By Michael Zolotnitsky, PT, DPT
Growing up with hemophilia made waking up with bruises, joint pain, or the inability to bear weight on my ankles a normal occurrence. Time and time again, my mother had to drive me to the local hematology clinic to have factor infused. I did not feel like a normal child. I let hemophilia bring me down and hold me back from living the life I wanted to live.
During a clinic visit when I was 12, my hematologist encouraged me to become more physically active. He suggested aquatics and that ignited a glimmer of hope within me. He explained that aquatic activity would exercise my joints in an unstressed environment. It was time to stop letting hemophilia hold me back and start working towards feeling like the other children. I was full of determination, and began a routine of aquatic therapy, weight training, and healthy eating. Just a year later I was infusing only on a prophylaxis regimen; I’d lost weight; and I’d actually begun playing basketball: I had never felt better! There was no turning back!
“It was time to stop letting hemophilia hold me back.”
For the past 13 years I’ve worked hard to prevent complications and joint bleeds by eating healthy foods, infusing independently on a prophylactic basis, participating in activities including aquatic exercise, running, weightlifting, and basketball, and being aware of my surroundings. The changes I saw in the way I looked and felt, and my ability to overcome the challenges of hemophilia and manage my bleeding disorder, motivated me to pursue a career in physical therapy. In 2014, I graduated from Chatham University with a Doctorate in Physical Therapy and began working in an orthopedic clinic in Old Bridge, New Jersey.
I am an advocate for aquatic therapy in conjunction with land-based exercise. I seek to motivate others with bleeding disorders to feel better both physically and emotionally. Recently, I developed a relationship with HFA through their Blood Brotherhood program to inspire individuals of all ages to stay active and ensure that they are never timid about pursuing an activity simply because of their bleeding disorder. I have been fortunate to have given several presentations on exercising with a bleeding disorder to the Blood Brothers of New Jersey, Indiana, and Rhode Island. Topics in those presentations have ranged from sharing pain management strategies, to discussing safe sports for the dads who have kids with hemophilia, to an actual aquatics exercise session.
At 26 years old, I look back at the past half of my life and take pride in my hard work. I’ve pursued a healthy lifestyle, suffered no major joint bleeds, and have now run three marathons in one year. I’ll continue eating healthy foods, training with weights five or six days a week, and bringing my story to hemophiliacs across the country to persuade everyone: never settle for life as a couch potato!
What the research says:
- The biggest benefit to working out in the pool is that the patient can offload about 65% of his or her body weight through the buoyancy of the water. That helps increase strength and function, free up range of motion, and reduce swelling and pain.1
- Implementing a training program comprising 30-minute sessions each of swimming, cycling, basketball, and yoga 3x/ week will significantly reduce hemarthrosis (bleeding into the joint) and increase range of motion.2
- Aquatic exercise statistically and significantly improves knee and hip flexibility, strength and aerobic fitness. A recent study showed that an overwhelming majority (81.7%) of people were able to stick with the program and no exercise-related adverse effect was observed or reported.3
- Other positive effects of aquatic therapy include: a decrease in fatigue levels and an increase in aerobic capacity; weight loss at the waist (50%) and neck (85%); decreased heart rate and blood pressure while in the water; improvement of blood circulation to the muscles; relaxation of muscles for a better stretch; enhanced mobility; added pain relief; more controlled breathing; and the benefit of being able to exercise multiple joints at the same time.4
Looking for other great ways to get in shape while managing your bleeding disorder? Check out HFA’s Healthy Bodies Bleed Less Toolkit!
- Check with your health care provider, physical therapist, or HTC to make sure aquatic exercise is right for you.
- Wear water shoes to prevent cuts while in the water as well as ankle bleeds from contact with the hard surface.
- Seek out a physical therapist to supervise your first couple of sessions.
- Be monitored by someone if you’re not yet a confident swimmer.
- Take it easy! Don’t overwork! Your muscles will be sore later even if they do not feel like they are working in the water.
Aquatic Exercises to Try
Walking—Walking forward and backward in chest-high water works the leg muscles while exerting no impact of the knees or hips. This is particularly important for people who have arthritis in those joints.
Side Lunge—Face the pool wall and take an oversized step to the side. Keep toes facing the wall of the pool. Repeat on the other side. Try three sets of 10 lunge steps. For variation, you can lunge-walk in a forward or sideways direction instead of standing in place.
Push-Ups—While standing in the water by the side of the pool, place your hands shoulder-width apart on pool edge. Press weight through your hands and raise your body up halfway out of the water, keeping elbows slightly bent. Hold for three seconds and slowly lower into pool.
Michael Zolotnitsky is an orthopedic physical therapist in Old Bridge, New Jersey, specializing in working with post-surgical patients, young athletes, older adults, people with post-concussion syndrome, and patients with neurological disorders such as multiple sclerosis and Parkinson’s disease. He was diagnosed with severe hemophilia A as a child and is committed to helping individuals in the bleeding disorder community. His long-term goal is to conduct research on developing exercise regimes that are safe for people with bleeding disorders, in order to encourage everyone to prevent bleeds and live a long, healthy life through physical activity.
*Before beginning any new activity, or if you are having joint or bleeding problems, make sure you check with your physician or physical therapist.
1“Physical Therapy and Aquatic Therapy: Land and Pool Based Therapy for Those with Bleeding Disorders,” Hemaware, 2012
2“The Effect of Aquatic Exercise Therapy on Muscle Strength and Joint’s Range of Motion in Hemophilia Patients.” 2013
3“Effects of aquatic exercise on flexibility, strength and aerobic fitness in adults with osteoarthritis of the hip or knee.” 2007
4“The effect of aquatic exercise therapy on muscle strength and joint’s range of motion in hemophilia patients.” 2013