Introduction
Overweight increases the secretion of pro‐inflammatory cytokines and serves as a major risk factor for arthropathy and cardiovascular diseases (CVD). This condition is becoming increasingly prevalent among patients with haemophilia (PWH). Different forms of exercise training could favourably modify weight‐related complications, cardiovascular risk factors and the inflammation.
Aim
To investigate the effects of resistance, aerobic and combined exercises on the pro‐inflammatory and anti‐inflammatory markers in overweight patients with moderate haemophilia A.
Methods
Forty‐eight patients with moderate haemophilia A, aged 35‐55 years, and body mass index (BMI) of 25‐30 kg/m2 were randomly assigned to resistance training (RT, n = 12), aerobic (AT, n = 12), combined training (CT, n = 12) and control (n = 12) groups. The patients participated in 45‐minutes exercise sessions three times a week for 6 weeks. Waist circumference (WC), waist‐to‐hip ratio (WHR), fat mass, fat‐free mass, interleukin‐10 (IL‐10), adiponectin, tumour necrosis factor‐α (TNF‐α), interleukin‐6 (IL‐6) and high sensitive C‐reactive protein (hs‐CRP) were measured before and after the 6 weeks of training.
Results
There was significant decrease in WC, WHR, BMI and weight in the AT, RT and CT groups as compared to the control group. Total HJHS scores decreased in the AT, RT, CT groups compared to the control groups (P ≤ 0.001). The decrease in hs‐CRP, IL‐6 and TNF‐α in the CT group was significant compared to the control group (P ≤ 0.02). The increase in IL‐10 and adiponectin was not significant in the RT, AT and CT groups compared to the control group.
Conclusion
CT was the most effective training mode for decreasing the pro‐inflammatory cytokines and increasing anti‐inflammatory markers in overweight patients with haemophilia A.
Episodic CFC replacement over a large range of doses does not alter the natural course of bleeding in haemophilia or the musculoskeletal deterioration and should not be recommended as a long term option for treatment. Prophylaxis is the only way to preserve musculoskeletal function in haemophilia.
Summary. Changes in articular cartilage after haemarthrosis have not been completely elucidated in haemophilic arthropathy. Insights into the pathophysiological mechanisms of blood‐induced joint damage mainly derived from histological, inflammatory and biochemical investigations. A structure–function relationship is another reasonable way to determine the joint overall health status. Cartilage, a viscoelastic connective tissue, is at least a biphasic material that should also work under minimal friction. Pendulum friction tester measures the mechanical aspects of joint lubrication and quantifies the biotribological properties of the joint. Indentation test is an in situ method characterizing the biomechanical properties of the cartilage. Gross, biotribological and biomechanical properties were determined in a rabbit model of experimental haemarthrosis. A sample of 1 mL of fresh autologous blood was injected in the left knee of rabbit’s joint twice weekly for four consecutive weeks. The right knee and animals in the control group were left untreated. After 8 days, joint perimeter, biotribological and biomechanical tests were performed. In a consistent manner, all data showed detrimental effects of the blood on the overall cartilage function under loading. Non‐weight bearing and early blood aspiration seem wise to be considered after haemarthrosis.
Among different groups of hemophiliacs, those suffering from Severe Hemophilia A (SHA) are most vulnerable to the complications of the disease. This study investigated the Health-Related Quality of Life (HR-QoL) among adult patients with SHA. A cross-sectional study was designed to gather demographic and clinical information from adult patients with SHA. Patients with inhibitors were excluded. The remaining were asked to complete the HR-QoL questionnaire after being examined for joint health using the Hemophilia Joint HealthScore (HJHS). The HR-QoL and joint conditions were measured in 38 patients. The mean EQ-5D value scores were 0.46 (SD=0.23) while the mean Visual Analogous Scale score was 50 (SD=18.7). The clinical examination of patients indicated that the HJHS were as follows: eight patients had a score of 55-75, 12 patients had a score of 40-55, 7 of them (25-40) and 11 patients had a score of 10-25. The results obtained from this study showed that HR-QoL in hemophilia patients was considerably low. Pain, anxiety/depression, and motion limitations were the main causes of the disutility for these patients respectively.
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