Please note
You will be given a paper copy of this leaflet by Ward staff. If you need extra diary pages these can be printed from the PDF file that is available to download.
We want to support you to be as well as possible when you are called in for your liver transplant, so that you will make a good recovery after surgery.
Research has shown that if a patient remains physically active before an operation, there is less chance that they will experience complications after their surgery, and make a quicker recovery. Keeping active also reduces the risk of developing cancer, heart disease and diabetes in the future.
This booklet is designed to give you some information about the things you can do to stay active, so that your recovery will be as swift and trouble free as possible. There is also a journal included to allow you to record your activity, review your progress and motivate you to do more.
If, after reading this booklet you have any more questions, get in touch with the Liver Transplant Co-ordinators by phone, email or in clinic or on the ward.
Watch our introductory video below:
Video transcript
hi I’m Mary I’m one of the physio that
works here at St James’s so regarding
exercise it’s really really important to
keep yourself as fit as you can in
preparation for your liver transplant we
all know things such as walking and
cycling are really good for your heart
and lungs but it’s really important to
work at your general strength as well so
we have devised a simple exercise
program of four exercises that will help
you to work on your heart and lung
strength as well as your general muscle
strength too so the four exercises we
ask you to complete three cycles of
twice a week so 4 3 2 to categorize the
exercises we’ve subdivided it into
beginners intermediate and advanced so
if you know it’s been a long time since
you’ve done any exercise or if you’re
struggling to get up and down a flight
of stairs or you know you’ve got
problems with your balance we suggest
that you start at the beginner level
otherwise start at intermediate and work
up or down accordingly so the next
question is how hard to push yourself so
again we’re using the scale that you
need to use yourself and we’ve
subdivided it into
easy moderate and hard so for easy if
you like on a scale of not to 10 it’s 1
to three so if you’re average person
it’s like taking a gentle stroll you
feel your go on for for minutes even
hours comfortably talking you could even
sing for the moderate probably a 4 to
six on a 10 scale you will feel that is
it’s the equivalent of going for a brisk
walk you’ll start to feel that your
heart is beating a bit faster that your
breathing is deeper and faster as well
you’re starting to get a bit Rosy
cheeked too if asked you could have a
conversation just about but you couldn’t
sing and the vigorous is the point where
you feel that you’re 7 to 10 on that 7
to 10 scale equivalent of going for a
run or even a Sprint and at this point
you will feel that your heart is really
racing you’ll feel that your cheeks are
getting really red your breathing’s
harder your breathing’s faster you feel
as if you’re about to break out into a
sweat you could talk just about not hold
conversation you certainly wouldn’t be
able to sing so for our exercises we’re
going to ask you to work at a vigorous
level followed by a rest period
everybody’s different and it’s your
vigorous level that you need to work to
so for some of you you might find that
you don’t even get out of The Beginner’s
section and that’s absolutely fine what
we need is that level of working where
you feel that your breathing is harder
and faster and you feel that your heart
is getting faster too and that you’re
about to break into a sweat if you are
not working hard enough you’re not at
that level
if you’re overdoing it you’ll find that
during the rest period you’re not
recovering before it’s time to move on
to the next exercise so I think we’re
ready to begin so we just need to make
sure that you’ve got adequate space
you’re wearing comfortable clothes
you’ve got a bottle of water at hand
some weights ideally if you haven’t got
weights you can improvise by using
things like bottles of water or cans of
beans or something like that and if you
do use an inhaler just have it at hand
as well so we’re ready to move to the
exercises if you would like to move to
the warm-up section
now
Getting started
It is advisable to start to increase your activity as soon as possible. The longer you spend on becoming more active, the greater difference you will notice after your surgery.
Your physical activity should include a combination of activities to improve your heart and lungs (cardiovascular) and strengthening exercises to help build up your muscles. If you already exercise or play a sport, keep this up if you can.
If you already have an existing problem with your arms, legs or balance, some of the exercises may need to be adapted.
- Give yourself plenty of space to complete the exercises.
- You will need to wear some comfortable clothes.
- Have a bottle of water nearby.
- Have some weights ready. If you don’t have any, you can improvise by using bottles of water, bags of sugar or tinned food.
- If you have been prescribed inhalers, make sure you have them handy.
