PDF herunterladen
Semin Thromb Hemost 2018; 44(08): 787-795
DOI: 10.1055/s-0038-1675381
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Impact of Exercise on Hemophilia

Eva Zetterberg
1   Department of Translational Medicine, Malmö Centre for Thrombosis and Haemostasis, Lund University, Malmö, Sweden
,
Marcus Ljungkvist
1   Department of Translational Medicine, Malmö Centre for Thrombosis and Haemostasis, Lund University, Malmö, Sweden
,
Maryem Salim
1   Department of Translational Medicine, Malmö Centre for Thrombosis and Haemostasis, Lund University, Malmö, Sweden
› Institutsangaben
Weitere Informationen

Publikationsverlauf

Publikationsdatum:
24. Oktober 2018 (online)

    Lizenzen und Reprints

Abstract

Sports and strenuous exercise have traditionally been discouraged for people with hemophilia (PWH) because of the perceived risk of bleeding. In this review, studies investigating the pros and cons of exercise are presented, and although most studies are of low validity, the randomized trials that do exist tell us that PWH benefit from exercise in terms of improved muscular function, endurance, and quality of life and that increased bleeding does not seem to be an issue. The authors also review the studies that have analyzed the current physical status of PWH compared with the general population in different countries. Finally, they review the current knowledge on the effect of exercise on specific coagulation factors as well as on global coagulation and demonstrate that exercise increases factor VIII levels in healthy persons, all persons with hemophilia B (HB) and in persons with mild and moderate hemophilia A (HA). Further, the authors did not find any evidence that the global coagulation capacity, measured with thrombin generation or thromboelastographic methods, increases after exercise in severe HA or HB.

Keywords

exercise - hemophilia - endurance - quality of life - thrombin generation
 

  • References

  • 1 Haskell WL, Lee IM, Pate RR. , et al. Physical activity and public health: updated recommendation for adults from the American College of Sports Medicine and the American Heart Association. Med Sci Sports Exerc 2007; 39 (08) 1423-1434
    Google Scholar
  • 2 Vermunt PW, Milder IE, Wielaard F. , et al. Behavior change in a lifestyle intervention for type 2 diabetes prevention in Dutch primary care: opportunities for intervention content. BMC Fam Pract 2013; 14: 78
    CrossrefPubMedGoogle Scholar
  • 3 Broderick JM, Guinan E, Kennedy MJ. , et al. Feasibility and efficacy of a supervised exercise intervention in de-conditioned cancer survivors during the early survivorship phase: the PEACH trial. J Cancer Surviv 2013; 7 (04) 551-562
    CrossrefPubMedGoogle Scholar
  • 4 Pahkala K, Laitinen TT, Heinonen OJ. , et al. Association of fitness with vascular intima-media thickness and elasticity in adolescence. Pediatrics 2013; 132 (01) e77-e84
    CrossrefPubMedGoogle Scholar
  • 5 Rongen-van Dartel SA, Repping-Wuts H, Flendrie M. , et al. Effect of aerobic exercise training on fatigue in rheumatoid arthritis: a meta-analysis. Arthritis Care Res (Hoboken) 2015; 67 (08) 1054-1062
    PubMedGoogle Scholar
  • 6 Brunner A, Stäuber F, Göhler S. , et al. Quadriceps strength, inter-extremity difference (IED) and joint status in adult persons with severe haemophilia in different age stages. Haemophilia 2013; 19 (02) 267-274
    CrossrefPubMedGoogle Scholar
