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Mancuso ME, Biasoli C, Marino R, Buzzi A, Preti D, Sannino L, Tempre R, Bendinelli S, Pompeo E, Siri G, Castaman G. Physical Activity, Bleedings and Quality of Life in Subjects with Haemophilia A without Inhibitors-A Multicenter, Observational Italian Study with a Wearable Device. J Clin Med 2024; 13:3036. [PMID: 38892747 PMCID: PMC11172795 DOI: 10.3390/jcm13113036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Revised: 04/29/2024] [Accepted: 05/16/2024] [Indexed: 06/21/2024] Open
Abstract
Background: This study aimed to gather data on physical activity (PA), bleeding, health-related quality of life, and health status, using a wearable device and an electronic patient-reported outcome (ePRO) app, in individuals with moderate or severe hemophilia A (HA) without inhibitors receiving treatment according to the clinical practice. Methods: This is a 12-month multicenter cohort study conducted in Italy. The primary outcomes included the description of PA by type and intensity, adherence to World Health Organization guidelines, bleeding, and health-related quality of life by EQ-5D questionnaire. PA data were collected continuously through a fitness tracker worn by the patient; all the other variables were collected through ePRO questionnaires. Results: Only 54 of the 103 enrolled subjects (52.4%) used their fitness tracker for the defined valid period; adolescents were the least compliant age group. PA was performed at low rates and intensity. Approximately 52% of the subjects had sedentary behavior. The mean EQ-5D values did not change over time. At least one bleeding was reported in 43.7% of the subjects, mostly with sedentary behavior. The PA in the 2 days preceding the bleeding was comparable to the one observed in the overall observational period. Conclusions: The systematic recording of data through a fitness tracker and ePRO app shows that subjects with HA without inhibitors have lower-than-expected PA and that they still experience issues related to bleeding.
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Affiliation(s)
- Maria Elisa Mancuso
- Center for Thrombosis and Hemorrhagic Diseases, IRCCS Humanitas Research Hospital and Humanitas University, 20089 Milan, Italy;
| | - Chiara Biasoli
- Centro Emofilia, Unità Opertaiva Complessa Medicina Trasfusionale, Dipartimento Patologia, Clinica Ospedale M. Bufalini, CESENA, 47521 Cesena, Italy;
| | - Renato Marino
- Ospedale Policlinico, S.S.D. Centro Emofilia e Trombosi, Piazza Giulio Cesare, 70124 Bari, Italy;
| | | | - Daniele Preti
- Federazione Associazioni Emofilici, 20155 Milan, Italy;
| | - Luigi Sannino
- Roche Italia, Viale G. B. Stucchi, 110, 20900 Monza, Italy; (L.S.); (R.T.); (E.P.)
| | - Rosaria Tempre
- Roche Italia, Viale G. B. Stucchi, 110, 20900 Monza, Italy; (L.S.); (R.T.); (E.P.)
| | - Sara Bendinelli
- Roche Italia, Viale G. B. Stucchi, 110, 20900 Monza, Italy; (L.S.); (R.T.); (E.P.)
| | - Elena Pompeo
- Roche Italia, Viale G. B. Stucchi, 110, 20900 Monza, Italy; (L.S.); (R.T.); (E.P.)
