title: Athletic participation in severe hemophilia: bleeding and joint outcomes in children on prophylaxis.
abstract: OBJECTIVE
  We sought to determine joint outcomes relative to impact level of athletic participation among school-aged children who had hemophilia and were taking prophylactic factor replacement, as well as to investigate prognostic factors for joint outcomes.
  
  
  METHODS
  School-aged boys with severe hemophilia A or B at a single center were included in the study. Clinical data on baseline joint status, BMI, hemophilia treatment, bleeding episodes, joint assessments, athletic participation, and injuries were retrospectively reviewed. Data on athletic participation were supplemented, when incomplete in the medical record, via structured telephone interview.
  
  
  RESULTS
  Among 37 children with severe hemophilia A or B receiving factor prophylaxis, 73% participated in high-impact activities, whereas 27% participated in exclusively low-impact activities. The frequency of joint hemorrhages and new injuries did not appreciably differ between high- and low-impact athletics. In most instances, children developed <1 bleed or injury per season. A new target joint developed in 1 (3%) child. Sixteen percent of children met established BMI criteria for overweight, and 3% were obese. In logistic regression analyses with adjustment for prophylaxis frequency, level of athletic participation was not a significant prognostic factor for joint hemorrhage.
  
  
  CONCLUSIONS
  In the setting of regular prophylaxis and adult coaching and supervision, significant bleeding complications were uncommon and level of impact of athletic participation was not a prognostic factor for joint outcomes. Athletic participation with appropriate supervision and precautions should be encouraged in children with hemophilia receiving prophylaxis, given potential health benefits in an increasingly overweight pediatric population.
authors.affiliation: Department of Pediatrics, Section of Hematology/Oncology/Bone Marrow Transplantation and Mountain States Regional Hemophilia and Thrombosis Center, University of Colorado Denver and Children's Hospital, Aurora, Colorado 80045-0507, USA.
authors.forename: Cassie
authors.initials: C
authors.lastname: Ross
authors.forename: Neil A
authors.initials: NA
authors.lastname: Goldenberg
authors.forename: Dana
authors.initials: D
authors.lastname: Hund
authors.forename: Marilyn J
authors.initials: MJ
authors.lastname: Manco-Johnson
mesh_terms: D000293:Adolescent; D000328:Adult; D001265:Athletic Injuries / Q000150:complications*; D002648:Child; D006395:Hemarthrosis / Q000209:etiology / Q000517:prevention & control*; D006467:Hemophilia A / Q000150:complications / Q000628:therapy*; D006470:Hemorrhage / Q000209:etiology / Q000517:prevention & control*; D006801:Humans; D008297:Male; D013177:Sports; D055815:Young Adult