Sports and Recreation
Regular physical exercise is important to everyone’s health. People who have bleeding disorders should talk to the doctors and nurses at their Hemophilia Treatment Center (HTC) about which sports and activities are appropriate for them. People with mild disorders may not have to avoid any activities. Others may have to stay away from rough sports like football and hockey. Some activities like swimming, walking, and golf are okay for everyone. Exercising raises the level of VWF in the blood in addition to providing other health benefits.
Many people believe that people with hemophilia should be inactive so they do not have bleeds. This is wrong. In fact, regular exercise is strongly advised. Through exercise, a person with hemophilia can develop strong muscles. These will protect his joints and reduce the chance of bleeds. He can also become more coordinated and have more stamina.
The section on physical therapy tells how a PT program provides routine exercise. Sports are good exercise as well. The purpose of this section is to explain how people with hemophilia and other severe bleeding disorders can take part in sports.
Sports can help a child's physical and mental growth. Children want to be liked by other children. Playing sports is a way to be accepted. When a child masters a sport, there is a sense of achievement. The child feels better about him or herself. Through sports, children can learn about team spirit. They can make the friends they need to enjoy life.
This section tells how to choose the sports that offer the most fun and exercise with the fewest bleeds. We will also talk about ways to avoid getting hurt when you play sports.
Choosing a sport
People with bleeding disorders vary in the sports they can or should play. The decision about which sport to try depends on the person. The people helping to decide should be the person with the bleeding disorder, the parents (if he or she is young), and the doctor. They should think about what the child wants to play, the child's abilities, and any physical problems the child has. These will change as he or she grows. The best sports for the child may change, too. The basic principle is to use common sense.
One of the first things to think about when choosing a sport is the child's build and physical abilities. If he has hemophilia, what are the conditions of his joints and muscles? Does he bleed often in the same joints? How much damage has already been done to his joints and muscles? A person with arthritis in his elbow, for instance, may not want to choose tennis. Think about whether or not the child enjoys the sport. A child should not be forced to play a sport he or she does not like.
When choosing a sport, think about how rough it can be on the body. Which joints and muscles are used in the sport? How much body contact is there? You have more control in some sports than others. For instance, downhill skiing is not as safe as cross-country skiing. Someone skiing downhill can fall or run into something while going very fast.
People argue about which is safer: organized sports like a league or team, or "pick-up", "back yard" sports. Those who say organized sports believe that players are more likely to wear safety gear such as helmets and pads. Players may also be more likely to learn the correct and safest moves from trained coaches. Those on the other side say organized sports are rougher than just playing with friends.
It is best to judge each sport on its own. Boys and girls may not play sports the same way in different places. Also, a sport that is okay for one age group may be too risky for another. Children may change the way they play a sport as they get older. For example, soccer may be fine for a young child but too rough when the child gets older.
Finally, a child should choose a sport that is popular in his or her area so there will be plenty of chances to play. Make sure that the facilities (like a swimming pool or golf course) are available and affordable.
You usually have to try several sports before you find the right one. In any sport, you will get hurt now and then. It is impossible to avoid all bleeding. The benefits of sports are still greater than the risks. You just need to think through the risks first.
Swimming is for everyone
Swimming is one of the best sports for people with hemophilia. It is a safe way to make your muscles stronger without putting pressure or stress on your joints. A child can start swimming very early in life. Even a baby can kick his legs and paddle his arms as he is held by a parent. As the child gets older and learns to swim, he can start swimming laps. Distance swimming builds strong muscles with few chances of getting hurt.
A child who swims may enjoy competing in swim meets. His swimming may also lead to a job as a lifeguard. Another advantage to swimming is that it is a sport the whole family can enjoy. Everyone can get his or her body in better shape. The family will feel closer as they play together.
Good sports for toddlers and preschoolers
Toddlers and preschoolers can enjoy sports suited to their ages. They can roll a ball back and forth to each other and play catch. They can also play running games for exercise. Sometimes, parents try to stop kids this age from playing outside. They are afraid they will get bumps and bruises. However, outside play is needed for a child's growth. With an adult nearby, outside play should be allowed. Even climbing on jungle gyms or slides can be allowed if the child shows a little caution.
Good sports for school age children
A school age child with a bleeding disorder can take part in his school's physical education (PE) program. It takes just a little planning by the parents and the teachers. Parents may need to teach the school staff about the bleeding disorder.
Parents and teachers will need to plan what to do in case of bleeds. They should talk about ways to get the child to report injuries or bleeds as soon as they happen. Adults should not scold the school age child for causing a bleed through reckless behavior. A child who expects to be punished or scolded for a bleed will learn to keep the bleed a secret as long as possible.
Some parents choose not to allow some competitive team sports. They will let the child shoot baskets or play catch with a softball but not play on a team. It all depends on the child's skills, training, and how roughly his or her friends play the game.
