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1. Destination fitness Supported by

2. purpose Destination fitness provides guidance and direction not only on how to keep moving, but also on how to do it safely. Physical activity will help you to achieve an active lifestyle, no matter how old you are or what type of bleeding disorder you have.

3. benefits of physical activity risks of physical activity Components of a fitness program roadblocks to physical activity choosing the right activities

4. benefits of physical activity physical activity makes us feel more alive... physical activity is essential for healthy growth and development... benefits…

5. benefits of physical activity physical activity... • increases self-esteem, self-confidence; • provides a sense of well-being; • develops social skills, interests and hobbies; • develops cardiovascular fitness; • reduces the risk of heart disease in later life; benefits…

6. benefits of physical activity physical activity... • enhances bone formation (Adolescence is a critical time for bone mass formation); • reduces the risk of osteoporosis; • helps maintain healthy body weight; • reduces stress on joints; • reduces risk of range-of-motion loss; • decreases risk of diabetes and high blood pressure; benefits…

7. benefits of physical activity physical activity... • develops strong muscles; • protects joints from injury through improved endurance; • improves muscle flexibility which reduces risk of strains/bleeds; • maintains/improves joint proprioception; • improves coordination and reflexes, and shortens reaction time; • develops motor skills; • maintains/improves general mobility and function; benefits…

8. benefits of physical activity physical activity... • increases blood flow which helps to repair damaged tissues; • reduces mental and muscular tension; • increases concentration and energy levels. benefits

9. risks of physical activity Avoiding all bleeds is unrealistic, but it is wise to avoid the more serious ones. Certain factors increase risk, especially for those with target joints. risks…

10. risks of physical activity contact • Contact in hockey, for example—between players, with the puck, against the boards—is much greater than in soccer. The risk of injury, therefore, is higher. speed Motorized sports like water skiing, snowmobiling and dirt biking carry a greater risk of injury than regular biking because of their speed. risks…

11. risks of physical activity force of impact Football, boxing, and riding a 4-wheeler, for example, are extremely risky, even to people without a bleeding disorder, because of the high force of impact. height The more height involved, such as in snowboarding, downhill skiing, and hang-gliding, the greater the risk of serious injury. risks…

12. risks of physical activity unpredictable conditions Waves in water skiing, and icy conditions when skiing are examples of how unpredictable conditions can affect the degree of risk. risks

13. components of a fitness program • Any type of physical activity (as long as it is chosen carefully) is generally considered preferable to none at all. • Nevertheless, to obtain maximum benefits, try to include aspects of all three of the following components in your journey to healthier living: • endurance or cardiovascular activities; • muscle strengthening activities; • flexibility exercises. fitness program…

14. components of a fitness program endurance or cardiovascular activities... • strengthen the heart and facilitate the transport of oxygen throughout the body; • decrease the risk of diabetes, stroke and high blood pressure. • Examples: swimming, brisk walking, cycling... muscle strengthening activities... • help condition your muscles, bones, tendons and ligaments to resist various forces, without sustaining injuries. • Examples: weight lifting, calisthenics, shovelling snow… fitness program…

15. components of a fitness program flexibility exercises... • aid your muscles, tendons and other soft tissues to attain and maintain their maximum range of motion; • help in the prevention of certain injuries through improved flexibility. • Examples: yoga, Tai Chi, specific stretches… other components... • Nutrition and sleep - Some experts would add proper nutrition and rest (sleep) as components of a complete fitness program. • Regardless of the component in question, progress your activity level(s) carefully, so as to minimize the risk of injury. fitness program

16. roadblocks to physical activity Many people, whether they have a bleeding disorder or not, find different reasons to avoid physical activity. It’s too cold outside! It’s too hot outside! roadblocks…

17. roadblocks to physical activity roadblocks... • I am just not in good enough shape. • I am too busy to exercise. • My joints are so badly damaged there’s no point in trying to get in shape. • My parents won’t let me. • I have a bad knee and am afraid of hurting it. • I don’t like exercise. I prefer quiet activitites. • I have an inhibitor... Each of these statements contains an element of truth, a reason why physical activity may be more difficult. Keep your reasons in mind as we go on to the next section: choosing the right activities! roadblocks