Before you start
Complete the following sections when you are first given this activity journal.
It is to help you identify how active you are currently and help you to stop and think about what you will get out of becoming more active.
You might want to write the answer to the first question on the front cover to remind you why you are being active every time you pick up this booklet.
I want to become more active because…
Write down why you want to be more active, e.g. to play with my children more
Being more active will allow me to…
Write down what you might be able to do if you are more active, e.g. go shopping
Things that stop me being active include…
Write down things that stop you being active, e.g. tiredness
I can start to overcome these things that stop me being active by…
Write down how you could overcome these obstacles, e.g. by resting before activity
The exercises
There are 4 exercises in this leaflet. They are designed to improve how well your heart and lungs work, as well as your overall muscle strength. For each set of exercises there are 3 levels:
Exercise scale
Level 1 – Easy
- Taking a gentle stroll. You could work at this level for hours. You could sing.
Level 2 – Moderate
- Going for a brisk walk. You feel your heart beating faster and your breathing is deeper. You are getting a bit rosy-cheeked. You could just about hold a conversation, but you couldn’t sing.
Level 3 – Hard
- Going for a run! Your heart is racing, your cheeks are getting redder, your breathing is deeper and harder, and you are breaking into a sweat. You could talk just about, but you couldn’t hold a conversation and you certainly couldn’t sing!
How hard do I work?
If it is a long time since you have done any strenuous exercise, you find it difficult to climb a flight of stairs, or you have problems with your balance, we would recommend that you start at Level 1 (Easy). Otherwise start at Level 2 (Moderate) and work up or down depending on how hard you needed to work. If you can, build up to working at Level 3 (Hard).
How often should I exercise?
We would like you to complete a set of 4 exercises repeated 3 times, twice a week.
If you find you are working at either the Moderate or Easy level, you may need to move to a harder set of exercises. If you find that the rest period is too short for you to recover, move down to an easier set of exercises.
Important
If you are experiencing considerable discomfort or pain, stop immediately and rest. If you do not feel comfortable or feel unsafe exercising alone, you can exercise with a friend or family member.
Warm up
Before you start your exercise session, make sure you warm up well. The warm up exercises are designed to loosen up your muscles, to avoid injury, followed by exercises to start to raise your pulse.
When you start the warm up, aim to work at a moderate level, and towards the end move to a hard level.
If you are finding the exercises too difficult to do standing up, feel free to do them sitting down.
Loosening exercises
Aim to do each loosening exercise for around 15 seconds. Watch the video below:
Video transcript
This is the warm-up to the exercise
program it’s important to prepare your
body for exercise
this will be gentle loosening exercises
followed by a pulse razor you should be
able to work at a moderate progressing
to a vigorous level towards the end
we’ve got mary here demonstrating the
warm-up for us so we’re going to get
started we’re just going to do some tour
tapping this is just going to be for 15
seconds just to loosen up your ankles a
little bit
that’s it good toe tapping
and then we’re going to progress now
just to ankle rolling again just turn
your ankle in that’s it get everything
nice and loose you can be sat down if
you’re finding this too difficult
and then the next thing we’re going to
do is just warm up your head and your
neck so we’re going to just do
neck to your chest for me mary
and then back up again
that’s it and all the way down
and back up again
and then we’re going to do some side
movements of your neck to each side
tapping your ear to your shoulder
that’s it
one more of each for me mary
lovely and then we’re just gonna
move your neck around so a bit of a neck
rotation that’s it bit of a twist
looking over your shoulder
lovely and then we’re going to move down
to your shoulders
so we’re going to go forwards and
backwards that’s it
that’s it really loosen up
and then you’re gonna shoulder shrug up
and down
that’s it
just really loosen up all those muscles
okay and then we’re going to move on to
your lower body so we’re going to lift
those knees up so we’re going to do some
knee raises that’s it
again if you’ve got problems with your
balance are you finding this too
difficult you can do this sat in a chair
as well that’s no problem
okay and then we’re going to move on to
some squats
so mary’s just going to do some small
knee bends there again if you’re finding
this too difficult or you’ve got
problems with your balance just hold on
to a chair or a surface that’s nearby
okay and then we’re just going to move
on to some side steps
that’s it
lovely again it’s absolutely fine to
hold on to a surface or a chair if
you’re finding this one a little bit
difficult
lovely another couple of seconds of that
and then we’re going to move on to what
we call our pulse razor this is the end
of your warm up and we want you to get
your heart pumping
so mary’s just going to start to do some
knee raising on the spot she’s going to
start off really slowly but then she’s
going to go
into a little bit of a faster knee raise
that’s it
go on mary really get your heart pumping
that’s it lovely she’s gone a bit faster
she’s going a bit faster and then she’s
gonna move on to a fast bit lovely go on
prepare yourself for the next stage of
the exercises mary
lovely keep going keep going keep going
lovely are you able to talk to me mary
fabulous
all right and then stop for me there
lovely and just tap your toes on the
spot for me
okay
that’s your warm-up complete hopefully
you’ll feel nice and loose and you’ll be
ready to move on to the exercise program
Warm up exercises
Toe tapping
- Step forward with alternate legs, whilst keeping your weight on the back foot.
