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Pre-surgery exercise advice

Pre- surgery exercise advice

This will reduce the size of your liver to ensure the operation can be done by keyhole/laparoscopic surgery. If your liver is too large it will be very difficult for the Surgeon to perform the operation safely. It may be necessary for the operation to be abandoned, or you will have to have an open operation, increasing the risks of surgery and delaying your recovery.

Prehabilitation advice

Our healthy lifestyle team is working together with our medical professionals, exercise specialists, dieticians and physiotherapists to bring you the most professional, effective and up-to-date evidenced-based advice programme of support before your surgery.

Our aim is to address all your medical and lifestyle issues before surgery, as we know this will improve your likelihood of successful surgery.

You have been given this exercise programme of recommended activities, together with an exercise diary as you have been identified as someone who will benefit from these activities.

If you have other mobility issues, e.g. cardiac and respiratory issues, read the leaflet carefully, and please discuss these suggested exercises with our team or your physiotherapist individually.

Please log your activity in the exercise diary you may have been given.  You may also be asked to report your progress to our Enhanced Recovery Nurses on a weekly basis.

The Exercise Plan

This will contain 2 or 3 elements, depending upon your surgery.

  1. Use a pedometer to count your daily steps. We advise you walk 10,000 steps every day. However, wherever you start, please log your steps accurately every day in the diary, and work up towards this goal before you come in for surgery.
  2. Exercises from our physiotherapy team are designed to improve your muscle strength and aid your post op mobility. Generally we advise you to  repeat these exercises x 10 repetitions, and 1-3 times daily. Then when you are ready progress to using a theraband or light weight.
  3. Using the above, or another activity everyday please ensure you get out of breadth with your exertion.  If you are not used to this, you will be advised how to exert yourself safely using the Borg scale of exertion.  On a daily basis please aim your exercise to be ‘somewhat hard’ which is 12-14 on the breathing scale  (see page 10).

When you are exercising it is normal to feel:

  • Slightly sweaty
  • Warm or slightly flushed
  • You are breathing deeper and faster, but can still talk
  • Your heart is beating faster.

However, you should slow down and make the movements smaller if:

  • Your breathing is uncomfortable
  • You feel excessively tired or are sweating a lot
  • Your perceived exertion score is higher than recommended

You should also STOP, SITDOWN, and do not resume any other exercise that day if:

  • You feel dizzy
  • You feel chest pain
  • Your heart beat becomes very irregular

Prehab exercises – sitting down

bend the knee as far as comfortable
Repeat 5 – 10 times

Lift your leg up off the seat keeping the knee bent, return to starting position
Repeat 5 – 10 times

Bend your head forward until you feel a stretch behind your neck.  Hold for approx 5 secsonds.  Then tilt your head backwards and feel the stretch, hold for 5 seconds
Repeat 5 times

point your ankle towards the floor then towards the ceiling.
Repeat 5 – 10 times

Prehab exercises – sitting

stand up and sit down slowly on a chair (this can be made easier by using your arms to push up off the chair)
Repeat 5 – 10 times

straighten your knee and lift your leg off the ground in front of you as comfort allows.
Repeat 5 – 10 times

pull your toes up, tighten your thigh muscle and straighten your knee, hold for approx 5 seconds and slowly relax your leg to the floor
Repeat 5 – 10 times

whilst sitting and facing forward, tilt your head towards one shoulder until you feel the stretch on the opposite side, hold for 5 seconds, repeat to other side.
Repeat 5 times

Prehab exercises – sitting or standing

sit or stand, keep upper arms close to the sides and elbows at right angles.  Turn forearms outwards then return.
Repeat 5 times

sit or stand, lift your arm up letting the thumb lead the way beside and above your head, repeat this with other arm.
Repeat 5 times

fully bend your wrist forwards then backwards hold for 5 seconds in each direction
Repeat 5 times

clasp your hands together, bend your wrist up and down slowly
Repeat 5 times                                

Prehab exercises – standing

stand, bend your elbow and then straighten your elbow.
Repeat 5 times

stand in front of a chair holding on with both hands.  Slowly crouch keeping to where comfortable, keeping feet firmly on the floor then return to standing.
Repeat 5 – 10 times

bend sideways at the waist, then repeat to other side.
Repeat 5 times

holding on to back of chair (if needed) and march on the spot.
Repeat 10 – 20 times

Prehab exercises:

At the foot of the stairs step up leading with your good leg and down with your bad leg remember moderate pace with control, hold on if required
Repeat 10 – 20 times

You can lie on the bed, lie on your back with legs straight. bend your ankles  (foot upwards) and push your knees down firmly against the bed. Hold 5 for seconds and relax
Repeat 5 – 10 times                        

Stand holding onto a chair, lift your leg out to the side
Repeat 5 times

Stand in front of a chair holding on with both hands. Bring your right leg behind you while keeping your other knee straight; repeat with left leg behind.
Repeat 5 – 10 times

Stand holding onto a wall or a chair for support lift your knee up to your waist and back down
Repeat 5 times

Holding on to back of chair (if needed) lift your heels of the floor
Repeat 10 – 15 times

Borg Scale of Exertion

If you have a heart or lung condition please use this scale to judge your perceived exertion.  It helps check you are exercising at a level that is both safe and effective for you.  We advise you aim to get out of breath during your exercise which is described as ‘somewhat hard’ Score 12-14, but still feels ok to continue.

How to describe your exertion Score
No exertion at all – no aches, fatigue, or breathlessness 6 – 7
Extremely light 7.5 – 8
Very light – e.g. Taking a short walk at your own pace 9 – 10
Light 11
Hard/heavy – it is hard and tiring, but continuing is not terribly difficult 15 – 16
Very Hard – very strenuous, you really have to push yourself and you are very tired 17 – 18
Extremely Hard 19
Maximum exertion 20

Further support

Organisation Contact
Live Well, Stay Well
Stop Smoking Bucks smoke free support service

0845 2707 222

How much is too much Alcohol assessment information

Love your Liver
British Red Cross Home from hospital service

Buckinghamshire 01296 739303