Exercise with Cirrhosis
Working out with End Stage Liver Disease can be Scary Sherri. There are definite benefits to doing Exercise with Cirrhosis. You can build muscle and cardiovascular strength while you maintain a higher energy level. I have worked out all my life; I know my body pretty well and it always pays off. If you have liver disease, ascites, portal valve hypertension, varices or a high MELD score, You can work out. Don’t be scared, be Strong! Here are some tips for how to handle it from your best friend.
This is a personal blog for me. That is because I thought I was a dead woman walking in August 2010. I believe that my bicycle riding while suffering from End Stage Liver Disease actually led to my liver finally failing, and the hospital stay where I was diagnosed with the Hepatitis C Virus. Exercise must be taken seriously when you have cirrhosis.
I am convinced that my overall health is better as a result of working out. YET – There is no denying that there are limitations that have to be addressed. Exercise with cirrhosis, no matter what stage you are in, must be monitored constantly with a liver that is scarred with fibrosis. Read my other blogs about the benefits of exercise with Hepatitis C.
I always listen to my body. I also inform the gym staff what my limitations are. I have an index card with my doctor, hospital, and family phone numbers as well as a medication list right beside me at the gym. I flat out tell them that if I hit the floor, call 911 and give the card to the EMSA workers. If you have had a variceal bleedout, you know what it is like.
The alternative is to grow weaker and die. Initially, I was in such poor health that I could barely keep my weight above 100 lbs. I was denied the Hepatitis C treatment. I looked like a starving refugee with the ascites. Yet I knew that diet and exercise were the keys to getting into shape and lowering my MELD score. It was my only hope to be able to treat and get rid of that ever climbing viral load.
I am going to simply list the limitations and the workarounds to exercise and cirrhosis. Pay close attention to how they should be addressed and monitored. My best advice is to talk it over with your hepatologist or transplant doctor. They may perform an endoscopy, Doppler Sonography, or MRI to check for stages of cirrhosis and grades of varices.
Check out my blog on the liver and varices for more information about liver function and failure. Also read about the Hepatitis C low sodium diet and cirrhosis regarding liver loving protein shakes and good food for liver absorption.
Can you hear how serious I sound? I do not take exercise with cirrhosis lightly. I want to encourage you to exercise, but I want you to be safe and smart.
Possible limitations and The Workarounds:
1. Portal Valve Hypertension can be part of the stage 4 cirrhosis. It means that your liver has reached the point where the main portal valve is restricting the flow of blood into the liver. What Portal Valve Hypertension means is that your blood cannot move through the liver to be filtered. It is forced it to look for alternate routes. That creates varices (kind of like little aneurisms) in your esophagus, stomach, or rectum.If you are at this stage you are probably taking a beta blocker like Nadolol to lower your blood pressure and thereby your pulse. A high blood pressure or a pulse over 65+- can cause the varices to form and also to burst. This leads to a bleedout or esophageal bleed. Yeah. Scary Sherri.
There are a couple of workarounds here.One is that you have to use low free weights to prevent varices from forming or bursting. Any exertion that is not done carefully can strain the varices through force. (think of a hernia) My doctor only allowed 5lb dumbbell weights at first. If you have read any of my stuff, you know that I was Knocking on Heaven’s Door. I had been working out at the YMCA 2 or 3 times a week. I wanted to live so bad! I fought to stay strong.
The first month after liver failure, ascites prevented me from doing much. I went to the gym for upper body baby exercise and stretching. No weight machinesl. Just low weights and very few repetitions to keep a minimum of strength. I focused on each repetition and made sure I was lifting the free weights with my muscle, not from my core, back, or stomach. No straining allowed!
For real? I went and sat on the machines some days. I lay in the floor on the mats and stretched til I felt strong enough to make the drive home. Now I am laughing. Once the diuretics kicked in and ascites was under control, I began to use the machines again. I worked with the lowest weights and very few repetitions.
The second problem with portal valve hypertension is that it can also raise the blood pressure. This will affect your cardio workout. Before diagnosis, I worked my heart to about 125 beats per minute (bpm). After diagnosis with Hepatitis C Virus, I learned to sit at the bike for 10 minutes and monitor my heart rate the entire time. Using monitors on the hand rail, I stayed at about 70 bpm. I would get off and walk around slowly for about 10 minutes and then go for 10 more.
