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Olsen LN, Fischer M, Evans PA, Gliemann L, Hellsten Y. Does Exercise Influence the Susceptibility to Arterial Thrombosis? An Integrative Perspective. Front Physiol 2021; 12:636027. [PMID: 33708141 PMCID: PMC7940832 DOI: 10.3389/fphys.2021.636027] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 02/01/2021] [Indexed: 12/14/2022] Open
Abstract
Arterial thrombosis is the primary cause of death worldwide, with the most important risk factors being smoking, unhealthy diet, and physical inactivity. However, although there are clear indications in the literature of beneficial effects of physical activity in lowering the risk of cardiovascular events, exercise can be considered a double-edged sword in that physical exertion can induce an immediate pro-thrombotic environment. Epidemiological studies show an increased risk of cardiovascular events after acute exercise, a risk, which appear to be particularly apparent in individuals with lifestyle-related disease. Factors that cause the increased susceptibility to arterial thrombosis with exercise are both chemical and mechanical in nature and include circulating catecholamines and vascular shear stress. Exercise intensity plays a marked role on such parameters, and evidence in the literature accordingly points at a greater susceptibility to thrombus formation at high compared to light and moderate intensity exercise. Of importance is, however, that the susceptibility to arterial thrombosis appears to be lower in exercise-conditioned individuals compared to sedentary individuals. There is currently limited data on the role of acute and chronic exercise on the susceptibility to arterial thrombosis, and many studies include incomplete assessments of thrombogenic clotting profile. Thus, further studies on the role of exercise, involving valid biomarkers, are clearly warranted.
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Affiliation(s)
- Line Nørregaard Olsen
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Mads Fischer
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Phillip Adrian Evans
- Haemostasis Biomedical Research Unit, Welsh Centre for Emergency Medicine Research, Morriston Hospital, SBU Health Board, Swansea, United Kingdom
- College of Medicine, Swansea University, Swansea, United Kingdom
| | - Lasse Gliemann
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Ylva Hellsten
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
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2
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Heuberger JAAC, Posthuma JJ, Ziagkos D, Rotmans JI, Daniels JMA, Gal P, Stuurman FE, Spronk HMH, Ten Cate H, Burggraaf J, Moerland M, Cohen AF. Additive effect of erythropoietin use on exercise-induced endothelial activation and hypercoagulability in athletes. Eur J Appl Physiol 2020; 120:1893-1904. [PMID: 32537688 PMCID: PMC7340646 DOI: 10.1007/s00421-020-04419-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Accepted: 06/05/2020] [Indexed: 11/25/2022]
Abstract
Purpose Recombinant human erythropoietin (rHuEPO) is known to increase thrombotic risk in patients and might have similar effects in athletes abusing the drug. rHuEPO is prohibited by anti-doping legislation, but this risk has not been investigated thoroughly. This analysis was designed to evaluate whether rHuEPO impacts hemostatic profile and endothelial and platelet activation markers in trained subjects, and whether the combination with exercise affects exercise induced alterations. Methods This double-blind, randomized, placebo-controlled trial enrolled healthy, trained male cyclists aged 18–50 years. Participants were randomly allocated (1:1) to receive subcutaneous injections of rHuEPO (epoetin-β; mean dose 6000 IU per week) or placebo (0.9% NaCl) for 8 weeks. Subjects performed five maximal exercise tests and a road race, coagulation and endothelial/platelet markers were measured at rest and directly after each exercise effort. Results rHuEPO increased P-selectin (+ 7.8% (1.5–14.5), p = 0.02) and E-selectin (+ 8.6% (2.0–15.7), p = 0.01) levels at rest. Maximal exercise tests significantly influenced all measured coagulation and endothelial/platelet markers, and in the rHuEPO group maximal exercise tests led to 15.3% ((7.0–24.3%), p = 0.0004) higher E-selectin and 32.1% ((4.6–66.8%), p = 0.0207) higher Platelet factor 4 (PF4) levels compared to the placebo group. Conclusion In conclusion, rHuEPO treatment resulted in elevated E- and P-selectin levels in trained cyclists, indicating enhanced endothelial activation and/or platelet reactivity. Exercise itself induces hypercoagulability, and the combination of rHuEPO and exercise increased E-selectin and PF4 levels more than either intervention alone. Based on this, exercise potentially increases thrombotic risk, a risk that might be enhanced in combination with rHuEPO use. Electronic supplementary material The online version of this article (10.1007/s00421-020-04419-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Jelle J Posthuma
- Departments of Internal Medicine and Biochemistry, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
| | - Dimitrios Ziagkos
- Centre for Human Drug Research, Zernikedreef 8, 2333 CL, Leiden, The Netherlands
| | - Joris I Rotmans
- Department of Internal Medicine, Leiden University Medical Centre, Leiden, The Netherlands
| | - Johannes M A Daniels
- Department of Pulmonary Diseases, VU University Medical Centre, Amsterdam, The Netherlands
| | - Pim Gal
- Centre for Human Drug Research, Zernikedreef 8, 2333 CL, Leiden, The Netherlands
| | - Frederik E Stuurman
- Centre for Human Drug Research, Zernikedreef 8, 2333 CL, Leiden, The Netherlands
| | - Henri M H Spronk
- Departments of Internal Medicine and Biochemistry, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
| | - Hugo Ten Cate
- Departments of Internal Medicine and Biochemistry, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
| | - Jacobus Burggraaf
- Centre for Human Drug Research, Zernikedreef 8, 2333 CL, Leiden, The Netherlands
- Leiden Academic Centre for Drug Research, Leiden, The Netherlands
| | - Matthijs Moerland
- Centre for Human Drug Research, Zernikedreef 8, 2333 CL, Leiden, The Netherlands
| | - Adam F Cohen
- Centre for Human Drug Research, Zernikedreef 8, 2333 CL, Leiden, The Netherlands
- Department of Internal Medicine, Leiden University Medical Centre, Leiden, The Netherlands
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3
