Download PDF
Semin Thromb Hemost
DOI: 10.1055/a-2778-9890
Review Article

Physical Activity in People with Hemophilia

Authors

  • Carlos Cruz-Montecinos

    1   Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago, Chile

  • Joaquín Calatayud

    2   Exercise Intervention for Health Research Group (EXINH-RG), Department of Physiotherapy, University of Valencia, Valencia, Spain

  • Lars Louis Andersen

    3   Department of Working Environment, National Research Centre for the Working Environment, Copenhagen, Denmark

  • Carla Daffunchio

    4   Department of Traumatology, Juan A. Fernández Hospital, Caba, Argentina
    5   Haemophilia Foundation, Caba, Argentina

  • Verónica Soto-Arellano

    6   Department of Hematología, Hospital Puerto Montt Dr. Eduardo Schütz Schroeder, Puerto Montt, Chile

  • Miguel López

    7   Department of Hematología, Clínica Alemana, Santiago, Chile

  • Sofía Pérez-Alenda

    8   Physiotherapy in Motion, Multispecialty Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, Valencia, Spain

  • Ana Chimeno-Hernández

    8   Physiotherapy in Motion, Multispecialty Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, Valencia, Spain

  • David Stephensen

    9   School of Nursing, Midwifery, Allied and Public Health, Canterbury Christ Church University, Canterbury, United Kingdom

  • Rodrigo Núñez-Cortés

    1   Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago, Chile
Further Information
   Permissions and Reprints

ABSTRACT

Hemophilia is a rare inherited bleeding disorder associated with recurrent musculoskeletal bleeding, chronic pain, and functional decline. Advances in prophylactic therapies, including extended half-life factors, non-factor therapies like emicizumab, and gene therapies, have fundamentally transformed care, enabling a paradigmatic shift from activity restriction to promotion. This review synthesizes recent evidence to examine the multifaceted role of physical activity (PA) in people with hemophilia (PwH), current challenges, and strategies to optimize health outcomes. PA confers substantial benefits for PwH, improving muscle strength, coordination, bone density, cardiovascular fitness, mental health, and quality of life. It modulates chronic pain through neuroplastic, anti-inflammatory, and neuroendocrine mechanisms, while exercise-derived molecules (exerkines) may directly influence cartilage health. With individualized prophylaxis and structured programming, both resistance and aerobic exercise can be prescribed safely using evidence-based risk stratification (categories I–III) and comprehensive monitoring approaches, including accelerometers, questionnaires, and subjective effort scales. Persistent barriers include chronic pain, fear of injury, insufficient professional guidance, and treatment inequities, while facilitators encompass enjoyment, social support, and adequate prophylactic coverage. Therapies providing continuous hemostatic protection have further expanded safe PA opportunities, supporting participation in previously restricted activities. In this new therapeutic era, PA should be recognized as a fundamental pillar alongside medical care. Not only for musculoskeletal preservation, but also as a strategy promoting metabolic and mental health. Ensuring access for all patients to both advanced therapies and tailored PA prescription, supported by education, enabling policies, and multidisciplinary care, is essential for democratizing active lifestyles within the global hemophilia community.

Keywords

exercise - healthy lifestyle - aerobic exercise - hemophilic arthropathy - strength training - sports medicine

Contributors' Statement

C.C.-M.: conceptualization, formal analysis, investigation, methodology, resources, software, supervision, validation, visualization, writing—original draft, writing—review and editing; C.J.: investigation, supervision, validation, writing—original draft, writing—review and editing; L.L.A.: formal analysis, validation, visualization, writing—original draft, writing—review and editing; C.D.: formal analysis, methodology, validation, visualization, writing—original draft, writing—review and editing; V.S.-A.: formal analysis, investigation, methodology, supervision, validation, writing—original draft, writing—review and editing; M.L.: formal analysis, methodology, validation, visualization, writing—original draft, writing—review and editing; S.P.-A.: formal analysis, validation, visualization, writing—original draft, writing—review and editing; A.C.-H.: methodology, validation, visualization, writing—original draft, writing—review and editing; D.S.: formal analysis, investigation, methodology, supervision, validation, visualization, writing—original draft, writing—review and editing; R.N.-C.: formal analysis, investigation, methodology, validation, visualization, writing—original draft, writing—review and editing.




Publication History

Received: 11 October 2025

Accepted: 23 December 2025

Accepted Manuscript online:
26 December 2025

Article published online:
08 January 2026

© 2026. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA