Physical Activity and Exercise for Hemophilia

About hemophilia

Hemophilia is an inherited X-linked recessive bleeding disorder, caused by a deficiency in coagulation factor VIII (hemophilia A), factor IX (hemophilia B), or factor XI (hemophilia C), that results from mutations in the clotting factor genes; it mainly affects males (hemophilia A and B, the two most common forms of this disease) and can be mild, moderate, or severe.

Physical Activity and Exercise for Hemophilia

Until the mid-1970s, hemophilia patients were advised to refrain from exercising due to a perceived risk of bleeding. But the consequences of physical inactivity, like obesity and bone density loss, were found to be more harmful than exercise. Today, physical activity is recognized as being essential for good health and health maintenance in people with hemophilia.

In its Guidelines for the Management of Hemophilia, the World Federation of Hemophilia recommends that physical activity be encouraged to promote fitness and neuromuscular health, with special attention paid to muscle strengthening, coordination, general fitness, body weight, and self-esteem.

For patients with significant muscle and bone weakness or problems, weight-bearing exercises that promote the development and maintenance of healthy bone density are encouraged (to the extent their joint health permits). Choice of activities should reflect an individual’s interests, ability, and resources. Non-contact sports, like swimming, are recommended,  while high-contact and collision sports, like rugby or football, are to be avoided. The guidelines also stress that patients should consult with a muscle and bone specialist before engaging in physical activities, discussing  whether a particular planned exercise or activity is appropriate, protective gear that might need to be used, needed prophylaxis (treatment factor and other measures), potential target joints (joints susceptible to bleeds), and required physical skills. After a bleed, it is best to return to any physical activity in a gradual manner, building up to a full pre-bleed level, so as to minimize the chance of a re-bleed.

A number of studies also report that physical activity can improve the effectiveness of treatments and prevent bleeding episodes in hemophilia patients. In older patients, a lack of physical can further increase the risk of diabetes, high blood pressure, high levels of fat in the blood, obesity, and osteoporosis and related fractures, in addition to hemophilia-related complications.

According to the World Health Organization (WHO), physical inactivity is the fourth leading risk factor for mortality, accounting for 6 percent of deaths worldwide. Health problems associated with physical inactivity are more severe for patients with hemophilia than for the general population. Obesity, for instance, is linked to an increased risk of cardiovascular disease and chronic joint inflammation, which promotes bleeding in the joints and the risk of fractures. In addition, muscle and bone disorders caused by hemophilic joint inflammation and aging are risk factors for falling injuries.

Generally, the point is that a strong body helps protect a person from bleeding. Besides, the benefits of physical activity are not just physical – they’re also emotional and spiritual.

Main physical benefits

  • Strong and flexible muscles support the joints, which help prevent bleeds and joint damage
  • Feeling fit and having energy helps reduce fatigue
  • Being of a healthy weight reduces the stress placed on the joints, which is particularly important in aging bodies
  • Improved balance and coordination helps joints and muscles  work better together, which again helps protect against bleeds

Main psycho-social benefits

  • Sweating is a great outlet to help relieve stress, and relax the mind
  • Being active boosts self-esteem, confidence, and is fun for children and adults, as long as you do something you like
  • Regular exercise can promote social acceptance and provide a peer group for social interaction

Top 10 recommended activities

  1. Swimming
  2. Table Tennis
  3. Walking
  4. Fishing
  5. Dancing
  6. Badminton
  7. Sailing
  8. Golf
  9. Bowling
  10. Cycling

Top 10 activities to avoid

  1. Boxing
  2. Rugby
  3. Soccer/Football
  4. Karate
  5. Wrestling
  6. Motorcycling
  7. Judo
  8. Hang-gliding
  9. Hockey
  10. Skateboarding

Activities for older adults with hemophilia

As we age, our risk of joint damage increases. As a result, older adults may experience chronic pain and reduced mobility. However, it is still essential to remain active to help strengthen joints and muscles, maintain a healthy weight, and provide an outlet for stress or tension.

Older adults are advised to choose activities that “go easy” on the joints, such as walking, swimming, yoga, Pilates, cycling, strength exercises (weight-bearing), dancing, or bowling. Activities like jogging, basketball, or soccer/football are not recommended.

Preparing for physical activity

Prophylaxis (or treatments to prevent bleeding episodes) is advised before engaging in any activity with a higher risk of injury.  Preliminary replacement therapy and prophylaxis are sometimes used together, depending on the bleeding risk.

Before a physical activity, prophylactic treatment is recommended, depending on coagulation factor activity levels. Adequate levels of clotting factors are always required (above 5 percent is standard for a normal level of daily activity, and greater than 15 percent is recommended before sports). The study cited above recommends physiotherapy on the day that prophylaxis is performed. A clotting factor level of 20 to 40 percent is advised prior to physiotherapy, it notes, although it goes on to note that a recommended pre-activity/physiotherapy dose has not been reported for patients with inhibitors.

People with hemophilia are strongly recommended to consult and work closely with pediatricians and physicians regarding physical activity and to check on coagulation system test values.

Hemophilia News Today is strictly a news and information website about the disease. It does not provide medical advice, diagnosis, or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.