• Center on Health Equity and Access
  • Clinical
  • Health Care Cost
  • Health Care Delivery
  • Insurance
  • Policy
  • Technology
  • Value-Based Care

Systematic Strength Training Protocols May Benefit People With Hemophilia


Strength training for people with hemophilia (PwH) should consider exercise variables and pain threshold, a review finds.

Strength exercises are often prescribed to patients with hemophilia (PwH), but little is known on how strength exercise variables and pain thresholds are measured to prescribe strength training to these patients; a recent systemic review provided guidance on directions for future research in this area, to improve the information patients receive.

These topics could include pain thresholds and exercise variables, such as prophylactic factor coverage, intensity, range of motion, time under tension, attentional focus modality, therapist experience in hemophilia, and adherence assessment and pain threshold.

“The aim of this systematic review was to analyze how strength exercise variables and pain thresholds have been used to prescribe strength training in people with hemophilia (PwH),” wrote the researchers of this review. “Knowledge of how research prescribes strength training may help clinicians and researchers for improving the quality of future research and clinical practice in PwH.”

The results were published in Haemophilia.

Eighteen studies were included, consisting of 11 RCTs, 5 before and after studies, and 2 non-randomized clinical trials, published between 2003 and 2022. Participants were included if they were aged 18 and older with a clinical diagnosis of hemophilia (mild, moderate, severe). In total, 561 people with hemophilia were included in the studies; 68% had severe hemophilia, 28.1% had moderate hemophilia, and 3.4% had mild hemophilia.

Most studies (77.8%) reported the strength treatment regimen for enrolled patients. However, only 2 of the studies (11.1%) included information on prophylactic factor coverage. None of the studies included information on specific pain threshold for prescribing strength training, and only one (5.6%) specified that exercise was performed within the patient’s pain threshold.

Most studies reported these exercise variables in their training:

  1. 94.4% reported weekly frequency
  2. 100% reported duration in weeks
  3. 88.9% reported number of sets/repetitions
  4. 77.8% reported repetitions to failure/not failure
  5. 77.8% reported types of contraction
  6. 55.6% reported rest duration
  7. 55.6% reported progression
  8. 77.8% reported supervision
  9. 72.2% reported exercise equipment
  10. 77.8% reported the frequency of bleeding during training

In contrast, only some studies reported these additional exercise variables in their training:

  • 50% reported intensity
  • 27.8% reported total or partial range of motion (ROM)
  • 27.8% reported time under tension
  • 0% reported attentional focus modality
  • 33.3% reported therapist experience in hemophilia
  • 50% reported adherence to assessments

As a result, this review showed that prophylactic factor coverage and pain threshold were under-reported when prescribing patients with hemophilia strength training, along with intensity, full or partial ROM, time under tension attentional focus modality, therapist experience in hemophilia, and adherence assessment.

Although the researchers acknowledged that the sample size of the included studies was relatively small, and most studies were at high risk or uncertain risk of bias, this systemic review provides more context to on key areas to prescribing strength training to people with hemophilia, where information may be lacking.

“These variables are relevant for improving muscle strength, structural adaptations, and physical function,” wrote the researchers. “However, all these variables should be further reported to improve clinical practice and comparison of different protocols in future systematic reviews and meta-analyses in PwH.”


Cruz‐Montecinos C, Núñez‐Cortés R, Chimeno‐Hernández A, et al. Exercise variables and pain threshold reporting for strength training protocols in people with haemophilia: a systematic review of clinical trials. Haemophilia. 2023. doi:10.1111/hae.14753

Related Videos
Dr Jeffrey Sippel
Dr. Jeffrey Sippel
Dr. Jeffrey Sippel
Takiyah Durham, MBA, and Margaret Larkins-Pettigrew, MD
dr peter lio
Related Content
© 2023 MJH Life Sciences
All rights reserved.