I am virus free! But I moved up to Grade 3 varices. After a bleedout during treatment, several bandings over a year’s time, and continued monitoring – the varices are under control. The stomach varices cannot be removed safely, so my heart rate and blood pressure will always have to be monitored closely. Knowing that exercise is important, my transplant doctor gave me the go ahead for cardio with caution.
2. 2. Muscle wasting with cirrhosis can be a result of poor protein metabolism. Because the liver cannot process food well, your body will actually steal from your muscles to function. Protein is needed to heal the liver, but is hard on it at the same time. What this means to someone who is trying to stay strong and keep muscle mass is that you have to eat good sources of protein and keep your muscles strong.
Your heart is a muscle and needs exercise just like your arms and legs do. That is why cardiovascular exercise is important. It can become a vicious cycle of deterioration if you do not try and keep your all of your muscles strong. You become weak and so you sit and then become weaker. That is simply not an option for this girl. I refuse to sit and become sicker. So I exercise.
There are workarounds here also. I set out to find a way to work out without killing myself. Even if you are just beginning, working out with low weights is an easy enough thing to do. Check out my Exercise with Hepatitis C workout blogs for at home workouts with yoga stretches and chair exercises. Sitting in a chair with 5 lb dumbbells doing sets of 12 curls can really help!
I am back at the gym now and find a leg extension or leg curl to be good machines. I started out at 20 or less lbs and did 12 reps before treatment. Now I am up to 2 sets of 12. My quads are looking great and I can walk or run with more endurance! I eventually moved to 10 lbs for upper body and now work out at 15 lbs at the gym. That is progress!
If I take a break for a few weeks, I reduce the weights or reps. You guys who are laughing at my low weights might start at a higher weight with your doctor’s permission. Skinny girl works out where she is able. I have no shame. 
You’ve got to start somewhere. I really am not even embarrassed by my weakness. When I am at the gym, I smile with satisfaction even if the people around me are working out at a higher weight. I’m alive. I feel positively triumphant! I make every lift slowly and deliberately. I have in my earphones. Sometimes it is a motivational speaker and other times it is relaxation music.
My all time fave workout since my diagnosis with Hepatitis C is a White Stripes song. Seven Nation Army. Okay. It’s an angry song. I was mad at the climbing viral load and the potential death sentence. When I listened to these lyrics, I was picturing being on treatment and the medicine killing every last Hepatitis C Virus cell. Positive imaging helped. I was eventually allowed to treat with the new protease inhibitors!
I hope this helps you dear friend. You will have your own mindset while getting mentally and physically stronger. I am pretty tough, but I have a tender heart. I can hold your hand and your heart through cyberspace while you get your life back. I’m clutching mine pretty tight right now. Xoxo Karen:)
pics via howfamilyhealth.com, facebook.com, sharecare.com,
Exercise with Cirrhosis
Blog posts by Karen Hoyt are written from a Best Friend’s view point. I always advise you to talk with your doctor about any changes you make regarding your health care.
22 thoughts on “Exercise with Cirrhosis”
I have stage 4 alcoholic cirrhosis and haven’t drank since last December. My Meld Score went from 23 to 15. Hopefully, I can get it down lower. I went from 240 lbs to 180 in 6 months. I have stayed between 180 and 185, while taking diuretics. My blood pressure is 90/40 and pulse is between 68 and 72. Ascites and varices are minimal. I’m planning to work out with light weights and walk on the treadmill without over doing it. It will take time to get on the liver transplant list. I don’t qualify because of my Meld Score and former alcohol usage. How long and how fast should I go on the treadmill? Should I do ab exercises?
Joe,
Congratulations of making some lifestyle changes and getting that MELD score down! You’ve done a lot of work. It sounds like your heart is working great with blood pressure and pulse like that! Even I’m envious. You are smart to keep working on staying healthy. It’s a Catch 22 with the MELD because healthy means lowering the number, but in the long run it is good. I got mine down and got as healthy as I could. Now with the tumor from end stage cirrhosis, it puts me in great shape for the transplant.
