{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T23:15:29Z","timestamp":1789773329109,"version":"4.0.1"},"reference-count":42,"publisher":"Public Library of Science (PLoS)","issue":"5","license":[{"start":{"date-parts":[[2021,5,12]],"date-time":"2021-05-12T00:00:00Z","timestamp":1620777600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100002322","name":"CAPES","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100002322","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\"><jats:title>Background<\/jats:title><jats:p>Physical inactivity is an important risk factor for cardiovascular disease. The benefits of exercise in patients with chronic diseases, including cardiovascular diseases, are well established. For patients with sickle cell disease, medical recommendation was to avoid physical exercise for fear of triggering painful crises or increasing the impairment of the cardiopulmonary function. Only recently, studies have shown safety in exercise programs for this population. Despite that, there is no report that assess the effects of physical exercise on cardiac parameters in patients with sickle cell disease.<\/jats:p><\/jats:sec><jats:sec id=\"sec002\"><jats:title>Objective<\/jats:title><jats:p>This study aimed to evaluate the impact of regular physical exercise (a home-based program) on cardiovascular function in patients with sickle cell disease.<\/jats:p><\/jats:sec><jats:sec id=\"sec003\"><jats:title>Design<\/jats:title><jats:p>A quasi-randomized prospective controlled trial.<\/jats:p><\/jats:sec><jats:sec id=\"sec004\"><jats:title>Setting<\/jats:title><jats:p>During the years 2015 and 2016, we started recruiting among adult patients treated at a Brazilian Center for Patients with Sickle Cell Disease to participate in a study involving a home exercise program. The experimental (exercise) and control groups were submitted to clinical evaluation and cardiovascular tests before and after the intervention. Analysis of variance was applied to compare groups, considering time and group factors.<\/jats:p><\/jats:sec><jats:sec id=\"sec005\"><jats:title>Participants<\/jats:title><jats:p>Twenty-seven adult outpatients with a sickle cell disease diagnosis.<\/jats:p><\/jats:sec><jats:sec id=\"sec006\"><jats:title>Interventions<\/jats:title><jats:p>Exercise group (N = 14): a regular home-based aerobic exercise program, three to five times per week not exceeding give times per week, for eight weeks; no prescription for the control group (N = 13).<\/jats:p><\/jats:sec><jats:sec id=\"sec007\"><jats:title>Main outcome measures<\/jats:title><jats:p>Echocardiographic and treadmill test parameters.<\/jats:p><\/jats:sec><jats:sec id=\"sec008\"><jats:title>Results<\/jats:title><jats:p>The exercise group showed significant improvement in cardiovascular tests, demonstrated by increased distance traveled on a treadmill (p&lt;0.01), increased ejection fraction (p &lt; 0.01) and improvement of diastolic function assessed by mitral tissue Doppler E\u2019 wave on echocardiography (p = 0.04). None of the patients presented a sickle cell crisis or worsening of symptoms during the exercise program.<\/jats:p><\/jats:sec><jats:sec id=\"sec009\"><jats:title>Conclusion<\/jats:title><jats:p>The selected home-based exercise program is safe, feasible, and promotes a favorable impact on functional capacity and cardiovascular function in sickle cell disease patients.<\/jats:p><\/jats:sec>","DOI":"10.1371\/journal.pone.0250128","type":"journal-article","created":{"date-parts":[[2021,5,12]],"date-time":"2021-05-12T17:27:56Z","timestamp":1620840476000},"page":"e0250128","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":13,"title":["Cardiovascular benefits of a home-based exercise program in patients with sickle cell disease"],"prefix":"10.1371","volume":"16","author":[{"given":"Jonas Alves","family":"de Araujo Junior","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniele Andreza","family":"Antonelli Rossi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Taina Fabri","family":"Carneiro Valad\u00e3o","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juliana Cristina","family":"Milan-Mattos","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aparecida Maria","family":"Catai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tatiana de Oliveira","family":"Sato","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joao Carlos","family":"Hueb","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Silmeia Garcia","family":"Zanati Bazan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paula Oliveira