Stretch Out

for Haemophilia
and Exercise
Your guide to exercises with
the stretch band

R R

This booklet was developed by

the NNHF Brazil 2 project team
The following exercises
can help you
improve strength and mobility
as well as balance.
Exercises with the Care of the
stretch band stretch band
Supervised physical activity has a direct impact on your quality of life. There are no “exercises for haemophilia”, • Do not use the elastic band if you are allergic to latex
different exercises serve different purposes and the situation of each person is unique. or to the material of the band.
• Whenever you see thinning or cracks in the elastic
General observations band, do not use it, you need to replace it.
• These exercises can help you improve strength, mobility, function and balance, but should not be carried • Protect your eyes during the exercises.
out without consulting your physiotherapist about the implementation of the proposed exercises for • Avoid leaving the band in the sun or close to high
your specific situation. No pre-designed programme of exercises can cover the needs of all people with temperatures.
haemophilia. • After using the band, use talcum powder to store it.
• Do not do the exercises if you suspect a bleeding or if there was a recent bleeding episode, especially if you This increases the lifespan. Also, keep it in a closed
have not recovered all the mobility you had before. bag.
• No exercise should produce bleeding, pain or any discomfort (dizziness, headache, shortness of breath). • Check the website of the producer for further infor-
If this happens, contact your doctor. mation about its care.
• Some exercises may vary according to the movements you can perform. You might not be able to do them
in their maximum amplitude. Respect your limits.
• After orthopaedic interventions, consult your physiotherapist and doctor about the most appropriate
moment to initiate the exercises with the elastic band.
• If you have any pain or difficulty in performing the exercise, stop and consult your physiotherapist.
• Always remember to perform the exercises in a safe environment, with enough space to keep a proper
balance and to perform the movements.
• The exercises should be performed slowly and in a controlled manner, breathing steadily and smoothly.
Never hold your breath.
• The elastic band should be tight throughout the movement, but not at its maximum, especially in the early
days of training.
• Start with a few repetitions (2 series of 5 movements) and increase gradually until you reach 3 series
of 10–12 movements for each exercise, with comfort. Relax for at least 10 seconds between the series of
exercises. Your physiotherapist is the most appropriate person to adapt the adequate progression of the
exercises to your case.
• Always keep a good body alignment during the exercises, with contracted abdomen and relaxed knees.
• If you experience irritation in the hands, you can use protective gloves to hold the elastic band. The edition and printing of this work is supported by a
• There are accessories that facilitate the use of elastic bands (straps and fasteners). grant from the Novo Nordisk Haemophilia Foundation.

1
FOR LOWER BODY AND TRUNK
EXERCISE
1 Wrap the centre/middle of the band
around your right foot. With the elbow
extended, hold the band on the side of
the body, holding it with slight tension.
2 Keeping the abdomen tight, bend your
elbow at the same time as you bend your
knee and then straighten the leg back.
3 Slowly return to starting position and
complete the series of repetitions before
you repeat the exercise with the left leg.
4 If necessary, find arm support on the op-
posite side, keeping your back straight
and not leaning your body forward.

R R NOTES

2
FOR LOWER BODY AND TRUNK
EXERCISE
1 Sit comfortably with your feet parallel
and apart, in the same direction as the
hips, holding the band down firmly with
both feet on the ground.
2 With your arms straight, hold the band
with slight tension.
3 Keep abdominals tight and lean forward
with your back straight, to get up.
4 Maintain the shoulders up, with a good
posture, without letting the band pull
them down.
5 Return to starting position slowly.

R R NOTES

3
FOR LOWER BODY AND TRUNK
EXERCISE
1 Sit comfortably, with the band around
the right foot and the left foot holding
the band on the floor and the left hand
firmly holding the ends of the band.
2 Make a movement with the right foot
upwards and out to the right.
3 Hold for 5 seconds and slowly return to
the starting position.
4 After completing the series, repeat on
the other side.

R NOTES

4
FOR LOWER BODY AND TRUNK
EXERCISE
1 Sit comfortably, with the band around
the right foot with your right forearm
pulling the band. The starting point of
the exercise is performed with the sup-
port of only the lateral edge of the right
foot.
2 The exercise is performed when you try
to overcome the resistance of the band
on the inside of the foot directing it to
the ground.
3 Hold for 5 seconds and slowly return to
starting position.
4 After completing the series, repeat on
the other side.

R NOTES

5
FOR LOWER BODY AND TRUNK
EXERCISE
1 Standing with your left leg forward
stepping on the middle of the band,
firmly grab the ends of the band keep-
ing your elbows bent with the hands on
your chest.
2 Keeping your right leg back, with the
knee slightly flexed, bend both knees
slightly, so that the left knee is directed
to the front and the right down.
3 Keep the abdominals tight to stabilise
your spine.
4 Slowly return to the starting position.
5 After having completed the series,
repeat on the other side.

R NOTES

6
FOR LOWER BODY AND TRUNK
EXERCISE
1 Standing with one foot on the middle of
the band facing forward, firmly grasp
the ends of the band with extended
arms and straight back.
2 Perform a mini-squat, supported by a
slight knee flexion.
3 If necessary, hold on a stable surface to
keep your balance. Hold for 5 seconds
and return to the starting position.
4 After doing a series with the right arm,
repeat the movement, changing the
position of the legs for the left arm.

