Exercise intensity: platelet function and platelet-leukocyte conjugate formation in untrained subjects

Post-exercise endothelial function is not associated with extracellular vesicle release in healthy young males

Acute exercise can result in temporary decrease in endothelial functions, which may represent a transient period of risk. Numerous mechanisms underpinning these responses included release of extracellular vesicles (EVs) derived from apoptotic or activated endothelial cells and platelets. This study aims to compare the time course of endothelial responses to moderate-intensity continuous exercise (MICE) and high-intensity interval exercise (HIIE) and the associations with EV release. Eighteen young healthy males (age: 22.6 ± 3.7 years, BMI: 25.6 ± 2.5 m²/kg, and VO_2peak: 38.6 ± 6.5 mL/kg/min) completed two randomly assigned exercises: HIIE (10 × 1 min-@-90% heart rate reserve (HRR) and 1 min passive recovery) and MICE (30 min-@-70% HRR) on a cycle ergometer. Flow-mediated dilation (FMD) was used to assess endothelial function and blood samples were collected to evaluate endothelial cell-derived EV (CD62E⁺) and platelet-derived EV (CD41a⁺), 10, 60, and 120 min before and after exercise. There were similar increases but different time courses (P = 0.017) in FMD (increased 10 min post-HIIE, P < 0.0001 and 60 min post-MICE, P = 0.038). CD62E⁺ remained unchanged (P = 0.530), whereas overall CD41a⁺ release was reduced 60 min post-exercise (P = 0.040). FMD was not associated with EV absolute release or change (P > 0.05). Acute exercise resulted in similar improvements, but different time course in FMD following either exercise. Whilst EVs were not associated with FMD, the reduction in platelet-derived EVs may represent a protective mechanism following acute exercise.

Comparable effects of circuit and traditional resistance exercise on platelet α2bβ3 receptor and platelet activation and function

BACKGROUND

Resistance exercise induces thrombocytosis and increases platelet activation and function. These changes might be related to exercise variables including exercise intensity and type.

OBJECTIVE

We compared the effects of traditional resistance exercise (TRE) and circuit resistance exercise (CRE) on cellular markers of platelet activation and function.

METHODS

In this crossover study ten healthy male (mean±SD: age, 25.6±2.4 years) subjects performed TRE encompassed 3 sets of 10 repetitions at 100% of 10-RM (10 repetition maximum) for 6 exercises, and CRE protocols included 3 sets of 10 repetitions at 100% of 10-RM for all 6 exercises consecutively, in two separate weeks. To measure platelet indices, PAC1, CD41a, CD42b and CD62P three blood samples were taken before, immediately after exercise, and after 30 min recovery.

RESULTS

Lactate concentration, blood pressure, platelet count (PLT), and mean platelet volume (MPV) were significantly (p <  0.05) increased following both resistance exercise trials. Significant increases in PAC1, and CD62P; and significant reductions for CD42b and CD41a were detected following both REs (p <  0.05). However, changes in PAC1 and CD62P were significantly different between the two protocols (p <  0.05), with higher increases detected following CRE.

CONCLUSIONS

Acute RE increases platelet indices and platelet activation; and that CRE results in higher platelet activation than TRE, probably due to exercise-induced increases in shear stress.

Variation in Platelet Activation State in Pre-Donation Whole Blood: Effect of Time of Day and ABO Blood Group

Background

Whilst there has been investigation into the effect of time of the day on platelet activation and function in healthy individuals, there is a lack of studies in the literature to examine this relationship among platelet donors.

Methods

We assessed the extent of platelet activation by percentage of platelets with surface-expressed P-selectin and flow cytometry in samples of whole blood from a group of qualified platelet donors (n = 84).

Results

The mean (SD) percentage of activated platelets in the pre-donation blood samples was 1.85 ± 1.57% (range 0.2–7.5%). In univariate analyses, the percentage of activated platelets was significantly and inversely correlated with the collection time (ie, the time of day blood samples were collected) (r = –0.35, p = 0.001) and positively correlated to mean platelet volume (MPV) (r = 0.29, p = 0.008). A weaker positive correlation was also observed with ABO blood group (r = 0.228, p = 0.036). Analysis of the collection time as a categorical variable showed a greater degree of activated platelets in samples collected between 8:00 h and 10:00 h than in samples collected during the hours of >10:00 h ≤14:00 h (2.5 ± 1.8 versus 1.1 ± 0.74, p < 0.001). In the adjusted linear regression model, collection time was a significant independent predictor of platelet activation state in whole blood (β = –0.26; p < 0.001), as did ABO blood group (β = 0.55; p = 0.019).

Conclusion

Our results show that collection time is the most important predictor of platelet activation state in pre-donation whole blood among platelet donors. This work may have implications for optimizing the timing of platelet donation.

Exercise intensity assessment and prescription in cardiovascular rehabilitation and beyond: why and how: a position statement from the Secondary Prevention and Rehabilitation Section of the European Association of Preventive Cardiology

A proper determination of the exercise intensity is important for the rehabilitation of patients with cardiovascular disease (CVD) since it affects the effectiveness and medical safety of exercise training. In 2013, the European Association of Preventive Cardiology (EAPC), together with the American Association of Cardiovascular and Pulmonary Rehabilitation and the Canadian Association of Cardiac Rehabilitation, published a position statement on aerobic exercise intensity assessment and prescription in cardiovascular rehabilitation (CR). Since this publication, many subsequent papers were published concerning the determination of the exercise intensity in CR, in which some controversies were revealed and some of the commonly applied concepts were further refined. Moreover, how to determine the exercise intensity during resistance training was not covered in this position paper. In light of these new findings, an update on how to determine the exercise intensity for patients with CVD is mandatory, both for aerobic and resistance exercises. In this EAPC position paper, it will be explained in detail which objective and subjective methods for CR exercise intensity determination exist for aerobic and resistance training, together with their (dis)advantages and practical applications.

