Exercise and Thalassemia
Elijah Goldberg, Ashutosh Lal MD, Shannon Gaine PNP, Ellen Fung Phd, RD
Children's Hospital Oakland Research Institute and Department of Hematology/Oncology, UCSF Benioff Children's Hospital Oakland
What is Exercise?
Exercise is any activity that requires physical exertion. This can include aerobic activities such as running, biking, and rowing in addition to weight bearing activities such as walking, lifting weights, or any other activity that increases your heart rate. The Center for Disease Control (CDC) gives a list of moderate-intensity exercises (1), which can include:
- Active recreation, such as canoeing, hiking, cross-country skiing, skateboarding, rollerblading
- Brisk walking
- Bicycle riding (stationary or road bike)
- House and yard work such as sweeping or pushing a lawn mower
- Playing games that require catching and throwing, such as baseball, softball, basketball and volleyball
Bone strengthening exercises:
- Hopping, skipping, jumping
- Jumping rope
- Sports such as gymnastics, basketball, volleyball, tennis
Light intensity activities can include:
- Slow walking
- Cooking food
- Washing dishes
- Putting away groceries
Why is Exercise Important?
To say exercise is one of the most important things in life is not an over-exaggeration; we were made to do physically strenuous activity. Exercise not only has pronounced physical effects such as increasing bone strength (2), muscle strength, and cardiovascular ability (2) (heart strength), but mental effects as well: A recent scientific review (3) found that exercise significantly reduced anxiety and depression. It also:
- Improved sleep
- Increased endurance
- Aided in stress relief
- Increased energy and stamina
- Reduced tiredness
- Increased mental alertness
- Aided in weight reduction
- Reduced cholesterol and improved cardiovascular fitness
Why is Exercise Especially Important for Thalassemia Patients?
Many individuals with thalassemia do not meet the recommendations for daily activity. This explains, in part, why bone strength is often lower than normal in patients with thalassemia, and further reinforces the point that exercise is crucial for patient health. For those with intermittent or frequent fatigue, or pain, light and moderate intensity activities are the most effective forms of exercise. Individuals who can also tolerate intensive exercise should be encouraged to maintain that level of physical fitness.
A recent study (4) looked into how exercise affects bone in children, and the results were remarkable. Children who followed an exercise regimen that included jumping significantly improved their bone mass compared with those who only participated in stretching, without weightbearing activity. The study concluded that exercise improves bone accrual by over 1% per year. With these increases compounded over multiple years, the gains are not to be dismissed offhand; in patients with thalassemia, the difference of a few percent can be the difference between a bruise and a fracture. Just a small amount of physical activity every day can greatly reduce your risk.
The effect of exercise is just as pronounced in adults; a large review study (5) found that aerobic exercise and high intensity resistance training consistently preserved or increased spine and hip Bone Mineral Density (BMD). Despite the fact that most adults have reached their genetic potential for peak bone mass and therefore are no longer actively increasing bone mass, maintenance (exercise) is still highly recommended as it improves muscle mass, balance and greatly reduces the risk of long term fracture. For a more detailed discussion of bone health in thalassemia, see this reference (6) on osteoporosis in Thalassemia.
How much exercise do I need to do?
The CDC recommends 60+ minutes of aerobic activity per day for children and adolescents, in addition to bone and muscle strengthening activities such as doing push-ups, or jumping rope (7).
For adults, the CDC advises a minimum of 150 minutes of moderate activity (such as brisk walking) every week, in addition to extra muscle strengthening activities such as lifting weights (8).
In reality, guidelines such as these may not be feasible for all patients with thalassemia, and that's okay. The important thing is to be doing what you can, when you can. Even a little light to moderate exercise every day may, over an extended period of time, drastically reduce overall risk of fracture (4) or osteoporosis, and increase overall physical and emotional health.
Individuals who have pain in their back or legs, or those who have a history of fracture, should talk with their healthcare provider before starting a new exercise program to reduce risk of injury.
What can I do at home?
Going out and walking or running every single day can sometimes be too much, so it can be good to have some activities that can be done at home. Here's a short list of possible activities:
- Jump rope
- Push-ups (can be modified to have knees on floor)
- Jumping jacks
- Jumping in place
- Sit ups
- Resistance band training
For a more detailed and personally tailored list, getting in contact with a personal trainer or physical therapist may be advised.
Where can I go to do exercise?
Dynamic exercising can vastly alter the experience of doing physical activity, and make a once-boring activity fun again. Connecting with your local or regional park can be a valuable asset. While you will likely have to look up possible resources in your area, here are a short list of parks and recreational facilities around Berkeley and Oakland.
Clicking the name of any park will bring up a google maps search directly to that park.
Tilden Park: 2501 Grizzly Peak Boulevard, Orinda, CA 94563
Tilden is a beautiful park with plenty of places to hike, walk, and climb. It also includes a golf course and a little farm which has a variety of cute animals, in addition to many miles of sprawling and gorgeous earthy terrain.
FROG Park: 5500 Claremont Ave, Oakland, CA 94618
With multiple play structures and a bunch of room to walk or run around in, FROG park can be an excellent resource for a bit of daily exercise.
Colby Park: 422 61st St, Oakland, CA 94609
Smaller than either FROG Park or Tilden Park, Colby still a quaint area to do some exercise or just relax.
Joaquin Miller Park: 3300 Joaquin Miller Rd, Oakland, CA 94602
Containing over 500 acres of woodland, Joaquin Miller Park has been described as "... a gem of history in the Oakland hills." With plenty of paths and beautiful scenery, this park can provide ample exercise for an indefinite amount of time.
Cordonices Park: 1201 Euclid Ave, Berkeley, CA 94708
With plenty of structures, slides, and stairs, this park is a definite blast whether you're looking for a brisk walk or a Quidditch match.
Redwood Regional Park: 7867 Redwood Road, Oakland, CA 94619
With trees up to 93 feet tall, Redwood Regional Park contains the largest amount of natural standing coast redwood in the East Bay. This beautiful park is a definite must-see, with shady trails and numerous historical landmarks.
- Aerobic, Muscle- and Bone-Strengthening: What Counts?. Centers for Disease Control and Prevention, 05 June 2015.
- Progressive skeletal benefits of physical activity when young as assessed at the midshaft humerus in male baseball players. Warden, S.J., Weatherholt, A.M., Gudeman, A.S. et al. Osteoporos Int (2017) 28: 2155. doi:10.1007/s00198-017-4029-9
- Exercise for Mental Health. Sharma A, Madaan V, Petty FD. Primary Care Companion to The Journal of Clinical Psychiatry. 2006;8(2):106.
- Does Exercise Influence Pediatric Bone? A Systematic Review. Specker B, Thiex NW, Sudhagoni RG. Clinical Orthopaedics and Related Research. 2015;473(11):3658-3672. doi:10.1007/s11999-015-4467-7.
- Exercise effects on bone mineral density in older adults: a meta-analysis of randomized controlled trials. Marques EA, Mota J, Carvalho J. Age. 2012;34(6):1493-1515. doi:10.1007/s11357-011-9311-8.
- New insights into the pathophysiology and management of osteoporosis in patients with beta thalassaemia. Voskaridou, E. and Terpos, E. (2004). British Journal of Haematology, 127: 127–139. doi:10.1111/j.1365-2141.2004.05143.x
- How Much Physical Activity Do Children Need? Centers for Disease Control and Prevention, 04 June 2015.
- How Much Physical Activity Do Adults Need? Centers for Disease Control and Prevention, 04 June 2015.