Hemorrhagic diathesis is a collective name for a group of congenital diseases that occur with increased bleeding, the most common of which is hemophilia. Hemophilia (a recessive mutation in the X chromosome) is a rare hereditary disease associated with a blood clotting disorder, caused by a deficiency – quantitative or functional – of the protein necessary for blood clotting – the so-called factor VIII or IX. 

Hemorrhagic diathesis is a collective name for a group of congenital diseases that occur with increased bleeding, the most common of which is hemophilia. Hemophilia (a recessive mutation in the X chromosome) is a rare hereditary disease associated with a blood clotting disorder, caused by a deficiency – quantitative or functional – of the protein necessary for blood clotting – the so-called factor VIII or IX. Hemophilia is diagnosed in 1 in 5000 newborns. Clinical manifestations and risk of bleeding range from mild bleeding to massive, life-threatening bleeding with the slightest injury.

Children with severe hemophilia are susceptible to spontaneous hemorrhage without injury. The disease is characterized by hemorrhages in joints or muscles, hematomas and prolonged bleeding after minor trauma; Severe bleeding such as intracranial bleeding may occur, affecting vital organs and the respiratory tract. Frequent hemorrhages in the joints provoke the disease synovitis (inflammation of the synovial membrane), which, in turn, leads to chronic degenerative joint diseases. With hemophilia at a young age, joint contracture and limited mobility may develop, accompanied by severe chronic pain. Most often, the disease affects the knees, ankles and elbows. Prophylactic treatment reduces the number of spontaneous bleedings, as well as the risk of hemophilic arthropathy.

Potential benefits of exercise

Physically active children with hemophilia have fewer episodes of bleeding than their inactive peers. Weightening the muscles around the affected joints helps protect the joints from hemarthrosis, increases joint strength, and reduces the risk of injury. Preventive physical activity aimed at strengthening the periarticular muscles has shown to be effective in reducing the incidence of hemorrhages. Proprioceptive (aimed at developing muscle-joint sense) training can reduce the amount of joint damage and improve physical fitness. Properly weighted exercise can improve bone health in children with severe hemophilia, who typically have low bone mineral density. Aerobic exercise has a positive effect on coagulation (blood clotting).

Potential risks during exercise

Children with hemophilia are less physically developed, less resilient, and have weaker muscles than their peers. Chronically ill children may be limited in physical activity due to parental anxiety, musculoskeletal pain, or deconditioning (loss of muscle tone). Although the disease itself does not affect physical fitness or athletic performance, chronic hemophilic arthropathy can lead to deterioration of muscle function, decreased muscle strength and endurance. Participation in contact sports can result in life-threatening bleeding. The actual risk of muscle, joint and intracranial hemorrhage depends on the child’s individual susceptibility to hemorrhage, the history of hemorrhage and adequate prophylactic treatment.

Recommendations for children with hemophilia

Children with hemophilia can and should be physically active;

• When choosing a type of training, choose non-contact sports with a low risk of injury;
• Sports activities should be started against the background of adequately selected replacement therapy;
• When exercising, preventive measures must be taken to reduce the risk of potential injuries and hemorrhages;
• Before choosing a specific type of activity, the child must undergo strict monitoring of joint and muscle function. If there are restrictions or contraindications, the doctor will recommend alternative safe types of physical activity.
• If the child is detrained or has never played sports, you can start classes with a group of physical therapy and general physical training.
• The trainer must be aware of the child’s illness, as well as that during the treatment, the risk of bleeding is minimized.
• The child needs special equipment and special clothes for classes.
• If an injury does occur, then it is necessary to return to physical activity according to an individual plan or including the stage of medical rehabilitation.
• Recommended sports for children with hemorrhagic diathesis are swimming, some types of athletics, curling, golf, table tennis, shooting, and ballroom dancing.
• Despite the existing restrictions, do not deprive your child of the joy of movement; rational physical activity can improve his well-being, raise self-esteem, and reduce the number of relapses of the disease.