Background: Low impact physical activity is important for patients with haemophilic arthropathies, but is often considered boring with suboptimal adherence. There is therefore a need for physical activities that motivate patient engagement. Aims: To evaluate the benefits of top rope climbing, increasingly used in other musculoskeletal disorders, as an engaging sports discipline in haemophilia. Materials/Methods: Six adult arthropathic patients with haemophilia (PWH) completed 12 sessions of tailored top rope climbing training. Functional and clinical joint status, climbing skills, quality of life (QoL), annual bleed rate (ABR) and joint findings with musculoskeletal ultrasound/power doppler (MSKUS/PD) were assessed before and after climbing. Results: Haemophilia joint health scores, dorsiflexion in arthropathic joints and climbing skills all improved. ABRs were comparable before and during climbing, and QoL remained high. MSKUS evaluation demonstrated no detrimental effects on synovial and cartilage health, with a decrease of inflammatory PD signal in some joints. Conclusion: We conclude that top rope climbing therapy (known as “Haemophilia Vertical”) can improve joint health in PWH with arthropathies. Haemophilia Vertical therefore emerges as an innovative athletic concept to promote physical activity among PWH. Further study investigating the longer-term impact in a larger cohort is warranted.