18. choosing the right activities before you start a new activity... • Speak to your physiotherapist who can help you to identify any joint or muscle problems that may affect your ability to participate in your chosen activity. • Consider having some baseline measurements done, such as heart rate, muscle flexibility, strength or % body fat. Then repeat these measures after a period of time to measure the effect of physical activity on your body. choosing…

19. choosing the right activities what do you like to do? • Individual or team activities? • Recreational or competitive level? • Indoor or outdoor? • Summer, winter or year-round? what do you know about the activity? • Do you know someone who has done it? • Have you seen it done? • Have you tried it? • Is there any preparation or equipment needed? • How much does it cost? • Is there good coaching/supervision available? • What types of injuries are possible? choosing…

20. choosing the right activities assess yourself / your child • Do you need prophylaxis? • Do you have a target joint? • Do you need to protect certain joints with braces or splints? • Have you spoken to your physiotherapist? • Do you need to build up strength/improve flexibility before you begin? start slowly • Try a few sessions before you commit yourself. • Have a plan for dealing with injuries. • Keep a record (once you start the activity): • Are you having MORE or FEWER bleeds? • Are you using MORE or LESS factor? choosing…

21. choosing the right activities categories of risks • Several attempts have been made to classify sports and activities by risk: • WFH “Go for It!” • NHF “Hemophilia Sports and Exercise” • You need to look at the… • potential for injury - Some activities are rough. • type of injury - Injuries may be infrequent but when they do occur they are very serious (e.g. head injury). remember! • Injuries related to sports and activities are caused by: • contact with players, objects, equipment; • speed (loss of control, collision); • force of impact; • unpredictable conditions; • height; • overuse (repetitive strain). choosing…

22. choosing the right activities think once! • Considered safe for most people with bleeding disorders • Tend to be individual, not team, activities • Tend to use little or no equipment • May still pose problems for some individuals, e.g. target joints, inhibitors, poor coordination Examples Tai Chi ▪ yoga ▪ swimming ▪ bicycling ▪ golf fishing ▪ hiking ▪ walking ▪ sailing ▪ canoeing ▪ kayaking choosing…

23. choosing the right activities think twice!! • Can cause some injuries, but can be fun to do with friends • Usually need some preparation: • learn skills and rules; • have proper equipment; • might need prior conditioning. • Involve more speed and potential for collision Examples badminton ▪ basketball ▪ baseball ▪ bowling ▪ tennis ▪ skating volleyball ▪ cross-country skiing ▪ running ▪ soccer ▪ hackeysack choosing…

24. choosing the right activities think again!!! • Because of the speeds involved and the risk of collision or body contact, these sports can cause serious injuryeven in people who do NOT have bleeding disorders. • These may seem like fun to do, but the types of injuries can be serious, even fatal. Examples football ▪ hockey ▪ downhill skiing ▪ rollerblading skateboarding ▪ karate/judo ▪ snowboarding ▪ wrestling boxing ▪ taekwondo ▪ dirt bike racing ▪ racquetball ▪ snowmobiling choosing

25. conclusion Being in good physical health doesn’t mean you have to go to the gym every day or push yourself until you hurt. Not every activity is for everyone. There are many things to consider when you choose a physical activitity. Your physiotherapist can help you decide if you should think once, think twice… or think again. The most important thing to remember is to listen to your body. Know your limits and don’t push past them. choosing

26. acknowledgements The CHS would like to acknowledge those people who contributed to the development of Destination fitness. Clare Cecchini National Program Manager, Canadian Hemophilia Society (retired) Karen Creighton Member, Hemophilia Ontario, Mississauga, ON Andrea Hann, PT Janeway Child Health Centre, St. John’s, NL Pamela Hilliard, PT Hospital for Sick Children, Toronto, ON Kathy Mulder, PT Children’s Hospital, Winnipeg, MB Raymond O’Shaughnessy Member, CHS Quebec Chapter, Terrebonne, QC David Page National Executive Director, Canadian Hemophilia Society Patricia Stewart Member, CHS Quebec Chapter, La Durantaye, QC Kristy Wittmeier Physiotherapy Innovation & Best Practice Coordinator, Winnipeg Regional Health Authority Nick Zourikian, PT CHU Sainte-Justine, Montreal, QC

27. Bon Voyage! Travelling with a bleeding disorder Charting your course Home care: The road to independence Navigating the emergency department Roadmap for managing pain Destination fitness Supported by