Patients with severe hemophilia can perform strength training to failure without increasing their fear of movement and without adverse effects, according to research published in the Journal of Clinical Medicine.

About 80% of people with hemophilia have bleeds in the musculoskeletal system, and patients are at risk of joint degeneration. In addition to prophylactic treatment, patients with hemophilia can benefit from low to moderate strength training.

The study authors aimed to determine the neuromuscular response, fear of movement, and potential adverse effects of performing resisted knee extensions to task failure in patients with hemophilia.

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The study included 12 patients with a mean age of 38.4. The authors used the Hemophilia Joint Health Score 2.1 (HJHS) to assess joint health. Fear of movement was assessed using the Tampa Scale for Kinesiophobia questionnaire. The authors measured the normalized values of amplitude (nRMS) and neuromuscular fatigue during exercise with surface electromyography (EMG).

Participants performed knee extensions ranging from light intensity to moderate intensity until task failure. Overall, patients were able to perform the exercises to failure without increasing pain, kinesiophobia, or adverse effects. Participants’ fear of movement improved when they performed the task to failure.

The authors note that patients could also exercise a few repetitions short of failure and still increase muscle strength and hypertrophy. Patients reached neuromuscular fatigue at moderate intensity, but at different levels for different muscles.

Patients reached the vastus lateralis (VL) maximum nRMS at about 7 repetitions before task failure. The vastus medialis (VM) and rectus femoris (RF) reached maximum nRMS in the study at about 15 repetitions short of task failure.

Patients did not self-report any adverse effects during the study, but it’s possible that subclinical bleeding may have occurred but not been measured.

The study results suggest that with prophylactic treatment, patients with severe hemophilia can safely perform knee extensions of moderate intensity.


Calatayud J, Martín-Cuesta J, Carrasco JJ, et al. Safety, fear and neuromuscular responses after a resisted knee extension performed to failure in patients with severe haemophilia. J Clin Med. 2021;10(12):2587. doi:10.3390/jcm10122587