Platelet-Leucocyte Aggregates as Novel Biomarkers in Cardiovascular Diseases

Simple Summary

Cardiovascular diseases are the most common cause of death worldwide. Hence, novel biomarkers are urgently needed to improve diagnosis and treatment. Platelet–leucocyte aggregates are conglomerates of platelets and leucocytes and are widely investigated as biomarkers in cardiovascular diseases. Platelet–leucocytes aggregates are present in health, but increase in patients with cardiovascular risk factors and acute or stable coronary syndromes, making them a potential diagnostic marker. Moreover, platelet–leucocyte aggregates predict outcomes after surgery or percutaneous treatment and could be used to monitor antiplatelet therapy. Emerging data about the participation of platelet–leucocyte aggregates in cardiovascular diseases pathogenesis make them an attractive target for novel therapies. Furthermore, simple detection with conventional flow cytometry provides accurate and reproducible results, although requires specific sample handling. The main task for the future is to determine the standardized protocol to measure blood concentrations of platelet–leucocyte aggregates and subsequently establish their normal range in health and disease.

Abstract

Platelet–leucocyte aggregates (PLA) are a formation of leucocytes and platelets bound by specific receptors. They arise in the condition of sheer stress, thrombosis, immune reaction, vessel injury, and the activation of leukocytes or platelets. PLA participate in cardiovascular diseases (CVD). Increased levels of PLA were revealed in acute and chronic coronary syndromes, carotid stenosis cardiovascular risk factors. Due to accessible, available, replicable, quick, and low-cost quantifying using flow cytometry, PLA constitute an ideal biomarker for clinical practice. PLA are promising in early diagnosing and estimating prognosis in patients with acute or chronic coronary syndromes treated by percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG). PLA were also a reliable marker of platelet activity for monitoring antiplatelet therapy. PLA consist also targets potential therapies in CVD. All of the above potential clinical applications require further studies to validate methods of assay and proof clinical benefits.

Responses of platelet CD markers and indices to resistance exercise with and without blood flow restriction in patients with type 2 diabetes

BACKGROUND

Diabetes mellitus is a common disorder with the risk of vascular injury.

OBJECTIVE

The aim of this study was to compare the effects of low-intensity resistance exercise with blood flow restriction versus high-intensity resistance exercise on platelet CD markers and indices in patients with type 2 diabetes.

METHODS

Fifteen female patients with type 2 diabetes (Mean±SD; age, 47.6±7.2 yrs) randomly completed two resistance exercise at an intensity corresponding to 20% and 80% of one-repetition maximum (1-RM), with and without blood flow restriction (REBFR and RE), respectively. We measured markers of platelet activation (P-selectin, GpIIb/IIIa, and CD42) and platelet indices before and immediately after exercise, and after 30 min recovery.

RESULTS

Platelet count (PLT) and plateletcrit (PCT) increased in response to REBFR more than the RE (p <  0.05), though, no significant differences in PDW and MPV were observed (p <  0.05). Although P-selectin (CD62P), CD61, CD41, and CD42 were reduced following resistance exercise in both trials, these reductions were non-significant (p <  0.05). Besides, no significant between-group differences were found for platelet CD markers (p <  0.05).

CONCLUSIONS

It is concluded that REBFR induces thrombocytosis, but responses of platelet CD markers in patients with type 2 diabetes are similar following low-intensity REBFR and high-intensity RE.

Dietary Antiplatelets: A New Perspective on the Health Benefits of the Water-Soluble Tomato Concentrate Fruitflow®

Our understanding of platelet functionality has undergone a sea change in the last decade. No longer are platelets viewed simply as regulators of haemostasis; they are now acknowledged to be pivotal in coordinating the inflammatory and immune responses. This expanded role for platelets brings new opportunities for controlling a range of health conditions, targeting platelet activation and their interactions with other vascular cells. Antiplatelet drugs may be of wider utility than ever expected but often cause platelet suppression too strong to be used out of clinical settings. Dietary antiplatelets represent a nutritional approach that can be efficacious while safe for general use. In this review, we discuss potential new uses for dietary antiplatelets outside the field of cardiovascular health, with specific reference to the water-soluble tomato extract Fruitflow^®. Its uses in different aspects of inflammation and immune function are discussed, highlighting exercise-induced inflammation, mediating the effects of air pollution, and controlling thrombotic aspects of the immune response. Potential future developments in women’s health, erectile dysfunction, and the allergic response indicate how broad the utility of dietary antiplatelets can be.

Exercise and Circulating Microparticles in Healthy Subjects

This study aimed to explore the relationship between exercise and circulating microparticles (CMPs). PubMed, Web of Science, Embase, and the Cochrane Library databases were searched until August 13, 2020, using the terms "exercise" and "cell-derived microparticles." The Cochrane tool of risk of bias and the Methodological Index for Non-Randomized Studies were used to grade the studies. Twenty-six studies that met criteria were included in this review, including one before-after self-control study, 2 cohort studies, 4 randomized control trials, 5 case-control studies, and 14 descriptive studies. The studies were divided into a single bout and long-term exercise. The types of MPs contained endothelium-derived microparticles (EMPs), leukocyte-derived microparticles (LMPs), platelet-derived microparticles (PMPs), and erythrocyte-derived microparticles (ErMPs). This first systematic review found that the levels of CMPs continued to increase after a single bout of exercise in untrained subjects and were lower in trained subjects. PMPs expressed a transient increase after a single bout of exercise, and the proportion and duration of PMPs increment reduced in long-term exercise. Most studies showed a decline in LMPs in trained subjects after a single bout and long-term exercise, and variable changes were found in EMPs and ErMPs after exercise. A single bout of exercise drives the vessels exposed to high shear stress that promotes the formation of CMPs. However, the decline in CMPs in trained subjects may be attributed to the fact that they have a better ability to adapt to changes in hemodynamics and cellular function during exercise.

Acute responses of platelet count and ADP-induced platelet aggregation to different high intensity interval exercise modes

BACKGROUND

Platelet activation is associated with abdominal obesity and exercise training is an important modulator of body weight.

OBJECTIVE

We investigated the effects of two high intensity interval exercise (HIIE) protocols of different intensity and duration on platelet indices and platelet aggregation in overweight men.

METHODS

Ten overweight men performed 6 intervals of 30s exercise at 110% of peak power output (PPO) interspersed by 3 : 30 min active recovery (1/7 protocol) at 40% of PPO and 6 intervals of 2 min exercise at 85% of PPO interspersed by 2 min active recovery (1/1 protocol) at 30% of PPO in two separate sessions. Platelet indices and platelet aggregation were measured before and immediately after both HIIEs.