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Braschi A. Acute exercise-induced changes in hemostatic and fibrinolytic properties: analogies, similarities, and differences between normotensive subjects and patients with essential hypertension. Platelets 2019; 30:675-689. [DOI: 10.1080/09537104.2019.1615611] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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4
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Stepien EL, Kwaśniewska M, Rębowska E, Golański J, Drygas W. Modified thrombin formation and fibrinolysis in an ultra-endurance marathon swimmer. Scand J Med Sci Sports 2018; 27:567-570. [PMID: 28387013 DOI: 10.1111/sms.12836] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- E L Stepien
- Department of Medical Physics, M. Smoluchowski Institute of Physics, Jagiellonian University, Krakow, Poland
| | - M Kwaśniewska
- Department of Social and Preventive Medicine, Medical University of Łódź, Łódź, Poland
| | - E Rębowska
- Department of Social and Preventive Medicine, Medical University of Łódź, Łódź, Poland
| | - J Golański
- Department of Haemostasis and Haemostatic Disorders, Medical University of Łódź, Łódź, Poland
| | - W Drygas
- Department of Social and Preventive Medicine, Medical University of Łódź, Łódź, Poland.,Department of Epidemiology, Cardiovascular Disease Prevention and Health Promotion, The Cardinal Stefan Wyszyński Institute of Cardiology, Warsaw, Poland
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Zadow EK, Kitic CM, Wu SSX, Fell JW, Adams MJ. Time of day and short-duration high-intensity exercise influences on coagulation and fibrinolysis. Eur J Sport Sci 2018; 18:367-375. [PMID: 29320303 DOI: 10.1080/17461391.2017.1420237] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Exercise has been demonstrated to have considerable effects upon haemostasis, with activation dependent upon the duration and intensity of the exercise bout. In addition, markers of coagulation and fibrinolysis have been shown to possess circadian rhythms, peaking within the morning (0600-1200 h). Therefore, the time of day in which exercise is performed may influence the activation of the coagulation and fibrinolytic systems. This study aimed to examine coagulation and fibrinolytic responses to short-duration high-intensity exercise when completed at different times of the day. Fifteen male cyclists (VO2max: 60.3 ± 8.1 ml kg-1 min-1) completed a 4-km cycling time trial (TT) on five separate occasions at 0830, 1130, 1430, 1730 and 2030. Venous blood samples were obtained pre- and immediately post-exercise, and analysed for tissue factor (TF), tissue factor pathway inhibitor (TFPI), thrombin-anti-thrombin complexes (TAT) and D-Dimer. Exercise significantly increased plasma concentrations of TF (p < .0005), TFPI (p < .0006), TAT complexes (p < .0012) and D-Dimer (p < .0003). There was a time-of-day effect in pre-exercise TF (p = .004) and TFPI (p = .031), with 0830 greater than 1730 (p .001), while 1730 was less than 2030 h (p = .008), respectively. There was no significant effect of time of day for TAT (p = .364) and D-Dimer (p = .228). Power output, TT time and heart rate were not significantly different between TTs (p > .05); however, percentage VO2max was greater at 1730 when compared to 2030 (p = .04). Due to a time-of-day effect present within TF, peaking at 0830, caution should be applied when prescribing short-duration high-intensity exercise bout within the morning in populations predisposed to hypercoagulability.
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Affiliation(s)
- Emma Kate Zadow
- a School of Health Sciences, Sports Performance Optimisation Research Team , University of Tasmania , Launceston , Tasmania , Australia
| | - Cecilia Marie Kitic
- a School of Health Sciences, Sports Performance Optimisation Research Team , University of Tasmania , Launceston , Tasmania , Australia
| | - Sam Shi Xuan Wu
- a School of Health Sciences, Sports Performance Optimisation Research Team , University of Tasmania , Launceston , Tasmania , Australia.,b Department of Health, Arts and Design , Swinburne University of Technology , Hawthorn , Victoria , Australia
| | - James William Fell
- a School of Health Sciences, Sports Performance Optimisation Research Team , University of Tasmania , Launceston , Tasmania , Australia
| | - Murray John Adams
- a School of Health Sciences, Sports Performance Optimisation Research Team , University of Tasmania , Launceston , Tasmania , Australia.,c School of Veterinary and Life Sciences , Murdoch University , Murdoch , Western Australia , Australia
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Bekos C, Zimmermann M, Unger L, Janik S, Hacker P, Mitterbauer A, Koller M, Fritz R, Gäbler C, Kessler M, Nickl S, Didcock J, Altmann P, Haider T, Roth G, Klepetko W, Ankersmit HJ, Moser B. Non-professional marathon running: RAGE axis and ST2 family changes in relation to open-window effect, inflammation and renal function. Sci Rep 2016; 6:32315. [PMID: 27653273 PMCID: PMC5032027 DOI: 10.1038/srep32315] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Accepted: 08/01/2016] [Indexed: 01/17/2023] Open
Abstract
Conflicting data exist on the relevance of marathon (M) and half marathon (HM) running for health. The number of non-professional athletes finishing M and HM events is steadily growing. In order to investigate molecular changes occurring in amateur athletes, we enrolled 70 non-professional runners finishing a single M (34) or HM (36) event at baseline, the finish line and during recovery, and 30 controls. The measurement of the Receptor for Advanced Glycation Endproducts, Interleukin 1 receptor antagonist, ST2 and cytokeratin 18 was combined with molecules measured during clinical routine. Results were analyzed in the light of blood cell analysis, lactate measurements, correction for changes in plasma volume and body composition assessments. There were intrinsic differences in body mass index, abdominal body fat percentage and training time between M and HM runners. C-reactive protein changes in M and HM runners. While soluble RAGE, AGEs and ST2 increased immediately after the race in HM runners, HMGB1 increased in HM and M after the race and declined to baseline after a recovery period. We give insights into the regulation of various molecules involved in physical stress reactions and their possible implications for the cardiovascular system or renal function.