  • 7 Falk B, Portal S, Tiktinsky R. , et al. Bone properties and muscle strength of young haemophilia patients. Haemophilia 2005; 11 (04) 380-386
    CrossrefPubMedGoogle Scholar
  • 8 González LM, Querol F, Gallach JE, Gomis M, Aznar VA. Force fluctuations during the Maximum Isometric Voluntary Contraction of the quadriceps femoris in haemophilic patients. Haemophilia 2007; 13 (01) 65-70
    PubMedGoogle Scholar
  • 9 Hilberg T, Herbsleb M, Gabriel HH, Jeschke D, Schramm W. Proprioception and isometric muscular strength in haemophilic subjects. Haemophilia 2001; 7 (06) 582-588
    CrossrefPubMedGoogle Scholar
  • 10 Khawaji M, Astermark J, Berntorp E. Lifelong prophylaxis in a large cohort of adult patients with severe haemophilia: a beneficial effect on orthopaedic outcome and quality of life. Eur J Haematol 2012; 88 (04) 329-335
    CrossrefPubMedGoogle Scholar
  • 11 Khawaji M, Akesson K, Berntorp E. Long-term prophylaxis in severe haemophilia seems to preserve bone mineral density. Haemophilia 2009; 15 (01) 261-266
    CrossrefPubMedGoogle Scholar
  • 12 Khawaji M, Astermark J, Akesson K, Berntorp E. Physical activity for prevention of osteoporosis in patients with severe haemophilia on long-term prophylaxis. Haemophilia 2010; 16 (03) 495-501
    PubMedGoogle Scholar
  • 13 Khawaji M, Astermark J, Akesson K, Berntorp E. Physical activity and joint function in adults with severe haemophilia on long-term prophylaxis. Blood Coagul Fibrinolysis 2011; 22 (01) 50-55
    CrossrefPubMedGoogle Scholar
  • 14 Boadas A, Osorio M, Gibraltar A. , et al; Desafio del Caribe Project. Favourable impact of regular swimming in young people with haemophilia: experience derived from ‘Desafio del Caribe’ project. Haemophilia 2015; 21 (01) e12-e18
    CrossrefPubMedGoogle Scholar
  • 15 Kargarfard M, Dehghadani M, Ghias R. The effect of aquatic exercise therapy on muscle strength and joint's range of motion in hemophilia patients. Int J Prev Med 2013; 4 (01) 50-56
    PubMedGoogle Scholar
  • 16 Murtezani A, Nevzati A, Ibraimi Z, Sllamniku S, Meka VS, Abazi N. The effect of land versus aquatic exercise program on bone mineral density and physical function in postmenopausal women with osteoporosis: a randomized controlled trial. Ortop Traumatol Rehabil 2014; 16 (03) 319-325
    CrossrefPubMedGoogle Scholar
  • 17 Vallejo L, Pardo A, Gomis M, Gallach JE, Pérez S, Querol F. Influence of aquatic training on the motor performance of patients with haemophilic arthropathy. Haemophilia 2010; 16 (01) 155-161
    CrossrefPubMedGoogle Scholar
  • 18 Salim M, Brodin E, Spaals-Abrahamsson Y, Berntorp E, Zetterberg E. The effect of Nordic walking on joint status, quality of life, physical ability, exercise capacity and pain in adult persons with haemophilia. Blood Coagul Fibrinolysis 2016; 27 (04) 467-472
    CrossrefPubMedGoogle Scholar
  • 19 Strike K, Mulder K, Michael R. Exercise for haemophilia. Cochrane Database Syst Rev 2016; 12: CD011180
    PubMedGoogle Scholar
  • 20 McGee S, Raffini L, Witmer C. Organized sports participation and the association with injury in paediatric patients with haemophilia. Haemophilia 2015; 21 (04) 538-542
    CrossrefPubMedGoogle Scholar
  • 21 Runkel B, Czepa D, Hilberg T. RCT of a 6-month programmed sports therapy (PST) in patients with haemophilia - Improvement of physical fitness. Haemophilia 2016; 22 (05) 765-771
    CrossrefPubMedGoogle Scholar
