Ministry of Higher Education and Scientific Research

Erbil Polytechnic University

Stage:2
Dep: Physiotherapy Department
Subject: Therapeutic Exercise

Effects of Exercise
on Blood Cells

Prepared by: Group of Students

Muhammad Nahro Aziz

Handren Fatih

Maryam Shareef

Supervised by: Dr.Mahdi Khaled Qadir

2020-2021
Preface

First of all, we would like to express our gratitude to Allah enabling us to complete
Our Report.
In order to gain more knowledge in the field of “Therapeutic Exercise”. We are required
to make a report on ‘Effects of Exercise on Blood Cells. The basic objective behind doing
this report is to get knowledge of Effects of exercise on human body.

Doing this report helped us to enhance our knowledge about affected blood cells by
Exercises.
We doing undergo many experiences related with our topic. Through this report we come
to know about importance of team work and role of devotion towards the work.
Contents

Headings Page Number

Preface

Introduction 1

Effects of Exercise Training on the

2-4
Erythrocytic

Underlying Mechanism 4-6

could Exercise Training Improve Anemia? 6-7

Conclusion 8

References 9
Introduction

Exercise training can increase total Hb and red cell mass, which enhances oxygen-carrying capacity.
The possible underlying mechanisms are proposed to come mainly from bone marrow, including
stimulated erythropoiesis with hyperplasia of the hematopoietic bone marrow, improvement of the
hematopoietic microenvironment induced by exercise training, and hormone- and cytokine-accelerated
erythropoiesis. Anemia is one of the most common medical conditions in
chronic disease. The effects of exercise training on counteracting anemia have * Exercise training
been explored and evaluated. The results of the research available to date are can increase total
Hb and red cell
controversial, and it seems that significant methodological limitations exist.
mass, which
However, exercise training might be a promising, additional, safe and enhances oxygen-
economical method to help improve anemia. There is a need for further carrying capacity.
investigation into the effects of and guidelines for exercise interventions
(especially strength training) in this population of patients, particularly
among cancer patients who are undergoing or have undergone chemotherapy or radiation treatments.
As the available data are limited, additional research to uncover the underlying mechanisms associated
with the effects of exercise training on anemia is clearly warranted.

1
 Effects of Exercise Training on the Erythrocytic

System Blood volume changes are an important adaptation to exercise training. Blood volume
represents the sum of erythrocyte volume and plasma volume. Erythrocyte volume and plasma volume
can change independently of one another to alter the blood volume. With endurance training, plasma
volume expansion can occur rapidly over several hours to days, whereas erythrocyte volume expansion
usually occurs slowly over many weeks to months in many cases, particularly with intensive endurance
training, the increase in plasma volume exceeds that of total red cell mass,
* Exercise helps
causing a reduction in Hb, HCT or RBC; in the literature, this has been termed
decrease you
‘sports anemia’. Besides this hemodilution, some other changes such as iron chances of
deficiency and an enhanced rate of red cell destruction with accompanying developing heart
hemolysis might also occur during exercise training. Despite this, athletes are at disease. It also
keeps your bones
no greater risk of developing a frank anemia than the no exercising population.
healthy and strong.
Red blood cell deficiency is rare in athletes. Reduced Hb, HCT and RBC levels
observed in endurance-trained athletes with so-called ‘sports anemia’ can
mainly be attributed to an exercise-induced plasma volume expansion causing
hemodilution and only to a lesser degree and in selected
athlete populations to hemolysis. Meanwhile, the elevated erythropoiesis induced by exercise training
likely overshadows the hemolysis in most cases. This could be inferred from data from previous
studies. The association of increased blood volume with physical activity was initially reported more
than 60 years ago when average blood volumes of 90 ml/kg measured in 8 exercised-trained women
and 14 exercise-trained men were compared with average blood volumes of only 62–75 ml/kg in 92
nontrained women and 174 nontrained men. Similar results have been reported in subsequent
investigations. Findings from a large-scale, cross sectional study indicated that athletes have a higher
RBC than controls. Increased reticulocytotic can also be observed after beginning aerobic or strength
training. The adaptations may be very noticeable, as evidenced by the fact that elite athletes possess
approximately 35% higher total Hb mass and blood volume than the normal population. Compared
with the well-known expansion of blood volume after endurance training, relatively little is known
about the effects of strength training on blood volume and its constitution. Strength training could
increase RETIC. It was noted that power athletes had
higher Hb, HCT and RBC than endurance athletes. We found that strength training increased HCT and
RBC

