2009

Liver Transplant Physiotherapy Program

Patient ______________________________________ Physiotherapist _______________________________ Date ________________________________________

Looking for more health information? Contact your local public library for books, videos, magazine articles and online health information. For a list of public libraries in Nova Scotia go to HTTP:// publiclibraries.ns.ca Capital Health promotes a smoke-free and scent-free environment. Please do not use perfumed products. Thank you! Capital Health, Nova Scotia Photos: Staff Prepared by: Physiotherapy, Capital Health, Halifax, NS © Designed and Printed by: QEII Audio Visual and Printing Departments WB85-1299 Created Dec. 2009 The information in this pamphlet is to be updated every 3 years.

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1

Table of Contents Why Do You Need an Exercise Program? ...................................................... 3 Stretching Exercises .................................................................................... 4 Heel Stretch............................................................................................. 4 Quadriceps Stretch .................................................................................. 5 Hamstring Stretch ................................................................................... 6 Strengthening Exercises ............................................................................. 6 Stomach/Trunk Exercises ............................................................................ 7 Bridging .................................................................................................. 7 Resisted Hip Bends .................................................................................. 8 Leg Exercises ............................................................................................... 8 Straight Leg Raise .................................................................................... 8 Standing Knee Bends............................................................................... 9 Abduction: Phase 1 ................................................................................. 9 Abduction: Phase 2 ............................................................................... 10 Quadriceps (thighs) ............................................................................... 10 Wall Slides ............................................................................................. 11 Sit to Stand ........................................................................................... 11 Arm Exercises ............................................................................................ 12 Shoulder Press ....................................................................................... 12 Abduction ............................................................................................. 12 Biceps Curl ............................................................................................ 13 Wall Push - Ups...................................................................................... 13 Stamina Exercises ..................................................................................... 14 Walking ................................................................................................... 14 Other Types of Endurance Exercises ........................................................ 14 Things to Avoid After Surgery.................................................................. 15 Saving Energy ........................................................................................... 16 The Recommended Program ................................................................... 17 2

19

Notes _________________________________________________________________

Staying active is very important while you wait for your liver transplant. People who are in better physical shape before their surgery are more likely to get better faster and with fewer complications.

_________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________

The one year survival rate of those in good physical condition before their liver transplant is almost twice that of those in poor physical condition.1 1

transplanation 2008;86:1077-1083

_________________________________________________________________ _________________________________________________________________

The home exercise program is designed to: 1. Increase your functional ability (i.e. To be able to do more without fatigue).

_________________________________________________________________

2. Increase your strength.

_________________________________________________________________

3. Increase how long you can do something physical without needing a rest.

_________________________________________________________________ _________________________________________________________________

4. Fit in with your daily routine.

The importance of exercise for you:

_________________________________________________________________

1. It is the key to your ongoing healing.

_________________________________________________________________

2. Helps to promote a healthy lifestyle.

_________________________________________________________________

3. Helps to prevent bone thinning (osteoporosis). 4. Maintains your overall physical fitness and mental health.

_________________________________________________________________ _________________________________________________________________

The three main parts to your exercise program are:

_________________________________________________________________

1. Stretching exercises

_________________________________________________________________

2. Strengthening exercises 3. Stamina exercises (cardiovascular exercise)

_________________________________________________________________ _________________________________________________________________ _________________________________________________________________ 18

Most people can keep on adding to their strength and stamina for up to 3-6 months after surgery. At this point you may decide to do only a few of the following exercises and spend the rest of the time doing a physical activity that you enjoy. 3

Stretching exercises

The recommended program

These should be done before and after each exercise session. Stretching can help to avoid muscle injury, help muscles get better after exercise and prevent muscle stiffness. Stretches should be performed slowly, without bouncing.

Exercise 3-4 times per week: 1. Stretching exercises 2. Strengthening exercises

1. Heel stretch

3. Endurance exercise (i.e. Walking) I. 3-5 minute warm up

Stand a couple of feet away from a wall. Place one foot in front of the other. Keep your back knee straight with heel on the floor. Slowly move your hips forward.

4. Stretching exercises

Or

If you have any questions or concerns about your exercise program, feel free to get in touch with us.

II. 10-40 minutes of exercise (depending on your exercise tolerance) III. 3-5 minute cool down

Phone: (902) 473-2151 Physiotherapy department Stand on a step holding onto the railing. Slide one foot back so your heel is over the edge. Let your heel drop down. You should feel a stretch on the back of your heel and calf. Hold for 20 seconds.

