Physical Training Oct 2012

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Bekris E.¹, Gissis I.³, Sambanis M.³, Anagnostakos K.², Sotiropoulos A.¹

1. Department of Physical Education and Sports Science, National and Kapodistrian University of Athens

2. General Hospital of Karpenissi, Resident Physician Orthopedics’

3. Department of Physical Education and Sports Science, Serres, Aristotle University of Thessaloniki

Abstract

The aim of this study is to investigate how a 12-week soccer training protocol affected Total Antioxidant Capacity (TAC), fibrinogen (Fib) and isoenzyme CK-MB levels in young soccer players. Blood samples were taken twice, before and after the training program. The players’ VO2 max was estimated too. The sample consisted of 62 young soccer players categorized into two groups (Group 1, Group 2) according to weekly soccer practices and age (10.62 ± 0.21 and 11.68 ± 0.11 years old respectively). Group 1 trained twice a week, while Group 2 trained 3 times a week. Both groups participated in a match per week. The training intervention was performed at a training session per week for Group 1 and at two training sessions per week for Group 2. The statistical analysis was carried out on a=0.1.The results showed significantly reduced CK-MB (p=0.00) and fibrinogen (p=0.01) levels, and increased VO2max, (p=0.08) and antioxidant capacity p=0.05) levels in Group 1, and reduced CK-MB (p=0.00) and fibrinogen (p=0.00) levels in Group 2. Significant differences were found between the two groups. Group 1 showed a greater improvement regarding T.A.C. (p=0.075) and CK – MB (p=0.000), while Group 2 clearly showed a greater improvement in fibrinogen (p=0.000). The results suggest that soccer training has a positive effect on TAC, Fib and CK-MB levels, thus reducing the risk of thrombosis and cardiovascular disease.

KEY WORDS: soccer, fibrinogen, TAC, CK-MB, game season.

Address for correspondence

Dr. Bekris Evaggelos

Department of Physical Education and Sports Science of Athens University

41 Ethnikis Antistaseos Str., 172 37 Daphne – Athens, Greece

e-mail: vag_bekris@yahoo.gr

INTRODUCTION

According to research, regular exercise prevents cardiovascular disease (Blair, Kohi, Barlow, Paffenbarger, Gibbons et al., 1995; Wannamethee, Shaper, & Walker, 1998; Tokmakidis, & Volaklis, 2008) and reduces the possibility of metabolic and cardiovascular disease. Moreover, regular exercise contributes to longevity (Isasi, Starc, Tracy, Deckelbaum, Berglund et al., 2000; El-Sayed, & Davies, 1995).

Exercise affects the cardiovascular system, the neurohormonal system, the muscular system, the coagulation mechanism and the mechanism of fibrinolysis, and it also helps prevent atheromatosis while it improves endotheliac function (Linke, Schoene, Gielen, Hofer, Erbs et al., 2001; Toutouzas, Volaklis, Panagiotidou, Lalos, & Tokmakidis, 2002; Laughlin, 2004; Gordon, Leighton, Moss, In: Kaminsky, 2006). Several studies in which adults or children participated point to inverse correlation between plasma fibrinogen levels and physical fitness (El-Sayed & Davies, 1995; Isasi et al., 2000), whereas some other studies in which children participated do not agree with the abovementioned findings (Thomas, Baker, & Davies, 2003; Thomas, & Williams, 2008). Additionally, studies show that vigorous exercise generates an imbalance between Reactive Oxygen Species (ROS) and antioxidants, referred to as oxidative stress (Leeuwenburgh, Fiebig, Chandwaney, & Ji, 1994; Vasankari, Kujala, Heinonen, & Ahotupa, 1995). On the other hand, regular exercise increases antioxidant capacity (Zergeroglu, Ficicilar, Erdogan, Ozdemir, Tekin et al., 2005; Michalczyk, Kłapcińska, Sadowska-Krępa, Jagasz, Pilis et al., 2008; Carlsohna, Rohnd, Bittmannb, Railaa, Mayerc et al., 2008). Regarding CK – MB several researches on adults found an increase in the levels of CK-MB in the plasma, mostly after unusually vigorous exercise, namely after competitive soccer matches (Jaffe, Garfinkel, Ritter & Sobel, 1984), a marathon race of 42.2 km (França, Barros Neto, Agresta, Lotufo & Kater,  2006), a 15 km road race ( Souza & Garcez-Leme, 2006), a 21 km road race (Lippi, Schena, Salvagno, Montagnana, Gelati et al., 2008) and participation in three, ninety-minute soccer matches within one week (Faramarzi, Gaeini & Kordi, 2007). According to (Boreham & Riddoch, 2001), the benefits of adequate regular exercise in childhood are many and can still be experienced in adulthood. Nowadays, when millions of children play soccer, it is imperative that researchers make full use of soccer practice in order to improve young soccer players’ health.

