First published on March 4, 2010

Physical Therapy 2010;90:509.

Physical Therapy
DOI: 10.2522/ptj.20080202
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Research Reports

Effects of a 6-Week, Individualized, Supervised Exercise Program for People With Bleeding Disorders and Hemophilic Arthritis

Ruth Mulvany, Audrey R. Zucker-Levin, Michael Jeng, Catherine Joyce, Janet Tuller, Jonathan M. Rose and Marion Dugdale

R. Mulvany, PT, DPT, is Associate Professor, Department of Physical Therapy, College of Allied Health Sciences, University of Tennessee Health Science Center, 930 Madison Ave, 6th Floor, Memphis, TN 38163 (USA).
A.R. Zucker-Levin, PT, PhD, MBA, GCS, is Associate Professor, Department of Physical Therapy, College of Allied Health Sciences, University of Tennessee Health Science Center.
M. Jeng, MD, is Associate Professor of Pediatrics, Stanford University, Palo Alto, California.
C. Joyce, MSW, is affiliated with the Comprehensive Hemophilia Clinic, Department of Hematology, College of Medicine, University of Tennessee Health Science Center.
J. Tuller, RN, MPH, is Clinical Nurse Coordinator, Comprehensive Hemophilia Clinic, Department of Hematology, College of Medicine, University of Tennessee Health Science Center.
J.M. Rose, PT, MS, ATC, Assistant Professor, Department of Physical Therapy, Health Science Center, College of Allied Health Sciences, University of Tennessee.
M. Dugdale, MD, is Medical Director, Comprehensive Hemophilia Clinic, Department of Hematology, College of Medicine, University of Tennessee Health Science Center.

rmulvaney{at}uthsc.edu

Background: People with bleeding disorders may develop severe arthritis due to joint hemorrhages. Exercise is recommended for people with bleeding disorders, but guidelines are vague and few studies document efficacy. In this study, 65% of people with bleeding disorders surveyed reported participating in minimal exercise, and 50% indicated a fear of exercise-induced bleeding, pain, or physical impairment.

Objective: The purpose of this study was to examine the feasibility, safety, and efficacy of a professionally designed, individualized, supervised exercise program for people with bleeding disorders.

Design: A single-group, pretest-posttest clinical design was used.

Methods: Thirty-three patients (3 female, 30 male; 7–57 years of age) with mild to severe bleeding disorders were enrolled in the study. Twelve patients had co-existing illnesses, including HIV/AIDS, hepatitis, diabetes, fibromyalgia, neurofibromatosis, osteopenia, osteogenesis imperfecta, or cancer. Pre- and post-program measures included upper- and lower-extremity strength (force-generating capacity), joint range of motion, joint and extremity circumference, and distance walked in 6 minutes. Each patient was prescribed a 6-week, twice-weekly, individualized, supervised exercise program. Twenty participants (61%) completed the program.

Results: Pre- and post-program data were analyzed by paired t tests for all participants who completed the program. No exercise-induced injuries, pain, edema, or bleeding episodes were reported. Significant improvements occurred in joint motion, strength, and distance walked in 6 minutes, with no change in joint circumference. The greatest gains were among the individuals with the most severe joint damage and coexisting illness.

Limitations: Limitations included a small sample size with concomitant disease, which is common to the population, and a nonblinded examiner.

Conclusions: A professionally designed and supervised, individualized exercise program is feasible, safe, and beneficial for people with bleeding disorders, even in the presence of concomitant disease. A longitudinal study with a larger sample size, a blinded examiner, and a control group is needed to confirm the results.


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