Effect of a Physical Exercise Program on the Inflammatory Response, Cardiac Functions, Functional Capacity, and Quality of Life in Patients with Sickle Cell Disease
Abstract
:1. Introduction
2. Methods
2.1. Study Design, Setting, and Participants
2.2. Interventions
2.2.1. Exercise Group
- (a)
- Initial phase: calisthenics and flexibility exercises, lasting approximately 10 min.
- (b)
- Main phase: aerobic exercise, with walking guidance and gradual increase in intensity and duration, with prescription as follows: In the first two weeks: 35 min of walking between 60% and 70% of maximum heart rate (HR max) achieved in the treadmill test; third and fourth week: 40 min of walking between 60% and 70% of HR max; fifth and sixth week: 40 min of walking between 65% and 75% of HR max; seventh and eighth week: 50 min of walking between 65% and 75% of HR max.
- (c)
- Final phase: relaxation phase, 10–15 min of calisthenics and flexibility exercises. This exercise protocol was based on previous studies and current recommendations that advocate low-intensity activities for individuals with sickle cell anemia, as high-intensity exercises can trigger painful crises. Current recommendations for maintaining health in the general population include moderate-intensity aerobic exercise, 150 min/week, but emphasize that sedentary individuals can benefit from lower volumes and intensities and with individualized progression [30,31]. The physical education teacher monitored activities carried out weekly via telephone.
2.2.2. Control Group
3. Outcomes
3.1. Primary
3.2. Secondary
4. Measurements
4.1. Clinical Evaluation
4.2. Anthropometric Assessment
4.3. Analysis of Inflammatory Biomarkers
4.4. Doppler Echocardiographic Assessment
4.5. Functional Capacity Assessment—Ergometric Test
4.6. Degree of Physical Activity Assessment
4.7. Quality of Life Assessment
4.8. Statistical Methods
5. Results
6. Discussion
7. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Conflicts of Interest
References
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Variables. | Control Group (n = 13) | Exercise Group (n = 14) | p |
---|---|---|---|
Age (years) | 25 (22.5–36.5) | 27.5 (22.6–36) | 1.0 |
Female | 5 (38.5%) | 9 (64.3%) | 0.339 |
Weight (kg) | 57.6 ± 14.5 | 60.0 ± 13.3 | 0.403 |
SAH, n (%) | 0 | 1 (7.1%) | 1.0 |
Obesity, n (%) | 0 | 1 (7.1%) | 1.0 |
Dyspnea, n (%) | 3 (23.1%) | 6 (42.9%) | 0.42 |
Folic acid, n (%) | 13 (100%) | 12 (85.7%) | 0.48 |
Hydroxyurea, n (%) | 3 (23.1%) | 5 (35.7%) | 0.678 |
Variables | Control Group (n = 13) | Exercise Group (n = 14) | p | ||||
---|---|---|---|---|---|---|---|
M1 | M2 | M2-M1 | M1 | M2 | M2-M1 | ||
Hemoglobin (g/dL) | 9.70 (7.50–10.4) | 10.2 (8.65–11.0) | 0.70 (0.42–1.15) | 9.30 (7.95–10.6) | 9.90 (9.05–11.1) | 0.60 (−0.28–1.53) | 0.942 |
