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1.
Clin Rehabil ; : 269215520912302, 2020 Mar 16.
Artigo em Inglês | MEDLINE | ID: mdl-32172602

RESUMO

OBJECTIVE: The aim of this study was to assess the benefit of using high-intensity interval training for cardiovascular patients undergoing outpatient rehabilitation in a standard short-term (three-week) program in Germany. DESIGN: This is a randomized controlled trial (RCT). SETTING: This study was conducted at Cardiowell (Wuppertal, Germany), an outpatient rehabilitation center. INTERVENTION: Patients underwent the typical three-week German outpatient rehabilitation program using either moderate continuous training (i.e. the standard training program) or high-intensity interval training. MAIN MEASURES: A total of 50 patients of an outpatient rehabilitation center were randomized into two groups. The control group underwent the standard rehabilitation protocol that applied moderate continuous training, and the intervention group trained according to a high-intensity interval protocol. Patients trained on a bicycle ergometer. Peak power output, oxygen uptake parameters, heart frequencies, and blood pressure were compared at the beginning and at the end of the rehabilitation program. RESULTS: After three weeks, the intervention group had improved to a significantly greater extent in maximal performance parameters than the control group: the peak power output (20.9 (±14.1) W; control 8.8 (±10.4) W), maximum oxygen uptake (0.33 (±0.33) L/min; control 0.05 (±0.29) L/min)), relative maximum oxygen uptake (3.4 (±4.2) mL/kg/min; control 0.9 (±3.1) mL/kg/min), and O2 pulse (1.8 (±2.2) mL/heart beat; control 0.35 (±1.7) mL/heart beat). CONCLUSION: The implementation of high-intensity interval training during a typical three-week German cardiac rehabilitation has the power to increase the outcome for the patients.

2.
Haemophilia ; 26(2): 200-215, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32091659

RESUMO

INTRODUCTION: Haemophilia is a congenital bleeding disorder with severe musculoskeletal complications. Resistance exercise is important to increase joint stability and to improve physical performance. AIM: This review aimed to investigate the safety and efficacy of resistance exercise interventions on people with haemophilia (PwH) and evaluate whether the American College of Sports Medicine resistance exercise criteria for healthy adults are valid for this population. METHODS: A systematic search in literature was conducted, using the databases PubMed, MEDLiNE, CINAHL, SCOPUS, PEDro and Cochrane Library. Out of 2.440 studies published between 1960 and November 2019, 14 studies (9 randomized controlled trials, 1 controlled trial, 4 single-group prospective studies) applying resistance exercise in juvenile and adult PwH corresponded to the inclusion criteria. RESULTS: Studies performed dynamic, isokinetic or a combination of isometric and dynamic resistance training. Most interventions were carried out in the context of a multimodal training. Resistance was provided using fixed and free weights, body weight, resistance bands and water resistance. Study protocols included clinical and home-based settings. Several studies suggest that training intensities lower than those known to increase the strength of healthy people are effective in increasing the strength of PwH. Resistance exercise seems to be a safe intervention if it is adequately monitored, individually adapted and applied with sufficient factor therapy. Due to the heterogeneity of study designs, training interventions and outcome measures a meta-analysis could not be performed. CONCLUSIONS: Further studies of higher methodological quality are needed to determine the optimal types of exercise, optimal dosage and timing.

3.
Haemophilia ; 26(2): 236-242, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32030862

RESUMO

INTRODUCTION: Haemophilic arthropathy is associated with pain that often becomes chronic, likely caused by peripheral and central mechanisms. In the field of haemophilia, to our knowledge, the role of the descending pain pathway, which can also be involved in these pain processes, has not been examined to date. AIM: In light of the dearth of existing literature, we sought to evaluate the function of endogenous descending pain modulation in patients with haemophilia. METHODS: Thirty adult patients with moderate to severe haemophilia A or B (median [interquartile range] age 51.0 [42.0-54.0]) and 23 healthy adult controls (age 46.5 [36.8-54.3]) underwent conditioned pain modulation (CPM) in order to examine the function of endogenous pain modulation. The CPM response was determined by scoring a test stimulus (heat) alone as well as under the influence of a conditioning stimulus (cold) on the basis of a numeric rating scale (NRS) (0 = 'no pain' to 100 = 'worst possible pain'). RESULTS: Patients with haemophilia demonstrated a statistically significant reduced CPM response when compared with the age-matched healthy controls (median (interquartile range) NRS score: patients: -10 (-17.5-[-7.5]) vs controls: -20 (-30.0-[-13.75]); P = .002). The determined difference in the CPM response between both cohorts showed a medium effect size of r = .433. CONCLUSION: The results of this study indicate that an impaired degree of endogenous pain modulation could be present in patients with haemophilia. Therefore, the function of the descending pain pathway should be considered regarding an individual and comprehensive pain management.