If you have varices, it is the heavy lifting that is a risk. The low weights are great if you are careful to lift with your muscles. BTW – have you had an endoscopy? Stick with the low weights and it will help to build individual muscle groups and also give your core strength. As far as abs, I can do over 100 crunches daily with no problems. Full sit ups are too hard on my neck and back. So I just crunch away. I got the exercise ball to help with that, but it requires a strong core as well. Those are tough, but totally worth it!
Cardio on the treadmill. Love it! If you’re just beginning, walk slow to your hearts content. Stand it in front of a tv and walk for as long as you want. I started at 20 minutes. My doctor approved a heart rate of 100. Anything over that and I slowed down. If you move to a jog and get over 100 beats per minute, go with that for a few minutes and then slow down and “recover”. When you can talk while you are doing it, you know you are at a good pace! 30 minutes 3 times a week is a great goal. I cycle or spin a lot now and go for anywhere from 20 minutes to an hour and a half.
I just passed the “Stress Test” at the hospital for a transplant. They made me get my cardio up to 139 bpm and hold it there. Whoa! They say that a transplant surgery is like running the Boston Marathon with no training as far as your heart is concerned. You are training for life dear friend. What a wonderful post to wake up to!
I wish you the very very best and hope to hear more! Keep me updated. What an encouragement your determination is! Thanks for posting!
xo Karen:)
Thanks Karen for your reply. I had an endoscopy last December, and they found small to moderate varices, so no banding was done. Do you think I should have another one after 8 months? I will attach some stuff to an email for you to check out. I’m being evaluated by the Liver Transplant Institute at the Orlando Florida Hospital in Florida. My hepatologist is Dr. Panjala.
You’re so lucky to be getting around the varices bandings. Definitely doing something right! I have them every year now since I have not had any bleeding in 2 years. Next one in September.
I didn’t get your email, but will watch for it. I have read a lot about Florida and many on a transplant group (private on fb) have had great experiences. There is a cancer retreat in Palm Beach that sounds marvelous! lol.
BTW – just got an email from a long distance runner who is beating the odds. He has end stage and cancer and is still going. Our liver is a hard working organ. It’s great to connect with people like you who are doing their best to live out their dreams.
I hope I hear from you soon,
xo Karen:)
What is your best email to send you medical attachments to give you more incite about my condition? I sent you an email with attachments in a previous email. I guess you didn’t receive it.
Take care,
Joe Donelan
Hi,
I’ve been looking for an email from you and so sorry that it didn’t work the first time. ihelpc.com@gmail.com is the one I check daily. Give it a try! I’ll be looking for it.
xo Karen:)
Karen,
Six months ago I was diagnosed with end stage cirrhosis, ascities and varices.
You are sooo right on! I am blessed with amazing doctors, friends and family. I am considering a “shunt” should the doctor advise. I’m just getting back into a routine of exercise and already over the past month I’ve seen progress. Yoga, stretching and meditation also has helped my mental strength. I’m so happy to “run” across your blog. Can you recommend any other sites that you have found helpful in living “right” with this lovely disease! lol God Bless.
Hay Bobby,
Woohoo! I’m glad you found the blog too. You sound like a proactive person who is taking your health seriously. It’s scary business, but it is definitely NOT the end. I have to admit that the reason I started the blog is because there was not a lot of hopeful advice out there that included lifestyle and health choices from a body, mind, spirit approach.
I know people who have lived for decades with end stage with the right food and lifestyle. Lets you and me be one of those, OK? I’m counting on it and I have a feeling you’ll be around for a long time too. Stay in touch with me from time to time please.
Take care of you… xoxo Karen:)
Hi. I’m a 45 year old nurse, male and have ESLD. I wasn’t really sure what to do when it all hit the fan last Feb. I’ve put myself on bed rest twice in the last year, thinking my liver needs to heal. I think I just helped the wasting along. My big issue (and it seems like something either no one else is dealing with it or they just do t want to talk about it) is my bilirubin level stays just hi enough 3-4 to keep me yellow tinged eyes and skin. It’s been very depressing for me and has had me at the brink of ending it all. I havnt started exercising outside of what I get from work because I’m afraid of making the yellow worse, but I think exercise might help metabolize it too (no idea). Has jaundice been an issue for you or any of your friends? And thanks for your blog? I think people are hiding in shame, I am and I’ve never been like that.