  • 22 Runkel B, Von Mackensen S, Hilberg T. RCT - subjective physical performance and quality of life after a 6-month programmed sports therapy (PST) in patients with haemophilia. Haemophilia 2017; 23 (01) 144-151
    CrossrefPubMedGoogle Scholar
  • 23 Sondermann J, Herbsleb M, Stanek FD, Gabriel H, Kentouche K. Health promotion for young patients with haemophilia. Counselling, adjuvant exercise therapy and school sports. Hamostaseologie 2017; 37 (02) 107-116
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 24 Negrier C, Seuser A, Forsyth A. , et al. The benefits of exercise for patients with haemophilia and recommendations for safe and effective physical activity. Haemophilia 2013; 19 (04) 487-498
    CrossrefPubMedGoogle Scholar
  • 25 Philpott J, Houghton K, Luke A. Physical activity recommendations for children with specific chronic health conditions: juvenile idiopathic arthritis, hemophilia, asthma and cystic fibrosis. Paediatr Child Health 2010; 15 (04) 213-225
    CrossrefPubMedGoogle Scholar
  • 26 Sherlock E, O'Donnell JS, White B, Blake C. Physical activity levels and participation in sport in Irish people with haemophilia. Haemophilia 2010; 16 (01) e202-e209
    CrossrefPubMedGoogle Scholar
  • 27 Seuser A, Boehm P, Ochs S, Trunz-Carlisi E, Halimeh S, Klamroth R. How fit are children and adolescents with haemophilia in Germany? Results of a prospective study assessing the sport-specific motor performance by means of modern test procedures of sports science. Haemophilia 2015; 21 (04) 523-529
    CrossrefPubMedGoogle Scholar
  • 28 Broderick CR, Herbert RD, Latimer J, van Doorn N. Patterns of physical activity in children with haemophilia. Haemophilia 2013; 19 (01) 59-64
    CrossrefPubMedGoogle Scholar
  • 29 von Mackensen S, Harrington C, Tuddenham E. , et al. The impact of sport on health status, psychological well-being and physical performance of adults with haemophilia. Haemophilia 2016; 22 (04) 521-530
    CrossrefPubMedGoogle Scholar
  • 30 Groen WG, Takken T, van der Net J, Helders PJ, Fischer K. Habitual physical activity in Dutch children and adolescents with haemophilia. Haemophilia 2011; 17 (05) e906-e912
    CrossrefPubMedGoogle Scholar
  • 31 Buzzard BM. Physiotherapy, rehabilitation and sports in countries with limited replacement coagulation factor supply. Haemophilia 2007; 13 (Suppl. 02) 44-46
    CrossrefPubMedGoogle Scholar
  • 32 El-Sayed MS, El-Sayed Ali Z, Ahmadizad S. Exercise and training effects on blood haemostasis in health and disease: an update. Sports Med 2004; 34 (03) 181-200
    CrossrefPubMedGoogle Scholar
  • 33 Lippi G, Maffulli N. Biological influence of physical exercise on hemostasis. Semin Thromb Hemost 2009; 35 (03) 269-276
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 34 Prisco D, Francalanci I, Filippini M, Hagi MI. Physical exercise and hemostasis. Int J Clin Lab Res 1994; 24 (03) 125-131
    CrossrefPubMedGoogle Scholar
  • 35 Smith JE. Effects of strenuous exercise on haemostasis. Br J Sports Med 2003; 37 (05) 433-435
    CrossrefPubMedGoogle Scholar
  • 36 Wang JS. Exercise prescription and thrombogenesis. J Biomed Sci 2006; 13 (06) 753-761
    CrossrefPubMedGoogle Scholar
  • 37 Andrew M, Carter C, O'Brodovich H, Heigenhauser G. Increases in factor VIII complex and fibrinolytic activity are dependent on exercise intensity. J Appl Physiol (1985) 1986; 60 (06) 1917-1922
    CrossrefPubMedGoogle Scholar
