Different Treatment Strategies May Affect Sports Participation in Hemophilia Patients, Study Suggests

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by Alice Melão |

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Hemophilia patients who take intermediate‐dose preventive medication may experience more of an age-related decline in sports participation, joint status, and physical functioning than those on a high dose, a population-based study suggests.

The study, “Sports participation and physical activity in adult Dutch and Swedish patients with severe haemophilia: A comparison between intermediate‐ and high‐dose prophylaxis,” was published in Haemophilia, the official journal of the World Federation of Hemophilia.

Development of more stable and effective engineered versions of clotting factors has improved the quality of life of people living with bleeding disorders. In particular, the increased availability of recombinant clotting factors and the introduction of preventive, or prophylactic, replacement therapies have allowed hemophilia patients to engage in a more active lifestyle and participate more in sports.

Because sports and physical activity have become more important parameters for outcomes in the hemophilia population, it has also become important to better understand the implications of these activities on treatment regimens and bleeding risk.

The National Hemophilia Foundation has categorized different types of sports based on their potential risk of bleeding. These categories range from safe-risk sports, which include those that have a low impact and with a low collision risk, such as walking and swimming, to moderate or high-risk sports, which include soccer, boxing, and rugby.

In this study, Dutch and Swedish researchers compared age‐related differences in sports participation and high‐risk sports between adults with hemophilia in the two countries, which each use different treatment strategies.

The study included 103 adult patients, of whom 71 — 43 from the Netherlands and 28 from Sweden — completed the sports questionnaire. The study also included 73 healthy volunteers from both countries.

Both groups of patients included mainly (87%) patients with severe hemophilia A, and the average age was 26 years.

In general, the treatment regimen was significantly less intensive in the Netherlands, with prophylaxis starting later in life — by a median age of 5 years compared with 1.7 years in the Swedish group — and with half of the current weekly prophylactic dosing.

Evaluation of the participants’ clinical outcomes revealed that the prevalence of joint damage in the Dutch group was double that in the Swedish group. Dutch patients also seemed to do slightly fewer activities and have a lower quality of life.

Researchers found that Dutch hemophilia patients had a trend for worse joint damage and more limited physical functioning with age, while Swedish patients remained stable.

All participants who completed a sports questionnaire reported being active in some kind of sport, with 59.2% of the patients engaged in moderate to dangerous (high-risk) physical activities.

The most commonly practiced sports were different between the two countries. Still, cycling, swimming, walking, fitness, bowling, billiards, skiing, jogging, and football (soccer) were among the 10 most common sports reported by both groups.

Researchers saw a clear decrease in how often Dutch patients engaged in sports per week with age, but this was not seen in Swedish patients.

An age-related decline in the proportion of hemophilia patients who engaged in high-risk sports in the Dutch group was also reported. While 75% of Swedish patients ages 30–40 practiced high‐risk sports, only 28% of Dutch patients in the same age range reported doing these same activities.

The team did not found any significant correlation between sports participation and clinical outcomes or treatment and bleeding parameters.

These findings show that Dutch hemophilia patients, “who received less intensive treatment” experience “age‐related decrease in (high‐risk) sports participation and joint health and a decrease in physical functioning,” according to the researchers.

Additional studies are still warranted to further explore the impact of the frequency, duration, and intensity of physical exercise in hemophilia populations. Such studies may provide better insights on the outcomes of these patients and support counseling on sports participation.