The Acute Effects of 2 Different Intensities of Resistance Exercise on Autonomic Function in Heart Failure Patients: A Randomized Controlled Trial.

BACKGROUND: Although a wide spectrum of resistance exercise intensities was recommended in the guidelines, none of them investigated the acute effects of different intensities of the resistance exercise on cardiac autonomic function in patients with chronic heart failure. This study aimed to investigate the acute effects of the low and high intensities of the resistance exercise on heart rate variability in chronic heart failure. METHODS: This randomized controlled trial was performed between October 2019 and December 2020. Fifty-seven patients with chronic heart failure (New York Heart Association class II and class III) underwent hemodynamic, functional capacity, and heart rate variability (time and frequency domains) assessments. They were randomly divided into R1, R2, and control groups. The intervention consisted of performing a short aerobic exercise including 15 minutes of walking at an intensity of 50% reserved heart rate for all 3 groups and additional resistance exercise with the intensity of 50% 1-repetition maximum and 75% 1-repetition maximum for R1 and R2 groups, respectively. RESULTS: The standard deviation of normal to normal intervals and standard deviation of average NN intervals became significantly lower in R2 (P =.031), and both high-frequency power and low-frequency power were significantly higher in R1 (P =.039 and P =.004, respectively) after the intervention. No significant changes were observed in the control group. Between-group changes were not significant for hemodynamics and functional capacity after treatment. The between-group comparison demonstrated a significant increase in root mean square of successive differences of the NN intervals in R1 in comparison to the control (P =.035). CONCLUSIONS: These findings indicate that resistance exercise in 50% 1-repetition maximum in comparison to 75% 1-repetition maximum had more favorable effects on the heart rate variability in chronic heart failure.

Validation study of the Persian version of the subjective exercise experiences scale (SEES) in Iranian adult individuals.

BACKGROUND: Subjective exercise experiences scale (SEES) is a 12-item questionnaire assessing global psychological responses to exercise, with three constructs including positive well-Being (PWB), psychological distress (PD), and fatigue (FAT). The present study aimed to assess the reliability and validity of the SEES questionnaire in the Iranian population. METHOD: This cross-sectional psychometric study was conducted on 138 adults immediately after 30 min of walking. The internal consistency of the questionnaire was evaluated with Cronbach's alpha coefficient. To assess the test-retest reliability, 38 of the participants were requested to fill in the questionnaire again after a week. The test-retest reliability was analyzed using the intra-class correlation coefficient (ICC). The concurrent validity was examined through the correlation matrix between the domains of SEES and SF12. Principle component analysis was performed to determine the factor loading of the measured variables. IBM SPSS statistics 24 was used for all calculations. RESULTS: Cronbach's alpha was 0.82, 0.82, and 0.81 for the PWB, PD, and FAT, respectively. The ICC value was acceptable for all subscales (ICC for PWB, PD, and FAT were 0.83, 0.88, and 0.74 respectively). There was a weak to moderate correlation between the SEES and SF-12 subclasses. Factor analysis confirmed the three-factor structure of the instrument, explaining 67.21% of the observed variance. Item 3 didn't fit in well with the three constructs and was deleted from the Persian version of the SEES. CONCLUSIONS: The Persian version of the SEES is a valid and reliable instrument to evaluate the psychological response to the exercise stimulus.

Muscle thickness and pennation angle in overweight persons with moderate haemophilia A after resistance and combined training: A randomized controlled trial.

INTRODUCTION: Muscular atrophy and overweightness develop arthropathy in persons with haemophilia (PWH), and exercise increases their muscle strength and decreases their body weight. Musculoskeletal ultrasonography may be a non-invasive, safe, valid, and reliable tool to investigate muscle thickness (MT) and pennation angle (PA) after exercise training. OBJECTIVES: The present study was conducted to evaluate the effects of 6 weeks of resistance training (RT) and combined resistance and aerobic training (CT) on MT and PA in overweight persons with moderate haemophilia A. MATERIALS AND METHODS: Forty-two persons with moderate haemophilia A with a mean age of 35-55 years and a BMI of 25-30 kg/m2 were randomly assigned to three groups of 14, namely RT, CT, and control. The RT group performed 40 minutes of RT, and the CT group performed 20 min of RT and 20 min of aerobic training. The PA and MT of the biceps brachii (BB), triceps brachii (TB), vastus medialis (VM), vastus lateralis (VL), and medial gastrocnemius (MG) were measured before and after the intervention using B-mode ultrasonography. RESULTS: Significant increases were observed in the MT of VM, VL, MG, BB, and TB and PA of VM, VL, and MG in the RT and CT groups compared to the control group (p < .001). No significant differences were observed between the intervention groups. CONCLUSION: Both RT and CT were effective in enhancing MT and PA in overweight persons with moderate haemophilia A.

