Important distinction, thank you Nita. You're right that PEM and deconditioning are mechanistically different and graded exercise in patients with true post-exertional malaise can cause harm preventing recovery. Thanks for educating and teach about the 2-day CPET protocol as a valuable tool to objectively identify/stratify these patients. I appreciate you raising this very important point (I've seen this in many patients and I've struggled with advising/helping/coaching with PEM). It's such an important nuance that matters for how we approach reconditioning in post-viral dysautonomia and why specialized centers are so helpful for patients that experience challenging symptoms, inadequate or no recovery/improvement.