Hi Firestormm Lots of really interesting points there, though I'm afraid I lost the thread a bit at times so excuse me if I've misunderstood bits. Re Deconditioning, Exercise and Graded Activity Thanks, those definitions look good to me too. Hope you'll be posting the fruits of your work on NICE guidelines etc. I think in PACE GET they may have allowed some activity rather than exercise eg housework (which can be aerobic) but there was some confusion over whether this was genuine incremental activity or just counting pre-existing activity towards 'progress'. However, the medium term goals for GET definitely included aerobic exercise, ideally up to 30 minutes vigorous exercise 3x a week, IIRC. And I agree they would probably get better results focusing on all activity, including mental exertion. Btw, the 6MWT was simply a test to measure progress, not part of the GET regime itself - though walking often was. Sorry, not sure exactly what your current levels are. But one thing that surprised me when I was severely affected and went for respite was the energy levels, particularly mental energy levels, of other people there. Most of them had advanced MS or other neurological conditions and were severely incapacitated; some could propel their own wheelchair, most could not. Yet, despite having to cope with huge problems, they were in some ways able to do much more than me e.g they could watch a film or go out to a pub. They probably spent similar times in bed and sitting to me (I was unusual in that I could sometimes walk a little and propel a wheelchair) so should have been deconditioned too, perhaps more than me. But it didn't seem to create the same level of problems with fatigue and energy. The same respite centre also undertook rehabilitation of people with neurological damage, eg from head injuries after a car crash. Patients such had often become very deconditioned after long stays in intensive care, or in comas. The interesting thing here was that they used a very structured and fairly intense rehabilitation programme to recover fitness, and function where possible. Although some of the people responsible for my care there had fairly standard views about ME, they did at least acknowledge that that kind of programme clearly wouldn't work in my case, though they had considered it in the beginning. Measuring Deconditioning and Fatigue There does seem to be agreement on measuring deconditioning, or at least a lack of fitness: VO2 max levels on a treadmill or cycle. As I mentioned in earlier posts, when CFS patients in 2 graded exercise trials has VO2max at baseline measured, they were not deconditioned. The Fulcher study that also measured VO2max after GET found a modest 13% improvement - but crucially it didn't correlate with overall improvement. I don't have problems with the principle of using questionnaires to measure purely subjective symptoms like fatigue (is there another way?) but activity is different as there are more objective alternatives eg actometers, though these are not perfect either. I'm not impressed by the Chalder scale either. According to Simon Wessely it was initially a list of questions cobbled together cos he thought they were plausible... Lenny Jason has/is doing some interesting work on fatigue questions that are more specific to our illness eg focusing on fatigue in relation to exertion. Results to date suggest it is very effective at discriminating between CFS patients and those with depression, who also suffer from fatigue. A larger study is under way.