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Affiliation(s)
- Christine Bekos
- Christian Doppler Laboratory for Cardiac and Thoracic Diagnosis and Regeneration, Medical University Vienna, Austria
- Department of Obstetrics and Gynaecology, Division of Gynaecology and Gynecological Oncology, Medical University Vienna, Austria
| | - Matthias Zimmermann
- Christian Doppler Laboratory for Cardiac and Thoracic Diagnosis and Regeneration, Medical University Vienna, Austria
| | - Lukas Unger
- Christian Doppler Laboratory for Cardiac and Thoracic Diagnosis and Regeneration, Medical University Vienna, Austria
| | - Stefan Janik
- Christian Doppler Laboratory for Cardiac and Thoracic Diagnosis and Regeneration, Medical University Vienna, Austria
| | - Philipp Hacker
- Christian Doppler Laboratory for Cardiac and Thoracic Diagnosis and Regeneration, Medical University Vienna, Austria
| | - Andreas Mitterbauer
- Christian Doppler Laboratory for Cardiac and Thoracic Diagnosis and Regeneration, Medical University Vienna, Austria
| | | | - Robert Fritz
- Sportordination, Alserstraße 27/1/6, Vienna, Austria
| | | | - Mario Kessler
- Austrian Red Cross, Nottendorfer Gasse 21, 1030 Wien, Austria
| | - Stefanie Nickl
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Medical University Vienna, Austria
| | - Jessica Didcock
- Christian Doppler Laboratory for Cardiac and Thoracic Diagnosis and Regeneration, Medical University Vienna, Austria
| | - Patrick Altmann
- Christian Doppler Laboratory for Cardiac and Thoracic Diagnosis and Regeneration, Medical University Vienna, Austria
| | - Thomas Haider
- Christian Doppler Laboratory for Cardiac and Thoracic Diagnosis and Regeneration, Medical University Vienna, Austria
- Department of Trauma Surgery, Medical University Vienna, Austria
| | - Georg Roth
- Department of Anesthesia, Critical Care and Pain Medicine, Medical University Vienna, Austria
| | - Walter Klepetko
- Department of Surgery, Division of Thoracic Surgery, Medical University Vienna, Austria
| | - Hendrik Jan Ankersmit
- Christian Doppler Laboratory for Cardiac and Thoracic Diagnosis and Regeneration, Medical University Vienna, Austria
- Department of Surgery, Division of Thoracic Surgery, Medical University Vienna, Austria
| | - Bernhard Moser
- Christian Doppler Laboratory for Cardiac and Thoracic Diagnosis and Regeneration, Medical University Vienna, Austria
- Department of Surgery, Division of Thoracic Surgery, Medical University Vienna, Austria
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Effects of Physical (In)activity on Platelet Function. BIOMED RESEARCH INTERNATIONAL 2015; 2015:165078. [PMID: 26557653 PMCID: PMC4628769 DOI: 10.1155/2015/165078] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/15/2015] [Accepted: 04/19/2015] [Indexed: 12/18/2022]
Abstract
As platelet activation is closely related to the liberation of growth factors and inflammatory mediators, platelets play a central role in the development of CVD. Virtually all cardiovascular risk factors favor platelet hyperreactivity and, accordingly, also physical (in)activity affects platelet function. Within this paper, we will summarize and discuss the current knowledge on the impact of acute and habitual exercise on platelet function. Although there are apparent discrepancies regarding the reported effects of acute, strenuous exercise on platelet activation, a deeper analysis of the available literature reveals that the applied exercise intensity and the subjects' cardiorespiratory fitness represent critical determinants for the observed effects. Consideration of these factors leads to the summary that (i) acute, strenuous exercise can lead to platelet activation, (ii) regular physical activity and/or physical fitness diminish or prevent platelet activation in response to acute exercise, and (iii) habitual physical activity and/or physical fitness also favorably modulate platelet function at physical rest. Notably, these effects of exercise on platelet function show obvious similarities to the well-recognized relation between exercise and the risk for cardiovascular events where vigorous exercise transiently increases the risk for myocardial infarction and a physically active lifestyle dramatically reduces cardiovascular mortality.
