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1: Investigations of our patient MCV: Mean corpuscular volume, MCH: Mean corpuscular hemoglobin, WBC: White blood cell, TSH: Thyroid stimulating hormone, LDH: Lactate dehydrogenase, DCT: Direct Coombs test, ANA: Anti-nuclear antibody, IF: Intrinsic factor, NCS: Nerve conduction study, SACD: Subacute combined degeneration of the spinal cord Fig

309 Several mechanisms have been proposed for exercises benefits, including 310 : Analgesic effects due to increased growth hormone and adrenocorticotrophin hormone Better autonomic nervous system balance through reduced sympathetic hyperactivity Anti-inflammatory effects with decreased inflammatory cytokine levels Better hypothalamic-pituitary-adrenal axis tone Increased release of serotonin, dopamine, and nerve growth factors Normalized pain signaling through reduced central and peripheral pain hypersensitization All types of exercise appear to have positive impacts on fibromyalgia, but different types of exercise may affect symptoms differently

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