Sickle Cell Disease: How to Exercise Without Triggering a Crisis

Sickle cell anemia is a genetic disorder that can cause periods of severe pain. People with sickle cell disease cover a wide range of overall wellness and fitness, says Chancellor Donald, MD, a hematologist, medical oncologist, and assistant professor at the Tulane University School of Medicine in New Orleans. “For our patients without severe complications, low- to moderate-intensity exercise may be beneficial,” he says.

Because the blood cells are not as efficient at carrying oxygen, it’s important to avoid high-intensity exercise, says Ainsley Rossi, a physical therapist and assistant professor of physical therapy at New York Medical College in Valhalla, New York, who recommends staying away from programs like high-intensity interval training and CrossFit. Instead, you can try the options below.

Brisk Walking or Hiking

Walking is an easy and accessible activity for people with sickle cell disease. You can walk around the block or hike a nature path — whatever sounds best to you. “This is an excellent and accessible way to get started with a fitness routine,” says Dr. Koprivnikar.

Stationary Cycling

Swimming

You can also join a water aerobics class for guided activity. “However, it's crucial to avoid cold water, as sudden temperature changes can be a trigger for a sickle cell crisis,” says Koprivnikar.

Dancing

Rowing

Choosing Your Workout

To decide which workout you want to try, think about how much you can already do and your personal preferences. Consider these factors as you choose your exercise:

Current Symptoms Rossi asks new patients about their current pain level, past experience with exercise, responses to activity, how frequently they have a pain crisis, how they are managing their disease, and what impact the disease has on their daily life.

Getting Started

• Check the weather for temperature and humidity levels.
• Choose the best workout location based on the weather.
• Hydrate before you start, and refill your water bottle and bring it with you.
• Wear light, breathable clothing.
• Plan for rest breaks after every 20 minutes of exercise.

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• Be prepared to stop if you get overtired.
• Only swim in warm water, and dry off immediately after getting out of the pool.
• Do a 5- to 10-minute warm-up with stretching and movement.

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• In the last 5 or 10 minutes of the workout, slow your activity to let your body cool down before stopping.

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“Start out small, with short gentle exercises — walking is great, and so is swimming if that is something you enjoy,” says Rossi. “Start at five minutes every other day, then increase in two- to five-minute increments each week until you are able to sustain 30 minutes of moderate-intensity exercise, ideally daily but at least four or five times per week.”

Modifications

Modifications can look like using resistance bands instead of heavy weights, or walking instead of jogging, says Sharp.

“Our patients have lived with this condition since birth — they often become experts regarding their own bodies,” says Dr. Donald, adding that you may be able to quickly tell if your pain feels like an oncoming crisis or not. Donald asks his patients to pay close attention to how they feel during the activity and afterward.

Here’s how Koprivnikar explains the difference between normal exercise soreness and warning signs of a sickle cell pain crisis:

Normal exercise soreness pain has these features:

• Dull, aching, tender, or tight
• Localized to the muscles you exercised
• Has a gradual onset, 12 to 48 hours after exercise
• Isn’t accompanied by any red flag symptoms (simply soreness in the muscles you worked)

A vaso-occlusive crisis (VOC) has these warning signs:

• Intense, sharp, throbbing, stabbing, or excruciating pain is a distinctly different and more severe quality of pain.
• Pain occurs anywhere but is common in the back, chest, abdomen, arms, and legs. The pain can also be migratory, moving from one part of the body to another.
• The onset of pain can start suddenly, occur during exercise, or come on shortly after.
• Crucially, VOC pain is often accompanied by other systemic symptoms, like yellow skin and whites of the eyes (jaundice), extreme fatigue, and swelling in your hands and feet.

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“With sickle cell anemia, scaling your activity based on your symptoms is crucial to long-term outcomes and maintaining consistent movement,” says Sharp, who always sets up a plan for low-energy days.

• Unusual or extreme fatigue
• Shortness of breath or difficulty breathing
• Sudden, severe pain that doesn't feel like typical muscle soreness
• Dizziness or weakness
• Chest pain
• Fever
• Jaundice

After a crisis, your healthcare provider will work with you to decide on the best path back to exercise. There is no universal timeline for restarting activity after a sickle cell crisis, says Koprivnikar, but returning to your exercise routine should be gradual.

“A patient's specific disease course, their treatment regimen, and any existing organ damage are the most important factors in tailoring a safe and effective exercise plan,” says Koprivnikar.

• When you have sickle cell disease, light- or moderate-intensity exercise offers benefits like a stronger heart, healthier muscles, and better mental health.
• You can avoid triggering a pain crisis by choosing low-impact exercise like walking, stationary cycling, swimming, dancing, and rowing.
• It’s important not to push yourself too hard when you have sickle cell disease, and your healthcare team can help you decide on a workout program with the least risk and most benefit.