The binding energy of nuclear matter including exchange and pionic effects is calculated in a quark-meson coupling model with massive constituent quarks. As in the case with elementary nucleons in QHD, exchange effects are repulsive. However, the coupling of the mesons directly to the quarks in the nucleons introduces a new effect on the exchange energies that provides an extra repulsive contribution to the binding energy. Pionic effects are not small. Implications of such effects on observables are discussed. © 1998 Published by Elsevier Science B.V. All rights reserved.