8-Week Exercise Program Yields Multiple Benefits

Patricia Inácio, PhD avatar

by Patricia Inácio, PhD |

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Hemophilia patients experienced improvements in joint health, mobility, and overall quality of life after completing a supervised eight-week exercise program, a study reports.

However, in order to achieve long-lasting benefits, regular exercise may be required.

The study, “Effects of a supervised therapeutic exercise program on musculoskeletal health and gait in patients with haemophilia: A pilot study,” was published in the journal Haemophilia.

Joint bleeding, also known as hemarthrosis, is one of the most frequent complications seen in patients with hemophilia. Joints in the elbows, knees, and ankles are the most commonly affected. Altogether, this contributes to patients’ poor physical performance, reduced quality of life, and impaired movement.

Regular physical activity is widely known to benefit people with hemophilia. However, certain studies have reported no changes in mobility and joint health with exercise. Also, the impact of an exercise program on movement capacity and walking parameters remains unknown.

To answer that, a team led by researchers in Turkey conducted a prospective, single-center pilot study to assess the effects of a supervised exercise program on muscle and bone health, as well as on walking parameters, functional capacity, and quality of life in adults with hemophilia A and B.

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In total, the study (NCT04297696) included 19 men with hemophilia (mean age 26.3 years), including 12 with hemophilia A and seven with hemophilia B. All had a confirmed diagnosis of joint disease affecting either the knees or ankles, and were receiving either preventive or on-demand therapy to control bleeds.

Patients who developed inhibitors against delivered clotting proteins — factor VIII (FVIII) in the case of hemophilia A, and factor IX (FIX) in the case of hemophilia B — were excluded.

Patients willing to join the eight-week tailored training program were placed in the exercise group (10 patients, mean age 26.3 years), while those who, due to social reasons, time issues, or lack of interest, did not express interest in the exercise program were assigned to the control group (nine patients, mean age 26.2 years).

The eight-week exercise program consisted of aerobic, proprioception (conscious awareness of body movements), strengthening, and stretching exercises. Aerobic exercises were conducted on a elliptical bike, while proprioception exercises focused on achieving balance on one leg with visual support. Strengthening and stretching were based on low-intensity exercises to prevent injuries.

At the end of each session, patients underwent a cryotherapy session targeting joints in the lower extremities, lasting 15 minutes on each joint.

Exercises were conducted three days a week in a gymnasium under the supervision of a physiotherapist.

The study’s main goal was to assess changes in the Hemophilia Joint Health Score (HJHS) version 2.1, and in a 2D video-based gait kinematic analysis (2D-GKA), which assesses the extent, speed, and direction of joint movement or body parts while a person is walking, after six months.

Scoring in the HJHS ranges from zero to 124, in which higher scores mean increasing joint damage. No joint damage is indicated by a score of zero.

Additional goals included assessing changes in the six-minute walking test (6MWT), a measure of exercise capacity and endurance, and in the scores of the Hemophilia Quality of Life Questionnaire for Adults (Hem-A-Qol), in which lower scores indicate a higher quality of life.

Patients were evaluated by a physiotherapist at the start of the study (baseline), at the end of the exercise program, and at six-months of follow-up. To make sure that all 19 patients completed the 24 sessions, the exercise program was extended for 15 days.

More than half (63.2%) of the patients had severe disease and were on preventive treatment; four (21%) had been submitted for knee replacement surgery.

Joint disease was identified in a total of 35 joints. Most of the affected joints were located in the right lower side of the body (nine patients; 47.4%), followed by the left lower side in seven patients (36.8%). Only three patients (15.8%) had joint disease affecting both sides of the lower body.

There were no significant differences between the exercise and control groups regarding sociodemographic and clinical data at baseline.

Immediately at the end of the exercise program, those in the exercise group showed improvements in joint health, as shown by a significant reduction of HJHS scores. Specifically, the total HJHS score dropped from a mean of 20.3 at baseline to 16.8 at the end of the exercise program.

Improvements in joint health in the exercise group were accompanied by significant improvements in quality of life, as shown by a drop in the Haem-A-Qol scores, which decreased from 42.9 at baseline to 39.2.

After six-months of follow-up, however, HJHS scores increased  to a mean of 19.7, showing that joint health recovery was not maintained in the absence of exercise. The same was seen in the Haem-A-Qol, with scores reaching a mean of 40.2.

No significant differences were seen at any time-point in any of the HJHS scores nor in the Haem-A-Qol in the control group.

Patients in the exercise group also had improvements at the end of the exercise program in most walking parameters, as shown by the 2D-GKA. These included knee extension and ankle dorsiflexion (backward bending and contracting of the ankle) in midstance — the phase of walking when the foot assumes more of a support and overall stability role.

Improvements in knee extension were seen in the latest stage of walking (late-swing phase) and in the extension of the ankle during the pre-swing phase — the phase immediately preceding the one when the foot is pushed and lifted off of the ground. Improvements also were seen in the 6MWT. None were seen in the control group.

Notably, benefits seen in some of these parameters, including ankle dorsiflexion during the mid-swing phase and knee extension during late-swing phase, were maintained in the exercise group at follow-up.

Overall, as noted by researchers, these findings suggest that an “8-week supervised therapeutic exercise program was successful in achieving improvement in joint health, [mobility], functional capacity, and [quality of life]” in hemophilia patients.