The Importance of Sports and Exercise for People with

Haemophilia

John Stack, CSCSinfo@summerfieldhealthandfitness.com

Importance of Physical Movement

Humans, by design, are meant to be active!

Need to start young

“Give the boy until he is seven and I will give you the man”

~ Jesuit maxim

A huge amount of physical development occurs in the first few years of life.

Youth Physical Development Model

AKA Play Games

Fundamental Movement SkillsFUN

• Running• Climbing• Rolling/Tumbling• Jumping/Skipping/Hopping• Swinging (either yourself or an object)• Bounding• Dodging/Change of Direction• Catching/Throwing• Static Balance

The modern child

?

Effects of Obesity

Plus for PWH:• Weak/soft

muscles• Lack of tone• Greater load on

jointsgreater chance of bleeds

It’s important to maintain a normal weight range.

Exercise and PWH

• Common knowledge that exercise benefits us all

• Haemophilia has previously severely limited how active an individual could be

• Current innovations in treatment, safety and preventative care have opened up the world of sports and exercise …

• PWH now encouraged to engage in physical activity

• All sports carry some degree of risk• But the physical, social and

psychological benefits often outweigh the risks*

• Sports are important for the development of self-esteem and enhanced confidence, especially during adolescence – Team sports particularly effective.

National Haemophilia Foundation, Haemophilia, Sports and Exercise, 1996

• Athletic activities encourage children to learn good judgement and become more independent

• Improved assertiveness and independence in children result in marked clinical improvement with fewer spontaneous bleeding episodes

Recommendations for Kids

• i.e. < 12 years old• 60 - 90 minutes MINIMUM per day,

comprising:– General physical activity (walking to school, free

play, etc.)– Fundamental movement skills– Sports practice

• Limit screen time

Adolescent PWH

Adolescent PWH

• Need to continue their sporting activities and be active generally

• Sporting LEVEL will increase (i.e. become more competitive, physical, etc.

• Needs to develop strength and muscle mass– Developed through strength training

• Strength training can improve quality of life• Strength training can prolong a sporting ‘career’

regardless of level at which it’s played.

Scientific Support for Strength Training

Green and Strickler, 1983

Increased strength, flexibility and joint stability gained from strength training reduces the frequency of joint bleeds for people with Haemophilia

Koch, et al, 1984 Exercise causes a transient increase in clotting factor levels for people with mild and moderate haemophilia

Titkinsky (2002) Data supports the use of resistance training for reducing the frequency and severity of bleeding episodes

Souza at al (2012) •Concluded that exercise can improve several outcomes of quality in people with Haemophilia •Referred to the improvement in blood coagulation mechanisms as a result of exercise

Gonzalez et al (2007) Authors highlight the need for increasing muscular power through resistance training to address particular weaknesses

Pietri (1992) Suggested that strength training be commenced early in the rehabilitation of joints after acute haemarthrosis

Hilberg et al (2003) ‘strongly’ recommend that specialised sports therapy be included as an integral component of the complete training regimen of haemophilic subjects

©2012 Summerfield Health and Fitness

Overall conclusion from research is that exercise, including strength training, is hugely beneficial essential to people with Haemophilia

©2012 Summerfield Health and Fitness

Benefits of Resistance Training

• A closely supervised, well-designed strength training programme :– Increases strength– Prevents muscular atrophy– Contributes to motor development, skill

mastery, feelings of competence and achievement and athletic success

– Reduces the risk of sports related injury–May help to reduce the frequency of

bleeding episodes

Essential considerations

• Programme must be well designed and supervised• Programme must complement other sporting

activities• Person must learn proper exercise technique• Exercise selection must account for any limitations

the PWH may have (e.g. joint replacement, target joints, etc.)

• Poor exercise technique will cause as many problems as not exercising at all

• Moderation is key

Recommendations for Adolescent PWH

• Be physically active every day• Play a sport 3 – 4 days a week• Strength train 2 – 3 days a week• Eat to support your lifestyle

Exercise and the Adult PWH

• Longer life expectancy now.• Quality of life v Quantity of Life• Holy grail of health– Maintain/Improve Muscle mass– Retain joint mobility/range of motion– Maintain/enhance strength

Case Study• Charlie• Aged 71• Has an under 21s county medal in GAA• “Recreational” cyclist • Started strength training summer 2014• Results:

– ‘First man home’– Stronger – More mobile– Improved quality of life

• Less pain• Less stiffness• More energy

The Incapacitated PWH

• Everything previously said works as long as he can exercise• What if he cannot comfortably exercise?• He still needs to strive to be healthy/maintain weight• Inactivity destroys a body.• How can he work around a target joint?• Once he is cleared by medical team/physios:

– Physical Therapy– Aqua-exercise

• Swimming• Resistance training in a pool

– Possible to train around the target joint • e.g. train the upper body if target joint is in the lower limb, etc.

Summary

• Physical activity is essential for PWH• Kids need to be active every day so that they

can develop FMS, maintain a normal body weight, and be healthy

• Adolescents (and adults) should supplement their physical activity with strength training

• People who are incapacitated must be helped to find a way to be active

Thank you.