Effects of a 6-Week, Individualized, Supervised Exercise Program for People With Bleeding Disorders and Hemophilic Arthritis

• Published in: Physical therapy 2010-04, Vol.90 (4), p.509-526
• Main Authors: Mulvany, Ruth, Zucker-Levin, Audrey R., Jeng, Michael, Joyce, Catherine, Tuller, Janet, Rose, Jonathan M., Dugdale, Marion
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Arthritis; Arthritis - physiopathology; Arthritis - rehabilitation; Blood Coagulation Disorders - physiopathology; Blood diseases; Blood products; Care and treatment; Child; Comorbidity; Data collection; Development and progression; Disease; Exercise; Feasibility Studies; Female; Health aspects; Hematologic diseases; Hemophilia; Humans; Joint surgery; Male; Methods; Middle Aged; Muscle Strength - physiology; Physical therapists; Physiological aspects; Prevention programs; Range of Motion, Articular - physiology; Rheumatoid arthritis; Severity of Illness Index; Studies; Surveys; Walking - physiology; Young Adult
• ISSN: 0031-9023; 1538-6724
• DOI: 10.2522/ptj.20080202

People with bleeding disorders may develop severe arthritis due to joint hemorrhages. Exercise is recommended for people with bleeding disorders, but guidelines are vague and few studies document efficacy. In this study, 65% of people with bleeding disorders surveyed reported participating in minimal exercise, and 50% indicated a fear of exercise-induced bleeding, pain, or physical impairment. The purpose of this study was to examine the feasibility, safety, and efficacy of a professionally designed, individualized, supervised exercise program for people with bleeding disorders. A single-group, pretest-posttest clinical design was used. Thirty-three patients (3 female, 30 male; 7-57 years of age) with mild to severe bleeding disorders were enrolled in the study. Twelve patients had co-existing illnesses, including HIV/AIDS, hepatitis, diabetes, fibromyalgia, neurofibromatosis, osteopenia, osteogenesis imperfecta, or cancer. Pre- and post-program measures included upper- and lower-extremity strength (force-generating capacity), joint range of motion, joint and extremity circumference, and distance walked in 6 minutes. Each patient was prescribed a 6-week, twice-weekly, individualized, supervised exercise program. Twenty participants (61%) completed the program. Pre- and post-program data were analyzed by paired t tests for all participants who completed the program. No exercise-induced injuries, pain, edema, or bleeding episodes were reported. Significant improvements occurred in joint motion, strength, and distance walked in 6 minutes, with no change in joint circumference. The greatest gains were among the individuals with the most severe joint damage and coexisting illness. Limitations included a small sample size with concomitant disease, which is common to the population, and a nonblinded examiner. A professionally designed and supervised, individualized exercise program is feasible, safe, and beneficial for people with bleeding disorders, even in the presence of concomitant disease. A longitudinal study with a larger sample size, a blinded examiner, and a control group is needed to confirm the results.