Hematocrit (%) | 30.2 (23.5–31.4) | 29.1 (23.8–35.0) | 0.90 (−1.15–3.50) | 30.5 (24.5–36.0) | 31.1 (25.6–34.4) | 1.00 (−1.60–2.00) | 0.645 |
Platelets (mil/mm3) | 343 (239–485) | 322 (255–453) | 4.00 (−43.5–29.0) | 493 (388–546) | 464 (385–566) | −0.5 (−35.8–37.8) | 0.923 |
White blood cells (cells/mm3) | 13,300 (8800–20,350) | 12,500 (9700–15,350) | 0.30 (−1.00–1.05) | 13,250 (11,575–17,175) | 13,350 (9700–17,025) | 0.45 (−0.50–1.60) | 0.451 |
Variables | Control Group (n = 13) | Exercise Group (n = 14) | p | ||||
---|---|---|---|---|---|---|---|
M1 | M2 | M2-M1 | M1 | M2 | M2-M1 | ||
TNF-alpha (pg/mL) | 9.87 (9.18–11.1) | 10.5 (9.41–10.8) | 0.53 (0.16–0.90) | 9.60 (8.73–10.6) | 10.6 (9.03–11.1) | 1.03 (−1.36–2.12) | 0.482 |
IL-6 (pg/mL) | 3.81 ± 1.45 | 3.46 ± 0.55 | −0.36 ± 1.23 | 3.53 ± 0.83 | 3.09 ± 0.53 | −0.44 ± 0.80 | 0.829 |
IL-1 (pg/mL) | 5.29 ± 0.38 | 5.23 ± 0.56 | −0.06 ± 0.49 | 5.23 ± 0.51 | 5.07 ± 0.35 | −0.16 ± 0.58 | 0.656 |
IL-10 (pg/mL) | 8.88 (6.91–10.2) | 9.13 (7.72–11.2) | 0.36 (−0.66–3.24) | 7.47 (6.86–8.54) | 8.07 (7.58–9.57) | 0.97 (−0.28–2.20) | 0.981 |
CRP (ng/mL) | 122.1 ± 47.1 | 130.4 ± 42.4 | 8.32 ± 37.3 | 116.7 ± 47.0 | 98.9 ± 51.5 | −17.7 ± 46.1 | 0.121 |
BNP (pg/mL) | 125 (120–155) | 127 (117–136) | −4.01 (−18.7–3.07) | 130 (120–136) | 125 (122–130) | −3.58 (−14.2–10.3) | 0.827 |
Variables | Control Group (n = 13) | Exercise Group (n = 14) | p-Value | ||||
---|---|---|---|---|---|---|---|
M1 | M2 | M2-M1 | M1 | M2 | M2-M1 | ||
Morphological | |||||||
LVDD (mm) | 50.0 ± 5.66 | 51.3 ± 3.99 | 1.31 ± 3.28 | 51.8 ± 6.78 | 52.6 ± 5.93 | 0.79 ± 4.26 | 0.726 |
LVSD (mm) | 33.2 ± 7.68 | 34.5 ± 8.42 | 1.23 ± 2.35 | 30.6 ± 5.49 | 31.4 ± 5.98 | 0.79 ± 2.52 | 0.640 |
PW (mm) | 8.96 ± 1.56 | 8.65 ± 1.30 | −0.31 ± 0.81 | 8.69 ± 1.40 | 9.05 ± 1.80 | 0.36 ± 1.36 | 0.139 |
IVS (mm) | 9.02 ± 1.76 | 8.81 ± 1.49 | −0.22 ± 0.81 | 8.36 ± 1.31 | 9.30 ± 1.68 | 0.94 ± 1.58 | 0.027 |
LVMI (g/m2) | 103.2 ± 40.0 | 100.4 ± 28.8 | −2.81 ± 17.4 | 94.9 ± 22.8 | 106.7 ± 32.5 | 11.8 ± 23.8 | 0.082 |
Systolic function | |||||||
EF (%) | 61.0 ± 10.1 | 63.0 ± 9.34 | 2.08 ± 4.44 | 66.8 ± 2.62 | 74.0 ± 6.40 | 7.21 ± 6.17 | 0.021 |
S wave (cm/s) | 9.00 ± 2.27 | 8.61 ± 1.85 | −0.39 ± 1.64 | 9.24 ± 1.37 | 9.83 ± 1.58 | 0.59 ± 2.18 | 0.203 |
St wave (cm/s) | 14.1 ± 3.24 | 13.2 ± 2.64 | −0.89 ± 2.58 | 14.1 ± 2.93 | 15.7 ± 3.10 | 1.65 ± 2.47 | 0.015 |
Diastolic function | |||||||
LAVI (mL/m2) | 32.4 ± 9.79 | 32.5 ± 10.2 | 0.14 ± 4.85 | 28.0 ± 8.41 | 31.9 ± 11.7 | 3.90 ± 4.90 | 0.056 |
E wave (cm/s) | 94.1 ± 24.6 | 92.5 ± 21.0 | −1.54 ± 13.7 | 91.8 ± 22.8 | 96.1 ± 25.6 | 4.29± 20.6 | 0.398 |
A wave (cm/s) | 53.2 ± 14.4 | 57.5 ± 15.9 | 4.31 ± 10.8 | 50.9 ± 17.9 | 53.7 ± 15.0 | 2.79 ± 8.80 | 0.691 |
