Original paper
Hemostatic response to acute physical exercise in healthy adolescents

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Summary

The chronic and immediate post-exercise responses in the hemostatic and fibrinolytic systems have been shown to be variable and reflect differing adaptations with ageing and responses to exercise protocols. This study investigated the effects of acute and exhaustive exercise on the amplitude and duration of hemostatic and fibrinolytic responses in young adolescent males. The sample comprised 10 sedentary boys (13.2 ± 0.5 years, 55.8 ± 11.3 kg, 165.7 ± 7.4 cm), who had not exercised or received any medication for at least 2 weeks before the experiments. The subjects performed exhaustive stepping exercise, consisting of 1 s up and down cycles to fatigue. When the subjects were unable to maintain the required stepping rhythm, they were given a 30 s recovery period. Following each 30 s recovery participants recommenced the stepping cadence until fatigue prevented them continuing. Venous blood samples were drawn before and immediately, 1 and 24 h after exercise to assess the following coagulation and fibrinolytic parameters: Platelet counts, activated partial thromboplastin time (aPTT), prothrombin time (PT), coagulation factor VIII (FVIII:C), von Willebrand factor (vWF), fibrinogen concentration, thrombin–antithrombin complex (TAT), D-dimer, plasminogen activator inhibitor (PAI-1), and tissue-type plasminogen activator (t-PA). Immediately following exercise, platelet counts, aPTT, FVIII, vWF and t-PA were significantly elevated in contrast to PAI-1, which decreased significantly until 1 h after exercise. FVIII and platelet counts were elevated at 1 and 24 h after exercise, respectively. Only the parameters FVIII and PAI-1 did not return to baseline values during the first hour after physical exercise. When compared to adults the results revealed different rates and ranges of coagulation and fibrinolysis parameters being activated by exhaustive exercise in this group of adolescents.

Introduction

The tendency for a post-exercise hypercoagulation state has been documented revealing higher circulating platelet counts, shorter activated partial thromboplastin time (aPTT) and a higher activity of factor VIII (FVIII).1, 2 Concomitantly, there appears to exist a global increase in fibrinolytic activity, expressed by an increase in tissue plasminogen activator (t-PA) and a decrease in plasminogen activator inhibitor (PAI-1) circulating levels.3, 4, 5, 6 However, many factors such as experimental design, exercise protocol, training status, health status, and methods of analysis, seem to interfere with the expression of markers for these two systems. Response data reported in the literature are often conflicting7, 8 especially concerning the magnitude of the response and the time necessary (varying from 1 to 24 h after exercise) to recover from acute exercise-induced alterations.2, 6, 9

Most studies examining the coagulation and fibrinolytic systems have been conducted on adults, in which arterial degenerative diseases could be well established as a consequence of their ageing.10 Endothelial dysfunction is a key factor in this atherosclerotic process, and markers of endothelial abnormalities have been sought, particularly those involved in a disturbed endothelium-dependent vasomotion or in a liberation of cell molecular products.11 Since von Willebrand factor (vWF), t-PA and PAI-1 play an important role in hemostasis and are released by endothelial cells, they are commonly used as markers for endothelial dysfunction.11 Epidemiological evidence indicates that elevated plasma concentrations of these markers are potent predictors of both myocardial infarction and stroke incidence.12 Since aging is associated with adverse changes in coagulation and fibrinolysis, suggesting a thrombophilic state,13 it is important to distinguish the modifications of the hemostatic system induced by acute exercise and those induced by ageing related endothelial impairment. In fact, as referred above, advanced age may influence the behaviour of many hemostatic parameters, determining responses such as, an increase in platelet aggregatability, an increase in PAI-1 plasma levels, and a decrease in t-PA activity, the latter probably associated with degenerative vascular diseases.14

Thus, because the hemostatic responses to acute physical exercise in adults may be influenced by age-dependent endothelial dysfunction,10 this study proposed to investigate these responses in young people not yet showing endothelial dysfunction, but already equipped with a mature hemostatic system. Limited research has examined the influence of acute exercise on the hemostatic system in young populations who already possess cardiovascular risk factors such as obesity.15 Therefore the aim of this study was to investigate the effects of acute and exhaustive exercise on the amplitude and duration of the hemostatic and fibrinolytic responses in young adolescent males.

Section snippets

Subjects and experimental protocol

Following the receipt of informed consent from their parents, 10 healthy sedentary boys (age = 13.2 ± 0.5 years, weight = 55.8 ± 11.3 kg, height = 165.7 ± 7.4 cm) volunteered to participate in this study. The subjects were required to refrain from having performed any type of heavy physical exercise or having received any medication for at least 2 weeks prior to the commencement of the study. The subjects were required to perform an exhaustive exercise consisting of stepping up and down from a step. The step

Results

The mean number of exercise sets performed was 14.0 ± 5.0, and the total time of exercise was 1289 ± 294 s. The total number of sets, the mean number of repetitions in each set, and the number of subjects that performed every set are shown in Table 1.

The absolute values for the studied hemostatic parameters are presented in Table 2, whilst the percentages of variation from the pre-exercise values are depicted in Fig. 1. Immediately after exercise, platelet counts, aPTT, FVIII, vWF and t-PA were

Discussion

Exercise-dependent effects on the coagulant activity of the FVIII/vWF complex have been studied with various exercise protocols of varying intensities and durations. Despite these differences in experimental protocols, studies with healthy adults suggest significant increases in coagulant activity.2, 3, 14 Compared to adult experiments, the present study, with adolescent males also showed significant increase in FVIII/vWF concentrations immediately after exercise. In adult studies conducted at

Practical implications

  • This study provides normal adolescent values of hemostatic responses of adolescent males.

  • Developmentally, adolescent boys demonstrate no detrimental changes in their hemostatic system.

  • When compared to adults, the results reveal adolescents show different rates and ranges of coagulation and fibrinolysis parameters being activated by exhaustive exercise.

Acknowledgement

The first author (JR) was kindly supported by CAPES, Brazil.

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