4.
Wien Klin Wochenschr ; 131(21-22): 558-566, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31535221

RESUMO

BACKGROUND: Hemophilia is a congenital bleeding disorder with an estimated frequency of 1:10,000 births. Repeated joint bleeding is a hallmark of the disorder and leads to painful hemophilic arthropathy. Regular exercise can help improve joint stability and function, reduce the risk of injury and bleeding and improve physical fitness and quality of life. This method paper describes an online training concept aiming to offer access to appropriate exercise instructions for people with hemophilia who are not able to attend regular training at a hemophilia center. METHODS: The online exercise program is accessible through the homepage of the Department of Physical Medicine, Rehabilitation and Occupational Medicine of the Medical University Vienna as well as through scanning a QR code printed on information material using a smart phone or tablet. RESULTS: The program contains exercises to improve mobility, coordination, muscular strength and flexibility. A brief introduction is given by a hematologist, a pediatrician and a physiatrist. An introductory video informs about contraindications and essential precautions, such as medical attendance and sufficient factor therapy to consider before starting the training. Another video gives advice on the exercise composition. The demonstrated exercises are explained by a physician and are available for adults and children. To individualize training recommendations and offer further diagnostic tools and physical treatment options as necessary, the Department of Physical Medicine, Rehabilitation and Occupational Medicine of the Medical University of Vienna will establish consultation hours for people with hemophilia. CONCLUSION: As hemophilia is an orphan disease, patients are mainly treated in specialized centers. For patients who live far from these centers or have limited access to a training there for other reasons, the physical medicine consultation hour and the implementation of online exercise instructions offer individually adapted exercise information for a regular home-based training to benefit from increased physical fitness and joint stability.


Assuntos
Artralgia/terapia , Hemofilia A , Aptidão Física , Adulto , Artralgia/etiologia , Criança , Exercício/fisiologia , Terapia por Exercício , Hemofilia A/complicações , Humanos , Qualidade de Vida
5.
Haemophilia ; 25(1): 136-143, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30520541

RESUMO

INTRODUCTION: The objective of this work was to examine the interrelations of posturographic and surface EMG (SEMG) characteristics of ankle muscles in patients with haemophilia while standing naturally. METHODS: Surface EMG of five bilaterally recorded ankle muscles was conducted in 24 patients with haemophilia (PwH, age: 42 [11] years, mean [SD], 22 A, 2 B, 21 severe, 3 moderate) with median (quartiles) WFH orthopaedic joint score of 30 (20/39) points and 24 non-haemophilic controls (Con, age: 42 [12]). Force plate (IBS) signals were captured simultaneously during bipedal stance with eyes open. Load proportion of the left and right sides as well as heel and forefoot were calculated via four independent pressure transducers. Overall, weight distribution (WD) indices are reported with higher results representing a poorer WD. RESULTS: Analyses of WD showed large differences between groups (PwH: 10.2 [5.4], Con: 5.2 [2.9], P < 0.001, d = 1.15). After clustering PwH, large effects (P = 0.02, ηp 2  > 0.16) were found for amplitude ratios of the lateral gastrocnemius (LG) muscle. In PwH, the degree of joint alteration of the right lower limb was associated with load proportion of the left side (ρ > 0.64, P = 0.001). CONCLUSION: Patients with greater dysbalance showed higher forefoot loads and appeared to compensate their altered joint situations with considerably higher amplitude ratios of LG. Further studies should investigate whether therapeutic interventions could alter postural alignment and muscle activation and how these can influence patients' joint function and symptoms.


Assuntos
Tornozelo/fisiologia , Hemofilia A/patologia , Hemofilia B/patologia , Músculo Esquelético/fisiologia , Equilíbrio Postural , Adulto , Estudos de Casos e Controles , Eletromiografia , Humanos , Pessoa de Meia-Idade , Índice de Gravidade de Doença
6.
Orphanet J Rare Dis ; 13(1): 38, 2018 03 05.
Artigo em Inglês | MEDLINE | ID: mdl-29506547

