Children with hemophilia should be active, but avoid extreme sports: Study
Children and adolescents with hemophilia bleeding disorder have an increased risk of bleeding when participating in contact sports, but the overall risk is low and varies depending on the sport, according to a recent study.
People with hemophilia lack a protein necessary for blood clotting. Because coagulation helps to stop bleeding, people with hemophilia may bleed longer than people without the disease. For a long time, they were told they could not and should not exercise because of the risk of bleeding. Times have changed, however, thanks to improved treatments, many of them are invited to play some sports.
The new study, published in the October 10 issue of the Journal of the American Medical Association, put real numbers on the risks associated with certain sports for children and adolescents with hemophilia.
The researchers analyzed the risk of bleeding associated with vigorous physical activity in 104 Australian children with hemophilia between 4 and 18 years. Participants had moderate or severe hemophilia and bleeding was controlled for a year to determine what preceded the event, including physical activity and sport.
A total of 436 bleeding episodes in a row. Of these, 336 occur without another bleeding episode in the previous two weeks. Eighty-eight participants reported at least one purge. Knees, ankles and elbows are the most frequent sites of bleeding. Most bleeding happened an hour after exercise.
The level of risk varies depending on the sport. More specifically, compared to being inactive, the risk of bleeding is almost three times higher for contact sports like football and basketball limited, and four times higher for contact sports such as rugby and shock and fight, according to the study. In other words: For a child who bled five times a year and play basketball twice a week and the fight once a week, sports are associated with one of the five annual bleeding, the authors of the study said.
"Sport and physical activity is beneficial for children with hemophilia, but the benefits must be weighed against the increased risk of bleeding, especially bleeding into muscles and joints," said study author Dr Carolyn Broderick, University of New South Wales in Sydney. Without treatment, hemophilia cause recurrent bleeding into joints.
"Children at increased risk of bleeding during sports, but because the increased risk is present while the activity is in progress and participation in vigorous physical activity involves only a small number of hours in the week, the number of hours spent idling, the absolute increase in the number of bleeding episodes associated with this sport can be small, "said Broderick." It may be reassuring for parents. '
Non-contact activities are most appropriate for children with hemophilia, but with limited contact sports can also be fine. "Contact sports should be avoided, but in countries where prophylaxis [prevention] administration of clotting factor is available, coagulation factor immediately preceding the contact and collision sports reduces the risk of bleeding," Broderick said.
"Of course, the sports in which there is a high risk of direct trauma to the head or vital organs, such as boxing, avoid the consequences of bleeding in the brain or other vital organs could be catastrophic" Mr. Broderick.
Preventive treatment with coagulation proteins and measures of fitness can really level the playing field for children with hemophilia who want to exercise, said Dr. Marilyn Manco-Johnson, a pediatric hematologist at the University of Colorado Children Hospital of Colorado at Denver.
"We have come a long way in the development of quality products, safe and effective so that we can make the most of the risks for these children," said Manco-Johnson, who wrote an editorial accompanying the study. "We can replace blood proteins to reduce the risk of bleeding due to injury, and the second risk is an injury that may require surgery or joint or muscle damage in the future."
Proper training can help reduce these risks, as Manco-Johnson. "Children with hemophilia to work a little harder to build muscle and strength," he added. People with hemophilia do not heal as well after surgery to repair damaged muscles or joints than their peers without coagulation disorder.
Exercise is good for children, another expert.
"The key is moderate exercise is very important and helps children with hemophilia tighten the muscles and joints and is highly recommended, but vigorous activity is the question mark," said Dr. Ziad Khatib, a pediatric hematologist Miami Children's Hospital. "If anyone loves the sport, I do not recommend letting the prevention itself, can do well."
Limits exist, Khatib said. "Children with severe hemophilia never be at a football or a college or a team of professional basketball," he said. "Most will be happy to mild to moderate exercise for fun."