| | - Giacomo Siri
- Alira Health S.r.l., Via Dante 14, 20121 Milan, Italy;
| | - Giancarlo Castaman
- Center for Bleeding Disorders and Coagulation, Department of Oncology, Careggi University Hospital, 50134 Florence, Italy;
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Pérez-Alenda S, Carrasco JJ, Querol-Fuentes F, Megías-Vericat JE, Querol-Giner F, Luz Sánchez-Sánchez M, Bonanad S, Núñez-Cortés R. Benefits of physical activity self-monitoring in patients with haemophilia: a prospective study with one-year follow-up. Haemophilia 2024; 30:791-799. [PMID: 38470981 DOI: 10.1111/hae.14988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 03/01/2024] [Accepted: 03/01/2024] [Indexed: 03/14/2024]
Abstract
INTRODUCTION Activity wristbands have been shown to be effective in relation to self-monitoring activity levels and increasing exercise adherence. However, previous reports have been based on short-term follow-ups in people with haemophilia (PWH). AIM (1) To evaluate compliance with physical activity (PA) recommendations in PWH during a 1-year follow-up period using activity wristbands to record daily steps and intensity; (2) To determine the effect of PA self-monitoring on clinical outcomes. METHODS A prospective observational study was conducted in 27 adults with severe haemophilia undergoing prophylactic treatment. The Fitbit Charge HR was used to track daily PA for an entire year. The participants were encouraged to try to reach a goal of 10,000 steps/day and to track their progress. The pre- and post-evaluation included quality of life (A36 Hemophilia-QoL Questionnaire), joint health (Haemophilia Joint Health Score), functionality (Timed Up and Go test), and muscle strength. RESULTS A total of 323.63 (95%CI: 194-364) valid days (i.e., > 2000 steps) were recorded. The annual average number of steps per day taken by participants was 10,379. Sixteen (59%) PWH reached 10,000 steps/day at baseline and 17 (63%) at 1 year follow-up, with no significant differences (x2 = .33; p = .56). A statistically significant improvement was observed in daily moderate activity time (p = .012) and in the 'physical health' quality of life subscale (mean difference: 2.15 points; 95%CI: .64-3.65; p = .007). CONCLUSION Our results suggest that patients with severe haemophilia who self-managed their PA can improve their long-term quality of life in the domain of physical health and also the daily time spent in moderate-intensity PA.
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Affiliation(s)
- Sofía Pérez-Alenda
- Physiotherapy in Motion Multispeciality Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, Valencia, Spain
| | - Juan J Carrasco
- Physiotherapy in Motion Multispeciality Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, Valencia, Spain
- Intelligent Data Analysis Laboratory, University of Valencia, Valencia, Spain
| | - Felipe Querol-Fuentes
- Physiotherapy in Motion Multispeciality Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, Valencia, Spain
| | | | - Felipe Querol-Giner
- Physiotherapy in Motion Multispeciality Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, Valencia, Spain
| | - María Luz Sánchez-Sánchez
- Physiotherapy in Motion Multispeciality Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, Valencia, Spain
| | - Santiago Bonanad
- Haemostasis and Thrombosis Unit, University and Polytechnic Hospital La Fe, Valencia, Spain
| | - Rodrigo Núñez-Cortés
- Physiotherapy in Motion Multispeciality Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, Valencia, Spain
- Departament of Physical Therapy, Faculty of Medicine, University of Chile, Santiago, Chile
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Tomschi F, Hmida J, Herzig S, Ransmann P, Brühl M, Schmidt A, Herzig M, Goldmann G, Strauß AC, Oldenburg J, Richter H, Hilberg T. Physical activity and factor VIII levels in patients with haemophilia: A real-world prospective observational study. Haemophilia 2024; 30:419-425. [PMID: 38385957 DOI: 10.1111/hae.14965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 01/31/2024] [Accepted: 02/05/2024] [Indexed: 02/23/2024]
Abstract
INTRODUCTION Regular physical activity (PA) is recommended for patients with haemophilia (PwH). For PwH it is crucial to ensure a sufficient factor level to prevent PA-induced bleedings. However, there is a gap in the literature dealing with specific factor levels, which are needed when performing specific types of PA. AIM To provide data on factor VIII (FVIII) levels at the start of PA performed by PwH. METHODS In this prospective 12-month real-world observational study, 23 PwH recorded every PA they performed and the FVIII levels at the start of the PA using a pharmacokinetic application. PA types were clustered according to the collision and injury risk into three categories (Cat I = low, Cat II = medium, Cat III = high risk). Haemophilia Joint Health Scores (HJHS) were performed at baseline, after 6 and 12 months. RESULTS 795 PA sessions of Cat I, 193 of Cat II, and 23 of Cat III were documented. FVIII levels at the start of PA were different between categories (Cat I: 29.8 ± 32.1%, Cat II: 38.3 ± 33.4%, Cat III: 86.6 ± 29.2%). Out of all PA sessions, 145 (14%) were performed at a factor level of ≤3%. Three PA-induced bleeding occurred. Baseline HJHS was 14.5 ± 13.6 points and did not change throughout the study. CONCLUSION This study provides real-life data on FVIII levels at the start of 1011 PA sessions. PwH are mainly active in low-risk sports with higher FVIII levels observed in Cat II and III, respectively. Only three PA-induced bleeding occurred, even though several PA were started with low FVIII levels.