RESUMO

Sports and exercise therapy becomes more and more integrated in the treatment plan of different diseases. Although the benefits of this therapy are of high quality evidence, e.g. in cardiovascular diseases, no concepts of sports therapy are available as a treatment option for rare diseases.During the last eighteen years, we analyzed the situation as well as necessity, and developed a model, contents and the concept of the "Programmed Sports Therapy (PST)" for the treatment of PwH (people with haemophilia) as our model of rare disease. Many studies have shown that motoric skills are depressed in PwH, and that this gap to healthy people increases during age. The only way to reduce this progression is an appropriate therapy, adapted to the necessities of PwH. In haemophilia, in particular, physio- and sports therapy treatments should go hand in hand, the first in the acute phase after bleeding, the second later, after the acute phase has finished. One model, which considers all the different challenges, can be the cogwheel model presented here. Since haemophilia is a rare disease, new training concepts are necessary because classical group therapies are often impossible. PST based on the combination of sports therapy camps together with a supervised autonomous home training helps to directly bring the training to the trainee, in order to enhance key competences and improve the individual situation in PwH, and perhaps in patients with other rare diseases.The experience and scientific data substantiate the success of "Programmed Sports Therapy (PST)" and even this can be a model for other rare diseases.


Assuntos
Terapia por Exercício , Hemofilia A/terapia , Esportes , Humanos
7.
Hamostaseologie ; 37(S 01): S9-S14, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-29582920

RESUMO

Studies describe benefits of exercise in Patients with haemophilia (PwH), but research on training sustainability is rare. Aim of this study was to observe the follow-up of a guided 6-month training intervention in PwH. This study included 28 PwH after a training intervention (RCT) over 6 months. N=17 continued training (TC), N=11 stopped training (TS) after the study time. Strength measurements and subjective physical performance were tested.The RCT revealed that all muscles tested increased significantly after training. In the follow-up phase, the muscles of TC increased further (in TS decreased), but not all of them significantly (M. triceps brachii: p=0.017; M. biceps brachii: n.s.; M. latissimus dorsi: n.s.; M. rectus abdominis: p=0.002; M. biceps femoris right: n.s.; left: p=0.028; M. quadriceps femoris both n.s. = not sig.). Subjective performance showed no clear changes in the follow-up phase.This is the first study evaluating a follow-up phase of programmed sports therapy (PST) in PwH. PST (6-month) resulted in some PwH continuing the successful training. Benefits were training routine, safety and partially further positive training effects, e.g. in strength performance.


Assuntos
Terapia por Exercício/métodos , Hemofilia A/reabilitação , Hemofilia B/reabilitação , Esportes para Pessoas com Deficiência , Adulto , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Força Muscular , Aptidão Física
8.
Front Physiol ; 7: 92, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27014090

RESUMO

AIM: The aim of the present study was to analyze the response of vascular circulating microRNAs (miRNAs; miR-16, miR-21, miR-126) and the VEGF mRNA following an acute bout of HIIT and HVT in children. METHODS: Twelve healthy competitive young male cyclists (14.4 ± 0.8 years; 57.9 ± 9.4 ml·min(-1)·kg(-1) peak oxygen uptake) performed one session of high intensity 4 × 4 min intervals (HIIT) at 90-95% peak power output (PPO), each interval separated by 3 min of active recovery, and one high volume session (HVT) consisting of a constant load exercise for 90 min at 60% PPO. Capillary blood from the earlobe was collected under resting conditions, during exercise (d1 = 20 min, d2 = 30 min, d3 = 60 min), and 0, 30, 60, 180 min after the exercise to determine miR-16, -21, -126, and VEGF mRNA. RESULTS: HVT significantly increased miR-16 and miR-126 during and after the exercise compared to pre-values, whereas HIIT showed no significant influence on the miRNAs compared to pre-values. VEGF mRNA significantly increased during and after HIIT (d1, 30', 60', 180') and HVT (d3, 0', 60'). CONCLUSION: RESULTS of the present investigation suggest a volume dependent exercise regulation of vascular regulating miRNAs (miR-16, miR-21, miR-126) in children. In line with previous data, our data show that acute exercise can alter circulating miRNAs profiles that might be used as novel biomarkers to monitor acute and chronic changes due to exercise in various tissues.

