Skip to main content

Advertisement

SpringerLink
Log in

Growth Hormone and Exercise Tolerance in Patients with Cystic Fibrosis

  • Leading Article
  • Published:
Sports Medicine Aims and scope Submit manuscript

Abstract

Cystic fibrosis (CF) is a life-limiting inherited disorder characterised by pulmonary disease, pancreatic dysfunction and symptoms of malnutrition that are all interrelated with low exercise capacity and poor survival rate. Therapy with growth hormone (GH) may improve the reduced dimensional and functional capacity associated with poor nutritional status and catabolism and therefore improve exercise tolerance, quality of life and survival rate in patients with CF. The literature about GH treatment and its effect on exercise tolerance are rather limited, not always consistent and methodological concerns restrict further analysis. GH treatment may have beneficial effects on both growth and exercise tolerance without serious complications in prepubertal children with CF. The observed dimensional changes of the muscular, cardiovascular and pulmonary system seem to improve aerobic exercise capacity and respiratory and peripheral muscle strength. The physiological background of the observed changes is not yet fully understood, therefore, larger-scale studies with an optimised design are required.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. FitzSimmons SC. The changing epidemiology of cystic fibrosis. J Pediatr 1993; 122: 1–9

    PubMed  CAS  Google Scholar 

  2. Lai HC, Kosorok MR, Sondel SA, et al. Growth status in children with cystic fibrosis based on the National Cystic Fibrosis Patient Registry data: evaluation of various criteria used to identify malnutrition. J Pediatr 1998; 132: 478–85

    Article  PubMed  CAS  Google Scholar 

  3. Lands LC, Heigenhauser JF, Jones NL. Analysis of factors limiting maximal exercise performance in cystic fibrosis. Clin Sci 1993; 83: 391–7

    Google Scholar 

  4. Boas SR, Joswiak ML, Nixon PA, et al. Factors limiting anaerobic performance in adolescent males with cystic fibrosis. Med Sci Sports Exerc 1996; 28: 291–8

    PubMed  CAS  Google Scholar 

  5. Hütler M, Schnabel D, Staab D, et al. Effect of growth hormone on exercise tolerance in children with cystic fibrosis. Med Sci Sports Exerc 2002; 34: 567–72

    Article  PubMed  Google Scholar 

  6. Kraemer R, Rüdeberg A, Hadorn B, et al. Relative underweight in cystic fibrosis and its prognostic value. Acta Paediatr Scand 1978; 67: 33–7

    Article  PubMed  CAS  Google Scholar 

  7. Corey M, McLaughlin FJ, Williams M, et al. A comparison of survival, growth, and pulmonary function in patients with cystic fibrosis in Boston and Toronto. J Clin Epidemiol 1988; 41: 583–91

    Article  PubMed  CAS  Google Scholar 

  8. Durie PR, Pencharz PB. A rational approach to the nutritional care of patients with cystic fibrosis. J R Soc Med 1989; 82Suppl. 16: 11–20

    PubMed  Google Scholar 

  9. Tomezsko JL, Stallings VA, Kawchak DA, et al. Energy expenditure and genotype of children with cystic fibrosis. Pediatr Res 1994; 35: 451–60

    Article  PubMed  CAS  Google Scholar 

  10. Kopelman H. Gastrointestinal and nutritional aspects. In: Shale D, editor. Cystic fibrosis. London: BMJ Publishing Group, 1996: 102–19

    Google Scholar 

  11. Hardin DS, Ellis KJ, Dyson M, et al. Growth hormone decreases protein catabolism in children with cystic fibrosis. J Clin Endocrinol Metab 2001; 86: 4424–8

    Article  PubMed  CAS  Google Scholar 

  12. Orenstein DM, Nixon PA, Ross EA, et al. The quality of well-being in cystic fibrosis. Chest 1989; 95: 344–7

    Article  PubMed  CAS  Google Scholar 

  13. Nixon PA, Orenstein DM, Kelsey SF, et al. The prognostic value of exercise testing in patients with cystic fibrosis. N Engl J Med 1992; 327: 1785–8

    Article  PubMed  CAS  Google Scholar 

  14. Moorcraft AJ, Dodd ME, Webb AK. Exercise testing and prognosis in adult cystic fibrosis. Thorax 1997; 52: 291–3

    Article  Google Scholar 

  15. Yarasheski KE. Growth hormone effects on metabolism, body composition, muscle mass, and strength. Exerc Sport Sci Rev 1994; 22: 285–312