- Feel free to use a chair back for balance or sit down if you need to.
Ankle rolling
- Stand on one leg.
- Rotate the other ankle clockwise for 15 seconds and then anticlockwise for 15 seconds.
- Repeat on the other leg.
- Sit down or hold the back of the chair if you need to.
Neck to chest
- Put your chin on your chest.
- Look up at the ceiling.
- Repeat for 15 seconds.
Side to side neck
- Look forward.
- Bend your neck to try to put your right ear on your right shoulder.
- Try to put your left ear on your left shoulder.
- Repeat each exercise for 15 seconds.
Neck rotation (looking over shoulder)
- Look straight ahead.
- Turn your head to try to look over your left shoulder.
- Turn to look over your right shoulder.
- Repeat for 15 seconds.
Shoulders forward and back
- Hunch both shoulders forward.
- Push both shoulders back and push your chest out slightly.
- Repeat for 15 seconds.
Shoulder shrugs
- Shrug both shoulders.
- Relax your shoulders down.
- Repeat for 15 seconds.
Knee raises (You can sit down for this exercise if you need to)
- Lift your right knee up so your thigh is in line with the floor.
- Do the same with the left knee.
- Repeat for 15 seconds.
Squats (Hold the back of a chair if you need to)
- Put your hands on your hips (or hold a chair if you need to).
- Bend both knees a little.
- Repeat for 15 seconds.
Side steps
- Step out to the right and back in again.
- Step out to the left and back in again.
- Repeat for 15 seconds.
Pulse raiser
- Raise your left knee then your right knee in turn.
- Gradually speed up (you may start a light jog if you want to!).
- Do this exercise for 30 seconds.
Beginning the exercises
There are 4 sets of exercises in each group. The exercises can be done at an Easy, Moderate or Hard level.
Easy level
- Sit in chair. Punches forward and above head (can add weights).
- Mountain climbs – hold back of chair, lift knees.
- Sitting jumping jacks (arms and legs out to the side). Can add weights.
- Squats (hold the back of the chair).
Moderate level
- Punch out and above body.
- Hold chair and move feet back. Raise knees quickly.
- Jumping jacks – Simultaneously raise same arm and leg standing up.
- Squats (no holding the back of the chair).
Hard level
- Punches across and upwards whilst holding weights.
- Hands on floor – moving legs up and down.
- Jumping jacks – move both arms and both legs at the same time.
- Squats (Reach out to the front as going down and go up on to tiptoes).
- Complete each exercise for 30 seconds with a 30 second break afterwards.
- During the rest periods, either sit in a chair and tap your toes or march on the spot.
- Once you have completed each set of four exercises, have a 30 second rest and repeat each set a further 2 times.
Easy (Level 1)
Punches (Level 1)
- Sit in a chair.
- Punch out to the front first with one arm, the with the other.
- Punch upwards and across your body, first with one arm then the other.
- Repeat this for 30 seconds.
If you would like to make this exercise a little more challenging, you can hold a light weight such as a tin of beans or a water bottle in each hand.
Important
Rest and recover for 30 seconds.
Mountain climbs (Level 1)
- Hold on to the back of a chair.
- Lift one knee then the other as high as you can.
- Repeat for 30 seconds.
Important
Rest and recover for 30 seconds.