Montandon","family":"Hokama","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7555-7215","authenticated-orcid":true,"given":"Newton Key","family":"Hokama","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meliza Goi","family":"Roscani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2021,5,12]]},"reference":[{"key":"pone.0250128.ref001","doi-asserted-by":"crossref","first-page":"2018","DOI":"10.1016\/S0140-6736(10)61029-X","article-title":"Sickle-cell disease","volume":"376","author":"DC Rees","year":"2010","journal-title":"Lancet"},{"key":"pone.0250128.ref002","volume-title":"Doen\u00e7a falciforme: condutas b\u00e1sicas para tratamento","author":"Minist\u00e9rio da Sa\u00fade, Secretaria de Aten\u00e7\u00e3o \u00e0 Sa\u00fade, Departamento de Aten\u00e7\u00e3o Especializada","year":"2013"},{"issue":"25","key":"pone.0250128.ref003","doi-asserted-by":"crossref","first-page":"67","DOI":"10.21307\/immunohematology-2019-234","article-title":"Sickle cell disease: a review","volume":"2","author":"SD Roseff","year":"2009","journal-title":"Immunohematology"},{"issue":"10","key":"pone.0250128.ref004","doi-asserted-by":"crossref","first-page":"1033","DOI":"10.1001\/jama.2014.10517","article-title":"Management of sickle cell disease: summary of the 2014 Evidence-Based Report by Expert Panel Members","volume":"312","author":"BP Yawn","year":"2014","journal-title":"JAMA"},{"issue":"1","key":"pone.0250128.ref005","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.jacc.2015.10.044","article-title":"Exercise-based cardiac rehabilitation for coronary heart disease","volume":"67","author":"L Anderson","year":"2016","journal-title":"J Am Col Cardiol"},{"key":"pone.0250128.ref006","doi-asserted-by":"crossref","first-page":"147","DOI":"10.3109\/10623320109165323","article-title":"Exercise in sickle cell anemia: effect on inflammatory and vasoactive mediators","volume":"8","author":"P Barbeau","year":"2001","journal-title":"Endothelium"},{"issue":"49","key":"pone.0250128.ref007","doi-asserted-by":"crossref","first-page":"151","DOI":"10.3233\/CH-2011-1465","article-title":"Exercise limitation, exercise testing and exercise recommendations in sickle cell anemia","author":"P Connes","year":"2011","journal-title":"Clin Hemorheol Microcirc"},{"key":"pone.0250128.ref008","article-title":"Physical exercise in sickle cell anemia: a systematic review","author":"DMS Pinto","year":"2020","journal-title":"Hematol Transf Cell Therapy"},{"key":"pone.0250128.ref009","doi-asserted-by":"crossref","first-page":"1309","DOI":"10.1164\/rccm.2002036","article-title":"Cardiopulmonary responses to exercise in women with sickle cell anemia","volume":"165","author":"LA Callahan","year":"2002","journal-title":"Am J Respir Crit Care Med"},{"key":"pone.0250128.ref010","doi-asserted-by":"crossref","first-page":"124","DOI":"10.1111\/bjh.12594","article-title":"Moderate endurance exercise in patients with sickle cell anaemia: effects on oxidative stress and endothelial activation","volume":"164","author":"C Fa\u00ebs","year":"2014","journal-title":"Br J Haematol"},{"issue":"11","key":"pone.0250128.ref011","doi-asserted-by":"crossref","first-page":"e554","DOI":"10.1016\/S2352-3026(18)30163-7","article-title":"Moderate-intensity endurance-exercise training in patients with sickle-cell disease without severe chronic complications (EXDRE): an open-label randomised controlled trial","volume":"5","author":"B Gellen","year":"2018","journal-title":"Lancet Haematol"},{"key":"pone.0250128.ref012","first-page":"e69","article-title":"Home-based cardiac rehabilitation: a scientific statement from the American Association of Cardiovascular and Pulmonary Rehabilitation, the American Heart Association, and the American College of Cardiology","volume":"140","author":"RJ Thomas","year":"2019","journal-title":"Journal of The American College of Cardiology"},{"key":"pone.0250128.ref013","doi-asserted-by":"crossref","first-page":"b5631","DOI":"10.1136\/bmj.b5631","article-title":"Home based versus centre based cardiac rehabilitation: Cochrane systematic review and meta-analysis","volume":"340","author":"HM Dalal","year":"2010","journal-title":"BMJ"},{"issue":"167","key":"pone.0250128.ref014","first-page":"211","article-title":"Statement on cardiopulmonary exercise testing","volume":"2","author":"American Thoracic Society, American College of Chest Physicians","year":"2003","journal-title":"Am J Respir Crit Care Med"},{"issue":"7","key":"pone.0250128.ref015","doi-asserted-by":"crossref","first-page":"1334","DOI":"10.1249\/MSS.0b013e318213fefb","article-title":"American College of