Activity Ratings Chart

O– An elliptical trainer is a workout machine that mixes parts of a bike, a stair stepper, and a ski machine. Some even have poles to help you exercise your arms too! It gives you a good cardio workout and is gentle on your joints, which means it’s easier on your knees and hips, and can provide a good substitute for higher impact activities.25

R– Using an elliptical machine is usually safe, but there are a few things to watch out for. Some people may feel knee pain, especially if they’ve had knee problems before or if they pedal with poor form. Doing the same motion over and over can make some muscles too strong while others get weaker, which might lead to injuries. Going too fast or using too much resistance can strain the muscles in your hips. Also, wearing the wrong shoes can increase the chance of getting sprains or strains. To stay safe, it’s important to use good form, wear proper shoes, and not push too hard.26

S– Practice good form and posture: shoulders back, head up, chin straight, abdominals tight and arms relaxed. Rest hands lightly on the handrails to help with balance (or use the workout bars if available). Try not to lean forward or grip the bars tightly. If needed, lower the resistance level. Pedaling forwards and increasing incline targets quadriceps strength.  Individuals with knee problems may improve comfort and performance by pedaling backwards at relatively lower inclines.27

O: Exergaming, also known as active video gaming, uses motion sensors, cameras, or wearable tech like the Kinect, Wii, or VR headsets to get players moving through activities like dancing, jumping, or running.63 These games aim to improve cardio, strength, coordination, and flexibility while keeping the experience fun. The goal is to reach moderate intensity—raising your heart rate, breathing faster, and feeling warm, yet still able to hold a conversation. Popular titles include Just Dance, where players follow dance routines; Ring Fit Adventure, which uses a ring controller for guided workouts; and Beat Saber, a VR game where players slash blocks to music. Exergaming blends fitness and fun into one active experience.64 65

R: Overexertion can result in muscle strains and irritation of tendons, the strong tissue that connects muscle to bone. Injuries may also result from hitting another player or object in the room

S: Make sure you are exercising in an open, uncluttered area and that there is adequate space between players. Controlled movement using good form is important to prevent injury. Listen to your body. Start slowly and increase time and intensity slowly. Do not exercise through pain. Contact your treatment team if you develop ongoing pain or muscle or joint bleeds, especially if the pain does not respond quickly to intervention.

O: Fencing is a competitive sport where two individuals duel with swords, aiming to score points by hitting specific target areas on their opponent. It features three types of weapons: Foil, Épée and Sabre. Known as “physical chess,” fencing blends athleticism with strategy, timing, and precision.

R: Fencing is considered a lower risk contact sport. Each weapon’s blade is flexible and designed to bend—not stab—on impact. With the use of proper protective gear—masks, jackets, gloves, and underarm protectors—serious injuries are rare. Still, injuries can occur. Most are minor skin issues like blisters, cuts, and bruises. The sport’s quick, dynamic movements can lead to sprains and strains, especially in the knees, ankles, and thighs. Repetitive training may also cause overuse injuries in the elbow and knee, and though uncommon, fractures are possible. Muscle and/or joint bleeds would likely accompany sprains/strains, or fractures.67 68

S: To increase safety, always wear full protective gear—mask, jacket, glove, and underarm protector. Follow the rules and only fence in supervised settings. Focus on perfecting your form, especially grip and footwork.

O– There are many types of fishing, including saltwater fishing (like deep sea or surf fishing), freshwater fishing (such as boat or fly fishing), bowfishing, and ice fishing.69 Each type offers a unique experience and may require different skills and knowledge.70 71

R– Fishing takes place in a wide range of environments—like piers, boats, oceans, rocky shores, ice, and rivers—and each setting carries its own unique set of risks. Risks can include stress, strain or bleeding in arm joints and/or muscles, as well as risk of falls on wet surfaces.

S– Think about safety each time you decide where to fish. Protect yourself from the elements and insects and wear appropriate clothing and shoes. Use safe handling with fishing knives, and when baiting, removing hooks and handling fish. Carry emergency/safety gear. Use life jackets and follow boating safety procedures. In case of a storm, head to shore if you can. Remember, you often need a fishing license for fishing, including catch-and-release. Each state has regulations about fishing licenses and daily limits.

O– Flag and touch football are safer, low-contact alternatives to tackle football and carry less risk. Playing flag football and touch football offers heart health benefits, can improve agility, and helps players develop skills in communication, strategic thinking, and teamwork.72 73 74

R– Although the sport does not include tackling, there is still a risk for collision between players, and injuries from light contact or falls. Common injuries include sprains, strains, and bruises. While rare, more serious injuries—such as fractures or concussions—are possible.75

S– Improve safety by participating in flag football or touch football in a supervised setting. Wear properly fitted protective gear (mouthguards, helmets, and flag belts). Follow the rules and listen to the referee to ensure a safe and fair game.

