Following this model, different studies have shown that this therapy is successful. In an early cohort study - published in 2003 - we were able to demonstrate that muscle strength in PwH can be improved by sports therapy although patients are limited by haemophilic arthropathy [
42]. This study result is in accordance with other studies of different research groups and also in line with us, that a sufficient training seemed to be able to improve muscular strength also in patients in different ages and with or without obvious haemophilic arthropathy [
43‐
46]. However, most of these studies were cohort studies/case reports or studies in children and criticized, due to the fact, that this kind of studies has almost always the possible bias that the active group is more motivated, which can possibly influence the study results. For handling this critic, we initiated a randomized controlled study which has been published just recently [
47]. In this study, it could be shown that the results of the cohort studies could be clearly confirmed in adult PwH also at the highest possible study design. It is important to point out the necessity of a well-trained therapist, which has the ability to teach, control and supervise the sports therapy training. A combination of strength with coordination training is relevant and the study results demonstrate the feasibility and improvement [
47]. The major importance of strength and coordination in the context of prevention of falling is addressed by Forsyth et al. [
48], and falling and fall risks become more and more a topic in PwH [
49]. Although some studies indicate changes in flexibility, this is directly dependent on the situation of the affected joint. The outcome will be less, whether contraction is fixed, so that the best range of motion (ROM) should be maintained as good as possible. Blamey et al. have also claimed to address any ROM limitations after a bleeding episode has resolved [
50]. Sports therapy as well as physiotherapy are often helpful, but if conservative treatments fail, other treatments such as radiosynoviorthesis or joint surgery are unavoidable [
51]. However, also in the case of e.g. total knee arthroplasty the clinical outcome is influenced by the preconditions, because the outcome is lowered, e.g. in PwH, with stiff knees [
52] and hospitalization is prolonged. At least, it could also be underpinned that endurance is also enhanced after sports therapy treatment. In this direct context, just for once the musculoskeletal system doesn’t stand in the center of interest. Especially in the industrial world, PwH have the same life expectancy as people without haemophilia and, therefore, also other diseases such as metabolic and cardiovascular diseases will be more present in PwH. The reduction of metabolic and cardiovascular diseases by the improvement of endurance performance is confirmed by sufficient studies. In addition, we know that physical endurance exercise can modulate the immunological function, but it is still unclear if this is also helpful in the context of HIV and/or Hepatitis infection, which are present in some PwH. Today it is undoubted that sports therapy is helpful to reduce deficits in the motoric skills in PwH. This could be shown by measuring objective as well as subjective physical performance parameters. The latter are not unimportant because the subjective physical performance is quite different to the objective physical performance in many cases and sometimes give a better overview of the personal reflexion concerning individual physical performance [
53]. This should be taken into consideration in respect of measuring physical performance. Not only qualities of performance are influenced by sports therapy, but also the quality of life in parts could be improved by a sports therapy program, as Runkel et al. revealed, too [
54]. Many therapists agree that advising physical activity is not enough, now it is “time to prescribe” as Lobet et al. title their publication [
55]. However, one central question is how to train PwH. In cardiovascular diseases with a higher prevalence it seemed to be easier because sports therapy groups or similar therapeutic options are more common in every bigger city.
Sports therapy is helpful for PwH. However with a low prevalence, such as in Haemophilia and other rare diseases, these options are often locally not present, which necessarily leads to the development of other concepts. On the basis of these backgrounds, the concept of “Programmed Sports Therapy” has been developed during the last years.