Regenerative Effect of Low-Intensity Pulsed Ultrasound and Platelet-Rich Plasma on the Joint Friction and Biomechanical Properties of Cartilage: A Non-traumatic Osteoarthritis Model in the Guinea Pig.

This study was aimed at investigating the effects of platelet-rich plasma (PRP) and low-intensity pulsed ultrasound (LIPUS) on the joint friction parameters and biomechanical properties of articular cartilage in a non-traumatic knee osteoarthritis (OA) model. Fifty adult male Dunkin Hartley guinea pigs were randomly divided into five groups: control, OA60, OA + US, OA + PRP and OA + US + PRP). Non-traumatic knee OA was induced with a single dose of 3 mg of mono-iodoacetate (MIA) by intra-articular injection. Intra-articular PRP was injected twice in the OA + PRP and OA + US + PRP groups. LIPUS was delivered in 10 sessions in the OA + US and OA + US + PRP groups. By use of the pendulum free oscillation test, joint friction (coefficient of friction) was measured. In addition, the instantaneous elastic modulus and aggregate modulus were measured using the stress-relaxation test. MIA injection decreased cartilage thickness, instantaneous elastic modulus and aggregate modulus, and increased joint friction. The friction coefficients in the OA + US and OA + US + PRP groups reached near-normal values, and there was no significant difference compared with the control group (p = 0.232 and p = 0.459, respectively). The instantaneous elastic modulus and aggregate modulus in the OA + US group increased significantly compared with the OA + PRP group (p < 0.05). It seems that both LIPUS and PRP injection effectively improved joint lubrication, but LIPUS was superior to PRP in improving the mechanical properties of the articular cartilage.

Effects of resistance added on aerobic training on autonomic function in cardiac patients.

OBJECTIVE: Autonomic imbalance in patients with chronic heart failure (CHF) and cardiovascular diseases (CVD) is characterized by reduced parasympathetic and enhanced sympathetic activity. Aerobic exercise improves autonomic function in patients with CHF and CVD. However, little is known about the effects of resistance training (RT) on cardiac autonomic function. Therefore, we aimed to investigate the effects of RT added on aerobic training on autonomic function in patients with CHF and CVD. DATA SOURCES: The relevant clinical trials were searched in PubMed, Physiotherapy evidence Database (PEDro, Science Direct and Google Scholar databases using the following keywords, "resistance or strength training", "chronic heart failure", "coronary artery disease", "myocardial infarction", "hypertension", "cardiovascular disease", "heart rate variability (HRV)", "heart rate recovery (HRR)", "muscle sympathetic nerve activity (MSNA)", and "autonomic function". DATA SYNTHESIS: Twelve articles with 323 subjects were eligible to be evaluated. The outcome measures included HRV, HRR, and MSNA. There were seven studies on CHF, two on CAD, and three studies on hypertension. Meta-analysis of all the studies showed that combined RT and aerobic training decreased MSNA significantly in patients with CHF and CAD (mean difference: -3.796; CI: -6.779 to 0.813; p=0.013; I2 =93.5%). No study evaluated the effects of RT or combined training on HRR. CONCLUSION: We could not find sufficient data about the effects of RT alone on HRV and HRR, but the results showed that combined RT and aerobic training improved MSNA in patients with CHF and CAD, significantly. Further studies with similar methodological principles on the same patient population are needed.

The Effects of a 2-W Laser on the Nasolabial Fold of Ageing Individuals Investigated by High-Frequency Ultrasonography: A Nonrandomized Controlled Trial.

