Effectiveness of physical exercise on postural balance in patients with haemophilia: A systematic review

Abstract

Introduction Balance training is important to improve balance and to decrease the risk of falls in patients with haemophilia (PWH). Aim To analyse the current knowledge about the effectiveness of physical exercise on postural balance in PWH. Methods A systematic search for clinical trials, published before November 2021, was conducted using the following electronic databases: PubMed/MEDLINE, Web of Science, Embase, Wiley Online Library and the Cochrane Central Register of Controlled Trials (CENTRAL). Two independent reviewers extracted the data and assessed the risk of bias. The certainty of the evidence was analyzed using GRADE. Results A total of ten studies involving 304 patients were included. The studies performed strength and balance exercises, and some included flexibility, mobilization, and/or aerobic exercises in their training programs. Postural balance was evaluated using a force platform and the one leg stand test was the most frequently used. Only five exercise programs achieved a significant increase in balance (pre‐post) with a strength, postural balance, flexibility, and aerobic intervention. In general, the quality rate of the risk of bias was fair but the overall quality of the evidence across the studies was very low. Conclusion Five studies showed that there is a positive change in balance after the intervention. However, there is currently an unclear demonstration of evidence for the use of physical exercises to improve postural balance in people with haemophilia. Further studies with a higher methodological quality are needed.

Exercise variables and pain threshold reporting for strength training protocols in people with haemophilia: A systematic review of clinical trials

“…The selected terms were combined using Boolean logical operators (OR, AND, NOT). In addition, a manual search of references included in previous systematic reviews was performed 8,18 . All references were analysed in Rayyan software (http://rayyan.qcri.org).…”

The effects of close kinetic chain exercises on proprioception and physical activity level in pediatric patients with hemophilia

“…12 In addition, increased proprioception and neuromuscular control have been demonstrated in PWH following postural stabilization training. 13 No study has been identified in the literature that investigated the effectiveness of an approach consisting of a core stabilization programme combined with CKC exercises on proprioception and physical activity in children with hemophilia.…”

“…In addition, increased proprioception and neuromuscular control have been demonstrated in PWH following postural stabilization training 13 …”

Postural Assessment Systems in the Prevention of Haemophilic Arthropathy: A Narrative Review

“…The end result of this is impaired function and balance [9]. The imbalance could increase the risk of falls and kinesiophobia in this population, as well as favour a sedentary lifestyle, worsening musculoskeletal conditions and increasing the risk of bleeding and healthcare costs [14,15].…”

“…This is why posture should be part of the routine evaluation in this population to allow the identification of dysfunction early and establish a tailored physical or rehabilitation program [18,19]. In this way, it will also be possible to better understand the joint conditions of the ankles and knees inpatients before surgery to more accurately recognise the effect of anexercise program on their balance [14]. The establishment of tailor-made exercise programs in haemophilia patients, which act on flexibility, strength, gait, and proprioception, helps to stop this negative cycle, protecting the joints from new bleeding episodes and improving patients' quality of life [18].…”