Sports Medicine position stand. Quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults: guidance for prescribing exercise","volume":"43","author":"CE Garber","year":"2011","journal-title":"Med Sci Sports Exerc"},{"issue":"1","key":"pone.0250128.ref016","doi-asserted-by":"crossref","first-page":"84","DOI":"10.1016\/0002-9149(92)90680-W","article-title":"Comparison of ischemic and physiologic responses during exercise tests in men using the standard and modified bruce protocols","volume":"69","author":"K. J. McInnis","year":"1992","journal-title":"The American Journal of Cardiology"},{"issue":"10","key":"pone.0250128.ref017","first-page":"753","article-title":"Does the modified Bruce protocol induce physiological stress equal to that of the Bruce protocol?","volume":"13","author":"M Trabulo","year":"1994","journal-title":"Revista Portuguesa de Cardiologia: Orgao Oficial da Sociedade Portuguesa de Cardiologia = Portuguese Journal of Cardiology: an Official Journal of the Portuguese Society of Cardiology"},{"issue":"1","key":"pone.0250128.ref018","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1249\/00005768-199401000-00017","article-title":"Comparison of submaximal exercise responses using the Bruce vs modified Bruce protocols","volume":"26","author":"KJ McInnis","year":"1994","journal-title":"Medicine and Science in Sports and Exercise"},{"key":"pone.0250128.ref019","doi-asserted-by":"crossref","first-page":"532","DOI":"10.1111\/ejh.13140","article-title":"Exercise capacity and clinical outcomes in adults followed in the Cooperative Study of Sickle Cell Disease (CSSCD)","volume":"101","author":"SM Badawy","year":"2018","journal-title":"Eur J Haematol"},{"issue":"2","key":"pone.0250128.ref020","doi-asserted-by":"crossref","first-page":"134","DOI":"10.1590\/S1517-86922013000200013","article-title":"Estimation of metabolic equivalent (MET) of an exercise protocol based on indirect calorimetry","volume":"19","author":"CF Coelho-Ravagnani","year":"2013","journal-title":"Rev Bras Med Esporte"},{"issue":"2","key":"pone.0250128.ref021","first-page":"358","article-title":"Recommendations for quantitation of the left ventricle by two-dimensional echocardiography. American Society of Echocardiography Committee on Standards, Subcommittee on Quantitation of Two-Dimensional Echocardiograms. Official Publication of the American Society of Echocardiography","volume":"5","author":"NB Schiller","year":"1998","journal-title":"Jour of the Amer. Society of Echocardiog"},{"issue":"2","key":"pone.0250128.ref022","doi-asserted-by":"crossref","first-page":"160","DOI":"10.1002\/ajh.20238","article-title":"Echocardiographic abnormalities in Brazilian sickle cell patients","volume":"78","author":"P Vicari","year":"2005","journal-title":"Am J Hematol"},{"issue":"4","key":"pone.0250128.ref023","first-page":"e30","article-title":"Sickle-cell Anemia and Latent Diastolic Dysfunction: Echocardiographic Alterations","volume":"104","author":"Oliveira Daniela Camargo Fattori Andr\u00e9","year":"2015","journal-title":"Arq. Bras. Cardiol"},{"issue":"Supplement_1","key":"pone.0250128.ref024","doi-asserted-by":"crossref","first-page":"4837","DOI":"10.1182\/blood-2019-128390","article-title":"Min Jung Kim, Agnes S Kim; Assessment of Cardiac Abnormalities in Sickle Cell Disease Patients Using Echocardiography","volume":"134","author":"Osama Mukarram","year":"2019","journal-title":"Blood"},{"key":"pone.0250128.ref025","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1007\/s00277-009-0764-0","article-title":"Echocardiographic findings in patients with sickle cell disease","volume":"89","author":"S.G. Naoman","year":"2010","journal-title":"Ann Hematol"},{"issue":"7","key":"pone.0250128.ref026","doi-asserted-by":"crossref","first-page":"1526","DOI":"10.1001\/archinte.1988.00380070044011","article-title":"Sickle Cell Heart Disease: Two-Dimensional Echo and Doppler Ultrasonographic Findings in the Hearts of Adult Patients with Sickle Cell Anemia","volume":"148","author":"BE Simmons","year":"1988","journal-title":"Arch Intern Med"},{"issue":"135","key":"pone.0250128.ref027","first-page":"1","article-title":"Cardiovascular effects and benefits of exercise","volume":"5","author":"MA Nystoriak","year":"2018","journal-title":"Front Cardiov Med"},{"issue":"25","key":"pone.0250128.ref028","doi-asserted-by":"crossref","first-page":"352","DOI":"10.1159\/000087184","article-title":"Exercise training in patients receiving maintenance hemodialysis: a systematic review of clinical trials","volume":"4","author":"BS Cheema","year":"2005","journal-title":"Am J