RESULTS

Platelet indices increased significantly following HIIE (P < 0.05), though, significant differences between the two protocols were only detected for platelet count, which was markedly increased following 1/1 protocol. Platelet aggregation increased significantly (P < 0.05) in response to the two HIIE protocols, with no significant difference being observed between the two protocols (P > 0.05).

CONCLUSIONS

It is concluded that HIIE leads to transient increases in markers of thrombus formation and that work to rest ratio is an important factor when investigating the changes in thrombocytosis following HIIE.

Aronia juice consumption prior to half-marathon race can acutely affect platelet activation in recreational runners

Long-distance running, especially in non-professional runners, can increase cardiac arrest risk by enhancing platelet activation and aggregation. Polyphenols can exert cardioprotective effects by positively influencing platelet function. This study aimed to examine the acute effects of polyphenol-rich aronia juice consumption, before simulation of a half-marathon race, on platelet activation and aggregation with leukocytes in recreational runners. In this acute crossover study,10 healthy male runners (age 30.8 ± 2.3 years) consumed breakfast with 200 mL of aronia juice or 200 mL of placebo. They warmed-up and ran a simulated half-marathon race (21.1 km). Blood was collected at baseline, and at 15 min, 1 h, and 24 h after the run. All variables were analyzed with 4 (time) × 2 (group) ANOVA with repeated measures on both factors. Results revealed a significant effect of group on platelet activation parameters: P-selectin and GPIIb-IIIa expressions significantly decreased in the aronia group compared with the placebo group (F_[1,9] = 10.282, p = 0.011 and F_[1,9] = 7.860, p = 0.021, respectively). The effect of time was significant on both platelet aggregation markers: platelet-monocyte and platelet-neutrophil aggregates were significantly lower after the race (F_[3,7] = 4.227, p = 0.014 and F_[3,7] = 70.065, p = 0.000, respectively), with changes more pronounced in the later. All effects remained when platelets were exposed to an agonist. These results suggest that aronia consumption could counteract the half-marathon race-induced changes in platelet function. Novelty Aronia juice consumption significantly decreased the expression of platelet activation markers but did not affect platelet aggregation. The race itself did significantly reduce platelet-neutrophil aggregation. Aronia juice may serve as a supplement beverage for recreational runners to alleviate enhanced platelet reactivity caused by prolonged running.

Platelet indices and function response to two types of high intensity interval exercise and comparison with moderate intensity continuous exercise among men after coronary artery bypass graft: A randomized trial

BACKGROUND

It has been indicated that the acute exercise increases the thrombotic events that stem from platelet hyper-reactivity. The present randomized controlled trial study was carried out with the aim to compare high-intensity interval exercise (HIIE) with moderate intensity continuous exercise (MICE) in terms of platelet indices and function in patients who had undergone post coronary artery bypass graft (CABG).

METHODS

30 men with a history of CABG were recruited and divided into 3 groups (MICE, HIIE-1, and HIIE-2). The MICE protocol consisted of running for 40 minutes with 65% of maximal heart rate (HRmax). Subjects in HIIE-1 group performed an interval exercise with work to rest ratio of 1:1 in which 10 rounds of running (95% HRmax) were followed by active recovery (35% HRmax). HIIE-2 subjects performed an interval exercise with work to rest ratio of 2:1 in which 7 rounds of running (85% HRmax) were followed by active recovery (45% HRmax). Before and immediately after the exercise protocols, blood samples were taken from subjects and analyzed to measure the variables.

RESULTS

Although platelet count (PLT) and hematocrit (HCT) were increased significantly after HIIE-1 and HIIE-2 in comparison to MICE (P < 0.050), the other platelet indices [mean platelet volume (MPV), platelet distribution width (PDW), plateletcrit (PCT)] were not significantly changed among groups (P > 0.050). The platelet aggregation and fibrinogen were further increased after HIIE-1 and HIIE-2 as compared with MICE; however, such increment were significant between HIIE-2 and MICE (P < 0.050).

CONCLUSION

It seems that HIIE, regardless of the type, has higher thrombotic potentials compared with MICE. Accordingly, MICE is safer than HIIE for rehabilitation in patients undergoing CABG.

Acute Impact of Different Exercise Modalities on Arterial and Platelet Function

PURPOSE

Acute coronary syndromes and ischemic stroke are associated with arterial events involving platelets, the endothelium, and atherosclerosis. Although regular physical activity is associated with lower risk of cardiovascular events and mortality, risk is transiently increased during and immediately after participation in an acute bout of exercise. No previous study has investigated the acute impact of exercise on platelet activation and arterial function in the same participants; it is also unknown if responses are dependent on exercise modality. We hypothesized that commonly adopted, yet physiologically distinct, modalities of exercise ("aerobic" vs "resistance") have differing effects on in vivo platelet activation and conduit artery diameter.

METHODS

Eight apparently healthy middle-age (53.5 ± 1.6 yr) male subjects took part in four 30-min experimental interventions (aerobic exercise, resistance exercise, combined aerobic/resistance exercise, or no-exercise), in random order. Blood samples were collected, and the measurement of brachial artery diameter by ultrasound was performed before, immediately after, and 1 h after each intervention. Platelet activation was determined by the positive binding of antibodies to surface receptors exposed on activated platelets (anti-CD62P and PAC-1).

RESULTS

Brachial artery diameter increased immediately after all three exercise modalities (P < 0.001) and remained above preexercise levels 1 h after resistance exercise and after combined aerobic/resistance exercise. No changes were observed in markers of in vivo platelet activation with any experimental protocol.

CONCLUSIONS

These data suggest that postexercise enhancement in arterial function may mitigate the acute impact of exercise on platelet activation.