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Affiliation(s)
- Fabian Tomschi
- Department of Sports Medicine, University of Wuppertal, Wuppertal, Germany
| | - Jamil Hmida
- Department of Sports Medicine, University of Wuppertal, Wuppertal, Germany
| | - Steffen Herzig
- Department of Sports Medicine, University of Wuppertal, Wuppertal, Germany
| | - Pia Ransmann
- Department of Sports Medicine, University of Wuppertal, Wuppertal, Germany
| | - Marius Brühl
- Department of Sports Medicine, University of Wuppertal, Wuppertal, Germany
- Institute for Experimental Haematology and Transfusion Medicine, University of Bonn, Bonn, Germany
| | - Alexander Schmidt
- Department of Sports Medicine, University of Wuppertal, Wuppertal, Germany
| | - Marie Herzig
- Department of Sports Medicine, University of Wuppertal, Wuppertal, Germany
| | - Georg Goldmann
- Institute for Experimental Haematology and Transfusion Medicine, University of Bonn, Bonn, Germany
| | - Andreas C Strauß
- Department of Orthopaedics and Trauma Surgery, University of Bonn, Bonn, Germany
| | - Johannes Oldenburg
- Institute for Experimental Haematology and Transfusion Medicine, University of Bonn, Bonn, Germany
| | | | - Thomas Hilberg
- Department of Sports Medicine, University of Wuppertal, Wuppertal, Germany
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Ramos-Petersen L, Rodríguez-Sánchez JA, Cortés-Martín J, Reinoso-Cobo A, Sánchez-García JC, Rodríguez-Blanque R, Coca JR. A Qualitative Study Exploring the Experiences and Perceptions of Patients with Hemophilia Regarding Their Health-Related Well-Being, in Salamanca. J Clin Med 2023; 12:5417. [PMID: 37629458 PMCID: PMC10455868 DOI: 10.3390/jcm12165417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 07/28/2023] [Accepted: 08/19/2023] [Indexed: 08/27/2023] Open
Abstract
Hemophilia is a chronic, congenital/hereditary and X-linked disease, characterized by an insufficiency of factors VIII or IX, which are necessary for blood clotting. Those affected by hemophilia often suffer from particular psychosocial problems, both in the acceptance, coping, treatment and self-management of their disease and in their family and social relationships, which are often mediated by these circumstances. The aim of this study was to explore the experiences of people with hemophilia or their family members, of in a specific region of Spain, regarding the impact of having hemophilia. Structured interviews were conducted and developed, using the studies of the World Federation of Hemophilia and Osorio-Guzmán et al. as a guide, as well as a literature review of qualitative work on hemophilia. Data were analyzed using a six-step thematic analysis. A total of 34 interviews were thematically analyzed. The results showed that three key themes emerged from the data: (1) the daily impact of having hemophilia, (2) uncertainty about the disease, (3) the role of associations and (4) support from institutions. The results make it clear that the disease has a major impact on their lives (work, family, leisure and personal environment). The main conclusion is that hemophilia has a negative impact on the daily lives of patients, families and caregivers.