O– Football encourages teamwork. Playing football has heart health benefits and can improve agility.

R– Youth football, a high-contact, high-collision sport, is responsible for nearly half of all high school sports injuries. More than 80% of kids will experience an injury while playing football, with a potential risk of serious trauma to the head, spine, and extremities. For children with bleeding disorders, a traumatic injury—especially to the head or spine—can be extremely dangerous and even life-threatening.76 77 78

S– If you choose to play, speak with your healthcare providers prior to starting the activity. Wear protective gear and avoid playing positions with heavy tackling.

O– Recreational Frisbee involves sailing a lightweight plastic disk with a flick of the wrist.

R– Recreational Frisbee involves little risk. However, lengthy play could result in stress, strain or bleeding in arm joints and/or muscles.

S– Stop playing if you become overly tired, or if you feel any discomfort in arm joints or muscles.

O– Played recreationally or competitively, the object of the game is to throw the disc into the target in the fewest number of throws. Players use forehand, backhand or overhead throws to accomplish different goals and work on developing skills including hand-eye coordination. This sport can involve weighted discs.80

R– Repeated throwing carries a risk for elbow overuse injuries, as well as joint and muscle bleeding, especially when weighted disks are used. Those who prefer to use of forehand throws have been shown to carry an increased injury risk.81

S– Injury risk can be minimized by limiting the number of throws per day, using backhand throws instead of forehand, and allowing for recovery between play. Focus on proper form and listen to your body.

O– Ultimate is played by two teams of 7 players with a flying disk on a field with end zones, similar to a football field. Players score by catching a pass in the opponent’s end zone. Ultimate is considered a limited-contact team sport that can be played recreationally or competitively. Participants run, cut, guard, jump, throw, catch and dive to catch the disc.82

R–The high intensity play of ultimate presents a significant injury risk. Frequent cutting, jumping, diving, and occasional physical contact often result in injury to the knees, ankles, and shoulders. The sport also has a high (~25%) lifetime risk of concussions, a potentially serious, and even life-threatening, injury for players with bleeding disorders. 83 84 85

S– Consider opting not to play ultimate due to the substantial risk of head injury. If you do choose to play, start slow, and consider cross training for strength, flexibility and especially aerobic conditioning to support high intensity play.

O: Gamified fitness blends exercise with game-like features to make workouts more engaging and motivating. By incorporating elements such as points, levels, badges, leaderboards, and challenges, it encourages users to stay consistent and push their limits. Platforms like Peloton, Zwift, and Fitbit use these tools to transform fitness into a more interactive and rewarding experience. Supporting this, a 2023 study found that features like challenge, immersion, and social interaction significantly enhanced user engagement with gamified apps.66

R: Overexertion can result in muscle strains and irritation of tendons, the strong tissue that connects muscle to bone. Injuries may also result from hitting another player or object in the room.

S: Make sure you are exercising in an open, uncluttered area and that there is adequate space between players Controlled movement using good form is important to prevent injury. Listen to your body. Start slowly and increase time and intensity slowly. Do not exercise through pain. Contact your treatment team if you develop ongoing pain or muscle or joint bleeds, especially if the pain does not respond quickly to intervention.

O– Golf is a low-impact, lifetime sport that provides a better workout for those who walk the course rather than use a cart.86

R– Golfing injuries are usually related to limited flexibility and/or repetitive, high-velocity movement of the spine, arms and legs required during the golf swing. The more balls struck per week, the higher the risk of injury. The most commonly injured areas of the body are the back, shoulder and elbow.87

S– To avoid golf injuries, it is important to develop a solid swing technique. Prior to play, warm up with active flexibility exercises and warm-up swings, starting with the wedge and gradually working up to the driver.

O– Gymnastics is a sport that combines strength, flexibility, balance, coordination, and control through a variety of physical exercises. Athletes perform routines on apparatus such as the balance beam, uneven bars, vault, pommel horse, rings, and floor, often incorporating dynamic aerial movements.

