
Warm-water exercise, gentle walking and light strengthening are common choices. Reviews support aerobic and strengthening exercise, but cannot say which exact type is best.
Should I exercise with chronic fatigue syndrome (ME/CFS)?
NICE (2021) advises against graded exercise therapy and general exercise programmes for ME/CFS, because they may worsen symptoms. Ask your ME/CFS team about pacing and a supervised plan.
Why does exercise make me worse?
In fibromyalgia, starting too hard can flare symptoms. In ME/CFS, worsening after activity (post-exertional malaise) is a key feature. Reduce the amount and speak to your clinician.
How do I start exercising with fibromyalgia?
Start with a few minutes, such as a short walk or water exercise, rest between sessions and add a minute or two only when the previous week felt manageable.
Is yoga or tai chi good for fibromyalgia?
They are gentle and popular, but we did not find trials we had read in full for fibromyalgia, so we cannot cite specific results.
When should I see a doctor?
See your GP if symptoms worsen after exercise, if you have new or unexplained symptoms, or if you think you may have ME/CFS and have not been assessed.
Sources
- Aerobic exercise training for adults with fibromyalgia. Cochrane Database of Systematic Reviews, 2017. doi.org/10.1002/14651858.cd012700
- Effectiveness of Therapeutic Exercise in Fibromyalgia Syndrome: A Systematic Review and Meta-Analysis of Randomized Clinical Trials. BioMed Research International, 2017. doi.org/10.1155/2017/2356346
- Myalgic encephalomyelitis (or encephalopathy)/chronic fatigue syndrome: diagnosis and management (NICE guideline NG206). National Institute for Health and Care Excellence, 2021. www.nice.org.uk/guidance/ng206