Does physical activity increase or decrease the risk of sickle cell disease complications?

Abstract

Sickle cell disease (SCD) is the most common inherited disease in the world. Red blood cell sickling, blood cell-endothelium adhesion, blood rheology abnormalities, intravascular haemolysis, and increased oxidative stress and inflammation contribute to the pathophysiology of SCD. Because acute intense exercise may alter these pathophysiological mechanisms, physical activity is usually contra-indicated in patients with SCD. However, recent studies in sickle-cell trait carriers and in a SCD mice model show that regular physical activity could decrease oxidative stress and inflammation, limit blood rheology alterations and increase nitric oxide metabolism. Therefore, supervised habitual physical activity may benefit patients with SCD. This article reviews the literature on the effects of acute and chronic exercise on the biological responses and clinical outcomes of patients with SCD.

Do we have to consider acidosis induced by exercise as deleterious in sickle cell disease?

“…Given that muscle exercise is tightly linked to intra‐ and extracellular acidosis resulting from the non‐oxidative glycolytic processes of energy production (Bangsbo et al., ; Bangsbo, Johansen, Graham, & Saltin, ; Brooks, ; Ferguson et al., ; Hermansen & Osnes, ; Juel, ; Marcinek, Kushmerick, & Conley, ; Osnes & Hermansen, ; Sahlin, ; Sahlin, Alvestrand, Brandt, & Hultman, ; Sahlin, Harris, Nylind, & Hultman, ), one can wonder whether physical activity could be deleterious for SCD patients. To prevent the occurrence of any associated risks, extending our knowledge about the potential deleterious effects of muscle exercise in SCD patients is of great interest, particularly given that rehabilitation based on physical activity is increasingly considered as a potential therapeutic strategy in this pathology (Liem, Akinosun, Muntz, & Thompson, ; Martin et al., ). In addition, in a recent study, an acid–base imbalance has been reported in exercising SCD mice, suggesting that the metabolic acidosis related to exercise could be exacerbated in SCD (Chatel et al., ).…”

“…() observed that, after a VOC, regular physical activity was associated with a shorter duration of hospitalization. Based on studies conducted in SCD mice, this beneficial effect of endurance training could be explained by improvements in several vascular, haemorheological, inflammatory, endothelial activation and oxidative stress parameters (Aufradet et al., ; Charrin et al., ; Faes, Charrin, Connes, Pialoux, & Martin, ; Martin et al., ). In a recent study conducted in SCD mice, Charrin et al.…”

“…Although physical activity has long been discouraged for SCD patients, several studies have suggested that endurance training could be safe and even have beneficial effects on well-being and health (Alcorn, Bowser, Henley, & Holloway, 1984;Camcioglu, Boşnak-Güçlü, Karadallı, Akı, & Türköz-Sucak, 2015;Liem et al, 2017;Martin et al, 2018;Tinti, Somera, Valente, & Domingos, 2010;Zanoni, Galvao, Cliquet Junior, & Saad, 2015). Alcorn et al (1984) observed that, after a VOC, regular physical activity was associated with a shorter duration of hospitalization.…”

“…Alcorn et al (1984) observed that, after a VOC, regular physical activity was associated with a shorter duration of hospitalization. Based on studies conducted in SCD mice, this beneficial effect of endurance training could be explained by improvements in several vascular, haemorheological, inflammatory, endothelial activation and oxidative stress parameters (Aufradet et al, 2014;Charrin et al, 2015;Faes, Charrin, Connes, Pialoux, & Martin, 2015;Martin et al, 2018). In a recent study conducted in SCD mice, Charrin et al (2017) observed that endurance training increased the fraction of venous oxygen-saturated Hb at rest and proposed that such an improvement could prevent HbS polymerization and RBC sickling, Charrin et al (2017) also discussed the potential beneficial effects associated with a reduction in blood acidosis related to acute exercise.…”

A Strategic Framework for Utilizing Late-Stage (T4) Translation Research to Address Health Inequities

“…Biological factors can be especially important when the distribution of genetic polymorphisms predominantly affects one population or subpopulation, as is the case for SCD, which occurs primarily in African Americans. 42 …”