R– Young gymnasts whose bodies are still growing and developing are at increased risk of injury due to their immature bones and joints, as well as the stress associated with repeated twisting, flipping and landing. The more difficult the routine (jumping dismounts or aerial moves), the higher the risk of injury. The most common injuries occur in the lower back, ankles, feet, knees, wrists, hands, often from overuse. Of greater concern for people with bleeding disorders is the inherent risk of traumatic injury, concussion and/or a bleed resulting from a blow to the head during a fall.88 89

S– Increase safety by using proper form and wearing recommended safety gear, such as wrist guards, hand grips, footwear and knee/elbow/heel pads. Make sure all equipment is in good working condition. Use safety harnesses and spotters when learning new skills. Avoid aerial skills. Look for a well-supervised setting that includes proper instruction, effective spotting, and well-maintained equipment. 90

O– These programs have been shown to improve cardiovascular fitness, while decreasing the percentage of body fat. HIFT includes programs like CrossFit®, a core strength and conditioning program composed of movements that are constantly varied at high intensity.55

R– Injury rates vary, as does the style of training. However, injury rates have been reported as high as nearly 75%.56 The risk is higher when exercises impact an old injury and/or are performed with poor form. Power lifting and Olympic lifting exercises, two main components of the CrossFit® program, are often linked to injury due to the high intensity and technical skills required for safe performance.

S– Participants are less likely to be injured when coaches are monitoring and correcting form. As with any strengthening program, proper form is key to injury prevention. Learn the skill before adding any weight. Adjust workouts to match fitness level and how the body feels on any given day. Monitor heart rate during workouts, consider using wearable tech to help with tracking. Increase intensity slowly and vary workout intensity. Include rest days to prevent overtraining. Participants may benefit from activity modifications to protect problem joints. Use modifications as needed, especially with activities that may stress areas of previous injury or bleeds.57

O– Hiking typically involves a long walk on dedicated paths or trails that may have sharp inclines or varied, rugged terrain. Walking is one of the lowest impact activities, allowing the heart health benefits of other aerobic activities, without the stress, strain and pounding that come with high-impact activity. Hiking can be a good social experience when done in groups, and it is an excellent lifetime activity. Gear needs vary by duration, distance, terrain and the environment.

R– Risks include getting lost, weather changes, wildlife encounter, falls, and over doing it. Physical challenges increase with terrain, altitude, and the amount of weight in your backpack. Ensure you have adequate water for the day as well as a plan of how you would return to your starting point if you had a lower extremity (leg) bleed or injury.

S–While overall risk is low, make sure to only hike on terrain that is appropriate for your ability. Pace yourself. Download offline maps and/or paper maps so you don’t have to rely on a charged phone and/or cell reception. Gear should include wearing appropriate clothing, sturdy shoes/hiking boots, water bottles with plenty of water, snacks, first aid kit, factor product and supplies, whistle, flashlight/headlamp, multitool, and a day pack. Day packs should not weigh more than 10% of your body weight. Using trekking poles can help your stability. Have a backup plan for returning to trailhead in case of injury or bleed.

O– Hockey is a high contact, high-impact sport, played on various surfaces, such as ice rinks, grass, and pavement.

R– Younger hockey players have a lower risk of high-impact, high-collision injuries. That said, injuries can still result from pucks, sticks, collisions, or falls. The rate of injury increases along with the size and the speed of players, especially after checking is introduced. Most injuries are of moderate severity and most likely to affect the lower extremity muscles. Concussions account for nearly 10% of all athletic injuries and can be serious, especially for individuals with bleeding disorders, where head trauma may lead to life-threatening outcomes. 91 92 93

S– Hockey tends to carry a lower risk of injury at less competitive levels, especially when players wear proper safety gear and are supervised. If you choose to play, always wear a helmet, padding, and the correct protective equipment. Injury risk increases with factors such as being female, playing in older age groups, having a recent or past injury, or a history of concussion. In contrast, lower injury rates are seen among goalies and in leagues that prohibit bodychecking. Of all risk factors, bodychecking policy remains the most important and modifiable, offering the greatest potential to reduce injuries in youth hockey.

O– Horseback riding can be safe for people with bleeding disorders, depending on how they participate and the precautions they take. Western and English riding differ in purpose, gear, and form. Western riding, developed for ranch work, uses a larger saddle with a horn and favors relaxed, one-handed control. English riding, with roots in European tradition, features a lighter saddle, two-handed reins, and focuses on precision and posture. With proper training, safety gear, and awareness, riders of all abilities can enjoy the benefits of horseback riding safely. 

R– Injury risk in horseback riding varies by activity. Leisure riding, such as trail or therapeutic riding, carries moderate risk. Though less frequent, serious injuries are possible and are often related to falling off the horse. Notably, horseback riding is a leading cause of sports-related head injuries. Other common injuries include sprains, strains, fractures, and dislocations.94 Injuries are more likely and often more severe with competitive events like jumping or racing.

