Patients Teaching - Physiotherapy

Pre-operative Exercises

While awaiting for your liver transplant, it is important to balance rest and exercise. Try to stay active by participating as much as possible, in ordinary daily activities. Ensure that frequent rest periods are incorporated into your schedule. Allow for changes in your energy and activity levels throughout the day. Don’t be discouraged by day-to-day fluctuations in what you are able to do.

Your level of general physical fitness is important to recovery after surgery. If you are relatively fit before surgery, then your recovery will be easier. Consult with your physician and physiotherapist about starting an exercise program. Walking is generally considered a good, safe form of cardiovascular exercise.

The following is an outline of general mobility exercises which may be useful to you, while awaiting transplant. Try to do these exercises at least once a day at home. You will be taught the following bed exercises:

a) deep breathing and coughing
b) incentive spirometry exercises
c) bed mobility exercises:

- ankle pumping
- hip and knee flexion
- static quadriceps
- arm raises
- knee extension over a pillow
- straight leg raise
- rolling and bridging

Breathing exercises are designed to reduce the chance of complications of blood clotting in the calves or pneumonia.

A few days after surgery, you should begin to sit at the side of the bed and get up into a chair with assistance. As your endurance and balance improve, you should begin walking. Initially, you will require some support or assistance. Gradually, you should increase the distance you can walk, and before going home, you should be walking independently.

For about the first 12 weeks after abdominal surgery, it is important to avoid straining the incision and healing muscles. You should not lift more than ten pounds or do any abdominal exercises (e.g., sit ups). Otherwise there are no restrictions to your activity.

Use common sense when you try something new, and ensure that you strike a happy balance between rest and exercise. Continue with you bed exercises and start a walking program to speed your recovery. Initially, walk slowly on a level surface. Start with short (e.g. 5 – 10 minutes) walks frequently ( 4 – 6 times) during the day. Gradually increase your walking time and decrease the number of walks per day. When you can walk continuously for twenty or thirty minutes once per day, you can begin to increase your walking speed. During your recovery, feel free to consult with your physiotherapist or physician if you have any questions.

Patient Teaching - Dietary

During your assessment phase, you will be seen by the clinical dietitian. You may be required to adjust your protein, sodium and fluid intake. You will be asked to complete a food record to ascertain your current nutrition status and to help set up a nutrition care plan. You will be seen in the outpatient clinic to monitor your weight, discuss nutrition restrictions and make modifications.

Early in the pot-operative stage, nutrition support will begin. This can range from eating orally, tube feeding, or intravenous. The route of feeding will depend on how well you can tolerate foods. Sometimes you calorie needs may be large and you may not be able to eat enough to maintain your weight. In this case, oral plus tube feeding may be recommended. Another way is to be fed intravenously – called TPN.

Several feeding methods may be combined before arriving at one that will provide enough calories and protein you need to heal.

You will be followed in the clinic as an outpatient and your weight will be monitored. Our experience has shown that transplant patients tend to gain weight after surgery for a variety of reasons. Losing weight can be very difficult, therefore every attempt will be made to prevent you from becoming overweight. If you were underweight prior to your surgery, the goal will be to increase your weight so that you will be within the current “healthy weight zone”. Thus, you will be asked to monitor your weight at home once weekly.