    Article  PubMed  CAS  Google Scholar 

  16. Coates AL, Boyce P, Muller D, et al. The role of nutritional status, airway obstruction, hypoxia, and abnormalities in serum lipid composition in limiting exercise tolerance in children with cystic fibrosis. Acta Paediatr Scand 1980; 69: 353–8

    Article  PubMed  CAS  Google Scholar 

  17. Marcotte JE, Canny GJ, Grisdale R, et al. Effects of nutritional status on exercise performance in advanced cystic fibrosis. Chest 1986; 90: 375–9

    Article  PubMed  CAS  Google Scholar 

  18. Marcotte JE, Grisdale RK, Levison H, et al. Multiple factors limit exercise capacity in cystic fibrosis. Pediatr Pulmonol 1986; 2: 274–81

    Article  PubMed  CAS  Google Scholar 

  19. Shah AR, Gozal D, Keens TG. Determinants of aerobic and anaerobic exercise performance in cystic fibrosis. Am J Respir Crit Care Med 1998; 157: 1145–50

    PubMed  CAS  Google Scholar 

  20. De Meer K, Gulmans VAM, van der Laag J. Peripheral muscle weakness and exercise capacity in children with cystic fibrosis. Am J Respir Crit Care Med 1999; 159: 748–54

    PubMed  Google Scholar 

  21. Szeinberg A, England S, Mindorff C, et al. Maximal inspiratory and expiratory pressures are reduced in hyperinflated, malnourished young adult male patients with cystic fibrosis. Am Rev Respir Dis 1985; 132: 766–9

    PubMed  CAS  Google Scholar 

  22. Ionescu AA, Chatham K, Davies CA, et al. Inspiratory muscle function and body composition in cystic fibrosis. Am J Respir Crit Care Med 1998; 158: 1271–6

    PubMed  CAS  Google Scholar 

  23. Pouliou E, Nanas S, Papamichalopoulos A, et al. Prolonged oxygen kinetics during early recovery from maximal exercise in adult patients with cystic fibrosis. Chest 2001; 119: 1073–8

    Article  PubMed  CAS  Google Scholar 

  24. Jenkins PJ. Growth hormone and exercise. Clin Endocrinol (Oxf) 1999; 50: 683–9

    Article  CAS  Google Scholar 

  25. Murray RD, Shalet SM. Growth hormone: current and future therapeutic applications. Exp Opin Pharmacother 2000; 1: 975–90

    Article  CAS  Google Scholar 

  26. Weber MM. Effects of growth hormone on skeletal muscle. Horm Res 2002; 58Suppl. 3: 43–8

    Article  PubMed  CAS  Google Scholar 

  27. Sackey AH, Taylor CJ, Barraclough M, et al. Growth hormone as a nutritional adjunct in cystic fibrosis: results of a pilot study. J Hum Nutr Diet 1995; 8: 185–91

    Article  Google Scholar 

  28. Von der Heiden R, Kraemer R, Birrer P, et al. Effect of growth hormone (rhGh) treatment on working capacity, body composition, lung function and immunological parameters in patients with cystic fibrosis [abstract]. Horm Res 1996; 46Suppl. 2: 52

    Google Scholar 

  29. Hardin DS, Stratton R, Kramer JC, et al. Growth hormone improves weight velocity and height velocity in prepubertal children with cystic fibrosis. Horm Metab Res 1998; 30: 636–41

    Article  PubMed  CAS  Google Scholar 

  30. Hardin DS, Ellis KJ, Dyson M, et al. Growth hormone improves clinical status in prepubertal children with cystic fibrosis: results of a randomized controlled trial. J Pediatr 2001; 139: 636–42

    Article  PubMed  CAS  Google Scholar 

  31. Alemzadeh R, Upchurch L, McCarthy V. Anabolic effect of growth hormone treatment in young children with cystic fibrosis. J Am Coll Nutr 1998; 17: 419–24

    PubMed  CAS  Google Scholar 

  32. Huseman CA, Colombo JL, Brooks MA, et al. Anabolic effects of biosynthetic growth hormone in cystic fibrosis patients. Pediatr Pulmonol 1996; 22: 90–5

    Article  PubMed  CAS  Google Scholar 

  33. Hardin DS, Sy JP. Effects of growth hormone treatment in children with cystic fibrosis: the National Cooperative Growth Study experience. J Pediatr 1997; 131: S65–8

