Benefits of Physical Activity for Individuals with Hemophilia – Recommendations of the MEMO Group

Introduction

Some studies have shown that individuals with hemophilia are as physically active as the general population. However, according to a recently published review, data on physical activity are significantly heterogeneous, and based on the experiences of Italian authors, participation in physical and sports activities is not sufficiently emphasized within comprehensive therapy, and unnecessarily many individuals with hemophilia exhibit no or low physical activity. Following these findings, they published recommendations on physical activity for individuals with hemophilia under the MEMO project (Movement for persons with haEMOphilia).

Key Consensus Points and Practical Recommendations

Experts suggest that low physical activity and possibly excessive parental protection of children with hemophilia contribute to the development of obesity and associated alterations in musculoskeletal function. Obesity is a current problem in the hemophilic population with similar or even higher prevalence than in the general population. It can affect the frequency of bleeding, pain, musculoskeletal function, and quality of life. Specific steps must be taken to prevent obesity and reduce weight, including reducing calorie intake and increasing physical activity.

Coordination, muscle strength, and flexibility are important pillars of joint function and stability, maintaining bone density, and reducing the risk of bleeding. An individualized physical program should focus not only on muscle and joint function but also on maintaining bone density, which is often reduced in young patients with severe hemophilia. Regular physical activity further contributes to improving overall quality of life, well-being, self-esteem, and social skills.

For individuals with arthropathy and older individuals, physical activity under the guidance of a trained physiotherapist is essential for improving stability and mobility to prevent falls and associated risks of fractures or bleeding. Even individuals with inhibitors should be motivated to engage in regular physical activity, with a need for an individualized plan and careful monitoring of prophylaxis effectiveness.

The selection of appropriate types of physical activity should be directed by a multidisciplinary team, including a hematologist, musculoskeletal specialists (orthopedists, rehabilitation physicians, and physiotherapists), and sports medicine specialists. This team should select suitable sports activities, ideally from childhood, considering potential risks and patient preferences to increase compliance and adherence to physical activity. The hematologist's key role in the multidisciplinary team is to optimize prophylactic therapy according to the risks of specific physical activities.

Conclusion

Physical activity brings numerous health benefits for individuals with hemophilia of all ages. In the hemophilic population, various recommendations must be followed to balance the benefits and risks and achieve the greatest possible adherence to physical therapy. Ideally, physical activity for individuals with hemophilia should be managed by a multidisciplinary team comprising various specialties.

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Source: Biasoli C., Baldacci E., Coppola A. et al.; MEMO Study Group (Appendix I). Promoting physical activity in people with haemophilia: the MEMO (Movement for persons with haEMOphilia) expert consensus project. Blood Transfus 2022; 20 (1): 66–77, doi: 10.2450/2021.0138-21.