Physical activity is an important part of a healthy life. Participation in sports, games and exercise is a fun way to improve the quality of our lives – physically, mentally and emotionally. This does not change because you have haemophilia. In fact, physical activity may be even more important to someone with haemophilia, since it helps to develop strong bones and muscles that protect the joints from the traumas of daily living.
 
It is vital that anyone with haemophilia discuss plans for physical activity with their doctor, who is familiar with their individual situation. Only they can properly advise and recommend appropriate physical activities.

Preparation
Anyone who plans to participate in sport or to take up a new sport, should prepare thoroughly in order to maximise their chances for success. This is no different for a person with haemophilia. Depending on the severity of the condition, a physical examination may be a good idea. Evaluating a person’s joint flexibility, ligament stability, muscular strength, and overall health will give the doctor or physiotherapist a better sense of what activities it would be appropriate to recommend.

Overall conditioning, which includes muscle strengthening and stretching exercises, should always be part of the exercise routine for the active person. Exercises that are more closely related to a specific sport will help to target those muscle groups that need to be strengthened in order to minimise injuries.

It is very important that someone with haemophilia participating in sport realises that bleeding episodes may occur. If there is a suspicion that bleeding had started, either spontaneously or as a result of an injury, it must be reported and treated quickly. Numerous bleeds occurring as a result of a sport may mean the end of participation, or the doctor may decide that prophylactic infusion of factor concentrate beforehand is an acceptable alternative.

Safe and Recommended Activities for People with Haemophilia
Golf   
Swimming   
Walking
Archery
Sailing
Tennis
Cycling
Fishing
Frisbee
Hiking
Tai Chi

Excellent musculoskeletal strengthening and cardiovascular conditioning. Non-competitive swimming creates little or no stress to joints.

Not Recommended – risks outweigh benefits for people with haemophilia
GAA 
Martial Arts    
Boxing       
Squash
Motorcycling       
Water-skiing
Hockey            
Wrestling
Rugby
Soccer
Hurling           
Ice Hockey
Skateboarding

If you are considering some of the following sports, please read our tips.

Athletics
Helps develop strong muscles, which protect joints. Good if care is taken only in selection of activity.

Basketball and Netball   
Individual skills such as dribbling and shooting can be enjoyed without contact. Proper basketball shoes, knee pads and wrist supports should be worn. 

Cycling   
Can start at a very young age and continue through to adulthood. A helmet must be worn.

Jogging   
Excellent cardiovascular conditioning. Softer surfaces are easier on joints.

Roller Skating / Blading    
Protective equipment such as helmet, knee pads, elbow pads, and wrist pads should be word at all times.

Tennis, Badminton   
Improves upper and lower body strength, good cardiovascular conditioning

Ten Pin Bowling    
Probably should not start too young, when upper body is still developing

Volleyball    
Risk of bruising of the hands, wrists, and forearms as a result of repeatedly hitting the ball increases as level of competition rises.


Warming Up / Stretching / Cooling Down
Guidelines for warming up and stretching before, and cooling down after, taking part in sport are the same for everybody. Most people don’t take the time to do these things properly and, as a result, injuries often happen. This is a serious consideration for a person with haemophilia, since injury prevention is imperative.

Warming Up
Warming up the muscles for an activity usually consists of performing the activity at a much lower level of intensity for a period of at least 5 to 10 minutes. This targets the specific muscles to be used.

Stretching
Following the warm up, you should stretch for at least 5 to 10 minutes, using whole – body stretching as well as concentrating on the major muscle groups you will be using; shoulders and back for swimming; calf, quadriceps and hamstrings for running and so on. Hold each stretch for at least 20 seconds and don’t bounce. For specific sports-related stretching exercises, see your doctor or physiotherapist.

Cooling Down
Cool down the muscle after sport in much the same manner as you warmed them up – by doing the activity at a greatly reduced level of intensity for a period of at least 5 to 10 minutes. You should then repeat the stretches as before.

What Happens if a Bleed Occurs?
Bleeds that occur as the result of a sports injury must be stopped with an infusion of factor concentrate, along with the application of “R.I.C.E.” – Rest, Ice, Compression and Elevation. Minor bleeds that can be resolved with a single infusion usually do not require much recuperation or rehabilitation. However, more serious bleeds can leave joints and muscles feeling stiff and sore for long periods. In these cases, flexibility and strength need to be slowly rebuilt before the sport is resumed. Serious bleeds that require multiple infusions should be evaluated by your doctor before clearance to resume the activity can be given.

Get Moving
Most medical experts agree that people with haemophilia should be encouraged to get fit and join in activities appropriate for their age and medical condition. Because each person will respond in a unique way, the information presented here must be viewed only as general guidelines applicable to people with haemophilia. Some activates suggested here might be inappropriate for some individuals. Decisions regarding the participation of a person with haemophilia in a sport, and the level of that participation should be made in consultation with the doctor at the haemophilia centre.

[This modified article is based on the WFH publication 'Go for it']

The following activities should be discussed with your centre director:
Soccer
Hurling

 
Click here to view a presentation on Physiotherapy in Haemophilia - What's new in 2009

Click here to view the WFH publication "Exercises for People wih Haemophilia" by Kathy Mulder