Point:Counterpoint: Sickle cell trait should/should not be considered asymptomatic and as a benign condition during physical activity

Gallais, Daniel Le; Lonsdorfer, J.; Bogui, Pascal; Fattoum, S.

doi:10.1152/japplphysiol.00338.2007

Cited by 28 publications

(13 citation statements)

References 28 publications

(20 reference statements)

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“…In addition, several studies have shown elevated blood viscosity, decreased RBC deformability and higher plasma concentrations of soluble adhesion molecules in this group of patients [11, 13, 19, 36, 37, 40]. It has been widely debated whether these abnormalities contribute to the higher prevalence of exercise-related sudden death in this population [5, 7, 18, 33] with no direct association established to date. We believe that ANS dysfunction might serve as the common link [20] and thus, we investigated the rheology of blood and the activity of ANS in SCT patients at rest and following strenuous exercise.…”

Section: Autonomic Nervous System Activity and Hemorheological Impmentioning

confidence: 92%

Sickle cell disease: Selected aspects of pathophysiology

Alexy¹,

Sangkatumvong

Connes

et al. 2010

Clinical Hemorheology and Microcirculation

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Sickle cell disease (SCD), a genetically-determined pathology due to an amino acid substitution (i.e., valine for glutamic acid) on the beta-chain of hemoglobin, is characterized by abnormal blood rheology and periods of painful vascular occlusive crises. Sickle cell trait (SCT) is a typically benign variant in which only one beta chain is affected by the mutation. Although both SCD and SCT have been the subject of numerous studies, information related to neurological function and transfusion therapy is still incomplete: an overview of these areas is presented. An initial section provides pertinent background information on the pathology and clinical significance of these diseases. The roles of three factors in the clinical manifestations of the diseases are then discussed: hypoxia, autonomic nervous system regulation and blood rheology. The possibility of a causal relationship between these three factors and sudden death is also examined. It is concluded that further studies in these specific areas are warranted. It is anticipated that the outcome of such research is likely to provide valuable insights into the pathophysiology of SCD and SCT and will lead to improved clinical management and enhanced quality of life.

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Section: Autonomic Nervous System Activity and Hemorheological Impmentioning

confidence: 92%

Sickle cell disease: Selected aspects of pathophysiology

Alexy¹,

Sangkatumvong

Connes

et al. 2010

Clinical Hemorheology and Microcirculation

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“…On the one hand, some researchers (6,26,37,45) argue that SCT can be considered asymptomatic and a benign condition during physical activity. Moreover, several studies (5,30,39) have shown that carriers of SCT may present predispositions for performance during very short supramaximal exercise.…”

mentioning

confidence: 99%

Effects of regular physical activity on skeletal muscle structural, energetic, and microvascular properties in carriers of sickle cell trait

Vincent

Oyono-Enguéllé

Féasson

et al. 2012

Journal of Applied Physiology

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To assess the effects of regular physical activity on muscle functional characteristics of carriers of sickle cell trait (SCT), 39 untrained (U) and trained (T) hemoglobin (Hb)AA (CON) and SCT subjects (U-CON, n = 12; U-SCT, n = 8; T-CON, n = 10; and T-SCT, n = 9) performed a graded exercise and a time to exhaustion (T(ex)) test, and were subjected to a muscle biopsy. Maximal power, total work performed during T(ex), citrate synthase and cytochrome c oxidase (COX) activities, respiratory chain complexes I and IV content, and capillary density (CD), diameter (COD), and surface area (CSA) were upregulated by the same proportion in T-CON and T-SCT compared with their untrained counterparts. These proportionally similar differences imply that the observed discrepancies between U-SCT and U-CON remained in the trained subjects. Specifically, both CD and COX remained and tended to remain lower, and both COD and CSA remained and tended to remain higher in T-SCT than in T-CON. Besides, carriers of SCT displayed specific adaptations with regular physical activity: creatine kinase activity; complexes II, III, and V content; and type I fiber surface area and capillary tortuosity were lower or unchanged in T-SCT than in U-SCT. In summary, our results show that 1) carriers of SCT adapted almost similarly to CON to regular physical activity for most of the studied muscle characteristics, 2) oxidative potential remains altered in physically active carriers of SCT compared with HbAA counterparts, and 3) the specific remodeling of muscle microvascular network persists in the trained state.

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“…113 Recent detailed reviews 30,114,115 of the physiology of sickle cell trait in athletes suggest that this condition may not be benign, as previously thought, but likely confers a slightly higher risk in high-intensity sports associated with an increased chance of heat injury and dehydration.…”

Section: -21mentioning

confidence: 91%

National Athletic Trainers' Association Position Statement: Preparticipation Physical Examinations and Disqualifying Conditions

Conley

Bolin

Carek

et al. 2014

Journal of Athletic Training

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Objective: To present athletic trainers with recommendations for the content and administration of the preparticipation physical examination (PPE) as well as considerations for determining safe participation in sports and identifying disqualifying conditions.Background: Preparticipation physical examinations have been used routinely for nearly 40 years. However, considerable debate exists as to their efficacy due to the lack of standardization in the process and the lack of conformity in the information that is gathered. With the continuing rise in sports participation at all levels and the growing number of reported cases of sudden death in organized athletics, the sports medicine community should consider adopting a standardized process for conducting the PPE to protect all parties.Recommendations: Recommendations are provided to equip the sports medicine community with the tools necessary to conduct the PPE as effectively and efficiently as possible using available scientific evidence and best practices. In addition, the recommendations will help clinicians identify those conditions that may threaten the health and safety of participants in organized sports, may require further evaluation and intervention, or may result in potential disqualification.

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Point:Counterpoint: Sickle cell trait should/should not be considered asymptomatic and as a benign condition during physical activity

Cited by 28 publications

References 28 publications

Sickle cell disease: Selected aspects of pathophysiology

Sickle cell disease: Selected aspects of pathophysiology

Effects of regular physical activity on skeletal muscle structural, energetic, and microvascular properties in carriers of sickle cell trait

National Athletic Trainers' Association Position Statement: Preparticipation Physical Examinations and Disqualifying Conditions

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