Good luck!

Repeat 2-3 times on each leg. This exercise stretches the calf muscles and heel cord.

4

17

Saving energy

2. Quadriceps

To help cope with the fatigue (low energy, feeling weak, or tired), try some energy saving techniques that let you do more things.

Stand on one foot using a chair for balance. Bend your other knee and grasp your ankle. Pull your ankle backwards until you feel a stretch in the front of the thigh. It is important to stand straight during this exercise.

1. Know the time of day you feel the most fatigue. Plan your day so that you are able to lie down and rest during that period. 2. Plan to take frequent rest breaks when performing an activity and allow for enough time to rest after the activity.

Or 3. Plan your day so you are able to finish the tasks most important to you first, and leave the less important things for some other day. 4. Ask for help with certain chores or activities so not to use all your energy during one task. 5. Pace yourself. Try to make the energy you have last throughout the activity rather then rushing and tiring before you are able to finish it. 6. Listen to your body! If you feel muscle soreness, tiredness or your movements have slowed, then stop the activity and take a rest.

Lying on your side, slightly bend the bottom leg for balance. Grasp the ankle of the top leg and pull backwards until you feel a stretch on the front of your thigh (Or have someone do this movement for you). Hold for 20 seconds. Repeat 2-3 times on each leg. This exercise stretches the muscles in the front of the thigh.

7. If you find walking is getting very hard, then you may want to think about a walking aid (walker or cane). Your physiotherapist will talk with you about what is best.

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5

3. Hamstring stretch

Other types of endurance exercise

Sit sideways on a firm couch or bed. Keep one leg straight and the other bent, with your foot on the floor. Put your hands on your thigh and lean forward bending at the hip.

If you have an exercise bike, you may use this instead of walking. Start cycling for a short period of time (for example 5 minutes) and add to your cycling time little by little. Do not add resistance until you are able to bike 15 minutes without a problem.

Hold for 20 seconds.

Remember to warm up and cool down.

Repeat 2-3 times on each leg. This exercise stretches the muscles at the back on the thigh.

Special instructions:

Strengthening exercises

Things to avoid after surgery

To safely do all your daily activities, you must add to your muscle strength and tone. The following exercises should be performed 3-4 times per week. When you can do an exercise easily 15 times, you should progress by adding more weight and doing fewer repetitions. You should avoid lifting a weight that makes you strain and hold your breath, as this will put too much stress on your heart and too much pressure in your belly.

• No lifting more than 15-20 pounds for the first 2 weeks. • After the first two weeks, no lifting more than 40 pounds for the next four weeks. Never hold your breath when lifting. • Avoid breath holding during bowel movements. • Avoid forceful coughing. • How much weight you can lift may vary depending on your surgery. Your doctor will advise you of any other things you should avoid that are specific to you and your surgery. You may return to your gym program at any time as long as the above restrictions are followed. If you are a golfer, only work on your short game for the first 6 weeks. You may return to driving 2-3 months after the transplant.

6

15

Stamina exercises

Stomach/trunk exercises

Stamina (endurance) exercises are the most important part of your program. Endurance means a steady activity that lasts for 15-20 minutes (minimum). The length of time you exercise is important for increasing the health of your heart, lungs, and muscles. Start exercising slowly and gradually increase the intensity. Don’t forget to stretch before exercising.

1. Bridging These exercises are to be done lying on your back, with knees bent and feet flat on the mat. Keep your feet flat on the mat. Raise your hips off the mat. Hold this position for 5 seconds. Repeat ____ times.

Walking Take note of the time you start walking. Walk for 3-5 minutes at a slow pace, then walk briskly and continuously for your exercise time. Start with a 10 minute walk and slowly add to your time over the next few weeks until you are walking for 30-40 minutes per day. At the end of your walk, take 3-5 minutes to walk at a slow pace.

Or

While you are exercising, you should not become short of breath or feel that your legs are very tired. You should be able to “WALK AND TALK”.

Keep your feet flat on the mat. Raise your hips off the mat and then lift your right foot off the mat and straighten it. Hold for 5 seconds.

Special instructions:

Repeat ______ times. Repeat with the left leg.

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7

2. Resisted hip bends

3. Biceps curl

Lying flat on your back, bring your knee towards your chest. Use your hand to resist your thigh from coming all the way to your chest.

