, Volume 33, Issue 1, pp 151-152

Avoidance behavior towards physical activity in chronic fatigue syndrome and fibromyalgia: the fear for post-exertional malaise

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We have read the Letter to the Editor written by Dr. Enlander [1] who commented on our review article addressing fear of movement and avoidance behavior towards physical activity in patients with chronic fatigue syndrome (CFS) and fibromyalgia (FM) [2]. We would like to thank Dr. Enlander for his interest in our review paper and for his efforts in stimulating international debate in this area. However, we feel that Dr. Enlander's letter is offline with the scope of the review article and, therefore, would like to take the opportunity to restore the focus.

We do not question the importance of post-exertional malaise for CFS and FM as highlighted by Dr. Enlander. We agree that the severe exacerbation of symptoms following exercise, as seen in CFS patients, is one of the core features of the illness [3, 4]. Moreover, we have contributed to a better understanding of post-exertional malaise in CFS patients. In an exercise immunology study, we showed that the change in complement C4a level wa