Exercise and the Liver/Hepatitis

THE IMPORTANCE OF EXERCISE FOR PEOPLE WITH LIVER DISEASE/HEPATITIS

The summer is just around the corner, and so, for many people, getting into shape is an important priority. As the warmer weather approaches we can no longer conceal our bodies under heavy sweaters and overcoats. Everyone wants to look their best at the beach and at all those barbecues and picnics. Individuals with liver disease are no exception. However, their are some fitness-related issues that apply specifically to people with liver disease that one should be aware of. This article, which is in part excerpted from my book “ Dr. Melissa Palmer’s Guide to Hepatitis and Liver Disease” will discuss why exercise and staying in shape is important for people with liver disease. In addition, I will provide some helpful hints on shaping up for the summer and well as for staying in shape year round.

Regular exercise is an important component necessary to combat liver disease. This isn’t something that can be read in any medical textbook or taught in medical school classrooms. This may explain why most liver doctors don’t realize how important exercise can be to maintaining their patients’ health. But I’ve seen the benefits over and over again in my practice. People who are in good shape and who exercise on a regular basis not only feel better, but often respond more positively to medical treatment. People do not have to do a lot of exercise in order to reap the benefits. Nor does it pay to overdo it. The main thing is simply to get going. Regular exercise will increase energy levels, decrease stress on the liver and, in many cases, even delay the onset of certain complications associated with liver disease. Of course, it is crucial to consult with a doctor before beginning any type of exercise program.

What Are The Benefits Of Exercise ?

The benefits of exercising are numerous. First, exercise gives people a general sense of well- being and improved self- image. It is a known fact that if a person feels well mentally, his or her immune system will be stronger, thereby giving him or her that extra edge to fight against disease.

Second, exercising gives a person a boost of energy. Fatigue is probably the most common and one of the most bothersome symptoms that plagues people with liver disease. Many individuals with liver disease frequently feel like they don’t have enough energy to make it across the room, let alone around the block. However, the best way to fight this seemingly relentless exhaustion is to exercise. Yes, this may seem like a viscious cycle, but most patients find that it actually works. Fatigue may in part have to do with the fact that both the heart and the liver are working overtime to keep an adequate supply of filtered blood circulating throughout the body. Adding a regular exercise routine enables both organs to work more efficiently. Over time, this will boost energy levels. While most people find it tough going at first, they eventually realize that the benefits are worth it.

Third, exercise improves cardiovascular function. As the body gets stronger and more aerobically fit, the cardiovascular system will be able to work more efficiently. Less effort will be required of the heart to pump blood to the liver and other organs of the body. This is why aerobically fit people have slower pulse rates. So, with each heartbeat, a greater volume of blood is pumped to the liver, brain, muscles etc. Therefore, less strokes of the heart are required to supply organs with an adequate amount of blood. Less effort on the heart equals stronger cardiovascular function and an increased overall energy level for the person with liver disease. It is extremely important to attempt to do some exercise while on interferon treatment, as this will decrease the fatigue, irritability and depression often associated with this medication.

Fourth, exercise results in a reduction of total body fat. While everyone knows that being overweight places a great deal of stress on the heart, most people don’t realize that it also makes it harder for the liver to do its job. When total body fat is reduced, fat content in the liver is simultaneously reduced. This often results in a significant reduction of elevated liver enzymes ( SGOT also known as AST, and SGPT also known as ALT). Eating right and getting plenty of exercise is probably the slowest way to lose weight known to humanity, but it’s also the safest. That’s especially true for people with liver disease. If one forgets about exercise and only counts calories to lose weight, then the likelihood of losing weight and keeping it off diminishes. Combining a healthy diet with regular exercise is the best bet for weight reduction and is also the best way to keep from regaining the weight.

The Benefits Of Exercise For Osteoporosis

Exercise is essential in order to decrease the incidence of potentially detrimental bone disorders. Osteoporosis is a bone disorder frequently associated with liver disease. It results in decreased bone density, leading to fragile, easily fractured bones. While osteoporosis is a disease that most frequently affects postmenopausal women, it can also affect premenopausal women with liver disease and men with liver disease. Postmenopausal women are particularly susceptible to osteoporosis because as estrogen production stops, bone loss accelerates. Furthermore, women naturally have a lower percentage of muscle and bone mass than men. This further increases their risk of developing osteoporosis. Other risks for osteoporosis include excessive alcohol use, advanced cirrhosis from any liver disease typically resulting in muscle wasting, and use of prednisone. Fortunately, individuals can reduce the likelihood of developing osteoporosis by making exercise and a healthy diet part of their lifestyle.