Nephrol"},{"issue":"19","key":"pone.0250128.ref029","doi-asserted-by":"crossref","first-page":"1067","DOI":"10.1002\/ejhf.862","article-title":"Exersice training in diastolic heart failure (Ex-DHF): rationale and design of a multicentre, prospective, randomized, controlled, parallel group trial","volume":"8","author":"F Edelmann","year":"2017","journal-title":"Eur J of Heart Failure"},{"issue":"37","key":"pone.0250128.ref030","first-page":"393","article-title":"Endothelial dysfunction in patients with chronic heart failure: systemic effects of lower-limb exercise training","volume":"2","author":"A Linke","year":"2001","journal-title":"J Am Coll Cardiol"},{"issue":"11","key":"pone.0250128.ref031","doi-asserted-by":"crossref","first-page":"69","DOI":"10.2147\/JIR.S158294","article-title":"Exercise-induced changes in stress hormones and cell adhesion molecules in obese men","author":"J Park","year":"2018","journal-title":"J Inflamm Res"},{"key":"pone.0250128.ref032","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1016\/j.bcmd.2017.06.002","article-title":"Moderate exercise training decreases inflammation in transgenic sickle cell mice","volume":"69","author":"E. Charrin","year":"2018","journal-title":"Blood Cells Mol. Dis"},{"issue":"6","key":"pone.0250128.ref033","doi-asserted-by":"crossref","first-page":"501","DOI":"10.1016\/S1474-4422(06)70469-0","article-title":"Pathophysiology and treatment of stroke in sickle-cell disease: present and future","volume":"5","author":"JA Switzer","year":"2006","journal-title":"The Lancet Neurology"},{"issue":"11","key":"pone.0250128.ref034","doi-asserted-by":"crossref","first-page":"502","DOI":"10.1016\/S2352-3026(18)30178-9","article-title":"Exercise training: a prescription for sickle-cell disease","volume":"5","author":"GJ Kato","year":"2018","journal-title":"The Lancet Haematology"},{"issue":"110","key":"pone.0250128.ref035","doi-asserted-by":"crossref","first-page":"543","DOI":"10.1126\/science.110.2865.543","article-title":"Sickle cell anemia, a molecular disease","author":"L Pauling","year":"1949","journal-title":"Science"},{"issue":"377","key":"pone.0250128.ref036","first-page":"302","article-title":"Sickle cell disease","author":"B Inusa","year":"2017","journal-title":"N Engl J Med"},{"key":"pone.0250128.ref037","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1080\/13557858.2011.552712","article-title":"Race and social attitudes about sickle cell disease","volume":"16","author":"SM Bediako","year":"2011","journal-title":"Ethnicity Health"},{"key":"pone.0250128.ref038","doi-asserted-by":"crossref","first-page":"214","DOI":"10.1136\/bjsports-2015-095317","article-title":"Does physical activity increase or decrease the risk of sickle cell disease complications?","volume":"52","author":"C Martin","year":"2018","journal-title":"Br J Sports Med Br J Sports Med"},{"key":"pone.0250128.ref039","doi-asserted-by":"crossref","first-page":"e26671","DOI":"10.1002\/pbc.26671","volume":"64","author":"RI Liem","year":"2017","journal-title":"Pediatr Blood Cancer"},{"key":"pone.0250128.ref040","doi-asserted-by":"crossref","first-page":"1257","DOI":"10.1002\/ajh.25936","article-title":"Muscle structural, energetic and functional benefits of endurance exercise training in sickle cell disease","volume":"95","author":"NA Merlet","year":"2020","journal-title":"Am J Hematol"},{"issue":"9","key":"pone.0250128.ref041","first-page":"1795","article-title":"Physiological Evaluation for Endurance Exercise Prescription in Sickle Cell Disease","volume":"51","author":"LA Messonnier","year":"2019","journal-title":"Med. Sci. Sports"},{"issue":"1","key":"pone.0250128.ref042","doi-asserted-by":"crossref","first-page":"111","DOI":"10.4314\/ahs.v18i1.15","article-title":"Impact of aerobic exercises on selected inflammatory markers and immune system response among patients with sickle cell anemia in asymptomatic steady state","volume":"18","author":"SM Abd El-Kader","year":"2018","journal-title":"Afri Health Sci"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0250128","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,12,27]],"date-time":"2022-12-27T05:04:30Z","timestamp":1672117470000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0250128"}},"subtitle":[],"editor":[{"given":"Walid Kamal","family":"Abdelbasset","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2021,5,12]]},"references-count":42,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2021,5,12]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0250128","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,5,12]]}}}