Vigorous physical activity is associated with a moderate but transient bleeding risk for hemophilia, resulting in an overall low risk for bleeds, suggests a study of Australian children.
The researchers investigated the magnitude of bleeding risk associated with inactivity or activities where collisions are unlikely, such as swimming (category 1), compared with activities that might involve significant collisions, such as basketball (category 2), and those in which collisions are inevitable, such as the category 3 sport, wrestling.
In all, 104 boys with moderate or severe hemophilia A or B were followed up for 4839 person-weeks, during which time there were 436 reported bleeds, 336 of which were not associated with a bleed in the previous 2 weeks.
For the patients, who were aged 4 to 18 years, category 2 activities were associated with a transient increase in the risk for bleeding compared with category 1 sports (30.6 vs 24.8%; odds ratio [OR]=2.7). The transient increase in risk was slightly higher again for category 3 activities (7.0 vs 3.5%; OR=3.7).
"To illustrate absolute risk increase, for a child who bleeds 5 times annually and is exposed on average to category 2 activities twice weekly and to category 3 activities once weekly, exposure to these activities was associated with only 1 of the 5 annual bleeds," report Carolyn Broderick (University of New South Wales, Sydney) and co-authors.
The researchers note that most bleeds occurred within an hour of activity, and that for each 1% increase in clotting factor level there was a 2% decreased risk for bleeding.
"Factor supplementation reduces risk for long periods yielding sustained reductions in relative risk. Consequently prophylactic clotting factor is likely to have a larger absolute effect on bleeding risk than physical activity," Broderick et al suggest in JAMA.
In an accompanying editorial, Marilyn Manco-Johnson (University of Colorado and Children's Hospital Colorado, Aurora, USA) highlights the need for guidelines on sports participation for children with hemophilia.
"These recommendations should include educating parents and athletes about potential short and long complications related to sports participation, risk reduction measures with prophylaxis regimens, conditioning and strengthening programs, and the healthful contributions of sports participation toward physical, social, and emotional development as well as the prevention of obesity," she emphasizes.
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