| Dr. Charlie Ware
It is a well-known fact that exercise exerts various positive health benefits like improved blood circulation, muscle function and anti-inflammatory actions on the general population. At the same time, it is also known that dehydration and extreme exertion can exacerbate inflammation and lead to further sickling of cells in SCD patients.
While this is true, the stress is on ‘extreme’ activities. It does not imply that kids with SCD should distance themselves from all forms of exercise. In previous articles of this series, we have explained how diet, lifestyle, exercise and supplementation can be used to complement the standard treatment of sickle cell disease.
In this piece, we demystify the apprehensions associated to exercise and SCD children. We will make recommendations based on the current body of research, and delineate the risk and benefits of different forms of exercise for SCD children.
Misconceptions Surrounding Exercise for SCD Children
Various studies and surveys that monitored kids with SCD have conveyed dismal self-reported physical activity levels. For instance, a recent study in Brazil found that 38% of kids with SCD were sedentary and 62% reported a very sedentary lifestyle.
This was pale in comparison to the healthy group wherein 75% of participants had a moderately active lifestyle with only 11% described as sedentary. This lack of physical activity can be attributed to a rampant misconception that any form of exercise will lead to SCD complications and painful crisis in patients.
In turn, these unproven claims inadvertently bait parents to encourage a sedentary lifestyle among SCD children. It is important to note that these claims are not backed by research, and a sedentary lifestyle is not the way forward to prevent the deterioration of health among children.
On the contrary, existing research categorically states that it is OK for kids with SCD to participate in moderate-intensity exercise and it does not cause inflammation or complications. A 2016 study on pediatric SCD determined that there is no direct relation between greater physical activity levels and pain in children.
A study published in Chest Journal even concluded that pulmonary vascular abnormalities in children do not limit exercise capacity. The only thing such children should avoid is contact sports or high-intensity exercise in very hot or cold weather.
Takeaway: It is perfectly safe for children with sickle cell disease to engage in low-to-moderate intensity exercise. There is no scientific literature or evidence to corroborate the negative personal beliefs and apprehensions regarding exercise for SCD kids.
Benefits of Moderate Intensity Exercise for SCD Children
There is a consensus among doctors and researchers regarding the safety and benefits of low-impact exercise for SCD children. Studies indicate that there is no risk of complications with moderate exercise because it works within the limited baseline of blood deoxygenation.
Researchers have been looking at the signs of inflammation in the blood work and genomic aspects of exercise to determine what happens at a molecular level when SCD patients exercise. The promising data demonstrates how moderate exercise leads to genetic changes that regulate inflammation and improve muscular function.
Moreover, exercise has many short and long-term benefits for children and adolescents with sickle cell disease. A 2018 study indicates that low-impact and moderate intensity exercise can reduce inflammation in transgenic sickle cell mice.
Some leading researchers in this field hypothesize that even vigorous-intensity exercise may not be off-limits. Promising as it sounds, it would be best to keep exercise intensity to a light-to-moderate level until this is demonstrated by additional research.
Takeaway: SCD kids with a sedentary lifestyle should be encouraged to take up low-to-moderate intensity exercise tailored to their condition.
Basic Guidelines for Exercise for SCD Children
We are understandably protective when it comes to children but old ill-founded interdicts need to be replaced with a pragmatic and well-researched approach to good health. Take a moment to read our article on how (and why) relaxation techniques and low-impact yoga can be an ideal choice for SCD children.
Physical exercise needs to be tailored to the situation and condition of a child with sickle cell disease. If children are transitioning from a highly sedentary lifestyle, they should start with a low-impact exercise with light intensity.
Other acceptable exercise options include hiking, spin classes, dance-fitness and indoor rowing machines or treadmills. Over time, you can steadily increase the duration and intensity until they actively participate in 3 to 5 moderate-intensity sessions per week.
Encourage them to start with a short warm-up and stretching session. It is also important to educate children on the need for proper hydration and periodic rest. There should be a short break or resting period every 15 to 20 minutes to avoid lactic acid buildup and dehydration. If there is any pain or discomfort, fall back to a light-intensity workout and consult a healthcare practitioner.
Takeaway: Children with SCD should start slow and gradually increase intensity while taking regular breaks and maintaining proper hydration. They should avoid contact sports and high-intensity exercise and stop at the first sign of fatigue.
Increasing the Potency of Exercise with Complementary Practices
Children with SCD should cultivate a healthy lifestyle that includes a well-balanced diet and sufficient rest/sleep. Complement exercise with appropriate nutrition and dietary supplements like Zinc that reduce inflammation and improve the quality of life.
In our article on nutrition for SCD, we spoke about the bioactive compounds in plants and how these phytochemicals help patients manage acute and chronic pain conditions.
Since children have distinct needs, opt for a kid-friendly supplement like EvenFlo Jr that is formulated specially for children. It promotes better blood circulation, reduces inflammation and helps manage muscle cramps, and has shown 97% effectiveness in a double blind study.
Parents may find it counterintuitive to urge children with SCD to adopt a regular exercise routine because of ubiquitous apprehensions. However, research has shown that moderate-intensity exercise (55%-65% of predicted maximum) is safe, feasible and beneficial for this population. In fact, it can be a viable way to reduce stress, improve blood circulation and strengthen the body.
We conclude with a summary of the salient aspects of exercise for SCD children:
- Customized Approach: Individually tailor exercises keeping the child’s age, condition and interests in mind under the guidance of certified trainers and/or healthcare practitioners.
- Low-impact Exercise: Opt for low-impact yoga or moderate intensity exercises like cycling, dancing, hiking, jogging or rowing. Avoid contact sports and high-intensity exercises.
- Hydration: SCD Children should maintain good hydration before, after and during exercise. Acquaint your child with the importance of hydration.
- Stay warm: Stress form heat and cold can trigger a crisis so activities like ice skating, swimming in cold water, etc. should be avoided. It is also best to avoid outdoor activities during extreme weather conditions.
- Take breaks: Regular breaks ensure that exercise doesn’t become strenuous. Exercise should be performed at 55% to 65% maximum capacity with a break once every 20 minutes.
- Balanced Diet: Complement exercise with a well-balanced diet with essential macro and micronutrients for energy, nourishment and a strong immune system.
- Dietary Supplements: Complement diet and exercise with all-natural supplements like EvenFlo Jr, Vitamin D, Zinc, Folic Acid and Chlorophyll to prevent deficiencies and improve quality of life.
- Rest/Sleep: A healthy lifestyle should be reinforced with ample rest to prevent fatigue and sufficient sleep to allow the body to rejuvenate.