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Background: Improved treatment options for people with haemophilia (PWH) have increased the possibilities for sports participation, but the risk of sports‐induced bleeding (SIB) is still considered considerable by many. Aim: To assess sports associated injury‐ and bleeding risk in PWH and to assess clotting levels associated with safe sports participation. Methods: Sports injuries and SIBs were prospectively collected for 12 months in PWH aged 6–49 without inhibitors playing sports at least once weekly. Injuries were compared according to factor levels, severity, joint health, sports risk category and sports intensity. Factor activity at the time of injury was estimated using a pharmacokinetic model. Results: 125 participants aged 6–49 (41 children, 90% haemophilia A; 48% severe, 95% severe on prophylaxis) were included. Sports injuries were reported by 51 participants (41%). Most participants (62%) reported no bleeds at all and only 16% reported SIBs. SIBs were associated with factor levels at time of injury (OR: 0.93/%factor level (CI 0.88–0.99); p =.02), but not with haemophilia severity (OR: 0.62 (CI 0.20–1.89); p =.40), joint health, sports risk category or sports intensity. PWH with factor levels <10% during sports injury had a bleeding risk of 41% versus 20% in those with higher (>10%) factor levels. Conclusion: The results of this study emphasize the importance of clotting factor levels in prevention of bleeds. This information is vital for patient counselling and tailoring prophylactic treatment with clotting factors and non‐replacement therapy. [ABSTRACT FROM AUTHOR]

Introduction: Predicting the risk of sports injuries and sports‐induced bleeds (SIBs) in people with haemophilia (PWH) may support clinical counselling. Aim: To assess the association between motor proficiency testing and sports injuries and SIBs and to identify a specific set of tests for predicting injury risk in PWH. Methods: In a single centre, prospective study male PWH aged 6–49 playing sports ≥1x/week were tested for running speed and agility, balance, strength and endurance. Test results below −2Z were considered poor. Sports injuries and SIBs were collected for 12 months while 7 days of physical activity (PA) for each season was registered with accelerometers. Injury risk was analysed according to test results and type of physical activity (%time walking, cycling, running). Predictive values for sports injuries and SIBs were determined. Results: Data from 125 PWH (mean [± SD] age: 25 [± 12], 90% haemophilia A; 48% severe, 95% on prophylaxis, median factor level: 2.5 [IQR 0–15]IU/dl) were included. Few participants (n = 19, 15%) had poor scores. Eighty‐seven sports injuries and 26 SIBs were reported. Poor scoring participants reported 11/87 sports injuries and 5/26 SIBs. The current tests were poor predictors of sports injuries (Range PPV: 0%–40%), or SIBs (PPV: 0%–20%). PA type was not associated with season (activity seasonal p values >.20) and type of PA was not associated with sports injuries or SIBs (Spearman's rho <.15). Conclusion: These motor proficiency‐ and endurance tests were unable to predict sports injuries or SIBs in PWH, potentially due to few PWH with poor results and low numbers of sports injuries and SIBs. [ABSTRACT FROM AUTHOR]

Haemophilia treatment has seen great advances in recent years with an accompanied reduced risk of physical activity (PA) related bleeds. Based on its known health benefits, people with haemophilia (PWH) are currently encouraged to regularly engage in PA. However, this may not always translate to increased levels of PA. In this narrative review we aim to provide a brief overview of what is currently understood regarding PA levels and influences for the three broad age groups of children and adolescents, adults and older adults. We also provide recommendations for members of the haemophilia team on important aspects related to promotion of PA in their clinical practice. We highlight that PA behaviour is multifactorial and that many PWH still have limited access to adequate care. Whilst some still face unique challenges to being more physically active, overall, the barriers and facilitators to activity are very similar to that of the general population. [ABSTRACT FROM AUTHOR]

Introduction: Although sports participation is advocated in people with haemophilia (PWH), detailed data concerning sports participation in Dutch PWH is lacking. Aim: to assess sports participation in Dutch PWH (6‐65 years) compared to the Dutch general population (GP). Methods: Data from a nationwide, cross‐sectional study in PWH were analysed. Sports participation (type, duration, frequency) was assessed by the Modifiable Activities Questionnaire (MAQ), limitations in activities using the (Paediatric) Haemophilia Activities List ((Ped)HAL). Sports in the two highest categories according to the National Hemophilia Foundation classification were considered high‐risk sports. Groups were compared using Chi‐square testing. Results: A total of 524 Adult PWH (median age: 45 (IQR: 30–55); 37% severe) and 126 paediatric PWH (median age: 11 (IQR: 8–14); 52% severe) were included. Sports participation was higher in adults (70%) than the GP (58%) and similar to the GP in children (PWH: 68%, GP: 72%). High‐risk sports participation decreased with age in PWH: from 65% (6‐12 years) to 17% (50‐65 years), which was also observed in the GP. Sports participation in children was independent of severity (non‐severe: 67% vs. severe: 65%; P = 0.97), but not in adults (non‐severe: 75%, severe: 62%; P < 0.01). Non‐severe PWH played more high‐risk sports than severe PWH: children at 65% vs. 48% (P = 0.05), adults at 25% vs. 15% (P = 0.07). Discussion: These results suggest that sports participation in PWH was comparable to the GP. Sports participation was dependent of haemophilia severity in adults. Children were more involved in high‐risk sports than adults. More studies on sports‐related injury‐risk are needed for adequate counselling. [ABSTRACT FROM AUTHOR]

