Impact of A Six Week Training Program on Ventilatory Efficiency, Red Blood Cell Rheological Parameters and Red Blood Cell Nitric Oxide Signaling in Young Sickle Cell Anemia Patients: A Pilot Study

Abstract

Patients with sickle cell anemia (SCA) show impaired ventilatory efficiency, altered blood rheology, high levels of oxidative/nitrosative stress and enhanced hemolysis with large amounts of circulating free hemoglobin, which reduces nitric oxide (NO) bioavailability. The aim of the study was to investigate whether physical exercise could improve these physiological and biological markers described to contribute to SCA pathophysiology. Twelve SCA patients participated in a controlled six weeks training program with moderate volume (two sessions per week with 15–30 min duration per session) and intensity (70% of the first ventilatory threshold). Parameters were compared before (T0) and after (T1) training. Daily activities were examined by a questionnaire at T0 and one year after the end of T1. Results revealed improved ventilatory efficiency, reduced nitrosative stress, reduced plasma free hemoglobin concentration, increased plasma nitrite levels and altered rheology at T1 while no effect was observed for exercise performance parameters or hematological profile. Red blood cell (RBC) NO parameters indicate increased NO bioavailability which did not affect RBC deformability. Participants increased their daily life activity level. The data from this pilot study concludes that even low intensity activities are feasible and could be beneficial for the health of SCA patients.

The Worst Things in Life are Free: The Role of Free Heme in Sickle Cell Disease

“…Several approaches to mitigate the harmful effects of oxidative stress in SCD have been proposed such as use of antioxidants ( 82 ), neutralization of products of hemolysis with haptoglobin (Hp) and hemopexin (Hpx) ( 83 ) and moderate strength and endurance exercise therapy ( 84 ). Recent studies showed that increase in physical activity improves blood rheology, increases NO bioavailability and reduction in oxidative stress and hemolysis in mice ( 85 – 87 ) and SCD patients ( 88 ).…”

Effect of voxelotor on cardiopulmonary testing in youths with sickle cell anemia in a pilot study

“…Several studies documented improved exercise performance in SCA patients after moderate exercise training 1,5,7–9 . Anecdotally, Subject 1 in this study, the only one who demonstrated increase in peak VO 2 , reported engaging in regular exercise after starting voxelotor, but this was not prospectively or objectively documented.…”

“…Sickle cell providers are often asked to provide sports clearance for students with SCA, but no athletic guidelines are available for SCA, as there are for SCT 3,4 . Additionally, regular exercise has been shown to benefit patients with SCA 1,5–9 . Thus, understanding exercise capacity in SCA is increasingly necessary.…”

“…3,4 Additionally, regular exercise has been shown to benefit patients with SCA. 1,[5][6][7][8][9] Thus, understanding exercise capacity in SCA is increasingly necessary.…”

Skeletal Muscle Satellite Cells in Sickle Cell Disease Patients and Their Responses to a Moderate-intensity Endurance Exercise Training Program

“…4,18 However, recent studies have demonstrated the safety and feasibility of endurance training in children and adults with SCD, with potential benefits for their functional capacity and quality of life. 20–24 Our previous study 24 reported several muscle benefits after 8 weeks of endurance training, such as slight hypertrophy of type I muscle fibers. This specific adaptation of type I fibers is related to the nature of the moderate-intensity endurance training program which recruited this type of fibers in particular.…”