Just as muscles grow in response to muscle contractions, bone strength and density increase when the muscles attached are contracting. Studies have shown that muscle and bone growth promoted by frequent weight-bearing exercise is vital to the prevention of osteoporosis. Supplementing the diet with at least 1000 - 1500 milligrams per day of calcium with vitamin D is also important. If a person already has osteoporosis, it needn’t keep him or her from exercising, but he or she will have to use more caution to keep from breaking any bones. High impact aerobic exercises which involve jumping and twisting, can increase the risk of injury should be avoided. Low impact exercises such as swimming and walking, are the safest choices for aerobic exercise. Weight- bearing exercises with light weights can generally be safely performed. Close attention should always be paid to proper form. Running on a hard surface, such as concrete pavement, should be avoided. Soft surfaces, such as specially designed running tracks or a sandy beach, are preferable.

The Types Of Exercise

People with liver disease should take up both aerobic and weight-bearing exercises, as they each play a different role in fighting liver disease. It is fortunate that in this day and age, there are an abundance of books, videotapes and television programs that help teach, step by step, both types of exercises. It is important to use these self- help materials prior to starting any exercise regimen. Other helpful ideas include scheduling a few appointments with a personal trainer to design a fitness routine that personally meets one’s needs. Many fitness trainers will even work in their clients’ homes. This is important, as many people are too self- conscious or too shy to exercise in a crowded gym, and/or lose self-motivation after the first few sessions at a gym. The chance of success is increased if a person picks an exercise that he or she already enjoys and that can easily be done at least three times a week.

Timing is also important. It is fine to exercise at any time of the day that is personally convenient and that fits into one’s own schedule. But, by the end of the day, most people are usually too mentally and physically tired to do anything, least of all, run on a treadmill. That is why most people with liver disease find that they need to do their exercises first thing in the morning. While some people may find it difficult to get up in the morning in the first place, once they get started with an exercise regimen, it will become easier and easier. And, individuals usually find that exercising in the morning helps give them an extra boost of energy to make it through the day. Finally, don’t overdo it. It’s more important to maintain a regular routine than to set any records.

Aerobic Exercises

Aerobic exercise trains the heart, lungs and entire cardiovascular system to process and deliver oxygen more quickly and efficiently to every part of the body. It’s the kind of exercise that gets your heart pumping. As one becomes more aerobically fit, the heart won’t have to work as hard to pump blood to the rest of the body, including the liver. The pulse will begin to slow down, making it easier for the liver to send the blood it has just filtered back to the rest of the body. The benefits of being an aerobically fit person include an overall improved energy level, which translates into decreased fatigue. Fortunately, one does not have to wear high-fashion workout clothes or go to a fancy gym to get aerobic exercise. Walking briskly, bicycling (either stationary or regular), swimming or using a treadmill all provide solid aerobic benefits. Many patients start off with something easy, like walking around the block. A helpful hint is to start by walking up and down the street close to home. In that way, if a bout of fatigue suddenly occurs, it won’t take long to get home.

Weight - Bearing Exercises

Weight-bearing exercises build up both bones and muscles. For many reasons, it is important for all individuals with liver disease to incorporate weight bearing exercises into to their daily exercise routines. First, as emphasized above, patients with liver disease need good strong bones because they are prone to osteoporosis. Weight training is the best way to fight against this, as stronger muscles equals stronger bones. Second, in advanced stages of liver disease, the body is forced to recruit muscle as a source of energy. People are at risk of developing severe muscle wasting and greatly diminished strength. However, if a person has a reserve of muscle built up on his/her body, it will take a much longer time for this complication of liver disease to develop. Third, people who have too much fat on their bodies are prone to worsen their underlying liver condition by developing a fatty liver and possible nonalcoholic steatohepatitis (NASH). NASH can also progress to cirrhosis. Weight training will reduce the amount of fat on the body, and increases muscle mass. Muscle is more efficient than fat for increasing overall metabolic rate. Therefore, the chance of developing a fatty liver and/or NASH will be reduced. Finally, since muscle weighs more than fat, weight training is the perfect means of gaining lean healthy weight for those people who are underweight.

