EXERCISE AND FITNESS

Hemophilia, though a life long condition has benefited from advances in medical
treatment. Factor replacement therapy has helped newer generations to mature without
the chronic haemophiliac arthopathies previously seen and caused by repeated joint
bleeds. Most forms of exercise are now suitable and accessible to the newer generations
of persons with hemophilia.

General exercise programmes are usually for fitness (either getting fit or maintaining
fitness). They would involve exercises to improve cardiovascular performances
and are of a repetitive nature. Exercise bike, rowing machine and treadmill (and
various equipment available in gyms) can all be used to improve fitness. The heart
rate needs increasing and then maintaining at this higher level for 20-30 minutes
to have a training effect. In addition, specific strengthening components can
be added to target a specific problem. To be effective, any exercise must be performed
regularly. To prevent injury, a correct warm-up is important with an appropriate
stretching programme. This will prepare the muscles (and other tissues) for the
effects of exercise. This is vitally important to people with hemophilia because
injury could mean an acute joint or muscle bleed. The warm-up is specific to the
activity to be undertaken. The muscles are slowly heated via gentle activity such
as cycling, to increase the heart rate and hence blood flow, to prepare them for
activity. As the muscles are warmed up gentle stretching is added in to address
the specific components needed. In relation to most aerobic activity or sports,
this includes muscles that have a tendency to get tight. These include calf (both
aspects-deep and superficial) hamstrings, quadriceps and hip muscles (adductors
and flexors). Stretching should be slow and held for several seconds; bouncing
further into range is not normally indicated; however, there may be exceptions
(depending on the sports you are stretching for) and these would need discussing
with your physiotherapist. The final part of the warm-up is activity specific
and would involve exercises preparing for the actual sports to be undertaken.
It may involve coordination or motor skill tasks such as ball work, or may involve
more "explosive" exercises such as sprinting then stopping.



After exercise, a cool-down period (the opposite of warm-up) including stretches,
is equally important. Exercise should not be painful and you should not experience
hot or swollen joints. These are the signs of an acute bleed, so immediate treatment
should be sought.

The physiotherapist, in addition to giving advice on an appropriate exercise programmes
will also design exercises specifically for a problem, say after injury, post-operatively
or after a bleed. Other forms of exercise may also be included:



(a) Stabilizing exercises, for restoring stability around joint,

(b) Postural exercises, to improve general posture,

(c) Mobilizing exercises, to improve movement in a joint or soft tissue and

(d) Relaxation exercises, to relieve stress of various sorts.

Benefits of Exercise

Physiological

Decrease viscosity of blood, increase Factor VIII level (not enough to impact
on hemophilia), increase collateral circulation, maintain and improve muscle
and joint function, Control weight, Help control blood pressure, Decrease lipids
in blood.

Psychological

Feeling of well-being, Promote lifestyle changes, Improve confidence, Reduce
stress

and anxiety, Promote release of endorphins (natural pain killers).

Exercises - What not to do

Exercise should not cause pain. Exercise should be done within control. You
shouldn't

hold breath while doing exercise. Exercise should not cause excessive strain,
especially

in areas away from where the exercise is aimed!