Graded exercise for chronic fatigue syndrome: too soon to dismiss reports of adverse reactions. Response 2 to letter to the editor by Kindlon and Goudsmit: New insights in post-exertional malaise in patients with myalgic encephalomyelitis/chronic fatigue syndrome

We are very pleased with the ongoing discussion following the publication of our special report in Journal of Rehabilitation Medicine (11). The major goal of that report was to encourage clinicians to plan treatment strategies to account for the biological as well the psychological aspect of CFS/ME, with special emphasis on post-exertional malaise as a unique feature of the illness. Kindlon & Goudsmit have correctly pointed out the clinical importance of studies examining the biological nature of post-exertional malaise in patients with CFS/ME. They correctly alerted readers to the interesting preliminary data reported in 2004 by White et al. (10). In line with that study, a number of recent research reports provide more consistent evidence favouring a biological nature of post-exertional malaise in patients with CFS/ME, which in turn supports the use of specific rehabilitation strategies that take account of these anomalies. Here we summarize these new and compelling findings.