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Affiliation(s)
- Laura Ramos-Petersen
- Department of Nursing and Podiatry, Faculty of Health Sciences, University of Malaga, Arquitecto Francisco Peñalosa 3, Ampliación de Campus de Teatinos, 29071 Malaga, Spain;
| | - Juan Antonio Rodríguez-Sánchez
- Department of Biomedical Sciences and Diagnosis, University of Salamanca, C/Alfonso X el Sabio S/N, 37007 Salamanca, Spain;
| | - Jonathan Cortés-Martín
- Research Group CTS1068, Andalusia Research Plan, Junta de Andalucía, Nursing Department, Faculty of Health Sciences, University of Granada, 18071 Granada, Spain; (J.C.-M.); (J.C.S.-G.); (R.R.-B.)
| | - Andrés Reinoso-Cobo
- Department of Nursing and Podiatry, Faculty of Health Sciences, University of Malaga, Arquitecto Francisco Peñalosa 3, Ampliación de Campus de Teatinos, 29071 Malaga, Spain;
| | - Juan Carlos Sánchez-García
- Research Group CTS1068, Andalusia Research Plan, Junta de Andalucía, Nursing Department, Faculty of Health Sciences, University of Granada, 18071 Granada, Spain; (J.C.-M.); (J.C.S.-G.); (R.R.-B.)
| | - Raquel Rodríguez-Blanque
- Research Group CTS1068, Andalusia Research Plan, Junta de Andalucía, Nursing Department, Faculty of Health Sciences, University of Granada, 18071 Granada, Spain; (J.C.-M.); (J.C.S.-G.); (R.R.-B.)
- San Cecilio Clinical University Hospital, 18016 Granada, Spain
| | - Juan R. Coca
- Social Research Unit on Health and Rare Diseases, Sociology and Social Work Department, University of Valladolid, 47002 Valladolid, Spain;
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Dodd C, Hashem F, Stephensen D, Bassett P. Wearable activity trackers in young people with haemophilia: What needs to be considered? Haemophilia 2023; 29:942-945. [PMID: 37060543 DOI: 10.1111/hae.14790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 03/09/2023] [Accepted: 03/29/2023] [Indexed: 04/16/2023]
Affiliation(s)
- Charlene Dodd
- Haemophilia and Thrombosis Centre, East Kent Hospitals University NHS Foundation Trust, Canterbury, Kent, UK
| | - Ferhana Hashem
- Centre for Health Service Studies, University of Kent, Canterbury, Kent, UK
| | - David Stephensen
- Haemophilia and Thrombosis Centre, East Kent Hospitals University NHS Foundation Trust, Canterbury, Kent, UK
| | - Paul Bassett
- Stats Consultancy Ltd, Freelance Statistical Consultancy, Bucks, Amersham, UK
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6
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Matlary RED, Grydeland M, Glosli H, Rueegg CS, Holme PA. Factors associated with physical activity in young people with haemophilia A on prophylaxis. Haemophilia 2023; 29:900-909. [PMID: 36913380 DOI: 10.1111/hae.14776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 02/13/2023] [Accepted: 02/21/2023] [Indexed: 03/14/2023]
Abstract
INTRODUCTION Physical activity (PA) is influenced by numerous factors, and the literature describing why people with haemophilia (PWH) are physically active or not is inconclusive. AIMS To investigate factors associated with PA (mean min/day in light (LPA), moderate (MPA), vigorous (VPA) and total PA, and proportion meeting World Health Organization (WHO) weekly moderate-to-vigorous (MVPA) recommendations) among young PWH A. METHODS Forty PWH A on prophylaxis from the HemFitbit study were included. PA was measured using Fitbit devices and participant characteristics were collected. Potential factors associated with PA were investigated by univariable linear regression models for continuous PA outcomes, and descriptively for teenagers meeting/not meeting WHO MVPA recommendations only, because all except one adult met PA recommendations. RESULTS Mean age (n = 40) was 19.5 years (SD 5.7). Annual bleeding rate was nearly zero and joint scores were low. We found an increase of four min/day in LPA (95% confidence interval (CI) 1-7) per year increase in age. Participants with 'Haemophilia Early Arthropathy Detection with Ultrasound' (HEAD-US) score ≥1 engaged in mean 14 min/day less MPA (95% CI -23.2 to -3.8), and 8 min less VPA (95% CI -15.0 to -0.4) compared to participants with HEAD-US score 0. Teenagers who met PA recommendations had slightly better joint status compared to those who did not meet recommendations. CONCLUSION These findings indicate that presence of mild arthropathy does not affect LPA but may have a negative impact on PA of higher intensities. Early start of prophylaxis may be an important determinant of PA.
