Very few patients are too unwell for rehabilitation — but the programme must be appropriately adapted. At Pulmovista Clinics, I have specific protocols for the most severely deconditioned patients: neuromuscular electrical stimulation (NMES) for patients who cannot initially perform active exercise; seated exercise programmes; very short initial exercise bouts of 5–10 minutes with generous rest intervals; and intensive breathing technique training and energy conservation education. The starting point is wherever your father actually is — not where we wish he were. Progress is slower for Stage 4 patients but it is real, measurable, and meaningful. I would rather assess him and find out what is possible than assume it is not.