20.500.12556/RUL-180996 Učinki intervalne in kontinuirane telesne vadbe na hemostazo pri koronarni bolezni Effects of interval and continuous exercise on haemostasis in coronary artery disease Uvod Neposredno po telesni vadbi je verjetnost za srčno-žilne zaplete povečana, vendar dolgoročno aerobna-dinamična vadba izboljša srčno-žilno zdravje. V srčno-žilni rehabilitaciji najpogosteje uporabljamo kontinuirano vadbo srednje intenzivnosti (MICT), v zadnjih časih se vse bolj uveljavlja tudi intervalna vadba visoke intenzivnosti (HIIT). HIIT v primerjavi z MICT naj bi hitreje izboljšala zmogljivost verjetno za ceno blago večje verjetnosti zapletov. Hemostaza je kazatelj razmerja med učinkovitostjo in varnostjo telesne vadbe pri srčnih bolnikih, vendar zanesljivih raziskav, ki bi primerjale učinke HIIT in MICT na hemostazo, nimamo na voljo. Namen raziskave je bil ovrednotiti učinek različnih vrst telesne vadbe (HIIT in MICT) na hemostazo – celokupni hemostatski potencial (CHP), celokupni fibrinolitični potencial (CFP) in celokupni koagulacijski potencial (CKP) – pri koronarnih bolnikih. Metode V intervencijsko randomizirano raziskavo smo vključili bolnike po prebolelem srčnem infarktu, ki so bili napoteni na ambulantni rehabilitacijski program in so izpolnjevali vključitvene kriterije, brez izključitvenih kriterijev. Bolnike smo naključno razporedili v dve skupini: bolniki v prvi skupini so izvajali telesno vadbo s HIIT protokolom 3 mesece 3 ure tedensko; bolniki v drugi skupini so telesno vadbo z MICT protokolom 3 mesece 3 ure tedensko. Bolnikom smo odvzeli šest vzorcev periferne venske krvi: izhodiščno (pred prvo vadbeno enoto, po prvi vadbeni enoti in po enournem počitku) ter po zaključku intervencijskega obdobja (pred zadnjo vadbeno enoto, po zadnji vadbeni enoti in po enournem počitku). Iz vzorcev smo določili CHP, CKP in CFP s spektrofotometrično analizo ter fibrinogen, D-dimer in von Willebrandov faktor antigen (vWF:ag) po validiranem protokolu. Rezultati V raziskavo smo vključili 117 preiskovancev, 59 v skupini HIIT in 58 v skupini MICT. Med skupinama ni bilo pomembnih razlik v osnovnih značilnostih. V obeh skupinah smo beležili porast največje porabe kisika (VO2peak) po programu rehabilitacije (iz 23,2 ± 6,1 na 25,2 ± 4,7 pri HIIT in iz 21,6 ± 5,7 na 24,4 ± 4,3 pri MICT), med vrstama vadbe ni bilo razlike. Izhodiščne vrednosti CHP, CKP, CFP in vWF:ag so bile primerljive med skupinama. V linearnem mešanem modelu za analizo hipnih učinkov vadbe pri netreniranih preiskovancih je imel čas (tj. učinek vadbe) statistično značilen vpliv pri vseh koagulacijskih spremenljivkah (CHP - F (2, 98.190) = 7,214, p = 0,001; CKP - F (2, 99.391) = 6,906, p = 0,002; CFP - F (2, 99.291) = 3,239, p = 0,043; fibrinogen - F (2, 114.355) = 43,683, p < 0,001; D-dimer - F (2, 110.594) = 4,855, p = 0,010; vWF:ag - F (2;110.407) = 19,279, p < 0,001). Interakcija čas*skupina (tj. učinek intervencije) je bila statistično značilna za D-dimer (F (2, 110.594) = 3,777, p 0,026), vendar ne za ostale spremenljivke. V linearnem mešanem modelu za analizo dolgoročnih učinkov vadbe smo zaznali povečanje CFP po intervenciji (F (1, 94.665) = 5,161, p = 0,0025) in zmanjšanje koncentracije fibrinogena (F (1, 110.318) = 4,635, p = 0,034). Na ostale hemostatske označevalce intervencija ni imela pomembnega učinka. Pri dolgoročnih učinkih ni bilo razlik pri interakciji čas*skupina. V linearnem mešanem modelu za analizo hipnih učinkov vadbe pri treniranih preiskovancih je imel čas značilen vpliv na CHP ( F (1, 90.753) = 7,214, p = 0,009) in CFP (F (1, 87.345) = 5,967, p = 0,017). Pri fibrinogenu smo zaznali razliko med HIIT in MICT (F (1, 111.211) = 4,228, p = 0,042). Pri vWF:ag smo zaznali značilno interakcijo čas*skupina (F(1,108.191) = 3,998, p = 0,048) . Zaključek Naši rezultati kažejo, da enota telesne vadbe pri netreniranih bolnikih s koronarno boleznijo povzroči hipno, vendar kratkotrajno povečanje hemostaze na račun povečane koagulacije in zmanjšane fibrinolize, ki se v obdobju počitka normalizira. Dolgoročno telesna vadba poveča fibrinolizo, brez učinka na koagulacijo. Pri treniranih preiskovancih enota telesne vadbe povzroči primerljivo hipno povečanje hemostaze, povečanje koagulacije in zmanjšanje fibrinolize v primerjavi z netreniranimi preiskovanci, vendar pri treniranih preiskovancih v obdobju počitka vrednosti hemostaze bolj upadejo in vrednosti fibrinolize bolj narastejo. Intervalna vadba visoke intenzivnosti in kontinuirana vadba zmerne intenzivnosti imata primerljiv učinek na hemostazo. Introduction Immediately after physical exercise, the risk of cardiovascular events increases; however, in the long term, aerobic exercise improves cardiovascular health. In cardiovascular rehabilitation, moderate-intensity continuous training (MICT) is most commonly used, though high-intensity interval training (HIIT) has been gaining ground in recent times. Compared to MICT, HIIT is thought to improve capacity more quickly, likely at the price of a slightly higher risk