Averaged across one week, 43% of all children met the Australian government physical activity guidelines for children and 36% met the guidelines for small-screen time. This study provides the first data regarding leisure-time physical activity in children with haemophilia living in Australia. The majority of Australian

children with haemophilia are not meeting the national physical activity and small-screen time guidelines. In the past, children with haemophilia were often restricted in their sports participation compared with their healthy peers. This resulted in lower levels of fitness and a tendency to being overweight [1-4]. In developing countries without widespread access to prophylaxis, sports participation levels in children with haemophilia remain low [5]. However, in countries where prophylaxis is readily available, participation in vigorous physical activity is often buy PXD101 Daporinad supplier comparable to that

of healthy peers [6-10]. Advice given to children with haemophilia regarding physical activity can differ greatly, even within the same treatment centre. The importance of physical activity in childhood and adolescence has long been recognized for its role in cardiovascular health, skeletal integrity and prevention of obesity and metabolic disease [11-14]. The current Australian government guidelines for physical activity and small-screen time in children state that all children should be engaged in at least 60 min of moderate MCE to vigorous physical activity and no more than 2 h of small-screen time per day [15]. The particular importance of physical activity in children with haemophilia is highlighted by a number of studies which have demonstrated impairments in skeletal health, fitness and body mass index, presumably as a result of restrictions in physical activity [1-5, 16]. Of course, the benefits of physical activity in children with haemophilia must be balanced against the possible risks, particularly the risk of bleeding into joints. Fear regarding the risk of participation

in physical activity, particularly vigorous physical activity persists. A study in the United States surveyed 110 youths with haemophilia regarding their knowledge, attitudes and behaviours. In this group, 60% reported avoiding or limiting physical activity to manage their haemophilia [17]. Early studies revealed that children with haemophilia had reduced aerobic and anaerobic fitness and strength when compared with their healthy peers [1, 2, 18]. A tendency to being overweight and obese has also been reported in children and adolescents with haemophilia [3, 19]. With the exception of a study by Engelbert et al. in the Netherlands which revealed slightly reduced aerobic capacity (z scores of −0.4 to −0.8), recent studies performed in countries with widespread availability of prophylactic clotting factor have revealed comparable fitness, strength and body mass index (BMI) in children with haemophilia when compared with their healthy peers [3, 20, 21].