2
and decreased MCHC in 20- to 45-year-old physically inactive men. McCarthy et al. reported that 12
weeks of strength training in sedentary young and middle-aged men could elevate erythrocyte volume
and blood volume, but the increase in plasma volume did not reach statistical significance. This result
demonstrated that expansion of plasma volume after strength training is possibly lower than that after
endurance training. Alternatively, strength training may directly increase the
number of blood erythrocytes. It has frequently been found that total blood volume, plasma volume
and red cell volume expand after aerobic
training, whereas others have reported no significant change in vascular volumes after training. In
2000, Sawka et al. reported an extensive review of the literature pertaining to blood volume and its
adaptations to exercise training. They found that at least 23 of 32 investigations demonstrated
significant blood volume expansion with endurance training. After examining 10 investigations that
reported absence of blood volum expansion after training, they contended 158 Acta Haematol
that exercise training elicits blood volume expansion. In brief, we agree with Sawka et al.and
Warburton et al. that the above-mentioned discrepancies are likely related to differences in participant
sampling, experimental conditions and/or the season in which the research was conducted. For
example, 10 weeks of moderate swimming in rats increased iron status, Hb and HCT, while strenuous
swimming caused the variables to change in the opposite direction. Initial Hb and HCT levels likely
influence training effects on erythropoiesis. It was observed that elite male cross-country
skiers with the lowest initial Hb and HCT experienced the largest increases during training at higher
altitudes. However, it has been found that both females and males exhibit similar erythrocytic
adaptation to aerobic training. The total blood volume and erythrocyte volume in female endurance
athletes were elevated compared to untrained controls [36], which was consistent
with findings in males. It is suggested that the typical response to endurance training is an increase in
blood volume independent of gender.
Identically, a cross-sectional study and longitudinal studies showed that strength training stimulates
erythropoiesis in young and middle-aged subjects, while some previous papers did not demonstrate an
improvement in Hb and HCT in young subjects. Several factors could also be proposed to further
explain these discrepancies. Firstly, in the adaptation of the erythrocytic system to strength training, the
training mode, intensity, frequency and volume as well as duration might play an important role.
Secondly, seasonal variation of red blood cell variables exists [31], and this possible effect of a
concomitant, potentially confounding
factor was probably not controlled for in some studies. Thirdly, age seems to be an influential factor for
erythrocytic adaptation to strength training. MurrayKolb et al. demonstrated no alterations in Hb and

3
HCT values after strength training for 12 weeks (5 exercises, 3 sets at 80% of 1RM) in healthy older
subjects. Similarly, no changes in Hb, HCT or RBC were found in older men and women after 6
months of strength training. Additionally, 12 weeks of strength training did not change Hb, erythrocyte
volume, plasma volume or total blood volume in older men. A comparative analysis showed that HCT,
Hb and RBC in highly trained pubescent athletes were decreased after continuous,
high-intensity strength (or aerobic) training Finally,
there is emerging recognition of considerable heterogeneity in the hematological response to exercise
training, ranging from frank non responders to good responders,
even in subjects with matched baseline characteristics. Erythropoiesis might be moderately influenced
by exercise training and probably depends more on genetic predisposition.

Underlying Mechanism

The training-induced higher plasma volume in endurance athletes is mainly achieved through a higher
renal
sodium reabsorption rate due to aldosterone, higher plasma protein production and a plasma protein
shift into the intravascular space. Accumulating evidence has shown that exercise training could
modulate bone marrow activity. MRI of the bone is an accurate, noninvasive imaging modality for
characterizing physiological conditions of the bone marrow. Alterations in the hematopoietic bone
marrow suggestive of stimulated hematopoiesis have been observed in endurance athletes by means of
MRI, and the stimulated erythropoiesis with hyperplasia of the hematopoietic bone marrow in
endurance athletes could explain their large red cell volume The conventional belief is that the
increased intravascular hemolysis induced by exercise training could cause elevated erythropoiesis.

