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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
1   Department of Pediatrics, Division of Hematology-Oncology, Nationwide Children’s Hospital, The Ohio State University, Columbus, Ohio, USA
,
Vanessa Bouskill
2   Department of Paediatrics, Division of Haematology-Oncology, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
,
Jane E. Schneiderman
3   Physiology and Experimental Medicine, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
4   Department of Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada
,
Fred G. Pluthero
2   Department of Paediatrics, Division of Haematology-Oncology, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
,
Walter H. A. Kahr
2   Department of Paediatrics, Division of Haematology-Oncology, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
5   Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
6   Department of Biochemistry, University of Toronto, Toronto, Ontario, Canada
,
Allison Craik
2   Department of Paediatrics, Division of Haematology-Oncology, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
,
Dewi Clark
2   Department of Paediatrics, Division of Haematology-Oncology, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
,
Karen Whitney
5   Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
,
Christine Zhang
2   Department of Paediatrics, Division of Haematology-Oncology, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
,
Margaret L. Rand
2   Department of Paediatrics, Division of Haematology-Oncology, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
5   Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
6   Department of Biochemistry, University of Toronto, Toronto, Ontario, Canada
,
Manuel Carcao
2   Department of Paediatrics, Division of Haematology-Oncology, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
5   Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
› Author Affiliations Financial support: This study was supported by Pfizer, Canada.
Further Information

Publication History

Received: 25 September 2015

Accepted after major revision: 11 February 2016

Publication Date:
27 November 2017 (online)

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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

 

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