9.
Circulation ; 133(15): 1438-48; discussion 1448, 2016 Apr 12.
Artigo em Inglês | MEDLINE | ID: mdl-26979085

RESUMO

BACKGROUND: A well-developed coronary collateral circulation provides a potential source of blood supply in coronary artery disease. However, the prognostic importance and functional relevance of coronary collaterals is controversial with the association between exercise training and collateral growth still unclear. METHODS AND RESULTS: This prospective, open-label study randomly assigned 60 patients with significant coronary artery disease (fractional flow reserve ≤0.75) to high-intensity exercise (group A, 20 patients) or moderate-intensity exercise (group B, 20 patients) for 4 weeks or to a control group (group C, 20 patients). The primary end point was the change of the coronary collateral flow index (CFI) after 4 weeks. Analysis was based on the intention to treat. After 4 weeks, baseline CFI increased significantly by 39.4% in group A (from 0.142±0.07 at beginning to 0.198±0.09 at 4 weeks) in comparison with 41.3% in group B (from 0.143±0.06 to 0.202±0.09), whereas CFI in the control group remained unchanged (0.7%, from 0.149±0.09 to 0.150±0.08). High-intensity exercise did not lead to a greater CFI than moderate-intensity training. After 4 weeks, exercise capacity, Vo2 peak and ischemic threshold increased significantly in group A and group B in comparison with group C with no difference between group A and group B. CONCLUSIONS: A significant improvement in CFI was demonstrated in response to moderate- and high-intensity exercise performed for 10 hours per week. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT01209637.


Assuntos
Circulação Colateral/fisiologia , Doença das Coronárias/terapia , Vasos Coronários/fisiopatologia , Terapia por Exercício , Adulto , Idoso , Angina Instável/etiologia , Angina Instável/terapia , Aorta/fisiopatologia , Pressão Arterial , Cateterismo Cardíaco/efeitos adversos , Pressão Venosa Central , Doença das Coronárias/fisiopatologia , Embolia Aérea/etiologia , Teste de Esforço , Terapia por Exercício/efeitos adversos , Terapia por Exercício/métodos , Tolerância ao Exercício , Feminino , Veia Femoral/fisiopatologia , Reserva Fracionada de Fluxo Miocárdico , Humanos , Masculino , Pessoa de Meia-Idade , Consumo de Oxigênio , Estudos Prospectivos
10.
Front Physiol ; 7: 643, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-28082910

RESUMO

Aim: mircoRNAs (miRNAs), small non-coding RNAs regulating gene expression, are stably secreted into the blood and circulating miRNAs (c-miRNAs) may play an important role in cell-cell communication. Furthermore, c-miRNAs might serve as novel biomarkers of the current vascular cell status. Here, we examined how the levels of three vascular c-miRNAs (c-miR-16, c-miR-21, c-miR-126) are acutely affected by different exercise intensities and volumes. Methods: 12 subjects performed 3 different endurance exercise protocols: 1. High-Volume Training (HVT; 130 min at 55% peak power output (PPO); 2. High-Intensity Training (HIT; 4 × 4 min at 95% PPO); 3. Sprint-Interval Training (SIT; 4 × 30 s all-out). c-miRNAs were quantified using quantitative real-time PCR with TaqMan probes at time points pre, 0', 30', 60', and 180' after each intervention. The expression of miR-126 and miR-21 was analyzed in vitro, in human coronary artery endothelial cells, human THP-1 monocytes, human platelets, human endothelial microparticles (EMPs) and human vascular smooth muscle cells (VSMCs). To investigate the transfer of miRNAs via EMPs, VSMCs were incubated with EMPs. Results: HVT and SIT revealed large increases on c-miR-21 [1.9-fold by HVT (cohen's d = 0.85); 1.5-fold by SIT (cohen's d = 0.85)] and c-miR-126 [2.2-fold by SIT (cohen's d = 1.06); 1.9-fold by HVT (cohen's d = 0.85)] post-exercise compared to pre-values, while HIT revealed only small to moderate changes on c-miRs-21 (cohen's d = -0.28) and c-miR-126 (cohen's d = 0.53). c-miR-16 was only slightly affected by SIT (1.4-fold; cohen's d = 0.57), HVT (1.3-fold; cohen's d = 0.61) or HIT (1.1-fold; cohen's d = 0.2). Further in vitro experiments revealed that miR-126 and miR-21 are mainly of endothelial origin. Importantly, under conditions of endothelial apoptosis, miR-126 and miR-21 are packed from endothelial cells into endothelial microparticles, which were shown to transfer miR-126 into target vascular smooth muscle cells. Conclusion: Taken together, we found that HVT and SIT are associated with the release of endothelial miRNAs into the circulation, which can function as intercellular communication devices regulating vascular biology.

