Table I.

Consensus statements on physical activity and sports in people with haemophilia

Statement	1st roundrating – 65 voters(mean value)	2nd roundrating – 40 voters(mean value)	Final rating* (mean value)
1. Persons with haemophilia (PwH) have a higher risk of chronic arthropathy as a result of repeated joint bleeding. Revised as: 1. People with haemophilia, particularly those with severe haemophilia, have a higher risk of chronic arthropathy as a result of repeated joint bleeding.	8.7	6.5	8.2
2. PwH, as a result of hypomobility and the excessive protection implemented, especially in children, by their parents, have an increased risk of obesity which enhances the risk of the onset of alterations in musculoskeletal functions. Revised as: 2. Poor physical activity and possible parental overprotection of children contribute to the risk of obesity and the onset of alterations in musculoskeletal functions.	7.5	7.6	8.2
3. Strength, flexibility, and coordination are important for improving joint stability and function, increasing bone density and reducing the risk of bleeding. Revised as: 3. Movement coordination, muscle strength and flexibility are important for improving joint function and stability, preserving bone density, and reducing the risk of bleeding.	8.5	8.3	8.5
4. Regular physical activity improves joint stability and function, can reduce the risk of acute bleeding episodes and the consequent complications and overall improves the QoL and interpersonal skills of the person with haemophilia. Revised as: 4. Regular physical activity enhances joint function and stability and can reduce the risk of acute bleeding episodes and related complications, thus overall improving the quality of life and interpersonal skills of the person with haemophilia.	8.3	8.4	8.7
5. In people with haemophilia with a good joint condition, such as to allow them normal activity or involve only minimal limitations, motor skills must be progressively aligned with those of their healthy peers.	8.0	8.4	8.3
6. In adults with arthropathy and the elderly, the risk of trauma/falls is increased due to structural and/or functional joint instability, resulting in an increased risk of injury, head trauma and intracranial haemorrhage. In these cases, instability should be minimised through personalised physiotherapy programmes.	8.3	8.8	8.6
7. Haemophiliacs with inhibitor should also be encouraged to carry out regular physical activity, but with particular caution and timely monitoring of the effectiveness of the prophylaxis for the prevention of acute bleeding events, so that physical activity is conducted in total safety. Revised as: 7. People with haemophilia with inhibitors should also be encouraged to carry out regular physical activity, but with particular caution and timely monitoring of the effectiveness of prophylaxis for the prevention of acute bleeding events, so that physical activity is conducted safely.	8.2	8.6	8.8
8. The choice of the type of sport to be practised should derive from a shared consensus between a multidisciplinary team composed of haematologists, specialists in the management of disorders of the musculoskeletal system (orthopaedists, physiatrists, physiotherapists), and specialists in sports medicine. The last will have the task of helping people with haemophilia to choose the sporting activity that best suits their physical conditions and assessing the absence of contraindications including those not related to haemophilia, also taking into account the wishes and expectations of the individual.	8.3	8.2	8.6
9. It is desirable that the multidisciplinary team promotes motor activity in PwH from the paediatric age and helps the individual to identify the most appropriate type of sport, in order to avoid subsequently limiting the practice of a particular sport following injuries, acute bleeding episodes, or requests for excessive performance, which could lead to frustration or even the complete refusal to practise any form of physical and sporting activity. Revised as: 9. It is desirable that the multidisciplinary team promotes motor activity in people with haemophilia since childhood and helps the individual to identify the most appropriate type of sport, also taking into account the potential risks, in order to avoid imposing subsequent limitations, which could cause frustration or even the patient’s complete refusal to practise any form of physical activity or sport.	8.4	7.7	8.5
10. The task of the specialists of the haemophilia centres is to optimise the replacement therapy, taking into account the risks related to the sporting practice of the individual. Revised as: 10. One of the tasks of the specialists of a haemophilia centre is to optimise the anti-haemorrhagic prophylaxis, taking into account the risks related to the sporting practice of the individual.	8.6	8.3	8.7

^*The third round of voting includes the seven online voters (who did not participate in the consensus meeting or in the discussion)