Anti-Gravity Treadmill Use in an Adult with Severe Hemophilic Arthropathy: A Case Report.
Objective:
The objective of this case report was to determine the effects of anti-gravity treadmill use on walking endurance, mobility, and quality of life in an adult with severe hemophilic arthropathy and limited options for exercise.
Methods:
The participant in this case report was a 53-year-old male with a diagnosis of hemophilia A: severe, hypertension, HIV+ (undetectable viral load), obesity (BMI: 36.5) and diabetes mellitus type 2. Pre-test video analysis of gait was recorded, functional mobility and fall risk was assessed with the Timed Up and Go (TUG), aerobic capacity and endurance was measured by the 6 Minute Walk Test (6MWT), disease impairment severity was measured by the Hemophilia Joint Health Score (HJHS), participation was measured by the Functional Independence Score in Hemophilia (FISH) and the Hemophilia Activities List (HAL) and quality of life was measured by the PROMIS Global Health Score. Intervention included four sessions of walking using the AlterG® anti-gravity treadmill™ with self-selected parameters for speed and duration after body weight percentage was reduced to 40% to achieve pain free walking. Post-test measures of all outcome measures and video gait analysis were recorded.
Summary:
The participant improved in all six outcome measures post-treatment. Distance covered during the 6MWT increased by 120 meters post-treatment (44% increase), the HJHS improved 4 points (6.6%), FISH improved 5 points (17.3%), HAL improved 9 points (5.3%) and the PROMIS Global Health Score improved 14 points (30.4%). The TUG improved from 15 seconds to 13 seconds, placing our participant below the 14 second cut off for high-fall risk. He reported a preference for this intervention over other modes of exercise because upright activity-induced back spasms and ankle pain were eliminated.
Gait and posture analyses revealed improvements in cadence, speed, alignment, and step length while walking in the AlterG® compared to land walking. Duration of exercise increased each session, peak speeds were reached sooner each session, and participant's ability to assume full weight bearing during cool down was achieved sooner each session. Participant reported both short-term and long-term reduction of anxiety and depressive symptoms post-treatment (62% increase in PROMIS sub-category of mental health).
Conclusion:
The results of this case report show the potential benefits of anti-gravity aerobic exercise for adults with severe hemophilic arthropathy. Therapeutic interventions incorporating reduction in body weight while walking, such as, therapeutic pool, body-weight support harness, lowering BMI, and AlterG® could be incorporated in physical therapy intervention plans for patients with severe hemophilic arthropathy to allow aerobic fitness training while minimizing stress on joints. To conclude, anti-gravity treadmill training using the AlterG® can be a safe, effective intervention for improvement of walking endurance, mobility, and quality of life in an adult with severe hemophilic arthropathy.
