The effect of resistance exercise on strength and safety outcome for people with haemophilia: A systematic review

Barbara Wagner, Steffen Krüger, Thomas Hilberg, Cihan Ay, Timothy Hasenoehrl, Dominikus Franz-Xaver Huber, Richard Crevenna, Barbara Wagner, Steffen Krüger, Thomas Hilberg, Cihan Ay, Timothy Hasenoehrl, Dominikus Franz-Xaver Huber, Richard Crevenna

Abstract

Introduction: Haemophilia is a congenital bleeding disorder with severe musculoskeletal complications. Resistance exercise is important to increase joint stability and to improve physical performance.

Aim: This review aimed to investigate the safety and efficacy of resistance exercise interventions on people with haemophilia (PwH) and evaluate whether the American College of Sports Medicine resistance exercise criteria for healthy adults are valid for this population.

Methods: A systematic search in literature was conducted, using the databases PubMed, MEDLiNE, CINAHL, SCOPUS, PEDro and Cochrane Library. Out of 2.440 studies published between 1960 and November 2019, 14 studies (9 randomized controlled trials, 1 controlled trial, 4 single-group prospective studies) applying resistance exercise in juvenile and adult PwH corresponded to the inclusion criteria.

Results: Studies performed dynamic, isokinetic or a combination of isometric and dynamic resistance training. Most interventions were carried out in the context of a multimodal training. Resistance was provided using fixed and free weights, body weight, resistance bands and water resistance. Study protocols included clinical and home-based settings. Several studies suggest that training intensities lower than those known to increase the strength of healthy people are effective in increasing the strength of PwH. Resistance exercise seems to be a safe intervention if it is adequately monitored, individually adapted and applied with sufficient factor therapy. Due to the heterogeneity of study designs, training interventions and outcome measures a meta-analysis could not be performed.

Conclusions: Further studies of higher methodological quality are needed to determine the optimal types of exercise, optimal dosage and timing.

Keywords: exercise; haemophilia; resistance; safety; strength; training.

Conflict of interest statement

The authors stated that they had no interests which might be perceived as posing a conflict or bias. The authors have no competing interests.

© 2020 The Authors. Haemophilia published by John Wiley & Sons Ltd.

Figures

Figure 1
Figure 1
Flowchart of the systematic literature research and the selection process

