SAFETY IN PROCEDURE OF EVALUATION FOR PRESCRIPTION OF ENDURANCE EXERCISES IN PATIENTS WITH SICKLE CELL DISEASE: A PILOT STUDY
(Abstract release date: 05/19/16)
EHA Library. Bartolucci P. 06/09/16; 133010; E1461
Prof. Pablo Bartolucci
Contributions
Contributions
Abstract
Abstract: E1461
Type: Eposter Presentation
Background
Physical activity is considered as potentially harmful in patients with sickle cell disease (SCD) and is therefore usually discouraged. Literature reports that during exercise, SCD patients may display gas exchange abnormalities, dyspnea, elevated pulmonary artery systolic pressure, left ventricular diastolic dysfunction, arterial hypoxemia. Vigorous exercise can also induce acidosis, hemorheological alterations, endothelial dysfunction and oxidative stress, which may trigger vaso-occlusive crisis in those patients. However, moderate and regular physical activity seems to be not only safe but also potentially beneficial for SCD patients (Barbeau et al. 2001, Faës et al. 2014, Martin et al. 2015).
Aims
The aim of the present study was i) to propose a submaximal incremental exercise test sufficiently intense to evaluate the physical ability of the patients but not intense enough to induce severe adverse events, and ii) to test the safety of moderate-intensity endurance exercise sessions individualized on basis of data obtained in i).
Methods
Twenty adult patients with homozygous SCD (12 men and 8 women, aged 21-53 years, 78.2±2.0% and 9.8±1.9% of HbS and HbF, respectively) participated in this study approved by the ethics committee (ClinicalTrials.gov NCT02571088).All patients underwent a submaximal incremental exercise (SIE). SIE started at 20 W and 30 W for women and men, respectively. After 2 minutes at this load, and every 2 minutes thereafter, workload increased by 10 W and 15 W for women and men, respectively. During exercise, twelve-lead EKG, heart rate (HR), pulmonary ventilation (VE), oxygen uptake (VO2), systolic (SBP) and diastolic (DBP) blood pressure, peripheral capillary oxygen saturation (SpO2), blood lactate concentrations ([Lac-]) and rate of perceived exertion (RPE) were measured. Exercise was stopped (exercise completion) when a [Lac-] of 4 mmol.L-1 was reached in order to limit acidosis. The first lactate threshold (LT1) was determined as the first inflection point of the [Lac-] vs. work rate curve.Besides, eight men and seven women of the group took part in three constant-load submaximal endurance exercise sessions. Each session lasted 40 min and consisted in a 5-min warm-up, 30 min of cycling at the workload corresponding to LT1, and 5 min of active recovery. HR, SpO2 and [Lac-] were checked regularly and values at the end of exercise were recorded. Work rate was adjusted between sessions to target a [Lac-] of ~2.5 mmol.L-1, which is usually used for endurance exercise in healthy sedentary and trained subjects.Descriptive statistics are expressed as mean ± standard error (SE).
Results
Results are presented in table 1. Although submaximal, the incremental exercise was physiologically stressful since exercise completion intervened at ~85% of maximal theoretical heart rate (HRmax-theor). SIE allowed estimation of LT1 and related parameters (e.g., workload) for prescription of endurance exercise in SCD patients. HR, SpO2, [Lac-] and RPE observed during the constant load exercises were close to the expected values based on SIE. None of the studied patients experienced severe adverse events during or after SIE and endurance exercises.
Conclusion
We concluded that this procedure of SIE allowed evaluation of physical ability of SCD patients without inducing severe adverse events. Besides, SIE provided useful data (i.e., LT1 and related parameters) allowing prescription of apparently safe endurance exercises in patients with SCD. Armed of this experience, an individualized endurance training program might be proposed to patients with SCD.
Session topic: E-poster
Keyword(s): Sickle cell anemia
Type: Eposter Presentation
Background
Physical activity is considered as potentially harmful in patients with sickle cell disease (SCD) and is therefore usually discouraged. Literature reports that during exercise, SCD patients may display gas exchange abnormalities, dyspnea, elevated pulmonary artery systolic pressure, left ventricular diastolic dysfunction, arterial hypoxemia. Vigorous exercise can also induce acidosis, hemorheological alterations, endothelial dysfunction and oxidative stress, which may trigger vaso-occlusive crisis in those patients. However, moderate and regular physical activity seems to be not only safe but also potentially beneficial for SCD patients (Barbeau et al. 2001, Faës et al. 2014, Martin et al. 2015).
Aims
The aim of the present study was i) to propose a submaximal incremental exercise test sufficiently intense to evaluate the physical ability of the patients but not intense enough to induce severe adverse events, and ii) to test the safety of moderate-intensity endurance exercise sessions individualized on basis of data obtained in i).