S– Many horseback riding injuries are preventable. The most avoidable causes include broken tack, slipped saddles, and skipped safety checks. To reduce risk, stables should be well-maintained and staffed by trained professionals who ensure proper horse care. Riders should avoid walking behind horses, making sudden movements/noises, or riding animals with unknown temperaments. All equipment—girth or cinch, stirrup leathers, stirrups, and reins—should be safety-checked and adjusted by a trained professional before riding. Riders should wear sturdy, ankle-high boots (or higher) and, most importantly, a properly fitted helmet, which can reduce traumatic brain injuries by 50%.

O– Indoor cycling class is an indoor group ride on stationary bicycles with energizing music led by an instructor, aka Spin class. Bikes are arranged so that each participant can see the instructor. The workout is variable and can include sprints, slower pedaling and added resistance to simulate hills.58 59

R–Conditions such as severe muscle breakdown and injuries occurring from falling off of the bike have been reported and are more likely to occur during “jumps,” rapid pedaling and when performing arm exercises while pedaling.60 Other potential risks include leg or butt soreness or injury due to overuse or poor form, neck pain due to poor posture, kidney stress due to overexertion, and inadequate recovery time. Beginners may feel intimidated due to the intensity of the work, instructor, and other riders.

S– To minimize injury, adjust your bike to fit your body. Maintain proper form and posture while exercising. Proper equipment is helpful and includes cycling shoes and padded shorts. Adjust workouts to match fitness level and how the body feels on any given day. Monitor heart rate during workouts, consider using wearable tech to help with tracking. Increase intensity slowly and vary workout intensity. Include rest days to prevent overtraining. Participants may benefit from activity modifications to protect problem joints. Use modifications as needed, especially with activities that may stress areas of previous injury or bleeds.

O- Operating a personal watercraft (PWC) involves straddling a vehicle similar to a motorcycle and driving, potentially at high speeds, across the water. Driving a Jet Ski® requires balance and coordination and may provide a cardio workout.95

R– This activity carries notable risks for anyone who participates, because a major accident can result in serious, potentially life-threatening injuries. The small size of PWCs makes it difficult for other boaters to see them. It’s harder to see what’s around you when driving a Jet Ski® quickly, especially if another boat is also moving fast. Most accidents happen because drivers aren’t paying attention, don’t have enough experience, go too fast, break boating rules, or have been drinking alcohol. Bad weather, unsafe water conditions, and trouble guessing where other boats are headed can also cause accidents. The most common PWC-related injuries are cuts, fractures, head injuries, sprains/strains, and internal injury. Though rare, spinal cord and traumatic brain injuries are possible.96

S– PWC drivers can minimize the risk of injury by following all US Coast Guard safety guidelines. Anyone driving a PWC should complete a boater safety course and may be required in some states. Wear a US Coast Guard-approved life vest or personal flotation device. Always attach the engine shut-off cord (lanyard) to the wrist and keep it free from the handlebars so that the engine stops if the driver falls off. Ride within your limits, stay alert to your surroundings and avoid aggressive driving. These measures will help reduce the risk of losing control, being thrown off the PWC and collision. Please check your state’s boating laws because rules can be different.

O– An excellent form of cardio exercise with muscle toning benefits, jumping rope can provide an intense workout. There are a variety of footwork patterns that can be practiced that can also improve agility and coordination. When performed with proper technique, this is a relatively low-impact activity because you only jump high enough to clear the rope (about one inch off the ground).

R - The most common injuries associated with jumping rope include sprained ankle, shin splints, lower leg muscle strain, and planar fasciitis. Because the activity is generally performed on the balls of the feet, this may cause stress to the ankles of people with bleeding disorders who have joint damage.97 98

S– Minimize impact by wearing proper footwear and practicing on a wood or rubberized surface versus a hard surface, such as concrete. Use a rope that is the proper length to decrease the risk of falling. Use good form when jumping and listen to your body.

O– Lacrosse is a fast-paced, high-contact sport played between opposing teams using a small, hard rubber ball and long-handled sticks. The game involves frequent collisions, including body and stick checking, making it physically demanding. Despite its intensity, lacrosse offers valuable benefits such as improved cardio and the development of teamwork and coordination skills.

R– Injuries, some serious, are common in lacrosse and can be serious. Concussions, sprains, and strains are among the most frequent. More serious injuries may involve the head, eyes, neck, spine, or limbs. Notably, lacrosse has a higher average annual concussion rate than American football. The causes of concussion differ by gender: female players are more likely to be injured by contact with the ball or stick, while male players more often sustain concussions from hitting the ground.99 100

S– If you decide to play lacrosse, wear padding and protective headgear, including a mouth guard.