PHYSICAL ACTIVITY, EXERCISE AND SPORTS
In the past people with haemophilia had to be extremely cautious. Thinking about doing sports was absolutely out of question! Today thanks to effective new treatment possibilities the situation has changed. Prevention of bleeds with the help of prophylaxis (regular infusion of coagulation factor concentrate) reduces the risk of bleeding and allows people with haemophilia to participate in physical activities considered dangerous before. Also for people with haemophilia who have inhibitors the currently available treatment possibilities, such as prophylaxis with bypassing agents, allow safe involvement in physical activities, exercise and even sports.
Today physical activities of the right selection and intensity are highly recommended!
What is the difference between physical activity, exercise and sports?
The terms physical activity, exercise and sports are often used interchangeably. However, they are different in some ways.
Physical activity – can be defined as any activity that involves some form of physical exertion and voluntary movements that burn calories. Such an activity causes a person’s body to work harder than normal. Examples of physical activity range from gardening, dancing, walking the dog, shoveling snow or raking leaves.
Exercise – also involves physical exertion, voluntary movements and burning calories. This form of physical activity, however, is specifically planned, structured and repetitive. It does not usually involve any kind of competition. Examples of exercise include jogging, cross-country skiing, recreational swimming, cycling and aerobics.
Sports – involve physical activity and exercise but differ in that they also have a set of rules, or goals to train and excel in specific athletic skills. Some are individual sports such as golf and swimming. Others are played in teams – for example, football and hockey. Sports are often, but not always, competitive.
Exercise should be started as early in life as possible and continued into the adulthood. It should become a good habit and a rule for healthy living.
In the case of hemophilia, the physical activity and exercise does not only has beneficial effects on the body in general, but also seems to reduce the incidence of bleeding in the muscles and joints. It is important to understand the benefits of physical activity, exercise and sports for keeping the joints in good condition:
- Help to develop strong and coordinated musculature which protects joints from pressure and trauma, thus reducing joint bleeding;
- Keep joints mobile through movements with a large range of motion, which promotes lubrication of the cartilage and fights stiffness;
- Improve balance, coordination, and reflexes, helping to reduce accidents which cause bleeding, e.g. sprains;
- Provide basic development of one’s body image and its location in space, thus creating better knowledge and positioning of the body which prevents a great many joint injuries and gives children a better grasp of their limits;
- Prevent sedentary lifestyle and reduce the risk of being overweight – a sworn enemy of joints!
One thing is for sure – the benefits of a physical activity for people with hemophilia outweigh the risks!
HOW MUCH ACTIVITY?
According to the recommendations from World Health Organization the level of physical activity for:
– children aged 5-17 should be at least 60 minutes daily,
– adults aged 18-64 and above should be at least 150 minutes daily.
This recommendation can be used for people with hemophilia who have inhibitors as well. However, it is essential to plan the activities individually and if possible consult a physiotherapist before engaging into specific exercises or sports.
WHAT KIND OF ACTIVITY?
The choice of a physical activity, exercise or sport for the person with haemophilia who has inhibitors depends on each individual and the circumstances they are living in. Above all, the physical activity should include the pleasure of participation for the child/adult with inhibitor, yet the common sense should prevail for participation in some high-risk sports and a physiotherapist should be consulted in case of doubt.
With careful consideration, reflection and trial an appropriate physical activity, exercise or sport benefiting each person with haemophilia who has inhibitors can be found.
It has to be taken into account that the classifications of sports in which haemophiliacs can partake generally consider only the level of risk, ignoring practical realities and failing to distinguish between physical activity in adults and children. These classifications are often too simplistic, leading to excessive prohibition of sports. In most physical activities, there needs to be a distinction between a leisure activity and a competitive activity.
In order to chose appropriate activity the condition and lifestyle if the individual should be considered, together with the specifics of each activity, e.g. which joints are affected and which muscles exercised, as well as the time it consumes, accessibility, equipment etc.
Here you can find a simple guide to some of the activities.
However, the following elements should be highlighted as they carry increased risk:
Contact sports – such as rugby, football, handball, are riskier than sports where contact is unintentional.
Repetitive motion and extremes of motion – Activities that use the joint at the limits of their range of motion can pinch the synovium and start a bleed. Examples are racquet sports, where the elbow may be hyperextended many times, and running and jumping where the ankle is repeatedly dorsiflexed (foot towards shin).
Speed – Motorized sports like snowmobiling and dirt biking carry a greater risk of injury than regular biking because of their speed.
Force of impact – Football and boxing, for example, are extremely risky, even to people without a bleeding disorder, because of the high force of impact and the fact that impact is frequent and deliberate.
Height – The more height involved, such as in downhill skiing, snowboarding and hang gliding, the greater the risk of serious injury.
Unpredictable conditions – Waves in water skiing, and icy surfaces when downhill skiing, are examples of how unpredictable conditions can affect the degree of risk. Players’ movements in team sports are also unpredictable and lead to collisions.
Sports must therefore be considered individually taking into account the desired effect, the way it is played, the intensity of the training, the stresses on the joints, the age, and above all, the condition of the person’s joints.
For further information, you can consult the following resources online:
- A publication “Destination Fitness” from Canadian Haemophilia Society;
- PLEASE FIND SOME MORE!
- “Destination Fitness”, CHS
- “Sport&Hemophilie”, Lobet S., PhD, PT and Van Damme A, Journal de la Société Belge de Pédiatrie-sport et Hémophilie-sport