The importance of physical activity for children with hemophilia is commonly communicated to families. To collect evidence-based data to support this message, a group of Dutch researchers developed an instrument to assess the overall physical fitness, joint health, muscle strength, motor competence and the prevalence of overweight concerns in children with hemophilia.
The study was published in the March 2009 issue of Haemophilia. The lead author of the study was D. C. M. Douma-van Riet, Department of Pediatric Physiotherapy, Erasmus MC Sophia Children’s Hospital in Rotterdam. Prior studies, according to Douma-van Riet and fellow authors, have suggested that children with hemophilia may be at increased risk for becoming overweight due to joint bleeds and the restrictions they place on activity.
In all, 158 boys with hemophilia (141 with hemophilia A and 17 with hemophilia B) were enrolled in the study: 65 with severe, 22 with moderate and 71 with mild. Their mean age was 12.7 years. The treatment regimen for 68 of the boys (43%) was prophylaxis; for 90 (57%) it was on-demand. Eight boys had a history of an inhibitor and two experienced complications during the assessment.
Researchers measured weight, body mass index, aerobic capacity (via stationary bicycle or walking), muscle strength (via hand-held dynamometer) and active range of motion in the elbow, knee and ankle. Motor competence was gauged by a self-reported tool. Children were asked to rate their motor competence in relation to the motor performance of their “healthy” peers. The information gathered was then converted into a scoring system, with higher scores indicating a greater self-rated competency in comparison to healthy peers. Although the instrument relied on self-reporting, the authors noted that “internal consistency and test-retest reliability” of the survey were shown to be satisfactory.
Findings revealed that 96 children performed at the highest level in the aerobic capacity test and that 15.8% of the boys were overweight. There was no significant disparity in the maximum aerobic capacity between the overweight boys and those with a normal weight. In addition, muscle strength was normal when compared with reference values. After adjusting for age or body weight, no significant correlations could be made between hemophilia severity and muscle strength.
Joint pain was detected in 23% of boys with severe hemophilia and 8% of those with mild diagnosis. The most commonly reported painful joint was the ankle, with pain reported by 15% of boys with severe hemophilia, 14% with moderate and 3% with mild. There was no association between decreased joint mobility and joint pain or between joint pain and maximum aerobic capacity. Further, 84% of the boys reported no joint pain.
“Dutch children with haemophilia have normal aerobic exercise capacity and muscle strength. The majority also has normal joint mobility. Overweight is slightly increased compared with reference values,” concluded authors.
Source: Douma-Van Riet DCM, Engelbert RHH, Van Genderen F, et al. Physical fitness in children with haemophilia and the effect of overweight. Haemophilia (2009), 15, 519-527.