# Exercise as it relates to Disease/Exercise implications for red cell deformity in patients with COPD

This is an analysis of the journal article "Influence or a moderate physical activity intervention on red cell deformability in patients suffering from chronic obstructive pulmonary disease (COPD)" by Ahmad et al., (2013)

## What is the background to this research?

Chronic obstructive pulmonary disease is "a serious, progressive and disabling condition that limits airflow in the lungs". COPD is a serious public health concern. In 2013 COPD was labelled the fifth leading cause of death in Australia with 4.4% of Australians passing away from the disease. As sedentary lifestyles become more common, the risk for COPD symptoms to have a larger impact on sufferers becomes greater. The research analysed attempts to assess the correlation between exercise and the symptomatic effects of COPD.
Red blood cells are responsible for gas transportation in the blood stream and are able to do so by their deformability. RBC's are able to change shape reversibly allowing them to flow through micro-vessels. Positively altering RBC deformability will enhance the patients gas transportation and reduce the symptomatic effects of COPD by increasing oxygen intake to the cells. RCD is an important factor in COPD due to the reduced lung capacity. Should RCD be altered positively, the patient will have an improved gas exchange.
The testing method for the research involved using gym equipment to perform strength and endurance exercise. The exercises involved can be modified to accommodate the fragility of older aged subjects. Furthermore, the exercises performed do not have to include expensive gym machines, rather any strength or endurance aspect which raises heart rate in order to improve circulation, VO2 intake etc. For the purpose of this testing, machines were used for the involved exercises.

## Where is the research from?

Ahmed etc. al., from the University of Cologne, Germany conducted this research in Cologne, Germany with focus on a controlled setting with access to the inhalation of Spiriva, an anti-cholinergic substance designed to prevent bronchoconstiction.

## What kind of research was this?

This is a qualitative research study, involving the use of venous blood samples and laser-assisted optical rotational cell analyser (LORCA) to measure red cell deformability.

## What did the research involve?

A random sample of 13 COPD patients were chosen through newspapers, advertisements and brochures by medical specialists. 10 COPD patients took part in the study due to 3 subjects missing more than 2 training units. The subjects (n=10; 5 males, 5 females; age 62±4 years; BMI 25.8±7) voluntarily signed up for a 10-week intervention which consisted of 2 x 60 minute training periods a week. The subjects were classed into 2 categories based their current breathing capabilities. Both groups were subjected to strength exercises, endurance exercises, breathing exercises and joint mobility movements. The Borg (6-20) scale was used to determine the difficulty of the exercise.

## What were the basic results?

Ahmed et al., found that the anthropometric data of the exercise intervention; BMI, physical fitness, lactate level, heart rate and blood pressure did not change significantly. The RCD altered significantly after the training period at the measurement times T1 (immediately after exercise) and T2 (30 minutes after exercise) but not in T0 (before exercise). In all measurements, no differences between male and female patients could be verified. The results show a significantly increased RCD after the 10 week intervention suggesting an improvement in microcirculation.

## How did the researchers interpret the results?

The researcher's interpretation of the results shows a positive correlation between strength and endurance exercise and increased RCD in COPD patients. Considerations were noted during the study. Almost every subject inhaled an unknown quantity of Spiriva (anti-cholinergic substance designed to prevent bronchoconstriction). Some patients had to take more unknown drugs than others due to the seriousness of their disease and their inability to perform the exercises without them. The researcher's acknowledge the change of RCD in the results was possibly influenced by the Spiriva and additional drugs. However, due to the same changes of RCD shown by every subject, the influence of the medication had minor importance.
As stated in the study, some patients were "hardly resilient" in reference to pushing through physical barriers. The Borg scale results show an average of 12-14 score directly prior to the subjects withdrawing from the specific exercise. The results were completely reliant on the subjects willingness to continue the exercises. This needs to be factored into the results as mindset and determination was not accounted for prior to the study.

## What conclusions should be taken away from this research?

Exercise can potentially increase RCD and microvessel blood flow COPD patients as long as those are willing to do regular exercise to maintain fitness and general health. There has been insufficient evidence undertaken to support the claim that exercise benefits RCD in COPD patients. Recently, a cross-link between exercise and RCD, and between exercise and COPD symptoms has been found. Recent studies have shown a lack of regular exercise results in a reduction of blood flow to areas of the brain potentially resulting in the unwillingness to continue post-study.

