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• Anemia is a decrease in the total amount of red
blood cells (RBCs) or hemoglobin in the blood, or a
lowered ability of the blood to carry oxygen.
(Rodak, 2007)) When anemia comes on slowly, the
symptoms are often vague and may include feeling
tired, weakness, shortness of breath or a poor
ability to exercise.(Rubenstein, 2013)
Exercise is any bodily activity that enhances or
maintains physical fitness and overall health and
wellness(Kylasov and Gavrov, 2011).
It is performed for various reasons, including increasing
growth and development, preventing aging,
strengthening muscles and the cardiovascular system,
honing athletic skills, weight loss or maintenance, and
also for enjoyment.
This review is done to explore the knowledge of
exercise as a concept in induced anemia.
Literature Review
• Some studies indicate that exercise may
increase life expectancy and the overall
quality of life. (Gremeaux et al., 2012).
• People who participate in moderate to high
levels of physical exercise have a lower
mortality rate compared to individuals who
by comparison are not physically active
(Woods et al., 2011).
• Moderate levels of exercise have been
correlated with preventing aging by reducing
inflammatory potential. (Kyu et al., 2016).
What Causes Anemia?
There are more than 400 types of anemia, which
are divided into three groups:
• Anemia caused by blood loss
• Anemia caused by decreased or faulty red blood cell
• Anemia caused by destruction of red blood cells
• Anemia, also sometimes known as low iron, comes
in various forms and has various causes.
• The iron molecule helps your red blood cells carry
life-giving oxygen around your body. Without iron-
carrying red blood cells circulating through our
blood stream, our bodies die from lack of oxygen.
• Anemia due to iron deficiency can happen quickly,
such as from rapid blood loss.
• Exercise is the physical exertion of the body -
making the body do a physical activity which results
in a level of physical fitness and mental health.
• We can also become anemic if our bodies do not
make enough red blood cells due to inadequate
intake of dietary iron or vitamin B12 or due to
chronic issues with a poorly functioning bone
marrow, which is where red blood cells are made.
• Exercise can sometimes increase the body’s need
for iron and B12 due to increase use by our
• Women tend to be at a higher risk of developing
anemia because of events such as heavy periods
and pregnancy. Female athletes who engage in
intense exercise on a regular basis are also at an
increased risk of becoming anemic.
• Exercise-induced anemia is a condition diagnosed in
apparently healthy athletes who display low
hematological values (red cell count, hemoglobin
[Hb], and hematocrit), believed to be a result of
compromised iron stores.
• As such, oxygen transport and utilization by the
working skeletal muscle may be compromised,
which may ultimately cause decrements to athletic
• Iron is a component of Hb and myoglobin that plays
a critical role in oxygen transport around the body
and oxygen utilization by the cells
• Exercise/Sports anemia is a condition that can cloud
the iron deficiency anemia diagnosis in athletic
populations (Rockwell & Hinton 2005).
• Some experts believe that the term sports anemia is
misleading and are discouraging its use, because
true anemia refers to low hemoglobin
concentration, and this is not the case with sports
anemia (Burke & Deakin 2000).
• Sports anemia can easily go undetected since it is
unlikely to hinder athletic performance in the way
that true iron deficiency anemia does (Eichner,
• It can be quite difficult to differentiate between
sports anemia and true iron anemia depletion from
a single blood test using readily available iron status
measures (Burke & Deakin 2000).
• Iron deficiency is common in athletes involved in
endurance sports. In female marathon runners, the
prevalence is as high as 28% (compared to 11% in
the general female population). Around 10–15% of
athletes with iron deficiency do have a mild form of
• Particularly if other contributory factors are involved
(for example, dietary restrictions and menstrual
bleeding), anaemia can be more severe, as described in
the above cases. Several mechanisms are generally
accepted to cause iron loss during exercise:
• exercise-induced haemolysis, due to mechanical forces
and oxidative stress;
• blood loss in the gastrointestinal and urinary tract, due
to microscopic lesions by the reduced visceral
circulation during exercise; and
• sequestration of iron in macrophages and decreased
iron absorption, due to increased hepcidin production
by the induction of an inflammatory response
• Increased pro-inflammatory markers, occult blood
loss in urine and faeces, and a decreased
haptoglobin level are observed in patients
immediately after intensive training (<24 hours).
Iron loss due to excessive sweating has also been
proposed as an underlying mechanism.
• Although high levels of iron have been measured in
sweat, this iron is probably derived from or
contaminated by cellular debris.
• Therefore, this concept is questioned and its
contributory role to IDA is, most likely, minimal.
Exercise-induced iron deficiency, or anemia, is a
condition that is commonly experienced by a large
proportion of the athletic community. Finally, the
exact mechanism responsible for exercise-
induced iron deficiency remains unclear.
• RL, Rubenstein SD (November 2013). "Anemia in the emergency department: evaluation and
treatment". Emergency Medicine Practice. 15 (11): 1–15; quiz 15–6. PMID 24716235. Archived from the original
on 2016-10-18.
• GBD (2015) Disease and Injury Incidence and Prevalence Collaborators (October 2016). "Global, regional, and
national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990-2015: a
systematic analysis for the Global Burden of Disease Study 2015". Lancet. 388 (10053)
• Peeling P (2010) Exercise as a mediator of hepcidin activity in athletes. Eur J Appl Physiol 110(5):877–883
• Peeling P, Dawson B, Goodman C, Landers G, Wiegerinck E, Swinkels D, Trinder D (2009) Effects of exercise on
hepcidin response and iron metabolism during recovery. Int J Sport Nutr Exerc Metab 19(6):583–597
• McClung JP, Karl JP, Cable SJ, Williams KW, Nindl BC, Young AJ, Lieberman HR (2009) Randomized, double-blind,
placebo-controlled trial of iron supplementation in female soldiers during military training: effects on iron
status, physical performance, and mood. Am J Clin Nutr 90(1):124–131
• Kylasov A, Gavrov S (2011). Diversity Of Sport: non-destructive evaluation. Paris: UNESCO: Encyclopedia of Life
Support Systems. pp. 462–491.
• Rodak BF (2007). Hematology : clinical principles and applications (3rd ed.). Philadelphia: Saunders.
p. 220. ISBN 978-1-4160-3006-5. Archived from the original on 2016-04-25.
• Gremeaux, V; Gayda, M; Lepers, R; Sosner, P; Juneau, M; Nigam, A (December 2012). "Exercise and
longevity". Maturitas. 73 (4): 312–7.
• Department Of Health And Human Services, United States (1996). "Physical Activity and Health". United States
Department of Health.
• Woods, Jeffrey A.; Wilund, Kenneth R.; Martin, Stephen A.; Kistler, Brandon M. (29 October 2011). "Exercise,
Inflammation and Aging". Aging and Disease. 3 (1): 130–140. PMC 3320801