Ray,
Oh hunnyo. I love to see that someone googles exercise with cirrhosis and finds me. We are SO united in our efforts to get better. I can hear the determination in your words, but you also have confusion. I get that. The doctors are usually surprised that we want to stay physically active while dealing with ESLD. There is not a lot of research on it.
Do you know that I’ve always had this light yellow tinge, but my jaundice does not stay too bad. I have never thought about how it must affect a person. I do know that my dad was an alcoholic and was severely jaundiced when he was in a hepatic coma. Once he quit drinking, he rarely had jaundice. When he did, it was a clue that he needed to get to the doctor.
I know that jaundice is caused by the livers problems moving bile and something about red blood cells gone awry. First, let me ask if you are eating a good liver loving diet? Are you on any medications? As a nurse, you probably know more than I do about this! That presents it’s own problem in creating fear I’ll bet.
I’m going to say this: Do NOT think about ending it all. You have many years left. Mild exercise can help you mentally and can never harm you if you follow the guidelines in my blog regarding varices, etc and let your doctor know what you plan.
No more shame. That underlying issue may be manifesting because of the jaudice. You can deal with that though. Even though you have liver disease and feel like other’s are judging you for it, you can approve of and accept yourself. You have feelings of shame, and it hurts, but maybe you can move past that by getting some mild exercise. Your first and best step was reaching out here.. I’ll be your best friend and I won’t quit sending love and prayers..
Keep me posted.. k?
xo Karen:)
Hi Karen,
Thanks for the kind words. It’ll be two years in June since I had a drink. I miss it, but it’s not the alcohol it’s just the inhibition you get and the silly ness with friends and strangers that can go along with it that I miss. I know you didn’t ask, just wanted to offer some background. So I was always a free spirit and drank daily, it got heavy with everything I perceived as a crisis, and there were many in my late 30’s and that’s when I first got sick. I gave up drinking but I guess the damage was done. What’s weird is in soft lighting I look great. (I tan too to try to hide the yellow, kinda look a bit orange sometimes), but when I’m at work, under the fluorescents the bili glows. One morning a nurse asked me at report What’s wrong with your eyes? I had no idea they were discolored til I looked at them in a hand mirror in the sun. This past Christmas a respiratory therapist called me yellow man ( she thought she was being funny) I’ve begged the Drs for some kind of jaundice treatment and they have nothing to offer. So I wait, and pray, and try things like beet root juice, and tofu products, and avoid fats as much as I can tolerate it. I’m not eating any sort of “liver lover diet) do you have a link to one? So now I’m on a roller coaster ride of some days feeling extremely sorry for myself, angry at myself and my enablers, to trying to forgive myself and get on enjoying what time I have left. I have friends and family who would like to be considered for transplant donor but Drs say I’m not sick enough. So I live with this fear of seeing old acquaintances, I watch to see if someone’s looking at me funny. I wear yellow tinted glasses ( that I hate ). Sorry I’m dumping I really need to get a counsellor. I take Rifaximin and lactulose to keep me going so my ammonia levels stay down, and I take nadolol to prevent varices. Aside from that I’m a hermit crab watching TV occasionally snuggling with my s/o, and dragging myself to work 3x/wk. I also go to school part-time and fight the urge to give that up. I’m thinking at this point increasing my endurance, strength, and flexibility could be a good thing. Thanks again for your support. Ray
Ray recently posted…I Don’t Want a Liver Transplant
Ray,
You know, I think a lot of people find that having a drink can take the edge off. It helps them to relax and also let go of some inhibitions. It’s funny how some will get jaundice and others don’t? I have been a few times, but for the most part, my bilirubin is good. I’m on the same medications that you are. Nadolol for varies and xifaxin for hepatic encephalopathy. I asked about going on lactulose, but they think not at this time…
You’re accomplished a lot to quit drinking and learn the try and manage the stress. And you’re also eating well and trying to exercise. Dang! You are one determined person! By staying in school and working a few days a week, you are improving yourself. That gives you better chances of taking care of your health and also living the life that you dream of. I don’t think that anything happens by accident. You’ve got an S/o who stands by you and that is a blessing in itself!