The purpose of this study was to explore the possible cardiovascular changes in selected biochemical parameters of the plasma (fibrinogen, TAC, CK-MB) of young soccer players who participated exclusively in soccer training, with different exercise characteristics (weekly frequency, total weekly duration) within a twelve-week period during the game season.

MATERIALS AND METHODS

Subjects

While designing the present study, 62 boys were examined and they were categorized into three groups based on the exercise characteristics (weekly frequency, total weekly duration). The first group (Group 1) consisted of 27 young soccer players who participated in a ninety-minute soccer practice twice a week and fifty-minute soccer match once a week. The second group (Group 2) consisted of 35 young soccer players who participated in a ninety-minute soccer practice three times a week and a ninety-minute soccer match once a week (Table 1).

Experimental design

Both groups’ participants underwent routine clinical examination (cardiogram, chest x-ray, systolic and diastolic blood pressure measurement) that didn’t reveal some apparent pathological condition. The study was performed in accordance with the Helsinki Declaration of 1975, as last modified in 2000, and was approved by the Ethical Committee of our University. The participants and their parents were thoroughly informed about the purpose, the procedure and the planning of the study. All parents signed a written consent about their children’s participation in this study.

Table 1. Mean values and standard deviations of the age, the body weight, the height and the years of training among the boys (n= 62) at the beginning of the study.

GROUPS (N=62)	AGE (YEARS)	YEARS OF TRAINING	HEIGHT (CM)	BODY WEIGHT (KG)
GROUP 1 (N=27)	10.62 ± 0.21	2 ± 0.8	144.90 ± 1.95	40.02 ± 1.28
GROUP 2 (N=35)	12.68 ± 0.11	4 ± 0.4	154.94 ±3.15	46.27 ± 2.40

Maximal Oxygen Uptake

Cardio respiratory fitness was assessed by means of the 20m shuttle run test as described by Léger, Mercier, Gadoury and Lambert (1988). In brief, participants were required to run between two lines 20m apart, while keeping the pace with audio signals emitted from a pre-recorded compact disk (CD). The initial speed was 8.5km/h, which was increased by 0.5km/h/min (1min equal one stage). The CD used was calibrated over 1min of duration. Participants were instructed to run in a straight line, to pivot on completing a shuttle, and to pace themselves in accordance with the audio signals. The participants were encouraged to keep running as long as possible throughout the course of the test. The test was finished when the participant failed to reach the end lines concurrent with the audio signals on two consecutive occasions. Otherwise, the test ended when the subject stopped because of fatigue. All measurements were carried out under standardized conditions on an indoor rubber floored gymnasium. The last stage completed was scored (precision of 0.5 steps).

Blood collection

There were two blood collection sessions, the former prior to the commencement of the training program, and the latter after its completion. The collections occurred in the morning, following an overnight fast and without any soccer game having taken place in the previous 36 hours. The athletes were sitting down during the collection. The samples were taken from the Royal Bonanza and Middle Banner Bonanzaveins. The blood quantity taken was 9 ml with a Cliss type syringe, without anticoagulant for serum reception. Fibrinogen levels were measured with anosofelometria method in special automatic reactors of the Dade Behring Company. A Roche / Hitachi in KIT, number 917 were used for the in vitro measurement of the MB iso-enzyme of Creatin Kinase in the human serum and plasma. An Olympus Au-600 automatic biochemical analyst was used for the measurement of Total Antioxidant Capacity (T.A.C.).