11.
J Hum Kinet ; 51: 71-81, 2016 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-28149370

RESUMO

This study aimed to describe the acute changes of both standard physiological-perceptual markers and circulating microRNAs in response to tennis match-play in a detailed case report. Two elite male baseliners with comparable tennis experience were tested for anthropometric and fitness related variables and played 2 h of match-play on a red-clay court. The changes of standard physiological-perceptual markers including the heart rate, lactate concertation, creatine kinase activity, urea concentration and rating of perceived exertion as well as circulating microRNA-133a, -486 and -126 expression rates were examined at 10 different time-points (i.e., pre, during and up to 24 h post match-play). Player 2 had lower fitness related variables, but a higher heart rate, lactate concentration, creatine kinase activity and rating of perceived exertion during play than player 1. Player 2 showed an increase in all microRNAs (≤3.83-fold), most evident post match-play, whereas player 1 demonstrated a decrease (≤0.41-fold). The time-course in the changes of all standard physiological-perceptual markers was similar in both players, whereas this of the microRNAs was different. It was concluded that the relative changes of the circulating microRNA-133a, -486 and 126 expression rates of both players differed in response to tennis match-play with respect to the experienced physiological-perceptual stress and the underlying fitness level. Therefore, circulating microRNAs can serve as additional biomarkers for tennis exercise physiology and may be assessed together with standard markers to conclude whether key cellular regulatory processes were induced in response to match-play.

12.
Eur J Appl Physiol ; 116(3): 535-40, 2016 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-26700745

RESUMO

PURPOSE: Physical exercise causes alterations in pain sensitivity. Many studies verified so-called exercise-induced analgesia caused by submaximal aerobic intensity. This study aimed to determine the effect of an endurance exercise to exhaustion on pain sensitivity of healthy young men. METHOD: Pressure pain thresholds (PPTs) [in Newton, (N)] of 50 healthy males (mean age 26 ± 4 years) were applied to knee, ankle and elbow joints as well as to the sternum and forehead. This was followed by a bout of cycling ergometer exercise to exhaustion. The whole process was repeated after 20 and 60 min respectively. RESULTS: Endurance exercise to exhaustion decreased PPTs at sternum and forehead significantly, while thresholds at the joints were not affected. Pain thresholds at forehead and sternum declined 20 min after exercise with the forehead's threshold being more reduced. PPTs remain decreased until 60 min after exercise (forehead: from 43.6 ± 15.2 N to 36.6 ± 19.8 N to 37.2 ± 13.4 N; sternum: from 46.8 ± 21.0 N to 42.5 ± 17.1 N to 44.8 ± 18.2 N). Modulation of pain sensitivity showed large effect sizes over time for both landmarks (forehead w = 0.65; sternum w = 0.50). CONCLUSION: Exhaustive endurance exercise is followed by a hyperalgetic condition at forehead and sternum. This may be due to either a reduction in pain inhibiting or an activation in pain stimulating pathways.


Assuntos
Exercício/fisiologia , Limiar da Dor , Adulto , Humanos , Masculino , Músculo Esquelético/fisiologia , Resistência Física
13.
Eur J Prev Cardiol ; 21(4): 484-91, 2014 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-23150891

RESUMO

BACKGROUND: MicroRNAs (miRNAs) are small non-coding molecules regulating gene expression. Recently circulating miRNAs could be detected in the plasma, serving as novel biomarkers. Different forms of exercise mobilize progenitor cells from the bone marrow, helping in tissue repair. Data of different forms of exercise on endothelial cell damage are lacking. The aim of the study was to evaluate the impact of different exercise modalities on the plasma concentration of miRNA-126, as a marker for endothelial damage. METHODS: The plasma concentration of miRNA-126 and miRNA-133 (marker for muscle damage) was assessed by qRT-PCR analysis in plasma samples from healthy individuals performing one of the following exercise tests: (1) maximal symptom-limited exercise test, (2) bicycling for 4 h, (3) running a marathon, and (4) resistance exercise. RESULTS: A maximal symptom-limited exercise test resulted in a significant increase of circulating miRNA-126 at maximum power (2.1-fold versus begin), whereas the concentration of miRNA-133 remained unchanged. In line, four hours of cycling increased plasma concentration of miRNA-126 with a maximum 30 minutes after begin (4.6-fold versus begin) without an impact on miRNA-133 concentration. Finishing a marathon race resulted in an increase of miRNA-126 and miRNA-133. In contrast, eccentric resistance training led to an isolated increase of miRNA-133 level (2.1-fold versus begin) with unchanged miRNA-126. CONCLUSION: Different endurance exercise protocols lead to damage of the endothelial cell layer as evident by an increase in miRNA-126. On the other hand, resistance exercise has no impact on the endothelial cells, but leads to a destruction of muscular cells.