When a child first learns a new sport or takes part in a risky sport, he or she will need safety gear. This includes helmets and elbow and knee pads. Parents should check all sports equipment. Roller skates, for example, should be shoe skates or should be firmly attached to the child's shoes.
Some sports a school age child might enjoy:
- jumping rope
- roller skating
Good sports for teens and adults
Most teens worry about their body shape and size and being "part of the crowd". Playing a sport is one way a teen can grow more confident and fit in with peers. Becoming good at a sport will help even an adult feel better about him or herself. The exercise from the sport will keep teens and adults in good shape. Sports for teens and adults may be competitive or not. Some may involve the whole family. Many adults do sports that can be played inside or outside. For instance, a biker can ride an exercise bicycle inside during bad weather.
With some sports, such as swimming or golf, you have fewer chances of getting hurt. These are fine for most people with bleeding disorders. Other sports are very risky and should not be played at all by people with hemophilia. These are mainly the contact sports like football and wrestling.
There are many other sports that fall between the low risk and very risky ones. Although you might get hurt playing these sports, it may be worth taking the chance. The sport can help you grow physically and mentally. A person trying to decide about one of these sports has to compare the risks to the benefits.
This chart lists the safest sports for a person with a bleeding disorder on the left and the most dangerous sports on the right. The safety of the sports in the middle depend on the player, his or her diagnosis, his or her skills, and how the game is played.
Preparing yourself to play safely
A person with a bleeding disorder is successful in playing a sport if he or she enjoys it, gets enough exercise, and has few injuries and bleeds. A player can make a sport work for him or her by preparing for it, learning the safety rules, and wearing safety gear.
The first step in preparing for a new sport is a check-up by your joint doctor (orthopedist). He or she will check your joints and tell you what to do and not to do. The staff at your HTC can help decide what safety gear you need to wear. They can also tell you if you need to take factor or other medicine before doing the sport.
People with bleeding disorders must get their bodies ready for the sport before they start to play. A training exercise program will make the muscles that are used in the sport stronger. This will lower the chances of having a bleed. In a training program, the player can learn the proper moves and ways to have fewer injuries. He or she can learn the correct way to use the equipment and safety gear.
No matter what sport is chosen, the player must be sure that factor and emergency care are nearby in case of injuries or bleeds.
When a child wants to play a risky sport
Sometimes a child wants to play a sport so much that he or she does not look at the danger. The child's wish not to be left out is more important to him or her than the risk. Parents wonder if they should just forbid the child to play. In many cases, this can do more harm than good. In the first place, the child is likely to play without the parents' knowing. In the second place, the parents and the child are no longer talking about what to do.
Almost every child with hemophilia will at some time try a sport his parents prefer him not to play. Luckily, children soon stop sports that cause them to have bleeds. Most children figure out on their own that they are better off not playing the sport.
When a bleed happens
No matter what sport a child tries, it is impossible to avoid all bleeds. The child with hemophilia needs to learn very early to tell when he is having a bleed. He needs to know that an injury can cause a bleed whether or not he sees blood. He must be trained to tell an adult right away when he has been hurt or when he thinks he is having a bleed. A young child must understand that a bleed is unlikely to stop without factor. He can be told that when a blood vessel is broken, he needs factor to help fix the vein.
Adults should not make a child feel that a bleed is his fault. The child should not think that a bleed is punishment for doing something risky or forbidden. All children get hurt. Some bleeds cannot be prevented anyway. Making a child feel guilty for causing a bleed may make him try to hide his bleeds.
Adults should praise a child for telling them when he has a bleed. Let him know that he will not be punished. This way, the child is more likely to report the bleed when it first starts. Do not demand to know what the child did to cause the bleed. Wait until the factor has been given. Then, if necessary, ask the child what he was doing before the bleed started. Getting factor should be seen by the child as a way of stopping the pain and not as a punishment.
After a bleed, you may not be sure when the child can start playing the sport again. If one dose of factor stopped the bleed and if there is no more pain, it is probably safe to play. If it takes more than one dose or there is pain or stiffness, you have to be careful. Call your hemophilia doctor for advice.
Children with mild hemophilia
Children with mild hemophilia have few bleeds. Most of the time, they need factor only after a bad accident or for an operation. Because of this, the parents of a child with mild hemophilia will need to pay close attention to his sports and play. Since he rarely has a bleed, he may not know when he needs to get treatment.
When a sport does not work
Not everyone will be good at the sport he or she chooses. Some children simply do not have the athletic skills for certain sports. Also, some children have to stop playing a sport because they have too many bleeds. When a child cannot play the sport he or she chooses, encourage the child to enjoy that sport in other ways. He or she can be a team manager, coach, scorekeeper, cheerleader, or mascot. He or she can always be what every team needs - a loyal fan.
Children who do not play a sport can still have their own exercise programs to build muscles. If a child feels left out, there are other skills that can be learned that will make the child feel good about him or herself. Playing a musical instrument and mastering chess are two examples.