Home-based and personalized endurance training program for patients with mild to moderate hemophilia A: What can be expected?

Introduction. - Some studies suggest that an acute exercise bout can improve the hemostatic process in patients with hemophilia A (HA). No interventional studies have been carried out to assess the influence of endurance training on this effect. We aimed (1) to determine the acceptability of a 6-week personalized endurance training program that HA patients could implement in their daily life and (2) to determine the impact of this endurance training program on endurance capacity and various factors supporting the hemostatic process. Methods. - Seventeen subjects with mild to moderate HA aged 18 to 45 years were engaged ina home-based and personalized endurance training program (eighteen training sessions, three sessions per week). For each subject, endurance capacity was assessed at inclusion duringan exhaustive exercise test coupled with gas exchanges. From this endurance assessment, a personalized interval endurance training plan was drafted and standardized to provide moderate [at the first ventilatory threshold (VT)] to high (at the second VT) metabolic intensity training. At inclusion, the hemostatic process was assessed at rest and after the exhaustive exercise bout. These same tests were repeated after the endurance training program. Results. - All 17 patients completed the endurance training program. There were no bleeding-related incidents. Endurance power was increased after the training program (maximal aerobic power: +14%, +0% to +32% for median, minimum and maximum values respectively, P = 0.003; first ventilatory threshold power: +22%, 0% to +100%, P = 0.0006; second ventilatory threshold power: +25%, 0% to +53%, P = 0.0004). In patients with mild HA, endurance training slightly increased FVIII levels when assessed after the maximal exercise bout. Conclusion. - Our results support the promotion of a personalized, standardized and home-based exercise prescription for hemophilia patients to improve their cardiorespiratory fitness without negatively influencing the coagulation process. (C) 2021 Elsevier Masson SAS. All rights reserved.