    Article  PubMed  CAS  Google Scholar 

  34. Root AW, Kemp SF, Rundle AC, et al. Effect of long-term recombinant growth hormone therapy in children-the National Cooperative Growth Study, USA, 1985–1994. J Pediatr Endocrinol Metab 1998; 11: 403–12

    Article  PubMed  CAS  Google Scholar 

  35. Okada S, Kopchick JJ. Biological effects of growth hormone and its antagonist. Trends Mol Med 2001; 7: 126–32

    Article  PubMed  CAS  Google Scholar 

  36. Le Roith D, Bondy C, Yakar S. The somatomedin hypothesis: 2001. Endocr Rev 2001; 22: 53–74

    Article  PubMed  Google Scholar 

  37. Wit JM. Growth hormone therapy. Best Pract Res Clin Endocrinol Metab 2002; 16: 483–503

    Article  PubMed  CAS  Google Scholar 

  38. Laursen EM, Lanng S, Rasmussen MH, et al. Normal spontaneous ans stimulated GH levels despite decreased IGF-I concentrations in cystic fibrosis patients. Eur J Endocrinol 1999; 140: 315–21

    Article  PubMed  CAS  Google Scholar 

  39. Taylor AM, Bush A, Thomson A, et al. Relation between insulin-like growth factor-I, body mass index, and clinical status in cystic fibrosis. Arch Dis Child 1997; 76: 304–9

    Article  PubMed  CAS  Google Scholar 

  40. Taylor AM, Thomson A, Bruce-Morgan C, et al. The relationship between insulin, IGF-I and weight gain in cystic fibrosis. Clin Endocrinol (Oxf) 1999; 51: 659–65

    Article  CAS  Google Scholar 

  41. Laursen EM, Juul A, Lanng S, et al. Diminished concentrations of insulin-like growth factor I in cystic fibrosis. Arch Dis Child 1995; 72: 494–7

    Article  PubMed  CAS  Google Scholar 

  42. Hardin DS. Growth hormone treatment in children with cystic fibrosis. Minerva Pediatr 2002; 54: 365–71

    PubMed  CAS  Google Scholar 

  43. Gulmans VAM, de Meer K, Binkhorst RA, et al. Reference values for maximum work capacity in relation to body composition in Dutch healthy children. Eur Respir J 1997; 10: 94–7

    Article  PubMed  CAS  Google Scholar 

  44. Gulmans VAM, de Meer K, Brackel HJL, et al. Maximal work capacity in relation to nutritional status in children with cystic fibrosis. Eur Respir J 1997; 10: 2014–7

    Article  PubMed  CAS  Google Scholar 

  45. Freeman W, Stableforth DE, Cayton RM, et al. Endurance exercise capacity in adults with cystic fibrosis. Respir Med 1993; 87: 541–9

    Article  PubMed  CAS  Google Scholar 

  46. Sherril DL, Camilli A, Lebowitz MD. On temporal relations between lung function and somatic growth. Am Rev Respir Dis 1989; 140: 638–44

    Google Scholar 

  47. Marks J, Pasterkamp H, Tal A, et al. Relationship between respiratory muscle strength, nutritional status, and lung volume in cystic fibrosis and asthma. Am Rev Respir Dis 1986; 133: 414–7

    PubMed  CAS  Google Scholar 

  48. Lands L, Desmond KJ, Demizio D, et al. The effects of nutritional status and hyperinflation on respiratory muscle strength in children and young adults. Am Rev Respir Dis 1990; 141: 1506–9

    PubMed  CAS  Google Scholar 

  49. Lands LC, Heigenhauser GJF, Jones NL. Respiratory and peripheral muscle function in cystic fibrosis. Am Rev Respir Dis 1993; 147: 865–9

    PubMed  CAS  Google Scholar 

  50. Jacobstein MD, Hirschfeld SS, Winnie G, et al. Ventricular interdependence in severe cystic fibrosis. Chest 1981; 80: 399–404

    Article  PubMed  CAS  Google Scholar 

  51. Florea VG, Florea ND, Sharma R, et al. Right ventricular dysfunction in adult severe cystic fibrosis. Chest 2000; 118: 1063–8

    Article  PubMed  CAS  Google Scholar 

  52. Chipps BE, Alderson PO, Roland JMA, et al. Noninvasive evaluation of ventricular function in cystic fibrosis. J Pediatr 1979; 95: 379–84