Methods
Twenty adult patients with homozygous SCD (12 men and 8 women, aged 21-53 years, 78.2±2.0% and 9.8±1.9% of HbS and HbF, respectively) participated in this study approved by the ethics committee (ClinicalTrials.gov NCT02571088).All patients underwent a submaximal incremental exercise (SIE). SIE started at 20 W and 30 W for women and men, respectively. After 2 minutes at this load, and every 2 minutes thereafter, workload increased by 10 W and 15 W for women and men, respectively. During exercise, twelve-lead EKG, heart rate (HR), pulmonary ventilation (VE), oxygen uptake (VO2), systolic (SBP) and diastolic (DBP) blood pressure, peripheral capillary oxygen saturation (SpO2), blood lactate concentrations ([Lac-]) and rate of perceived exertion (RPE) were measured. Exercise was stopped (exercise completion) when a [Lac-] of 4 mmol.L-1 was reached in order to limit acidosis. The first lactate threshold (LT1) was determined as the first inflection point of the [Lac-] vs. work rate curve.Besides, eight men and seven women of the group took part in three constant-load submaximal endurance exercise sessions. Each session lasted 40 min and consisted in a 5-min warm-up, 30 min of cycling at the workload corresponding to LT1, and 5 min of active recovery. HR, SpO2 and [Lac-] were checked regularly and values at the end of exercise were recorded. Work rate was adjusted between sessions to target a [Lac-] of ~2.5 mmol.L-1, which is usually used for endurance exercise in healthy sedentary and trained subjects.Descriptive statistics are expressed as mean ± standard error (SE).
Results
Results are presented in table 1. Although submaximal, the incremental exercise was physiologically stressful since exercise completion intervened at ~85% of maximal theoretical heart rate (HRmax-theor). SIE allowed estimation of LT1 and related parameters (e.g., workload) for prescription of endurance exercise in SCD patients. HR, SpO2, [Lac-] and RPE observed during the constant load exercises were close to the expected values based on SIE. None of the studied patients experienced severe adverse events during or after SIE and endurance exercises.
Conclusion
We concluded that this procedure of SIE allowed evaluation of physical ability of SCD patients without inducing severe adverse events. Besides, SIE provided useful data (i.e., LT1 and related parameters) allowing prescription of apparently safe endurance exercises in patients with SCD. Armed of this experience, an individualized endurance training program might be proposed to patients with SCD.
Session topic: E-poster
Keyword(s): Sickle cell anemia
Abstract: E1461
Type: Eposter Presentation
Background
Physical activity is considered as potentially harmful in patients with sickle cell disease (SCD) and is therefore usually discouraged. Literature reports that during exercise, SCD patients may display gas exchange abnormalities, dyspnea, elevated pulmonary artery systolic pressure, left ventricular diastolic dysfunction, arterial hypoxemia. Vigorous exercise can also induce acidosis, hemorheological alterations, endothelial dysfunction and oxidative stress, which may trigger vaso-occlusive crisis in those patients. However, moderate and regular physical activity seems to be not only safe but also potentially beneficial for SCD patients (Barbeau et al. 2001, Faës et al. 2014, Martin et al. 2015).
Aims
The aim of the present study was i) to propose a submaximal incremental exercise test sufficiently intense to evaluate the physical ability of the patients but not intense enough to induce severe adverse events, and ii) to test the safety of moderate-intensity endurance exercise sessions individualized on basis of data obtained in i).
Methods
Twenty adult patients with homozygous SCD (12 men and 8 women, aged 21-53 years, 78.2±2.0% and 9.8±1.9% of HbS and HbF, respectively) participated in this study approved by the ethics committee (ClinicalTrials.gov NCT02571088).All patients underwent a submaximal incremental exercise (SIE). SIE started at 20 W and 30 W for women and men, respectively. After 2 minutes at this load, and every 2 minutes thereafter, workload increased by 10 W and 15 W for women and men, respectively. During exercise, twelve-lead EKG, heart rate (HR), pulmonary ventilation (VE), oxygen uptake (VO2), systolic (SBP) and diastolic (DBP) blood pressure, peripheral capillary oxygen saturation (SpO2), blood lactate concentrations ([Lac-]) and rate of perceived exertion (RPE) were measured. Exercise was stopped (exercise completion) when a [Lac-] of 4 mmol.L-1 was reached in order to limit acidosis. The first lactate threshold (LT1) was determined as the first inflection point of the [Lac-] vs. work rate curve.Besides, eight men and seven women of the group took part in three constant-load submaximal endurance exercise sessions. Each session lasted 40 min and consisted in a 5-min warm-up, 30 min of cycling at the workload corresponding to LT1, and 5 min of active recovery. HR, SpO2 and [Lac-] were checked regularly and values at the end of exercise were recorded. Work rate was adjusted between sessions to target a [Lac-] of ~2.5 mmol.L-1, which is usually used for endurance exercise in healthy sedentary and trained subjects.Descriptive statistics are expressed as mean ± standard error (SE).