  • 38 Womack CJ, Ivey FM, Gardner AW, Macko RF. Fibrinolytic response to acute exercise in patients with peripheral arterial disease. Med Sci Sports Exerc 2001; 33 (02) 214-219
    CrossrefPubMedGoogle Scholar
  • 39 Kupchak BR, Creighton BC, Aristizabal JC. , et al. Beneficial effects of habitual resistance exercise training on coagulation and fibrinolytic responses. Thromb Res 2013; 131 (06) e227-e234
    CrossrefPubMedGoogle Scholar
  • 40 Groen WG, den Uijl IE, van der Net J, Grobbee DE, de Groot PG, Fischer K. Protected by nature? Effects of strenuous physical exercise on FVIII activity in moderate and mild haemophilia A patients: a pilot study. Haemophilia 2013; 19 (04) 519-523
    CrossrefPubMedGoogle Scholar
  • 41 Koch B, Luban NL, Galioto Jr FM, Rick ME, Goldstein D, Kelleher Jr JF. Changes in coagulation parameters with exercise in patients with classic hemophilia. Am J Hematol 1984; 16 (03) 227-233
    CrossrefPubMedGoogle Scholar
  • 42 Rizza CR. Effect of exercise on the level of antihaemophilic globulin in human blood. J Physiol 1961; 156: 128-135
    CrossrefPubMedGoogle Scholar
  • 43 Beltrame LG, Abreu L, Almeida J, Boullosa DA. The acute effect of moderate intensity aquatic exercise on coagulation factors in haemophiliacs. Clin Physiol Funct Imaging 2015; 35 (03) 191-196
    CrossrefPubMedGoogle Scholar
  • 44 Kumar R, Bouskill V, Schneiderman JE. , et al. Impact of aerobic exercise on haemostatic indices in paediatric patients with haemophilia. Thromb Haemost 2016; 115 (06) 1120-1128
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 45 Fijnvandraat K, Peters M, ten Cate JW. Inter-individual variation in half-life of infused recombinant factor VIII is related to pre-infusion von Willebrand factor antigen levels. Br J Haematol 1995; 91 (02) 474-476
    CrossrefPubMedGoogle Scholar
  • 46 Al Dieri R, de Laat B, Hemker HC. Thrombin generation: what have we learned?. Blood Rev 2012; 26 (05) 197-203
    CrossrefPubMedGoogle Scholar
  • 47 Whiting D, DiNardo JA. TEG and ROTEM: technology and clinical applications. Am J Hematol 2014; 89 (02) 228-232
    CrossrefPubMedGoogle Scholar
  • 48 Sucker C, Zotz RB, Senft B. , et al. Exercise-induced hemostatic alterations are detectable by rotation thrombelastography (ROTEM): a marathon study. Clin Appl Thromb Hemost 2010; 16 (05) 543-548
    CrossrefPubMedGoogle Scholar
  • 49 Hilberg T, Menzel K, Wehmeier UF. Endurance training modifies exercise-induced activation of blood coagulation: RCT. Eur J Appl Physiol 2013; 113 (06) 1423-1430
    CrossrefPubMedGoogle Scholar
  • 50 Hernández Madrid A, Potpara TS, Dagres N. , et al. Differences in attitude, education, and knowledge about oral anticoagulation therapy among patients with atrial fibrillation in Europe: result of a self-assessment patient survey conducted by the European Heart Rhythm Association. Europace 2016; 18 (03) 463-467
    CrossrefPubMedGoogle Scholar
  • 51 Sholzberg M, Floros G, Schneiderman JE. , et al. Effect of moderate intensity exercise on haemostatic capacity in adults with haemophilia A and B: pilot study. Haemophilia 2017; 23 (02) e162-e165
    CrossrefPubMedGoogle Scholar
  • 52 Krüger S, Weitz C, Runkel B, Hilberg T. Pain sensitivity in patients with haemophilia following moderate aerobic exercise intervention. Haemophilia 2016; 22 (06) 886-893
    CrossrefPubMedGoogle Scholar