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8
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Posthuma JJ, van der Meijden PE, ten Cate H, Spronk HM. Short- and Long-term exercise induced alterations in haemostasis: a review of the literature. Blood Rev 2015; 29:171-8. [DOI: 10.1016/j.blre.2014.10.005] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Accepted: 10/23/2014] [Indexed: 01/24/2023]
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9
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Posthuma JJ, Loeffen R, van Oerle R, Henskens YMC, ten Cate H, Spronk HMH, van der Meijden PEJ. Long-term strenuous exercise induces a hypercoagulable state through contact activation. Thromb Haemost 2014; 111:1197-9. [PMID: 24477547 DOI: 10.1160/th13-11-0963] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2013] [Accepted: 12/28/2013] [Indexed: 11/05/2022]
Affiliation(s)
| | | | | | | | | | | | - Paola E J van der Meijden
- Paola E. J. van der Meijden, Department of Biochemistry, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands, Tel.: +31 43 3881684, Fax: +31 43 3884159, E-mail:
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10
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Bird SR, Linden M, Hawley JA. Acute changes to biomarkers as a consequence of prolonged strenuous running. Ann Clin Biochem 2013; 51:137-50. [PMID: 24000373 DOI: 10.1177/0004563213492147] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND A single bout of strenuous running exercise results in perturbations to numerous biomarkers. An understanding of these is important when analysing samples from individuals who have recently performed such exercise. METHODS A literature search was undertaken using the search terms, exercise, marathon and delayed onset of muscle soreness. The search was then refined using the terms for key biomarkers known to be altered by exercise. RESULTS The magnitude of changes to biomarkers is proportional to the severity of the running bout. Familiar, moderate intensity running exercise produces brief transient changes in common biomarkers such as lactate, whereas more severe bouts of running exercise, such as marathons and ultra-marathon events can produce changes to biomarkers that are normally associated with pathology of the muscles, liver and heart. Examples being changes to concentrations and/or activity of myoglobin, leucocytes, creatine kinase, bilirubin, cardiac troponins, lactate dehydrogenase, alanine aminotransferase and aspartate aminotransferase. While persisting for longer, these changes are also transient and full recovery occurs within days, without any apparent long-term adverse consequences. Additionally, unfamiliar exercise involving forceful eccentric muscle contractions, such as running downhill, can cause increases in creatine kinase and delayed onset of muscle soreness that peaks 36-72 h after the exercise bout. CONCLUSIONS Strenuous running exercise can produce changes to biomarkers that are normally associated with disease and injury, but these do not necessarily reflect chronic pathology.
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Affiliation(s)
- Stephen R Bird
- The Discipline of Exercise Sciences, School of Medical Sciences, RMIT University, Melbourne, Australia
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11
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Alterations in coagulatory and fibrinolytic systems following an ultra-marathon. Eur J Appl Physiol 2013; 113:2705-12. [PMID: 23974848 DOI: 10.1007/s00421-013-2709-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2013] [Accepted: 08/07/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE The aim of this study was to examine coagulatory and fibrinolytic responses to the Western States Endurance Run (WSER, June 23 to 24, 2012). The WSER is a 161-km (100 mile) trail foot race through the Sierra Nevada Mountains that involves 6,030 m of climb and 7,001 m of descent. METHODS We examined 12 men and 4 women [mean (95 % CI), age 44.6 years (38.7-50.6)] who completed the race (24.64 h; range 16.89-29.46). Blood samples were collected the morning before the race, immediately post-race, and 1 (D1) and 2 (D2) days post-race (corresponding to 51-54 h and 75-78 h from the start of the race, respectively). Hypercoagulable state was characterized by prothrombin fragment 1+2 (PTF 1+2) and thrombin-antithrombin complex (TAT). Fibrinolytic state was assessed by plasminogen activator inhibitor antigen (PAI-1 Ag), tissue plasminogen activator antigen (tPA Ag), and D-Dimer. Muscle damage was assessed by serum creatine kinase (CK) and myoglobin concentrations. RESULTS Significant (P ≤ 0.05) increases were observed immediately post-race for thrombin generation markers, PTF 1+2 (3.9-fold) and TAT (2.4-fold); markers of fibrinolysis, tPA Ag (4.0-fold), PAI-1 Ag (4.5-fold), and D-Dimer (2.2-fold); and muscle damage markers, CK (154-fold) and myoglobin (114-fold). Most markers continued to be elevated at D1, as seen by PTF 1+2, TAT (1.5- and 1.3-fold increase at D1), and D-Dimer (2.5- and 2.1-fold increase at D1 and D2, respectively). Additionally, PTF 1+2:tPA and TAT:tPA ratios, which assessed balance between coagulation and fibrinolysis, were slightly, but significantly increased at D1 (69 and 36 %) and D2 (19 and 31 %). CK and myoglobin also remained elevated at D1 (54- and 7-fold) and D2 (25- and 2-fold) time points. CONCLUSION The WSER produced extensive muscle damage and activated the coagulation and fibrinolytic systems. Since we observed a slight imbalance response between the two systems, a limited potential for thrombotic episodes is apparent in these highly trained athletes.
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Koudouovoh-Tripp P, Sperner-Unterweger B. Influence of mental stress on platelet bioactivity. World J Psychiatry 2012; 2:134-47. [PMID: 24175179 PMCID: PMC3782187 DOI: 10.5498/wjp.v2.i6.134] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2011] [Revised: 10/10/2012] [Accepted: 10/23/2012] [Indexed: 02/05/2023] Open
Abstract
It is well established that various mental stress conditions contribute, or at least influence, underlying pathophysiological mechanisms in somatic, as well as in psychiatric disorders; blood platelets are supposed to represent a possible link in this respect. The anculeated platelets are the smallest corpuscular elements circulating in the human blood. They display different serotonergic markers which seem to reflect the central nervous serotonin metabolism. They are known as main effectors in haematological processes but recent research highlights their role in the innate and adaptive immune system. Platelets are containing a multitude of pro-inflammatory and immune-modulatory bioactive compounds in their granules and are expressing immune-competent surface markers. Research gives hint that platelets activation and reactivity is increased by mental stress. This leads to enhanced cross talk with the immune system via paracrine secretion, receptor interaction and formation of platelet leucocyte-aggregates. Recently it has been demonstrated that the immune system can have a remarkable impact in the development of psychiatric disorders. Therefore platelets represent an interesting research area in psychiatry and their role as a possible biomarker has been investigated. We review the influence of mental stress on what is termed platelet bioactivity in this article, which subsumes the mainly immune-modulatory activity of platelets in healthy volunteers, elderly persons with chronic care-giving strain, patients with cardiovascular diseases who are prone to psychosocial stress, as well as in patients with posttraumatic stress disorder. Research data suggest that stress enhances platelet activity, reactivity and immune-modulatory capacities.