Hold a weight in your left hand and bend your elbow to touch your shoulder.

Hold 5 seconds.

Repeat with the right hand.

____ Lbs _____ times.

Repeat ____ times.

Leg exercises

4. Wall push – ups

1. Straight leg raise

Stand two steps away from the wall. Place both hands on the wall at shoulder height. Bend forward bringing your nose to the wall. Straighten arms and repeat.

Lie on your back with left leg straight and right knee bent with foot flat on the mat. Lift your left leg straight up, stopping at the height on your right knee.

Repeat ____ times.

Repeat ____ times. Repeat with your left knee bent and the right knee straight.

8

13

Arm exercises

2. Standing knee bends

Do exercises 1-3 in standing or sitting.

Standing with a chair in front of you for support, bend your knee bringing your right heel backwards towards your buttocks. Hold 5 seconds.

1. Shoulder press

Repeat _____ times. Repeat with the other leg.

Hold a weight in your left hand with elbow bent. Push the weight up over your head. Use _____lbs, repeat ____ times. Repeat with your right hand.

3. Abduction: Phase 1 2. Abduction Hold a weight in your right hand. Lift your arm out to the side to shoulder height. ____ Kgs/lbs ___ times.

Lie on your back with your left leg bent and right leg straight. Lift your right leg up and out to the side. Bring it back beside the left leg and relax. Repeat ____ times.

Repeat with the left hand.

Repeat with the other leg.

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4. Abduction: Phase 2

6. Wall slides

Lie on your side, with your top leg straight and bottom leg bent. Lift your top leg up and then slowly lower it. Turn onto your other side and repeat with the other leg.

Stand with your back against the wall, placing both feet one step away from the wall. Bend your knees sliding down the wall. Hold for _____ seconds, then straighten up and rest. Repeat ______ times.

Repeat ____ times.

7. Sit to stand 5. Quadriceps (thighs)

Sitting on a chair, practice rising up and out of the chair. You may use your arms if you need to. When your legs are strong enough, cross your hands over your chest and do the same exercise without using your arms.

Sit on a chair, slowly straighten your right leg. Hold for a count of 5 seconds then lower slowly to the starting position. Remember to keep your back straight. Repeat ___ times. Repeat with your left leg.

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4. Abduction: Phase 2

6. Wall slides

Lie on your side, with your top leg straight and bottom leg bent. Lift your top leg up and then slowly lower it. Turn onto your other side and repeat with the other leg.

Stand with your back against the wall, placing both feet one step away from the wall. Bend your knees sliding down the wall. Hold for _____ seconds, then straighten up and rest. Repeat ______ times.

Repeat ____ times.

7. Sit to stand 5. Quadriceps (thighs)

Sitting on a chair, practice rising up and out of the chair. You may use your arms if you need to. When your legs are strong enough, cross your hands over your chest and do the same exercise without using your arms.

Sit on a chair, slowly straighten your right leg. Hold for a count of 5 seconds then lower slowly to the starting position. Remember to keep your back straight. Repeat ___ times. Repeat with your left leg.

10

11

Arm exercises

2. Standing knee bends

Do exercises 1-3 in standing or sitting.

Standing with a chair in front of you for support, bend your knee bringing your right heel backwards towards your buttocks. Hold 5 seconds.

1. Shoulder press

Repeat _____ times. Repeat with the other leg.

Hold a weight in your left hand with elbow bent. Push the weight up over your head. Use _____lbs, repeat ____ times. Repeat with your right hand.

3. Abduction: Phase 1 2. Abduction Hold a weight in your right hand. Lift your arm out to the side to shoulder height. ____ Kgs/lbs ___ times.

Lie on your back with your left leg bent and right leg straight. Lift your right leg up and out to the side. Bring it back beside the left leg and relax. Repeat ____ times.

Repeat with the left hand.

Repeat with the other leg.

12

9

2. Resisted hip bends

3. Biceps curl

Lying flat on your back, bring your knee towards your chest. Use your hand to resist your thigh from coming all the way to your chest.

Hold a weight in your left hand and bend your elbow to touch your shoulder.

Hold 5 seconds.

Repeat with the right hand.

____ Lbs _____ times.

Repeat ____ times.

Leg exercises

4. Wall push – ups

1. Straight leg raise

Stand two steps away from the wall. Place both hands on the wall at shoulder height. Bend forward bringing your nose to the wall. Straighten arms and repeat.

