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Overview of Anemia

This condition is due to the decreased quantity or quality of red blood cells and results in a decline in the capacity of the blood to carry oxygen. Anemia is considered a sign of any disorder that affects the production, normal destruction, or loss of red blood cells. Anemia is defined by hemoglobin levels of less than 12 g/100 dL for women and less than 14 g/100 dL for men. Clients may experience anemia as a temporary result of an injury or disease process or may need ongoing treatments to maintain an adequate supply of oxygen in the blood stream. Clients with anemia may experience fatigue, dyspnea, and weakness, which will limit their daily activities.

Comorbidities to Consider

  • Clients undergoing treatment for diseases that create anemia, such as cancers and bone marrow disorders, may also have limited mobility due to these diseases.

  • A long-term reduction in activities can lead to secondary deconditioning effects for the cardiovascular and neuromusculoskeletal systems.

Client Examination

Keys to Examination of Clients

  • Clients with anemia will be assessed by complete blood counts, counts of red blood cell indices, and levels of serum iron, serum ferritin, and vitamin B12.

Recommended Baseline Testing of Fitness Levels

  • Clients can be assessed for their tolerance to exercise activities with walking or cycle ergometer tests.1 Testing should be performed with close monitoring of vital signs and with slow progression of exercise intensities.

  • Clients may also need to be assessed for balance and coordination by standing and walking activities, as some chronic conditions produce peripheral neuropathies.

Exercise Prescription


Type: Walking, cycling, arm ergometer, and acquatic activities

Intensity: Low levels

Duration: Short durations, 10–20-minute bouts with rest periods

Frequency: Daily as tolerated

Getting Started

Walking activities will be the most common form of exercise for clients with severe debilitation due to primary conditions that create anemia.1 Clients may choose aquatic exercise program when taking safety precautions. Clients with anemia will need close and ongoing monitoring of their heart rate, oxygen saturation levels, and dyspnea levels during exercise sessions. Exercise intensities can be self-assessed by perceived exertion levels or by taking heart rate levels during the exercise program. Monitoring of oxygen saturation and heart rate will help determine when clients are exercising in a state of decreased blood oxygen. The parameters of exercise will need to be appropriate for the clients' primary or secondary condition that has created their anemia.2,3 Daily levels of fatigue should be assessed to prescribe an appropriate level of exercise based on clients' progression or deterioration from their primary condition.4 Clients can be progressed to ...

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