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Affiliation(s)
- Pia Koudouovoh-Tripp
- Pia Koudouovoh-Tripp, Clinic for Biological Psychiatry, Department of Psychiatry and Psychotherapy, Innsbruck Medical University, Anichstrasse 35, 6020 Innsbruck, Austria
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13
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Inflammatory response to strenuous muscular exercise in man. Mediators Inflamm 2012; 2:335-42. [PMID: 18475542 PMCID: PMC2365428 DOI: 10.1155/s0962935193000468] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/1993] [Accepted: 07/29/1993] [Indexed: 12/04/2022] Open
Abstract
Based on the humoral and cellular changes occurring during strenuous muscular work in humans, the concept of inflammatory response to exercise (IRE) is developed. The main indices of IRE consist of signs of an acute phase response, leucocytosis and leucocyte activation, release of inflammatory mediators, tissue damage and cellular infiltrates, production of free radicals, activation of complement, and coagulation and fibrinolytic pathways. Depending on exercise intensity and duration, it seems likely that muscle and/or associated connective tissue damage, contact system activation due to shear stress on endothelium and endotoxaemia could be the triggering mechanisms of IRE. Although this phenomenon can be considered in most cases as a physiological process associated with tissue repair, exaggerated IRE could have physiopathological consequences. On the other hand, the influence of several factors such as age, sex, training, hormonal status, nutrition, anti-inflammatory drugs, and the extent to which IRE could be a potential risk for subjects undergoing intense physical training require further study.
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15
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Sucker C, Zotz RB, Senft B, Scharf RE, Kröger K, Erbel R, Möhlenkamp S. Exercise-Induced Hemostatic Alterations Are Detectable by Rotation Thrombelastography (ROTEM): A Marathon Study. Clin Appl Thromb Hemost 2009; 16:543-8. [DOI: 10.1177/1076029609342091] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Rotation thrombelastography (ROTEM) provides a whole blood assay that allows the assessment of plasmic- and platelet-related hemostasis in a single-step procedure. In our current study, we focused on the capability of the method to detect hemostatic alterations induced by physical exercise, enrolling 33 healthy participants of the Dusseldorf Marathon 2006. Venous blood drawn immediately before and after finishing the marathon was analyzed by a rotational thrombelastograph (Pentapharm, Munich, Germany). On initiation of blood coagulation by recalcification, standard ROTEM parameters were determined. Comparison of the results obtained before and after the physical exercise was performed using the Student t test for paired samples. As a result, the mean clotting time (CT) determined from blood samples obtained immediately after the marathon was significantly shorter (662.9 ± 67.8 seconds vs 505.6 ± 97.3 seconds, P = .002) and the mean maximal clot firmness was significantly broader (48.4 ± 6.6 mm vs 51.5 ± 4.5 mm, P = .0004) when compared to results obtained before the physical exercise. Differences between mean clot formation times (CFTs; 280.6 + 96 seconds vs 270.4 ± 73.8 seconds) and mean α angles (45.9° ± 8° vs 47.8° ± 5.8°) before and after the marathon were not statistically significant. Remarkably, some participants showed opposed results, particularly prolongation of CT and narrowing of maximum clot firmness (MCF). Our study demonstrates that ROTEM is sensitive to exercise-induced hemostatic alterations. The method appears to be capable of detecting even distinct changes in hemostasis in a single-step procedure. Further analyses are needed to clarify which hemostasis parameters influence ROTEM results and which ROTEM results are independent predictors of exercise-induced alterations of plasmic and platelet function. This might help to explain interindividual differences in exercise-induced alterations of hemostasis.
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Affiliation(s)
- Christoph Sucker
- Department of Hemostasis and Transfusion Medicine, Heinrich Heine University Medical Center Dusseldorf, Dusseldorf, Germany,
| | - Rainer B. Zotz
- Department of Hemostasis and Transfusion Medicine, Heinrich Heine University Medical Center Dusseldorf, Dusseldorf, Germany
| | - Beate Senft
- Department of Hemostasis and Transfusion Medicine, Heinrich Heine University Medical Center Dusseldorf, Dusseldorf, Germany
| | - Rudiger E. Scharf
- Department of Hemostasis and Transfusion Medicine, Heinrich Heine University Medical Center Dusseldorf, Dusseldorf, Germany
| | - Knut Kröger
- Department of Angiology, University Clinic Essen, Essen, Germany
| | - Raimund Erbel
- West German Heart Center Essen, University Clinic Essen, Essen, Germany
| | - Stefan Möhlenkamp
- West German Heart Center Essen, University Clinic Essen, Essen, Germany
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Abstract
OBJECTIVES To review the effects of exercise on haemostasis and examine the possible clinical sequelae of these changes. METHODS The search strategy included articles from 1966 to August 2002 using Medline and SportDiscus databases, and cross referencing the bibliographies of relevant papers. RESULTS Exercise results in activation of both the coagulation and fibrinolytic cascades, as shown by a reduction in whole blood clotting time and activated partial thromboplastin time, an increase in the activity of several components of the cascades, and an increase in fibrin degradation products. In vitro tests suggest that coagulation remains activated after fibrinolysis has returned to baseline levels. CONCLUSIONS Both the coagulation and fibrinolytic cascades are stimulated by strenuous exercise, but the temporal relation between the two and its clinical significance remains to be clarified. Doctors and athletes should be aware of the haemostatic changes induced by exercise, and further work is needed to clarify the possible role of these changes in sudden cardiac death.
