Oefeningen bij hemofilie — gewrichtsbescherming, factor-bewust, NSAID-vermijdend

The 2020 WFH (World Federation of Hemophilia) guidelines by Srivastava et al. + Tiktinsky 2002 established the modern framework: regular exercise PROTECTS joints in hemophilia via muscle strength + proprioception that reduce bleed risk. Prophylactic factor replacement (emicizumab + recombinant factor concentrates) enables near-normal activity for many. AVOID contact sports + collision sports without prophylaxis + ortho clearance. AVOID NSAIDs (ibuprofen, naproxen, aspirin) for pain — bleeding risk; acetaminophen + opioids are first-line under medical guidance per WFH. Joint bleeds (hemarthrosis) require immediate RICE + factor replacement + medical evaluation. Strength + low-impact aerobic + swimming are evidence-based. Inhibitor status (antibodies against factor) affects treatment + activity recommendations. The exercise priorities are therefore: strength + proprioception around vulnerable joints (knees, ankles, elbows historically; shoulders + hips also), low-impact aerobic, posture + posterior chain to protect spine, breath/parasympathetic anchors. AVOID contact sports without ortho + hematology clearance.

Volya's catalogue carries the foundation moves chosen for joint protection: supported-glute-bridge for posterior chain that protects knee + hip joints, wall-push-up for upper-body strength scaling without high-impact, scapular-retraction for shoulder + elbow joint protection, cat-cow for spinal mobility, supine-knee-to-chest for low-back release, quad-set for VMO + knee protection (critical for hemophilia knee health), calf-raise-rehab for posterior-chain + ankle protection, ankle-pump for venous return + ankle mobility, diaphragmatic-breathing for parasympathetic regulation. The AI coach also knows the nutrition side — protein 1.2-1.4 g/kg/day for muscle around vulnerable joints, iron consideration (chronic blood loss may cause deficiency — annual ferritin labs; iron supplementation per hematology if deficient; AVOID empirical iron without labs), vitamin K CONSISTENT intake from leafy greens (NOT avoidance), calcium 1000-1200 mg + vitamin D 1000-2000 IU for bone health (hemarthropathy + immobilization bone loss), anti-inflammatory (omega-3, Mediterranean) supports joint health, alcohol AVOID excess (platelet function + factor metabolism), AVOID NSAIDs for pain (bleeding additive — acetaminophen + opioids first-line per WFH), AVOID herbal supplements that affect bleeding (ginkgo, garlic, ginseng, ginger high-dose, vitamin E megadose) without hematology clearance. CRITICAL: hematology + Hemophilia Treatment Center (HTC) + National Hemophilia Foundation + World Federation of Hemophilia + 988. Joint bleed = RICE + factor + immediate medical evaluation. This is NEVER a replacement for hematology care.