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Affiliation(s)
- Ruth Elise D Matlary
- Department of Haematology, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - May Grydeland
- Department of Physical Performance, Norwegian School of Sport Sciences, Oslo, Norway
| | - Heidi Glosli
- Centre for Rare Disorders, Oslo University Hospital, Oslo, Norway.,Department of Paediatric Research, Oslo University Hospital, Oslo, Norway
| | - Corina Silvia Rueegg
- Oslo Centre for Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway
| | - Pål André Holme
- Department of Haematology, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Matlary RED, Grinda N, Sayers F, Versloot O, McLaughlin P. Promoting physical activity for people with haemophilia in the age of new treatments. Haemophilia 2022; 28:885-890. [PMID: 35896000 PMCID: PMC9796679 DOI: 10.1111/hae.14641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 07/12/2022] [Accepted: 07/13/2022] [Indexed: 01/07/2023]
Abstract
Haemophilia treatment has seen great advances in recent years with an accompanied reduced risk of physical activity (PA) related bleeds. Based on its known health benefits, people with haemophilia (PWH) are currently encouraged to regularly engage in PA. However, this may not always translate to increased levels of PA. In this narrative review we aim to provide a brief overview of what is currently understood regarding PA levels and influences for the three broad age groups of children and adolescents, adults and older adults. We also provide recommendations for members of the haemophilia team on important aspects related to promotion of PA in their clinical practice. We highlight that PA behaviour is multifactorial and that many PWH still have limited access to adequate care. Whilst some still face unique challenges to being more physically active, overall, the barriers and facilitators to activity are very similar to that of the general population.
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Affiliation(s)
- Ruth Elise D. Matlary
- Department of HaematologyOslo University HospitalOsloNorway,Institute of Clinical MedicineUniversity of OsloOsloNorway
| | - Nathalie Grinda
- Haemophilia Reference CentreBicêtre Hospital AP‐HP University Paris XIParisFrance
| | - Fionnuala Sayers
- Haemophilia Comprehensive Care CentreBelfast Health and Social Care TrustBelfastUK
| | - Olav Versloot
- Centre for Benign Haematology, Thrombosis and Haemostasis, Van Creveldkliniek, University Medical Center UtrechtUtrecht UniversityUtrechtthe Netherlands,Department of PhysiotherapyInstitute of Movement StudiesUniversity of Applied ScienceUtrechtthe Netherlands
| | - Paul McLaughlin
- Katharine Dormandy Haemophilia Centre and Thrombosis UnitRoyal Free London NHS Foundation TrustLondonUK
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8
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Mathews N, Pluthero FG, Rand ML, Stain AM, Carcao M, Blanchette VS, Kahr WHA. Thromboelastography and thrombin generation assessments for pediatric severe hemophilia A patients are highly variable and not predictive of clinical phenotypes. Res Pract Thromb Haemost 2022; 6:e12800. [PMID: 36186102 PMCID: PMC9511091 DOI: 10.1002/rth2.12800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 07/02/2022] [Accepted: 07/23/2022] [Indexed: 11/24/2022] Open
Abstract
Background Severe hemophilia A (SHA) patients vary in severity of bleeding, arthropathy, and requirements for replacement factor VIII (FVIII). Baseline hemostatic activity assays using calibrated automated thrombography (CAT) and thromboelastography (TEG) may offer insights into the physiological basis of clinical heterogeneity. Objectives Use CAT and TEG to measure baseline hemostatic activity in a cohort of 30 pediatric SHA patients with available clinical data. Determine effect of contact activation inhibition with corn trypsin inhibitor (CTI). Assess heterogeneity among patients for baseline hemostatic activity and examine correlations between assay results and clinical parameters including FVIII dosing regimen, von Willebrand factor level, and Pettersson arthropathy score. Methods SHA blood after FVIII washout was subjected to TEG, and platelet‐rich (PRP) and platelet‐poor