TABLE 5.

Study sample characteristics and main findings of bleeds, PA and treatment

Author Sample size (n)	Age (y)	Type	Severity	Traumatic bleeds	Spontaneous bleeds	Other bleeds	Treatment	Bleeds and PA
Janco et al. (1996)28 n = 96	4–17	Both	All	Yes	Yes	NA	OD	Spontaneous joint bleeds (p < .05) and traumatic soft tissue bleeds (p < .03) with strenuous PA when controlled for factor level.
Fromme et al. (2007)31 n = 71	7–42	NS	All	NS	NS	Exercise‐induced	NS	17.6% of bleeds were exercise‐induced. 10.3% in youths, significantly less than adults (33.3%) (p < .05). Sports such as football, basketball and swimming were associated with bleeding complications. No statistically significant correlation between rate of bleeding complications and severity of haemophilia.
Tiktinsky et al. (2009)32 n = 44	12–25	Both	Sev	Yes	Yes	NA	PR excluded; Treatment NS	Traumatic bleeds significantly associated with strenuous PA (p < .01). No significant differences between activity levels and mean number of bleeds.
Ross et al. (2009)33 n = 37	6–21	Both	Sev	NS	NS	Joint bleeds	PR	Not associated with high‐impact PA (OR 0.32 (95% CI: 0.04–2.7, p = .3)) Median acute joint bleeds for high impact PA: 0.05 (0–4); low impact PA: 0.5 (0–2).
Sherlock et al. (2010)34 n = 61	16–63	NS	All	NS	NS	Sport‐related	NS	55% of participants has sport‐associated bleeds. Bleeding episodes were reported in 7/8 patients with sev haemophilia.
Gonzalez et al. (2011)37 n = 41	8–18	FVIII	All	NS	NS	‘a bleeding episode during the previous year’	OD & PR	Patients who suffered from a bleeding episode during the previous year vs. those who did not did significantly more vigorous PA. (t39 = 3.41, p = .002, r = .28).
Khair et al. (2012)38 n = 84	6–18	Both	All	NS	NS	Total, joint and sport‐related bleeds in 6 months	OD & PR	Not associated with sedentary behaviour, sport participation, frequency or duration of sport.
Broderick et al. (2012)39 n = 104	5–14	Both	Mod/Sev	NS	NS	‘An episode of bleeding requiring treatment with clotting factor’	OD & PR	Vigorous PA transiently associated with a moderate relative increase in risk of bleeding, thus absolute increase in risk associated with PA was low.
Broderick et al. (2013)25 n = 104	4–18	Both	Mod/Sev	NS	NS	NS	OD & PR	Not associated with absolute or vigorous PA (r s = .05 and .07, respectively).
McGee et al. (2015)42 n = 48	10–19	Both	All	NS	Excluded	New target joints/injuries: soft tissue/haemarthrosis/muscle haemorrhage and head injury	Most on PR	Mean number of ‘injuries’ not associated with sport participation (p = .44). Two subjects (mild/mod haemophilia) who did sport developed target joints compared to those who did not participate in sport.
von Mackensen et al. (2016)27 n = 50	17–66	Both	All	NS	NS	Total, joint and sport‐related bleeds in 6 months	OD & PR	Not associated with sedentary behaviour, sport participation, frequency or duration of sport.
Versloot et al. (2019)49 n = 71	18–40	Both	Sev	NS	NS	Joint bleeds (annual and 5‐year)	PR	Not associated with high‐risk sport participation (r s = −.25, p = .27/ r s = .08, p = .76) in either cohort.
Goto et al. (2019)50 n = 106	18–64	Both	All	NS	NS	Bleeding caused by sports; Intra‐articular bleeding	OD & PR	84 (79.2%) experienced bleeding whilst playing sports. No significant association between intra‐articular bleeds during past 12 months and PA (r s = −.072, p = .466).
Bérubé et al. (2020)54 n = 24	6–18	Both	Sev	NS	NS	Bleeds in past year	PR or immune tolerance therapy	No significant differences in number of bleeds episodes in past year between ‘Risk Profile’ and ‘Safe Profile’ categories (3.8 (6.3) vs. 4.7 (6.7), respectively).

Abbreviations: All = Mild, moderate and severe; Both = FVIII and FIX deficiency; Mod = moderate; NA = not applicable; NS = not specified; OD = on demand; PA = physical activity; PR = prophylaxis; r = effect size; r _s = Spearman's rho; Sev = severe; y = years (age).