This condition is the end-stage disease of the liver resulting from a variety of diseases, most commonly hepatitis C and alcohol abuse. Cirrhosis of the liver tissue is from inflammation, fibrotic scarring, and obstruction of biliary channels. These changes lead to jaundice, portal hypertension, and decreased clearing of waste from the blood. Clients experience more fatigue, malnutrition, and muscle cramping as the disease progresses.1 Fatigue is related to significant reduction in muscle mass and strength and increased presence of ammonia in the circulating plasma.2,3 At end-stage, the client develops ascites of the abdomen and edema in the lower extremities, which may significantly reduce the client's daily activities.
Comorbidities to Consider
Diminished aerobic capacity is related to myocardial thickening, limited pulmonary function, and inability to increase cardiac output during activities.4,5
Clients often develop diabetes and display greatly reduced cardiovascular and skeletal muscle functions.2,4
Keys to Examination of Client
Discuss clients' problems with mobility and fatigue.
Ask clients if they have symptoms of abdominal pain, muscle cramping, nausea, and nutritional intake before recommending an exercise program.
Recommended Baseline Testing of Fitness Levels
Use a 6-minute walk test or a 10-meter velocity test as a baseline for endurance.
Assessments of mobility, muscle strength, and fatigue levels establish a baseline for physical activities.
Type: Walking, treadmill walking, cycle ergometry
Intensity: Low to moderate intensities1,6
Duration: 5–10-minute bouts with rest periods
Frequency: Three to four times per week
Clients with well-compensated liver disease should be encouraged to participate in mild to moderate exercise programs.6,7 Ongoing evaluation of the condition is needed to adjust the exercise program to limit any complications secondary. Clients can be advised to exercise for short periods with rest breaks using their perceived exertion levels to adjust the daily intensity level. The client should be assessed for abdominal swelling and edema in the lower extremities during and after exercise. Abdominal pain, vomiting of blood, and increased distention of abdominal veins are possible signs of portal hypertension. Clients who have developed ascites that is not controlled with diuretics will be restricted from exercise activities. Clients with well-compensated liver disease should be encouraged to increase the duration and frequency of their exercise activities. Long-term adaption of exercise activities may serve to improve quality of life measures and the client's sense of well-being.7,8
H. Skeletal muscle in liver disease. In Skeletal Muscle: Pathology, Diagnosis and Management, ed. Preedy and Peters. Cambridge University Press, 2002.