  • 53 Gilbert MS. Prophylaxis: musculoskeletal evaluation. Semin Hematol 1993; 30 (03) (Suppl. 02) 3-6
    Google Scholar
  • 54 Freynhagen R, Baron R, Gockel U, Tölle TR. painDETECT: a new screening questionnaire to identify neuropathic components in patients with back pain. Curr Med Res Opin 2006; 22 (10) 1911-1920
    CrossrefPubMedGoogle Scholar
  • 55 Nagel B, Gerbershagen HU, Lindena G, Pfingsten M. [Development and evaluation of the multidimensional German pain questionnaire]. Schmerz 2002; 16 (04) 263-270
    CrossrefPubMedGoogle Scholar
  • 56 Hilberg T, Czepa D, Freialdenhoven D, Boettger MK. Joint pain in people with hemophilia depends on joint status. Pain 2011; 152 (09) 2029-2035
    CrossrefPubMedGoogle Scholar
  • 57 Borg G. Psychophysical scaling with applications in physical work and the perception of exertion. Scand J Work Environ Health 1990; 16 (Suppl. 01) 55-58
    CrossrefPubMedGoogle Scholar
  • 58 Cooper KH. Aerobics. California: Bantam Books; 1969
    Google Scholar
  • 59 Gould D. Examining the validity of pressure ulcer risk assessment scales: developing and using illustrated patient simulations to collect the data. J Clin Nurs 2001; 10 (05) 697-706
    CrossrefPubMedGoogle Scholar
  • 60 Al-Sharif FA, Al-Jiffri OH, El-Kader SM, Ashmawy EM. Impact of mild versus moderate intensity aerobic walking exercise training on markers of bone metabolism and hand grip strength in moderate hemophilic A patients. Afr Health Sci 2014; 14 (01) 11-16
    CrossrefPubMedGoogle Scholar
  • 61 Hilliard P, Funk S, Zourikian N. , et al. Hemophilia joint health score reliability study. Haemophilia 2006; 12 (05) 518-525
    CrossrefPubMedGoogle Scholar
  • 62 Coopersmith S. Self-esteem Inventory. California: Consulting Psychologists Press; 1984
    Google Scholar
  • 63 Gimeno F, Buceta JM, Perez LM. El cuestionario caracteristicas paicologicas relacionadas con el rendimiento deportivo (CPRD): caracteristicas psicometricas. Análise psicológica 2001; 1: 93-113
    PubMedGoogle Scholar
  • 64 Martens R, Vealey RS, Burton D. Competitive anxiety in sport. Champaign, IL: Human Kinetics; 1990
    Google Scholar
  • 65 Jaenes JC, Caracuel JC, Pérez Gil JA. Adaptación española del test CSAI-2: un estudio en corredores españoles de maratón. Poster presented at the VII Congreso Nacional de la actividad física y del deporte, Murcia, España: Sociedad Murciana de Psicología de la Actividad Física y del Deporte, 1999
    PubMedGoogle Scholar
  • 66 Maldonado ML. Test persona bajo la lluvia. Available at: http://www.infogerontologia.com/documents/miscelanea/test_evaluacion/testpersonabajolalluvia.pdf2002 . Accessed March 1, 2018
    PubMedGoogle Scholar
  • 67 Simonton C, Matthews-Simonton S, Creigthon JL. Getting Well Again. Los Angeles: Tarcher; 1978
    Google Scholar
  • 68 McGavin CR, Gupta SP, McHardy GJ. Twelve-minute walking test for assessing disability in chronic bronchitis. BMJ 1976; 1 (6013): 822-823
    CrossrefPubMedGoogle Scholar
  • 69 Bohannon RW, Larkin PA, Cook AC, Gear J, Singer J. Decrease in timed balance test scores with aging. Phys Ther 1984; 64 (07) 1067-1070
    CrossrefPubMedGoogle Scholar
  • 70 von Mackensen S, Czepa D, Herbsleb M, Hilberg T. Development and validation of a new questionnaire for the assessment of subjective physical performance in adult patients with haemophilia--the HEP-Test-Q. Haemophilia 2010; 16 (01) 170-178
    CrossrefPubMedGoogle Scholar
