Sports participation recommendations for patients with bleeding disorders

There are several sets of guidelines recommending sports participation for patients with bleeding disorders. Though there is a perceived risk of injury and the associated bleeding complications, several studies have been done in this patient population and have found no increased risk. In addition, there are many other benefits to participation including improvement in physical fitness status, better health outcomes, improvement in quality of life, and the development of increased flexibility, gait coordination, and muscular strength, which may actually reduce the risk of subsequent injury. With adequate pre-participation preparation and surveillance, patients with hemophilia have few restrictions in their choice of activity. In the United States, the National Hemophilia Foundation (NHF) proposes stratification of activities into safe, safe-to-moderate, moderate, moderate-to-dangerous, and dangerous risk groups. The safe through moderate categories can be routinely recommended with the proper preparation. Though hematologists often use these recommendations when counseling their patients, these guidelines may not be as accessible for primary care and sports medicine providers. This article is to serve as a review of the related literature, specifically on the benefits of physical activity without an increased risk of injury in hemophilia patients, and will summarize a set of recommendations regarding safe athletic participation for individuals with bleeding disorders from both individual studies and from health regulatory bodies like the NHF.