Concept

The “Programmed Sports Therapy“ (PST) is a particular combination of exercise therapy, optimally adapted to the special needs of a rare disease and aiming to improve the patients’ physical situation. Although several studies have proved a positive influence of specific training on patients’ performance and quality of life and therapeutic exercise represents an essential part of treatment guidelines, many people affected do not have the possibility to receive this type of therapy. This can be due to different reasons, such as a lack of participating institutions close to the peoples’ homes or of specialized therapeutic supervision. With the implementation of PST for patients with haemophilia, these reason were supposed to be counteracted.

PST has been developed for patients with haemophilia by an interdisciplinary team containing doctors as well as sports- and physiotherapists. It combines advised group training with supervised home training conducted independently at home. The group training is realized in form of sports camps which take place two times a year for 3-4 days. These camps are used to initiate physical activity in a group within the individual’s possibilities. In order to optimize training and its purpose in consideration of the individual needs as well as to improve the patients’ physical and emotional situation, they get practical and theoretical instructions in the form of seminars. Individual training plans which are being developed together with the patients during the sports camps guide the home training and allow each patient to individually continue training at home. During the times between the single sports camps, therapists and patients are in constant exchange in order to motivate, answer questions, and to continuously adapt the training plan to the patients’ needs. Modern media further support home training.

The contents of the PST combine particular exercises for improving the joint situation with a general exercise program for maintaining general health of the body. PST is based on “The Integrated Model of Joint Function” by LEE & VLEEMING (2000), with slight modifications. The model comprises the four components: Emotion & Awareness, Motor Control, Active Component/Stability and Passive Component/Stability. On the one hand, these components individually provide a direct therapeutic approach to the joint while, on the other hand, interacting closely with each other. The therapeutic contents primarily aim at maintaining and improving the individual capacity of the body performing daily activities. Hereby, the therapy’s content focuses on training of body awareness as well as training of locomotor and cardiovascular systems (Fig. 1).

From our point of view, the training of body awareness, and thus the optimization of body scheme allows the most effective entry into sports therapy for people with haemophilia. An improved body perception and movement awareness facilitates practicing and learning of motor exercises.

After a conscious awareness of joint access is achieved, maintenance and improvement techniques for joint mobility are employed. With tonus regulating measures, existing muscle tensions should be resolved at the end of each training session using gentle stretch and relaxation techniques. In addition to these basic exercises, muscle-activating ones for strength and coordination training are integrated into therapy sessions.

Furthermore, a regular and individually adjusted endurance training aiming at the cardiovascular system and muscle metabolism should improve cardiac function and subsequently, physical workload capacity. The metabolism is being stimulated which, amongst other things, leads to a better supply of muscles and joints and thus of cartilage, too. Excess weight, which always represents an additional workload for the joints, is also supposed to be reduced. This reduction can be achieved not only by cycling on the home trainer, Nordic Walking, gait training or aqua jogging, but also by increasing repetitions during strength training in combination with low intensity.

The therapeutic methods and techniques applied in the framework of the programmed sports therapy in the past years have proven to be effective, sensitive and individually adaptable. PST can be adjusted to any requirements, age and grade of physical restriction and due to its separate components, the concept of PST can be applied to other rare diseases, too.