Jacks (Level 1)
- Sit near the front of the chair (an upright chair will be better for this exercise).
- Move one leg out to the side. AT THE SAME TIME move the same arm out to the side and upwards.
- Repeat with the other arm and leg.
- Continue this for 30 seconds.
If you would like to make this exercise a little more challenging, you can hold a light weight such as a tin of beans or a water bottle in each hand.
Important
Rest and recover for 30 seconds.
Squats (Level 1)
- Hold the back of the chair.
- Bend both knees and squat down a little whilst continuing to hold the back of the chair.
- Repeat for 30 seconds.
- If you find this too easy, you can squat a little lower.
Important
Rest and recover for 30 seconds.
Watch our easy exercises:
Beginners exercise program transcript
welcome to the beginners exercise
program we’ve got Mary demonstrating the
exercises for you this afternoon so
we’re just going to get started so there
will be four
exercises they will last for 30 seconds
and then you will have 30 seconds rest
in between so to get us started the
first exercis is is punches we’re going
to start that now so reach forward
that’s it just going to reach above a
head as well lovely now if you’re find
this exercise too easy sat down you can
add a little bit of Weights into your
hand water bottles tins of beans
something like that just to make sure
that you’re getting a little bit out of
breath working yourself hard building up
those muscles in your upper body You’ve
Got 5 seconds left Mary three two one
and then just stop for me there now just
tap your toes up and down Mary that’s it
we’re just going to have a bit of a
recovery for 30 seconds before before
moving on to the next
exercise hopefully you’ll feel that your
breathing is just slowing down a little
bit now as you’re
recovering you’ve got 10 seconds now
Mary before we move on to our mountain
climbers so she will need to stand up
because we’re going to use the chair for
this exercise in three two one so she’s
just holding on to a surface and then
she’s lifting her knees as high as she
can like climbing the
mountain
holding on to the surface is just
helping with balance a little bit but
point in this exercise is to make it
feel like it’s quite hard work and
you’re getting yourself out of breath so
keep going Mary you feeling okay yes
lovely You’ve Got 5 seconds
left three two and one and then we’re
just going to rest again so if you want
to keep standing and just matching on
the spot you can the next next exercise
is something what we call Jumping Jacks
and you will be satting the chair for it
so if you’re finding that you do need to
sit down that’s absolutely fine lovely
Mary just make sure you keep tapping
your toes that’s it it’s a bit of an
active
recovery we’ve got 5 seconds before
moving on to the next exercise and we’re
calling it jumping jacks and if you
start that now Mary for me so that’s it
arms and legs out to the side you’ve got
30 seconds of this
again this is one where if you are
finding it a little bit too easy you can
add those weights into your hands that
can be weights can be bottles of water
tins of beans anything lying around the
house that you can hold on to nice and
safely 5 seconds left three 2 one and
then you just do your recovery now Mary
lovely so just keeping your feet moving
keep your toes
tapping for that 30 second
recovery nearly there we’re on going to
be on moving on to our last exercise
which is a squat so we are going to be
standing up for this one but we’re going
to use the chair just to hold on
to so that’s in 5 seconds Mary Four 3
two and one and we’re going to start
squatting lovely so just a small knee
Bend coming down Keep Holding On Again
if you’re finding that this is a bit of
an easy exercise you can come a little
bit lower into your squat you can speed
it up a little
bit you’re nearly there Mary you’ve got
10 seconds left you feeling okay you can
still talk to me good
sign 4 3 2 1 and just stop there for me
Mary so we’re just going to keep that 30
seconds worth of rest so Mary’s resting
just by holding on and just slowing down
the speed that she’s walking there
that’s your first cycle of exercises
complete what we need you to do is Rerun
the video after the 30 seconds is up
complete your second cycle of exercises
and then make sure you complete your
third cycle of exercises and then you’ve
completed the exercise
program that’s your 30 seconds there
Mary so if you stop for me good luck
with the next two
cycles.
Moderate (Level 2)
These exercises are similar to the Easy exercises, but they have been adapted to make them a little more challenging.
Punches (Level 2)
- Stand up.
- Punch out to the front first with one arm, then with the other.
- Punch upwards and across your body, first with one arm then the other.
- Repeat this for 30 seconds.
