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Effect of Army Basic Training in Sickle-Cell Trait

Effect of Army Basic Training in Sickle-Cell Trait Abstract • In order to determine if sickle-cell trait (SCT) represents an inherent adverse effect on response to training, we objectively evaluated exercise performance in 22 healthy, black men with SCT (hemoglobin AS) and 15 controls (hemoglobin AA) before and after seven weeks of army basic training at an altitude of 1270 m. An incremental exercise test to exhaustion on a cycle ergometer was used. Before basic training, peak exercise measurements did not reveal significant differences between groups other than a slightly lower, albeit significant, value for oxygen uptake (Vo2) per kilogram (42±1 vs 45±1.4 mL/min per kilogram) for the SCT group. Both groups experienced modest overall cardiovascular improvement reflected in both peak and submaximal exercise responses. No statistically significant difference was observed between the SCT and the control groups at the end of basic training for any of the measured variables at peak exercise, including power (258±6 vs 266±9W), Vo2 (3.24±.06 vs 3.36±.16 L/min), Vo2 per kilogram (46±0.7 vs 46±1.2), minute ventilation (138±4 vs 147±8 L/min), heart rate (185±2 vs 184±3 beats per minute), oxygen pulse (17.6±.3 vs 18.4±1 mL/min per beat), as well as anaerobic threshold (1.81±.04 vs 1.80±.06 L/min), respectively. No medical problems directly attributed to SCT were reported; it remains uncertain, however, whether a seizure experienced by one of the other SCT basic trainees after a two-mile run was SCT related. The results of this study would, therefore, suggest that for the majority of individuals who possess SCT, the response to the moderate training regimen provided by army basic training is not impaired. (Arch Intern Med 1988;148:1140-1144) References 1. Sears DA: The morbidity of sickle cell trait: A review of the literature. Am J Med 1978;64:1021-1036.Crossref 2. Diggs LW: The sickle cell trait in relation to the training and assignment of duties in the armed forces: I. Policies, observations, and studies. Aviat Space Environ Med 1984;55:180-185. 3. Jones SR, Binder RA, Donowho EM: Sudden death in sickle cell trait. N Engl J Med 1970;282:323-325.Crossref 4. Koppes GM, Daly JJ, Coltman CA Jr, et al: Exertion-induced rhabdomyolysis with acute renal failure and disseminated intravascular coagulation in sickle cell trait: Case report. Milit Med 1974;139:313-315. 5. Helzlsouer KJ, Hayden FG, Rogal AD: Severe metabolic complications in a cross-country runner with sickle cell trait. JAMA 1983;249:777-779.Crossref 6. Kark JA, Posey DM, Schumacher HR, et al: Sickle-cell trait as risk factor for sudden death in physical training. N Engl J Med 1987;317:781-787.Crossref 7. Francis CK, Bleakley DW: The risk of sudden death in sickle cell trait: Noninvasive assessment of cardiac response to exercise. Cathet Cardiovasc Diagn 1980;6:73-80.Crossref 8. Robinson JR, Stone WJ, Asendorf AC: Exercise capacity of black sickle cell trait males. Med Sci Sports Exerc 1976;8:244-245.Crossref 9. Alpert BS, Flood NL, Strong WB, et al: Responses to exercise in children with sickle cell trait. AJDC 1982;136:1002-1004. 10. Weisman IM, Zeballos J, Johnson BD, et al: The cardiopulmonary effects of stressful exercise at 4000 ft of individuals with sickle cell trait (SCT). Am Rev Respir Dis 1985;131:A307. 11. Ramirez A, Hartley LH, Rhodes D, et al: Morphological features of red blood cells in subjects with sickle cell trait. Arch Intern Med 1976;136:1064-1066.Crossref 12. Weisman IM, Zeballos R, Johnson B, et al: Percent hemoglobin S (%HbS) and percent sickling (%S) as correlates for exercise performance at 4000 ft in individuals with sickle cell trait (SCT). Fed Proc 1985;44:1012. 13. Jones NL, Campbell EJM: Clinical Exercise Testing , ed 2. Philadelphia, WB Saunders Co, 1982, p 81. 14. Beaver WL, Wasserman K, Whipp BJ: On-line computer analysis and breath-by-breath graphical display of exercise function tests. J Appl Physiol 1973;34:128-132. 15. Wasserman K: The anaerobic threshold measurement in exercise testing. Clin Chest Med 1984;5:77-88. 16. Patton JF, Daniels WL, Vogel JA: Aerobic power and body fat of men and women during army basic training. Aviat Space Environ Med 1980;51:492-496. 17. Murphy JR: Sickle cell hemoglobin (HbAS) in black football players. JAMA 1973;225:981-982.Crossref 18. Binder RA, Jones SR: Prevalence and awareness of sickle cell hemoglobin in a military population. JAMA 1970;214:909-911.Crossref 19. Hansen JE: Exercise instruments, schemes and protocols for evaluating the dyspneic patient. Am Rev Respir Dis 1984;129:525-527. 20. American Heart Association: Exercise Testing and Training With Apparently Healthy Individuals: A Handbook for Physicians . New York, American Heart Association, 1972. 21. Pollock ML: The quantification of endurance training programs. Exerc Sport Sci Rev 1973;1:155-188.Crossref 22. Yeh MP, Gardner RM, Adams TD, et al: Anaerobic threshold: Problems of determination and validation. J Appl Physiol 1983;55:1178-1186. 23. Vogel JA, Patton JF, Mello RR, et al: An analysis of aerobic capacity in a large United States population. J Appl Physiol 1986;60:494-500. 24. Eichner ER: Sickle cell trait, exercise, and altitude. Physician Sports Med 1986;14:144-157. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

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References (28)

