Impact of aerobic exercise on haemostatic indices in paediatric patients with haemophilia

Riten Kumar; Vanessa Bouskill; Jane E. Schneiderman; Fred G. Pluthero; Walter H. A. Kahr; Allison Craik; Dewi Clark; Karen Whitney; Christine Zhang; Margaret L. Rand; Manuel Carcao

doi:10.1160/TH15-09-0757

Thrombosis and Haemostasis, Table of Contents

Thromb Haemost 2016; 115(06): 1120-1128
DOI: 10.1160/TH15-09-0757

Coagulation and Fibrinolysis

Schattauer GmbH

Impact of aerobic exercise on haemostatic indices in paediatric patients with haemophilia

Results from a prospective cohort study

Riten Kumar

¹Department of Pediatrics, Division of Hematology-Oncology, Nationwide Children’s Hospital, The Ohio State University, Columbus, Ohio, USA

,

Vanessa Bouskill

²Department of Paediatrics, Division of Haematology-Oncology, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada

,

Jane E. Schneiderman

³Physiology and Experimental Medicine, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada

⁴Department of Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada

,

Fred G. Pluthero

²Department of Paediatrics, Division of Haematology-Oncology, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada

,

Walter H. A. Kahr

²Department of Paediatrics, Division of Haematology-Oncology, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada

⁵Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada

⁶Department of Biochemistry, University of Toronto, Toronto, Ontario, Canada

,

Allison Craik

²Department of Paediatrics, Division of Haematology-Oncology, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada

,

Dewi Clark

²Department of Paediatrics, Division of Haematology-Oncology, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada

,

Karen Whitney

⁵Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada

,

Christine Zhang

²Department of Paediatrics, Division of Haematology-Oncology, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada

,

Margaret L. Rand

²Department of Paediatrics, Division of Haematology-Oncology, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada

⁵Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada

⁶Department of Biochemistry, University of Toronto, Toronto, Ontario, Canada

,

Manuel Carcao

²Department of Paediatrics, Division of Haematology-Oncology, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada

⁵Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada

› Author Affiliations

Abstract

Summary

This study investigated the impact of aerobic exercise on laboratory assessments of haemostatic activity in boys (5–18 years of age) with haemophilia A (HA) or B (HB), examining the hypothesis that laboratory coagulation parameters temporarily improve with exercise. Thirty subjects meeting eligibility criteria (19 HA; 11 HB; mean age: 12.8 years) were invited to participate. They underwent a replacement factor washout period and were advised against strenuous activity for three days prior to the planned intervention. At study visit, baseline blood samples were drawn prior to exercise on a stationary cycle ergometer, aiming to attain 3 minutes (min) of cycling at 85 % of predicted maximum heart rate. Blood work was repeated 5 min (t5) and 60 min (t60) post exercise completion. Samples were assessed for platelet count (PC), factor VIII activity (FVIII:C), von Willebrand antigen (VWF:Ag), ristocetin cofactor activity (VWF:RCo) and platelet function analysis (PFA-100); maximum rate of thrombus generation (MRTG) in blood was measured via thromboelastography and plasma peak thrombin generation (PTG) via calibrated automated thrombography. Mean duration of exercise was 13.9 (± 2.6) min. On average, t5 samples showed significant elevation, relative to baseline in PC, FVIII:C, VWF:Ag, VWF:RCo and PTG, while FVIII:C, VWF:Ag, VWF:RCo and MRTG were significantly elevated in t60 samples. Within the cohort, participants with severe HA showed no change in FVIII:C levels with exercise. The greatest improvement in haemostatic indices was observed in post-adolescent males with mild-moderate HA, who thus represent the group most likely to benefit from a reduction of bleeding risk in the setting of exercise.

Keywords

Haemophilia - exercise - factor VIII

Full Text

References

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