The benefits of exercise for patients with haemophilia and recommendations for safe and effective physical activity

Abstract

Most health care professionals involved in the management of people with haemophilia (PWH) believe that exercise is beneficial and its practice is widely encouraged. This article aims to demonstrate that appropriate exercise (adapted to the special needs of the individual PWH) may be beneficial for all PWH through improved physical, psychosocial and medical status. Based on evidence gathered from the literature, many PWH, particularly those using long-term prophylaxis or exhibiting a mild/moderate bleeding phenotype, are as active as their healthy peers. PWH experience the same benefits of exercise as the general population, being physically healthier than if sedentary and enjoying a higher quality of life (QoL) through social inclusion and higher self-esteem. PWH can also gain physically from increased muscle strength, joint health, balance and flexibility achieved through physiotherapy, physical activity, exercise and sport. Conversely, very little data exist on activity levels of PWH in countries with limited resources. However, regarding specific exercise recommendations in PWH, there is a lack of randomized clinical trials, and consequently formal, evidence-based guidelines have not been produced. Based on published evidence from this review of the literature, together with the clinical experience of the authors, a series of recommendations for the safe participation of PWH in regular physical activities, exercises and sport are now proposed. In summary, we believe that appropriately modified programmes can potentially allow all PWH to experience the physical and psychosocial benefits of being physically active which may ultimately lead to an improved QoL.

Balance, falls, and exercise: Beliefs and experiences in people with hemophilia: A qualitative study

“…There are conflicting data in the literature about the amount of exercise regularly performed by people with hemophilia,9, 11, 12 and boys and teens with hemophilia report barriers to exercise and are unsure of options 12…”

Effectiveness of Physiotherapy in the Treatment of Hemophilic Arthropathy a Systematic Review

“…The development of typical clinical manifestations associated with hemophilic arthropathy may lead to a decrease in physical capacity and a poorer perception of quality of life [36]. Among the studies analyzed in this study, three articles [22,27,28] have noted how, following a physiotherapy intervention, the quality of life of patients with hemophilia, among other dependent variables, improved.…”

“…The patient's involvement in a physiotherapy intervention and their adherence to it is an important success factor that must be encouraged. In the same way that efforts are made to implement adherence to pharmacological treatment, greater scientific evidence is needed to demonstrate the safety and efficacy of these techniques [36]. Reducing the fear of developing bleeding as a result of a physical therapy intervention together with clinical improvement will allow a greater adherence in these patients.…”

Physiotherapeutic approach for pain and quality of life of a hemophilic patient. Case report

“…There is currently consensus among health care professionals about the use of physiotherapy for hemophilic individuals because it corrects motor deficits, improves functionality, decreases pain and improves quality of life (QL) 1 . Regular exercises aim at better psychosocial conditions, increase or maintenance of muscle strength and trophism, joint mobility and stability, flexibility, balance and functionality, thus improving daily life activities (DLA) 7,8 . Different physiotherapeutic modalities are welcome to treatment, especially kinesiotherapy 7,8 .…”

“…Regular exercises aim at better psychosocial conditions, increase or maintenance of muscle strength and trophism, joint mobility and stability, flexibility, balance and functionality, thus improving daily life activities (DLA) 7,8 . Different physiotherapeutic modalities are welcome to treatment, especially kinesiotherapy 7,8 . However, literature still lacks sources discussing and exploring the best physiotherapeutic treatment for hemophilic patients 1,5,7 .…”