ABSTRACT
The alternative response to the symptoms of Chronic fatigue syndrome (CFS) may be inactivity, particularly in response to anxiety about the symptoms, particularly pain. The provisional National Institute for Clinical Excellence guidelines suggest that adults with mild/moderate CFS should be offered graded exercise leading to increases in duration, then increases in intensity up to aerobic level. Clinical experience would suggest, however, that some patients, particularly in tertiary settings, find aerobic exercise difficult to do because of the aftermath of severe symptoms. The evidence base would also support using graded exercise in a careful way, starting off gently and building up to aerobic exercise. A complex issue is whether it should be left at anaerobic exercise, as Snell et al would suggest, or whether the person needs to do aerobic exercise to benefit.
