Hemophilia and sports

Study: High-Impact Activity Doesn't Increase Joint Bleeds

Jarring the joints can be good
Author: Sarah Aldridge

“PF Flyers make you run faster and jump higher,” boasted an old advertisement for Keds® sneakers. Turns out those two activities may be helpful, not harmful, to children with severe hemophilia.

In a study published in the November 2009 issue of Pediatrics, Marilyn Manco-Johnson, MD, and colleagues at the Mountain States Regional Hemophilia and Thrombosis Center at the University of Colorado found that high-impact activities did not produce more joint bleeds than low-impact activities.

During a 30-month period, the study measured participation in high- and/or low-impact activities among 37 boys ages 6 to 21 who had severe hemophilia and were on prophylaxis. High-impact activities included basketball, baseball, running and skateboarding. Low-impact activities included circuit weight training, cycling, golf and swimming.

Activities were assigned a level of risk adapted from the National Hemophilia Foundation’s (NHF’s) booklet, Playing It Safe: Bleeding Disorders, Sports and Exercise. There was adult supervision during the activities, which were held at least twice weekly for a minimum of 30 minutes. During the study, only one participant developed a target joint—a teenager who played soccer—and most of the participants developed fewer than one bleed per season, regardless of the activity. 

“Surprisingly, we found that kids with severe hemophilia could take a lot more in the way of impact sports than is often attributed to them,” says Manco-Johnson. “One of my concerns is that impact, particularly for the lower extremities, is very important to push calcium into bones and build strength.” The early pounding, she says, promotes bone density, helping prevent osteoporosis later.

Planning with Prevention

The boys were encouraged to problem solve about injury prevention, factor dosing and wearing protective gear.

“I’m very impressed that the kids in the study transitioning at age 18 are very good decision-makers,” Manco-Johnson says. “They are very able to weigh risks and benefits of participation.”

But that doesn’t mean risky behavior was absent. “You’ll notice in the footnote that we had advised against participation in football and hockey, given that these are high risk for head and neck trauma and other injuries,” says Neil Goldenberg, MD, PhD, study co-author. A few boys still participated in those activities, against medical advice.

In a state that prides itself on physical fitness, another surprise was the high rate of overweight and obesity among the study subjects—19%. Boys at the Colorado hemophilia treatment center (HTC) were thought to be leaner and more active than at other HTCs; many in the study participated in an average of four seasons of activity yearly.

“We thought the frequency of obesity would be low,” Goldenberg says. “It was an awakening to me that our physically active children with hemophilia are not spared from the national epidemic of childhood obesity.”

With many parents driving their kids to activities, children miss out on carefree hours playing outside after school. Some may also be discouraged from pursuing active lifestyles after developing a target joint or joint bleed. “Expectations for fitness are lower than for children without bleeding disorders,” says Manco-Johnson. “That’s something we have to address.”