How to implement endurance exercise training in sickle cell disease

Exercise and training in sickle cell disease: Safety, potential benefits, and recommendations

Sickle cell disease (SCD) is a genetic disorder characterized by complex pathophysiological mechanisms leading to vaso-occlusive crisis, chronic pain, chronic hemolytic anemia, and vascular complications, which require considerations for exercise and physical activity. This review aims to elucidate the safety, potential benefits, and recommendations regarding exercise and training in individuals with SCD. SCD patients are characterized by decreased exercise capacity and tolerance. Acute intense exercise may be accompanied by biological changes (acidosis, increased oxidative stress, and dehydration) that could increase the risk of red blood cell sickling and acute clinical complications. However, recent findings suggest that controlled exercise training is safe and well tolerated by SCD patients and could confer benefits in disease management. Regular endurance exercises of submaximal intensity or exercise interventions incorporating resistance training have been shown to improve cardiorespiratory and muscle function in SCD, which may improve quality of life. Recommendations for exercise prescription in SCD should be based on accurate clinical and functional evaluations, taking into account disease phenotype and cardiorespiratory status at rest and in response to exercise. Exercise programs should include gradual progression, incorporating adequate warm-up, cool-down, and hydration strategies. Exercise training represents promising therapeutic strategy in the management of SCD. It is now time to move through the investigation of long-term biological, physiological, and clinical effects of regular physical activity in SCD patients.

Cardiac diastolic maladaptation is associated with the severity of exercise intolerance in sickle cell anemia patients

This pilot study focusing on Sickle Cell Anemia (SCA) patients offers a comprehensive and integrative evaluation of respiratory, cardiovascular, hemodynamic, and metabolic variables during exercise. Knowing that diastolic dysfunction is frequent in this population, we hypothesize that a lack of cardiac adaptation through exercise might lead to premature increase in blood lactate concentrations in SCA patients, a potential trigger for acute disease complication. SCA patients were prospectively included in PHYSIO-EXDRE study and underwent a comprehensive stress test with a standardized incremental exercise protocol up to 4 mmol L-1 blood lactate concentration (BL4). Gas exchange, capillary lactate concentration and echocardiography were performed at baseline, during stress test (at ∼ 2 mmol L-1) and BL4. The population was divided into two groups and compared according to the median value of percentage of theoretical peak oxygen uptake (%V ˙ O 2 p e a k t h ) at BL4. Twenty-nine patients were included (42 ± 12 years old, 48% of women). Most patients reached BL4 at low-intensity exercise [median value of predicted power output (W) was 37%], which corresponds to daily life activities. The median value of %V ˙ O 2 p e a k t h at BL4 was 39%. Interestingly, diastolic maladaptation using echocardiography during stress test along with hemoglobin concentration were independently associated to early occurrence of BL4. As BL4 occurs for low-intensity exercises, SCA patients may be subject to acidosis-related complications even during their daily life activities. Beyond assessing physical capacities, our study underlines that diastolic maladaptation during exercise is associated with an early increase in blood lactate concentration.

Modelling of Blood Lactate Time-Courses During Exercise and/or the Subsequent Recovery: Limitations and Few Perspectives

Because lactate is an important metabolic intermediate and a signalling molecule between/within cells/organs, it appears essential to be able to describe the kinetics of this central molecule, during and/or after physical exercise. The present study aimed to confront three models and their approaches [Freund and co-workers (F&co), Beneke and co-workers (B&co), and Quittmann and co-workers (Q&co)] to investigate the lactate exchange (γ₁) and removal (γ₂) abilities (min⁻¹) during and/or after exercise. Nine healthy male subjects performed 3- and 6-min easy, moderate, and heavy exercise. Blood lactate concentration (BLC) was measured every 5 s over the entire period of exercise and recovery. Approaches differ depending on the domain in which the model is applied: considering exercise and part of the recovery (B&co and Q&co) or the entire period of recovery (F&co). The different approaches result in differing γ₁ and γ₂ values. Model fitting is closer to the experimental values following the method (model and approach) of F&co. Complementary analyses show that consideration of (i) exercise drastically impairs the quality of model fitting and therefore the γ₁ and γ₂ values and (ii) the entire period of recovery considerably improves the quality of fits and therefore of the γ₁ and γ₂ values. We conclude that (i) it is neither realistic nor reliable to take into account exercise and recovery in the same model and (ii) the longer the period of recovery studied, the better the quality of the γ₁ and γ₂ values.