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| Clinical risks to participating in physical exercise and the risk of injury associated with particular sports/activities Patricia Longmuir. |
Abstract
Clinical risks to participating in physical exercise and the risk of injury associated with particular sports/activities
Prevalent obesity and inactivity contribute to the function, pain, joint bleeding and quality of life impacts experienced by children at risk of severe bleeding, including those with hemophilia, non-hemophilia bleeding disorders or who are being treated with anticoagulants. Physical activity develops coordination, strength, and flexibility, increasing joint stability and function, maintaining bone density, reducing bleeding injury risk and improving clinical outcomes. Children with bleeding risk should align their lifestyle with the recommended 60 minutes of moderate (or higher) intensity aerobic activity daily, with flexibility and bone/muscle strengthening activities 2-3 days per week.
Multiple sets of recommendations are available to guide the physical activity participation of these patients. These recommendations were based on expert consensus, with some referencing sport injury database statistics among athletes and most published prior to current therapeutics. The current guidelines become problematic when they are contradictory (e.g., bowling is rated as high, moderate or low risk in guidelines from different organizations) or when children wish to participate in activities that are not specified in the guidelines (e.g., gym class, swimming or skating in a backyard or public facility).
The impact risks associated with children’s physical activity can be objectively assessed using digital video recordings to summarize the frequency, type, direction, body location and speed of impacts (i.e., falls, collisions with walls/players/equipment) that occur. Analyses using computer vision and artificial intelligence indicate that the speed and frequency of impacts during some permitted activities (e.g., school gym class) may be similar to restricted activities (e.g., karate lessons). However, whether these impacts constitute a risk of severe bleeding requires further research. Is it the frequency of impacts, the force/speed of impact, impacts to particular areas of the body or repeated impacts to the same location that increases the bleeding risk? Does impact risk vary by participant age, teacher/instructor/leader approach or other important variables? Utilizing computer vision and AI to identify bleeding risk (not simply impact risk) will make it feasible for us to provide objective, evidence-based information to patients, families and clinicians about appropriate physical activity settings for those with bleeding risk. Ultimately, the goal is to support patients and families with evidence-based guidelines that enable them to assess the risk of not only common childhood activities but also the unique activity experiences they may encounter (e.g., swimming with dolphins on vacation, tubing at the cottage).
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