plasma was used for CAT assays. Varying concentrations of tissue factor (TF) were used. Statistical analysis examined relationships between assay results, and clinical parameters. Results CTI treatment was required to obtain TEG and CAT results representative of baseline hemostatic activity. Weak activity was observed in assays with low TF concentrations (0.5–2 pM), and most but not all samples approached normal activity levels at high TF concentrations (10–20 pM). A significant positive correlation was observed between results of TEG and CAT‐PRP assays. Correlations were not detected between hemostatic assay results and clinical parameters. Conclusions In vitro hemostatic assay results of samples containing platelets showed concordance. Assay results were not predictive of FVIII requirements or correlated with other clinical parameters. SHA patient heterogeneity is influenced by factors other than baseline hemostatic activity.
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Affiliation(s)
- Natalie Mathews
- Division of Haematology/Oncology Hospital for Sick Children Toronto Ontario Canada
| | - Fred G Pluthero
- Cell Biology Program Research Institute, Hospital for Sick Children Toronto Ontario Canada
| | - Margaret L Rand
- Division of Haematology/Oncology Hospital for Sick Children Toronto Ontario Canada.,Translational Medicine Program Hospital for Sick Children Toronto Ontario Canada.,Departments of Laboratory Medicine & Pathobiology Biochemistry, and Pediatrics, University of Toronto Toronto Ontario Canada
| | - Ann Marie Stain
- Division of Haematology/Oncology Hospital for Sick Children Toronto Ontario Canada
| | - Manuel Carcao
- Division of Haematology/Oncology Hospital for Sick Children Toronto Ontario Canada.,Department of Pediatrics University of Toronto Toronto Ontario Canada
| | - Victor S Blanchette
- Division of Haematology/Oncology Hospital for Sick Children Toronto Ontario Canada.,Department of Pediatrics University of Toronto Toronto Ontario Canada
| | - Walter H A Kahr
- Division of Haematology/Oncology Hospital for Sick Children Toronto Ontario Canada.,Cell Biology Program Research Institute, Hospital for Sick Children Toronto Ontario Canada.,Departments of Pediatrics and Biochemistry University of Toronto Toronto Ontario Canada
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9
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Cruz-Montecinos C, Núñez-Cortés R, Vasconcello-Castillo L, Solís-Navarro L, Carrasco-Alonso B, Calatayud J, Pérez-Alenda S, Torres-Castro R. Exercise capacity in people with haemophilia: A systematic review. Haemophilia 2022; 28:891-901. [PMID: 35896002 DOI: 10.1111/hae.14646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Revised: 07/14/2022] [Accepted: 07/15/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Exercise capacity has been established as a protective factor against joint impairment in people with haemophilia (PWH). However, little is known about how exercise capacity is affected in PWH. AIM To analyse exercise capacity, as assessed by standardised laboratory or field tests in PWH. METHODS A systematic review was conducted to identify manuscripts investigating physical capacity in PWH. An electronic search of PubMed/MEDLINE, Embase, Web of Science, CENTRAL and CINAHL was conducted from inception to 13 April, 2022. Two independent reviewers performed data extraction and assessed study quality using the critical appraisal tools of the Joanna Briggs Institute. RESULTS Nineteen studies with 825 patients were included. Most studies used the six-min walk test (6MWT) or peak/maximal oxygen consumption (VO2 max). In children, the distance walked ranged from 274 ± 36.02 to 680 ± 100 m. In adults, the distance walked ranged from 457.5 ± 96.9 to 650.9 ± 180.3 m. VO2 max ranged from 37 ± 8 to 47.42 ± 8.29 ml kg-1 min-1 . Most studies reported lower values of exercise capacity compared to standardised values. Overall, the quality of the studies was moderate. CONCLUSION Most of the studies showed that PWH have lower exercise capacity compared to reference values of 6MWT or VO2 max. Based on these results, it is necessary to emphasise in both the promotion and the prescription of physical exercise in PWH.