4
This was described as the ‘hemolysis pull’ model. On the other hand, adult blood cells develop in the
bone marrow, which serves as the main site of human hematopoiesis. There exist specific
microenvironments or niches in which hematopoietic stem cells (HSCs) survive, self-renew and
differentiate as well as sustain the lifelong process of constant replenishment of mature hematopoietic
cells. Emerging evidence suggests that the hematopoietic microenvironment might be improved by
exercise training. One crucial component and regulator of the HSC niche are osteoblasts, the bone-
forming cells derived from mesenchymal stem cells. Osteoblasts play a central role in hematopoiesis. It
has been shown that osteoblasts produce many factors essential for the survival, renewal and
maturation of HSCs Signals from osteoblasts can directly initiate and modulate HSC proliferation in
the context of mobilization Hematopoiesis was severely altered in mice with an induced osteoblast
deficiency. Recently, we found that higher activity of osteoblasts is associated with greater red cell
production after 20 weeks of strength training.
It had been hypothesized that adipocyte accumulation in bone marrow can cause anemia. This
hypothesis was proven by a subsequent experimental study Exercise Training, Red Blood Cell
Production and Anemia which showed that bone marrow adipocytes are negative
regulators of the hematopoietic microenvironment. It was reported that exercise training not only
enhanced bone formation and osteoblast differentiation but also
inhibited audiogenic differentiation in bone marrow in mice. Theoretically, these changes might also
contribute to the improvement of the hematopoietic microenvironment after exercise training.
Therefore, it was proposed that osteoblast activation and inhibited audiogenic differentiation induced
by exercise training might improve the hematopoietic microenvironment in the bone marrow. This
‘hematopoietic microenvironment push’ model could be complementary to the ‘hemolysis pull’ model
in explaining elevated erythropoiesis during exercise training. Another possible explanation for the
higher total Hb mass in elite endurance athletes is altered erythropoietin (EPO) receptor affinity and
increased transferrin receptor expression in bone marrow. In summary, adaptive changes of bone
metabolism induced by exercise training might facilitate erythropoiesis. Exercise training has been
shown to affect the concentrations of several cytokines and hormones that regulate the self-renewal,
proliferation and maturation of HSCs.
Increased concentrations of tumor necrosis factor-, interleukin-1, interleukin-6, interleukin-1 receptor
antagonist and granulocyte colony-stimulating factor have been observed after exercise, which may
influence bone marrow function. It is recognized that contracting skeletal muscles synthesize and
release interleukin-6 into the systemic circulation in response to exercise, which stimulates and
increases the migratory activity of mesenchymal stem cells. Moreover, endurance exercise causes the

5
release of mediators active on the bone marrow, thereby augmenting the mobilization of circulating
hematopoietic progenitor cells (CD34+) and the release of reticulocytes from the bone marrow,
suggesting that exercise can have a physiologic impact by potentially mobilizing stem cells.
It is well known that hormones can stimulate the proliferation and differentiation of red cell precursors,
which activate increased erythropoiesis in hemopoietic tissues, ultimately producing red blood cells.
Hormonal release is altered by exercise training, which may also be involved in the potentiation of
human erythropoiesis. In the adult human, the kidney is the main organ for the production and release
of EPO, which stimulates erythropoiesis. However, renal EPO production is not significantly affected
by intensive or long-lasting bouts of exercise in either trained or untrained subjects and
therefore does not explain enhanced erythropoiesis. Despite the lack of an increase in circulating EPO
during physical exercise, RETIC may increase 1–2 days thereafter. Stress hormones such as
catecholamines and cortisol stimulate the release of young red blood cells from the bone marrow.
Cortisol also increases the production of red blood cells Moreover, blood concentrations of testosterone
and growth hormone as well as insulin-like growth factor are elevated after exercise training, which
may increase red blood cell production. However, the hormonal responses to exercise training are
lowered with increasing age, which might be related to the impaired capacity of the erythrocytic system
to respond to exercise training in the elderly.

could Exercise Training Improve Anemia?