If you would like to make this exercise a little more challenging, you can hold a light weight such as a tin of beans or a water bottle in each hand.
Important
Rest and recover for 30 seconds.
Mountain climbs (Level 2)
- Hold on to the back of the chair.
- Move your legs back a little.
- Raise your left and then your right leg up as if you were running on the spot.
Important
Rest and recover for 30 seconds.
Jacks (Level 2)
- Stand upright.
- Point one leg out to the side.
- At the same time bring both arms up in a circle above your head.
- Step back in again and bring your arm down.
- Repeat on the other side.
Important
Rest and recover for 30 seconds.
Squats (Level 2)
- Stand upright.
- Bend both knees and squat down a little whilst continuing to hold the back of the chair.
- Repeat for 30 seconds.
If you find this too easy, you can squat a little lower.
Important
Rest and recover for 30 seconds.
Watch our moderate exercises:
Intermediate exercise program transcript
Welcome to the intermediate exercise
program hello Kirsty. Hi. So you’re going to
be shown the four exercises they’re one
after each other and you get 30 seconds
of doing the exercise and 30 seconds of
rest in between so I’m going to get
started on the exercises and I’m going
to talk you through it your first
exercise is punching okay so cus is
going to start and demonstrate the
exercise for you and your 30 seconds is
going to start now so keep punching out
in front of you across your body body
that’s it lovely cury really go for it
reach up a little bit higher for me
fabulous just feel yourself getting a
little bit out of breath that’s
absolutely fine Kirsty doesn’t seem to
me like she’s getting too out of breath
so she needs to go a little bit faster
make sure she’s hitting that higher
activity level where she’s reaching a
sort of seven and an eight on that scale
of getting herself out of breath so
she’s working hard lovely nearly there
and that’s your 30 seconds so just stop
for me Kirsty and just do do your rest
for me so you’ve got 30 seconds worth of
rest keep moving keep your toes tapping
before we move on to the next
exercise you will need a chair or a
surface to hold on to for the next
exercise kirsty’s got a chair
here lovely you’ve got another 15
seconds just to
rest hopefully you’ll feel your heart
rate start to lower a little bit now and
you’ll be catching your breath back
ready to start another 30 seconds of
exercise so three seconds left of rest
so just get ready for your next exercise
Kirsty which is mountain climbers okay
so just hold on to your surface a chair
and then knees to chest fast as you can
Kirsty lovely remember we want you to
get out of breath we want your heart
pumping lovely keep going now we’ve got
another 20 seconds left so really go for
it really go for it you’re doing really
well there Kirsty Can you feel it yeah
lovely 10 seconds left and then you can
have that rest again brilliant
lovely and that’s two seconds one second
and you just rest for me again so keep
your toes tapping just keep moving for
me before the next exercise begins again
okay
lovely so the next exercise you’re not
going to start yet you’re still resting
but it’s called jumping jacks you got 10
seconds before you’re going to move into
this
Kirsty
3 seconds two seconds and start your
jumping jacks
lovely lovely so just step in lifting
your arm out to the side
again Kirsty should just feel that she’s
going to start getting out of breath now
if she’s not then she needs to go faster
and work a little bit harder
lovely 30 seconds again remember for
this one so you’ve got 10 seconds left
now
Kirsty lovely
5
Seconds two and one and you can rest
again now for me cursy just keep
moving okay just before we move into our
last
exercise so our last exercise is going
to be a squat not quite ready yet you
still got about 15 seconds left just to
have a bit of a
rest 10
seconds
and then five 4 3 2 one and without
holding on you’re just going to do a
gentle squat down and up lovely and
you’re going to go for 30 seconds again
if you’re finding it too easy just speed
it up a little bit for me again
Kirsty again you want to find yourself
that you’re getting a little bit out of
breath you can’t really hold a
conversation but you’re not exhausted
that you’re going to pass out and that’s
where we want you to be working at you
should be finding it a little bit hard
but not exhausting keep going for
me and that’s 30 seconds
there and that’s just rest for me again
stepping and then what we’d like you to
do is replay the video and do the
exercises again for another cycle and
that will be your second cycle and then
you’ll do it again for a third and then
you’ll have completed the exercise
program.
