Sports participation recommendations for patients with bleeding disorders

Abstract

There are several sets of guidelines recommending sports participation for patients with bleeding disorders. Though there is a perceived risk of injury and the associated bleeding complications, several studies have been done in this patient population and have found no increased risk. In addition, there are many other benefits to participation including improvement in physical fitness status, better health outcomes, improvement in quality of life, and the development of increased flexibility, gait coordination, and muscular strength, which may actually reduce the risk of subsequent injury. With adequate pre-participation preparation and surveillance, patients with hemophilia have few restrictions in their choice of activity. In the United States, the National Hemophilia Foundation (NHF) proposes stratification of activities into safe, safe-to-moderate, moderate, moderate-to-dangerous, and dangerous risk groups. The safe through moderate categories can be routinely recommended with the proper preparation. Though hematologists often use these recommendations when counseling their patients, these guidelines may not be as accessible for primary care and sports medicine providers. This article is to serve as a review of the related literature, specifically on the benefits of physical activity without an increased risk of injury in hemophilia patients, and will summarize a set of recommendations regarding safe athletic participation for individuals with bleeding disorders from both individual studies and from health regulatory bodies like the NHF.

Sports participation and physical activity in patients with von Willebrand disease

“…This is in contrast to patients with severe haemophilia, who participated less frequently in high‐risk sports such as soccer, while they more often participated in swimming (Figure ) . This is in line with the recommendation on sports participation in haemophilia patients, as recently reviewed by Howell et al…”

“…In the healthy population and haemophilia patients, sports participation and physical activity are associated with a better quality of life and may reduce the frequency of spontaneous bleeding due to improved strength and fitness . In accordance, we also found that VWD patients who participated in sports and patients who were more physically active scored their general health status better and felt more happy, than other VWD patients.…”

“…It has been previously shown that although patients with haemophilia A and B participate as frequently in sports as the general population, they often participate in different types of sports . Patients generally avoided sports with a high risk of bleeding, such as soccer, as is advised by the World Federation of Hemophilia (WFH) and the American National Hemophilia Foundation (NFH) . Patients with haemophilia more often participated in swimming and cycling than the general population …”

The multiple benefits of sport in haemophilia

“…These nonphysical aspects of sports activities can lead to a better management of the health condition . On the other hand, the haemophilia‐treating physicians and the community of patients and their caregivers should also keep in mind that even the best treated and most physically fit patient can bleed if participating in sport activities at high risk of trauma …”

A atividade física e a qualidade vida do estudante de medicina no Brasil

“…As evidências sobre os benefícios da atividade física regular são incontestáveis (58)(59)(60)(61)(62)(63)(64) A bibliografia relata benefícios relacionados à prevenção primária e secundária de doenças crônicas, bem como à diminuição da prevalência de morte em função de tais doenças, além dos efeitos positivos na qualidade de vida e de bemestar dos sujeitos estudados (65)(66)(67)(68) .…”