  • 71 Bullinger MKI. SF-36 Fragebogen zum Gesundheitszustand: Handanweisung. Gõttingen, Bern, Toronto, Seattle: Hogrefe-Verlag GmbH; 1998
    Google Scholar
  • 72 von Mackensen S, Gringeri A. Quality of life in hemophilia. In: Preedy VR, Watson RR. , eds. Handbook of Disease Burdens and Quality of Life. Heidelberg, Germany: Springer; 2010: 1896-1920
    Google Scholar
  • 73 Czepa D, von Mackensen S, Hilberg T. Haemophilia & Exercise Project (HEP): the impact of 1-year sports therapy programme on physical performance in adult haemophilia patients. Haemophilia 2013; 19 (02) 194-199
    CrossrefPubMedGoogle Scholar
  • 74 Herbsleb M, Hilberg T. Maximal and submaximal endurance performance in adults with severe haemophilia. Haemophilia 2009; 15 (01) 114-121
    CrossrefPubMedGoogle Scholar
  • 75 Hilberg T, Herbsleb M, Puta C, Gabriel HH, Schramm W. Physical training increases isometric muscular strength and proprioceptive performance in haemophilic subjects. Haemophilia 2003; 9 (01) 86-93
    CrossrefPubMedGoogle Scholar
  • 76 Hill K, Fearn M, Williams S. , et al. Effectiveness of a balance training home exercise programme for adults with haemophilia: a pilot study. Haemophilia 2010; 16 (01) 162-169
    CrossrefPubMedGoogle Scholar
  • 77 Duncan PW, Weiner DK, Chandler J, Studenski S. Functional reach: a new clinical measure of balance. J Gerontol 1990; 45 (06) M192-M197
    CrossrefPubMedGoogle Scholar
  • 78 Hill KBJ, McGann A, Maltese D, Berkovits D. A new test of dynamic standing balance for stroke patients: reliability, validity, and comparison with healthy elderly. Physiother Can 1996; 48: 257-262
    CrossrefPubMedGoogle Scholar
  • 79 Podsiadlo D, Richardson S. The timed “Up & Go”: a test of basic functional mobility for frail elderly persons. J Am Geriatr Soc 1991; 39 (02) 142-148
    Google Scholar
  • 80 Fix A, Daughton D. Human activity profile: professional manual. Odessa, FL: Psychological Assessment Resources Inc.; 1988
    PubMedGoogle Scholar
  • 81 Hill KD, Schwarz JA, Kalogeropoulos AJ, Gibson SJ. Fear of falling revisited. Arch Phys Med Rehabil 1996; 77 (10) 1025-1029
    CrossrefPubMedGoogle Scholar
  • 82 Guyatt GH, Sullivan MJ, Thompson PJ. , et al. The 6-minute walk: a new measure of exercise capacity in patients with chronic heart failure. Can Med Assoc J 1985; 132 (08) 919-923
    Google Scholar
  • 83 Von Mackensen S, Eifrig B, Zäch D, Kalnins J, Wieloch A, Zeller W. The impact of a specific aqua-training for adult haemophilic patients--results of the WATERCISE study (WAT-QoL). Haemophilia 2012; 18 (05) 714-721
    CrossrefPubMedGoogle Scholar
  • 84 Khair K, Littley A, Will A, von Mackensen S. The impact of sport on children with haemophilia. Haemophilia 2012; 18 (06) 898-905
    CrossrefPubMedGoogle Scholar
  • 85 Ravens-Sieberer U, Bullinger M. Assessing health-related quality of life in chronically ill children with the German KINDL: first psychometric and content analytical results. Qual Life Res 1998; 7 (05) 399-407
    CrossrefPubMedGoogle Scholar
  • 86 von Mackensen S, Bullinger M. ; Haemo-QoL Group. Development and testing of an instrument to assess the Quality of Life of Children with Haemophilia in Europe (Haemo-QoL). Haemophilia 2004; 10 (Suppl. 01) 17-25
    CrossrefPubMedGoogle Scholar
  • 87 Mount A, Xiong S, Shan X. , et al. Electrochemical conversion and storage systems: general discussion. Faraday Discuss 2014; 176: 153-184
    CrossrefPubMedGoogle Scholar