Publisher
American Medical Association
Copyright
Copyright © 1988 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1988.00380050144021
Publisher site
See Article on Publisher Site

Abstract

Abstract • In order to determine if sickle-cell trait (SCT) represents an inherent adverse effect on response to training, we objectively evaluated exercise performance in 22 healthy, black men with SCT (hemoglobin AS) and 15 controls (hemoglobin AA) before and after seven weeks of army basic training at an altitude of 1270 m. An incremental exercise test to exhaustion on a cycle ergometer was used. Before basic training, peak exercise measurements did not reveal significant differences between groups other than a slightly lower, albeit significant, value for oxygen uptake (Vo2) per kilogram (42±1 vs 45±1.4 mL/min per kilogram) for the SCT group. Both groups experienced modest overall cardiovascular improvement reflected in both peak and submaximal exercise responses. No statistically significant difference was observed between the SCT and the control groups at the end of basic training for any of the measured variables at peak exercise, including power (258±6 vs 266±9W), Vo2 (3.24±.06 vs 3.36±.16 L/min), Vo2 per kilogram (46±0.7 vs 46±1.2), minute ventilation (138±4 vs 147±8 L/min), heart rate (185±2 vs 184±3 beats per minute), oxygen pulse (17.6±.3 vs 18.4±1 mL/min per beat), as well as anaerobic threshold (1.81±.04 vs 1.80±.06 L/min), respectively. No medical problems directly attributed to SCT were reported; it remains uncertain, however, whether a seizure experienced by one of the other SCT basic trainees after a two-mile run was SCT related. The results of this study would, therefore, suggest that for the majority of individuals who possess SCT, the response to the moderate training regimen provided by army basic training is not impaired. (Arch Intern Med 1988;148:1140-1144) References 1. Sears DA: The morbidity of sickle cell trait: A review of the literature. Am J Med 1978;64:1021-1036.Crossref 2. Diggs LW: The sickle cell trait in relation to the training and assignment of duties in the armed forces: I. Policies, observations, and studies. Aviat Space Environ Med 1984;55:180-185. 3. Jones SR, Binder RA, Donowho EM: Sudden death in sickle cell trait. N Engl J Med 1970;282:323-325.Crossref 4. Koppes GM, Daly JJ, Coltman CA Jr, et al: Exertion-induced rhabdomyolysis with acute renal failure and disseminated intravascular coagulation in sickle cell trait: Case report. Milit Med 1974;139:313-315. 5. Helzlsouer KJ, Hayden FG, Rogal AD: Severe metabolic complications in a cross-country runner with sickle cell trait. JAMA 1983;249:777-779.Crossref 6. Kark JA, Posey DM, Schumacher HR, et al: Sickle-cell trait as risk factor for sudden death in physical training. N Engl J Med 1987;317:781-787.Crossref 7. Francis CK, Bleakley DW: The risk of sudden death in sickle cell trait: Noninvasive assessment of cardiac response to exercise. Cathet Cardiovasc Diagn 1980;6:73-80.Crossref 8. Robinson JR, Stone WJ, Asendorf AC: Exercise capacity of black sickle cell trait males. Med Sci Sports Exerc 1976;8:244-245.Crossref 9. Alpert BS, Flood NL, Strong WB, et al: Responses to exercise in children with sickle cell trait. AJDC 1982;136:1002-1004. 10. Weisman IM, Zeballos J, Johnson BD, et al: The cardiopulmonary effects of stressful exercise at 4000 ft of individuals with sickle cell trait (SCT). Am Rev Respir Dis 1985;131:A307. 11. Ramirez A, Hartley LH, Rhodes D, et al: Morphological features of red blood cells in subjects with sickle cell trait. Arch Intern Med 1976;136:1064-1066.Crossref 12. Weisman IM, Zeballos R, Johnson B, et al: Percent hemoglobin S (%HbS) and percent sickling (%S) as correlates for exercise performance at 4000 ft in individuals with sickle cell trait (SCT). Fed Proc 1985;44:1012. 13. Jones NL, Campbell EJM: Clinical Exercise Testing , ed 2. Philadelphia, WB Saunders Co, 1982, p 81. 14. Beaver WL, Wasserman K, Whipp BJ: On-line computer analysis and breath-by-breath graphical display of exercise function tests. J Appl Physiol 1973;34:128-132. 15. Wasserman K: The anaerobic threshold measurement in exercise testing. Clin Chest Med 1984;5:77-88. 16. Patton JF, Daniels WL, Vogel JA: Aerobic power and body fat of men and women during army basic training. Aviat Space Environ Med 1980;51:492-496. 17. Murphy JR: Sickle cell hemoglobin (HbAS) in black football players. JAMA 1973;225:981-982.Crossref 18. Binder RA, Jones SR: Prevalence and awareness of sickle cell hemoglobin in a military population. JAMA 1970;214:909-911.Crossref 19. Hansen JE: Exercise instruments, schemes and protocols for evaluating the dyspneic patient. Am Rev Respir Dis 1984;129:525-527. 20. American Heart Association: Exercise Testing and Training With Apparently Healthy Individuals: A Handbook for Physicians . New York, American Heart Association, 1972. 21. Pollock ML: The quantification of endurance training programs. Exerc Sport Sci Rev 1973;1:155-188.Crossref 22. Yeh MP, Gardner RM, Adams TD, et al: Anaerobic threshold: Problems of determination and validation. J Appl Physiol 1983;55:1178-1186. 23. Vogel JA, Patton JF, Mello RR, et al: An analysis of aerobic capacity in a large United States population. J Appl Physiol 1986;60:494-500. 24. Eichner ER: Sickle cell trait, exercise, and altitude. Physician Sports Med 1986;14:144-157.

Journal

Archives of Internal MedicineAmerican Medical Association

Published: May 1, 1988

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