Electromyographic and Safety Comparisons of Common Lower Limb Rehabilitation Exercises for People With Hemophilia

Abstract

Background Ankles and knees are commonly affected in people with hemophilia and thus are targets for prevention or rehabilitation. However, to our knowledge, no studies have evaluated muscle activity and safety during exercises targeting the lower limbs in people with hemophilia; this lack of information hinders clinical decision-making. Objective The aim of this study was to compare the tolerability of, safety of, and muscle activity levels obtained with external resistance (elastic or machine)–based and non–external resistance–based lower limb exercises in people with hemophilia. Design This was a cross-sectional study. Methods Eleven people who had severe hemophilia and were undergoing prophylactic treatment participated. In a single experimental session, participants performed knee extension and ankle plantar flexion during 3 exercise conditions in random order: elastic band–based resistance (elastic resistance), machine-based resistance (machine resistance), and no external resistance. Exercise intensities for the 2 external resistance–based conditions were matched for perceived exertion. Muscle activity was determined using surface electromyography (EMG) for the rectus femoris, biceps femoris, gastrocnemius lateralis, and tibialis anterior muscles. Participants were asked to rate exercise tolerability according to a scale ranging from “very well tolerated” to “not tolerated” and to report possible adverse effects 24 and 48 hours after the session. Results No adverse effects were reported, and exercise tolerability was generally high. In the knee extension exercise, the rectus femoris normalized EMG values during the elastic resistance and machine resistance conditions were similar; 29% to 30% higher activity was obtained during these conditions than during the non–external resistance condition. In the ankle plantar flexion exercise, the gastrocnemius lateralis normalized EMG value was 34% higher during the machine resistance condition than without external resistance, and the normalized EMG values during the elastic resistance and other conditions were similar. Limitations The small sample size and single training session were the primary limitations of this study. Conclusions Exercises performed both with elastic bands and with machines at moderate intensity are safe, feasible, and efficient in people with severe hemophilia, providing comparable activity levels in the agonist muscles.

EMG, Rate of Perceived Exertion, Pain, Tolerability and Possible Adverse Effects of a Knee Extensor Exercise with Progressive Elastic Resistance in Patients with Severe Haemophilia

“…Importantly, no pain increases and no adverse effects were found after the experimental session. This matches with previous studies that have shown a high tolerability of elastic resistance training in patients with arthritis [32] and chronic obstructive pulmonary disease [33], as well as in PWH [10,11]. A high tolerability, together with the possibility of exercising autonomously using the bands, generates greater satisfaction, which is related to higher exercise adherence [34,35].…”

“…However, it seems that a tailored haematological treatment can help avoid major adverse effects after performing moderate intensity exercises in a single session [10,11], or even during a program with two weekly sessions for two months [12]. Despite the fact that it has been used in previous works [10,11], the lack of validation of the tolerability scale is a limitation. Since we did not include a control group, we do not know whether our results in PWH may differ from those achieved in healthy people, and future studies should corroborate this.…”

“…Different types of resistance can be used to perform strength training, which can induce specific physiological responses [9]. Among all types of resistance, recent studies point out that training with elastic bands is an optimal option due to its economic accessibility, portability, safety and effectiveness [10][11][12]. Specifically, two studies conducted in PWH have shown that, in general, elastic bands provide similar muscle activation to other traditional methods, such as machines [10] or free weights [11], in lower and upper limbs, respectively.…”

“…Among all types of resistance, recent studies point out that training with elastic bands is an optimal option due to its economic accessibility, portability, safety and effectiveness [10][11][12]. Specifically, two studies conducted in PWH have shown that, in general, elastic bands provide similar muscle activation to other traditional methods, such as machines [10] or free weights [11], in lower and upper limbs, respectively. However, there are no other studies using elastic resistance in PWH, while their use in other chronic pathologies is more common [13].…”

The effect of resistance exercise on strength and safety outcome for people with haemophilia: A systematic review

“…Two recent cross-sectional studies on people with severe haemophilia undergoing prophylactic treatment showed that externally resisted exercises (using elastic resistance bands, machine resistance and free weights) at moderate intensities for the upper and lower extremities mostly provided greater muscle activity than conventional non-resisted exercises, were safe and well tolerated. 48,49 Elastic resistance bands are portable, inexpensive and avoid possible impacts.…”