Lie on your back with left leg straight and right knee bent with foot flat on the mat. Lift your left leg straight up, stopping at the height on your right knee.

Repeat ____ times.

Repeat ____ times. Repeat with your left knee bent and the right knee straight.

8

13

Stamina exercises

Stomach/trunk exercises

Stamina (endurance) exercises are the most important part of your program. Endurance means a steady activity that lasts for 15-20 minutes (minimum). The length of time you exercise is important for increasing the health of your heart, lungs, and muscles. Start exercising slowly and gradually increase the intensity. Don’t forget to stretch before exercising.

1. Bridging These exercises are to be done lying on your back, with knees bent and feet flat on the mat. Keep your feet flat on the mat. Raise your hips off the mat. Hold this position for 5 seconds. Repeat ____ times.

Walking Take note of the time you start walking. Walk for 3-5 minutes at a slow pace, then walk briskly and continuously for your exercise time. Start with a 10 minute walk and slowly add to your time over the next few weeks until you are walking for 30-40 minutes per day. At the end of your walk, take 3-5 minutes to walk at a slow pace.

Or

While you are exercising, you should not become short of breath or feel that your legs are very tired. You should be able to “WALK AND TALK”.

Keep your feet flat on the mat. Raise your hips off the mat and then lift your right foot off the mat and straighten it. Hold for 5 seconds.

Special instructions:

Repeat ______ times. Repeat with the left leg.

14

7

3. Hamstring stretch

Other types of endurance exercise

Sit sideways on a firm couch or bed. Keep one leg straight and the other bent, with your foot on the floor. Put your hands on your thigh and lean forward bending at the hip.

If you have an exercise bike, you may use this instead of walking. Start cycling for a short period of time (for example 5 minutes) and add to your cycling time little by little. Do not add resistance until you are able to bike 15 minutes without a problem.

Hold for 20 seconds.

Remember to warm up and cool down.

Repeat 2-3 times on each leg. This exercise stretches the muscles at the back on the thigh.

Special instructions:

Strengthening exercises

Things to avoid after surgery

To safely do all your daily activities, you must add to your muscle strength and tone. The following exercises should be performed 3-4 times per week. When you can do an exercise easily 15 times, you should progress by adding more weight and doing fewer repetitions. You should avoid lifting a weight that makes you strain and hold your breath, as this will put too much stress on your heart and too much pressure in your belly.

• No lifting more than 15-20 pounds for the first 2 weeks. • After the first two weeks, no lifting more than 40 pounds for the next four weeks. Never hold your breath when lifting. • Avoid breath holding during bowel movements. • Avoid forceful coughing. • How much weight you can lift may vary depending on your surgery. Your doctor will advise you of any other things you should avoid that are specific to you and your surgery. You may return to your gym program at any time as long as the above restrictions are followed. If you are a golfer, only work on your short game for the first 6 weeks. You may return to driving 2-3 months after the transplant.

6

15

Saving energy

2. Quadriceps

To help cope with the fatigue (low energy, feeling weak, or tired), try some energy saving techniques that let you do more things.

Stand on one foot using a chair for balance. Bend your other knee and grasp your ankle. Pull your ankle backwards until you feel a stretch in the front of the thigh. It is important to stand straight during this exercise.

1. Know the time of day you feel the most fatigue. Plan your day so that you are able to lie down and rest during that period. 2. Plan to take frequent rest breaks when performing an activity and allow for enough time to rest after the activity.

Or 3. Plan your day so you are able to finish the tasks most important to you first, and leave the less important things for some other day. 4. Ask for help with certain chores or activities so not to use all your energy during one task. 5. Pace yourself. Try to make the energy you have last throughout the activity rather then rushing and tiring before you are able to finish it. 6. Listen to your body! If you feel muscle soreness, tiredness or your movements have slowed, then stop the activity and take a rest.

Lying on your side, slightly bend the bottom leg for balance. Grasp the ankle of the top leg and pull backwards until you feel a stretch on the front of your thigh (Or have someone do this movement for you). Hold for 20 seconds. Repeat 2-3 times on each leg. This exercise stretches the muscles in the front of the thigh.

7. If you find walking is getting very hard, then you may want to think about a walking aid (walker or cane). Your physiotherapist will talk with you about what is best.

16

5

Stretching exercises

The recommended program

These should be done before and after each exercise session. Stretching can help to avoid muscle injury, help muscles get better after exercise and prevent muscle stiffness. Stretches should be performed slowly, without bouncing.