Enhanced Strength and Sprint Levels, and Changes in Blood Parameters during a Complete Athletics Season in 800 m High-Level Athletes

The purpose of this study was to analyze changes in sprint, strength, hematological, and hormonal parameters in high-level 800 m athletes during a complete athletics season. Thirteen male athletes of national and international level in 800 m (personal best ranging from 1:43 to 1:58 min:ss) participated in this study. A total of 5 tests were conducted during a complete athletics season. Athletes performed sprint tests (20 and 200 m), countermovement jump (CMJ), jump squat (JS), and full squat (SQ) tests. Blood samples (red and white blood profile) and hormones were collected in test 1 (T1), test 3 (T3), and test 5 (T5). A general increase in the performance of the strength and sprint parameters analyzed (CMJ, JS, SQ, 20 m, and 200 m) during the season was observed, with a significant time effect in CMJ (P < 0.01), SQ (P < 0.01), and 200 m (P < 0.05). This improvement was accompanied by a significant enhancement of the 800 m performance from T3 to T5 (P < 0.01). Significant changes in some hematological variables: hematocrit (Hct) (P < 0.01), mean corpuscular volume (MCV) (P < 0.001), mean corpuscular hemoglobin content (MCHC) (P < 0.001), white blood cells count (WBC) (P < 0.05), neutrophils (P < 0.05), monocytes (P < 0.05), and mean platelet volume (MPV) (P < 0.05) were observed throughout the season. The hormonal response and creatin kinase (CK) did not show significant variations during the season, except for insulin-like growth factor I (IGF-1) (P < 0.05). In conclusion, our results suggest the importance of strength levels in middle-distance athletes. On the other hand, variations in some hematological parameters and a depression of the immune system occurred during the season. Therefore, monitoring of the mechanical, hematological and hormonal response in athletes may help coaches and athletes to optimize the regulation of training contents and may be useful to diagnose states of overreaching or overtraining in athletes throughout the season.

Cardioprotective Effect of Crocin Combined with Voluntary Exercise in Rat: Role of Mir-126 and Mir-210 in Heart Angiogenesis

Background

Crocin is reported to have a wide range of biological activities such as cardiovascular protection. Recent epidemiologic studies have shown that exercise reduces cardiovascular morbidity and mortality in the general population.

Objective

The aim of this study was to evaluate the effect of crocin and voluntary exercise on miR-126 and miR-210 expression levels and angiogenesis in the heart tissue.

Methods

Animals were divided into 4 groups: control, exercise, crocin, and exercise-crocin. Animals received oral administration of crocin (50 mg/kg) or performed voluntary exercise alone or together for 8 weeks. Akt, ERK1/2 protein levels, miR-126 and miR-210 expression were measured in the heart tissue. Immunohistochemical method was used to detect CD31 in the heart tissue.

Results

Akt and ERK1/2 levels of the heart tissue were higher in crocin treated group and voluntary exercise trained group after 8 weeks. Combination of crocin and exercise also significantly enhanced Akt and ERK1/2 levels in the heart tissue. MiR-126, miR-210 expression and CD31 in the heart increased in both crocin and voluntary exercise groups compared with control group. In addition, combination of exercise and crocin amplified their effect on miR-126 and miR-210 expression, and angiogenesis.

Conclusion

Crocin and voluntary exercise improve heart angiogenesis possibly through enhancement of miR-126 and miR-210 expression. Voluntary exercise and diet supplementation with crocin could have beneficial effects in prevention of cardiovascular disease.

Acute impact of conventional and eccentric cycling on platelet and vascular function in patients with chronic heart failure

Evidence-based guidelines recommend exercise therapy for patients with chronic heart failure (CHF). Such patients have increased atherothrombotic risk. Exercise can transiently increase platelet activation and reactivity and decrease vascular function in healthy participants, although data in CHF are scant. Eccentric (ECC) cycling is a novel exercise modality that may be particularly suited to patients with CHF, but the acute impacts of ECC cycling on platelet and vascular function are currently unknown. Our null hypothesis was that ECC and concentric (CON) cycling, performed at matched external workloads, would not induce changes in platelet or vascular function in patients with CHF. Eleven patients with heart failure with reduced ejection fraction (HFrEF) took part in discrete bouts of ECC and CON cycling. Before and immediately after exercise, vascular function was assessed by measuring diameter and flow-mediated dilation (FMD) of the brachial artery. Platelet function was measured by the flow cytometric determination of glycoprotein IIb/IIIa activation and granule exocytosis in the presence and absence of platelet agonists. ECC cycling increased baseline artery diameter (pre: 4.0 ± 0.8 mm vs. post: 4.2 ± 0.7 mm; P = 0.04) and decreased FMD%. When changes in baseline artery diameter were accounted for, the decrease in FMD post-ECC cycling was no longer significant. No changes were apparent after CON. Neither ECC nor CON cycling resulted in changes to any platelet-function measures (all P > 0.05). These results suggest that both ECC and CON cycling, at a moderate intensity and short duration, can be performed by patients with HFrEF without detrimental impacts on vascular or platelet function.NEW & NOTEWORTHY This is the first evidence to indicate that eccentric (ECC) cycling can be performed relatively safely by patients with chronic heart failure (CHF), as it did not result in impaired vascular or platelet function compared with conventional cycling. This is important, as acute exercise can transiently increase atherothrombotic risk, and ECC cycling is a novel exercise modality that may be particularly suited to patients with CHF.

Effects of a single bout of strenuous exercise on platelet activation in female ApoE/LDLR-/- mice

Strenuous physical exercise leads to platelet activation that is normally counterbalanced by the production of endothelium-derived anti-platelet mediators, including prostacyclin (PGI₂) and nitric oxide (NO). However, in the case of endothelial dysfunction, e.g. in atherosclerosis, there exists an increased risk for intravascular thrombosis during exercise that might be due to an impairment in endothelial anti-platelet mechanisms. In the present work, we evaluated platelet activation at rest and following a single bout of strenuous treadmill exercise in female ApoE/LDLR^-/- mice with early (3-month-old) and advanced (7-month-old) atherosclerosis compared to female age-matched WT mice. In sedentary and post-exercise groups of animals, we analyzed TXB₂ generation and the expression of platelet activation markers in the whole blood ex vivo assay. We also measured pre- and post-exercise plasma concentration of 6-keto-PGF_1α, nitrite/nitrate, lipid profile, and blood cell count. Sedentary 3- and 7-month-old ApoE/LDLR^-/- mice displayed significantly higher activation of platelets compared to age-matched wild-type (WT) mice, as evidenced by increased TXB₂ production, expression of P-selectin, and activation of GPIIb/IIIa receptors, as well as increased fibrinogen and von Willebrand factor (vWf) binding. Interestingly, in ApoE/LDLR^-/- but not in WT mice, strenuous exercise partially inhibited TXB₂ production, the expression of activated GPIIb/IIIa receptors, and fibrinogen binding, with no effect on the P-selectin expression and vWf binding. Post-exercise down-regulation of the activated GPIIb/IIIa receptor expression and fibrinogen binding was not significantly different between 3- and 7-month-old ApoE/LDLR^-/- mice; however, only 7-month-old ApoE/LDLR^-/- mice showed lower TXB₂ production after exercise. In female 4-6-month-old ApoE/LDLR^-/- but not in WT mice, an elevated pre- and post-exercise plasma concentration of 6-keto-PGF_1α was observed. In turn, the pre- and post-exercise plasma concentrations of nitrite (NO₂^-) and nitrate (NO₃^-) were decreased in ApoE/LDLR^-/- as compared to that in age-matched WT mice. In conclusion, we demonstrated overactivation of platelets in ApoE/LDLR^-/- as compared to WT mice. However, platelet activation in ApoE/LDLR^-/- mice was not further increased by strenuous exercise, but was instead attenuated, a phenomenon not observed in WT mice. This phenomenon could be linked to compensatory up-regulation of PGI₂-dependent anti-platelet mechanisms in ApoE/LDLR^-/- mice.