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Affiliation(s)
- J E Smith
- Academic Department of Sports Medicine, Royal London Hospital (Mile End), Bancroft Road, London E1, UK.
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17
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Sawka MN, Convertino VA, Eichner ER, Schnieder SM, Young AJ. Blood volume: importance and adaptations to exercise training, environmental stresses, and trauma/sickness. Med Sci Sports Exerc 2000; 32:332-48. [PMID: 10694114 DOI: 10.1097/00005768-200002000-00012] [Citation(s) in RCA: 269] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This paper reviews the influence of several perturbations (physical exercise, heat stress, terrestrial altitude, microgravity, and trauma/sickness) on adaptations of blood volume (BV), erythrocyte volume (EV), and plasma volume (PV). Exercise training can induce BV expansion: PV expansion usually occurs immediately, but EV expansion takes weeks. EV and PV expansion contribute to aerobic power improvements associated with exercise training. Repeated heat exposure induces PV expansion but does not alter EV. PV expansion does not improve thermoregulation, but EV expansion improves thermoregulation during exercise in the heat. Dehydration decreases PV (and increases plasma tonicity) which elevates heat strain and reduces exercise performance. High altitude exposure causes rapid (hours) plasma loss. During initial weeks at altitude, EV is unaffected, but a gradual expansion occurs with extended acclimatization. BV adjustments contribute, but are not key, to altitude acclimatization. Microgravity decreases PV and EV which contribute to orthostatic intolerance and decreased exercise capacity in astronauts. PV decreases may result from lower set points for total body water and central venous pressure, while EV decreases may result from increased erythrocyte destruction. Trauma, renal disease, and chronic diseases cause anemia from hemorrhage and immune activation which suppresses erythropoiesis. The re-establishment of EV is associated with healing, improved life quality, and exercise capabilities for these injured/sick persons.
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Affiliation(s)
- M N Sawka
- U.S. Army Research Institute of Environmental Medicine, Natick, MA 01760-5007, USA
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18
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Möckel M, Ulrich NV, Röcker L, Ruf A, Klefisch F, Patscheke H, Eichstädt H, Störk T, Frei U. Exhaustive cycle exercise induces P-selectin expression, coagulation, and fibrinolysis activation in ultraendurance athletes. Thromb Res 1999; 94:263-9. [PMID: 10336243 DOI: 10.1016/s0049-3848(99)00008-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- M Möckel
- Department of Nephrology/Intensive Care Medicine, Charité/Campus Virchow-Klinikum, Humboldt University, Berlin, Germany.
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19
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Weiss C, Welsch B, Albert M, Friedmann B, Strobel G, Jost J, Nawroth P, Bärtsch P. Coagulation and thrombomodulin in response to exercise of different type and duration. Med Sci Sports Exerc 1998; 30:1205-10. [PMID: 9710858 DOI: 10.1097/00005768-199808000-00004] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE The present study was conducted to evaluate the role of the duration of exercise and the impact of the exercise type for exercise-induced activation of coagulation. METHODS Eleven male triathletes were subjected to stepwise maximal (17 min) and 1-h maximal exercise in swimming, cycling, and running. Changes of hemostatic variable sand of plasma thrombomodulin, a marker of endothelial cell activation, were monitored. RESULTS Irrespective of the type of exercise, alterations in markers of thrombin (prothrombin fragment 1 + 2, thrombin-antithrombin III complexes) and fibrin formation (fibrinopeptide A) were more pronounced after 1-h exercise than after stepwise maximal exercise. Hemostatic parameters rose to the highest levels after running resulting in substantial fibrin formation as indicated by fibrinopeptide A increasing from 1.33 ng.mL-1 to 2.25 ng.mL (P < 0.05) after 1-h exercise testing. Significant changes of plasma thrombomodulin were detected exclusively after running with increases from 38.2 ng.mL-1 to 44.2 ng.mL-1 (1 h, P < 0.01). CONCLUSIONS The data demonstrated that prolonged exercise is necessary for exercise-induced activation of coagulation resulting in thrombin and fibrin formation and suggested that endothelial cell activation possibly due to mechanical factors associated with running might play a role.