References

    1. World Federation of Haemophilia . Guidelines for the Management of Haemophilia; 2012. . Accessed December 12, 2019
    1. Strike K, Mulder K, Michael R. Exercise for haemophilia. Cochrane Database Syst Rev. 2016;12:CD011180.
    1. Brunner A, Stäuber F, Göhler S, et al. Quadriceps strength, inter‐extremity difference (IED) and joint status in adult persons with severe haemophilia in different age stages. Haemophilia. 2013;19(2):267‐274.
    1. Czepa D, Von Mackensen S, Hilberg T. Haemophilia & Exercise Project (HEP): subjective and objective physical performance in adult haemophilia patients–results of a cross‐sectional study. Haemophilia. 2012;18(1):80‐85.
    1. Herbsleb M, Hilberg T. Maximal and submaximal endurance performance in adults with severe haemophilia. Haemophilia. 2009;15(1):114‐121.
    1. Hilberg T, Herbsleb M, Puta C, Gabriel HHW, Schramm W. Physical training increases isometric muscular strength and proprioceptive performance in haemophilic subjects. Haemophilia. 2003;9(1):86‐93.
    1. Seuser A, Boehm P, Ochs S, Trunz‐Carlisi E, Halimeh S, Klamroth R. How fit are children and adolescents with haemophilia in Germany? Results of a prospective study assessing the sport‐specific motor performance by means of modern test procedures of sports science. Haemophilia. 2015;21(4):523‐529.
    1. Runkel B, Czepa D, Hilberg T. RCT of a 6‐month programmed sports therapy (PST) in patients with haemophilia ‐ improvement of physical fitness. Haemophilia. 2016;22(5):765‐771.
    1. González LM, Querol F, Gallach JE, Gomis M, Aznar VA. Force fluctuations during the Maximum Isometric Voluntary Contraction of the quadriceps femoris in haemophilic patients. Haemophilia. 2007;13(1):65‐70.
    1. Herbsleb M, Abqu‐Hamdan R, Puta C, et al. Schwere und mittelschwere Hämophilie unter prophylaktischer Substitutionstherapie. Maximale Drehmomente der Knieextensoren und Knieflexoren bei Kindern und Jugendlichen [Severe and moderate haemophilia under prophylactic replacement treatment ‐ maximal knee extensor and flexor torque of children and adolescents]. Hamostaseologie. 2012;32(1):62‐69.
    1. Hilberg T, Herbsleb M, Gabriel HHW, Jeschke D, Schramm W. Proprioception and isometric muscular strength in haemophilic subjects. Haemophilia. 2001;7(6):582‐588.
    1. Runkel B, Kappelhoff M, Hilberg T. Complex strength performance in patients with haemophilia A. Method development and testing. Hamostaseologie. 2015;35(1):12‐17.
    1. Douma‐van Riet DCM, Engelbert RHH, Van Genderen FR, Ter Horst‐De Ronde MTM, De Goede‐Bolder A, Hartman A. Physical fitness in children with haemophilia and the effect of overweight. Haemophilia. 2009;15(2):519‐527.
    1. Engelbert RH, Plantinga M, Van der Net J, et al. Aerobic capacity in children with hemophilia. J Pediatr. 2008;152(6):833‐838.e1.
    1. Falk B, Portal S, Tiktinsky R, et al. Bone properties and muscle strength of young haemophilia patients. Haemophilia. 2005;11(4):380‐386.
    1. Falk B, Portal S, Tiktinsky R, Weinstein Y, Constantini N, Martinowitz U. Anaerobic power and muscle strength in young hemophilia patients. Med Sci Sports Exerc. 2000;32(1):52‐57.
    1. Pietri MM, Frontera WR, Pratts IS, Súarez EL. Skeletal muscle function in patients with hemophilia A and unilateral hemarthrosis of the knee. Arch Phys Med Rehabil. 1992;73(1):22‐28.
    1. Garber CE, Blissmer B, Deschenes MR, et al. College of Sports Medicine position stand. Quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults: guidance for prescribing exercise. Med Sci Sports Exerc. 2011;43(7):1334‐1359.
    1. Tiktinsky R, Falk B, Heim M, Martinovitz U. The effect of resistance training on the frequency of bleeding in haemophilia patients: a pilot study. Haemophilia. 2002;8(1):22‐27.
    1. Blamey G, Forsyth A, Zourikian N, et al. Comprehensive elements of a physiotherapy exercise programme in haemophilia–a global perspective. Haemophilia. 2010;16(5):136‐145.
    1. Souza JC, Simoes HG, Campbell CSG, Pontes FL, Boullosa DA, Prestes J. Haemophilia and exercise. Int J Sports Med. 2012;33(2):83‐88.
    1. Liberati A, Altmann DG, Tetzlaff J, et al. The PRISMA statement for reporting systematic reviews and meta‐analyses of studies that evaluate health care interventions: explanation and elaboration. PLoS Medicine. 2009;6(7):e1000100.
    1. Cohen J. Statistical Power Analsis of the Behavioral Sciences; 1988.
    1. Sawilowsky SS. New effect size rules of thumb. J Mod Appl Stat Methods. 2009;8(2):597‐599.
    1. Gonnermann A, Framke T, Großhennig A, Koch A. No solution yet for combining two independent studies in the presence of heterogeneity. Stat Med. 2015;34(16):2476‐2480.
    1. Higgins GSJPT. Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]; 2011.
    1. Zeng X, Zhang Y, Kwong JS, et al. The methodological quality assessment tools for preclinical and clinical studies, systematic review and meta‐analysis, and clinical practice guideline: a systematic review. J Evid Based Med. 2015;8(1):2‐10.
    1. Slim K, Nini E, Forestier D, Kwiatkowski F, Panis Y, Chipponi J. Methodological index for non‐randomized studies (minors): development and validation of a new instrument. ANZ J Surg. 2003;73(9):712‐716.