Hard (Level 3)
These exercises are similar to the moderate level and are designed to work at the maximum level. Do each exercise for 30 seconds and rest for 30 seconds between each. Complete each set of four exercises 3 times.
Punches (Level 3)
- Stand up and hold a suitable weight in each hand.
- Punch out to the front with first the left and then the right hand.
- Punch upwards and across your body.
- Repeat this for 30 seconds.
Important
Rest and recover for 30 seconds.
Mountain climbs (Level 3)
- Place both hands on the floor directly below your shoulders.
- Move your legs back so you are taking most of your weight on your shoulders and arms.
- Bring first one leg and then the other upwards in a running motion.
- Repeat for 30 seconds.
Important
Rest and recover for 30 seconds.
Jacks (Level 3)
- Stand up with your hands by your sides.
- Jump and bring each leg out to the side
- AT THE SAME TIME bring each arm in a circular motion out to the side and above your head.
- Jump your legs back in and bring your arms down in the same circular motion.
If you find it too easy, you can hold some light weights.
Important
Rest and recover for 30 seconds.
Squats (Level 3)
- Stand with your legs a bit wider than your shoulders.
- Bend your knees and squat down a little.
- AT THE SAME TIME bring both arms out in front of you.
- As you stand up, bring both arms above your head and spring up on to your toes.
Important
Rest and recover for 30 seconds.
Watch our hard exercises:
Hard exercise program transcript
so this is the advanced exercise program
Mike’s going to be taking us through the
exercises this
afternoon same if you’ve watched the
beginners and the intermediate exercises
it’s the same principle so we’re going
to be doing four exercises they’re going
to last for 30 seconds and then you’ll
have 30 second rest okay so we’re going
to get started with our first exercise
which is punches so Mike ready lovely so
this is going to be 30 seconds of
exercise Mike’s got some weights in his
hand so he’s making it even more
difficult for himself he’s working
himself hard by reaching really high and
going really fast he’s going to start
getting himself out of breath and feel
like it’s getting quite hard to complete
this exercise is over halfway through
you’ve got 10 seconds left Mike
lovely 5 seconds left keep going Mike
you’re doing really well and then stop
there for me so what I want Mike to do
is just have a rest but he’s going to
just keep himself moving on the spot
just so they can let his breathing
recover but not stand completely
still and next exercise when when we’ve
completed our 30 second rest is
something called mountain climbers I
think this is one of the most difficult
exercises on the video don’t need any
equipment at this
stage he’s going to do it in 3 seconds 2
seconds so you’re going to get onto the
floor on his hands and knees bringing
his knee to his chest now Mike’s really
going for it he’s quite fit it’s
absolutely fine if you don’t move your
legs half as fast as Mike is doing here
it’s working your upper body it’s
working your legs going to be getting
yourself really out of breath for this
are you okay there Mike lovely can talk
to me so that’s a good
sign You’ve Got 5 seconds left Mike and
then you do a rest
again one and then stop there for me so
just have a stand up keep moving on the
spot just let your Brea in recover
lovely our next exercise is going to be
one that we call jumping jacks again
it’s quite high intensity it’s quite
vigorous you’ve got 10 seconds left Mike
before moving on to your Jumping
Jacks and three two one and jumping
jacks for me lovely now Mike’s doing
this exercise really well
if he was finding this too easy he could
add some weights into his hand for this
as well as it stands at the minute I
think this is the perfect intensity for
Mike though I can tell that he’s getting
quite short of breath so we’ll not make
it harder for him at this
stage You’ve Got 5 seconds left Mike
before you do a rest again two one and
stop there for me and just keep moving
on the spot just let your breathing
recover again
so the next exercise again no equipment
is needed it’s going to be a squat with
a bit of a reach on it as
well so you’ve got about 10 seconds mate
before we move on to the last exercise
in the
cycle that’s five 4 3 2 1 and then squat
for me Mike and good reach up onto his
toes lovely lovely really reach
high
lovely again this is a really good
strengthening exercise for your legs
it’s halfway
through can you still talk to me Mike y
brilliant good sign you got 5 seconds
left three two one and then just rest
for me again Mike so he’s just going to
keep keep himself moving tap his TOS for
30 seconds now that is one cycle of the
exercise
completed so once the 30 seconds of rest
is up I want you to replay the video and
that will be your second cycle and then
what you need to do is replay it for a
third cycle so that you’ve done three
cycles of the exercises and then your
exercise program will be complete okay
nearly finished there Mike so that’s
your rest period over restart the video
and good luck
Cool down
Once you have finished the exercises it is very important to cool down afterwards. This can be done by walking briskly on the spot for a couple of minutes and then gradually slow down to a stop. This cool down will help bring your heart rate down and prevent injuries after exercise.