Introduction: Biomechanical qualities of the skin tissue change following numerous pathological and natural (ageing) conditions. The best skin treatments are those resulting in a positive outcome with the fewest adverse effects. In this study, high-frequency ultrasonography (US), which provides a quantifiable scale, was utilized to evaluate the impact of a 2-W laser on characteristics of nasolabial fold (NLF) including depth and area, epidermis and dermis thicknesses, and Young's modulus (YM). Methods: Nine female subjects (54.09±0.09 years old) with Fitzpatrick skin types III-IV and five young control participants (26±1.28 years old) for providing the control data were included in this study. Laser therapy was applied twice weekly for seven consecutive sessions. A class IV laser with 810-nm and 980-nm wavelengths, 2-W power, and 25-Hz frequency was applied twice a week for seven consecutive sessions. The energy administered had a density of 8 J/cm2. An evaluation using high-frequency ultrasound (40 MHz) was accomplished before and 48 hours after the final treatment session. The Face-Q questionnaire was used to assess the patient's perspective on this procedure. Results: For each US parameter, the intraclass correlation coefficient was high (ICC>0.9). After the laser treatment, NLF depth, area, epidermis, dermis, YM, and Face-Q significantly improved compared to baseline (P<0.05). Conclusion: For the assessment of skin tissue, high-frequency US is a reliable technique. The 2-W laser is a safe, effective, and non-invasive procedure for enhancing skin features.

Comparison of low level and high power laser combined with kinesiology taping on shoulder function and musculoskeletal sonography parameters in subacromial impingement syndrome: a Randomized placebo-controlled trial.

BACKGROUND: Subacromial impingement syndrome (SAIS) is a common cause of shoulder pain. The effects of physiotherapy modalities including low-level laser (LLL) and high power laser (HPL) on the SAIS have mostly been evaluated by the subjective outcome variables accompanied with the controversial findings and none of them has compared a combination of these two modalities, yet. OBJECTIVES: The present study was conducted to evaluate the effects of low-level laser (LLL) and high power laser (HPL) combined with kinesiology taping (KT), on the pain, function, and musculoskeletal ultrasound (MSKUS) parameters in the SAIS. METHODS: Thirty patients with SAIS were randomly divided into the LLL-KT, HPL-KT, and sham-KT groups, respectively. Patients received seven treatment sessions. Visual analogue scale (VAS), shoulder pain and disability index (SPADI), MSKUS parameters were measured before and 48 hours after the treatment cessation. RESULTS: Pain intensity significantly reduced in the LLL-KT (-2.43 (0.97)), HPL-KT (-3.43 (1.99)), and sham-KT (-2.43 (1.62)) (P < .01). All the SPADI subscales are significantly reduced in all the groups (P < .05), except for the pain in the sham-KT (P = .06). Significant improvements were only observed in the diameters of biceps (P < .05), supraspinatus tendon thickness in short and long axes (P < .05), occupation ratio (P = .004), and echogenicity (P = .03) in the HPL-KT. Although the acromiohumoral distance (AHD) significantly increased in all the groups including the sham-KT (P < .01), supraspinatus tendon thickness significantly decreased (P < .05), and echogenicity increased (P = .003) just in the HPL-KT. CONCLUSIONS: Kinesiology taping method alone is an effective intervention. Nevertheless, adding the analgesic and anti-inflammatory effects of both LLL and HPL to KT seems to result in better improvement of the pain, function, and MSKUS parameters in the SAIS. Findings of this study suggested that the HPL is more beneficial than the LLL or KT alone for management of the patients with SAIS.

An efficient and effective ambulatory service model for severe hemophilia-A patients; an introduction to a novel home care model.

INTRODUCTION: Hemophilia A (HA) is an inherited deficiency in blood coagulation factors. Starting the treatment based merely on patients' hemorrhage feelings results in more than 63.6% mistakes in joint bleeding diagnosis. This study aimed to design a useful ambulatory service model for Patients With Severe Hemophilia A (PWSHA). METHODS: This study was done in 3 steps. In step-I, the current service model to PWSHA in Tehran was evaluated. In step II, an ambulatory service model was proposed according to the existed gaps and their requirement. In step III, the model's acceptability was assessed from the perspective of clinicians, PWSHA, and healthcare policymakers. RESULTS: There were 1660 PWSHA in Tehran in 2018. The average use of Factor VIII (FVIII) was 44814 IU in Iran. The yearly budget of FVIII in Tehran was 10,627,320 US$ in 2018. We proposed a home care model with five care centers in Tehran. Ten caregivers and three hematologists for each care center were suggested to cover all services per day. The extracted data indicated that the total service demand would be 39 for each center per day. The results of the questionnaires in all groups were supportive and cooperative. CONCLUSION: The current service delivery model to PWSHA has significant economic and clinical defects. Implementing our model can significantly improve the efficiency of bleeding management in PWSHA. Most of the PWSHA, healthcare managers, and clinicians were satisfied with the proposed model.