Exercise 3-4 times per week: 1. Stretching exercises 2. Strengthening exercises

1. Heel stretch

3. Endurance exercise (i.e. Walking) I. 3-5 minute warm up

Stand a couple of feet away from a wall. Place one foot in front of the other. Keep your back knee straight with heel on the floor. Slowly move your hips forward.

4. Stretching exercises

Or

If you have any questions or concerns about your exercise program, feel free to get in touch with us.

II. 10-40 minutes of exercise (depending on your exercise tolerance) III. 3-5 minute cool down

Phone: (902) 473-2151 Physiotherapy department Stand on a step holding onto the railing. Slide one foot back so your heel is over the edge. Let your heel drop down. You should feel a stretch on the back of your heel and calf. Hold for 20 seconds.

Good luck!

Repeat 2-3 times on each leg. This exercise stretches the calf muscles and heel cord.

4

17

Notes _________________________________________________________________

Staying active is very important while you wait for your liver transplant. People who are in better physical shape before their surgery are more likely to get better faster and with fewer complications.

_________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________

The one year survival rate of those in good physical condition before their liver transplant is almost twice that of those in poor physical condition.1 1

transplanation 2008;86:1077-1083

_________________________________________________________________ _________________________________________________________________

The home exercise program is designed to: 1. Increase your functional ability (i.e. To be able to do more without fatigue).

_________________________________________________________________

2. Increase your strength.

_________________________________________________________________

3. Increase how long you can do something physical without needing a rest.

_________________________________________________________________ _________________________________________________________________

4. Fit in with your daily routine.

The importance of exercise for you:

_________________________________________________________________

1. It is the key to your ongoing healing.

_________________________________________________________________

2. Helps to promote a healthy lifestyle.

_________________________________________________________________

3. Helps to prevent bone thinning (osteoporosis). 4. Maintains your overall physical fitness and mental health.

_________________________________________________________________ _________________________________________________________________

The three main parts to your exercise program are:

_________________________________________________________________

1. Stretching exercises

_________________________________________________________________

2. Strengthening exercises 3. Stamina exercises (cardiovascular exercise)

_________________________________________________________________ _________________________________________________________________ _________________________________________________________________ 18

Most people can keep on adding to their strength and stamina for up to 3-6 months after surgery. At this point you may decide to do only a few of the following exercises and spend the rest of the time doing a physical activity that you enjoy. 3

Table of Contents Why Do You Need an Exercise Program? ...................................................... 3 Stretching Exercises .................................................................................... 4 Heel Stretch............................................................................................. 4 Quadriceps Stretch .................................................................................. 5 Hamstring Stretch ................................................................................... 6 Strengthening Exercises ............................................................................. 6 Stomach/Trunk Exercises ............................................................................ 7 Bridging .................................................................................................. 7 Resisted Hip Bends .................................................................................. 8 Leg Exercises ............................................................................................... 8 Straight Leg Raise .................................................................................... 8 Standing Knee Bends............................................................................... 9 Abduction: Phase 1 ................................................................................. 9 Abduction: Phase 2 ............................................................................... 10 Quadriceps (thighs) ............................................................................... 10 Wall Slides ............................................................................................. 11 Sit to Stand ........................................................................................... 11 Arm Exercises ............................................................................................ 12 Shoulder Press ....................................................................................... 12 Abduction ............................................................................................. 12 Biceps Curl ............................................................................................ 13 Wall Push - Ups...................................................................................... 13 Stamina Exercises ..................................................................................... 14 Walking ................................................................................................... 14 Other Types of Endurance Exercises ........................................................ 14 Things to Avoid After Surgery.................................................................. 15 Saving Energy ........................................................................................... 16 The Recommended Program ................................................................... 17 2

19

2009

Liver Transplant Physiotherapy Program

Patient ______________________________________ Physiotherapist _______________________________ Date ________________________________________

Looking for more health information? Contact your local public library for books, videos, magazine articles and online health information. For a list of public libraries in Nova Scotia go to HTTP:// publiclibraries.ns.ca Capital Health promotes a smoke-free and scent-free environment. Please do not use perfumed products. Thank you! Capital Health, Nova Scotia Photos: Staff Prepared by: Physiotherapy, Capital Health, Halifax, NS © Designed and Printed by: QEII Audio Visual and Printing Departments WB85-1299 Created Dec. 2009 The information in this pamphlet is to be updated every 3 years.

20

1