So get a counselor or come on over here. haha. We all need to vent sometimes. I do it in blogs for the whole world to see. It’s not easy living with liver disease. Kudos to you for coming this far and always know that I’m here for you and will help you in any way that I can.
xoxo Karen:)
Hi Karen,
There doesn’t appear to be much readily available medical information and guidance about exercising while suffering from liver disease and particularly when it has become decompensated with ascites and varices etc so it was a welcome surprise to come across this site and your blog on this aspect.
I am however a little mystified by the comment in your early blog where you indicate you believe your bicycle riding while suffering from end stage liver disease actually led to your liver finally failing and the hospital stay where you were diagnosed with Hep C!. By this do you mean that your were unaware you were suffering from liver disease while bicycle riding and that it was this unmonitored activity that exacerbated the problem leading to your hospital stay and diagnosis?
Your comment attracted my interest because in a way I can empathise with it as my own diagnosis probably followed a similar path. With many years as an endurance athlete and cyclist behind me I was traning for a specific event when I
developed jaundice which led to brief hospitalisation and a diagnosis of an autoimmune liver disease which owing to the already advanced stage of fibrosis I had probably had for many years without suffering any symptoms or having any knowledge of it. Unfortunately the disease has since advanced to cirrhosis which has become decompensated.
Needless to say I have often wondered whether the many years of high intensity physical exercise may have led to a worsening of the liver disease that at the time I didn’t know I had.
Nowadays it is extremely frustrating when running or bicycling at snails pace because of the medications and physical limitations of the disease when my mind is still constantly telling me that I can still perform as well as in the past when clearly I can not.
Lots of good tips and guidance in your blog and one of them has led me to retrieve my heart rate monitor that I had shelved in a cupboard a couple of years ago
Best Wishes,
Regards
Hello there! I am a friend of Karen. She had a procedure this past Monday, is a little under the weather. I am filling in for her for a bit.
Karen was not aware that she had any HCV until she was hospitalized. That had to be horrible to find out all at once. I am not a professional but I have read that walking is good for us, even when we have liver damage. You just want to be careful not to do too much. I am happy that Karen has been able to help you and I know she is too. That is great that you are once again monitoring your heart rate. Good job! Take Care, Dee
I hope Karen is doing well. She’s a light of inspiration. I just logged in to let her know that I am now undergoing the testing and the Dr feels it is time for a transplant. For me this is great news, please share it with her and let her know she’s in my thoughts and prayers. The liver is such an important organ, it’s more complicated than the heart, but doesn’t get nearly the amount of attention. Wine and drinking is pushed regularly on TV and in movies. It’s really scary. People with liver disease end up being some of the strongest people you could meet. Karen’s like that and I hope I will be too. When I’m better I want to pay it forward. Thanks Karen! Good luck!
Hello there! Thanks so much for writing in. Karen is doing well after her transplant. In fact I am amazed at how well. She must have had an excellent doctor and nursing staff. She will be very happy to read your good thoughts. You are so right, it is very scary to have liver disease or cirrhosis. I agree with you, I have met some wonderful people who have been through so much. I appreciate you letting Karen know how you are doing. I am sure she will be reading all of the posts very soon. I imagine she is just so exhausted right now. It has only be 5 days since transplant. I was looking around on Karen’s site and I found this. I thought it might help you. I had no idea how big this site was or how many articles. In fact I have gotten lost on it a few times 🙂 This is like an index. Please keep in touch. Dee
https://www.ihelpc.com/about-2/best-friends-start-here/
Hurray for Karen tell her I want to hear all about it when she’s better.
Hey there, I am with you! I want to hear all about her transplant when she feels up to it. If I know her, she is already formulating it 🙂
Take Care, Dee
Please don’t publish previous comment. Realized I. Light of all I shared the risk of sharing email. Thanks!
Hi there! It is not a problem, I will delete your earlier post. How are you doing? How are you feeling?
Nice work Dee! I have liver disease albeit self diagnosed. My liver functions have been borderline for awhile, and although I hate to admit it, I’m drinking more than ever. There’s more to tell than I care to share from my iPhone, but it’s encouraging to see someone like yourself providing such positive motivation and a rock solid attitude:). I’ve been through sickness before as my wife had breast cancer. Again, lots more to tell but I’m out of the house and on a cell phone
Hi there, wow! Thank you, you are the first person to say such nice things. I have been helping Karen out since her Liver Transplant in April. She is doing well though still recovering. Again, thank you, you brightened my day, Dee
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