Impact of commonly prescribed exercise interventions on platelet activation in physically inactive and overweight men

The exercise paradox infers that, despite the well‐established cardioprotective effects of repeated episodic exercise (training), the risk of acute atherothrombotic events may be transiently increased during and soon after an exercise bout. However, the acute impact of different exercise modalities on platelet function has not previously been addressed. We hypothesized that distinct modalities of exercise would have differing effects on in vivo platelet activation and reactivity to agonists which induce monocyte‐platelet aggregate (MPA) formation. Eight middle‐aged (53.5 ± 1.6 years) male participants took part in four 30 min experimental interventions (aerobic AE, resistance RE, combined aerobic/resistance exercise CARE, or no‐exercise NE), in random order. Blood samples were collected before, immediately after, and 1 h after each intervention, and incubated with one of three agonists of physiologically/clinically relevant pathways of platelet activation (thrombin receptor activating peptide‐6 TRAP, arachidonic acid AA, and cross‐linked collagen‐related peptide xCRP). In the presence of AA, TRAP, and xCRP, both RE and CARE evoked increases in MPAs immediately post‐exercise (P < 0.01), whereas only AA significantly increased MPAs immediately after AE (P < 0.01). These increases in platelet activation post‐exercise were transient, as responses approached pre‐exercise levels by 1 h. These are the first data to suggest that exercise involving a resistance component in humans may transiently increase platelet‐mediated thrombotic risk more than aerobic modalities.

The Acute Risks of Exercise in Apparently Healthy Adults and Relevance for Prevention of Cardiovascular Events

BACKGROUND

Increased physical activity (PA) is associated with improved quality of life and reductions in cardiovascular (CV) morbidity and all-cause mortality in the general population in a dose-response manner. However, PA acutely increases the risk of adverse CV event or sudden cardiac death (SCD) above levels expected at rest. We review the likelihood of adverse CV events related to exercise in apparently healthy adults and strategies for prevention, and contextualize our understanding of the long-term risk reduction conferred from PA.

METHODS

A systematic review of the literature was performed using electronic databases; additional hand-picked relevant articles from reference lists and additional sources were included after the search.

RESULTS

The incidence of adverse CV events in adults is extremely low during and immediately after PA of varying types and intensities and is significantly lower in those with long-standing PA experience. The risk of SCD and nonfatal events during and immediately after PA remains extremely low (well below 0.01 per 10,000 participant hours); increasing age and PA intensity are associated with greater risk. In most cases of exercise-related SCD, occult CV disease is present and SCD is typically the first clinical event.

CONCLUSIONS

Exercise acutely increases the risk of adverse CV events, with greater risk associated with vigorous intensity. The risks of an adverse CV event during and immediately after exercise are outweighed by the health benefits of vigorous exercise performed regularly. A key challenge remains the identification of occult structural heart disease and inheritable conditions that increase the chances of lethal arrhythmias during exercise.

Effects of Physical (In)activity on Platelet Function

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.

Vascular function and brain-derived neurotrophic factor: The functional capacity factor

Brain-derived neurotrophic factor (BDNF) is essential for neurocognitive function. This study aims at establishing a plausible link between level of serum BDNF, functional capacity (FC), and vascular function in 181 young (age 25.5±9.1 years old), apparently healthy adults. Fasting blood samples were drawn from participants' antecubital veins into plain glass tubes while they were in a sitting position to evaluate serum BDNF using enzyme-linked immunosorbent assay (ELISA). Mercury-in-silastic strain-gauge plethysmography was used to determine arterial function indices, blood flow and vascular resistance at rest and following 5 minutes of arterial ischemia. The 6-minute walk distance (6MWD) test was used to determine FC, according to the American Thoracic Society Committee on Proficiency Standards for Clinical Pulmonary Function Laboratories guidelines. It was conducted in an enclosed corridor on a flat surface with a circular track 33 meters long. The walking course was demarcated with bright colored cones. The 6MWD correlated with BDNF (r=0.3, p=0.000), as well as with forearm blood inflow (r=0.5, p=0.000) and vascular resistance (r = -0.4, p=0.000). Subsequent comparison showed that BDNF and blood inflow were greater (p<0.05) while vascular resistance was less (p<0.05) in participants who achieved a longer 6MWD. Similarly, BDNF correlated with forearm blood inflow (r=0.4, p=0.000) and vascular resistance (r = -0.4, p=0.000). Subsequent comparison showed improved vascular function (p<0.05) in the participants with greater BDNF. In conclusion, these findings might suggest that improved vascular function in individuals with greater FC is mediated, at least partially, by an enhanced serum BDNF level.

