Bleeding disorders, sports and exercise

General Stretching Program

Knee to Chest

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Lie on the floor with

legs straight.

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Bring one knee toward

chest.

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Use hands on shin or

back of thigh to provide

gentle pressure.

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Hold 30 seconds, 

then lower leg.

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Repeat with lower leg.

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Stretch should be felt

along lower back and

buttocks.

 

                                                 

Hamstring Stretch

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Lie on back.

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Grasp right thigh 

with hands.

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Try to straighten knee.

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Do 

not

move hips.

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Hold 30 seconds.

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Repeat with other leg.

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Stretch is felt in back 

of thigh.

Calf Stretch

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Stand facing wall with one

foot in front of the other, 

feet straight.

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Lean toward wall bending

front knee, keeping back

knee straight and keeping

back heel on the floor.

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Hold 30 seconds, then

stand and relax.

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Repeat with other leg 

forward.

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Stretch should be felt along

the back and the calf.

Saddle Stretch

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Sit with legs straight in a 

V pattern.

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Lean forward by pressing hips

forward, not 

rounding upper back.

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Keep knees facing up.

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Use hands and arms for

support, if necessary.

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Hold 30 seconds, then release

by sitting up.

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Stretch should be felt in lower

back and inner thighs.

Quad Stretch

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Stand facing a wall; balance with

one hand on wall.

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Bend one knee behind and grasp

foot with either hand.

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Gently pull foot toward buttock

while keeping the hip extended.

Do not let hip flex forward.

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Hold 30 seconds, then relax.

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Repeat with opposite leg.

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Stretch should be felt along front

of thigh and ankle.

Runner’s Lunge

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Stand with one leg in front of the other 

with feet pointing forward.

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Keep front heel on the floor; let 

back heel off the floor.

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Lean forward onto front leg, 

keeping back knee straight.

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Use hands on front thigh or 

floor depending on flexibility.

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Hold 30 seconds, then relax.

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Stretch should be felt along groin, 

hamstrings, and front of hip.

*be extra gentle if there is a history of iliopsoas bleeds.

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Back Shoulder Stretch

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Reach one arm across chest at

shoulder level (sitting or standing).

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Use opposite arm to provide gentle

pressure at elbow.

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Turn head to look over 

shoulder being stretched.

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Hold 30 seconds, then relax.

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Repeat to opposite side.

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Stretch should be felt across upper

back and shoulders.

Side Trunk Stretch

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Reach one arm over and behind

head (sitting or standing).

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Use opposite hand at elbow 

to provide gentle pressure.

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Hold 30 seconds, then relax.

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Repeat with the opposite arm.

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Stretch should be felt along the side

of trunk and shoulders.

Excerpted from

Stretching

©

1980 by Bob and Jean Anderson, Shelter Publications, Inc., P.O. Box 279, Bolinas, CA 94924, $13.00

Distributed in book stores by Random House. Reprinted by permission.

Hip Stretch

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Stand in same position as for

the calf stretch, left foot

forward.

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Lean into right hip, keeping

both feet on the floor.

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Hold 30 seconds, then stand 

and relax.

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Repeat to left side with right

foot forward.

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Stretch should be felt along

the side of the trunk, hip, and 

upper leg.

Upper Chest Stretch

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Grasp towel or rod at the ends 

(sitting or standing).

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Lift towel over and slightly behind 

head.

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Hold 30 seconds, then lower 

forward to relax.

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Stretch should be felt along front of 

upper chest and shoulders.

Front Shoulder Stretch

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Grasp towel or rod behind back,

below shoulders (standing or 

sitting in backless chair).

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Lift arms back away from body.

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Hold 30 seconds, then lower 

to relax.

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Stretch should be felt in the front of

shoulders.

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Appendix 2 

Strength Training Recommendations*

Programs generally consist of one to three sets of each exercise for 6 to 15

repetitions. After the individual has done 15 repetitions in good form, weight

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Child/Adolescent

Adult

Older Adult

resistance can be increased in one to three pound increments.

Training should be done for 20 to 30 minutes, two to three times a week,

always resting the body on the day following the workout.

Frequency

1-2x/week, then encourage other forms of activity

2-3x/week

2-3x/week with 48 hour rest between sessions

Duration

1-2 sets of 8-10 different exercises involving all major muscle groups

1-5 sets involving all major muscle groups

1-2 sets involving all major muscle groups for

30 minutes/ usually 1-2 exercises for each

muscle group

Intensity

1.

Amount of weight should be (a) light enough to allow completion of

8-10 reps/set using good form through full joint motion and with

normal breathing and (b) heavy enough that the last few repetitions

are difficult to complete.

2.

Avoid lifting maximal amount of weight possible.

3.

Rest 1-3 minutes between sets.

1.

Amount of weight should be (a) light

enough to allow completion of 8-12

reps/set using good form through full

joint motion and with normal breathing

and (b) heavy enough that the last few

repetitions are difficult to complete. 

2.

Rest 1-3 minutes between sets. 

1.

Amount of weight should be (a) light

enough to allow completion of 10-15

reps/set using good form through full joint

motion and with normal breathing and (b)

heavy enough that the last few repetitions

are difficult to complete. 

2.

Rest 1-3 minutes between sets.

Progression

1.

Vary program by modifying frequency, duration, amount of weight, # of

reps, # of sets (< or = 2 sets), # of exercises/muscle group. 

2.

When muscles are not tired after 1-2 sets of 8-10 reps, increase weight

to next higher level.

3.

When muscles cannot complete 8-10 reps, decrease weight. 

1.

Vary program by modifying frequency,

duration, amount of weight, # of reps, # of

sets (< or = 5 sets), # of exercises/muscle

group. 

2.

