Physical Activity in Hemophiliacs and How to Ensure it Safely
Physical activity is beneficial − and this holds true for patients with hemophilia as well. New therapeutic modalities offer additional possibilities to optimize prevention so that, among other things, it allows hemophiliacs to engage in sports.
A New Perspective on Sports and Physical Activity in Hemophiliacs
Current treatment options for hemophilia allow a different view on physical activity and individual sports compared to the past. The original goal of treatment – the preventive administration of the missing factor VIII or IX – was to prevent recurrent joint bleeding, including spontaneous bleeding, and the development of arthropathy. However, recently, the possibility of participating in various physical activities has been increasingly supported for hemophiliacs, as recommended by the World Federation of Hemophilia (WFH). Physical activity for people with hemophilia means improved joint and bone health. Additionally, regular physical activity brings weight control, prevention of obesity, and a range of other issues. It also positively impacts mental well-being.
More Ambitious Prophylaxis Goals
Clinical experience and data show that patients with less severe forms of hemophilia could benefit from more intensive physical activity through prophylaxis. Therefore, the objective of prophylaxis can vary individually for different patients. A new goal of prophylaxis in some situations is the possibility to increase the so-called trough level (the minimum factor level below which it should not drop with properly set prophylaxis). Previously, the goal was not to fall below 1%, now the aim could be not to fall below 3-5%, and in the most optimistic case, below 12%.
Possibility to Better Optimize Treatment
Such goals may be difficult to achieve with traditional factor concentrates, as their biological half-life requires relatively frequent administration (e.g., daily dosing). Such a regimen is acceptable only for some patients. Merely increasing the dose while maintaining the original prophylaxis frequency is not sufficient to increase minimum levels.
Newly available preparations with an extended half-life, prepared with technologies such as pegylation, fusion with the Fc fragment of immunoglobulin, or albumin, enable many patients to better optimize their treatment. For some, it is sufficient to ensure minimum factor levels while reducing the number of injections administered. Conversely, others may benefit precisely from increasing the minimum level, usually while maintaining a relatively frequent administration of injections. Some patients will appreciate the adjustment of the prophylactic regimen in the long term, while for others, it is possible to temporarily adjust prevention during periods of planned increased activity.
All of this should be considered in the care of hemophiliacs and support their active lifestyle. Today's available medications offer many possibilities.
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Source: Jiménez-Yuste V., Auerswald G., Benson G. et al. Achieving and maintaining an optimal trough level for prophylaxis in haemophilia: the past, the present, and the future. Blood Transfus 2014; 12: 314-319.
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