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Affiliation(s)
- C Weiss
- Department of Sports Medicine, University of Heidelberg, Germany
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20
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Weiss C, Seitel G, Bärtsch P. Coagulation and fibrinolysis after moderate and very heavy exercise in healthy male subjects. Med Sci Sports Exerc 1998; 30:246-51. [PMID: 9502353 DOI: 10.1097/00005768-199802000-00012] [Citation(s) in RCA: 72] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
To examine the relationship between exercise intensity and activation of coagulation and fibrinolysis, we measured markers of thrombin, fibrin, and plasmin formation in 12 male subjects (mean 24+/-4 yr (SD)) before and after running on a treadmill for 1 h at two different intensities corresponding to moderate (82% maximal heart rate (HR), 68% VO2max) and very heavy (94% maximal HR, 83% VO2max) exercise. During moderate exercise plasma levels of tissue plasminogen activator (t-PA) antigen rose from 3.7+/-0.5 (mean+/-SE) to 14.6+/-1.8 ng x mL[-1] (P < 0.01) and of plasmin-alpha-antiplasmin (PAP) complexes from 2.1+/-0.3 to 4.2+/-0.7 nmol x L[-1] (P < 0.01), whereas prothrombin fragment 1+2 (PTF1+2), thrombin-antithrombin III (TAT) complexes and fibrinopeptide A (FPA) did not change significantly. In response to very heavy exercise, mean plasma levels of t-PA antigen and PAP complexes exceeded the upper limit of normal values 2.5- (P < 0.01) and two-fold (P < 0.01), respectively, while significant increases of plasma levels of PTF1+2 (P < 0.01), TAT (P < 0.05), and FPA (P < 0.01) occurred within the range of normal. We conclude that in healthy young individuals, exercise-induced activation of coagulation is well balanced by activation of the fibrinolytic system, since moderate exercise results in increased plasmin formation only, while at very heavy exercise generation of plasmin seems to exceed that of thrombin and fibrin.
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Affiliation(s)
- C Weiss
- Abteilung für Sportmedizin der Medizinischen Klinik und Poliklinik der Universität Heidelberg, Germany
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21
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Schobersberger W, Wirleitner B, Puschendorf B, Koller A, Villiger B, Frey W, Mair J. Influence of an ultramarathon race at moderate altitude on coagulation and fibrinolysis. ACTA ACUST UNITED AC 1996. [DOI: 10.1016/s0268-9499(05)80074-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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22
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Chicharro JL, Sánchez O, Bandrés F, Vaquero AF, Pérez M, Lucía A, Guantes Y, Legido JC. Blood coagulability changes during exercise and its relationship with the anaerobic threshold. Thromb Res 1995; 79:515-22. [PMID: 7502277 DOI: 10.1016/0049-3848(95)00141-d] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- J L Chicharro
- Unidad de Investigación Escuela de Medicina del Deporte. Universidad Complutense de Madrid, Spain
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23
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Camus G, Deby-Dupont G, Duchateau J, Deby C, Pincemail J, Lamy M. Are similar inflammatory factors involved in strenuous exercise and sepsis? Intensive Care Med 1994; 20:602-10. [PMID: 7706577 DOI: 10.1007/bf01705731] [Citation(s) in RCA: 56] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
An increasing body of data suggest that strenuous exercise triggers an inflammatory response having some similarity with those occurring in sepsis. Indices of this inflammatory response to exercise (IRE) especially include leukocytosis, release of inflammatory mediators and acute phase reactants, tissue damage, priming of various white blood cell lines, production of free radicals; activation of complement, coagulation and fibrinolytic cascades. Inflammatory responses to strenuous exercise and sepsis could in part be due to the release of endotoxin in blood as common triggering factor, but it seems that tissue damage and/or contact system activation are more important triggering mechanisms in exercising subjects. While the magnitude and duration of cellular and humoral changes associated with IRE are quite different from those observed in sepsis, recent human studies suggested that chronic and/or excessive IRE could have adverse effects. Among the possible consequences of acute and chronic IRE are delayed onset muscular soreness and loss of force, cardiovascular complications, intravascular hemolysis, hypoferraemia and increased susceptibility to infection.
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Affiliation(s)
- G Camus
- Laboratory of Human Applied Physiology, Université de Liège, Sart Tilman, Belgium
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24
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Molz AB, Heyduck B, Lill H, Spanuth E, Röcker L. The effect of different exercise intensities on the fibrinolytic system. EUROPEAN JOURNAL OF APPLIED PHYSIOLOGY AND OCCUPATIONAL PHYSIOLOGY 1993; 67:298-304. [PMID: 8299595 DOI: 10.1007/bf00357626] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
The effects of moderate 30-min cycle ergometer exercise (aerobic metabolism) followed by short-term exercise at maximal capacity (anaerobic metabolism) on fibrinolytic activity were investigated in ten female and ten male healthy, untrained subjects. The following parameters of fibrinolytic activity were measured initially (t0), at the end of the aerobic phase (t1), at the end of the anaerobic phase (t2) and after a 30-min recovery period (t3): tissue plasminogen activator (PAt) activity, PAt concentration, plasminogen activator (PAt) activity, PAt concentration, plasminogen activator inhibitor (PAi) activity, and D-Dimer concentration. Moderate long-term exercise caused a slight but significant increase in PAt concentration and PAt activity (t1; P < 0.01), whereas short-term exercise at maximal capacity (t2) produced a substantial elevation in both these parameters (P < 0.01). This would suggest that PAt was not inhibited totally by PAi which would itself seem to be consumed during exercise. In addition, a slight exercise intensity-dependent increase in D-Dimer concentration was measured--circumstancial evidence not only for elevated fibrinolytic potential, but also for an actual increase in fibrin degradation (t2: P < 0.01). After t3 both PAt activity and D-Dimer concentration were still slightly but significantly increased. The results obtained in the tests of fibrinolytic activity showed no significant difference between the men and the women. It would seem that the release of PAt is more markedly stimulated by short-term intense physical exercise than by long-term moderate exercise and actually causes increased fibrin degradation.