Watch our cool down video:
Cool down video transcript
My name is Sandra and I’m just going to
take you through the cool down so you
will have just completed the four
exercises you’ll have done it three
times a cycle of three and the aim is to
do that twice a week so let’s start with
just some gentle walking on the spot so
remember you will have good and bad days
that’s the nature of liver disease some
days you’ll find the exercises really
easy sometimes it’ll be more difficult
so you just have to judge that yourself
and adapt the exercises to how you
feeling that day the main thing to
remember is any activity is better than
none like we said earlier cycling
running walking brilliant exercises to
keep you active but things like diy
things like housework are all great
activities to get your heart pumping and
to get you slightly breathless as well
so think outside the box and pick
something you enjoy it’ll make you more
likely to stick to it and keep active
did you know that a smartphone now is
recording your step counter without you
even knowing it so you if you have a
smartphone you might be able to tell how
many steps you’re doing daily at the
moment the goal standard is to aim for
10,000 steps a day however the nature of
liver disease that’s probably an
unrealistic Target to aim for a good
start would be to identify how many
steps you’re able to do at the moment if
that was 3,000 then you could try and
increase your steps by 500 a week in
four weeks you’ll be doing 5,000 steps
and that’s a really good way to just
start increasing your activity levels so
the most important thing is to choose an
activity that you’re going to enjoy and
that you’ll stick to keeping active is
the most important thing to remember
hope you’ve enjoyed the exercise program
and good luck.
Other activity
Patients waiting for a liver transplant can vary a lot in how unwell they feel. This means that the amount of activity someone can do will vary a lot as well. Try not to compare yourself to other patients, as they may be affected differently to you.
People with liver disease may have days where it is more difficult to stay active, for example when you have a lot of fluid around your abdomen (called ascites) or when you are more confused (called hepatic encephalopathy). Don’t be disheartened if this happens to you, but try to keep as active as you can on those particular days. You may find you need to reduce how hard you work when you are doing the exercises.
You may be able to gradually increase your activity levels day to day as well. This can be things like cycling or running if you are able, but also walking is a good activity to help increase your fitness. You may find you can build this in to your day to day life, such as taking the stairs instead of the lift. Also day to day activities such as housework, gardening and DIY help to build your strength up and get you more ready for liver transplant. Choose an activity you enjoy, and it will make it easier to continue doing this.
If you have a smartphone, you may have a step counting app or a health app built in. If not you can download one. This can be a good way to record your progress and after a period of time you will probably see an increase in what you can do.
Many organisations recommend 10,000 steps a day. If this is too much for you, set a goal you can achieve and aim towards that. Each week try to increase that goal a little, to help increase what you are able to do.
Remember
Any activity is better than none!
My daily activity diary
Please complete the daily activity diary in the paper copy you have been given by clinical staff or download and print pages from the PDF file. (The download option is at the top of this page).
Activity after your transplant
After your liver transplant, becoming mobile as soon as possible will help in several ways:
- It can prevent the development of a chest infection.
- It can help prevent blood clots in your legs (called a deep vein thrombosis).
- It improves circulation and promotes wound healing.
- It helps your bowel return to normal.
Gradually getting back on your feet on the ward will make the jump from hospital to home easier.
The first steps
Within 48 hours of your transplant, it is likely you will be ready to sit out of bed for the first time. You will be helped by the physiotherapists and nurses, who will support you and move the equipment which will still be attached to you. You will usually sit out for up to a couple of hours and the staff will help you back into bed. If things are going really well, the staff will support you to have a short walk on the same day.
The physiotherapists will help you to become confident walking until you are safe enough to walk around by yourself. It will get easier as your drips and drains are removed. At this point, aim to gradually build up the amount you are walking on the ward each day. It is helpful if friends and family encourage you to walk with them at visiting time.