Effects of acute and chronic exercise in patients with essential hypertension: benefits and risks

The importance of regular physical activity in essential hypertension has been extensively investigated over the last decades and has emerged as a major modifiable factor contributing to optimal blood pressure control. Aerobic exercise exerts its beneficial effects on the cardiovascular system by promoting traditional cardiovascular risk factor regulation, as well as by favorably regulating sympathetic nervous system (SNS) activity, molecular effects, cardiac, and vascular function. Benefits of resistance exercise need further validation. On the other hand, acute exercise is now an established trigger of acute cardiac events. A number of possible pathophysiological links have been proposed, including SNS, vascular function, coagulation, fibrinolysis, and platelet function. In order to fully interpret this knowledge into clinical practice, we need to better understand the role of exercise intensity and duration in this pathophysiological cascade and in special populations. Further studies in hypertensive patients are also warranted in order to clarify the possibly favorable effect of antihypertensive treatment on exercise-induced effects.

Mean platelet volume (MPV) predicts middle distance running performance

BACKGROUND

Running economy and performance in middle distance running depend on several physiological factors, which include anthropometric variables, functional characteristics, training volume and intensity. Since little information is available about hematological predictors of middle distance running time, we investigated whether some hematological parameters may be associated with middle distance running performance in a large sample of recreational runners.

METHODS

The study population consisted in 43 amateur runners (15 females, 28 males; median age 47 years), who successfully concluded a 21.1 km half-marathon at 75-85% of their maximal aerobic power (VO2max). Whole blood was collected 10 min before the run started and immediately thereafter, and hematological testing was completed within 2 hours after sample collection.

RESULTS

The values of lymphocytes and eosinophils exhibited a significant decrease compared to pre-run values, whereas those of mean corpuscular volume (MCV), platelets, mean platelet volume (MPV), white blood cells (WBCs), neutrophils and monocytes were significantly increased after the run. In univariate analysis, significant associations with running time were found for pre-run values of hematocrit, hemoglobin, mean corpuscular hemoglobin (MCH), red blood cell distribution width (RDW), MPV, reticulocyte hemoglobin concentration (RetCHR), and post-run values of MCH, RDW, MPV, monocytes and RetCHR. In multivariate analysis, in which running time was entered as dependent variable whereas age, sex, blood lactate, body mass index, VO2max, mean training regimen and the hematological parameters significantly associated with running performance in univariate analysis were entered as independent variables, only MPV values before and after the trial remained significantly associated with running time. After adjustment for platelet count, the MPV value before the run (p = 0.042), but not thereafter (p = 0.247), remained significantly associated with running performance.

CONCLUSION

The significant association between baseline MPV and running time suggest that hyperactive platelets may exert some pleiotropic effects on endurance performance.

Platelet activation in essential hypertension during exercise: pre- and post-treatment changes with an angiotensin II receptor blocker

BACKGROUND

Acute exercise may exert deleterious effects on the cardiovascular system through a variety of pathophysiological mechanisms, including increased platelet activation. However, the degree of exercise-induced platelet activation in untreated hypertensive (UH) individuals as compared with normotensive (NT) individuals has yet to be established. Furthermore, the effect of antihypertensive treatment on exercise-induced platelet activation in essential hypertension (EH) remains unknown.

METHODS

Study 1 consisted of 30 UH and 15 NT subjects. UH subjects who received treatment were included in study 2 and were followed-up after a 3-month treatment period with an angiotensin II receptor blocker (ARB; valsartan). Circulating monocyte-platelet aggregates (MPA) and platelet P-selectin were measured as platelet activation markers at baseline, immediately after a treadmill exercise test, and 10, 30, and 90 minutes later.

RESULTS

Maximal platelet activation was observed at 10 minutes after peak exercise in both groups. In UH subjects, MPA levels remained increased at 30 minutes after peak exercise, despite BP fall to baseline levels. MPA levels were significantly higher in UH subjects than NT subjects at maximal exercise and at 10 and 30 minutes of recovery. Post-treatment MPA levels increased significantly only at 10 minutes into recovery and were similar to those of NT subjects.

CONCLUSIONS

Acute high-intensity exercise exaggerates platelet activation in untreated patients with EH compared with NT individuals. Angiotensin II receptor blockade with adequate BP control greatly improves exercise-induced platelet activation in EH. Further studies are needed to clarify whether this phenomenon depends purely on BP lowering or benefits also from the pleiotropic effects of ARBs.

Voluntary exercise prevents lead-induced elevation of oxidative stress and inflammation markers in male rat blood

Regular mild exercise enhances antioxidant and anti-inflammatory systems of the body. The present study investigates voluntary exercise effects on lead toxicity as a known oxidative stressor. Male Sprague-Dawley rats were randomly divided into 2 groups. Sedentary control: the animals were housed 7 weeks in the regular cages. Exercise group: the animals were housed 7 weeks in the running wheel equipped cages, that is, the animal model of voluntary exercise. During the 7th week, all animals were administered lead acetate. Blood samples were collected at the end of the 6th week and 7th week (before and after lead administrations). Glutathione peroxidase (GPx), superoxide dismutase (SOD), catalase (CAT), malondialdehyde (MDA), and tumor necrosis factor (TNF-α) were measured in the samples. Our results showed that lead administration reduced blood SOD, GPx and CAT and increased TNF-α; in the controls, but in the exercise group, changes were not statistically significant. MDA in both groups increased after lead injections but it was significantly lower in exercise group compared to the sedentary animals. We concluded that voluntary exercise may be considered as a preventive tool against lead-induced oxidative stress and inflammation.

Acute changes to biomarkers as a consequence of prolonged strenuous running

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.

Effect of aerobic interval training and caffeine on blood platelet function

PURPOSE

Hyperactive platelets contribute to the thrombotic response in humans, and exercise transiently increases platelet function. Caffeine is routinely used by athletes as an ergogenic aid, but the combined effect of exercise and caffeine on platelet function has not been investigated.

METHODS

Twelve healthy males were randomly assigned to one of four groups and undertook four experimental trials of a high-intensity aerobic interval training (AIT) bout or rest with ingestion of caffeine (3 mg·kg(-1)) or placebo. AIT was 8 × 5 min at approximately 75% peak power output (approximately 80% V˙O2peak) and 1-min recovery (approximately 40% peak power output, approximately 50% V˙O2peak) intervals. Blood/urine was collected before, 60, and 90 min after capsule ingestion and analyzed for platelet aggregation/activation.

