1. Adaptive Physical Activities

2. Objectives Upon Completion of this session, you will: Understand the importance of physical activity Understand how to adapt activities to you physical condition

3. Benefits of Sports & Exercise Physical benefits – Builds healthy joints – Decreases weight to take pressure off knees and ankles – Lowers risk of joint bleeds Emotional benefits – Builds self-esteem and self-confidence – Increases energy level – Helps reduce feelings of depression and anxiety – Can help enhance academic performance

4. Today’s topics Choosing an activity that’s right for you Preparing properly for your activity Safely enjoying strength and aerobic training

5. Should people with hemophilia participate in sports and exercise?

6. Choosing the Right Activity Important considerations 1,2 The current state of your joints/muscles How often and where you bleed How old you are and where you live Your current activity level and experience with sports/activities The risk level of the activity Consult your clinician or HTC for advice on the right physical activities for you.

7. Choosing the Right Activity Risk – ratings by activity 1 11.522.53 Safe Safe to Moderate Risk Moderate Risk Moderate to Dangerous Risk Dangerous Elliptical machineBicyclingAerobicsBaseballBMX Racing GolfPilatesBowlingBasketballFootball HikingRowing machine Cross-country skiing Horseback riding Hockey (Field, Ice, Street) Non-contact Martial arts/ Tai chi SpinningRunning/JoggingSkateboardingLacrosse SwimmingTreadmillTennis Skiing (downhill) or Snowboarding Trampoline Walking Weight lifting/ Resistance training YogaSoccerWrestling

8. What do you need to do before participating in an activity?

9. Preparing For Your Sport or Activity

10. Preparing For Your Sport or Activity Preparation leads to success 1,2 Visit your HTC to discuss your plans Talk with your physical therapist and clinician Prepare and follow through with your treatment plan Start a preseason training/conditioning program Stretch before and after participating in a sport or activity Commit and Schedule your activity…make it happen!

11. Preparing For Your Sport or Activity Ensuring a safe experience 1,2 Don’t participate during active bleeds or when injured Identify bleeds early and follow with treatment Warm up and cool down Eat and hydrate properly Wear appropriate safety equipment Consult your clinician or HTC for advice on the right physical activities for you.

12. Preparing For Your Sport or Activity Benefits of stretching 1,2 Helps prevent injuries Increases flexibility Allows joints to move more freely Consult your clinician or HTC for advice on the right physical activities for you.

13. Preparing For Your Sport or Activity Guidelines for stretching 1 Stretch slowly and hold each stretch for at least 30 seconds Stretch only to a point where you feel a steady pulling sensation—not pain Breathe regularly Do not bounce; it can damage your muscles Gradually increase the number of repetitions and duration Never stretch during an active bleed

14. Preparing For Your Sport or Activity Basic stretches: the hamstring stretch 1 Lie on your back Grasp right thigh with both hands Try to straighten your knee Do not move your hips Hold for 30 seconds Repeat with your other leg Consult your clinician or HTC for advice on the right physical activities for you.

15. Preparing For Your Sport or Activity Basic stretches: the calf stretch 1 Stand facing a wall with one foot in front of the other, feet straight Lean toward the wall, bending your front knee Keep your back knee straight and your back heel on the floor Hold 30 seconds, then stand and relax Repeat with opposite leg forward Consult your clinician or HTC for advice on the right physical activities for you.

16. What other types of stretches could you do?

17. Participating in Strength and Aerobic Training Participating in Strength and Aerobic Training

18. Participating in Strength and Aerobic Training Benefits of strength training 1-3,5-7 Muscle strength helps support your joints Improves motor skills and sports performance May reduce the risk of injury Consult your clinician or HTC for advice on the right physical activities for you.

19. Participating in Strength and Aerobic Training Resistance/exercise bands 8 Help develop muscular strength and endurance Easy to use Can provide a “whole-body workout” Consult your clinician or HTC for advice on the right physical activities for you.

20. Participating in Strength and Aerobic Training Exercise band workout: the hamstring curl 8 Hold chair for balance Loop band around ankles Shift weight onto one leg slightly bent at knee With knees aligned and foot flexed, contract hamstring Bend other leg 90 degrees behind you Consult your clinician or HTC for advice on the right physical activities for you.

21. Participating in Strength and Aerobic Training Weight training 1,7,9 Builds strength May not be appropriate for adolescents and young adults Power lifting not recommended Consult your clinician or HTC for advice on the right physical activities for you.

