This is the situation where many families feel hopeless — and where I most want to push back against that hopelessness. Even patients with very severe breathlessness at rest can benefit from adapted pulmonary rehabilitation. At Pulmovista, for the most severely deconditioned Stage 4 patients, we begin with seated exercises, neuromuscular electrical stimulation (which builds muscle without requiring the patient to exercise actively), breathing technique training, and energy conservation education. The programme is built from wherever the patient actually is — not from where we wish they were. Progress is slower, but it is real and meaningful.