In children with hemophilia, individually planned exercise within the framework of the World Health Organization’s (WHO’s) International Classification of Functioning (ICF) is an effective physiotherapeutic strategy that contributes to joint health, motivates participation, and increases functional and physical activity levels.
A randomized study was conducted among male participants from Turkey with hemophilia A or hemophilia B. Results of the study were published in the Turkish Archives of Pediatrics.
The WHO ICF considers health to be “the demonstration of the relationship between body structure and function, activities, participation, and personal and environmental factors.” According to the WHO ICF model, “A comprehensive view of health involves the measurement of activities and participation.”
It is well recognized that effective movement and individualized physiotherapeutic interventions can improve the quality of life (QoL), levels of physical activity, and participation among children with hemophilia. In fact, for individuals with hemophilia to continue to perform their activities of daily living with quality, no pain, and no restrictions, the functioning of their musculoskeletal systems needs to be protected and improved with physiotherapy and rehabilitation beginning at an early age.
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In individuals with hemophilia who do not receive any physiotherapy, degenerative joint changes and arthropathy intensify with time. The researchers of the current study sought to develop an effective physiotherapy approach that would enhance the functional level, physical activity, joint health, and participation among pediatric patients with hemophilia.
Twenty-nine males between 8 and 18 years of age participated in the present analysis. From January 2021 to May 2021, all participants were recruited from the Physiotherapy Unit at the Hemophilia Society of Turkey. The 29 pediatric participants with hemophilia were randomized in a 1:1 ratio to 1 of 2 groups: (1) an individualized exercise program group with a physiotherapist that comprised 14 participants (exercise group) or (2) an individual counseling home-exercise program group (counseling group) that comprised 15 age-matched children.
The following workouts, performed at the Hemophilia Society of Turkey center under the supervision of a physiotherapist, were used in the exercise group:
- Warming exercises, including gentle, slow, prolonged stretches within the pain-free range, along with joint range of motion exercises and soft tissue flexibility;
- Strengthening exercises;
- Balance and proprioceptive exercises; and
- Cool-down exercises.
In the counseling group, the following occurred:
- Teaching of ergonomics and joint protection principles;
- Families of the children were informed about why the exercises were needed, the harmful effects of inactivity, the risks and benefits associated with participating in physical activities and sports, and use of a resting-activity cycle when bleeding was reported; and
- Patients performed exercises under a supervised program at home.
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Results of the study showed that in both groups, the Hemophilia Joint Health Status; 6-minute walk test; Canadian Occupation Performance Measure; International Physical Activity Questionnaire; muscle strength; and range of motion of the elbow, knee, and ankle all were improved significantly in both groups (P <.05).
“In addition to improving QoL and joint health status, increasing participation situations must be included in exercise or rehabilitation programs,” the researchers noted. “Individually prescribed and supervised exercise programs by experienced physiotherapists improved the physical function of children with bleeding disorders without increasing pain and bleeding,” they concluded.
Atay C, Tarakci E, Yeldan I, Zülfikar B. The effects of exercise training on physical activity level, daily living activities, and participation in children with hemophilia. Turk Arch Pediatr. Published online May 1, 2023. doi:10.5152/TurkArchPediatr.2023.22226