Abstract
Persons with haemophilia (PwH) have historically been advised to avoid physical activity (PA) to limit bleeding risk, leading many to adopt sedentary lifestyles. The paradigm shift in treatment for PwH toward prophylaxis with extended half-life factor concentrates and non-factor replacement therapy has substantially reduced joint bleeding and deterioration, allowing PwH to lead more active lives with improved protection against bleeds. This has led to increased recognition of the importance of regular PA for musculoskeletal strength, joint and cardiovascular health, quality of life, and social/psychological well-being among PwH. Nonetheless, hesitation regarding risks of PA for PwH persists, and key clinical questions including haemostatic protection for safe participation in PA remain largely unanswered. This narrative review summarises the considerations for PA in PwH and its role in haemophilia management with associated recommendations from key organisations, focusing on shared decision-making and individualised treatment planning. Key strategies to increase PA among PwH include promoting sustained behavioural change and potential use of wearable activity trackers. Higher haemostatic potential is consistently associated with protection against PA-related bleeds. An increasing evidence base indicates that both factor and non-factor therapies can safely enhance physical function and support greater PA, although additional evidence is needed for novel and emerging treatments. Further research is needed to help clinicians individualise prophylaxis regimens in a holistic manner that includes consideration of PA. Recommendations for PA in PwH must continue to progress alongside the evolving therapeutic landscape.