In the Dutch haemophilia population, the distribution of patients with severe haemophilia is approximately 50%.1 This could lead to selection bias, as more adherent and more active patients are likely more prone to complete these questionnaires. A total of 267 participants with haemophilia A or haemophilia B who used prophylaxis completed both questionnaires and were included in the analyses. Keywords: adherence; compliance; Haemophilia; physical activity; sport EN adherence compliance Haemophilia physical activity sport e402 e405 4 06/14/21 20210501 NES 210501 Patients with severe haemophilia (PWH) lack clotting factor VIII or factor IX activity (<1 IU/dl) and are at risk of spontaneous bleeds in joints, soft tissue and muscles.1 In the Netherlands, regular replacement therapy (prophylaxis) to prevent bleeding and subsequent joint damage is a standard treatment.1 This replacement therapy consists of intravenously self-administered clotting factor concentrate 2-3 times/week, usually started before the age of 3 years.1 In young children, parents generally perform these injections. [Extracted from the article]

Introduction: Sports participation in children with hemophilia is generally considered to be associated with increased injury risk, which is generally considered highest in severe hemophilia. Aim: To assess sports participation according to age and severity in children with hemophilia and its association with sports injuries. Methods: In a retrospective single‐center study, sports participation, injuries, and bleeding data from three consecutive annual clinic visits were collected for young patients with hemophilia (PWH, aged 6‐18). Sports in categories 2.5 and 3 of 3 according to the National Hemophilia Foundation classification were considered high‐risk. Groups were compared using chi‐square testing. Results: 105 PWH (median age: 13(IQR 10‐14); 53% severe; bleeding rate: 1/y) were identified; three were unable to perform sports and were excluded. The majority of PWH (77%) played sports weekly, of which 80% high‐risk sports. Sports participation (median 3.0x/wk), and the proportion of injured PWH was similar in severe (42%) and non‐severe (33%) PWH. Sports injuries were rare (65% no injuries in 3 years, median 0/y (IQR 0‐1)). Annually, PWH did not report more injuries (15%) than age‐matched boys (28%). Sports injuries were not associated with frequency and type of sports. Discussion: This retrospective study showed high sports participation (including high‐risk sports) and low injury rates. Sports participation was similar across severities and injury rates were not higher than among the general population. Injuries were not associated with frequency or type of sports. A prospective study with objective assessment of sports participation and injuries is warranted to confirm these findings and avoid recall bias. [ABSTRACT FROM AUTHOR]

Introduction: Differences in treatment and outcome have been reported for persons with haemophilia (PWH) on intermediate‐dose (Dutch) and high‐dose (Swedish) prophylaxis, but the potential influence of sports participation has not been considered. Aim: To compare sports participation and clinical outcome between adult Dutch and Swedish PWH. Methods: Self‐reported sports participation (type and frequency per week), physical functioning (SF‐36PF: 100‐0), joint status (HJHS: 0‐144), perceived limitations (HALsum: 100‐0) and physical activity (IPAQ) were recorded. Sports were classified according to National Haemophilia Foundation classification (5 categories, highest two were classified as high‐risk sports). Sports participation and clinical outcome were compared according to country and age (18‐22, 23‐29, 30‐40 years) using non‐parametric tests and Spearman correlations (rho). Results: Seventy‐one adult PWH (NL: 43, SWE: 28) completed sports questionnaires (mean age: 26 years). All participants engaged in sports, including 59.2% in high‐risk sports (33.9% twice weekly). Dutch PWH showed a significant age‐related decline in (high‐risk) sports participation (7x/wk in PWH 18‐22 years to 2x/wk in PWH 30‐40 years, P < 0.05), joint health (HJHS: median 2‐15.5, P < 0.01) and physical functioning (SF‐36PF: median 100 to 77.5, P < 0.01), while Swedish did not. Sports participation was not associated with bleeding (Spearman's rho = −0.119). Conclusion: All participants reported sports participation, including 59.2% in high‐risk sports. Dutch PWH treated with intermediate‐dose prophylaxis showed an age‐related decline in sports participation, joint status and physical functioning, whereas Swedish PWH on high‐dose prophylaxis did not. Sports participation was not associated with bleeding. [ABSTRACT FROM AUTHOR]

In recent years, sports participation in Dutch patients with haemophilia (PWH) has been comparable to the general population (GP), especially in children.3,4 The recent COVID-19 pandemic has forced governments worldwide to take drastic actions. Physical activity (PA) in general and sports participation in particular have been promoted for years for their positive effects on human health.1 This applies to both healthy persons and persons with congenital, chronic diseases, such as haemophilia.2 Because of these positive health effects, PA and sports participation have been advocated by haemophilia physicians since the introduction of prophylactic infusions in the 1970s and 1980s. Despite an abundancy of literature regarding exercise strategies during, and return to sports after the COVID-19 pandemic, we were only able to identify three studies on the effects of the social restrictions on sports. [Extracted from the article]