Immediate effects of footwear with vibration applied to the swing phase of the gait cycle on dynamic balance in patients with diabetic peripheral neuropathy.

Sensory and sub-sensory foot vibration have beneficial effects on the static and dynamic balance of patients with diabetic peripheral neuropathy (DPN). Previous foot vibration during walking was applied at sub-sensory threshold in both stance and swing phases of the gait cycle in DPN. This study aimed to investigate the effects of footwear with vibration above the sensory threshold applied to the swing phase of the gait cycle on the dynamic balance of DPN. Fifteen patients with DPN and 10 matched healthy control participants were enrolled in this study. Dynamic balance assessment was investigated by the sit to stand and turn tests while electromyography activity (root mean square, RMS) of the vastus lateralis (VL), tibialis anterior (TA), and peroneus longus (PL) muscles were recorded at baseline, after 10 min of wearing the vibratory sandal without vibration, and after 10 min of wearing the sandal with vibration. Repeated measure analysis of variance was conducted for data analysis. Wearing the vibratory sandal slightly increased the speed of weight transfer in both groups and COP sway in DPN (P > 0.05), and close to significant decrease of turn sway (P = 0.07) in both groups. There were significant differences of the PL RMS in turn test (P = 0.03) in DPN and peak RMS of the PL after 10 min of wearing the sandal with vibration in both groups (P < 0.05). The results of the present study demonstrated that PL activity was significantly influenced by the vibratory sandal as its tendon passing across the sole and in direct contact with the source of the vibration.

Effects of short-term aerobic, resistance and combined exercises on the lipid profiles and quality of life in overweight individuals with moderate hemophilia A: A randomized controlled trial.

Background: Overweight is related to increased risks of cardiovascular diseases and dyslipidemia, and reduced quality of life (QOL). Exercise training improves QOL and modifies cardiovascular risk factors and lipid profile. The present study was conducted to compare three types of exercise in terms of their short term effects on QOL and lipid profile in overweight individuals with moderate hemophilia A (IWMHA). Methods: This study was a randomized, controlled, assessor-blinded trial (IRCT20180128038541N1). Sixty IWMHA with a body mass index (BMI) of 25-30 kg/ m2 and a mean age of 35-55 years were randomly assigned to four groups of 15, namely aerobic training (AT), resistance training (RT), combined training (CT) and control. The intervention groups participated in 45-minute exercises three days a week for six weeks. The 36-item short-form health survey (SF-36) was used to measure QOL. Total cholesterol (TC), triglycerides (TG), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), waist-to-hip ratio (WHR), and waist circumference (WC) were measured before and after six weeks of training. For the data analysis using SPSS version 20, the ANCOVA was used to determine the differences among the four groups. Results: A significant decrease was observed in the intervention groups compared to the control group in terms of weight, BMI, LDL-C, TC, WHR, and WC (p<0.05). Significant increase was observed in HDL-C and SF-36 subscales in the intervention groups compared to the control group (p<0.001). There was no significant difference among the intervention groups (p>0.05). In comparison with the control group, more significant improvement was observed in the TC, TG, LDL-C, HDL-L, and SF-36 subscales in the CT group compared to the RT and AT groups. Conclusion: CT was the most effective training method in improving lipid profile and QOL in overweight IWMHA.

Health status and quality of life in patients with severe hemophilia A: A cross-sectional survey.

Among different groups of hemophiliacs, those suffering from Severe Hemophilia A (SHA) are most vulnerable to the complications of the disease. This study investigated the Health-Related Quality of Life (HR-QoL) among adult patients with SHA. A cross-sectional study was designed to gather demographic and clinical information from adult patients with SHA. Patients with inhibitors were excluded. The remaining were asked to complete the HR-QoL questionnaire after being examined for joint health using the Hemophilia Joint Health Score (HJHS). The HR-QoL and joint conditions were measured in 38 patients. The mean EQ-5D value scores were 0.46 (SD=0.23) while the mean Visual Analogous Scale score was 50 (SD=18.7). The clinical examination of patients indicated that the HJHS were as follows: eight patients had a score of 55-75, 12 patients had a score of 40-55, 7 of them (25-40) and 11 patients had a score of 10-25. The results obtained from this study showed that HRQoL in hemophilia patients was considerably low. Pain, anxiety/depression, and motion limitations were the main causes of the disutility for these patients respectively.

Correction to: "Comparative repair capacity of knee osteochondral defects using regenerated silk fiber scaffolds and fibrin glue with/without autologous chondrocyes during 36 weeks in rabbit model.

