Effects of Remote Versus Outpatient Exercise Training on Lower Extremity Motor Function and Quality of Life in People with Hemophilia: Randomized Controlled Trial

Objective To compare the efficacy of personalized remote exercise training versus outpatient exercise training in improving joint health, motor function, and quality of life in people with hemophilia (PWH). Methods PWH patients who received rehabilitation treatment in the Department of Rehabilitation Medicine at Peking Union Medical College Hospital from August to November 2025 were selected as the study subjects and randomly divided into a remote exercise training group and an outpatient exercise training group. Both groups re- ceived rehabilitation training three times per week for eight consecutive weeks. The remote training group per- formed home-based exercises guided by a mobile application, while the outpatient group received therapist-su- pervised training in the clinic. Assessments before and after the intervention included the Hemophilia Joint Health Score version 2. 1 (HJHS 2. 1), joint Range of Motion (ROM), the European Quality of Life Five-Di- mension Scale (EQ- 5D), the Generalized Anxiety Disorder- 7 (GAD- 7), and the Patient Health Questionnaire-9 (PHQ-9) for anxiety and depression symptoms. Results A total of 17 eligible PWH were en- rolled, comprising 8 in the remote training group and 9 in the outpatient training group. Following the interven- tion, the HJHS total score improved by 18. 36%in the remote group and by 21. 00%in the outpatient group. For the most affected joint's ROM, within-group analysis showed that the outpatient group achieved statistically sig- nificant improvement in knee joint extension and flexion angles. However, no significant changes were observed in ankle dorsiflexion or plantarflexion angles in either group. In terms of quality of life, the outpatient training group showed a significant improvement in EQ- 5D-VAS scores after the 8-week intervention compared with baseline; meanwhile, the remote training group demonstrated significant improvements in both EQ- 5D- 5L and VAS scores. No statistically significant within-group or between-group differences were found for GAD- 7 and PHQ-9 scores. Conclusions Both personalized remote exercise training and outpatient exercise training signif-icantly improve joint health and quality of life in PWH. Remote exercise training, characterized by high accessi- bility and flexibility, can serve as an effective alternative for joint health management in this population.