## What are the implications of this research?

The research shows that strength and endurance exercise interventions can improve RCD in COPD patients to deal with the symptomatic effects of the disease and promote/maintain general fitness. However, due to the frequency and difficulty of the exercises, these outcomes are contingent on the willingness of the subjects to continue their training regimes. Whilst the testing method involved gym equipment, patients can complete strength and endurance exercises by other means in order to promote their health and fitness.

## Further reading

For further readings on red cell deformability and exercise in COPD patients please click on the below links;
Red blood cells in sports: effects of exercise and training on oxygen supply by red blood cells - http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3824146/
Effects of swimming exercise on red blood cell rheology in trained and untrained rats - https://www.ncbi.nlm.nih.gov/pubmed/10846020

## References

* 1 2 3 4 5 Ahmad, B., Ferrari, N., Montiel, G., Bloch, W., Raabe-Oetker, A., Skrobala, N., & Brixius, K. (2013). Influence of a moderate physical activity intervention on red cell deformability in patients suffering from chronic obstructive pulmonary disease (COPD). Wiener Medizinische Wochenschrift, 163(13-14), 334–339. doi:10.1007/s10354-013-0183-7
* 1 2 Health and Welfare, A. I. of. (2016). COPD — chronic obstructive pulmonary disease (AIHW). Retrieved September 22, 2016, from AIHW, http://www.aihw.gov.au/copd/
* ↑ Barnes, A. S. (2012). Obesity and sedentary lifestyles. Obesity and Sedentary Lifestyles, 39(2), 224–227.
* 1 2 3 Unknown. (2014, May). Chronic Obstructive Pulmonary Disease (COPD) and exercise. Retrieved September 26, 2016, from Exercise is Medicine Australia, http://exerciseismedicine.org.au/wp-content/uploads/2014/05/2014-COPD-FULL.pdf
* ↑ Kim, J., Lee, H., & Shin, S. (2015). Advances in the measurement of red blood cell deformability: A brief review. Journal of Cellular Biotechnology, 1(1), 63–79. doi:10.3233/JCB-15007
* ↑ Mairbäurl, H. (2013). Red blood cells in sports: Effects of exercise and training on oxygen supply by red blood cells. Frontiers in Physiology, 4(332), . doi:10.3389/fphys.2013.00332
* ↑ HigueraMedically, V. (2005). Exercise for COPD. Retrieved September 26, 2016, from healthline, http://www.healthline.com/health/copd/exercise
* ↑ Government, A. (2013, February). Physical activity guidelines for older adults. Retrieved September 27, 2016, from Health Direct, https://www.healthdirect.gov.au/physical-activity-guidelines-for-older-adults
* ↑ BERNARD, S., LeBLANC, P., WHITTOM, F., CARRIER, G., JOBIN, J., BELLEAU, R., & MALTAIS, F. (1998). Peripheral muscle weakness in patients with chronic obstructive pulmonary disease. American Journal of Respiratory and Critical Care Medicine, 158(2), 629–634. doi:10.1164/ajrccm.158.2.9711023
* ↑ Smith, J. (1995). Exercise, training and red blood cell turnover. Sports medicine (Auckland, N.Z.)., 19(1), 9–31. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/7740249
* ↑ Mador, M., Krauza, M., & Shaffer, M. (2012). Effect of exercise training in patients with chronic obstructive pulmonary disease compared with healthy elderly subjects. Journal of cardiopulmonary rehabilitation and prevention., 32(3), 155–62. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/22487615
* ↑ Alfini, A. J., Weiss, L. R., Leitner, B. P., Smith, T. J., Hagberg, J. M., & Smith, C. J. (2016, August 29). Use it or lose it: UMD SPH study shows that stopping exercise decreases brain blood flow. Retrieved September 27, 2016, from University of Maryland, https://sph.umd.edu/news-item/use-it-or-lose-it-umd-sph-study-shows-stopping-exercise-decreases-brain-blood-flow