The published online of the original version contains mistakes.

The effects of six-week resistance, aerobic and combined exercises on the pro-inflammatory and anti-inflammatory markers in overweight patients with moderate haemophilia A: A randomized controlled trial.

INTRODUCTION: Overweight increases the secretion of pro-inflammatory cytokines and serves as a major risk factor for arthropathy and cardiovascular diseases (CVD). This condition is becoming increasingly prevalent among patients with haemophilia (PWH). Different forms of exercise training could favourably modify weight-related complications, cardiovascular risk factors and the inflammation. AIM: To investigate the effects of resistance, aerobic and combined exercises on the pro-inflammatory and anti-inflammatory markers in overweight patients with moderate haemophilia A. METHODS: Forty-eight patients with moderate haemophilia A, aged 35-55 years, and body mass index (BMI) of 25-30 kg/m2 were randomly assigned to resistance training (RT, n = 12), aerobic (AT, n = 12), combined training (CT, n = 12) and control (n = 12) groups. The patients participated in 45-minutes exercise sessions three times a week for 6 weeks. Waist circumference (WC), waist-to-hip ratio (WHR), fat mass, fat-free mass, interleukin-10 (IL-10), adiponectin, tumour necrosis factor-α (TNF-α), interleukin-6 (IL-6) and high sensitive C-reactive protein (hs-CRP) were measured before and after the 6 weeks of training. RESULTS: There was significant decrease in WC, WHR, BMI and weight in the AT, RT and CT groups as compared to the control group. Total HJHS scores decreased in the AT, RT, CT groups compared to the control groups (P ≤ 0.001). The decrease in hs-CRP, IL-6 and TNF-α in the CT group was significant compared to the control group (P ≤ 0.02). The increase in IL-10 and adiponectin was not significant in the RT, AT and CT groups compared to the control group. CONCLUSION: CT was the most effective training mode for decreasing the pro-inflammatory cytokines and increasing anti-inflammatory markers in overweight patients with haemophilia A.

Insights into cryotherapy and joint bleeding: cryotherapy and hemophilia.

: There is some controversy over the use of cryotherapy. Low temperatures (Temp) could interfere with coagulation and increase the risk of bleeding. We sought to examine the effect of cryotherapy on joint swelling, temperature, friction, and inflammatory condition after experimental hemarthrosis. The left knee of 23 albino rabbits, 10 in heparin Ice, five in citrate Ice, four in heparin control, and four in citrate control were injected intraarticularly with 1 ml of blood. In total, four animals were considered to be in normal control group. Joint diameter, Temp, and ultrasonography were assessed before the blood injection. One day after the intraarticular blood injection, cryotherapy was applied 4 times per day for 4 consecutive days. Joint diameter and Temp were measured twice a day. After cessation of the protocol, joint diameter and Temp were assessed and sonography performed, animals euthanized, the friction test was performed and the synovial membrane collected, respectively. Joint diameter and Temp were increased after the intraarticular blood injection. Cryotherapy was capable of reducing the swelling and Temp. Ultrasonography findings approved the positive effect of cryotherapy on joint swelling. The proinflammatory tumor necrosis factor (TNF-α) reduced by cryotherapy in both cryotherapy groups but Interleukin 1ß was only reduced in heparin group. Interleukin-4 increased in heparin Ice group that was in comparison with TNF-α reduction. Cryotherapy reduced joint swelling and has a positive effect on controlling joint inflammation and Temp.

Health care resource utilization and cost of care for haemophilia A and B patients in Iran.

BACKGROUND: Despite the fact that the total therapeutic expenditure of haemophilia is paid by the national health system in Iran, a limited number of research has been performed to evaluate the economic burden of haemophilia. It is even more important when considering the fact that "prophylaxis" has never been used as the main treatment protocol in haemophiliacs in the country, causing high arthropathy rates. The aim of this study is to evaluate the cost drivers in the treatment of haemophilia A and B patients in Iran. METHODS: The national registry database of Ministry of Health (MoH) was queried to identify total number of individuals characteristics diagnosed with Factor VIII and IX deficiency. The service package defined by the department for special diseases was used as the reference for the type and frequency of health care utilization in haemophiliacs in Iran. The direct medical costs including prescription, medical intervention, inpatient, outpatient and diagnostics services and arthroplasty were considered. The prices were extracted from Iranian medical tariff book 2014-15. Medication cost was obtained from the Iranian Food and Drug Organization. RESULTS: Among 8,337 patients registered with bleeding disorders, 3,948 and 848 were identified with haemophilia A and B respectively, of whom 856 (18%) patients had inhibitor at any time in the past. In the two groups, 2,328 (59%) and 452 (53%) patients suffered from severe, 686 (17%) and 186 (22%) from moderate and 902 (23%) and 185 (22%) from mild type of haemophilia. The average annual health care cost for every patient was USD 15,130, mostly allocated to medication USD 10,180 (67%), followed by therapeutic services USD 4,775 (32%) while diagnostic services stood third USD 177 (1%). CONCLUSIONS: There is an urgent need for developing clinical practice guidelines for treatment protocols, procedures and supportive care in haemophilia management in Iran.