R NOTES

7
FOR LOWER BODY AND TRUNK
EXERCISE
1 Laying with bent legs, arms extended at
your sides, palms down, hold the band
over the abdomen and hold it to the
sides of the trunk.
2 Lift the hip against the resistance of the
band, holding for 5 seconds and slowly
descending.

U NOTES

8
FOR LOWER BODY AND TRUNK
EXERCISE
1 Sitting and keeping your back straight
and legs extended, place the band on
the forefoot and move your toes down.
2 Hold for 5 seconds and slowly return to
starting position.

If you have difficulties in keeping this

posture, try bending one leg while the
other leg it doing the exercise.

T NOTES

9
UPPER LIMB AND SHOULDER GIRDLE
EXERCISE
1 Lying down, with elbows bent and fore-
arms facing upwards, firmly grasp the
band facing the palms to your face.
2 Keep one arm still while the other leads
outwards towards the floor.
3 Hold for 5 seconds and slowly return to
starting position.
4 After completing the series, repeat on
the other side.

This exercise can also be done with the

palms of the hands facing the legs.

R NOTES

10
UPPER LIMB AND SHOULDER GIRDLE
EXERCISE
1 Lean on a stable surface with your left
leg slightly bent directed to the front,
holding the band with the foot.
2 Keep your right leg back, with relaxed
knees and upright.
3 Holding the band with the right hand
and extended elbow, pull up towards
your shoulder, hold for 5 seconds and
slowly return.
4 After doing the exercise with the right
arm, repeat it with the left arm changing
the position of the legs.

R NOTES

11
UPPER LIMB AND SHOULDER GIRDLE
EXERCISE
1 Tie the band on a door handle or other
suitable surface and stand sideward to
it with the right elbow flexed and the
left extended.
2 Firmly grasping one end of the band
with the arm that is flexed in front of the
body, with the palm of the hand turned
to the body.
3 Extend the elbow toward the side of the
body. Hold for 5 seconds and slowly re-
turn to starting position.
4 After completing the series, repeat on
the other side.

R R NOTES

12
UPPER LIMB AND SHOULDER GIRDLE
EXERCISE
1 Tie the band on a door handle or other
suitable surface and sit on a chair. With
the upper body leaning a bit forward,
extended arms and the palms of the
hands directed downwards, grasp the
ends of the band firmly with slight
tension.
2 Flexing the elbows toward the shoul-
ders, move the trunk back, making the
movement as if you were rowing, press-
ing the shoulder blades together.
3 Keep the abdominals tight. Slowly re-
turn to starting position.

R NOTES

13
UPPER LIMB AND SHOULDER GIRDLE
EXERCISE
1 Tie the band to a door handle or other
suitable surface and stand sideways
with your right hand firmly grasping
one end of the band, with the elbow in
90° of flexion.
2 Pull the band bringing the hand to-
wards the body. Hold for 5 seconds and
slowly return to starting position.
3 After completing the series, repeat on
the other side.

R NOTES

14
UPPER LIMB AND SHOULDER GIRDLE
EXERCISE
1 To work the same part of the body, but
with another movement (external rota-
tion), stand sideways with your right
hand firmly grasping one end of the
band, with the elbow in 90° of flexion.
2 Pull the band away from the door han-
dle at the height of the middle of your
body.
3 Hold for 5 seconds and slowly return to
starting position.
4 After completing the series, repeat on
the other side.

R NOTES

15
 The “Stretch Out for Haemophilia
and Exercise” booklet
This booklet has been created as a joint effort between the NNHF Brazil 2 project team of the
Hemocentro of the University of Campinas and the Grupo MSK Brasil in order to stimulate the
practice of guided physical activity amongst people with bleeding disorders.

Grupo MSK Brasil is a group of nine physiotherapists from different regions of the country created
in collaboration with the Brazilian Federation of Haemophilia. The aims of the group are: Discuss
the musculoskeletical manifestations in haemophilia and elaborate a proposal for a national
model of musculoskeletal assessment standardisation for haemophilia.

The Novo Nordisk Haemophilia Foundation thanks the Grupo MSK Brasil and the Brazil 2 project
team for the creation of the “Stretch Out for Haemophilia and Exercise” booklet.

16
 Take care of yourself.
Invest in you!

Produced by NNHF, Zurich, 3/2012. Design and production: Branded Design, Copenhagen. Illustartions: Johannes Bojesen. Printed by Bording PRO 17
Improving access to care
for people
with haemophilia
Founded in 2005, the Novo Nordisk Haemophilia Foundation (NNHF) is a non-profit organisation
dedicated to funding development programmes that improve access to care for people with
haemophilia and allied bleeding disorders in the developing world. In collaboration with local
partners and internationally renowned experts, the Foundation’s programmes and Better Practice
Sharing activities address three focus areas: capacity building, diagnosis and registry as well as
education and awareness raising.

Novo Nordisk Haemophilia Foundation

Andreasstrasse 15
8050 Zurich Oerlikon
Switzerland
Tel + 41 43 222 43 00
info @nnhf.org
www.nnhf.org