Participation in sports activities, frequency and severity of sports injuries in children with hemophilia

Introduction

Participation in sports activities is an essential part of the development of all children, not just those with chronic illnesses. Numerous positive effects of physical activity on the health of children with hemophilia have been described, such as improved physical endurance, strength, proprioception, maintenance of muscle mass and bone density, reduced risk of bleeding, and overall improvement in quality of life.

However, independent of hemophilia, participation in high-risk sports activities is associated with an increased risk of injury or bleeding. Due to this risk, parents of children with hemophilia may hesitate to allow sports activities for their children, which can be a barrier to achieving an active lifestyle, despite the administration of effective bleeding prophylaxis.

The primary aim of the study published by the Dutch authors was to clarify the rate of involvement of boys with hemophilia in sports activities over a 3-year observation period. The secondary aim was to evaluate the association between sports activity in children and the occurrence of sports injuries.

Study Methodology

This retrospective study evaluated regularly collected data regarding participation in sports activities, occurrence of injuries and bleeding in children with hemophilia aged 6–18 years. For study purposes, data from the last 3 years, collected annually, were analyzed. Patients with the presence of an inhibitor or neurological impairment were excluded from the study. Sports were categorized into 5 risk categories according to the US National Hemophilia Foundation (NHF) classification. School physical education was not counted as a sports activity within the study. The acquired data were compared with data from the general population.

Evaluated Patient Population

A total of 102 patients met the inclusion criteria of the study. In total, 86% had type A hemophilia, 53% had severe bleeding disorder, 5% had moderate, and 42% had mild hemophilia. Due to the low number of patients with moderate hemophilia (n = 5), they were included in the “non-severe” hemophilia group along with individuals with mild disease. The median age was 13 years (interquartile range [IQR] 11–15), and all patients with severe hemophilia and 2 with moderate hemophilia underwent continuous prophylaxis. A total of 69 patients (68%) experienced 187 bleeding episodes, while 33 (32%) had no bleeding during the observation period.

Findings

Participation in sports activities during the observation period was recorded in 87 patients (85%), with 70 of them engaging in high-risk sports activities. Most patients (59%) participated in one sports activity, with the median weekly frequency of sports at 3 times (IQR 2–3). The most commonly performed categories according to NHF were moderately high to high-risk activities (NHF 2.5), mainly because a large portion of patients played soccer (49%). Apart from soccer, children with hemophilia also frequently participated in swimming and judo. The overall proportion of children with hemophilia involved in sports activities was similar to that of the general population.

The proportion of children involved in sports activities was similar among children with severe and other forms of the disease. Similarly, this was true for the weekly frequency and the proportion of children involved in high-risk sports activities. Despite the high proportion of children regularly engaging in sports activities, the occurrence of sports injuries was rare. A total of 56 sports injuries were recorded over 3 years in 33 children, with a median of 1.7 injuries over 3 years. Thus, no injuries were recorded in 65% of children during the 3-year follow-up. The proportion of injured children was similar between those with severe hemophilia (42%) and others (33%). In the annual comparison, there was no increased incidence of injuries in children with hemophilia compared to age-matched controls (15% vs. 28%).

Bleeding episodes were recorded more frequently than sports injuries in children. Despite prophylactic therapy, bleeding was more frequently observed in individuals with severe disease. The proportion of patients experiencing bleeding episodes was similar in children involved in sports activities and those without a history of sports activities.

Conclusion

Regardless of the severity of the disease, children with hemophilia showed a comparably high participation in sports activities (including high-risk ones) similar to the general population. Additionally, these children did not exhibit an increased occurrence of injuries compared to the general population. Sports injuries were not associated with the frequency of sports activity or the type of sport. The study results can motivate children to engage in regular physical activities. The authors noted that a prospective study would be needed to confirm these findings and address recall bias.

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Source: Versloot O., Timmer M. A., de Kleijn P. Sports participation and sports injuries in Dutch boys with haemophilia. Scand J Med Sci Sports 2020; 30 (7): 1256–1264, doi: 10.1111/sms.13666.