Assuntos
Células Endoteliais/metabolismo , MicroRNAs/sangue , Resistência Física/genética , Adulto , Ciclismo , Células Endoteliais/patologia , Feminino , Marcadores Genéticos , Humanos , Masculino , Treinamento de Resistência , Corrida , Fatores de Tempo , Regulação para Cima
14.
Mol Med Rep ; 9(1): 211-6, 2014 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-24213018

RESUMO

An increasing number of studies examining gene expression associated with diseases in children is likely, in the near future, to provide simple and easy to use methods for the isolation of RNA for gene expression profiling. Prerequisites for such studies are likely to encompass the use of small amounts of blood, as well as less invasive blood collection methods. In the current study, RNA was isolated from 20 µl capillary blood samples from the earlobes of 10 adults for quantitative PCR experiments. The results were compared with RNA isolated from venipuncture samples of the 10 samples. The expression of 4 mRNAs and 1 microRNA (miRNA), miRNA­126, was measured. The quantitative PCR results obtained with the capillary blood probes were similar to results using venous blood samples. The few differences observed may result from a variation in the blood cell composition. The use of capillary blood samples from the earlobe for gene expression analysis is likely to allow this method to be used in newborns, babies and children. In addition, such a method, using microliters of blood samples, may also be useful for other medical studies e.g., in cases where repetitive blood sampling is necessary or in patients with bleeding disorders.


Assuntos
Coleta de Amostras Sanguíneas , Perfilação da Expressão Gênica , MicroRNAs/metabolismo , RNA/metabolismo , Adulto , Capilares , Orelha , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , RNA/isolamento & purificação , RNA Mensageiro/metabolismo
15.
Arthritis Res Ther ; 15(5): R148, 2013 Oct 07.
Artigo em Inglês | MEDLINE | ID: mdl-24286243

RESUMO

INTRODUCTION: Haemophilic arthropathy following recurrent joint bleedings is one of the major disease-related complications in people with haemophilia (PWH), leading to mostly chronic joint pain. Since many antinociceptive principles interfere with the clotting system, PWH are restricted in treatment options, thereby defining a medical need for novel therapeutic principles. However, we lack the availability of an animal model for joint pain in haemophilic arthropathy for testing these. METHODS: In this study, we aimed to validate the rat model of repeated autologous intraarticular blood injections specifically for pain-related behavior. During an observation period of 50 days, groups of animals were injected weekly into one knee joint with either whole blood or cellular/plasma components. RESULTS: Injections induced primary hyperalgesia starting after the third injection, accompanied by mild functional gait changes and joint swelling. Secondary hyperalgesia and quantitative gait disturbances were not observed. This phenotype was most prominent in whole blood injected animals, with effect sizes of cells and plasma being additive. In order to differentiate haemophilia-related arthropathy from traumatic joint bleeding, another group was injected with whole blood only once, which did not cause any alterations. CONCLUSIONS: Repeated autologous intraarticular injections of blood showed a time course, inflammatory response and reduction in pain thresholds similar to the signs and symptoms observed in PWH. Therefore, this model may be utilised in the future for testing novel antinociceptive principles in haemophilia-associated joint pain.


Assuntos
Artralgia/complicações , Transfusão de Sangue/métodos , Modelos Animais de Doenças , Hemofilia A/complicações , Animais , Artralgia/etiologia , Artralgia/fisiopatologia , Comportamento Animal/fisiologia , Feminino , Hemofilia A/etiologia , Membro Posterior/fisiopatologia , Hiperalgesia/complicações , Hiperalgesia/etiologia , Hiperalgesia/fisiopatologia , Injeções Intra-Articulares , Articulação do Joelho/irrigação sanguínea , Articulação do Joelho/patologia , Articulação do Joelho/fisiopatologia , Limiar da Dor/fisiologia , Ratos , Ratos Endogâmicos Lew , Fatores de Tempo , Reação Transfusional
16.
Eur J Appl Physiol ; 113(6): 1423-30, 2013 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-23238930