Training protocol

The program was elaborated during the game season. Group 1 had a ninety-minute training session twice a week and Group 2 had a ninety-minute training session three times a week. The training intervention units were the same during the whole training program for both groups. The intervention took place at a training session per week for Group 1 and at two training sessions per week for Group 2. The two training intervention units of Group 2 took place with a forty-eight-hour difference. The last training session of the week was of mild intensity, remained the same and kept the same characteristics (duration, intensity, etc) it had before the training program. Both groups participated in a championship tournament in a match per week. All soccer players participated for the same amount of time (for a half-time) during the whole game season. Group 1 participated in a 9 vs. 9 game that lasted 50 minutes (two half-times of 25 minutes) in a field of 90 x 45 m. Group 2 participated in an 11 vs. 11 game that lasted 90 minutes (two half times of 45 minutes) in a regular-sized field. The intervention trainings were done using the method of competitive games. The training principles of intervals were used during the training for the games and young soccer players began their next set of the game when their heartbeats dropped at 120-130 beats per minute. Six to seven repetitions of competitive games, with different technical and tactical demands and with a four-minute duration each, took place during the training intervention unit whereas the rest of the training unit’s time was filled with flexibility exercises, muscle extensions, technique skills of medium intensity and a training game with two goal posts. The characteristics of the training intervention unit were recorded with Polar RS400 heart rate monitors and were transferred to a personal computer via Polar Trainer 5 software.

Table 2. Young soccer’s activities during the twelve weeks of training protocol.

Concise table of activities during the twelve-week training protocol in both groups (Group 1 and Group 2) with different training characteristics.
GROUP 1	GROUP 2
12 vigorous trainings 1training / week Duration: 90 minutes each Average intensity: 80% (HR max) 40 minutes of 85% - 95% HR max intensity	24 vigorous trainings 2 trainings / week Duration: 90 minutes each Average intensity: 80% (HR max) 40 minutes of 85% - 95% HR max intensity
12 low-intensity trainings 1 training / week Average intensity: 60% (HR max)	12 low-intensity trainings 1 training / week Average intensity: 60% (HR max)
12 half times in a 9 vs. 9 game 12x25m= 300 minutes of participation in matches	12 half times in an 11 vs. 11 game 12x45m= 540 minutes of participation in matches
Total training duration 1080 minutes	Total training duration 2160 minutes
85% - 95% HR max training duration: 480 minutes, or 20 hours	85% - 95% HR max training duration: 960 minutes, or 40 hours
Total training duration: 2460 minutes, or 41 hours	Total training duration: 3780 minutes, or 63 hours

Statistical analysis

Paired Samples Test was used to compare the average variables within each group (before and after the training intervention program), whereas variance analysis by two way ANOVAs with repeated measures was used for the comparisons between the groups (before and after the training intervention program). The analysis was carried out on a=0.1 significance level.

RESULTS

Regarding Group 1, there was a statistically significant decrease in the levels of CK-MB (p=0.00 < 0.1) and fibrinogen (p=0.01 < 0.1) and a statistically important increase in the maximal oxygen uptake (VO2max), (p=0.08 < 0.1) and the antioxidant capacity (p=0.05 < 0.1).

Table 3. Mean values in the variables of Group 1 before and after intervention training.

Group 1 Parameters	Before Intervention Training	After Intervention Training
CK-MB	22.00 ± 1.63 U/L	11.85 ± 0.73 U/L
Total Antioxidant Capacity (TAC)	1.06 ± 0.08 mmol/l	1.29 ± 0.10 mmol/l
Fibrinogen (Fib)	383.57 ± 35.62 mg%	298.85 ± 16.29 mg%
Maximal Oxygen Uptake (VO2max)	48.98 ± 1.15 ml/kg/min	50.20 ± 0.95 ml/kg/min

Table 4. Mean values in the variables of Group 2 before and after training intervention.

Parameters of Group 2	Before Training Intervention	After Training Intervention
CK-MB	24.20 ± 1.31 U/L	12.20 ± 0.37 U/L
Total Antioxidant Capacity (TAC)	1.33 ± 0.69 mmol/l	1.33 ± 0.58 mmol/l
Fibrinogen (Fib)	290.60 ± 18.77 mg%	233 ± 13.69 mg%
Maximal Oxygen Uptake (VO2max)	54.31 ± 0.98 ml/kg/min	55.41 ± 2.09 (ml/kg/min)

Statistically important decrease was found in Group 2 in the levels of CK-MB (p=0.00 < 0.1, Fig. 2) and fibrinogen (p=0.00 < 0.1 Fig. 3,) on a level of importance α=0.1. There was also an increase in the indices of VO2max and TAC; however, these differences were not statistically significant (Table 4).

Comparisons between the two groups before and after the training intervention program

Variance analysis by two way ANOVAs with repeated measures showed statistically significant differences between the two groups in the following variables.

