History: Exercise, Sports and Haemophilia


A lot of epidemiological studies confirm the importance of physical activity for the prevention of different diseases. Physical activity can prevent the incidence of various diseases, e.g. cardiovascular diseases. The purpose of sports goes beyond the prevention; a focused sports therapy in sense of rehabilitation can reduce suffering.

Until the late sixties Haemophilic patients did not have the possibilities to use physical activity as a remedy of prevention and rehabilitation. Until thirty years ago is was strongly advised against any physical activity not being urgently required to accomplish everyday life. Sport was almost prohibited. Inactivity was regarded as the best prophylaxis to avoid joint bleedings. But inactivity hindered the development of strong well coordinated body muscles, which are the requirement for an optimal protection of the joints. The resulting muscle imbalance combined with movement dysfunction led to possible unwished joint displacement, which favoured the incidence of joint bleedings and thus of joint damage and of haemophilic arthropathy.

Previous studies about the consequences of physical inactivity of haemophilic patients have shown the following deficits compared with healthy controls:

- lower aerobic working capacity of haemophilic children
- reduced muscular strength of the lower extremities of haemophilic children and adults
- impaired coordination performance of haemophilic adults
- as well as a lower anaerobic working capacity and muscular strength of haemophilic children

The knowledge of these coherences initiated a process of rethinking in the last 20 years. In conjunction with the possibility and availability of clotting factor concentrates in the early sixties tentative attempts were made to allow physical activity for haemophilic patients too. Later physical activity was deemed as a necessity. Beside independent sport activities without instructions and control, physiotherapy was the only method for a preventive and rehabilitative treatment.

Today there is an agreement about the purpose of selective physical activities even for haemophilic patients, so that sports activity guided by a skilled trainer can be recommended. An adequate sports therapy based on the clinical picture, e.g. like it has been established for cardiovascular diseases, is not part of the adjuvant treatment of haemophilia. Especially the vagueness about specific training contents, methods and forms as well as their effects on haemophilic patients are difficulties in the development and realisation of a targeted sports therapy. Despite of these issues sports therapy is gaining in importance recently. Amongst others the advantages are in the sustainable positive transfer of trained motor skills and the influence of the group dynamics on the strengthening of social skills. In addition sport therapeutic measures can significantly improve the patient’s self-confidence and thus contribute to a different pain perception.

We see a good potential to utilise sports therapy for individuals with haemophilia, especially for a targeted improvement of the joint situation. In a paper from Hilberg (2001) it was proved that the coordination in haemophilic individuals is clearly limited compared to healthy controls. Fortunately the study also showed that training can lead to an improvement of these skills for haemophilic individuals too. The function of coordination or in a narrower sense proprioception, is necessary to provide an optimal joint protection.