Striking a Balance- Activity Choices for People with Hemophilia

Introduction

Everyone can benefit from regular physical activity.
Activity increases muscle strength and flexibility, improves cardiovascular fitness, enhances coordination, and generally leads to increased all-around well-being.
People of all ages and levels of physical ability can participate in some form of physical activity.
Individuals with hemophilia derive the same benefits from physical activity as everyone else.

From an early age, physical activity and movement is essential for normal gross motor development.
Infants and toddlers learn and grow through physical exploration of their environment.
Balance, coordination and kinesthetic awareness emerge and develop rapidly in the pre-school years.
Very young children can be encouraged to participate in some physical activities, such as swimming.

Participating in physical activity can help enhance a positive self image and sense of physical well-being.
Self esteem and a sense of accomplishment can be enhanced.
Participating in sports allows children to interact with others, to learn rules of competition and good sportsmanship.
Physical activity can provide peer acceptance.

Regular physical activity can lead to improved cardiovascular endurance, muscle strength and muscle flexibility, balance and coordination.
Research indicates that children whose joints are supported by well-developed muscles are better able to withstand the traumas of daily living. Children with strong muscles have fewer spontaneous bleeding episodes.
Strong muscles, good balance and keen coordination all help to protect joints from injury and damage.

Before you select an activity for your child, there are many issues to consider:

What is the severity of your child’s hemophilia?
Does your child have an inhibitor?
Does your child have a target joint? Will it be exacerbated by the proposed activity?
Is your child receiving prophylaxis? Will you need to adjust the infusion schedule?
Consult with the members of your hemophilia treatment centre if you would like advice on making activity choices.

As children age, some sports become more physical and potentially dangerous. For example, soccer and basketball are often safe to play when a child is young and there is limited contact, but in adolescence these sports become quite physical and can potentially lead to serious knee and ankle injuries.
Prohibition of these sports is controversial.
One view is that early prohibition of these sports should occur, in order to avoid forced withdrawal at a later age as a result of, or in order to avoid, injury.
The other view, is that refusing permission to participate in these sports will frustrate the child, especially in adolescence, alienating him from parents and healthcare staff, and forcing him to try the activities secretly (if they do get hurt, they will not seek treatment for fear of repercussions).
Parents and children need to weigh the pros and cons together when making decisions regarding activity choices.
Pick-up sports versus organized sports: While organized sports may be more competitive and physical, they usually are better supervised and require the use of protective equipment. Pick-up games can be more dangerous due to the lack of supervision, preparedness and use of protective gear.

There are three components of physical fitness: cardiovascular fitness, muscle and ligament flexibility, and muscle strength

Cardiovascular fitness is achieved through aerobic activities, such as swimming, walking, running, cycling or rowing.
These are activities which elevate the heart rate for a sustained period of time.
These activities can be either weight-bearing or non-weight-bearing.

Muscle and ligament flexibility is achieved through stretching activities.
Warm up stretches prior to cardio activities help to prevent injuries.
Cool down stretches after cardio activities are particularly effective as the muscles are warm and more pliable.

Strength training may be achieved in two ways: through isolated, targeted training of particular muscle groups, and through functional activity.
Isolated targeted training can be done in many ways: using nautilus machines, free weights, therapy bands, therapy balls and other resistive devices.
Weight training is not recommended for children under the age of fourteen due to musculoskeletal and psychological immaturity.
Functional strength training is achieved through the physical activity undertaken. For example, in running, cycling and walking, leg muscles are strengthened; in swimming and rowing, leg and arm muscles are strengthened.

Participation in sports carries certain risks.
Factors that influence the choice of activities for people with hemophilia include age, frequency and site(s) of bleeding, existing muscle or joint damage, culture and social views.
The need and desire to participate in certain sports varies with the individual and is often age-related.
Thought should be given to choosing a sport that can be sustained throughout a lifetime.
For many children, the risks of playing soccer, baseball, or basketball will be greatly outweighed by the social pressures to participate in these activities with their peers.
Both the National Hemophilia Foundation and the World Federation of Hemophilia have rated a wide variety of sports, and have divided them into three categories:
- Sports where most individuals with hemophilia can safely participate in the sport. These include swimming, walking, fishing, hiking, golf, cycling, bowling and yoga.
- Sports where the physical, social and psychological benefits often outweigh the risks. The majority of sports fall into this category including: basketball, baseball, soccer, skiing, volleyball.
- Sports where the risks outweigh the benefits. The nature of these activities make them dangerous even for those without hemophilia. These are mainly full contact sports including: football, boxing, hockey, lacrosse, rugby, and wrestling.

The best way to avoid injury is to make appropriate activity choices, to wear all the necessary safety equipment when participating in sports and to be educated to appreciate the early signs and symptoms of a bleeding episode.
If an injury occurs, the key approach is RICE: rest, ice, compression and concentrate, and elevation.
Children should not resume sports activities until an active bleed has resolved.
Children need to learn the early signs and symptoms of bleeding episodes, and must be taught to report a suspected bleed immediately, in order to receive treatment promptly.
Numerous bleeds that occur as the result of participating in a particular sport may signal the end of participation in that sport. Keeping accurate diaries of bleeding episodes will help determine any connections between physical activity and bleeding episodes.
Prophylactic factor infusion prior to activity may allow for continued participation in a particular sport. This is an individual decision which involves analyzing the benefits and risks of the activity.
Keep in mind that there is a wide array of physical activities to choose from. Always feel free to discuss options with the members of the comprehensive care team.