title: A combination of 6 months of treatment with pyridostigmine and triweekly exercise fails to improve insulin-like growth factor-I levels in fibromyalgia, despite improvement in the acute growth hormone response to exercise.
abstract: OBJECTIVE
  People with fibromyalgia (FM) often have low insulin-like growth factor-I (IGF-I) levels and a suboptimal growth hormone (GH) response to acute exercise. As previous work had demonstrated a normalization of the acute GH response to exercise with the use of pyridostigmine (PYD), we tested the hypothesis that 6 months of PYD therapy plus supervised exercise would increase IGF-I levels.
  
  
  METHODS
  Subjects with primary FM were randomized into 4 groups: (1) PYD/exercise; (2) PYD/diet recall; (3) placebo/exercise; and (4) placebo/diet recall. The dosing of PYD was 60 mg tid for 6 months. Resting IGF-I levels were measured at baseline and after 6 months of treatment. In addition the acute GH response to exercise at VO2 max was measured at baseline and after treatment.
  
  
  RESULTS
  A total of 165 FM subjects (mean age 49.5 yrs, 5 male) were entered and 154 (93.3%) completed the study. Six months of therapy (PYD plus exercise or exercise alone) failed to improve the IGF-I levels. The use of PYD 1 hour prior to exercise improved the acute GH response (4.54 ng/dl) compared to placebo (1.74 ng/dl) (p = 0.001) at the end of the 6-month trial. The acute GH response to exercise at baseline did not correlate with IGF-I, age, depression, medications, estrogen status, or obesity.
  
  
  CONCLUSIONS
  A combination of triweekly supervised exercise plus the daily use of PYD for 6 months failed to increase IGF-I levels in patients with FM, despite the confirmation that PYD normalizes the acute GH response to strenuous aerobic exercise.
authors.affiliation: Schools of Nursing and Medicine, Oregon Health and Science University, Portland, Oregon, USA. jonesk@ohsu.edu
authors.forename: Kim Dupree
authors.initials: KD
authors.lastname: Jones
authors.forename: Atul A
authors.initials: AA
authors.lastname: Deodhar
authors.forename: Carol S
authors.initials: CS
authors.lastname: Burckhardt
authors.forename: Nancy A
authors.initials: NA
authors.lastname: Perrin
authors.forename: Ginger C
authors.initials: GC
authors.lastname: Hanson
authors.forename: Robert M
authors.initials: RM
authors.lastname: Bennett
mesh_terms: D002800:Cholinesterase Inhibitors / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D004311:Double-Blind Method; D005081:Exercise Therapy; D005260:Female; D005356:Fibromyalgia / Q000097:blood / Q000503:physiopathology / Q000534:rehabilitation*; D013006:Growth Hormone / Q000097:blood*; D006801:Humans; D007334:Insulin-Like Growth Factor I / Q000378:metabolism*; D008297:Male; D008875:Middle Aged; D011729:Pyridostigmine Bromide / Q000627:therapeutic use*; D017211:Treatment Failure; D016896:Treatment Outcome
chemical_list: D002800:Cholinesterase Inhibitors; D007334:Insulin-Like Growth Factor I; D013006:Growth Hormone; D011729:Pyridostigmine Bromide