Staying active: Stay physically fit and learn to assess the risks and benefits of activities

Important tips from the National Hemophilia Foundation

Keeping fit

Physical activity is good for everyone. Sports and exercise involve friendship, teamwork, and competition and can help develop independence and self-confidence. For people with hemophilia, physical fitness is especially important, because well-developed muscles provide better joint support and better protection from the wear and tear of daily living. Regular exercise has even been shown to decrease the number of spontaneous bleeds (bleeds that are not caused by injury).

Some benefits of physical fitness

Thinking ahead

Before engaging in sport- or exercise-related activity, it's important to consider a preventive regimen (infusing factor before an activity that might cause a bleed). Preventive treatment may:

• Help avoid a bleed and the pain, swelling, and on-demand therapy (therapy after a bleed begins) that may be required
• Provide the ability to participate in more activities

Ask a health care provider about preventive treatment. If a doctor has recommended preventive treatment, it's important to follow his or her recommendations.

Choosing well

Armed with the right knowledge, people with hemophilia can enjoy the many benefits of sports and exercise. Here are some things to consider when choosing a sport or physical fitness activity:

• Current level of physical fitness
• Past bleeding history, especially with joint bleeds (for example, a person who has had recurrent ankle bleeds probably should not take up jogging, but swimming could be a great alternative)
• Timing—the best time to engage in physical activity is soon after an infusion, when factor level is high

NATIONAL HEMOPHILIA FOUNDATION SPORTS RATINGS BY ACTIVITY

Safe [1]
aquatics archery elliptical machine	fishing Frisbee® disc tossing golf	hiking snorkeling stationary bike	swimming tai chi walking

Safe-Moderate [1.5]
biking body sculpting circuit training	Frisbee® disc golf Pilates physioball	rowing machine ski machine spinning	treadmill weight lifting (resistance training)

Moderate [2]
aerobics bowling cardio kickboxing dance	diving (recreational) jumping rope rock climbing (indoor) roller skating	rowing/crew running/jogging skiing (cross-country) stepper	T-ball tennis ultimate Frisbee® yoga

Moderate-Dangerous [2.5]
baseball basketball canoeing cheerleading gymnastics horseback riding ice skating	inline skating Jet Ski® karate kayaking kung fu mountain biking racquetball	river rafting scooter (nonmotorized) scuba diving skateboarding skiing (downhill) skiing (telemark)	snowboarding soccer softball surfing track and field volleyball waterskiing

Dangerous [3]
BMX racing boxing diving (competitive) football hockey (field, ice, street)	lacrosse motorcycling / motor cross racing power lifting	rock climbing (natural setting) rodeo rugby scooter (motorized)	snowmobiling trampoline weight lifting (power lifting) wrestling

The National Hemophilia Foundation does not recommend any sports activities rated 3 for people with bleeding disorders.

Frisbee is a registered trademark of Wham-O, Inc.
Jet Ski is a registered trademark of Kawasaki Heavy Industries, Ltd.
Chart adapted from Playing it Safe: Bleeding Disorders, Sports and Exercise, courtesy of the National Hemophilia Foundation.

Download a pdf of this chart.

For people with hemophilia, it's important to be safe during sports and exercise. Some activities may not be appropriate for some people. Consult with your Hemophilia Treatment Center (HTC) or a health care provider before beginning a sports- or exercise-related activity.

Being sensible

It's important to be aware of common-sense limitations when playing sports or exercising. For example:

• Engage in low-impact sports and activities for a lower risk of injury
• Avoid activities that might put stress on a joint that seems to bleed more often than others
• Listen to your body and stop if it gets tired or does not feel right

People with hemophilia are advised to do some conditioning, or training, before playing sports or starting a fitness regimen. This could include stretching for flexibility, weight training for strength, aerobic training for endurance, and practicing skills that are specific to the sport or activity. Taking it slow at the beginning is important to minimize injury. It's also a good idea to warm up before physical activity and cool down afterward.

Finally, knowing the early signs of a bleed is critical, because delaying treatment can make a bleed worse—which could lead to permanent damage. Any injury received during sports or exercise must be evaluated and treated by an HTC.

A few words for parents

Children of all ages get a lot out of sports and exercise. Early on, it's critical to a child's development to run, jump, climb, and play. Once school starts, children build strength, endurance, and agility through sports and exercise, not to mention learning teamwork, self-esteem, and how to win and lose. For children with hemophilia, it's often the fears of adults (parents and school personnel) that get in the way.

While frequent bruising is part of life for any child with hemophilia, he or she may still participate in sports and exercise. Here are some tips for parents:

• Don't let your fear of injury stop your child from being active
• Talk about risks and precautions with your child
• Use appropriate safety equipment
• Communicate with school personnel and coaches

If an injury does occur, it should be treated correctly and at once. Meet with the appropriate school staff to ensure there is a plan in place in the event that your child is injured or has a bleed.

Talk with the physical therapist at a local treatment center about an exercise program that meets your child's needs. With an appropriate exercise program, many chronic posture problems that occur in people with hemophilia can be avoided. By maintaining mobile joints and strong, flexible muscles, most people with hemophilia should be able to continue with regular daily activities at home, school, and work.