EXERCISE RESPONSE IN OMANI CHILDREN WITH SICKLE CELL DISEASE

Exercise Response in Omani Children with Sickle Cell Disease

by

Mahfoodha AL Kitani

A thesis submitted for the degree of Doctor of Philosophy

University of Bath

School for Health

COPYRIGHT

Attention is drawn to the fact that copyright of this thesis rests with its author. This copy of the thesis has been supplied on condition that anyone who consults it is understood to recognise that its copyright rests with its author and that no quotation from the thesis and no information derived from it may be published without the prior written consent of the author. The thesis may be made available for consultation within the University Library and may be photocopied or lent to other libraries for the purpose of consultation.

Signature of author:………………

Abstract

In this study we try to explore the concept of “Sickle Cell Disease” in a holistic context. The main focus of the research is on “Sickle Cell Disease” and its relation with “Exercise Response”. The research also analyzes many aspects of “Sickle Cell Disease” and tries to gauge its effect on “Exercise Response”.

ACKNOWLEDGEMENTS

I would take this opportunity to thank my research supervisor, family and friends for their support and guidance without which this research would not have been possible.

Table of Content

ABSTRACT3

ACKNOWLEDGEMENTS4

CHAPTER 1: INTRODUCTION8

Statement of the problem9

Literature review:11

Sickle Cell Disease (SCD):11

Function14

HbSS RBC17

Pathogenesis of sickle cell disease:18

Factors effect sickling:21

How the sickle gene persists?23

Epidemiologically:24

Geographically:24

Types of Sickle Cell Disease:25

Treatment of sickle cell disease:28

Sickle Cell Trait:28

Role of growth and maturation:31

Growth, Maturation and Physical activity:32

Changes in physical parameters during maturity:33

Body composition:33

Assessing growth and maturation:35

Non invasive measure:37

Growth & Maturation in children with SCD38

Assessing physical activity and performance:41

Subjective measures:41

Objective measures:42

Direct observation:45

Exercise performance in SCD/SCT45

Factors limiting exercise performance in SCD/SCT50

CHAPTER 2: MATERIAL AND METHODS53

Introduction54

Anthropometry54

Physical Activity Questionnaire55

Maturation:56

20m Multistage fitness test: study 257

Treadmill exercise test: study 2 & 358

Blood sampling:59

Blood analysis:59

CHAPTER 3: PHYSICAL FITNESS PROFILES IN OMANI CHILDREN WITH SICKLE CELL DISEASE/TRAIT61

Introduction:61

Subjects and Methods:63

Treadmill exercise test64

Heart rate and blood sampling:64

Index of physical fitness:65

Statistical analysis:65

Results:65

Anthropometrics measurements:66

Index of physical fitness:67

Blood analysis:69

Blood lactate70

Discussion:71

APTER 4: CARDIOVASCULAR RESPONSES TO EXERCISE IN SCD/SCT AND NORMAL OMANI CHILDREN76

Introduction76

Subjects79

Body Composition80

Haematological indices80

Maturation and physical activity assessment81

Treadmill exercise test:81

Multistage fitness test (MFT):82

Statistical analysis:82

Results:82

Anthropometric measurements and body composition:82

Physical activity questionnaire:84

Results from Maturation measurement:84

Haematological measurements:84

Multistage fitness test:93

Discussion:94

Body composition:97

Haematological indices:99

Study limitations:100

Conclusion:100

CHAPTER 5: EFFECT OF ACUTE BOUT OF EXERCISE ON IL-6 CONCENTRATION IN OMANI CHILDREN WITH SICKLE CELL DISEASE102

Introduction102

Subjects:103

Anthropometric measures:104

Haematological indices:105

Treadmill exercise test:105

Statistical analysis:106

Results:106

Anthropometric and body composition measurements106

Haematological measures107

Physical activity and maturation108

Changes in heart rate109

Changes in interlukine -6 (IL-6):110

Discussion:111

Effect of exercise on postprandial lipemia and markers of inflammation in children with sickle cell disease112

INTRODUCTION112

Aims of the study:116

Methods:117

Anthropometric measurements:118

Research Design118

Experimental trails:119

Statistical Analysis120

Results:120

Blood sampling and analyses133

Conclusion135

REFERENCES140

LIST OF FIGURES

Figure 1: Morphological differences between normal blood cell and sickle cell (www.sicklecellinfo.com)13

Figure 2: Mode of inheritance14

Figure 3.22

Figure 4: the inheritance of SCT31

Figure 5:53

Figure 6:………………………………………………………………………………………….91

Figure 7:………………………………………………………………………………………….96

Figure 8: Means ± SD of Hb in SCD, SCT and Normal children87

Figure 9: Mean ± SD of Hct in SCD, SCT and normal children88

Figure 10: Mean ± SD of WBC in children with SCD, SCT and Normal88

Figure 11: Mean ± SD of RBC in SCD, SCT and Normal children89

Figure 12: Mean ...