History, Current state of Research

Epidemiological studies confirm the importance of physical activity in order to prevent different diseases. Physical activity can prevent the incidence of various diseases, e.g. cardiovascular diseases. The purpose of sports goes beyond prevention; a focused sports therapy in the field of rehabilitation can reduce suffering. Until the late sixties haemophilic patients did not have the possibilities to use physical activity as means of prevention and rehabilitation. Thirty years ago still, they were advised to be only as active as required to manage everyday life. Sports was almost prohibited.

Inactivity was regarded as suitable form of prophylaxis for avoiding joint bleedings. But inactivity, however, hinders the development of strong and well-coordinated body muscles, which is a precondition for an optimal protection of joints. The consequential muscle imbalance combined with dysfunctions in movement led to possible joint displacement, which increased the incidence of joint bleedings and thus of joint damage and haemophilic arthropathy.

Previous studies on consequences of physical inactivity for haemophilic patients have revealed the following deficits in comparison with healthy controls:

• lower endurance capacity of haemophilic children
• reduced muscular strength in lower extremities of haemophilic children and adults
• reduced coordinative skills in haemophilic adults
• as well as lower anaerobic performance and muscular strength of haemophilic children.

The knowledge of these circumstances initiated a process of rethinking in the following years. Along with the possibility to substitute and the availability of sufficient clotting factor concentrates at the beginning of the early sixties, tentative attempts allowing physical activity for haemophilic patients started. Later one, physical activity was even considered as a necessity. Apart from independent sport activities without instructions and control, physiotherapy was the only method of preventive and rehabilitative treatment.

Nowadays, there is an agreement on the meaningfulness of selected physical activities for haemophilic patients too, so that exercise guided by a skilled trainer can be recommended. An adequate sports therapy which is based on the clinical picture, e.g. like it has been established for cardiovascular diseases, is not yet part of the adjuvant treatment of haemophilia. Especially the vagueness concerning specific training, methods and forms as well as their effects on haemophilic patients feature difficulties in the development and implementation of a targeted sports therapy. Despite these issues, sports therapy is recently gaining importance. Amongst others, advantages are the sustainable positive transfer of trained motor skills and the influence of 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 potential in applying sports therapy to individuals with haemophilia, especially in order to improve joint status. A paper by Hilberg (2001) 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 in haemophilic individuals, too. A well-working coordination or in a narrower sense proprioception, is necessary for providing an optimal joint protection.