E/A | 1.82 ± 0.50 | 1.64 ± 0.24 | −0.19 ± 0.35 | 1.92 ± 0.64 | 1.88 ± 0.62 | −0.05 ± 0.52 | 0.422 |
E′ wave (cm/s) | 12.0 (9.85–13.0) | 11.0 (10.0–11.7) | −0.92 ± 2.37 | 12.0 (10.6–13.0) | 13.5 (11.8–15.0) | 1.51 ± 3.58 | 0.050 |
A′ wave (cm/s) | 7.0 (6.0–8.0) | 7.0 (7.0–8.0) | 0.0 (−1.0–1.0) | 8.5 (7.0–11.5) | 8.0 (7.0–12.0) | 0.0 (−1.0–1.0) | 0.766 |
E/E’ | 8.19 ± 2.62 | 8.51 ± 2.03 | 0.32 ± 1.87 | 7.83 ± 2.24 | 7.11± 1.77 | −0.72 ± 2.65 | 0.253 |
E′t wave (cm/s) | 14.6 ± 3.36 | 12.7 ± 2.59 | −1.94 ± 2.84 | 13.8 ± 3.31 | 15.0 ± 3.36 | 1.21 ± 4.67 | 0.046 |
A′t wave (cm/s) | 9.0 (7.0–14.0) | 10.0 (9.0–11.5) | 0.4 (−1.0–1.5) | 9.0 (7.75–15.7) | 10.5 (7.0–13.8) | 0.0 (−2.93–3.25) | 0.788 |
Variables | Control Group (n = 13) | Exercise Group (n = 14) | p | ||||
---|---|---|---|---|---|---|---|
M1 | M2 | M2-M1 | M1 | M2 | M2-M1 | ||
Level of physical activity | |||||||
Job | 2380 (570–4870) | 2367 (764–4412) | 137 (−83.5-252) | 2779 (1109–5100) | 2954 (1250–4477) | 61.0 (−318–1111) | 0.790 |
Transportation | 641 (396–801) | 785 (448–1079) | 117 (45–194) | 594 (211–1255) | 726 (211–1539) | 51.5 (0–211) | 0.273 |
Housework | 2400 (1463–2576) | 2456 (1540–2655) | 150 (−56–363) | 1200 (485–3277) | 1293 (679–2886) | 105 (−180–204) | 0.452 |
Leisure | 1045 (419–2835) | 1100 (624–2140) | −206.2 ± 1040 | 1249 (180–2400) | 2803 (1897–3784) | 1261 ± 860 | <0.001 |
Walking | 1300 (644–2090) | 1568 (874–2240) | 114 (−84.5–267) | 1286 (528–2751) | 2442 (805–3501) | 544 (171–845) | 0.024 |
Moderate activity | 6563 ± 4584 | 6680 ± 4145 | 117 ± 1491 | 6769 ± 3691 | 7152 ± 4003 | 382 ± 1607 | 0.660 |
Vigorous activity | 0.0 (0.0–441) | 0.0 (0.0–0.0) | 0.0 (−360–0.0) | 0.0 (0.0–480) | 0.0 (0.0–356) | 0.0 (−34–113) | 0.331 |
Activity level rating | 3.0 (3.0–4.0) | 3.5 (3.0–4.0) | 0.0 (0.0–0.8) | 4.0 (4.0–5.0) | 5.0 (4.0–5.0) | 1.0 (0.0–1.0) | 0.111 |
Total activity | 12,974 (9305–23,191) | 14,830 (10,224–19,497) | 584 (−1785–1263) | 14,940 (9524–22,038) | 16,155 (12,675–22,292) | 1945 (957–4175) | 0.021 |
Functional capacity | |||||||
VO2 peak (ml/kg/min) | 35.0 (28.6–35.1) | 35.0 (24.2–35.3) | 0.06 (−0.55–0.57) | 35.6 (35.0–47.3) | 48.3 (40.2–59.9) | 9.40 (1.78–16.9) | <0.001 |
Distance (m) | 552.8 ± 160.1 | 586.7 ± 217.4 | 33.92 ± 97.2 | 809.1 ± 232.2 | 1020.7 ± 252.9 | 211.6 ± 130.7 | <0.001 |
Time (min) | 9.91 ± 2.13 | 10.3 ± 2.29 | 0.36 ± 0.87 | 12.9 ± 2.62 | 14.8 ± 2.13 | 1.88 ± 1.55 | 0.005 |
HR rest (bpm) | 76.3 ± 10.6 | 75.9 ± 6.78 | −0.39 ± 7.34 | 80.1 ± 14.2 | 72.1 ± 13.1 | −8.07 ± 10.1 | 0.034 |
HR max. (bpm) | 163.2 ± 12.7 | 166.5 ± 13.1 | 3.39 ± 9.73 | 179.1 ± 10.6 | 182.1 ± 12.3 | 3.00 ± 10.6 | 0.923 |
Quality of life | |||||||