1. Statistically significant differences regarding T.A.C. between the two groups (p-value=0.075 < 0.1), with Group 1 clearly showing bigger improvement, as seen in the diagram above (Fig.1).

Figure 1. Statistically significant difference between the groups (p-value=0.075 < 0.1) regarding T.A.C.

2. Statistically significant differences regarding CK – MB between the two groups (p -value=0.000 < 0.1), with Group 1 clearly showing bigger improvement, as seen in the diagram above (Fig. 2).

Figure 2. Statistically significant difference between the groups (p-value=0.000 < 0.1) regarding CK – MB.

3. Statistically significant differences regarding fibrinogen between the two groups (p -value=0.000 < 0.1), with Group 2 clearly showing bigger improvement, as seen in the diagram above (Fig. 3).

Figure 3. Statistically significant difference between the groups (p-value=0.000 < 0.1) regarding fibrinogen.

DISCUSSION

Fibrinogen response to training

According to the study results, the 12-week training intervention had a positive impact on fibrinogen levels in both groups. It is clear that one 90-minute, weekly training intervention, with an average intensity of 80% HRmax (which reached 85% - 95% HRmax for 40 minutes) could generate lower fibrinogen levels to the first group’s young soccer players. The greater reduction in fibrinogen levels in the second group was probably attributable to the larger number of training interventions in that group. These results concur with those of studies that applied a similar (12–week) exercise / training protocol with gradually increasing intensity from 70% to 80% HRmax (El-Sayed & Davies, 1995). There is also concurrence with other studies that applied an intense intermittent method to obese children, improving the fibrinogen levels along with endothelial function (Tjønna, Stølen, Bye, Volden, Slørdahl et al., 2009). The results also agree with those of some other researchers, who believe that to minimize cardiovascular risk, a person should undergo vigorous exercise (Stratton, Chandler, Schwartz, Cerqueira, Levy et al., 1991; Mensink, Deketh, Mul, Schuit & Hoffmeister, 1996; Lakka & Salonen, 1993; Tanasescu, Leitzmann, Rimm, Willet, Stampher et al., 2002) which should be more intense than normal, as there is considerably more exertion on the body (Blanck, 1999).

T.A.C. response to training

Several studies that were carried out on adults and teenagers ascertain that regular exercise contributes to increased Total Antioxidant Capacity levels (Leeuwenburgh, Fiebig, Chandwaney, & Ji, 1994; Carlsohna, Rohnd, Bittmannb, Railaa, Mayerc et al., 2008). The present study suggests that the intervention training program led to favorable TAC levels in both groups. In Group 1, there was a statistically significant increase in TAC levels, whereas in Group 2, although there was an increase, it was not statistically significant. The greater improvement in Group 1 TAC levels is probably attributable to the larger VO2 max increase in that group as compared to that in Group 2. It could also be ascribed to the initially lower VO2 max levels (which can improve with less training) in Group 1. Fatouros, Jamurtas, Viliotou, Pouliopoulou, Fotinakis et al., (2004) corroborate this view. According to them, TAC levels are affected by the subjects’ fitness levels prior to any specific training protocol. Moreover, the present study concurs with researchers who claim that the differences between antioxidant capacity levels seem to be influenced by many different factors, such as the frequency and the type of training (Michalczyk et al., 2008), the duration (Bloomer, Davis, Consitt & Wideman, 2007), the quantity and the intensity of the applied training program during the time that the measurements took place (Goto, Higash, Kimura, Noma, Hara et al., 2003), and the trainees’ ages (Fatouros et al., 2004).

CK- MB response to training

According to the present study results, CKMB levels increased in both groups, thus proving the benefits of increasing the exercise intensity once or twice a week against cardiovascular risk. The greater CKMB improvement in Group 1 is probably attributable to greater fitness (VO2 max) and TAC improvement in that group. The present study results agree with those of Frederico, Justo, Da Luz, Da Silva, Medeiros et al., (2009), who studied male mice in which CKMB levels dropped after a 12-week exercise protocol. According to the researchers mentioned above, the beneficial effect of exercise on CKMB levels is probably attributable to antioxidant enzymes increasing, while oxidative stress dropped.

CONCLUSIONS

The present study concluded that the specific twelve-week training protocol:

a) Significantly helps the reduction of biochemical parameters, such as fibrinogen and CK-MB, which contribute to cardiovascular disease, and

b) can positively alter TAC (as it happened in Group 1), but this alteration probably depends on many factors, such as the combination of the duration and the intensity of the training program as well as the level of young soccer players’ physical fitness .