    Article  PubMed  CAS  Google Scholar 

  53. Benson LN, Newth CJL, Desouza M, et al. Radionuclide assessment of right and left ventricular function during bicycle exercise in young patients with cystic fibrosis. Am Rev Respir Dis 1984; 130: 987–92

    PubMed  CAS  Google Scholar 

  54. Hortop J, Desmond KJ, Coates AL. The mechanical effects of expiratory airflow limitation on cardiac performance in cystic fibrosis. Am Rev Respir Dis 1988; 137: 132–7

    Article  PubMed  CAS  Google Scholar 

  55. Perrault H, Coughlan M, Marcotte JE, et al. Comparison of cardiac output determinants in response to upright and supine exercise in patients with cystic fibrosis. Chest 1992; 101: 42–51

    Article  PubMed  CAS  Google Scholar 

  56. Pianosi P, Pelech A. Stroke volume during exercise in cystic fibrosis. Am J Respir Crit Care Med 1996; 153: 1105–9

    PubMed  CAS  Google Scholar 

  57. Caidahl K, Eden S, Bengtsson BÅ. Cardiovascular and renal effects of growth hormone. Clin Endocrinol 1994; 40: 393–400

    Article  CAS  Google Scholar 

  58. Thuesen L, Christiansen JS, Sørensen KE, et al. Increased myocardial contractility following growth hormone administration in normal man: an echocardiographic study. Dan Med Bull 1988; 35: 193–6

    PubMed  CAS  Google Scholar 

  59. Fazio S, Sabatini D, Capaldo B, et al. A preliminary study if growth hormone in the treatment of dilated cardiomyopathy. N Engl J Med 1996; 334: 809–14

    Article  PubMed  CAS  Google Scholar 

  60. Clemmons DR, Snyder DK, Williams R, et al. Growth hormone administration conserves lean body mass during dietary restriction in obese subjects. J Clin Endocrinol Metab 1987; 64: 878–83

    Article  PubMed  CAS  Google Scholar 

  61. Ho KY, Weissberger AJ. The antinatriuretic action of biosynthetic human growth hormone in man involves activation of the renin-angiotensin system. Metabolism 1990; 39: 133–7

    Article  PubMed  CAS  Google Scholar 

  62. Möller N, Jörgensen JO, Möller N, et al. Expansion of extracellular volume and suppression of atrial natriuretic peptide after growth hormone administration in normal man. J Clin Endocrinol Metab 1991; 72: 768–72

    Article  PubMed  Google Scholar 

  63. Bengtsson BÅ, Eden S, Lönn L, et al. Treatment of adults with groth hormone deficiency with recombinant human growth hormone. J Clin Endocrinol Metab 1993; 76: 309–17

    Article  PubMed  CAS  Google Scholar 

  64. Möller J, Jörgensen JOL, Frandsen E, et al. Body fluids, circadian blood pressure and plasma renin during growth hormone administration: a placebo-controlled study with two growth hormone doses in healthy adults. Scand J Clin Lab Invest 1995; 55: 663–9

    Article  PubMed  Google Scholar 

  65. Vihervuori E, Virtanen M, Koistinen H, et al. Hemoglobin level is linked to growth hormone-dependent proteins in short children. Blood 1996; 87: 2075–81

    PubMed  CAS  Google Scholar 

  66. Ten Have SMTH, van der Lely AJ, Lamberts SWJ. Increase in haemoglobin concentrations in growth hormone deficient adults during human recombinant growth hormone replacement therapy. Clin Endocrinol 1997; 47: 565–70

    Article  Google Scholar 

  67. Cuneo RC, Salomon F, Wiles CM, et al. Growth hormone treatment in growth hormone-deficient adults: II. Effects on exercise performance. J Appl Physiol 1991; 70: 695–700

    PubMed  CAS  Google Scholar 

  68. Halvorsen S, Bechensteen AG. Physiology of erythropoietin during mammalian development. Acta Paediatr Suppl 2002; 91: 17–26

    Article  PubMed  CAS  Google Scholar 

  69. Sawka MN, Convertino VA, Eichner ER, et al. Blood volume: importance and adaptations to exercise training, environmental stresses, and trauma/sickness. Med Sci Sports Exerc 2000; 32: 332–48

    Article  PubMed  CAS  Google Scholar 

  70. Hussey J, Gormley J, Leen G, et al. Peripheral muscle strength in young males with cystic fibrosis. J Cyst Fibr 2002; 1: 116–21