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Affiliation(s)
- A B Molz
- Institut für Physiologie der FU Berlin, Germany
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25
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Prisco D, Paniccia R, Guarnaccia V, Olivo G, Taddei T, Boddi M, Gensini GF. Thrombin generation after physical exercise. Thromb Res 1993; 69:159-64. [PMID: 8465274 DOI: 10.1016/0049-3848(93)90013-e] [Citation(s) in RCA: 27] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Many investigators have studied the influence of physical exercise on hemostatic system and it is well accepted that exercise causes an activation of coagulation as indicated by a shortening of aPTT and by an increase in plasma factor VIII activity and levels. A controversial point remains whether this clotting activation leads to a significant thrombin generation and fibrin formation. The type of physical exercise performed and the methods used to study blood coagulation may be two major sources of discrepancies in different studies. In the last years sensitive and reliable methods became available to evaluate prothrombin activation and thrombin generation. Thus in this study we have investigated the influence of a well standardized treadmill stress test, controlled by the measurement of cardiorespiratory and metabolic parameters, on plasma concentration of different markers of clotting activation in healthy untrained young subjects. Blood samples were also withdrawn just before anaerobic threshold to investigate a possible role of metabolic acidosis in changes of clotting system.
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Affiliation(s)
- D Prisco
- Clinica Medica I, University of Florence, Italy
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27
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Naesh O, Hindberg I, Trap-Jensen J, Lund JO. Post-exercise platelet activation--aggregation and release in relation to dynamic exercise. CLINICAL PHYSIOLOGY (OXFORD, ENGLAND) 1990; 10:221-30. [PMID: 2161722 DOI: 10.1111/j.1475-097x.1990.tb00090.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Relatively scarce information is found on the period immediately following physical stress, with special reference to human platelet activity. This, in connection with earlier observations of an increase in platelet release products and hyperaggregability following surgical stress, has initiated the present study. We studied platelet function in eight healthy non-mediated volunteers during and 1 h after cycle exercise of submaximal intensity. ADP-induced platelet aggregability was enhanced in the last minute of exercise followed by a decreased aggregability 1 h after. Adrenaline-induced platelet aggregation showed the same attenuation after exercise but no change during work. The release products beta-thromboglobulin and serotonin in plasma showed significant increases after exercise. This is taken as evidence of an enhanced platelet activity following exercise. A normal stress-response, measured as increase in cyclic AMP in plasma, was observed. In conclusion, platelets are activated following moderate exercise and it seems valid to include the post-exercise period in future studies.
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Affiliation(s)
- O Naesh
- Department of Clinical Physiology/Nuclear Medicine, Frederiksberg Hospital, Copenhagen, Denmark
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28
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Röcker L, Taenzer M, Drygas WK, Lill H, Heyduck B, Altenkirch HU. Effect of prolonged physical exercise on the fibrinolytic system. EUROPEAN JOURNAL OF APPLIED PHYSIOLOGY AND OCCUPATIONAL PHYSIOLOGY 1990; 60:478-81. [PMID: 2118111 DOI: 10.1007/bf00705040] [Citation(s) in RCA: 50] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The effect of a test marathon race on plasma fibrinolytic activity (FA) was studied in 16 endurance athletes before, immediately after, 3 h, and 31 h after the run. Tissue plasminogen activator (t-PA) activity increased about 31-fold immediately after the run. Similar increases were found in t-PA antigen concentration. Plasminogen activator inhibitor (PAI) was not detectable immediately after the race and was significantly decreased 3 h (P less than 0.05) and 31 h (P less than 0.01) later. B beta 15-42 peptide increased by 0.63 pmol.ml-1 (P less than 0.001), D-dimer by 68.3 ng.ml-1 (P less than 0.05). Euglobulin lysis time (ELT) was reduced from 109 to 18 min (P less than 0.001). The increased t-PA activity and t-PA antigen concentration disappeared in the course of the first 3 h after exertion. ELT also reached its pre-exercise levels at this time. Thirty-one hours after the race ELT and t-PA antigen levels were slightly but significantly reduced (P less than 0.05), whereas B beta 15-42 peptide remained increased (P less than 0.05). t-PA activity was unchanged compared with pre-exercise values. It seems that the exercise-induced FA is mainly caused by the marked increase of t-PA antigen and t-PA activity.
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Affiliation(s)
- L Röcker
- Institut für Leistungsmedizin (LLZ), FU Berlin, Federal Republic of Germany
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29
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Estellés A, Aznar J, Tormo G, Sapena P, Tormo V, España F. Influence of a rehabilitation sports programme on the fibrinolytic activity of patients after myocardial infarction. Thromb Res 1989; 55:203-12. [PMID: 2506665 DOI: 10.1016/0049-3848(89)90437-4] [Citation(s) in RCA: 32] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The influence of regular physical exercise on fibrinolysis was studied in two groups of patients after myocardial infarction. The two groups were of similar age and living habits. One of the groups took part in a rehabilitative training programme while the other group did not participate in any sports activities. Several fibrinolytic variables, including plasminogen activator inhibitor (PAI) activity and PAI-1 antigen, were studied before and after an ergometric test performed at three different times: at the end of hospitalization (before beginning the rehabilitation programme), three months and six months after myocardial infarction. Our results indicate that by the sixth month fibrinolytic activity, measured by the tissue plasminogen activator (t-PA) capacity, had decreased significantly (p less than 0.025) in the patients who were not participating in the rehabilitation programme whereas it had increased slightly in the patients involved in the rehabilitation programme in comparison with the initial values. It was also observed that while PAI activity remained constant or decreased slightly in patients after six months in the rehabilitative sports programme, these PAI levels increased significantly in patients who were not in the sports programme. Our results indicate that there was a significant decrease in the fibrinolytic capacity of patients who were not participating in the rehabilitation sports programme, while the patients involved in the rehabilitation programme showed a slight improvement in their fibrinolytic activity.
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Affiliation(s)
- A Estellés
- Research Centre, Hospital La Fe, Valencia, Spain
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