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Affiliation(s)
- Carlos Cruz-Montecinos
- Departament of Physical Therapy, Faculty of Medicine, University of Chile, Santiago, Chile.,Department of Physiotherapy, Physiotherapy in Motion Multispeciality Research Group (PTinMOTION), University of Valencia, Valencia, Spain.,Section of Research, Innovation and Development in Kinesiology, Kinesiology Unit, San José Hospital, Santiago, Chile
| | - Rodrigo Núñez-Cortés
- Departament of Physical Therapy, Faculty of Medicine, University of Chile, Santiago, Chile.,Department of Physiotherapy, Physiotherapy in Motion Multispeciality Research Group (PTinMOTION), University of Valencia, Valencia, Spain.,International Physiotherapy Research Network (PhysioEvidence), Barcelona, Spain
| | - Luis Vasconcello-Castillo
- Departament of Physical Therapy, Faculty of Medicine, University of Chile, Santiago, Chile.,International Physiotherapy Research Network (PhysioEvidence), Barcelona, Spain
| | - Lilian Solís-Navarro
- International Physiotherapy Research Network (PhysioEvidence), Barcelona, Spain.,Global Research on Wellbeing (GRoW), Facultat Ciències de la Salut Blanquerna, Universitat Ramon Llull, Barcelona, Spain
| | | | - Joaquín Calatayud
- National Research Centre for the Working Environment, Copenhagen, Denmark.,Exercise Intervention for Health Research Group (EXINH-RG), Department of, Physiotherapy, University of Valencia, Valencia, Spain
| | - Sofía Pérez-Alenda
- Department of Physiotherapy, Physiotherapy in Motion Multispeciality Research Group (PTinMOTION), University of Valencia, Valencia, Spain
| | - Rodrigo Torres-Castro
- Departament of Physical Therapy, Faculty of Medicine, University of Chile, Santiago, Chile.,International Physiotherapy Research Network (PhysioEvidence), Barcelona, Spain
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10
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Ai D, Huang K, Li G, Zhen Y, Wu X, Zhang N, Huo A, Chen Z, Wu R. Exploration of the minimum necessary FVIII level at different physical activity levels in pediatric patients with hemophilia A. Front Pediatr 2022; 10:1045070. [PMID: 36389359 PMCID: PMC9665406 DOI: 10.3389/fped.2022.1045070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 10/13/2022] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Physical activity can increase joint stability and reduce the risk of injury in hemophilia patients. There is limited clinical data on target trough FVIII levels during physical activity in hemophilia A patients. Hence, this study aimed to explore the target trough FVIII level required to avoid bleeding during different physical activities in hemophilia A patients. METHODS Patients with severe or moderate hemophilia A, who underwent pharmacokinetics (PK) tests at our center were enrolled in this study. Physical activities and clinical information such as bleeding were recorded. The FVIII level during physical activity was calculated by the WAPPS-Hemo. RESULTS A total of 105 patients were enrolled in this study. A total of 373 physical activities were recorded, of which 57.6% (215/373) was low-risk activities and the remaining 42.4% (158/373) was medium-risk activities. Most common physical activities were bicycling (59.0%), swimming (43.8%), running (48.6%), and jumping rope (41.0%). The FVIII trough level of low-risk physical activity was 3.8 IU/dl (AUC = 0.781, p = 0.002) and moderate-risk physical activity was 7.7 IU/dl (AUC = 0.809, p < 0.001). FVIII trough levels [low-risk activities: 6.1 (3.1, 13.2) IU/dl vs. 7.7 (2.3, 10.5) IU/dl, moderate-risk activities: 9.6 (5.8, 16.9) IU/dl vs. 10.2 (5.5, 11.0) IU/dl] were not statistically different between the mild arthropathy group and the moderate-severe arthropathy group. Multiple bleeding risk tended to increase with physical activities classified as moderate-risk (OR [95% CI]: 3.815 [1.766-8.238], p = 0.001). CONCLUSION The minimum necessary FVIII level increased with higher risk physical activity, irrespective of arthropathy.