RESUMO

Randomized controlled trials (RCTs) on the topic of physical training and blood coagulation are rare and the effects are unclear. The aim of this study was to investigate whether endurance training adjusts blood coagulation and fibrinolysis at rest and after exercise. The study included 50 healthy untrained non-smokers randomized into training (TR 49 ± 6 years) or control group (CO 48 ± 6 years). Each subject performed an exercise test adjusted at 80 % individual anaerobic threshold (IAT) for 60 min before and after 12 weeks (80 % IAT: before TR 123 ± 20, CO 125 ± 26 W; after TR 148 ± 23 W, CO 127 ± 25 W; mean ± SD). Blood was taken at rest and after exercise to determine coagulation (e.g., aPTT, thrombin potential, TAT, F1+2, several coagulation factors) and fibrinolytic (e.g., tPA, PAI) parameters. The training intervention induced an elevation of physical capacity in TR by 17 % (rel. VO2max) that led to a statistical relevant prolongation of aPTT at rest. Although absolute power output during the second exercise test was 20 % higher in TR, we detected an attenuated exercise-induced decrease of aPTT and attenuated increase of F1+2 after training. Resting levels of tPA- and PAI-Ag decreased slightly but not significantly after training. Exercise-induced changes were comparable after training in spite of higher power output in TR. Although the effects are small in healthy men, training modifies exercise-induced blood coagulation positively. The fact that exercise-induced changes in blood coagulation and fibrinolysis are rather attenuated or unchanged in the training group, in spite of a 20 % higher absolute power output during exercise, substantiates the adjusting effect of endurance training and the importance of physical fitness in primary prevention.


Assuntos
Limiar Anaeróbio , Exercício/fisiologia , Fibrinólise , Adulto , Humanos , Masculino , Pessoa de Meia-Idade , Resistência Física
17.
Trials ; 13: 167, 2012 Sep 14.
Artigo em Inglês | MEDLINE | ID: mdl-22974129

RESUMO

BACKGROUND: Exercise training (ET) in addition to optimal medical therapy (OMT) in patients with stable coronary artery disease (CAD) has been demonstrated to be superior to percutaneous coronary interventions (PCI) with respect to the composite endpoint of death, myocardial infarction, stroke, revascularization and hospitalization due to worsening of angina. One mechanism leading to this superiority discussed in the literature is the increase in coronary collateral blood flow due to ET. Until now, data demonstrating the positive effect of ET on the collateral blood flow and the functional capacity of the coronary collateral circulation are still lacking. METHODS/DESIGN: The EXCITE trial is a three-armed randomized, prospective, single-center, open-label, controlled study enrolling 60 patients with stable CAD and at least one significant coronary stenosis (fractional flow reserve ≤0.75). The study is designed to compare the influence and efficacy of two different 4-week ET programs [high-intensity interval trainings (IT) versus moderate-intensity exercise training (MT) in addition to OMT] versus OMT only on collateral blood flow (CBF). The primary efficacy endpoint is the change of the CBF of the target vessel after 4 weeks as assessed by coronary catheterization with a pressure wire during interruption of the antegrade flow of the target vessel by balloon occlusion. Secondary endpoints include the change in plaque composition as assessed by intravascular ultrasound (IVUS) after 4 weeks, myocardial perfusion as analyzed in MRI after 4 weeks and 12 months, peak oxygen uptake (V02 peak), change in endothelial function and biomarkers after 4 weeks, 3, 6 and 12 months. The safety endpoint addresses major adverse cardiovascular events (death from cardiovascular cause, myocardial infarction, stroke, TIA, target vessel revascularization or hospitalization) after 12 months. DISCUSSION: The trial investigates whether ET for 4 weeks increases the CBF in patients with significant CAD compared to a sedentary control group. It also examines the impact of two intensities of ET on the CBF as well as the histological plaque composition. The trial started recruitment in June 2009 and will complete recruitment until June 2012. First results are expected in December 2012 (4-week follow-up), final results (12-month long-term secondary endpoint) in December 2013. TRIAL REGISTRATION: Clinical trial registration information-URL: http://www.clinicaltrials.gov.Unique identifier: NCT01209637.


Assuntos
Circulação Colateral , Circulação Coronária , Estenose Coronária/terapia , Vasos Coronários/patologia , Vasos Coronários/fisiopatologia , Terapia por Exercício/métodos , Placa Aterosclerótica , Projetos de Pesquisa , Biomarcadores/sangue , Cateterismo Cardíaco , Angiografia Coronária , Estenose Coronária/diagnóstico , Estenose Coronária/mortalidade , Estenose Coronária/patologia , Estenose Coronária/fisiopatologia , Vasos Coronários/diagnóstico por imagem , Endotélio Vascular/fisiopatologia , Terapia por Exercício/efeitos adversos , Terapia por Exercício/mortalidade , Reserva Fracionada de Fluxo Miocárdico , Alemanha , Humanos , Imagem por Ressonância Magnética , Imagem de Perfusão do Miocárdio/métodos , Consumo de Oxigênio , Estudos Prospectivos , Índice de Gravidade de Doença , Fatores de Tempo , Resultado do Tratamento , Ultrassonografia de Intervenção
18.
Pain ; 152(9): 2029-35, 2011 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-21616597

