Reduced Physical Activity In Adult and Pediatric Patients with Thalassemia

Abstract

5174 The U.S. Government's “2008 Physical Activity Guidelines for Americans” recommends children perform at least 60 minutes of moderate to vigorous intensity physical activities (PA) a day while the recommendation for adults is 30 minutes per day at least 5 days a week. As fewer Americans meet these guidelines, it is unknown where patients with thalassemia (Thal) stand. Based on anecdotal evidence, it is assumed that patients with Thal have decreased PA due to their severe anemia and cardiomyopathies secondary to iron overload. However, there is a paucity of objective data on physical activity patterns in Thal. The primary objective of this prospective observational study is to examine PA patterns in a small group of representative patients with Thal using a 3-dimensional accelerometer, compared to age-matched national reference data. Additionally we will explore the relationship between PA and body composition. Methods: Nine pediatric (4 M; 13.8 ± 1.7 yrs) and 10 adult (6M, 31.0 ± 8.4 yrs) patients were provided an Actigraph GT3X accelerometer to wear for 7 days on 2 separate occasions, 3 months apart. Partial results from the baseline measurement will be presented here. Accelerometer output, defined as counts or records of acceleration, was valid if the patient wore the Actigraph for >10 hrs/day for at least 3 weekdays and 1 weekend day. Based on published criteria using mean counts per minute, time spent in sedentary, moderate and vigorous physical activity intensity was compared to National Health and Nutrition Examination Survey (NHANES) data from 2003–2004 and to the 2008 PA guidelines. Whole body lean and fat mass was assessed by Dual Energy X-ray Absorptiometry. Lean mass index (LMI = kg/m2) Z-score was calculated and compared to national averages from the NHANES study. Results: Preliminary results show that Thal are less active than their healthy counterparts. Adults with Thal spend less time in vigorous intensity activities compared to the pediatric patients (p<0.05). Both groups spend more sedentary time per day than their age-matched reference group (Adult Male Thal: 9.3± 0.8 vs. NHANES: 7.2±0.13 hrs/day; Females: 12.1± 5.2 vs. 7.5±0.9 hrs/day, Pediatric Female Thal: 12.1±0.4 vs. 7.7±0.08 hrs/day). The mean counts per minute in Thal was less than in their healthy counterparts (Adult Male Thal: 211 ± 27.4 vs. NHANES: 385.7 counts/min; Adult Female: 282 ± 73.5 vs. 378.1±17.6 counts/min; Pediatric Female: 170 ± 82 vs. 309.7± 5 counts/min) indicating less overall PA. Only 12.5% of Thal met the PA guidelines for moderate and vigorous intensity PA for their age. LMI Z-scores were significantly lower than reference data for both pediatric and adult patients (p<0.001) indicating lower lean mass than in the general population. There appears to be a relationship between lean mass and physical activity but more patients will be needed to assess this relationship. In conclusion, we have shown that Thal are less physically active and have significantly reduced muscle mass compared to the general US population. Physical activity may improve patients' quality of life (reduce depression, pain, improve sleep) and reduce comorbidities associated with the disease (muscle wasting, low bone mass, diabetes). However, more research is needed with larger samples to relate these measures of PA with functional patient outcomes. This research was funded in part by a grant from the Cooley's Anemia Foundation. Disclosures: No relevant conflicts of interest to declare.

Cardiopulmonary testing in adult patients with β-thalassemia major in comparison to healthy subjects

“…Poor physical fitness is a common feature among thalassemia patients. Several reports have shown that patients with thalassemia have lower mean scores of quality of life (QoL) than healthy subjects [ 18 , 19 ] and that especially the mean scores for physical activity were lower than scores of other dimensions [ 20 ].…”

“…It is known that thalassemia patients are less physically active and have significantly reduced muscle mass compared to the general population [ 19 ]. In our study, the filling of IPAQ questionnaire confirms that only a small percentage of them (27.8%) spend time in vigorous intensity activities and that moderate/vigorous PA is associated with best V’O 2 peak values.…”

Depression Leads to Physical Inactivity in Patients with Beta-Thalassemia Major

“…There is no significant difference in the physical activity performed pre-transfusion and posttransfusion. 11 This can be caused by depression, 25 low levels of Hb in the long term, 26 the buildup of iron due to repeated blood transfusions and not taking iron-chelating drugs, 27 and pain resulting from bone marrow expansion and loss of bone mass. 28 Many factors can make BTM patients more susceptible to depression and low physical activity, including the impact of therapy and transfusions.…”

“…10 Both pediatric and adult thalassemia sufferers spend more time with a sedentary lifestyle per day than their age group. 11 Thalassemia sufferers with depression experience decreased quality of life and almost two times the risk of limiting physical activity when compared to patients without depression. 3 Research conducted by Gariépy et al 11 stated that only 12.5% of thalassemia patients performed moderate and vigorous activity following the recommendations of the Physical Activity Guidelines.…”