Year of grant:
2019

Research Area:
Heilsa - Sjúkrakassagrunnurin

Project type:
Ph.d.

Project title:
Effect of long-term exercise on haemostasis and inflammation compared with standard care in patients with stable coronary artery disease.

Grant number:
3029

Project manager:
Jacobina Kristiansen

Institution/company:
Depilin fyri heilsu- og sjúkrarøktarvísindi, Fróðskaparsetrið

Other participants:
Anne-Mette Hvas, Steen Dalby Kristensen, Magni Mohr, Erik L, Grove.

Project period:
Planned01/11/2019-31/10/2022
Final 01/11/2019-31/12/2022

Total budget:
3.284.234 DKK

Grant from the FRC in DKK:
816.745 DKK

Project description:
Original
Background: The number of patients with coronary artery disease (CAD) is increasing, and exercise training has a central role in the rehabilitation of these patients. Exercise is recommended at least 5 times per week, as it reduces the risk of cardiovascular death and hospital admissions. Haemostasis and inflammatory activity in the arterial wall are unfavourably altered in CAD patients compared to healthy controls. The relatively sparse evidence from previous studies is conflicting, and further investigation is warranted. Objective: To investigate if exercise training is associated with favourable effects on haemostasis and inflammation. Material and methods: The study is a randomised controlled trial. A total of 150 CAD patients and 25 age- and sex-matched individuals without CAD will undergo a short-term strenuous exercise intervention. Subsequently, patients will be randomised to either a supervised long-term exercise program for 3 months or standard care. Blood samples will be obtained at baseline and post exercise in both short- and long-term exercise groups. Platelet turnover, platelet aggregation, coagulation, fibrinolysis, and inflammatory biomarkers will be measured. Results: In the short-term exercise groups, we will compare measurements at baseline with measurements immediately after and 2 hours after strenuous exercise. We will additionally compare measurements of CAD patients with healthy individuals. During long-term exercise, between-group responses will be compared, and blood samples obtained one, two and three months after randomisation will be tested against baseline. Perspectives: Exercise is a non-pharmacological low-cost treatment, which is recommended on a daily basis in CAD patients. The present study clarifies the effects of short- and long-term exercise on haemostasis and inflammation in CAD patients with the aim of paving the way for novel treatment strategies and evidence-based recommendations on exercise training.

Final

Hjartaæðrasjúka er tann sjúkan, ið krevur flest mannalív globalt. Fólk við hjartaæðrasjúku, ið venja regluliga, doyggja minni sannlíkt av hjartaæðrasjúku og verða ikki líka ofta innløgd á sjúkrahúsi. Harafturat fáa tey eina betri lívsgóðsku. Samstundis vita vit, at akutt hørð venjing kann økja um vandan fyri deyða, hóast hetta er sera sjáldsamt. Enn er óvist, hvørjar mekanismurnar eru handan hesar broytingar eftir bæði akutta og reguliga venjing. Blóðplátur og blóðstorknan spæla ein stóran leiklut, tá blóðtøppar verða gjørdir, og møguliga kann venjing ávirka hesa skipanina.

Grein I: Vit gjørdu eitt systematiskt yvirlit yvir verandi vitan, um hvussu reglulig venjing ávirkar blóðplátu funktiónina hjá fólkum við hjartaæðrasjúku og frískum fólkum. Vit funnu 40 kanningar, sum samanlagt kannaðu 1.166 fólk við hjartaæðrasjúku og 1.071 frísk fólk. Reglulig venjing hevði onga týðiliga ávirkan á blóðplátu funktiónina, hvørki hjá fólkum við hjartaæðrasjúku ella hjá frískum. Verandi kanningar høvdu tó nógvar veikleikar, og vitanin á hesum økinum var ófullfíggjað. Tískil mettu vit tað neyðugt við fleiri randomiseraðum kanningum, fyri at koma hesum nærri.

Grein II: Vit kannaðu ávirkanina av regluligari háorku interval venjing hjá 142 fólkum við hjartaæðrasjúku. Høvuðsúrslitini vóru konditión og lívsgóðska. Við hesi randomiseraðu kanningini vístu vit, at 12 vikur við regluligari háorku interval venjing var bæði trygt og hóskandi fyri fólk við hjartaæðrasjúku. Harafturat fingu tey betri konditión og eina betri lívsgóðsku samanborið við tey, sum ikki vandu.