References

1. Blair, S.N., Kohi, K.W., Barlow, C.E., Paffenbarger, R.S., Gibbons, L.W., & Macers, C.A. (1995) Changes in physical fitness and all-cause mortality. A prospective study of healthy and unhealthy men. JAMA, 273, 1093-1098.

2. Blanck, B. (1999). Fitness Volleyball. National strength and Conditioning Association (N.S.C.A). The Ohio State University, USA.

3. Bloomer, R.J., Davis, P.G., Consitt, L.A., & Wideman, L. (2007). Plasma protein carbonyl response to increasing exercise duration in aerobically trained men and women. Am J. Hypertens, 20(8), 825-830.

4. Boreham, C., & Riddoch, C. (2001). The physical activity, fitness and health of children. Journal of Sports Sciences, 19(12), 915 – 929.

5. Carlsohna, A.R., Bittmannb, F., Railaa, J., Mayerc, F., & Schweigerta, F.J. (2008). Exercise Increases the Plasma Antioxidant Capacity of Adolescent Athletes. Ann Nutr Metab, 53, 96-103.

6. Carmen, R.I., Thomas, J.S., Russell, P.T., Richard, D., Lars, B., & Steven S. (2000). Inverse Association of Physical Fitness with Plasma Fibrinogen Level in Children. The Columbia University Bio Markers Study. American Journal of Epidemiology, 152(3), 212-218.

7. El-Sayed, M.S., & Davies, B.A. (1995). Physical conditioning program does not alter fibrinogen concentration in young healthy subjects. Med Sci Sports Exerc, 27(4), 485-489.

8. Faramarzi, M., Gaeini, A.A., & Kordi, M.R. (2007). The effects of high intensity intermittent exercise and carbohydrate supplementation on variations of specific biochemical markers of myocardial muscle (ctni and ck-mb) in soccer players. Olympic Fall, 15(3), 35-44.

9. Fatouros, I.G., Jamurtas, A.Z., Viliotou, V., Pouliopoulou, S., Fotinakis, P., Taxildaris, K., & Deliconstantinos, G. (2004). Oxidative stress responses in older men during endurance training and detraining. Med Sci Sports Exerc, 36(12), 2065-2072.

10. França, S.C., Barros Neto, T.L., Agresta, M.C., Lotufo, R.F., & Kater, C.E. (2006). Divergent responses of serum testosterone and cortisol in athlete men after a marathon race. Arq Bras Endocrinol Metab, 50(6), 1082-1087.

11. Frederico M., Justo. S., Da Luz, G., Da Silva, S., Medeiros, C., Barbosa, V., Silva, L., Boeck, C., icardo Pinho, R., & De Souza, C. (2009). Exercise training provides cardioprotection via a reduction in reactive oxygen species in rats submitted to myocardial infarction induced by isoproterenol. Informa Healthcare, 43(10), 957-964.

12. Gordon, N.F., Leighton, R.F., & Mooss, A. (2006). Factors associated with increased risk of coronary heart disease. In: Kaminsky LA, editor. ACSM’s Resource Manual for Guidelines for Exercise Testing and Perscription.5. Philadelphia, PA: Lippincott Williams & Wilkins, 95–114.

13. Goto, C., Higashi, Y., Kimura, M., Noma, K., Hara, K., Nakagawa, K., Kawamura, M., Chayama, K., Yoshizumi, M., & Nara, I. (2003). Effect of different intensities of exercise on endothelium-dependent vasodilation in humans: role of endothelium-dependent nitric oxide and oxidative stress. Circulation, 108(5), 530-535.

14. Jaffe,, A.S., Garfinkel, B.T., Ritter, C.S., & Sobel, B.E. (1984). Plasma MB creatine kinase after vigorous exercise in professional athletes. Am J Cardiol, 53(6), 856-858.

15. Lakka, T.A., & Salonen, J.T. (1993). Moderate to high intensity conditioning leisure time physical activity and high cardiorespiratory fitness are associated with reduced plasma fibrinogen in eastern Finnish men. J Clin Epidemiol, 46, 1119–1127.

16. Laughlin, M.H. (2004). Physical activity in prevention and treatment of coronary disease: the battle line is in exercise vascular cell biology. Med Sci Sports Exerc, 352-362.