Functional capacity | 65.0 (52.5–70.0) | 70.0 (61.0–82.5) | 5.0 (2.5–11.5) | 71.0 (63.8–80.0) | 90.0 (82.5–95.0) | 13.5 (6.5–20.3) | 0.067 |
Physical aspects | 60.0 (52.0–72.5) | 60.0 (49.5–70.0) | 0.0 (−4.0–5.0) | 54.5 (25.0–100.0) | 100.0 (59.3–100.0) | 8.50 (0.0–41.8) | 0.022 |
Pain | 47.5 ± 20.2 | 54.8 ± 17.2 | 7.31 ± 9.38 | 53.4 ± 23.8 | 59.9 ± 29.5 | 6.54 ± 21.0 | 0.904 |
General state | 50.2 ± 13.7 | 52.7 ± 15.4 | 2.54 ± 9.22 | 53.3 ± 19.7 | 59.6 ± 15.2 | 6.36 ± 18.0 | 0.500 |
Vitality | 50.7 ± 10.1 | 51.9 ± 12.6 | 1.19 ± 8.00 | 56.8 ± 13.3 | 59.9 ± 12.2 | 3.14 ± 14.4 | 0.670 |
Social aspects | 52.3 ± 21.5 | 52.9 ± 18.7 | 0.60 ± 8.01 | 64.9 ± 20.2 | 67.7 ± 19.6 | 2.81 ± 17.3 | 0.679 |
Emotional aspects | 67.0 (52.5–80.8) | 70.0 (51.3–86.0) | 3.00 (−8.80–7.95) | 66.8 (33.5–100.0) | 100.0 (62.5–100.0) | 1.5 (0.0–36.3) | 0.302 |
Mental health | 52.7 ± 18.3 | 52.0 ± 16.7 | −0.62 ± 5.84 | 69.1 ± 13.7 | 67.6 ± 14.7 | −1.43± 9.08 | 0.786 |
Variables | Time | Distance Walked | VO2 Peak | |||
---|---|---|---|---|---|---|
Correlation Coefficient | p-Value | Correlation Coefficient | p-Value | Correlation Coefficient | p | |
IL-10 | −0.188 | 0.344 | −0.220 | 0.266 | −0.228 | 0.259 |
TNF-alpha | −0.101 | 0.614 | −0.123 | 0.536 | −0.130 | 0.524 |
BNP | −0.334 | 0.088 | −0.343 | 0.080 | −0.362 | 0.069 |
IL-1 | −0.156 | 0.433 | −0.233 | 0.240 | −0.286 | 0.155 |
IL-6 | −0.367 | 0.059 | −0.444 | 0.020 | −0.480 | 0.013 |
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Antonelli Rossi, D.A.; De Araujo Junior, J.A.; Luvizutto, G.J.; Bazan, R.; Salmazo, P.S.; Modolo, G.P.; Hueb, J.C.; Nunes, H.R.d.C.; Hokama, N.K.; Minicucci, M.F.; et al. Effect of a Physical Exercise Program on the Inflammatory Response, Cardiac Functions, Functional Capacity, and Quality of Life in Patients with Sickle Cell Disease. J. Clin. Med. 2023, 12, 3952. https://doi.org/10.3390/jcm12123952
Antonelli Rossi DA, De Araujo Junior JA, Luvizutto GJ, Bazan R, Salmazo PS, Modolo GP, Hueb JC, Nunes HRdC, Hokama NK, Minicucci MF, et al. Effect of a Physical Exercise Program on the Inflammatory Response, Cardiac Functions, Functional Capacity, and Quality of Life in Patients with Sickle Cell Disease. Journal of Clinical Medicine. 2023; 12(12):3952. https://doi.org/10.3390/jcm12123952
Chicago/Turabian StyleAntonelli Rossi, Daniele Andreza, Jonas Alves De Araujo Junior, Gustavo José Luvizutto, Rodrigo Bazan, Péricles Sidnei Salmazo, Gabriel Pinheiro Modolo, João Carlos Hueb, Hélio Rubens de Carvalho Nunes, Newton Key Hokama, Marcos Ferreira Minicucci, and et al. 2023. "Effect of a Physical Exercise Program on the Inflammatory Response, Cardiac Functions, Functional Capacity, and Quality of Life in Patients with Sickle Cell Disease" Journal of Clinical Medicine 12, no. 12: 3952. https://doi.org/10.3390/jcm12123952