Grein III: Í hesi randomiseraðu kanningini kannaðu vit hvussu reglulig venjing ávirkaði blóðplátur og blóðstorknan hjá 142 fólkum við hjartaæðrasjúku; 78 fólk sum ikki vandu og 64 fólk, sum vandu regluliga í 12 vikur. Tá hesir báðir bólkarnir blivu samanbornir, sóu vit ongar broytingar í blóðplátu funktión ella blóðstorknan eftir 12 vikur.

Grein IV: Vit kannaðu hvussu akutt hørð venjing ávirkar blóðplátu funktión og blóðstorknan hjá 165 fólkum við hjartaæðrasjúku og 25 frískum fólkum. Blóðplátu funktiónin øktist í báðum bólkum beint eftir harða venjing, og var verandi nakað hækkað 2 tímar aftaná. Blóðstorknanin broyttis ikki stórvegis beint eftir harða venjing, men eftir 2 tímar var systemið, ið upploysir blóðtøppar, týðiliga aktiverað.

Samanumtikið kunnu vit staðfesta, at reglulig háorku interval venjing hjá fólkum við hjartaæðrasjúku er trygg. Harafturat betrar venjingin um konditión og lívsgóðsku. Akutt hørð venjing kveikir blóðplátu funktiónina, men eisini systemið sum upploysir blóðtøppar. Tað sær ikki út til, at broytingar í blóðplátum og blóðstorknan kunnu forklára ágóðarnar av regluligari venjing hjá fólkum við hjartaæðrasjúku.

Ritgerðin fevnir um 4 vísindaligar greinir:

Grein I: Kristiansen J, Grove EL, Pedersen OB, Kristensen SD, Hvas AM. Effect of regular exercise training on platelet function in patients with cardiovascular disease and healthy individuals: A systematic review. Thromb Res. 2022 Dec. Epub ahead of print.

Grein II: *Kristiansen J, *Sjúrðarson T, Grove EL, Rasmussen J, Kristensen SD, Hvas AM, Mohr M. Feasibility and impact of whole-body high-intensity interval training in patients with stable coronary artery disease: a randomised controlled trial. Sci Rep. 2022 Oct 14;12(1):17295. *Shared first author

Grein III: Kristiansen J, Grove EL, Sjúrðarson T, Rasmussen J, Mohr M, Kristensen SD, Hvas AM. Haemostasis and fibrinolysis after regular high-intensity interval training in patients with coronary artery disease: a randomised controlled trial. Open Heart. 2022 Nov;9(2):e002127.

Grein IV: Kristiansen J, Grove EL, Sjúrðarson T, Mohr M, Kristensen SD, Hvas AM. Haemostatic and fibrinolytic response to acute strenuous exercise training in patients with stable coronary artery disease. In preparation.



Project status:
Liðug

Project output:
PhD Thesis defended on 11 April 2023 at Aarhus University

Scientific articles, books, thesis etc.

Kristiansen J, Grove EL, Pedersen OB, Kristensen SD, Hvas AM. Effect of regular exercise training on platelet function in patients with cardiovascular disease and healthy individuals: A systematic review. Thromb Res. 2022 Dec. Epub ahead of print.

*Kristiansen J, *Sjúrðarson T, Grove EL, Rasmussen J, Kristensen SD, Hvas AM, Mohr M. Feasibility and impact of whole-body high-intensity interval training in patients with stable coronary artery disease: a randomised controlled trial. Sci Rep. 2022 Oct 14;12(1):17295. *Shared first author

Kristiansen J, Grove EL, Sjúrðarson T, Rasmussen J, Mohr M, Kristensen SD, Hvas AM. Haemostasis and fibrinolysis after regular high-intensity interval training in patients with coronary artery disease: a randomised controlled trial. Open Heart. 2022 Nov;9(2):e002127.

Kristiansen J, Grove EL, Sjúrðarson T, Mohr M, Kristensen SD, Hvas AM. Haemostatic and fibrinolytic response to acute strenuous exercise training in patients with stable coronary artery disease. In preparation.

Sjúrðarson T, Kristiansen J, Nordsborg, NB, Gregersen, NO, Lydersen, LN, Grove, EL, Kristensen, SD, Hvas, AM, Mohr M. The angiotensin-converting enzyme I/D polymorphism does not impact training-induced adaptations in exercise capacity in patients with stable coronary artery disease. Sci Rep. Under review.

Storage and access rights to collected data

: Dáta er goymt á redcap dátabasuni. Granskarar áhugaði í atgongd til dáta kunnu venda sær til professara Magna Mohr ella professara Anne-Mette Hvas.



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