of complications. Haemostasis is one of the indicators of the balance between the efficacy and safety of physical exercise in cardiac patients, but there are no studies comparing the effects of HIIT and MICT on haemostasis. The aim of this study was to evaluate the acute and chronic effect of different types of physical exercise (HIIT and MICT) on haemostasis appraised by the overall haemostatic potential (OHP), overall fibrinolytic potential (OFP), and overall coagulation potential (OCP) in patients with coronary artery disease. Methods In this randomised interventional study, we included patients after a recent myocardial infarction, that were referred to a rehabilitation programme. Patients were randomly allocated into two groups: the first group performed HIIT-based exercise for three months, three hours per week; those in the second group performed MICT-based exercise for three months, three hours per week. Six peripheral venous blood samples were collected from each patient: at baseline (before the first exercise session, after the first exercise session, and after one hour of rest) and at the end of the intervention period (before the last exercise session, after the last exercise session, and after one hour of rest). OHP, OCP, and OFP were determined using spectrophotometric analysis, fibrinogen, D-dimer, and von Willebrand factor antigen (vWF:ag) were assessed according to validated protocols. Results A total of 117 subjects were included in the study, 59 in the HIIT group and 58 in the MICT group. There were no significant differences between the groups in baseline characteristics. Both groups showed an increase in peak oxygen uptake (VO2peak) after the rehabilitation programme (from 23.2 ± 6.1 to 25.2 ± 4.7 in the HIIT group and from 21.6 ± 5.7 to 24.4 ± 4.3 in the MICT group), with no difference between the groups. Baseline values of OHP, OCP, OFP, and vWF:ag were comparable between the groups. In the linear mixed model analysing the acute effects in untrained individuals, time (i.e., the effect of exercise) had a statistically significant impact on all coagulation variables – OHP (F (2, 98.190) = 7,214, p = 0,001); OKP (F (2, 99.391) = 6,906, p = 0,002); OFP (F (2, 99.291) = 3,239, p = 0,043); fibrinogen (F (2, 114.355) = 43,683, p < 0,001); D-dimer (F (2, 110.594) = 4,855, p = 0,010); vWF:ag (F (2;110.407) = 19,279, p < 0,001). The time*group interaction (i.e., the intervention effect) was statistically significant only for D-dimer (F (2, 110.594) = 3.777, p = 0.026). In the linear mixed model analysing the long-term effects of exercise, a significant increase in OFP (F (1, 94.665) = 5.161, p = 0.0025) and a decrease in fibrinogen concentration (F (1, 110.318) = 4.635, p = 0.034) were observed after intervention. There were no differences in the time*group interaction for long-term effects. In the linear mixed model analysing the acute effects of exercise in trained individuals, time had a significant effect on OHP (F (1, 90.753) = 7.214, p = 0.009) and OFP (F (1, 87.345) = 5.967, p = 0.017). A difference between HIIT and MICT was observed for fibrinogen (F (1, 111.211) = 4.228, p = 0.042). For vWF:ag, a significant time*group interaction was detected (F (1,108.191) = 3.998, p = 0.048). Conclusion Our study shows that a single session of physical exercise in untrained patients with coronary artery disease triggers an acute, but short-lived, increase in haemostasis due to increased coagulation and decreased fibrinolysis, which normalises during the resting period. In the long term, physical exercise increases fibrinolysis without affecting coagulation. In trained subjects, a session of physical exercise results in a similar acute increase in haemostasis, increased coagulation, and decreased fibrinolysis compared to untrained subjects; however, in trained subjects, haemostasis values decrease more during the rest period and fibrinolysis values increase more. High-intensity interval training and moderate-intensity continuous training have a comparable effect on haemostasis. koronarna bolezen hemostaza kardiološka rehabilitacija celokupni hemostatski potencial intervalna vadba kontinuirana vadba coronary artery disease hemostasis cardiac rehabilitation overall hemostatic potential interval training continuous training true false false Slovenski jezik Angleški jezik Doktorsko delo/naloga 2026-03-21 07:16:13 2026-03-21 07:16:32 2026-03-23 03:56:55 0000-00-00 00:00:00 2026 0 0 0000-00-00 NiDoloceno NiDoloceno NiDoloceno 0000-00-00 0000-00-00 0000-00-00 1970-01-01 38982 8385.pdf 8385.pdf 1 365F821432D93EAB028A50ACFA7CF06E ca373c7fc5148a476840a3bf27de496ef73e2e7d1da342ba91de0b40c12628cc 6a3de8ac-24ed-11f1-b0ab-0050569b8976 https://repozitorij.uni-lj.si/Dokument.php?lang=slv&id=231048 8386.pdf 8386.pdf 1 5AC2A41B63809F2F4B432B13377D4FA7 2010c85ab1678a32c9f2ef9b3711bc35558c9c7efac0cd10fa89f57be5021f9f 6a3ec9c8-24ed-11f1-b0ab-0050569b8976 https://repozitorij.uni-lj.si/Dokument.php?lang=slv&id=231049 Medicinska fakulteta 0 0 0