The effect of exercise training on improving anemia is still controversial. Some investigators have
observed that moderate-intensity exercise training had significant, positive effects on improving
disease-related anemia. Apart from these observations, Matsuo and Suzuki found that dumbbell
exercise improved nonanemic iron deficiency in young women without iron supplementation. In a
randomized clinical trial, Coleman et al. found that exercise training and epoetin- therapy could reduce
the number of red cell transfusions and attempts at stem cell collection for patients receiving
intensive treatment for multiple myeloma. In patients with anemia, submaximal exercise seemed not to
affect the concentration of haematopoietically active cytokines. However, it led to an increased
concentration of growth hormone, which was speculated to be responsible for improved hematopoiesis
observed after an exercise program in patients with chronic disease. Matsuo and colleagues conducted
animal studies and reported that long-term resistance exercise is more effective than aerobic exercise in

6
improving iron status and blood Hb in moderately and severely iron-deficient rats by increasing heme
synthesis in the bone marrow. They suggested that resistance exercise may be a useful preventive
therapy for iron deficiency anemia. As mentioned above, the number of adult bone marrow adipocytes
correlates inversely with the hematopoietic activity of marrow. It is known that fatty infiltration of
hematopoietic red marrow follows radiation therapy or chemotherapy and is a diagnostic feature in
biopsies from patients with marrow aplasia. Whether exercise training could improve the hematopoietic
microenvironment under such conditions is unknown; this is an interesting topic and warrants further
study. Because currently available studies have provided inconsistent results, we would like to raise
some concerns about methodological considerations related to assessing the effectiveness of exercise
training intervention to improve anemia. Firstly, the key issue here is how to identify anemia
improvement more reliably and precisely. Because of methodological issues, it has been difficult for a
long time to determine total Hb mass. The concentration-based indices, including Hb and HCT, were
widely used in previous studies. However, they could remain unchanged because of proportional
increases in plasma volume and total red cell volume induced by exercise training. In this situation,
these indices can hide a substantial total Hb mass increase. However, it is also possible that in some
cases, the increase in total red cell mass exceeds that of plasma volume, causing an elevation in Hb,
HCT or RBC. It is well known that expansion of plasma volume usually occurs with endurance
training. In this context, Hb and total Hb mass (also RBC and red cell mass) are therefore different
physiological parameters, which may reflect different oxygen-carrying capacity. Since the 1990s,
measurement methods with increased convenience and precision have been developed and modified.
Total Hb mass and red cell mass might better reflect the alteration and adaptation of erythropoiesis
induced by exercise training. Secondly, the mode of training likely plays a role in blood adaptation to
exercise training. In most of the aforementioned studies, endurance training was used to counteract
anemia. Besides the expansion of plasma volume after endurance training but not after strength
training, endurance training might be a small and slow stimulus for erythropoietic adaptation. On the
other hand, the literature shows that strength training is a strong stimulus for bone metabolism Hence,
further study is needed to explore the effectiveness of strength training in improving anemia. Thirdly, it
is suggested that seasonal variation of red blood cell variables should be properly controlled in
intervention studies.

7
Conclusion

Exercise training stimulates erythropoiesis and elevates total Hb and red cell mass, which enhances
oxygen carrying capacity. The possible underlying mechanisms are proposed to occur mainly in bone
marrow, including stimulated erythropoiesis with hyperplasia of the hematopoietic bone marrow,
improvement of the hematopoietic microenvironment induced by exercise training, and hormone- and
cytokine-accelerated erythropoiesis. This adaptation might help improve anemia and fitness in patients.
The effects of exercise training on counteracting anemia have been explored and evaluated. The results
of the research available to date are controversial, and it seems that significant methodological
limitations exist. In spite of this, we contend that exercise training might be a promising, additional,
safe and economical method to help improve anemia, even though efficacy as well as the appropriate
mode, intensity and frequency of exercise training (especially strength training) in different types
of anemia are yet to be established and require more research. As the available data are limited, there is
a need for further investigation to uncover the underlying mechanisms associated with the effects of
exercise training on anemia, particularly among cancer patients undergoing
or having undergone chemotherapy or radiation. Measurement of total Hb and red cell mass could more
reliably and precisely reflect red blood cell turnover and is
recommended in future studies.
 8
References

✓ https://www.researchgate.net/publication/232478416_Effects_of_Exercise_Tr
aining_on_Red_Blood_Cell_Production_Implications_for_Anemia/link/55d340
3908ae0b8f3ef92812/download
✓ https://academic.oup.com/bjaed/article/4/6/185/314696
✓ https://medlineplus.gov/ency/article/007165.htm
✓ https://www.frontiersin.org/articles/10.3389/fphys.2013.00332/full?fbclid=Iw
AR2wgUbEUhtzpVWkn2RWRiX-6aqg8jzLyYLQFI0F2l2hnxwFk34cvxyacac