Firstly with regard to the use of wheelchairs, I have no doubt that for many patients with CFS who have become severely disabled by fatigue, muscle wasting and muscle pain, wheelchairs provide a vital mechanism to maintain independence with the associated positive psychological and physical benefits.

I do not believe that the same can be said for all patients with CFS. For some patients a wheelchair may reinforce patterns of inactivity and take away the only opportunities in which they may be inadvertently "pushed" to undertake the minimal physical activity essential to maintain muscle tone etc.

There is also the difficulty of the fact that this disorder remains highly controversial in the medical and general communities, and therefore the "blessing" of providing wheelchairs to patients severely affected by this disorder, in the broader perspective, may be outweighed by the very deleterious effects that this may have on the perceptions of "patient with CFS" from the medical and wider communities.

Finally, the issue of physical rehabilitation therapy is relevant, as I will discuss below. My research has clearly shown that the function of muscles in patients with CFS is normal.

Research elsewhere has shown that the structure of the muscles in patients with CFS is normal. The evidence is suggesting that CFS is likely to arise as a result of an abnormality within the brain.

In view of this information, I have no doubt that although physical activity may precipitate transient fatigue and muscle pain, I do not believe it can be harmful in the longer term.

Previously healthy individuals who are "put to bed" for a period of weeks inevitably experience some loss of tone and wasting in their muscles, and when asked to recommence physical activity they will typically experience marked fatigue and muscle pain. However, with continued activity these symptoms resolve.

We now have some limited experience with rehabilitation of patients severely affected with CFS, and Dr. Simon Wessely in the United Kingdom is soon to report the results of a formal trial of rehabilitation therapy. Our experience concurs with that of Dr. Wessely in suggesting that in severely affected patients with CFS, physical rehabilitation can bring about a substantial improvement in function.

It is important that one is very clear about the terminology being used here. I am not suggesting that graded exercise brings about a cure (and therefore perhaps implies that there was no organic process underlying the disability). I am suggesting it brings about improvements in function.

I believe a reasonable analogy can be made with the rehabilitation of patients after major heart attack. Patients with severe heart failure due to the irreparable damage of a considerable portion of the heart muscle, can be rehabilitated from a situation in which they are house-bound or even bed-ridden, to one in which they maintain a significantly greater degree of functional activity, even to the extent of getting back to sedentary employment. The nature of the disease process affecting the heart muscle remains unchanged.

Given the limitations of available therapies for CFS, I believe there is adequate evidence to suggest that slow, graded rehabilitation may represent a vital opportunity for some patients with CFS to use adaptive processes to overcome some of the limitations the disorder imposes.

Reprinted from M.E. and You, Newsletter of the M.E./C.F.S. Soc. of N.S.W. Inc. Written by Dr. Andrew Lloyd.

Reprinted from Emerge, June 1990.