Before you Start

 If you experience any of the following, do not exercise or stop immediately:

  • Racing pulse
  • Fever
  • Suddenly short of breath or breathless
  • Chest pain, light headed, or dizzy
  • Headache or blurred vision
  • Nausea
  • Confusion or disorientation

Excessively sore muscles for more than 24 hours after an exercise session indicates that the intensity of the exercise needs to be decreased. Allow 1 to 2 days of rest before exercising the same sore muscle group again at the lower intensity level.

People living with cirrhosis tend to avoid exercise for many reasons. Gradually, the muscles weaken and common tasks become more and more difficult to do. Loss of muscle strength affects balance, mobility, and can interfere with social activities and hobbies. Performing the right set of exercises at the right intensity can minimize muscle loss and weakness. This can help to maintain or increase your current activities.

Most people with cirrhosis can and should exercise regularlyTalk to your physician about starting an exercise program before you begin.

THIS EXERCISE PROGRAM IS NOT MEDICAL ADVICE

This website should not be relied upon or serve as a replacement for medical advice from your doctor(s). Do not disregard or delay or discontinue your ongoing medical treatment because of your use of this website. Your continued treatment by your qualified medical practitioners is important to your health. If you have any concerns, address these with your medical team.

Any medical guidelines or recommendations from your medical practitioner regarding exercise in liver disease supersedes any information on this website. The information on the website is provided on an “as is” basis without any representations or warranties.

Getting Started

Before starting the programming, please check with your doctor to ensure that this is safe for you and to assess your risk for veins in the food pipe (esophageal varices). The Introductory Level exercises are a safe starting point for most patients with cirrhosis as the exertion level and intensity are similar to performing every day activities of daily living (e.g., walking, dressing, bathing).
An exercise program specific for patients with cirrhosis has four components:

Aerobic
Improves cardiovascular health, examples are walking or swimming. This can be any activity including walking, jogging, dancing, or climbing stairs. The key is to elevate the heart rate to the point where you are moderately short of breath but can still participate in a conversation. If needed, take a rest break as needed and then continue the activity. The goal is to to complete 150 minutes of aerobic activity each week. If you are just beginning to exercise, slowly build up to this by adding 5-10 minutes each week.

Muscle Strengthening
Resistance exercises build strength to make everyday activities easier, such as climbing stairs, shopping, and gardening. Start with Intro level and then progress to P1 when you can complete 3 sets of 15 repetitions of the exercise without rest and the targeted muscles are not fatigued.

  • Shoulders (lateral arm raises): Strengthens muscles and improves the range of motion in the shoulders and neck.
  • Biceps (arm curls): Strengthens the bicep muscle in the upper arm and also improves hand and grip strength.
  • Triceps (triceps extension): Strengthens muscles in the forearms, shoulders, chest, and lower back as well as the tricep muscles in the upper arms.
  • Quadriceps (leg extensions): Improves stability when on your feet; helps blood circulation in the legs
  • Hamstring (leg curls): Improves the stability of the feet and ankles when standing, walking, or climbing stairs; good for getting the blood circulating in the leg after sitting or standing for a while
  • Lower Leg (calf raises): Improves the stability of the feet and ankles when standing, walking, or climbing stairs; good for getting the blood circulating in the leg after sitting or standing for a while
  • Multiple JointsImproves overall range of motion, strength balance and posture
Flexibility
Gentle stretches improve the range of motion in joints and helps with mobility. These are a series of static position muscle stretches. They improve overall mobility and range of motion.

Balance
Poses held for a set time improve overall stability and movement. Improves movement, spatial awareness, and ability to recover from slipping or being bumped in crowds.

Intensity

On the Borg Scale, the target area when exercising is to be between numbers 3 and 5.

The Talk Test – Exercise to the point where you can still talk out loud but are breathing somewhat heavily.

Exercising will get easier. Keep your doctor up to date on your progress and let them know if you wish to progress to the next level. Do NOT advance without your doctor’s approval!

Click here to see the Borg Scale & Talk Test

One of four levels of intensity can be followed. Most people with cirrhosis should be able to complete the Program 1 level of exercises. For some people, you may be referred to a certified exercise specialist or physiotherapist who will create a personalized exercise program for you.

There are four levels for each exercise. Your “Exercise Prescription” will indicate which level to complete.

  • Program 1 (easiest):  No equipment, can be done while lying or reclining in bed or on a couch, suitable for most patients with cirrhosis
  • Program 2: Can done while seated, good for those who may have balance issues, with or without equipment
  • Program 3: Sitting or standing with resistance bands for added muscle strengthening
  • Program 4 (hardest): – Balanced posture using light hand-held weights
Equipment

Resistance Bands – Resistance bands provide extra resistance to strengthen muscles when exercising. Once an exercise can be completed without taking a rest between the repetitions and you feel minimal to moderate muscle fatigue, consider introducing a resistance band. Make sure to start with the stretchiest (easiest) band first. Sporting goods stores, online stores, and department stores usually offer these.

Hand-Held Weights or Dumbbells – Use when a wide range of motion is required of the exercise or when exercise resistance bands are no longer challenging. When an exercise can be completed without needing rest between the sets and not feeling muscle fatigue. Make sure to start with the lightest weights possible to prevent injury, usually 1 lb. Sporting goods stores, online stores, and department stores usually offer these.

Safety

Most people with cirrhosis can and should engage in regular exercise.  Your physician or nurse practitioner may want to review your health and do some tests before you begin exercising, or when you wish to progress to a new level.

When exercising, there are some basic principles to be aware of to ensure your safety:

  • Wear non-slip shoes
  • Drink water before, during & after exercise
  • Clear area that is free of clutter or furniture in which you can move about freely without tripping or knocking something over
  • Have balance supports like a chair or wall within easy reach
  • Place equipment nearby, ready for use when you need them but not so close to trip on

Tips To Remember

Below is a list of advice that patients have found most helpful for exercising. The list has been approved by physicians, physiotherapists, and certified exercise specialists with experience in cirrhosis patient care.

  • Practice a new exercise correctly in front of a mirror to make sure it is being done correctly. Doing an exercise with the incorrect posture or wrong muscles is not helpful.
  • Avoid lifting the shoulders when performing arm exercises, especially those targeting the upper body and arms. Between sets, inhale, and relax the shoulders downwards.
  • Smile!
  • Take rest breaks as needed. LISTEN to your body!
  • Perform each muscle strengthening exercise in a slow and controlled manner. Save the speed for the aerobic sessions!
  • Drink a meal supplement or eat a snack before or after an exercise session.

Click here for MORE exercise tips

References:

The information on this page was compiled by the Cirrhosis Care Alberta project team (physicians, nurse practitioners, registered nurses, registered dietitians, physiotherapists, pharmacists, and patient advisors).

This information is not intended to replace advice from your healthcare team. They know your medical situation best. Always follow your healthcare team’s advice.

Last reviewed March 15, 2021
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