Results
Results are presented in table 1. Although submaximal, the incremental exercise was physiologically stressful since exercise completion intervened at ~85% of maximal theoretical heart rate (HRmax-theor). SIE allowed estimation of LT1 and related parameters (e.g., workload) for prescription of endurance exercise in SCD patients. HR, SpO2, [Lac-] and RPE observed during the constant load exercises were close to the expected values based on SIE. None of the studied patients experienced severe adverse events during or after SIE and endurance exercises.
Conclusion
We concluded that this procedure of SIE allowed evaluation of physical ability of SCD patients without inducing severe adverse events. Besides, SIE provided useful data (i.e., LT1 and related parameters) allowing prescription of apparently safe endurance exercises in patients with SCD. Armed of this experience, an individualized endurance training program might be proposed to patients with SCD.
Session topic: E-poster
Keyword(s): Sickle cell anemia
Type: Eposter Presentation
Background
Physical activity is considered as potentially harmful in patients with sickle cell disease (SCD) and is therefore usually discouraged. Literature reports that during exercise, SCD patients may display gas exchange abnormalities, dyspnea, elevated pulmonary artery systolic pressure, left ventricular diastolic dysfunction, arterial hypoxemia. Vigorous exercise can also induce acidosis, hemorheological alterations, endothelial dysfunction and oxidative stress, which may trigger vaso-occlusive crisis in those patients. However, moderate and regular physical activity seems to be not only safe but also potentially beneficial for SCD patients (Barbeau et al. 2001, Faës et al. 2014, Martin et al. 2015).
Aims
The aim of the present study was i) to propose a submaximal incremental exercise test sufficiently intense to evaluate the physical ability of the patients but not intense enough to induce severe adverse events, and ii) to test the safety of moderate-intensity endurance exercise sessions individualized on basis of data obtained in i).
Methods
Twenty adult patients with homozygous SCD (12 men and 8 women, aged 21-53 years, 78.2±2.0% and 9.8±1.9% of HbS and HbF, respectively) participated in this study approved by the ethics committee (ClinicalTrials.gov NCT02571088).All patients underwent a submaximal incremental exercise (SIE). SIE started at 20 W and 30 W for women and men, respectively. After 2 minutes at this load, and every 2 minutes thereafter, workload increased by 10 W and 15 W for women and men, respectively. During exercise, twelve-lead EKG, heart rate (HR), pulmonary ventilation (VE), oxygen uptake (VO2), systolic (SBP) and diastolic (DBP) blood pressure, peripheral capillary oxygen saturation (SpO2), blood lactate concentrations ([Lac-]) and rate of perceived exertion (RPE) were measured. Exercise was stopped (exercise completion) when a [Lac-] of 4 mmol.L-1 was reached in order to limit acidosis. The first lactate threshold (LT1) was determined as the first inflection point of the [Lac-] vs. work rate curve.Besides, eight men and seven women of the group took part in three constant-load submaximal endurance exercise sessions. Each session lasted 40 min and consisted in a 5-min warm-up, 30 min of cycling at the workload corresponding to LT1, and 5 min of active recovery. HR, SpO2 and [Lac-] were checked regularly and values at the end of exercise were recorded. Work rate was adjusted between sessions to target a [Lac-] of ~2.5 mmol.L-1, which is usually used for endurance exercise in healthy sedentary and trained subjects.Descriptive statistics are expressed as mean ± standard error (SE).
Results
Results are presented in table 1. Although submaximal, the incremental exercise was physiologically stressful since exercise completion intervened at ~85% of maximal theoretical heart rate (HRmax-theor). SIE allowed estimation of LT1 and related parameters (e.g., workload) for prescription of endurance exercise in SCD patients. HR, SpO2, [Lac-] and RPE observed during the constant load exercises were close to the expected values based on SIE. None of the studied patients experienced severe adverse events during or after SIE and endurance exercises.
Conclusion
We concluded that this procedure of SIE allowed evaluation of physical ability of SCD patients without inducing severe adverse events. Besides, SIE provided useful data (i.e., LT1 and related parameters) allowing prescription of apparently safe endurance exercises in patients with SCD. Armed of this experience, an individualized endurance training program might be proposed to patients with SCD.
Session topic: E-poster
Keyword(s): Sickle cell anemia
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