    1. Eid MA, Ibrahim MM, Aly SM. Effect of resistance and aerobic exercises on bone mineral density, muscle strength and functional ability in children with hemophilia. Egypt J Med Hum Genet. 2014;15(2):139‐147.
    1. Parhampour B, Torkaman G, Hoorfar H, Hedayati M, Ravanbod R. Effects of short‐term resistance training and pulsed electromagnetic fields on bone metabolism and joint function in severe haemophilia A patients with osteoporosis: a randomized controlled trial. Clin Rehabil. 2014;28(5):440‐450.
    1. Cuesta‐Barriuso R, Gómez‐Conesa A, López‐Pina JA. Effectiveness of two modalities of physiotherapy in the treatment of haemophilic arthropathy of the ankle: a randomized pilot study. Haemophilia. 2014;20(1):71‐78.
    1. Cuesta‐Barriuso R, Torres‐Ortuño A, Nieto‐Munuera J, López‐Pina JA. Effectiveness of an educational physiotherapy and therapeutic exercise program in adult patients with hemophilia: a randomized controlled trial. Arch Phys Med Rehabil. 2017;98(5):841‐848.
    1. Cuesta‐Barriuso R, Gómez‐Conesa A, López‐Pina JA. Manual and educational therapy in the treatment of hemophilic arthropathy of the elbow: a randomized pilot study. Orphanet J Rare Dis. 2018;13(1):151.
    1. Goto M, Takedani H, Haga N, et al. Self‐monitoring has potential for home exercise programmes in patients with haemophilia. Haemophilia. 2014;20(2):121‐127.
    1. Zaky LA, Hassan WF. Effect of partial weight bearing program on functional ability and quadriceps muscle performance in hemophilic knee arthritis. Egypt J Med Hum Genet. 2013;14(4):413‐418.
    1. Kargarfard M, Dehghadani M, Ghias R. The effect of aquatic exercise therapy on muscle strength and joint's range of motion in hemophilia patients. Int J Prev Med. 2013;4(1):50‐56.
    1. Mulvany R, Zucker‐Lewin AR, Jeng M, et al. Effects of a 6‐week, individualized, supervised exercise program for people with bleeding disorders and hemophilic arthritis. Phys Ther. 2010;90(4):509‐526.
    1. Czepa D, Herbsleb M, Ziezio R, Kurz E, Koch J, Hilberg T. Haemophilia and Exercise Project (HEP): Gelenkstatus und Lebensqualität vor und nach einer zweijährigen Sporttherapie [Haemophilia and Exercise Project (HEP): joint status and quality of life before and after two years of sports therapy]. Dtsch Z Sportmed. 2008;59(3):62‐67.
    1. Greene WB, Strickler EM. A modified isokinetic strengthening program for patients with severe hemophilia. Dev Med Child Neurol. 1983;25(2):189‐196.
    1. Khriesat I, Thonaibat W, Hammaury M. Haemophiliac knee: role of physiotherapy. Bahrain Med Bull. 2000;22(4):164‐166.
    1. Hawker GA, Mian S, Kendzerska T, French M. Measures of adult pain: Visual Analog Scale for Pain (VAS Pain), Numeric Rating Scale for Pain (NRS Pain), McGill Pain Questionnaire (MPQ), Short‐Form McGill Pain Questionnaire (SF‐MPQ), Chronic Pain Grade Scale (CPGS), Short Form‐36 Bodily Pain Scale (SF‐36 BPS), and Measure of Intermittent and Constant Osteoarthritis Pain (ICOAP). Arthritis Care Res. 2011;63(11):240‐252.
    1. Negrier C, Seuser A, Forsyth A, et al. The benefits of exercise for patients with haemophilia and recommendations for safe and effective physical activity. Haemophilia. 2013;19(4):487‐498.
    1. Csapo R, Alegre LM. Effects of resistance training with moderate vs heavy loads on muscle mass and strength in the elderly: a meta‐analysis. Scand J Med Sci Sports. 2016;26(9):995‐1006.
    1. Seuser A. Hämophilie und Knorpel ‐ die Rolle der Bewegung [Haemophilia and cartilage–the role of movement]. Hamostaseologie. 2012;32(1):52‐61.
    1. Stone MHE, Collins D, Plisk S, Haff G, Stone MHE. Training principles: evaluation of modes and methods of resistance training. J Strength Cond Res. 2000;22(3):65‐76.
    1. Griffiths P, Needleman J. Statistical significance testing and p‐values: defending the indefensible? A discussion paper and position statement. Int J Nurs Stud. 2019;99:103384.
    1. Winters‐Stone KM, Neil SE, Campbell KL. Attention to principles of exercise training: a review of exercise studies for survivors of cancers other than breast. Br J Sports Med. 2014;48(12):987‐995.
    1. Calatayud J, Pérez‐Alenda S, Carrasco JJ, et al. Upper‐body exercises with external resistance are well tolerated and enhance muscle activity in people with hemophilia. Phys Ther. 2019;99(4):411‐419.
    1. Calatayud J, Pérez‐Alenda S, Carrasco JJ, et al. Electromyographic and safety comparisons of common lower limb rehabilitation exercises for people with hemophilia. Phys Ther. 2020;100(1):116-126.
    1. Herbsleb M, Tutzschke R, Czepa D, et al. Isometrische Maximalkraftmessungen der Quadricepsmuskulatur [Maximal isometric strength measures of the quadriceps muscles. Feasibility and reliability in patients with haemophilia]. Hamostaseologie. 2010;30(1):97‐103.
    1. Daniels L, Worthingham C. Pruebas functionales musculares. Técnicas manuales de exploración. Nueva Editor Interam. 1973.
    1. Borg GA. Perceived exertion: a note on ‘history’ and methods. Med Sci Sports. 1973;5(2):90‐93.
    1. Robertson RJ, Goss FL, Rutkowski J, et al. Concurrent validation of the OMNI perceived exertion scale for resistance exercise. Med Sci Sports Exercise. 2003;35(2):333‐341.

Source: PubMed

Sponsors et collaborateurs

Les conditions médicales

Interventions en matière de drogue

3
S'abonner