Exercise variables and pain threshold reporting for strength training protocols in people with haemophilia: A systematic review of clinical trials

Abstract

Introduction: Although strength exercise is often prescribed for people with haemophilia (PWH), it remains unknown how exercise variables and pain thresholds are used to prescribe strength training in PWH. Aim: To analyse how strength exercise variables and pain thresholds have been used to prescribe strength training in PWH. Methods: A systematic search was conducted in PubMed, Embase, Web of Science, CENTRAL and CINAHL databases from inception to 7 September 2022. Studies whose intervention included strengthening training in adults with haemophilia were included. Two independent reviewers were involved in study selection, data extraction and risk of bias assessment.Results: Eighteen studies were included. The least reported variables among the studies were: prophylactic factor coverage (11.1%), pain threshold/tolerability (5.6%), intensity (50%), total or partial range of motion (27.8%), time under tension (27.8%), attentional focus modality (0%), therapist experience in haemophilia (33.3%) and adherence assessment (50%). In contrast, weekly frequency (94.4%), duration (weeks) (100%), number of sets/repetitions (88.9%), repetitions to failure/not to failure (77.8%), types of contraction (77.8%), rest duration (55.6%), progression (55.6%), supervision (77.8%), exercise equipment (72.2%) and adverse event record (77.8%) had a higher percentage of reported (>50% of studies). Conclusion: Future research on strength training for PWH should improve information on pain threshold and other important variables such as prophylactic factor

Benefits of physical activity self‐monitoring in patients with haemophilia: a prospective study with one‐year follow‐up

“…Given that exercise can be considered safe and feasible in PWH when expert supervision and prophylaxis are available, 6,40 it is important to emphasise that clinicians should promote PA among people with haemophilia as well as their participation in sporting activities, and this type of device can help to control and monitor their progress. Pain as a barrier to PA is also an important consideration for PA and exercise promotion and clinicians should take this into account 41 …”

“…Pain as a barrier to PA is also an important consideration for PA and exercise promotion and clinicians should take this into account. 41 Finally, to promote PA in this population, healthcare teams should be aware of the barriers that limit PA in PWH. For example, a fear of trauma-induced bleeding and lack of correct information from physicians could be crucial factors.…”

How does joint impairment affect the functional capacity of the lower limb in early haemophilia‐related arthropathy?

“…31 The velocities should gradually increase and adapt based on the individual's capability, considering the recommendations for strength training in individuals with haemophilia. For more details, see the revision by Cruz-Montecinos et al 32 Ageing is a relevant factor that must be studied in people with haemophilia. Ageing is also related to the advanced deterioration of joints in people with haemophilia, regardless of severity.…”

“…The velocities should gradually increase and adapt based on the individual's capability, considering the recommendations for strength training in individuals with haemophilia. For more details, see the revision by Cruz‐Montecinos et al 32 …”

Hemophilic Arthropathy of the Knee and Its Association with Reduced Muscle Strength and Activation and the Pressure Pain Threshold: A Case-Control Study

“…The pressure pain threshold can adversely affect the generation of strength, preventing maximum muscle benefit from being achieved due to a lower tolerance to pain [11]. In patients with chronic pain, a 20-30% reduction in strength in the painful limb is considered normal [12].…”