Once again, there are lots of self-help books and videotapes that describe how to create a personalized weight-bearing exercise routine. It’s a good idea to hire a personal fitness trainer who can design an individualized routine specific to an individual’s needs. It is important that the trainer is aware of the client’s liver disorder, and that sometimes he or she will sometimes not be able to exercise to full capacity. A person with liver disease should never push themselves, or allow themselves to be pushed by a trainer. If too tired, or if a body part feels strained, stop exercising until feeling better. Fitness training has become a field that requires certification, so make sure that the trainer is certified.

It is important to remember to work out every part of your body evenly. ( Did you know that there are eleven distinct body parts to work out? ). In that way, the chances of injury are decreased. A few stretching exercises should always be performed first to warm up the muscles before doing weight bearing exercises. The amount of weight being lifted should allow for eight to twelve. This is known as a repetition ( rep), and is defined as one full and individual execution of an exercise. A set is a distinct grouping of repetitions, followed by a brief rest interval. One should do three sets of a given type of exercise. Aim to work out each body part at least once a week. Twice a week is ideal.

Putting Together An Exercise Program

Nobody expects a person beginning an exercise regimen to run a marathon or enter a bodybuilding contest. Setting impossibly high standards only guarantees failure. But if a person starts with easy goals and works their way up, they are much more likely to make exercise part of their daily routine. A good beginning regimen might include ten- to - twenty minutes of aerobic exercise, followed by a few weight-bearing exercises, three times a week. Everyone should work at his or her own pace until he or she is working out daily, or at least three to five times per week. But even if a person can only exercise for a few minutes at a time, there is no need to despair. Doing a little exercise is better than doing none at all. And, it will get easier as time goes on.

When a person is in an acute phase of hepatitis or is experiencing a severe exacerbation or relapse of disease, any form of intense exertion should be avoided. There’s no need for enforced bedrest, however. a person should listen to his or her body. If exhausted, then it’s time to rest. If up to physical activity, then by all means be active. But, one must also be aware of one’s personal limitations and know when it’s time to call it quits. The liver has only so much energy to distribute to the rest of the body, so it’s never wise to overdo it. Again, it is crucial to consult with the doctor prior to commencing any exercise program.

Adequate Water Consumption

The body requires water in order to carry out its essential functions. Exercise leads to water lose and dehydration. Dehydration is exacerbated during the summertime. Therefore, it is important for people with liver disease to drink at least six to eight 8- ounce glasses of water per day. It is especially important for people with chronic hepatitis B or C who are on interferon therapy to stay well-hydrated. These people should probably increase their water intake to at least twelve 8-ounce glasses of water per day. Patients with liver disease often find that drinking abundant amounts of water helps give them an improved sense of well-being. And, patients on interferon often find that liberal water consumption helps them with some of side effects of the medication. On the other hand, individuals with ascites ( the accumulation of fluid in the peritoneal cavity) are prone to excessive water retention. These individuals are advised to restrict their water intake to approximately three to four 8 ounce- glasses of water per day, depending upon the degree of fluid accumulation present. When drinking bottled mineral water, it is important to take note of the water’s sodium content. In some instances, the sodium content may present a problem for individuals on sodium restricted diets.

A Word of Warning About Crash Diets and Diet Pills

The recommended way to lose weight is to adopt a healthy, balanced diet and to exercise regularly. It is easy to be tempted to take a shortcut through this approach via the use of a crash diets or diet pills. This is definitely not recommended. These mass- market solutions may produce seriously adverse, or perhaps even fatal consequences in an individual with liver disease. Many fad diets emphasize one particular category of nutrient, say protein, or even just one specific type of food, like grapefruit, to the exclusion of everything else. A healthy person’s liver might be able to tolerate this approach, but a damaged liver often cannot. The nutritional imbalance which an ill-advised fad diet can create can easily throw a weakened liver into failure and land a person in the hospital. The same applies to diet pills. Remember, everything that is ingested eventually has to be processed by the liver. Diet pills may add to the stress of an already burdened liver, thereby increasing the likelihood that a person’s condition will worsen rather than improve.

By reading this article, you have acquired some useful knowledge about the importance of exercise for people with liver disease. For additional information you may wish to consult my book. Until next time - continue to keep up the fight for a healthy liver.

Melissa Palmer, MD is the author of " Dr. Melissa Palmer's Guide of Hepatitis and Liver Disease". (Published 2004. Penguin Putnam).

The office of Melissa Palmer, M.D. is located at:

1097 Old Country Road Suite 104

Plainview, N.Y 11803

To arrange an appointment with Dr. Palmer, call

(516) 939-2626

Return to liverdisease.com home page