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Review
. 2018 Nov 30;2018(1):418-425.
doi: 10.1182/asheducation-2018.1.418.

Balancing exercise risk and benefits: lessons learned from sickle cell trait and sickle cell anemia

Robert I Liem  1
Affiliations
Review

Balancing exercise risk and benefits: lessons learned from sickle cell trait and sickle cell anemia

Robert I Liem. Hematology Am Soc Hematol Educ Program. .

Abstract

Development of exercise guidelines for individuals with sickle cell trait (SCT) and sickle cell anemia (SCA) is hampered by the need to weigh the benefits against risks of exercise in these populations. In SCT, concern for exercise collapse associated with sickle cell trait has resulted in controversial screening of student athletes for SCT. In SCA, there exists unsubstantiated concerns that high-intensity exercise may result in pain and other complications. In both, finding the "right dose" of exercise remains a challenge for patients and their providers. Despite assumptions that factors predisposing to adverse events from high-intensity exercise overlap in SCT and SCA, the issues that frame our understanding of exercise-related harms in both are distinct. This review will compare issues that affect the risk-benefit balance of exercise in SCT and SCA through these key questions: (1) What is the evidence that high-intensity exercise is associated with harm? (2) What are the pathophysiologic mechanisms that could predispose to harm? (3) What are the preventive strategies that may reduce risk? and (4) Why do we need to consider the benefits of exercise in this debate? Addressing these knowledge gaps is essential for developing an evidence-based exercise prescription for these patient populations.

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Conflict of interest statement

Conflict-of-interest disclosure: The author declares no competing financial interests.

Figures

Figure 1.
Figure 1.
Timeline of important milestones related to application of exercise science and medicine in SCT and SCA. 6-MWD, 6-minute walk distance; ACSM, American College of Sports Medicine; CHAMP, Consortium for Health and Military Performance; NATA, National Athletic Trainers’ Association; NCAA, National Collegiate Athletic Association.
Figure 2.
Figure 2.
The balance of short-term potential risks of acute exercise vs long-term benefits of regular exercise in individuals with SCT and SCA.
See this image and copyright information in PMC

References

    1. Denham J, O’Brien BJ, Marques FZ, Charchar FJ. Changes in the leukocyte methylome and its effect on cardiovascular-related genes after exercise. J Appl Physiol (1985). 2015;118(4):475-488. - PubMed
    1. Radom-Aizik S, Zaldivar FP Jr, Haddad F, Cooper DM. Impact of brief exercise on circulating monocyte gene and microRNA expression: implications for atherosclerotic vascular disease. Brain Behav Immun. 2014;39:121-129. - PMC - PubMed
    1. Whitham M, Parker BL, Friedrichsen M, et al. Extracellular vesicles provide a means for tissue crosstalk during exercise. Cell Metab. 2018;27(1):237-251. - PubMed
    1. O’Connor FG, Bergeron MF, Cantrell J, et al. ACSM and CHAMP summit on sickle cell trait: mitigating risks for warfighters and athletes. Med Sci Sports Exerc. 2012;44(11):2045-2056. - PubMed
    1. Quattrone RD, Eichner ER, Beutler A, Adams WB, O’Connor FG. Exercise collapse associated with sickle cell trait (ECAST): case report and literature review. Curr Sports Med Rep. 2015;14(2):110-116. - PubMed