If you are concerned or are nervous about climbing the stairs when you go home, the physiotherapists can practise these with you before you leave hospital.
Breathing exercises
It’s not unusual to have a build-up of sputum in your lungs after your operation; it is one of the side effects of the general anaesthetic. If you find that you are chesty, it is important for you to keep your lungs clear of sputum to prevent a chest infection. The easiest way to do this is by regularly practising deep breathing exercises and coughing. We recommend you do this even if you feel your chest is clear.
As soon as you have woken up from the anaesthetic you can start to do the breathing exercises. You will have a system of pain relief called a patient-controlled analgesia system (PCAS). This is a large syringe of pain killer that you will control yourself with a handset. The nurses will show you how to use this. You can also ask the nursing staff to give you a rolled up towel that you can hold over your wound to support it and make coughing more comfortable.
You may not be completely pain free, but if you are in too much pain to cough and take a deep breath, tell the staff looking after you, as they can often give you a bit more painkiller to make you more comfortable.
To do your breathing exercises, take a deep breath in, and hold this for a few seconds before breathing out. Repeat this 4-8 times and then have a cough. You should do this every hour that you are awake.
As well as coughing to help you clear sputum from your chest, you can also “huff” to help clear sputum, by taking a medium breath in and breathing out quickly, in the same way you would clean your glasses, or steam up a window. You may find that you can cough sputum more easily after you have changed position or been walking.
First activity at home
When you go home it is important to continue the activity that you started in hospital. Set a goal each week to walk slightly further than the previous, but remember to rest as well if you need to. To begin with aim to walk as far as you were walking in hospital, and then build upon this. At first you may want to walk with someone, if you do not feel confident walking on your own.
Aim to walk 5 days each week, starting for around 10 minutes, and then gradually build up the length of time you are walking to around 45 minutes each time. If you want to start more strenuous activity, you need to talk this through with your doctor first. It might be that you are able to take up swimming after a few months once your scar has healed but it can take up to a year for your stomach muscles to completely heal. Doing anything too strenuous may result in damage to those muscles. If you are unsure about taking up exercise, talk it through with the doctor when you come to clinic.
Keeping active whilst waiting for a liver transplant requires determination and commitment to do some form of activity even though you may feel unwell.
The benefits of staying as active as possible whilst waiting for a liver transplant will be seen when you are recovering from the operation. You will find that you have fewer complications and make a speedier recovery if you have remained active.
Remember
- Discover what activity you can manage comfortably, regardless of how little or how much.
- Aim to do this activity up to 5 times each week, every week.
- Some days you may find that you can manage more activity than on other days. This is normal for patients with liver disease or recovering from a liver transplant.
- Following the advice in this booklet will ensure you are safe whilst exercising.
- If you are worried that your level of activity is decreasing, contact your liver doctor or one of the transplant co-ordinators.
British Transplant Games
The British Transplant Games is the flagship event of the charity Transplant Sport, and has been in existence for 40 years, since the first games in Portsmouth in 1978.
Since these early beginnings, the Games have grown and are held every year in different cities throughout the UK. The British Transplant Games have been staged annually since 1978 in 17 host cities across the UK including Portsmouth (1994), Edinburgh (2007), Belfast (1998) Medway (2012), Sheffield (2013), Bolton (2014), Newcastle/Gateshead (2015) & Liverpool (2016). Leeds was proud to host the 2022 British Transplant Games.
Over the past 40 years the Games have grown to a four day annual event with over 800 transplant recipients aged from 2 – 80+ taking part in over 20 different sports, and over 1000 supporters watching.
The Games aim to demonstrate the benefits of transplantation, encouraging transplant patients to regain fitness, whilst increasing public awareness of organ donation and the need to discuss their wishes with their families. They also seek to thank and celebrate donor families and the gift of life.
Some competitors come to win medals, training for their specialist events and hoping to be selected for Team GB & Northern Ireland competing at the World Transplant Games.
Most come to meet new friends, catch up with old friends, enjoy new sports at their own pace and relax for a few days with others who’ve also faced debilitating illness but are now fit and well because of a successful transplant.
Useful contacts
Liver Transplant Co-ordinators
Office hours are Monday to Friday 8am-5pm.
There is a 24 hour answerphone in operation on this line.