17. Leeuwenburgh, C., Fiebig, R., Chandwaney, R., & Ji, L.L. (1994). Aging and exercise training in skeletal muscle: responses of glutathione and antioxidant enzyme systems. Am J Physiol, 267(2), 439-445.

18. Léger, L.A, Mercier, D., Gadoury, C., & Lambert, J. (1988). The multistage 20 metre shuttle run test for aerobic fitness. J Sports Sci, 6, 93-101.

19. Linke, A., Schoene, N., Gielen, S., Hofer, J., Erbs, S., Schuler, G., & Hambrecht R. (2001). Endothelial Dysfunction in Patients With Chronic Heart Failure: Systemic effects of Lower- Limp Exercise Training. J Am Coll Cardiol, 37, 392-397.

20. Lippi, G., Schena, F., Salvagno, G.L., Montagnana, M., Gelati, M., Tarperi, C., Banfi, G., & Guidi, G.C. (2008). Acute variation of biochemical markers of muscle damage following a 21-km, half-marathon run. Scand J Clin Lab Invest, 68(7), 667-672.

21. Mensink, M., Deketh, M., Mul, M., Schuit, A.J., & Hoffmeister, H. (1996). Physical activity and its association with cardiovascular risk factors and mortality. Epidemiology, 7(4), 391-397.

22. Michalczyk, M., Kłapcińska, B., Sadowska-Krępa, E., Jagasz, S., Pilis, W., Szołtysek-Bołdys, I., Chmura, J., Kimsa, E., & Kempa, K. (2008). Evaluation of the blood antioxidant capacity in two selected phases of the training cycle in professional soccer players. J Hum Kinetics, 19, 93-108.

23. Souza, A., & Garcez-Leme, L.E. (2006). Evaluation of myocardial alterations using the enzymatic profile of elderly long-distance runners. Springer Link, 3(2), 91 - 94.

24. Stratton, J.R., Chandler, W.L., Schwartz, R.S., Cerqueira, S.R., Levy, D.M., & Kahn, C.W. (1991). Effects of physical conditioning on fibrinolytic variables and fibrinogen in young and old healthy adults. Circulation, 83, 1692–1697.

25. Tanasescu, M., Leitzmann, M., Rimm, E., Willet, W., Stampher, M., Hu, F. (2002). Exercise type and intensity in relation to coronary heart disease in men. JAMA, 288, 1994-2000.

26. Thomas, N.E., Baker, J.S., & Davies, B. (2003). Established and Recently Identified Coronary Heart Disease Risk Factors in Young People: The Influence of Physical Activity and Physical Fitness. Sports Medicine, 33(9), 633-650.

27. Thomas, N.E., & Williams, D.R. (2008). Inflammatory factors, physical activity and physical fitness in young people. Scand J Med Sci Sports, 18(5), 543-556.

28. Tjønna, A.E., Stølen, T.O., Bye, A., Volden, M., Slørdahl, S.A., Odegård, R., Skogvoll, E., & Wisløff, U. (2009). Aerobic interval training reduces cardiovascular risk factors more than an lti treatment approach in overweight adolescents. Clin Sci (Lond), 116(4), 315-316.

29. Tokmakidis, S., & Volaklis, K. (2008). Exercise as a therapeutic tool in patients with coronary artery disease. Paschalidis Publications, Athens (GR).

30. Toutouzas, P., Volaklis, K., Panagiotidou, A., Lalos, S., & Tokmakidis, S. (2002). Exercise as a therapeutic tool treatment in patients with coronary artery disease. Heart and Vessels, 4, 313-327.

31. Vasankari, T., Kujala, U., Heinonen, O., & Ahotupa, M. (1995). Measurement of serum lipid peroxidation during exercise using three different methods: diene conjugation, thiobarbituric acid reactive material and uorescentchromolipids. Clin Chim Acta, 234, 63±69.

32. Wannamethee, S.G., Shaper, A.G., & Walker, M. (1998). Changes in physical activity, mortality and incidence of coronary heart disease in older men. Lancet, 351, 1603-1608.

33. Zergeroglu, A.M., Ficicilar, H., Erdogan, A., Ozdemir, S., Tekin, D., & Ersoz, G. (2005). Effects Of Short-Term Exercise Training On Platelet Function And Plasma Total Antioxidant Status. Science in Sports & Exercise, 37(5), p: S30.