When muscles are not tired after 2-3 sets

of 8-12 reps, increase weight to next

higher level. 

3.

When muscles cannot complete 2 sets of

8-12 reps, decrease weight. 

1.

Vary program by modifying frequency,

duration, amount of weight, # of reps, 

# of sets (< or = 3 sets), # of exercises/muscle

group. 

2.

When muscles are not tired after 2-3 sets of

10-15 reps, increase weight to next higher

level. 

3.

When muscles cannot complete 2 sets of 

10-15 reps, decrease weight. 

Precautions

1.

Monitor form

2.

Monitor amount of weight used

3.

Use a spotter when possible.

4.

Stop exercise in presence of pain. Check posture/position and try to

exercise again. If it is still painful, discontinue that exercise and seek

assistance from the HTC or your physical therapist.

5.

Do not lift weights with any joint or muscle that is currently bleeding.

After bleed resolution, resume lifting gradually with decreased weight

and # of reps and/or sets. 

6.

Remember that a child or teen has not reached physiological maturity. 

7.

Do not exercise if you feel ill or overly fatigued.

1.

Monitor form

2.

Monitor amount of weight used 

3.

Use a spotter when possible. 

4.

Stop exercise in presence of pain. Check

posture/position and try to exercise again.

If it is still painful, discontinue that

exercise and seek assistance from the

HTC or your physical therapist. 

5.

Do not lift weights with any joint or

muscle that is currently bleeding. After

bleed resolution, resume lifting gradually

with decreased weight and # of reps

and/or sets. 

6.

Do not exercise if you feel ill or overly

fatigued.

1.

Monitor form 

2.

Monitor amount of weight used

3.

Use a spotter when possible.

4.

Stop exercise in presence of pain. Check

posture/position and try exercise again. If it

is still painful, discontinue that exercise and

seek assistance from the HTC or your

physical therapist.

5.

Do not lift weights with any joint or muscle

that is currently bleeding. After bleed

resolution, resume lifting gradually with

decreased weight and # of reps and/or sets. 

6.

Do not exercise if you feel ill or overly

fatigued. 

*American College of Sports Medicine/Centers for Disease Control and Prevention

 

                                                                                        

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Appendix 3 

Cardiovascular Activity Recommendations*

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Child/Adolescent (2-18 years)

Adult

Frequency/

Duration/

Intensity

1.

30 minutes of enjoyable and moderate intensity level activities

daily.

2. 

30 minutes of vigorous physical activity 3-4/week

3. 

Activity time can be divided into shorter time periods; e.g., 

15 minutes at morning recess and 15 minutes after school.

1.

At least 30 minutes of moderate intensity activities on most days 

of the week.

2.

Increasing time and intensity of activities will provide greater health benefits.

3.

At least 30-60 minutes of aerobic activity 5x/week is usually required for weight

loss.

Precautions

Progressing to a vigorous level activity may increase the likelihood

of injury or joint bleed, especially if the body is not adequately

trained or if the activity places stress on a target joint.

Progressing to a vigorous level activity may increase the likelihood of injury or joint

bleed, especially if the body is not adequately trained or if the activity places stress on

a target joint.

Progression

(CDC)

If...

1.

You are now inactive 

2.

If you are now active, but below the recommended activity

levels

3.

If you are now participating in at least moderate intensity level

activities 5x/week,

Then…

1.

Add a few minutes of moderate intensity level activities daily until you gradually

work up to 30 minutes or more.

2.

Work up to 30 minutes of moderate intensity level activities for at least 5x/week OR

work up to at least 20 minutes of vigorous intensity activity for at least 3x/week

3.

Greater health benefits are possible by increasing the intensity and/or frequency of

activities.

*American College of Sports Medicine/American Heart Association/

Centers for Disease Control and Prevention

 

                                      

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Additional Resources

Articles from H-emAware published by the National Hemophilia Foundation:

“Pump Up for Prevention” by Alice Anderson, PT, MS, PCS, 

November/December 2001

“Exercise Mentoring: The Motivation to Get Moving” by Wayne Richards, MSW,

LCSW, July/August 2002

“Playing to Win: Preventing Common Sports-Related Injuries” by Marvin Gilbert,

MD and Irene Vlaskamp, PT, May/June 2003

“Strength Training Guidelines for Children, Adolescents and Adults with Bleeding

Disorders” by Kris Albrecht, PT, PCS, May/June 2003

“Exercise Heals” by Ann Conti Morcos, MA, ELS, May/June 2003

“Aquatic Therapy: It’s Not Just Swimming,” by Grace Hernandez, PT, 

May/June 2003

“Bench Warmer” by Jeffrey Kallberg, PT, March/April 2004

Peter Jones, MD, Brenda Buzzard, MCSP and Lily Heijnen, MD, 

Go for It: Guidance

on Physical Activity and Sports for People with Haemophilia and Related Disorders.

World Federation of Hemophilia, 1998.

 

        

The National Hemophilia Foundation is dedicated to

finding better treatments and cures for bleeding and

clotting disorders and to preventing the complications

of these disorders through education, advocacy and

research. 

Established in 1948, the National Hemophilia

Foundation is a non profit 501(c)3 organization with

chapters throughout the country. Its programs and

initiatives are made possible through the generosity of

individuals, corporations and foundations as well as

through a cooperative agreement with the Centers for

Disease Control and Prevention (CDC).

For more information or for help, please call the

organization’s information resource center at

800.42.HANDI, ext. 2 or go to www.hemophilia.org. 

116 West 32nd Street, 11th Floor

New York, NY 10001

(212)-328-3700  

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(800) 42-HANDI  

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fax [phone]

www.hemophilia.org  

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[e-mail]

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AT I O N A L

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for all bleeding and clotting disorders