Exercises for antiphospholipid syndrome (APS) — bleeding-cautious on warfarin, AVOID prolonged immobility, hydration

Miyakis 2006 Sapporo + Sydney 2023 ACR/EULAR antiphospholipid syndrome criteria. APS is defined by antiphospholipid antibodies (lupus anticoagulant, anti-cardiolipin, anti-β2-glycoprotein-I) + thrombosis (arterial or venous) and/or pregnancy morbidity (≥3 consecutive early miscarriages, 1 late fetal loss, or premature birth from severe preeclampsia/placental insufficiency). Triple-positive serology (LA + aCL + aB2GPI) carries the highest risk. APS may be primary or secondary (lupus is the most common associated autoimmune). Catastrophic APS (CAPS) is a multi-organ thrombotic emergency. Treatment is anticoagulation: warfarin INR 2-3 for venous events, INR 3-4 for arterial events. DOACs are NOT recommended in APS — the TRAPS 2018 trial showed increased cerebrovascular events with rivaroxaban vs warfarin in triple-positive APS. Heparin + low-dose aspirin during pregnancy. Hydroxychloroquine adjunct in lupus-APS. Exercise priorities reflect anticoagulation: AVOID contact sports + collision activities + high-fall-risk activities (bleeding); AVOID prolonged immobility (Cannegieter 2006 travel-DVT relevant — anything >2 hours seated needs hydration + ankle-pumps + walk break); hydration ≥2.5 L/day (dehydration concentrates blood + raises thrombosis risk).

Volya's catalogue carries the foundation moves: supported-glute-bridge for posterior chain low-intensity work, wall-push-up for scaled upper-body strength, scapular-retraction for posture, cat-cow for spinal mobility, supine-knee-to-chest for low-back release, diaphragmatic-breathing for parasympathetic regulation, standing-march for managed cardio (anticoagulation-safe), ankle-pump for circulation + DVT prevention (critical for APS), calf-raise-rehab for posterior chain + venous return. The AI coach also knows the nutrition side — warfarin × vitamin K means CONSISTENT intake (not avoidance) — write down typical kale/spinach/Brussels sprouts portions and KEEP them; if you change diet (start salads, stop salads), tell rheum/hematology for INR re-check, AVOID grapefruit + Seville orange + cranberry juice (warfarin metabolism CYP2C9/CYP3A4), AVOID alcohol excess (warfarin INR variability + bleeding), AVOID high-dose vitamin E + ginkgo + garlic supplements + ginger supplements (bleeding risk on warfarin), omega-3 1-3 g/day EPA+DHA (mild anticoagulant effect — tell rheum + INR check on starting/stopping), pregnancy modifier heparin + LDA + folate + AVOID NSAIDs + iron + B12 + Mediterranean, hydration ≥2.5 L/day, AVOID prolonged immobility (Cannegieter 2006). CRITICAL: APS Foundation of America + ACR + hematology + rheumatology + maternal-fetal medicine if pregnancy + cardiology if cardiac involvement + dietitian familiar with warfarin. This is NEVER a replacement for hematology + rheumatology care.