22. Participating in Strength and Aerobic Training Guidelines for weight training 7,9 Planning for a good, low-risk weight-training program includes: Goal setting based on a physical exam Supervision and safety considerations The program should include: Warm-up, stretching, cooldown A spotter An appropriate number of sets and increments Consult your clinician or HTC for advice on the right physical activities for you.

23. What other types of exercises help strengthen core muscles?

24. Participating in Strength and Aerobic Training Fitness ball core exercises: squat and reach 10 Hold the ball before you with knees bent Keep a straight back, arms parallel to the floor Tighten abdominal muscles Turn the trunk of your body and reach with the ball to your left ; hold for three deep breaths Return to the starting position, then repeat the motions, but go to the right Consult your clinician or HTC for advice on the right physical activities for you.

25. Participating in Strength and Aerobic Training Fitness ball core exercises: the bridge 10 Lie on your back with your legs on top of the fitness ball Tighten your abdominal muscles Lift your hips and bottom off the floor; hold for three deep breaths Return to the start position and repeat the motions Consult your clinician or HTC for advice on the right physical activities for you.

26. How do you know if an activity is aerobic?

27. Participating in Strength and Aerobic Training Aerobic training 2 Requires low to moderate exertion levels over extended periods of time A good program includes: −Maintaining target heart rate −150 minutes of moderate physical activity per week Consult your clinician or HTC for advice on the right physical activities for you.

28. Participating in Strength and Aerobic Training Benefits of aerobic training 1,2 Improves cardiovascular fitness Increases endurance Strengthens the heart and lungs Examples: −Swimming −Biking −Walking Consult your clinician or HTC for advice on the right physical activities for you.

29. Participating in Strength and Aerobic Training Measuring your exertion level 1 Light intensity – if you can sing Moderate intensity – if you can talk but not sing Vigorous intensity – if you have difficulty talking

30. Participating in Strength and Aerobic Training Identifying your target heart rate 1 Target heart rate: 60% to 75% of your maximum heart rate Example of a 20-year-old man Maximum heart rate: 220 – age (20) = 200 Target heart rate: 60% to 75% of 200 (maximum heart rate) Target heart rate = 120 to 150 beats per minute

31. Participating in Strength and Aerobic Training Strength and Aerobic Training Fitness logs Record your daily progress: Exercise Fluids Food intake Consult your clinician or HTC for advice on the right physical activities for you.

32. Balancing Sports and Exercise Fitness programs are beneficial for everyone, including people with hemophilia. It is important to choose the right program for you. The key to a successful program is preparation. Consult your clinician or HTC for advice on the right physical activities for you.

33. References 1.Baxter Facts First Presentation “Balancing Sports and Exercise”. 2.Playing It Safe: Bleeding Disorders, Sports, and Exercise. New York, NY: National Hemophilia Foundation; 2005. 3.Hemophilia, Sports, and Exercise. New York, NY: National Hemophilia Foundation and American Red Cross; 1996. 4.Strength training. Mayo Clinic Web site. www.mayoclinic.com/health/strength-training/HQ01710. Accessed June 1, 2010. 5.Aerobic exercise: top 10 reasons to get physical. Mayo Clinic Web site. www.mayoclinic.com/health/aerobic- exercise/EP00002/NSECTIONGROUP=2. Accessed May 26, 2010. 6.3 biggest benefits of strength training. A2Z of Health, Beauty and Fitness Web site. http://health.learninginfo.org/benefits- strength-training.htm. Accessed May 26, 2010. 7.Why strength training. Centers for Disease Control and Prevention Web site. www.cdc.gov/physicalactivity/growingstronger/why/index/html. Accessed May 26, 2010. 8.Faigenbaum AD. Strength training for children and adolescents. Clin Sports Med. 2000;19:593-619. 9.Whole-body exercise band workout page. American Council on Exercise Web site. www.acefitness.org/getfit/RubrBndWkout.pdf. Accessed May 26, 2010. 10.Metcalf JA, Roberts SO. Strength training and the immature athlete: an overview. Pediatr Nurs. 1993;19:325-332.w 10. Slide show: core exercises with a fitness ball. Mayo Clinic Web site. www.mayoclinic.com/health/core- strength/SM00046&slide=2. Accessed May 26, 2010. 11. What is aerobic exercise? Medicinenet Web site. www.medicinenet.com/aerobic_exercise/article.htm#what. Accessed June 23, 2010.

34. THANK YOU! The Blood Brotherhood Program is supported by Cooperative Agreement Number 1U27DD000537-01 from CDC. And Thank You to Baxter for their Programming Support.