Frequency of Participation in Sports Activities and the Risk of Injury in Children with Hemophilia
In children with hemophilia, numerous positive effects of physical activity on their health have been described. However, due to concerns about injuries and joint bleeding, young hemophiliacs may often be limited in real participation in sports life. Results from published studies, however, indicate that with proper therapy, the frequency of injuries is similar to that of the general population.
Introduction
Participation in sports activities is a crucial part of the development of children, including those with hemophilia. Participation in sports activities is statistically associated with a higher risk of injury, regardless of the presence of hemophilia. Parents of hemophiliacs may hesitate to allow sports activities for their children due to this potential risk. However, according to available − especially recent − studies, it seems that the frequency of hemophiliacs participating in sports activities is comparable to that of the general population and is not associated with a higher risk of injury or joint bleeding compared to the general population.
Study Results
Versloot et al. published a study focusing on the frequency of participation in sports activities among children and adult hemophiliacs (ages 6–65) compared to the general Dutch population. A total of 524 adults participated in the study (median age 45 years, interquartile range [IQR] 30–55 years, 37% with severe hemophilia) and 126 children (median age 11 years, IQR 8–14 years, 52% with severe hemophilia). Participation of hemophiliacs in sports activities was higher compared to the general population among adults (70 vs. 58%) and comparable among children (68 vs. 72%). The proportion of hemophiliacs participating in high-risk bleeding activities decreased with age, from 65% in the 6–12 years age group to 17% in the 50–65 years age group, with a similar trend observed in the general population. Participation in sports activities among children was independent of the severity of hemophilia (67 vs. 65%; p = 0.97), while there was a higher proportion of sporting patients in the group with non-severe hemophilia among adults (75 vs. 62%; p < 0.01). The study also revealed that individuals with non-severe hemophilia were more likely to engage in high-risk sports compared to patients with severe hemophilia (25 vs. 15%, p = 0.07 among adults; 65% vs. 48%, p = 0.05 among children).
Ross et al. focused their study on the risk of injuries and bleeding during athletics in children with hemophilia receiving prophylactic treatment. A total of 37 children with hemophilia A and B participated in the study. Out of these, 73% engaged in high-impact activities, and 27% participated only in low-impact activities. The frequency of joint bleeding and new injuries did not significantly differ between the two groups. In most cases, children experienced less than one episode of bleeding or injury during the season. In 1 child (< 3% of subjects), a so-called target joint developed.
McGee et al. published a retrospective study evaluating the risk of injury during organized sports activities in children with hemophilia. The assessment included boys with hemophilia aged 10–18 years with factor VIII or IX levels < 40% for the period from January 1, 2008, to December 31, 2010. A total of 48 boys, with an average age of 14.3 ± 2.6 years (age range 10.0–18.8 years), participated in the study. Overall, 64.6% of the boys suffered from a deficiency of coagulation factor VIII, 54.2% had severe hemophilia, 18.8% had moderate, and 27.1% had mild hemophilia. The majority participated in at least one organized sport (62.5%; n = 30). A total of 77 injuries were recorded in 36 boys (75%). The average number of injuries per boy was 1.6 ± 1.5. There was no statistically significant difference in the average number of injuries (p = 0.44) and the development of target joints (p = 0.52) between boys engaged in organized sports and those not involved in organized sports. The study results indicated that participation in organized sports is common among hemophiliacs aged 10–18 years and is not associated with an increased risk of injury or the development of target joints.
Conclusion
The results of the cited studies indicated that the frequency of participation in sports activities is similar among hemophiliac children and adults as in the general population, including participation in high-risk bleeding sports activities. The frequency of injuries or joint bleeding during sports activities is similar among hemophiliacs as in individuals without bleeding disorders. Given the current standards of hemophilia therapy, regular physical activity is a significant benefit for the overall physical and mental health of hemophiliacs.
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Sources:
1. Versloot O., van Balen E. C., Hassan S. et al.; Haemophilia in the Netherlands 6 steering committee. Similar sports participation as the general population in Dutch persons with haemophilia; results from a nationwide study. Haemophilia 2021; 27 (5): 876–885, doi: 10.1111/hae.14366.
2. Ross C., Goldenberg N. A., Hund D. et al. Athletic participation in severe hemophilia: bleeding and joint outcomes in children on prophylaxis. Pediatrics 2009; 124 (5): 1267–1272, doi: 10.1542/peds.2009-0072.
3. McGee S., Raffini L., Witmer C. Organized sports participation and the association with injury in paediatric patients with haemophilia. Haemophilia 2015; 21 (4): 538–542, doi: 10.1111/hae.12696.
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