    Article  CAS  Google Scholar 

  71. Bigland B, Jehring B. Muscle performance in rats, normal and treated with growth hormone. J Physiol 1952; 116: 129–36

    PubMed  CAS  Google Scholar 

  72. Jørgensen JOL, Pedersen SA, Thuesen L, et al. Beneficial effects of growth hormone treatment in GH-deficient adults. Lancet 1989; I: 1221–5

    Article  Google Scholar 

  73. Cuneo RC, Salomon F, Wiles CM, et al. Growth hormone treatment in growth hormone-deficient adults: I. Effects on muscle mass and strength. J Appl Physiol 1991; 70: 688–94

    PubMed  CAS  Google Scholar 

  74. Goldberg AL, Goodman HM. Relationship between growth hormone and muscular work in determining muscle size. J Physiol 1969; 200: 655–66

    PubMed  CAS  Google Scholar 

  75. Rasmussen RL, Faulkner RA, Mirwald RL, et al. A longitudinal analysis of structure/function related variables in 10–16 year old boys. In: Beunen G, Ghesquiere J, Reybrouck T, et al. editors. Children and exercise. Stuttgart: Ferdinand Enke Verlag, 1990: 27–33

    Google Scholar 

  76. Wallymahmed ME, Foy P, Shaw D, et al. Quality of life, body composition and muscle strength in adult growth hormone deficiency: the influence of growth hormone replacement therapy for up to 3 years. Clin Endocrinol 1997; 47: 439–46

    Article  CAS  Google Scholar 

  77. Ayling CM, Moreland BH, Zanelli JM, et al. Human growth hormone treatment of hypophysectomized rats increases the proportion of type-I fibres in skeletal muscle. J Endocrinol 1989; 123: 429–35

    Article  PubMed  CAS  Google Scholar 

  78. Daugaard JR, Brmnert M, Manhem P, et al. Effect of 6 months of GH treatment on myosin heavy chain composition in GH-deficient patients. Eur J Endocrinol 1999; 141: 342–9

    Article  PubMed  CAS  Google Scholar 

  79. Woodhouse LJ, Asa SL, Thomas SG, et al. Measures of submaximal aerobic performance evaluate and predict functional response to growth hormone (GH) treatment in GH-deficient adults. J Clin Endocrinol Metab 1999; 84: 4570–7

    Article  PubMed  CAS  Google Scholar 

  80. Lange KH, Andersen JL, Beyer N, et al. GH administration changes myosin heavy chain isoforms in skeletal muscle but does not augment muscle strength or hypertrophy, either alone or combined with resistance exercise training in healthy elderly men. J Clin Endocrinol Metab 2002; 87: 513–23

    Article  PubMed  CAS  Google Scholar 

  81. Zorzano A, James DE, Ruderman NB, et al. Insulin-like growth factor I binding and receptor kinase in red and white muscle. FEBS Lett 1988; 234: 257–62

    Article  PubMed  CAS  Google Scholar 

  82. De Meer K, Jeneson JA, Gulmans VA, et al. Efficiency of oxidative work performance of skeletal muscle in patients with cystic fibrosis. Thorax 1995; 50: 980–3

    Article  PubMed  Google Scholar 

  83. Boas SR, Danduran MJ, McColley SA. Energy metabolism during anaerobic exercise in children with cystic fibrosis and asthma. Med Sci Sports Exerc 1999; 31: 1242–9

    Article  PubMed  CAS  Google Scholar 

  84. Moser C, Tirakitsoontorn P, Nussbaum E. Muscle size and cardiorespiratory response to exercise in cystic fibrosis. Am J Respir Crit Care Med 2000; 162: 1823–7

    PubMed  CAS  Google Scholar 

  85. McGaulley GA. Quality of life assessment before and after growth hormone treatment in adults with growth hormone deficiency. Acta Paediatr Scand 1989; 356 Suppl.: 70–2

    Article  Google Scholar 

  86. Boucher GP, Lands LC, Hay JA, et al. Activity levels and the relationship to lung function and nutritional status in children with cystic fibrosis. Am J Phys Med Rehabil 1997; 76: 311–5

    Article  PubMed  CAS  Google Scholar 

  87. Whitehead HM, Boreham C, McIIrath EM, et al. Growth hormone treatment of adults with growth hormone deficiency: results of a 13-month placebo controlled cross-over study. Clin Endocrinol 1992; 36: 45–52

