1. Exercise From Aerobics To Zumba
Lyle Hawes, PT

2. Introduction
Medical/Surgical Rotation
Liver Medicine/Liver and Kidney Transplantation
In-Patient setting

3. PT Responsibilities
Evaluate Muscular-Skeletal system
Functional mobility
Establish a Plan of Care

4. PT Responsibilities
Co-ordinate with:
MDs, PA-C/APRN
Nursing and PCAs
Social Work, Case Managers, Dietitians
Make discharge recommendations

5. Benefits of Exercise
Decreased
Blood Pressure
Cholesterol

6. Stress, Depression, and Anxiety
Benefits of Exercise
Decreased
Fatty Liver
Stress, Depression, and Anxiety

7. Strength and Flexibility
Benefits of Exercise
Increased
Fitness Level
Muscle Mass
Strength and Flexibility

8. Benefits of Exercise
Increased
Liver Oxygenation
Concentration

9. Helps control blood sugar Helps control weight
Benefits of Exercise
Other Benefits
Helps control blood sugar
Helps control weight

10. Delays or reduces effects of arthritis Improved sleeping ability
Benefits of Exercise
Other Benefits
Delays or reduces effects of arthritis
Improved sleeping ability
Leads to a longer and healthier life

11. Post Transplantation Findings
Liver transplantation patients demonstrate similar performance to other transplanted organs
Reason for liver transplantation does not effect Health Related Quality of Life (HRQoL), let’s just call it QOL

12. Post Transplantation Findings
Physical fatigue can lead to a downward spiral of less activity and more fatigue
Physical fatigue is the most distressing post-transplant symptom

13. Post Transplantation Findings
First 6-12 months post transplant are most sedentary and fatiguing
Greater incidence of obesity

14. Post Transplantation Findings
Decreased cardiopulmonary fitness
Decreased muscle strength

15. Post Transplantation Findings
Second and third years show increased activity and QOL
QOL improves, but remains less than general population
Increased age significantly effects QOL in all populations

16. Post Transplantation Findings
Liver transplant patients are living longer
Returning to work or volunteering promotes a greater feeling of worth and improves QOL

17. Getting Started
Talk to your MD and get cleared for exercise, ask for specific precautions, check medication effects
Determine type, frequency, duration, and intensity of exercise

18. Getting Started Plan to progress your exercise program
This can be modified as you move along
Consider the season and daily weather

19. Getting Started
Start slow
Ask for Help

20. Getting Started Exercise with a partner or group
Encouragers/Motivators/Competitors
Add technology (e.g. Fitbit, GPS trackers, etc.)
Fitness professional

21. Getting Started Add technology (e.g. Fitbit, GPS trackers, etc.)
Fitness professional

22. Getting Started Listen to your body Sleep Diet
Supplements (check with MD, Dietitian, and/or Pharmacist)

23. Getting Started Listen to your body
Rest for pain or swelling, inform your MD
Establish a routine; time of day, day of the week
Dress comfortably with proper clothing and footwear

24. Getting Started Stay with it!
One week, One month, Three months, and continue
Feel and appreciate the difference in your body and your energy

25. Classic Exercise Program
Warm Up
Three to five minutes
Active range of motion

26. Classic Exercise Program
Warm Up
Walk around
Gentle stretches

27. Classic Exercise Program
Strength Training
Every other day
Upper extremities, lower extremities, core/trunk

28. Classic Exercise Program
Weights, Machines, Bands, or Tubes
Start with low weight and repetitions;
8-12 repetitions, two to three sets
Gradually increase the weight/resistance

29. Classic Exercise Program
Benefits
Preserve bone mass
Increased strength (and muscle mass), increased metabolic rate over a longer period of time.

30. Classic Exercise Program
Aerobic Exercises
Lower resistance
Increased repetition, time, and intensity
Many different choices
Three to five times per week

31. Classic Exercise Program
Aerobic Exercises
Benefits
Preserve bone mass
Increased cardiopulmonary performance
Decreased
Blood pressure, cholesterol, blood glucose, stress, depression, and anxiety

32. Classic Exercise Program
Aerobic Exercises
Decreased
Blood pressure, cholesterol, blood glucose, stress, depression, and anxiety

33. Classic Exercise Program
Cool Down
Three to five minutes
Walk, active range of motion, stretch (muscles are looser and warmer)

34. Classic Exercise Program
Cool Down
For stretching, no bouncing motions, slow and hold positions
Allows a gentle transition to baseline, decreased risk for dizziness or blood pressure drop

35. Classic Exercise Program
Intensity
Your body will warm up as you exercise
Heart should beat faster

36. Classic Exercise Program
Intensity
It should be harder than everyday function, but you should still be able to carry on a conversation
Sweating is good!

37. How Do you Start? Find something that fits into your schedule
Find something that you will enjoy, and do
Find things that fit the above criteria and… get started!

38. 1 MET ≡ 1 kcal/kg/h ≡ 4.184 kJ/kg/h
The Metabolic Equivalent of Task (MET), is the rate of energy consumption
1 MET ≡ 1 kcal/kg/h ≡ kJ/kg/h
MET values of activities range from 0.9 (sleeping) to 23 (running at 22.5 km/h; a 4:17 pace mile).

39. MET
For example an activity with a MET value of 2 (walking at 3 km/h) would require twice the energy that an average person consumes at rest

40. Example Activities Nooky/sex 2-6 Orienteering 9 Paddle Ball 6
Aerobic Step
8.5
Bicycling, general
Cross Fit Training 8
Dancing, general
3-4.5
Excavating/shoveling 5
Fishing
2-6
Golf, cart/walk
Hiking 6
Inactivity, Sleep/Stand
Jogging
7-10
Kickball 7
Lacrosse
Music Drums 4
Nooky/sex
2-6
Orienteering 9
Paddle Ball 6
Quilting/sewing machine
2.8
Rope Jumping
8-12
Ski, CC/Swim
7-14/7-10
Tai Chi 4
Using Crutches 5
Volley Ball
3-8
Walking
3-6
Xylophone 3
Yoga
3.2
Zumba
8.8

41. Thanks