Comparative repair capacity of knee osteochondral defects using regenerated silk fiber scaffolds and fibrin glue with/without autologous chondrocytes during 36 weeks in rabbit model.

The reconstruction capability of osteochondral (OCD) defects using silk-based scaffolds has been demonstrated in a few studies. However, improvement in the mechanical properties of natural scaffolds is still challengeable. Here, we investigate the in vivo repair capacity of OCD defects using a novel Bombyx mori silk-based composite scaffold with great mechanical properties and porosity during 36 weeks. After evaluation of the in vivo biocompatibility and degradation rate of these scaffolds, we examined the effectiveness of these fabricated scaffolds accompanied with/without autologous chondrocytes in the repair of OCD lesions of rabbit knees after 12 and 36 weeks. Moreover, the efficiency of these scaffolds was compared with fibrin glue (FG) as a natural carrier of chondrocytes using parallel clinical, histopathological and mechanical examinations. The data on subcutaneous implantation in mice showed that the designed scaffolds have a suitable in vivo degradation rate and regenerative capacity. The repair ability of chondrocyte-seeded scaffolds was typically higher than the scaffolds alone. After 36 weeks of implantation, most parts of the defects reconstructed by chondrocytes-seeded silk scaffolds (SFC) were hyaline-like cartilage. However, spontaneous healing and filling with a scaffold alone did not eventuate in typical repair. We could not find significant differences between quantitative histopathological and mechanical data of SFC and FGC. The fabricated constructs consisting of regenerated silk fiber scaffolds and chondrocytes are safe and suitable for in vivo repair of OCD defects and promising for future clinical trial studies.

Effects of short-term resistance training and pulsed electromagnetic fields on bone metabolism and joint function in severe haemophilia A patients with osteoporosis: a randomized controlled trial.

OBJECTIVES: To assess the effects of short-term resistance training and pulsed electromagnetic fields on bone metabolism and joint function in patients with haemophilia with osteoporosis. DESIGN: A randomized, controlled, patient and blood sample assessor-blinded, six-week trial, three times weekly. SETTING: Hospital outpatients with severe haemophilia A and osteoporosis. SUBJECTS: Forty-eight patients were randomly assigned to resistance training (RT, n = 13), combined resistance training with pulsed electromagnetic fields (RTPEMF, n = 12), pulsed electromagnetic fields (PEMF, n = 11) and control (n = 12) groups. INTERVENTION: The RT group received 30-40 minutes of resistance exercises and placebo pulsed electromagnetic fields. The RTPEMF group received the same exercises with lower repetition and 30 minutes of pulsed electromagnetic fields. The PEMF group was exposed to 60 minutes of pulsed electromagnetic fields (30 Hz and 40 Gauss). MAIN MEASURES: Bone-specific alkaline phosphatase, N-terminal telopeptide of type 1 collagen, and joint function, using the modified Colorado Questionnaire, were measured before and after the programme. RESULTS: The absolute change of bone-specific alkaline phosphatase was significant in the RT and RTPEMF groups compared with the control group (25.41 ± 14.40, 15.09 ± 5.51, and -4.73 ± 2.93 U/L, respectively). The absolute changes in the total score for joint function were significant for knees, ankles, and elbows in the RT group (9.2 ± 1.38, 5.1 ± 0.5, and 3.2 ± 0.8, respectively) and the RTPEMF group (7.7 ± 1.0, 3.3 ± 0.6, and 2.5 ± 0.7, respectively) compared to the PEMF and control groups. This value was significant for knee joints in the PEMF group compared to the control group (3.4 ± 0.5 and 0.66 ± 0.4, respectively). CONCLUSIONS: Resistance training is effective for improving bone formation and joint function in severe haemophilia A patients with osteoporosis.