RESULTS

AIT increased platelet reactivity to adenosine diphosphate (placebo 30.3%, caffeine 13.4%, P < 0.05) and collagen (placebo 10.8%, caffeine 5.1%, P < 0.05) compared with rest. Exercise placebo increased adenosine diphosphate-induced aggregation 90 min postingestion compared with baseline (40.5%, P < 0.05), but the increase when exercise was combined with caffeine was small (6.6%). During the resting caffeine protocol, collagen-induced aggregation was reduced (-4.3%, P < 0.05). AIT increased expression of platelet activation marker PAC-1 with exercise placebo (P < 0.05) but not when combined with caffeine.

CONCLUSION

A single bout of AIT increases platelet function, but caffeine ingestion (3 mg·kg(-1)) does not exacerbate platelet function at rest or in response to AIT. Our results provide new information showing caffeine at a dose that can elicit ergogenic effects on performance has no detrimental effect on platelet function and may have the potential to attenuate increases in platelet activation and aggregation when undertaking strenuous exercise.

Endurance exercise intensity determination in the rehabilitation of coronary artery disease patients: a critical re-appraisal of current evidence

In the care of coronary artery disease (CAD) patients, the benefits of exercise therapy are generally established. Even though the selected endurance exercise intensity might affect medical safety, therapy adherence and effectiveness in the rehabilitation of CAD patients in how to determine endurance exercise intensity properly remains difficult. The aim of this review is to describe the available methods for endurance exercise intensity determination in the rehabilitation of CAD patients, accompanied with their (dis)advantages, validity and reproducibility. In general, endurance exercise intensity can objectively be determined in CAD patients by calculating a fraction of maximal exercise tolerance and/or determining ventilatory threshold after execution of a cardiopulmonary exercise test with ergospirometry. This can be translated to a corresponding training heart rate (HR) or workload. In the absence of ergospirometry equipment, target exercise HR can be calculated directly by different ways (fraction of maximal HR and/or Karvonen formula), and/or anaerobic threshold can be determined. However, the use of HR for determining exercise intensity during training sessions seems complicated, because many factors/conditions affect the HR. In this regard, proper standardization of the exercise sessions, as well as exercise testing, might be required to improve the accuracy of exercise intensity determination. Alternatively, subjective methods for the determination of endurance exercise intensity in CAD patients, such as the Borg ratings of perceived exertion and the talk test, have been developed. However, these methods lack proper validity and reliability to determine endurance exercise intensity in CAD patients. In conclusion, a practical and systematic approach for the determination of endurance exercise intensity in CAD patients is presented in this article.

Cell-derived microparticles promote coagulation after moderate exercise

Cell-derived procoagulant microparticles (MP) might be able to contribute to exercise-induced changes in blood hemostasis.

PURPOSES

This study aimed to examine (i) the concentration and procoagulant activity of cell-derived MP after a moderate endurance exercise and (ii) the differences in the release, clearance, and activity of MP before and after exercise between trained and untrained individuals.

METHODS

All subjects performed a single bout of physical exercise on a bicycle ergometer for 90 min at 80% of their individual anaerobic threshold. MP were identified and quantified by flow cytometry measurements. Procoagulant activity of MP was measured by a prothrombinase activity assay as well as tissue factor-induced fibrin formation in MP-containing plasma.

RESULTS

At baseline, no differences were observed for the absolute number and procoagulant activities of MP between trained and untrained subjects. However, trained individuals had a lower number of tissue factor-positive monocyte-derived MP compared with untrained individuals. In trained subjects, exercise induced a significant increase in the number of MP derived from platelets, monocytes, and endothelial cells, with maximum values at 45 min after exercise and returned to basal levels at 2 h after exercise. Untrained subjects revealed a similar increase in platelet-derived MP, but their level was still increased at 2 h after exercise, indicating a reduced clearance compared with trained individuals. Procoagulant activities of MP were increased immediately after exercise and remained elevated up to 2 h after exercise.

CONCLUSIONS

We conclude that increased levels of MP were found in healthy individuals after an acute bout of exercise, that the amount of circulating MP contributes to an exercise-induced increase of hemostatic potential, and that there were differences in kinetic and dynamic characteristics between trained and untrained individuals.

Evidence-based risk assessment and recommendations for exercise testing and physical activity clearance in apparently healthy individuals1This paper is one of a selection of papers published in this Special Issue, entitled Evidence-based risk assessment and recommendations for physical activity clearance, and has undergone the Journal’s usual peer review process

Increased physical activity (PA) is associated with improved health and quality of life in the general population. A dose–response effect is evident between increasing levels of PA participation and a lower relative risk for cardiovascular disease and all-cause mortality. However, there is also clear evidence that PA acutely increases the risk of an adverse cardiovascular (CV) event and sudden cardiac death (SCD) significantly above levels expected at rest. Adverse CV events during PA may be triggered acutely by the physiological stress of exercise. This investigation will review the available literature describing the CV risks of exercise testing and PA participation in apparently healthy individuals. A systematic review of the literature was performed using electronic databases, including Medline, CINAHL, SPORT discus, EMBASE, Cochrane DSR, ACP Journal Club, and DARE; additional relevant articles were hand-picked and the final grouping was used for the review using the AGREE process to assess the impact and quality of the selected articles. Six hundred and sixteen relevant articles were reviewed with 51 being identified as describing adverse CV events during exercise and PA. Data suggests the risks of fatal and nonfatal events during maximal exercise testing in apparently healthy individuals rarely occur (approximately <0.8 per 10 000 tests or 1 per 10 000 h of testing). The incidence of adverse CV events is extremely low during PA of varying types and intensities, with data limited almost exclusively to fatal CV events, as nonfatal events are rarely reported. However, this risk is reduced by 25%–50% in those individuals who have prior experience with increased levels of PA, particularly vigorous PA. Throughout a wide age range, the risk of SCD and nonfatal events during PA remain extremely low (well below 0.01 per 10 000 participant hours), but both increasing age and PA intensity are associated with greater risk. In most cases of exercise-related SCD, undetected pre-existing disease is present and SCD is typically the first clinical event. The risks of an adverse CV event during exercise testing and PA are rare and are outweighed by the health benefits. Given this risk-benefit relationship, the PAR-Q is an appropriate method to identify those at higher risk across a wide age span and should be used in conjunction with appropriate clinical guidelines for guiding individuals towards graduated PA. There are not adequate data to describe the risks of PA in those individuals considered to be at higher risk but without cardiovascular disease.

