A recent breakthrough study suggests that low- to moderate-intensity aquatic exercise can significantly improve both physical and psychosocial well-being in people living with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), bringing new hope for a condition often marked by persistent fatigue and limited treatment options. Published on April 17, 2025, and led by Dr. Suzanne Broadbent, Associate Professor of Clinical Exercise Physiology at the University of the Sunshine Coast, this randomized controlled trial (RCT) challenges the longstanding caution against physical activity for ME/CFS patients—a group that also includes a high proportion of those battling fibromyalgia symptoms.
For decades, Thai and international ME/CFS communities have faced conflicting guidance when it comes to exercise. Traditional beliefs, in both Western and Thai medicine, often dictate rest and limited activity for fear of post-exertional malaise (PEM)—a severe worsening of symptoms after physical or mental activity (source: https://www.hcplive.com/view/aquatic-exercise-improves-physical-psychosocial-outcomes-me-cfs). But total inactivity can lead to increased risks of diabetes, cardiovascular disease, and other chronic conditions. Thai doctors, similarly to global practitioners, have struggled to recommend appropriate, safe exercise regimens for ME/CFS, considering patient fears around symptom relapse and the presence of co-morbidities like fibromyalgia—which is characterized by amplified muscle pain and tenderness.
In this six-month study, 32 ME/CFS patients, averaging 55 years old, were selected at random to participate in either a self-paced, low-to-moderate intensity aquatic exercise program or maintain their usual routines as a control group. For those in the exercise group, the regimen consisted of two 20-minute water-based sessions each week, focused on gentle movements and stretches. Outcomes were measured using a comprehensive battery of tests familiar to rehabilitation professionals in Thailand, such as the six-minute walk test, hand-grip strength assessment, Sit-to-Stand drills, Apley’s shoulder test, and Sit–Reach test. Importantly, both physiological and psychosocial health indicators—including fatigue and levels of anxiety and depression—were tracked with internationally recognized scales (FACIT and HADS questionnaires), along with direct patient reporting of tiredness and pain.
The results were striking. The aquatic exercise group saw a 13.7% increase in their walking distance, a 33.7% improvement in lower limb strength (as measured by Sit-to-Stand), and a 12.9% boost in peak expiratory pulmonary flow, all of which were statistically significant. Thai physiotherapists would recognize these gains as vital for daily mobility—especially in older patients. Even more importantly, fatigue was reduced by nearly 30%, depression improved by over 21%, and combined anxiety and depression scores dropped by about 17%. Resting diastolic blood pressure also showed a meaningful reduction. Crucially, none of the participants experienced a worsening of PEM or any adverse events—an essential point for those with ME/CFS, who often fear that any attempt at exercise might leave them bedridden for days.
Dr. Broadbent emphasized in her published report: “Six months of self-paced, low-moderate aquatic exercise significantly improved fatigue, depression, walk distance, lower limb strength and peak expiratory flow. 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” (source: https://www.hcplive.com/view/aquatic-exercise-improves-physical-psychosocial-outcomes-me-cfs). She also cited the rarity of robust, controlled studies on physical intervention for ME/CFS, reinforcing the novelty—and value—of these findings.
The implications for Thailand are significant. While swimming pools and aquatic therapy are already commonplace in many urban hospitals and wellness centers in Bangkok, regional differences in access persist. ME/CFS and fibromyalgia are underdiagnosed in Thailand, often due to limited awareness and overlapping symptom profiles with more familiar conditions such as “โรคอ่อนแรงเรื้อรัง” (chronic weakness disease). This new research may provide Thai doctors and rehabilitation specialists with the evidence needed to cautiously encourage aquatic exercise for patients who fear post-exertional flare-ups. Indeed, water-based exercise has long been respected in Thai culture for its “เย็น” (cooling) and “เบาแรง” (gentle) characteristics—qualities especially appreciated by older adults and those with chronic pain.
A key aspect of this study is the self-paced approach. Unlike traditional group exercise classes, which may inadvertently push participants too hard, this model respects the unique pacing required by people with ME/CFS, allowing for breaks and adjustments according to personal limits. This aspect could translate well into the Thai context—สุภาษิตไทย (Thai proverbs) often emphasize moderation, such as “เดินช้าๆ แต่ไปถึง” (walk slowly, but arrive). Encouraging ME/CFS patients to find their own rhythm may help reduce anxiety about “keeping up” and empower more people to participate safely.
Despite these positive findings, limitations remain. The study involved only 32 participants and was conducted in Australia; broader studies in Asia, including Thailand, would help confirm these effects across different cultural contexts. Furthermore, while improvements were seen in many measures, the Sit–Reach and Apley Shoulder flexibility scores did not show consistent gains, likely due to individual variability. Dr. Broadbent and her team acknowledged these shortcomings but remain optimistic about the therapeutic value of tailored aquatic exercise.
Globally, ME/CFS is recognized as a major cause of disability, with millions affected and no definitive cure. According to the World Health Organization and the US CDC, ME/CFS can severely impair patients’ ability to work, study, and participate in family and social life. The need for safe, practical interventions resonates with “สังคมผู้สูงอายุ” (aging society) trends in Thailand, where many older adults already suffer from multiple chronic conditions—often undiagnosed or undertreated.
Looking forward, this study paves the way for greater integration of aquatic therapy in Thai rehabilitation practice. For local hospitals and wellness centers, piloting similar self-paced aquatic programs with careful monitoring could become a best practice for chronic fatigue and pain management. Community groups and government organizations like the Ministry of Public Health (สธ.) may also consider training more physiotherapists and exercise specialists in aquatic therapy, particularly in provinces outside Bangkok, to improve national accessibility.
For Thai readers—especially those suffering from unexplained chronic fatigue or pain—the evidence points to a new, gentle pathway toward better health. If you or a loved one struggles with ME/CFS-like symptoms, speak to your physician about the possibility of trying low-intensity aquatic exercise. Choose a safe, supervised pool environment, and remember to pace yourself—ฟังร่างกายของเรา (listen to your body). As researchers continue to test and refine these interventions, each gentle step—or swim—may bring new energy and hope to those most in need.
For further reading and detailed study findings, visit HCPLive.