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Affiliation(s)
- Di Ai
- Hematology Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Kun Huang
- Hematology Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Gang Li
- Hematologic Disease Laboratory, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Yingzi Zhen
- Hematology Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Xinyi Wu
- Hematology Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Ningning Zhang
- Department of Radiology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Aihua Huo
- Department of Radiology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Zhenping Chen
- Hematologic Disease Laboratory, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Runhui Wu
- Hematology Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
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Promoting physical activity in people with haemophilia: the MEMO (Movement for persons with haEMOphilia) expert consensus project. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2022; 20:66-77. [PMID: 34694222 DOI: 10.2450/2021.0138-21] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 07/29/2021] [Indexed: 12/27/2022]
Abstract
Regular physical activity can increase joint stability and function, reduce the risk of injury, and improve quality of life of people with haemophilia (PwH). However, a recent review of the literature shows that appropriate physical activity and sport are not always promoted enough in the overall management of PwH. A group of Italian experts in haemophilia care undertook a consensus procedure to provide practical guidance on when and how to recommend physical exercise programmes to PwH in clinical practice. Three main topics were identified -haemophilia and its impact on movement, physical activity recommendations for PwH, and choice and management of sports activity in PwH- and ten statements were formulated. A modified Delphi approach was used to reach a consensus. The group also created practical tools proposing different physical activities and frequencies for different age groups, the Movement Pyramids, to be shared and discussed with patients and caregivers. In conclusion, in the opinion of the working group, physical activity can be considered as a low-price intervention that can prevent/reduce the occurrence of chronic diseases and should be further encouraged in PwH to obtain multiple physical and psychological benefits. Future research should include prospective studies focusing on participation in sports, specific risk exposure and clinical outcomes.
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López-Casaus A, Jiménez-Sánchez C, Cordova-Alegre P, Alfaro-Gervon F, Esteban-Repiso L, Lafuente-Ureta R. Hemophilia Patient Experience in a Physical Therapy-Guided Health Education Intervention: A Mixed-Method Design. Healthcare (Basel) 2021; 9:healthcare9121728. [PMID: 34946454 PMCID: PMC8701070 DOI: 10.3390/healthcare9121728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Revised: 12/09/2021] [Accepted: 12/10/2021] [Indexed: 11/26/2022] Open
Abstract
People with hemophilia usually have negative joint consequences due to their illness. Evidence suggests that exercise and therapeutic education bring some benefits. An important factor that affects health interventions was the experience and degree of satisfaction. Thus, it is relevant to analyze qualitative and quantitative data to obtain a complete view of the patient’s experience. As a result, a concurrent nested mixed method with quantitative predominance study design was carried out. Nine people with hemophilia of Hemoaralar with a homogeneous environment participated in this study. The items evaluated were the level of satisfaction through the GCPC-UN-ESU survey and the experience with healthcare interventions through a focus group. A high level of satisfaction was obtained, but some divergences between quantitative and qualitative data were found. Further research about physical therapy and this type of intervention in people with hemophilia should be considered to better address the impact of living with the disease.
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