Abstract
Background: low–moderate intensity strength training to failure increases strength and muscle hypertrophy in healthy people. However, no study assessed the safety and neuromuscular response of training to failure in people with severe haemophilia (PWH). The purpose of the study was to analyse neuromuscular responses, fear of movement, and possible adverse effects in PWH, after knee extensions to failure. Methods: twelve severe PWH in prophylactic treatment performed knee extensions until failure at an intensity of five on the Borg CR10 scale. Normalised values of amplitude (nRMS) and neuromuscular fatigue were determined using surface electromyography for the rectus femoris, vastus medialis, and vastus lateralis. After the exercise, participants were asked about their perceived change in fear of movement, and to report any possible adverse effects. Results: Patients reported no adverse effects or increased fear. The nRMS was maximal for all the muscles before failure, the median frequency decreased, and wavelet index increased during the repetitions. The vastus lateralis demonstrated a higher maximum nRMS threshold and earlier fatigue, albeit with a lower and more progressive overall fatigue. Conclusions: severe PWH with adequate prophylactic treatment can perform knee extensions to task failure using a moderate intensity, without increasing fear of movement, or adverse effects.
Highlights
Haemophilia is a rare bleeding disorder related to the X chromosome which is caused by the deficiency of clotting factors VIII and IX [1]
Controlled strength training is appropriate for people with haemophilia (PWH) because, up to a certain intensity, it appears to be safe; does not involve impacts or falls [9]; may decrease the frequency of pain and bleeding; and improves strength and hypertrophy, which is closely related to the ability of patients to perform the activities of daily living [10], proprioception, and bone mineral density [11]
A study that performed knee extensions at 50% of 1RM until failure in healthy and active subjects verified that the decrease in Median frequency (MF) was lower for the vastus medialis (VM) compared to the vastus lateralis (VL) and the rectus femoris (RF), regardless of sex [37]. Another previous study by Grabiner et al [38] found no difference in the quadriceps muscle MF in healthy men while performing isometric or isotonic knee extensions. Despite this and considering the increased sensitivity of the WIRW51 compared to MF to detect fatigue in the quadriceps during dynamic contractions [26,27], we believe that our results are logical and further complement the more attenuated MF response and higher Normalised values of amplitude (nRMS) threshold we found in the VL
Summary
Haemophilia is a rare bleeding disorder related to the X chromosome which is caused by the deficiency of clotting factors VIII (haemophilia A) and IX (haemophilia B) [1]. In addition to prophylactic treatment, strength training has been postulated as a valid therapeutic option for the management and prevention of repetitive hemarthrosis and for the improvement of muscle function [8]. Controlled strength training is appropriate for PWH because, up to a certain intensity, it appears to be safe; does not involve impacts or falls [9]; may decrease the frequency of pain and bleeding; and improves strength and hypertrophy, which is closely related to the ability of patients to perform the activities of daily living [10], proprioception, and bone mineral density [11]
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