VERONIQUE BEETS
Veronique Beets is Physiotherapist, Wellington Haemophilia Treatment Centre, New Zealand
Thriving as we age with a bleeding disorder
Not so long ago, people with bleeding disorders had significantly shortened life expectancies. Physical exertion was actively discouraged, for fear of triggering bleeds. Thankfully, today things are very different. Modern prophylaxis (preventive treatment) and personalised care mean many people with bleeding disorders now live long, active lives well into older age. This brings a new challenge for clinicians, helping our patients manage the physical changes that come with ageing. Exercise is one, if not the best, tool we have for that.
Ageing brings its own health considerations – heart health, metabolic changes, joint preservation – and for people with bleeding disorders, these sit alongside the joint and bleed management many of us already think about daily.
But the benefits of regular exercise go well beyond the joints.
Aerobic activity builds cardiovascular fitness and helps manage weight, which reduces day-to-day load on target joints.
Strengthening the muscles around a target joint improves stability and may reduce both pain and bleed episodes.
Weight-bearing and resistance exercise also helps support bone density, which tends to run lower in people with bleeding disorders.1
Balance and functional strength training lowers fall risk, increasingly important as we get older.
And exercise supports better sleep, mood and cognitive health, cutting the risk of anxiety and depression too.
The evidence backs this up. Regular physical activity is linked to about a 19% lower risk of heart disease and stroke, a 17% lower risk of type 2 diabetes, and up to a 28% lower risk of certain cancers.2 For older adults specifically, structured exercise programmes cut the rate of falls by roughly a fifth,3 which matters a lot when you’re already managing joint damage.
So how much do we actually need? The World Health Organization’s guidelines apply well to most people with bleeding disorders and give a clear, workable weekly target:2
Aerobic activity: at least 150 to 300 minutes of moderate-intensity activity (anything that makes you breathe faster and gets your heart rate up) per week, or 75 to 150 minutes if it’s vigorous. Depending on your own physical circumstances, the activity can vary from walking, swimming, aqua jogging to tennis.
Strength: muscle-strengthening (pushing and pulling movements) activity covering all major muscle groups, on 2 or more days a week. This is a vital component to help maintain bone density.
Balance: for older adults, varied activity that emphasises functional balance and strength, on 3 or more days a week, to maintain function and prevent falls. However, it is recommended you start working on balance before you notice a problem (e.g. tai chi, yoga, specific falls prevention programmes).
Every move counts: if you can’t hit these targets, any activity helps. Start small and build up.
These targets are safe and achievable for most people with bleeding disorders, but should always be tailored with your HTC physiotherapist, particularly around higher-impact activity, contact sport, and factor cover for more vigorous sessions.
To turn all this into something practical, here’s an example close to home: community-based exercise groups offer a safe, structured space to actually get moving.
We run one such group weekly in Wellington, New Zealand, at one of our community hospitals, established more than ten years ago by the Haemophilia physiotherapist and still going strong today. It’s a two-hour session each week, split between land and water.
Full disclosure: it’s not two full hours of exercise! There’s plenty of time for socialising too—which is probably everyone’s favourite part (along with the Christmas lunch—thank you, HFNZ!).
The Gym Session: Structured functional movement, progressive resistance work with light weights or resistance machines, and some gentle aerobic conditioning to build core stability and support target joints.
The Hydrotherapy Session: The pool offers real advantages for recovery from acute bleeds, ageing joints and chronic arthropathy. Buoyancy eases load on weight bearing joints such as spine, hips, knees and ankles for low-impact movement. Hydrostatic pressure helps circulation and reduces chronic joint swelling. And the natural resistance of the water provides a safe way to strengthen muscle without high-impact forces that come with exercising on land.
Suitable for all: the group ranges in age from thirties to eighties, both men and woman, and physical ability varies from mobility restricted to mostly wheelchair-based to being able to play tennis. The goal is your own individualised programme, with the benefit of exercising alongside others.
While the physical gains are important, social connection is just as powerful.
Our participants proudly named themselves the ‘Masters Group’. It’s open to anyone: some attend weekly, others drop in when the need arises, particularly after a flare-up or acute bleed, and just knowing the group is there every week is a benefit in itself.
Exercising together builds peer support, shared learning and real friendships. Members motivate, encourage and support one another. Often, that’s the difference between showing up on a low-energy week and staying home. Shared conversation, our vital ‘talk therapy’, does as much for mental wellbeing as the pool does for joint health.
In their own words
‘For at least 10 years, a like-minded group of us have met at Kenepuru Hospital under the watchful eye of our treatment centre physiotherapist. Many of us would not be nearly as active without the group’s exercise and swimming — we’re extremely grateful to our local health board for supporting it.’
‘I’m grateful for the Masters Group — it’s been through a few permutations, a lot like my joints! My mantra is ‘use it or lose it’, and I’m inspired by fellow members with significant physical challenges who keep showing up with a positive ‘let’s go’ attitude.’
‘I get a lot of inspiration from the members with severe conditions. It’s a friendly, sociable, inclusive group — we exercise, laugh, talk sport, check in on each other, and have fun.’
Whether you’re managing existing joint damage or taking your first steps toward an active routine, it’s never too late. Exercise really is medicine, for the heart, the mind, the bones, and for quality of life generally.
Always check in with your Haemophilia Treatment Centre (HTC) physiotherapist or healthcare team before starting something new, so it’s tailored safely to you.
To find local support, reach out to your local Haemophilia Foundation or HTC.
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