Thrombosis, physical activity, and acute coronary syndromes

Acute coronary syndromes (ACS) are common, life-threatening cardiac disorders that typically are triggered by rupture or erosion of an atherosclerotic plaque. Platelet deposition and activation of the blood coagulation cascade in response to plaque disruption lead to the formation of a platelet-fibrin thrombus, which can grow rapidly, obstruct coronary blood flow, and cause myocardial ischemia and/or infarction. Several clinical studies have examined the relationship between physical activity and ACS, and numerous preclinical and clinical studies have examined specific effects of sustained physical training and acute physical activity on atherosclerotic plaque rupture, platelet function, and formation and clearance of intravascular fibrin. This article reviews the available literature regarding the role of physical activity in determining the incidence of atherosclerotic plaque rupture and the pace and extent of thrombus formation after plaque rupture.

Are fixed-rate step tests medically safe for assessing physical fitness?

Maximal oxygen uptake (VO(2max)) can be predicted by fixed-rate step tests. However, it remains to be analyzed as to what exercise intensities are reached during such tests to address medical safety. In this study, we compared the physiological response to a standardized fixed-rate step test with maximal cardiopulmonary exercise testing (CPET). One hundred and thirteen healthy adults executed a maximal CPET on bike, followed by a standardized fixed-rate step test 1 week later. During these tests, heart rate (HR) and VO(2) were monitored continuously. From the maximal CPET, the ventilatory threshold (VT) was calculated. Next, the physiological response between maximal CPET and step testing was compared. The step test intensity was 85 ± 24% CPET VO(2max) and 88 ± 11% CPET HR(max) (VO(2max) and HR(max) were significantly different between CPET and step testing; p < 0.01). In 41% of the subjects, step test exercise intensities >95% CPET VO(2max) were noted. A greater step testing exercise intensity (%CPET VO(2max)) was independently related to higher body mass index, and lower body height, exercise capacity (p < 0.05). Standardized fixed-rate step tests elicit vigorous exercise intensities, especially in small, obese, and/or physically deconditioned subjects. Medical supervision might therefore be required during these tests.

Blood coagulation and fibrinolysis in healthy, untrained subjects: effects of different exercise intensities controlled by individual anaerobic threshold

The influence of different exercise intensities on haemostasis in healthy, untrained subjects has not been intensively studied. We investigated untrained subjects for alterations in coagulation and fibrinolysis induced by two exercise intensities, precisely controlled by individual anaerobic threshold (IAT). Twenty-five healthy, untrained non-smokers (age 25 ± 3 years; relative VO(2) peak 43.1 ± 5.2 ml/kg/min) underwent exercise tests at 80% (moderate) and 100% (strenuous) of IAT for 60 min. Blood samples were taken after 30 min rest and immediately after exercise. The present results reveal that an exercise intensity at 100% IAT induces a more pronounced coagulation activity than exercises at 80% IAT. 100% IAT led to a significant higher increase in FVIII (80% IAT 85 ± 33 to 114 ± 30% vs. 100% IAT 81 ± 20 to 132 ± 29%) and TAT (80% IAT 2.5 ± 1.4 to 2.9 ± 1.0 μg/l vs. 100% IAT 2.6 ± 1.0 to 5.4 ± 4.2 μg/l). Furthermore, both exercises affected fibrinolysis, but it was significantly higher at 100% IAT (tPA activity; 80% IAT 0.44 ± 0.17 to 4.65 ± 2.67 U/ml vs. 100% IAT 0.43 ± 0.19 to 6.47 ± 3.97 U/ml). The data show that fibrinolytic activity is significantly elevated already after moderate exercise (80% IAT). After strenuous exercise (100% IAT), coagulation is more sharply enhanced together with a higher increase of fibrinolysis in comparison with 80% IAT. However, haemostasis seems to be in balance after moderate as well as after strenuous exercise intensity in healthy, untrained participants. Based on these data, exercise-induced changes of both haemostatic systems should also be tested in patients with cardiovascular diseases in order to be in a position to give recommendations for endurance training modalities in rehabilitation training.

Exercise-induced normalization of decreased BDNF serum concentration in elderly women with remitted major depression

Major depression (MD) has been associated with decreased brain-derived neurotrophic factor (BDNF) serum levels, while antidepressant drugs were found to increase these decreased BDNF levels. We investigated if this is also caused by a single exercise session in elderly women with remitted MD. In our study 35 elderly women with a (partially) remitted depressive episode of unipolar depression according to DSM-IV criteria within the last year and 20 age-matched healthy female controls were included. Depression severity was assessed by HAMD. Serum levels of BDNF were measured by ELISA. Blood samples were taken during the rest period before beginning the exercise including spiroergometry, at the end of the exercise and after a 30-min recovery period. At baseline MD patients showed significantly decreased BDNF serum levels compared to healthy female controls. After a single 30-min exercise period, we found a significant increase of BDNF serum levels in MD patients towards values comparable with the baseline levels of the healthy controls, followed by a significant decrease after 30 min rest, while the healthy controls showed only a mild but non-significant increase. In conclusion, a single exercise session leads to a significant up-regulation and transient normalization of BDNF serum levels in elderly women with remitted MD. This mechanism may contribute to the beneficial therapeutic and relapse-preventing effects of physical activity on MD.

Role of platelets in neuroinflammation: a wide-angle perspective

OBJECTIVES

This review summarizes recent developments in platelet biology relevant to neuroinflammatory disorders. Multiple sclerosis (MS) is taken as the "Poster Child" of these disorders but the implications are wide. The role of platelets in inflammation is well appreciated in the cardiovascular and cancer research communities but appears to be relatively neglected in neurological research.

ORGANIZATION

After a brief introduction to platelets, topics covered include the matrix metalloproteinases, platelet chemokines, cytokines and growth factors, the recent finding of platelet PPAR receptors and Toll-like receptors, complement, bioactive lipids, and other agents/functions likely to be relevant in neuroinflammatory diseases. Each section cites literature linking the topic to areas of active research in MS or other disorders, including especially Alzheimer's disease.

CONCLUSION

The final section summarizes evidence of platelet involvement in MS. The general conclusion is that platelets may be key players in MS and related disorders, and warrant more attention in neurological research.