Paper Presentation: Research Topics — Perceptual Responses during Exercise Testing with Adolescents and Young Adults with Sickle Cell Disease: What Does Tired Really Mean (216-2)

11:50am –12:10 pm Friday, September 6

Exercise has an important role in health promotion and is recommended for individuals with sickle cell disease (SCD) to enhance physical and mental health. However, exercise is challenging for them because exercise capacity is limited due to the pathophysiology of the disease, health risks such as vaso-occlusion are associated with excessive exercising, and exercise guidelines are vague and do not focus on improving exercise capacity or fitness. Mild to moderate exercise is advised, but self-regulation of these intensities is difficult. To regulate intensity, one SCD recommendation is to stop exercising at the first sense of fatigue.

It is unclear whether the recommendation to stop exercising at the onset of perceived fatigue is the ideal indicator to guide exercise intensity/cessation or if there are more accurate perceptual cues. In healthy and clinical populations, perceived effort and affect are perceptual cues that are more commonly used to guide exercise intensity. This study (a) examined perceived effort, affect, and fatigue in relation to metabolic state (gas exchange) in adolescents and young adults (AYAs) with SCD; (b) explored guidelines AYAs use to self-regulate exercise; and (c) compared perceived effort and affect at anaerobic threshold (gas exchange threshold) to healthy AYAs. Twenty-two AYAs with SCD completed an incremental cycle test until volitional exhaustion. Gas exchange threshold (GET) was determined from gas exchange data. Perceived effort, affect, and fatigue were assessed every 2 minutes. A mixed-effects linear model was conducted to model changes in perceived effort, affect, and fatigue across time. Mean scores of effort and affect at GET were compared to published data. Interviews were conducted to explore self-regulation strategies. The majority were male (64%) and mean (SD) age was 23.7 (6.7) years. The mean (SD) VO2 peak was 19.2 (5.43). Both perceived fatigue and perceived effort at GET were lower than expected, and perceived effort was significantly lower than healthy AYAs (p < 0.0001). Perceived affect was significantly higher than healthy AYAs (p=0.0009). Interviews revealed most (95%) stopped exercising when fatigue was moderate to severe, and many stopped when symptoms were severe (chest tightness, blurry vision, can’t breathe). Of the 3 perceptual cues (fatigue, affect, effort), perceived effort, or how hard one feels one is working while exercising, aligned more consistently and shows promise of being an indicator of anaerobic state during exercise in AYAs with sickle cell anemia. Nurses should review strategies that AYAs with SCD use to self-regulate exercise intensity to ensure safe exercise. AYAs with SCD may benefit from training to interpret bodily responses to exercise to improve self-regulation.

Suzanne Ameringer, PhD RN
CNE Hours: