How to Exercise With Hereditary Angioedema

Staying active is an important component of a healthy lifestyle — it improves heart health, builds strength, and supports mental well-being. For people living with hereditary angioedema (HAE), a rare genetic condition that causes sudden swelling episodes, physical activity is a little more complicated.

While regular exercise comes with lots of benefits and may even help with disease management, it also may trigger an attack in some people.

The good news is that most people with HAE can enjoy some level of physical activity.

“Participation in sports and physical activities is generally safe when the disease is well-controlled and on-demand therapy is readily accessible,” says Yael Gernez, MD, PhD, clinical associate professor of pediatrics in immunology and allergy at Stanford Medicine.

The goal is finding the sweet spot — identifying exercises or sports that you enjoy and that support your health while minimizing the risk of triggering an attack. It’s also important to talk with your healthcare provider before starting any new physical activity or exercise program.

“Regular communication with a healthcare provider who is knowledgeable about HAE and your history is essential,” says Dr. Gernez.

But general recommendations on exercise and HAE are limited by a lack of direct research, she says. “Current recommendations are based on expert consensus and extrapolating from clinical guidelines.” That’s why it’s important to discuss exercise plans with your healthcare provider.

Exercise may help manage stress, a known trigger for HAE attacks, says Gernez. “Although direct evidence is limited, regular physical activity is considered a beneficial stress-reduction strategy and may help reduce attack frequency by alleviating emotional stress,” she says.

The reality is that some forms of exercise can increase the risk of swelling. Attacks may be triggered by:

• Physical trauma
• Pressure
• Vibration
• Intense exertion
• Emotional stress during activity

Low-impact, noncontact activities are generally the safest for people with HAE, especially for people with frequent or poorly controlled attacks. These options let you reap the benefits of movement without putting unnecessary stress on the body.

Gernez recommends the following:

• Walking or light hiking are simple, accessible ways to stay active and also to manage stress.
• Swimming is gentle on the joints and poses minimal risk of pressure-related swelling.
• Yoga or Pilates, with their focus on breathing as well as on building strength, may also help with stress control.

“An individualized exercise plan and regular communication with knowledgeable healthcare providers are essential. Coaches or supervisors should be informed of the condition, and on-demand therapy should be available during activities,” Gernez says.

Certain activities carry a higher risk of triggering swelling and are best avoided or approached with caution, especially if your HAE isn’t controlled:

• Contact sports (football, hockey, martial arts) because of trauma and injury risk
• High-impact activities (long-distance running, intense aerobics), which may increase exertion-related attacks
• Pressure-heavy activities (rowing, canoeing, long cycling sessions) where repeated pressure against one body area can trigger swelling

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• Endurance events that push the body to — or past — its physical limits
• Competitive sports or high-pressure situations

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If a potentially risky sport is important to you, discuss it with your doctor. In some cases, with strong preventive treatment and immediate access to on-demand medication, it may be possible to participate more safely.

• Talk With Your Healthcare Team Ask about preventive treatment strategies and whether your exercise routine should be adjusted.
• Keep Medication Readily Available Always carry your on-demand treatment in case an attack begins during an activity. If you’re in a supervised setting, such as a gym or exercise class, let staff know about your condition.
• Warm Up and Pace Yourself Gradually build intensity instead of jumping into vigorous activity.
• Stay Hydrated Dehydration can increase stress on the body.
• Avoid Overdoing It Balance consistency with moderation. If a particular activity regularly triggers swelling, it may not be the right fit.

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• Exercise has lots of benefits for people with hereditary angioedema (HAE), including stress reduction, better sleep, and improved heart health, but it needs to be discussed with a healthcare provider.
• Some activities can trigger swelling, especially those involving trauma, pressure, or high intensity, so low-impact options like walking, swimming, and yoga are usually the safest choices.
• Because airway attacks, while rare, can be life-threatening, it’s essential to have an individualized plan, carry on-demand medication, and let coaches or exercise partners know about your condition.
• Research on exercise and HAE is limited, so work closely with your healthcare provider to find the right balance between staying active and minimizing risks.