Exercise-Induced Changes in Coagulation and Fibrinolysis in Healthy Populations and Patients with Cardiovascular Disease

Abstract

This review highlights the clinical significance of coagulation and fibrinolytic responses, and adaptations in healthy individuals and patients with cardiovascular disease (CVD). Much of the review focuses on indicators of the potential for coagulation and fibrinolysis. The terms 'coagulation potential' and 'fibrinolytic potential' are used frequently, as much of the literature in the area of exercise haemostasis evaluates factors that reflect an increased potential for coagulation, while coagulation per se, may or may not be occurring. Similarly, fibrinolysis is definitively the lysis of inappropriate or excessive blood clot, which may or may not be occurring when the enzymes that stimulate fibrinolysis are activated. Nevertheless, markers of coagulation and fibrinolytic potential are associated with CVD, ischaemic events, and cardiovascular mortality. Additionally, fibrinolytic potential is associated with other established CVD risk factors. Ischaemic events triggered by physical exertion are more likely to occur due to an occlusive thrombus, suggesting the exercise-induced responses related to haemostasis are of clinical significance. The magnitude of increase in coagulation potential, platelet aggregation and fibrinolysis appears to be primarily determined by exercise intensity. Patients with CVD may also have a larger increase in coagulation potential during acute exercise than healthy individuals. Additionally, the magnitude of the fibrinolytic response is largely related to the resting fibrinolytic profile of the individual. In particular, high resting plasminogen activator inhibitor-1 may diminish the magnitude of tissue plasminogen activator response during acute exercise. Therefore, acute responses to exercise may increase the risk of ischaemic event. However, chronic aerobic exercise training may decrease coagulation potential and increase fibrinolytic potential in both healthy individuals and CVD patients. Due to the aforementioned importance of resting fibrinolysis on the fibrinolytic response to exercise, chronic aerobic exercise training may cause favourable adaptations that could contribute to decreased risk for ischaemic event, both at rest and during physical exertion.

Physical Activity, Sedentary Time, and Cardiovascular Disease Biomarkers at Age 60 to 64 Years

“…One explanation for these findings is thought to be because of beneficial effects of physical activity (PA) on endothelial function and the relatively less well‐studied biomarkers of atherosclerosis 5, 6, 7, 8, 9, 10, 11, 12. The anti‐inflammatory effects of PA have been well documented with consistent findings of decreases in pro‐inflammatory markers C‐reactive protein (CRP) and interleukin‐6 (IL‐6) following brief exercise interventions,8, 9 in addition to decreases in leptin and increases in adiponectin levels with exercise‐induced fat loss 5.…”

The effects of whole body vibration and exercise on fibrinolysis in men

“…Myocardial infarctions (MI) and strokes are typically a result of unresolved blood clot formation. Thus, fibrinolysis may be clinically important with regard to preventing adverse coronary events (60).…”

“…Once the bleeding has stopped, the clot is dissolved. However, if left unresolved occlusive thrombi may result in an ischemic event (60).…”

“…tPA is synthesized, stored, and released from endothelial cells in the vasculature, sympathetic neurons and skeletal muscle (11). Factors known to stimulate the release of tPA include epinephrine, low blood glucose and thrombin (60).…”

“…Plaque in the blood vessels may rupture, resulting in the creation of a blood clot, or thrombus, which may occlude an artery and cause an ischemic event (8,24,60). A low fibrinolytic potential has been shown to be a marker for increased risk of an adverse coronary event (26,41).…”