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Abstract of a research study from OHSU showing that Fibromyalgia patients have an abnormal Growth Hormone response to exercise which can be improved by the daily use of pyridostigmine and exercise


  Chronic Therapy with Exercise and Pyridostigmine Improves Growth Hormone Response to Exercise, Fatigue, Sleep Quality and Quality of Life in Fibromyalgia: Preliminary Intent to Treat Analyses  

Jones, K.D. Bennett, R.M., Burckhardt, C.S., Deodhar, A.A., Perrin, N.  Oregon Health & Science University (OHSU)

Purpose: Fibromyalgia (FM) patients have a suboptimal growth hormone (GH) response to the stress of acute exercise but a single dose of pyridostigmine plus exercise normalizes the GH response. We have now assessed whether 6 months of pyridostigmine (180 mg/d), with or without thrice-weekly exercise has a long-term beneficial effect on GH secretion and FM symptoms.  

Methods: In all, 165 FM patients (age 49.37 + 8.00 years, 8 male) were randomized into 4 treatment groups: 1.Drug & exercise 2. Drug alone 3. Exercise alone, 4. Placebo pill. Serum GH levels were measured immediately after exercising to anaerobic threshold pre and post intervention. FM symptoms were measured with FM Impact Questionnaire (FIQ) and the Quality of Life Scale (QOLS). A 2 (time) x 2 (drug) x 2 (exercise) repeated measures ANCOVA was used to evaluate changes in GH, FIQ and QOLS, controlling for baseline levels in 153 subjects who completed both pre and post testing.   

Ninety-one percent of the 165 subjects failed to produce a normal GH response to the stress of acute exercise testing. In addition, total IGF-1 was below the age expected norm (140.78 +/- 57.9 mg/dl). Neither BMI nor IGF-1 differentiated normal from subnormal GH response. At post-test, there was a significant difference between groups in post-exercise to anaerobic threshold that was not explained by BMI differences over time (F(3,146) = 4.43, p = .005). Symptom changes: There were significant between group differences in FIQ fatigue, (F (3,144) = 4.96, p = .032). The drug & exercise group had significantly lower fatigue than did drug alone (p= .008) and the placebo alone (p= .032). There were significant between group differences in FIQ sleep quality (F (3,143) =3.58, p=0.15). The drug & exercise group was significantly more rested than placebo alone (p= .002). Drug only was more well rested than placebo (p= .028), but not exercise alone. There were significant differences between groups on QOLS over time (F (3,146) =3.30, p= .022). Quality of life was most improved in the drug & exercise group compared to the exercise group (p=0.21), and placebo alone (p= .003).

Conclusions: The data indicate 91% of FM subjects fail to release GH as expected during the stress of exercise to anaerobic threshold. Furthermore, 6-months of daily pyridostigmine normalizes the GH response to acute exercise. Pyridostigmine had a greater independent effect on GH secretion than 6 months of exercise.  Symptoms of fatigue, sleep quality and quality of life were most improved in the drug & exercise group. Exercise had a greater independent effect on reducing fatigue. Pyridostigmine had a greater independent effect on sleep quality and quality of life.


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