Preventing Hemophilic Joint Disease with Activity and Nutrition
We promote physical activity and good nutrition for patients with hemophilia.
Physical activity benefits everyone. Sports and exercise are healthy for children and adults with hemophilia. Physical fitness and muscle strength are important cornerstones of our approach to care, since well-developed muscles provide better joint support, better protection from daily wear and tear, and better recovery after joint bleeds. Regular exercise has even been shown to decrease the number of spontaneous bleeds (bleeds that are not caused by injury). Continuous, steady exercise several times per week in a fitness center or at home will help to maintain range of motion and flexibility. Early mobilization after joint bleeds is also beneficial to avoid joint stiffness and joint freeze.
In addition, improving physical fitness has many more positive effects on our lives such as:
- Increasing bone strength and bone calcification
- Increasing social contacts
- Developing independence and self-esteem
- Increasing energy
- Improving performance in school and professional life
- Decreasing weight and risk of obesity
- Preventing depression and anxiety
- Lowering risk of heart attacks, strokes and diabetes
However, as a patient with hemophilia you have to think ahead and prepare for sports!
Before starting with an exercise or sports program you need to be on an appropriate clotting factor replacement. You have to be sure to do appropriate exercises, and do them right. We therefore strongly recommend that you consult with us first. Jason, our physical therapist, will show you exercises and develop an appropriate sports program for you that is safe, fun and effective. Jason is at the center for you every Tuesday afternoon. Call our center for an appointment with Jason, 619-471-0035.
General rules for physical activity:
- Avoid isolated muscle exercises with heavy weights. Those will put undue stress on your joints. Use elastic resistance bands instead.
- Avoid risky sports like rock climbing, motor biking, boxing and such. Challenging your clotting system with trauma and injury may not be safe and put your live at unnecessary risk.
- If you are a patient on prophylaxis: If you exercise during day times infuse your prophylaxis at regular intervals in the morning to protect you during the day. If you exercise in the evening, time your prophylaxis for the late afternoon top provide maximum protection thereafter. Try to coordinate your gym with clotting factor infusions.
- If you are a patient on demand: Administer an extra dose just before sports.
The National Hemophilia Foundation has categorized athletic activities by risk in its Playing It Safe handbook (PDF, see pages 18 and 19). Patients with hemophilia should never engage in activities in Risk Category 3.
It’s important that patients with hemophilia keep weight controlled, since excess weight and obesity will affect joint health. Being overweight, even just moderately, impacts weight-bearing joints and can increase joint pain. During walking, knees and ankles – joints typically severely affected by hemophiliac bleeding – need to bear about 5 times a person's total body weight. For every pound overweight, about five pounds of extra weight is added to each joint. In contrast, a 10-pound weight-loss will relieve about 50 pounds of extra stress from each joint.
To find out if you are above the recommended normal weight, use a body mass index (BMI) calculator. The body mass index is a composite score that considers your height and weight to assess body fat and categorize you as normal weight, overweight or obese.
In order to decrease or maintain your weight, the United States Department of Agriculture recommends eating a diet rich in whole grains, fruits and vegetables, and low in fats, added sugars and salt (sodium).
Decrease your portions and make half your plate fruit and vegetables! Go to www.choosemyplate.gov and check it out.
As a patient with hemophilia you have to be very careful regarding dietary supplements, since many supplements can increase bleeding tendency or clotting times, just like aspirin or non-steroidal anti-inflammatories (e.g., Motrin®, Exedrin®, or Alleve®). Discuss any supplement or over-the-counter pain pills with your hemophilia doctor.
Here are some supplements that you may need to avoid after having weighed their benefits against the risks of bleeding with your hemophilia doctor:
- High doses of Vitamin E
- Fish oil
- Gingko biloba
- Black cohosh
- Cat’s claw
- Pau d’arco