RESUMO

Recurrent joint bleedings in people with hemophilia (PWH) often progress into the full clinical picture of hemophilic arthropathy, accompanied by chronic pain. Although chronic pain is commonly present in PWH, investigations assessing pain thresholds have not been performed yet. Thus, the aim of this study was to obtain objective and subjective measures of joint pain in PWH and to relate these to the severity of joint pathology. Thirty-six patients (aged 43±11 years) with hemophilia A and B (31 severe A, 1 B; 3 moderate A, 1 B) and 40 healthy control subjects (aged 42±14 years) participated in this study. Mechanical pain thresholds were obtained as objective parameters using an algometer, while subjective pain intensity and quality were assessed using numeric analogue scales. Quality of life was estimated using the Short-Form Health Survey (SF-36) questionnaire. Overall, we found reduced mechanical pain thresholds as obtained from the knee (PWH--left 38.1 [28.7/57.7], right 29.5 [20.9/49.3]; control--left 67.4 [56.8/112.6], right 60.9 [42.6/97.2]), and elbow (PWH--left 23.4 [15.3/33.4], right 23.5 [20.1/35.1]; control--left 56.7 [32.6/86.6], right 53.0 [30.7/87.7] in N; median [25th/75th percentile]) joints in PWH. Interestingly, this increased pain sensitivity was related to the severity of clinical joint pathology. In addition, PWH reported their pain in a more descriptive and not affective manner and scored similar to controls in the mental domain of the SF-36, thereby indicating good coping strategies despite the chronic nature of their complaints. In conclusion, pain sensitivity at the site of the affected joints is increased and closely related to joint pathology in people with hemophilia.


Assuntos
Artralgia/complicações , Artralgia/fisiopatologia , Hemofilia A/complicações , Hemofilia A/fisiopatologia , Adulto , Idoso , Articulação do Tornozelo/patologia , Articulação do Tornozelo/fisiologia , Artralgia/patologia , Estudos Transversais , Articulação do Cotovelo/patologia , Articulação do Cotovelo/fisiologia , Feminino , Hemofilia A/patologia , Humanos , Articulação do Joelho/patologia , Articulação do Joelho/fisiologia , Masculino , Pessoa de Meia-Idade , Medição da Dor/métodos , Prevenção Secundária , Adulto Jovem
19.
Eur J Appl Physiol ; 111(2): 253-60, 2011 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-20859637

RESUMO

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.


Assuntos
Limiar Anaeróbio/fisiologia , Coagulação Sanguínea/fisiologia , Exercício/fisiologia , Fibrinólise/fisiologia , Saúde , Adulto , Desempenho Atlético/fisiologia , Teste de Esforço , Tolerância ao Exercício/fisiologia , Humanos , Individualidade , Masculino , Metabolismo/fisiologia , Educação Física e Treinamento , Esforço Físico/fisiologia , Aptidão Física/fisiologia , Adulto Jovem
20.
J Appl Physiol (1985) ; 107(6): 1943-50, 2009 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-19797690

RESUMO

Exercise stimulates the release of hematopoietic and endothelial progenitor cells (EPC) from the bone marrow. However, no data are available concerning the time frame of EPC release during strenuous exercise. The aim of the present study was to investigate the time-dependent release of progenitor cells during strenuous exercise. Eighteen healthy young men cycled for 4 h continuously at 70% of their individual anaerobic threshold. Peripheral blood was drawn at 16 predefined time points during and after finishing cycling. A significant rise in heart rate and leukocytes was obvious, whereas lactate levels and hematocrit did not change. The amount of circulating progenitor cells, EPCs, mature endothelial cells (mECs), and microparticles, quantified by flow cytometry, showed a significant time-dependent increase at 210/240 min. In addition a very early rise in VEGF and later increase in IL-6, both measured by ELISA, were evident. All observed changes were normalized 24 h after finishing the test. In conclusion, strenuous activity in healthy individuals leads to a time-dependent increase in mECs, PCs, and EPCs that may be related to VEGF and IL-6.


Assuntos
Exercício/fisiologia , Células-Tronco Hematopoéticas/fisiologia , Células-Tronco Mesenquimais/fisiologia , Adulto , Limiar Anaeróbio , Análise de Variância , Contagem de Células , Ensaio de Imunoadsorção Enzimática , Teste de Esforço , Citometria de Fluxo , Humanos , Interleucina-6/metabolismo , Masculino , Resistência Física , Fatores de Tempo , Fator A de Crescimento do Endotélio Vascular/metabolismo
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