Exercise and sport in the treatment of haemophilic patients: a systematic review

Abstract

In haemophiliacs, the physical condition, muscular strength, aerobic resistance, anaerobic resistance and proprioception have all diminished. Muscle atrophy and instability, being more vulnerable to stressful motor demands, increase the risk of lesion and establish a vicious circle that is hard to break: pain, immobility, atrophy, articular instability and repeated bleeding episodes. In haemophilia, physical and/or sporting activities were not recommended until the seventies. Nowadays, the overall policy is to recommend certain physical activities, especially swimming, to improve the patient's quality of life, thanks to prophylaxis programmes. The objective of this study is to perform a systematic review of the exercise and sporting activities recommended for haemophiliacs. Experimental and observational studies and clinical assays about rehabilitation for haemophiliacs with exercise and sporting activities have been included. The relevant studies were identified in Medline, Cinahl, Embase and SportDiscus, and key words were: haemophilia, exercise and sport (with no language restrictions). Works were independently analysed by reviewers and the following were identified: of 3603 studies, 103 were included in this review: 29 (28.15%) were experimental, 27 (26.21%) were observational and 47 (45.63%) were clinical. Physiotherapy, physical activity and sport are basic elements to improve quality of life and the physical condition, increase strength and resistance and to reduce the risk of musculoskeletal lesions and to prevent haemophilic atrophy. In general, professionals in haemophilia believe that regular exercise and rehabilitation with physiotherapy is fundamental, particularly in countries where replacement therapy is not readily available.

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

“…In HA, recurrent hemarthroses lead to joint degeneration, joint deformities, severe functional deficiency, and consequently generating pain as described in this report 15 . HA patients have complications such as strength deficits and muscle atrophies, joint instability, hypomobility, proprioceptive decrease and limitation of biomechanical movements, thus making difficult pain relief 16 . Patient has reported using factor VIII concentrate and has maintained this therapy during physiotherapeutic treatment.…”

“…This strategy associated to physiotherapy may decrease the duration of hemorrhages, generating better results and lower public expenditures 17 . Some studies suggest that exercises increase the level of circulating factor VIII 18 and when early performed provide positive results, such as decreased joint bleedings, pain relief, increased muscle strength and resistance and prevention of possible mioarticular deformities, assuring better QL and fitness to patients 16 . This is why we have chosen physical exercises as the intervention modality for this study.…”

Vérzékenységben szenvedő gyermekek és serdülők életminőségének és mentális jóllétének vizsgálata szülői beszámoló alapján

“…A profilaktikus kezelés bevezetésével azonban a sportolás a haemophiliás gyermekek számára is lehetséges, sőt javasolt időtöltés lett. A gyermekek speciális szükségeit figyelembe vevő közösségi sportprogramok, táborok növelik a fizikai, érzelmi és szociális jóllét mértékét (von Mackensen, 2007;Negrier és mtsai, 2013), illetve segítenek megelőzni a mozgásszervi szövődményeket (Gomis, Querol, Gallach, Gonzalez, & Aznar, 2009). Khair, Littley, Will, & von Mackensen (2012) multicentrikus vizsgálatukban azt találták, hogy azok a fiúk, akik kevesebb, mint napi 2 órát töltenek a televízió, illetve számítógép előtt, kevesebbet hiányoznak az iskolából, továbbá a rendszeresen sportoló fiúk jobb életminőségről számolnak be.…”

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

“…This hematological disease is characterized by hemorrhages in the locomotor system, mainly located in muscles and joints (haemarthrosis) [3]. Joint bleeding mainly occurs in knees, ankles and elbows [4]. Repeated haemarthrosis in the same joint leads to the development of synovial membrane hypertrophy, chemical and enzymatic intra articular alterations, and finally joint degeneration (hemophilic arthropathy) [5].…”