Doc. Petr Dulíček: Physical activity in hemophiliacs? Today it is a reality - just don't be afraid!

Is physical activity recommended for patients across medical fields? Does its benefit also apply to hemophiliacs?

Of course. Physical activity is important both for psychological and physical reasons. Psychologically, it leads to increased self-esteem and a sense of equality with people who do not have hemophilia. Physically, it also benefits because it allows the strengthening of large muscle groups and better stabilization of the load-bearing joints. However, as with healthy people, it must be carried out in such a way that it helps the individual, not harms them. And the load needs to be increased gradually.

What should we imagine by the term "safe physical activity" for hemophiliacs?

By "safe," I imagine an activity that does not inherently increase the risk of bleeding. So we certainly do not recommend contact sports for individuals with a severe form of hemophilia, even if they are on regular prophylaxis. Similarly, sports that involve a risk of falls, which again increases the risk of bleeding, are not suitable.

Which sports are suitable then? And how about top-level sports?

The times and recommendations are changing significantly. In the past, sports were practically impossible for severe forms of hemophilia; today, there are individuals with hemophilia among top athletes—I mean, for example, a participant in the Tour de France. In our country, we have an individual with a mild form of hemophilia who even plays football among top athletes. And which sports do we recommend? They definitely include swimming, walking, running, or fitness exercises.

Does physical activity in sports mean an increased risk of bleeding due to greater blood flow to the tissues?

We do not have experience that sports at an intensity that leads to significantly increased blood flow also lead to an increased risk of bleeding.

What about the susceptibility to injuries? Is it higher in children with hemophilia?

As a doctor who cares for adult individuals, it is difficult for me to answer this question. But at 18, we receive them with a detailed history, and in more than 30 years of practice, I have not noticed that these patients have more operations or serious injuries.

What benefits do modern preparations bring to hemophiliacs?

Thanks to advances in treatment, their lives are becoming more active, mainly due to preparations with prolonged effect and non-factor treatment. Moreover, some apply the concentrate before training to temporarily increase the level of coagulation factor.

How to optimize and dose prophylactic treatment depending on the level of physical activity?

Some patients have remained on prophylaxis with standard preparations precisely because they apply them, for example, 3 times a week, always before training, while others are satisfied with administration twice a week or non-factor treatment. Each individual finds a regimen that suits them best, and we strive to meet their needs, including laboratory checks.

Do modern technologies also help hemophiliacs who play sports? I am referring, for example, to the HaemActive fitness application developed for hemophiliacs.

We are aware of this possibility; it allows for individualized load. I do not have personal experience yet, but this time will certainly come because younger generations are already much more proficient in handling modern technologies.

What should a doctor primarily educate hemophiliacs about concerning sports?

Mainly not to be afraid of physical activity. The era of fear is over; we have the possibility to significantly limit the risk of spontaneous bleeding. We encourage patients to do what they enjoy and gradually increase the load. A sedentary life is not suitable in terms of muscle strength or the increased risk of developing lifestyle diseases.

MUDr. Andrea Skálová
editorial team proLékaře.cz