    Article  CAS  Google Scholar 

  88. Selvadurai HC, McKay KO, Blimkie CJ, et al. The relationship between genotype and exercise tolerance in children with cystic fibrosis. Am J Respir Crit Care Med 2002; 165: 762–5

    PubMed  Google Scholar 

  89. Zemel BS, Jaward AF, FitzSimmons S, et al. Longitudinal relationship among growth, nutritional status, and pulmonary function in children with cystic fibrosis: analysis of the Cystic Fibrosis Foundation National CF Patient Registry. J Pediatr 2000; 137: 374–80

    Article  PubMed  CAS  Google Scholar 

  90. Snyder DK, Clemmons DR, Underwood LE. Treatment of obese, diet-restricted subjects with growth hormone for 11 weeks: effects on anabolism, lipolysis, and body composition. J Clin Endocrinol Metab 1988; 67: 54–61

    Article  PubMed  CAS  Google Scholar 

  91. Steinkamp G, von der Hardt H. Improvement of nutritional status and lung function after long-term nocturnal gastrostomy feedings in cystic fibrosis. J Pediatr 1994; 124: 244–9

    Article  PubMed  CAS  Google Scholar 

  92. Snyder DK, Clemmons DR, Underwood LE. Dietary carbohydrate content determines responsiveness to growth hormone in humans. J Clin Endocrinol Metab 1989; 69: 745–52

    Article  PubMed  CAS  Google Scholar 

  93. Skeie B, Askanazi J, Rothkopf MM, et al. Improved exercise tolerance with long-term parenteral nutrition in cystic fibrosis. Crit Care Med 1987; 15: 960–2

    Article  PubMed  CAS  Google Scholar 

  94. Dodge JA. Nutritional requirements in cystic fibrosis: a review. J Pediatr Gastroenterol Nutr 1988; 7Suppl. 1: S8–S11

    Article  PubMed  Google Scholar 

  95. Bell L, Durie P, Forstner GG. What do children with cystic fibrosis eat? J Pediatr Gastroenterol Nutr 1984; 3Suppl. 1: S137–46

    Article  PubMed  Google Scholar 

  96. Kawchak DA, Zhao H, Scanlin TF, et al. Longitudinal, prospective analysis of dietary intake in children with cystic fibrosis. J Pediatr 1996; 129: 119–29

    Article  PubMed  CAS  Google Scholar 

  97. Kellis E, Kellis S, Gerodimos V, et al. Reliability of isokinetic concentric and eccentric strength in circumpubertal soccer players. Ped Exerc Sci 1999; 11: 218–28

    Google Scholar 

  98. Ramsey BW, Boat TF. Outcome measures for clinical trials in cystic fibrosis: summary of a Cystic Fibrosis Foundation consensus conference. J Pediatr 1994; 124: 177–92

    Article  PubMed  CAS  Google Scholar 

  99. Robbins MK, Ontjes DA. Endocrine and renal disorders in cystic fibrosis. In: Yankaskas JR, Knowles MR, editors. Cystic fibrosis in adults. Philadelphia (PA): Lippincott-Raven Publishers, 1999: 383–418

    Google Scholar 

  100. Bradley J, McAlister O, Elborn S. Pulmonary function, inflammation, exercise capacity and quality of life in cystic fibrosis. Eur Respir J 2001; 17: 712–5

    Article  PubMed  CAS  Google Scholar 

  101. Bucuvalas JC, Chernausek SD. Growth hormone and cystic fibrosis: good for more than growth? J Pediatr 2001; 139: 616–8

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgements

No sources of funding were used to assist in the preparation of this manuscript. The author has no conflicts of interest that are directly relevant to the content of this manuscript.

Author information

Authors and Affiliations

  1. Department of Physical Medicine and Rehabilitation, Haukeland University Hospital, 5021, Bergen, Norway

    Matthias Hütler

  2. Department of Biological Sciences, Centre for Sports and Exercise Science, University of Essex, Colchester, UK

    Ralph Beneke

Authors
  1. Matthias Hütler
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ralph Beneke
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Matthias Hütler.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Hütler, M., Beneke, R. Growth Hormone and Exercise Tolerance in Patients with Cystic Fibrosis. Sports Med 34, 81–90 (2004). https://doi.org/10.2165/00007256-200434020-00002

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.2165/00007256-200434020-00002

Keywords

Search

Navigation