Physical activity and sport post liver transplant

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Physical activity plays an important role in improving the social, emotional and physical health of children who have had a liver transplant.

Key points

  • Playing and being physically active are important parts of a child’s motor and social development, and have positive impacts on overall health.
  • Children post liver transplant are encouraged to participate in physical activity and sport.
  • Physical activity can help to address some of the side effects associated with post-transplant treatments.
  • Full physical activity can typically resume eight weeks following transplant surgery. Contact sports are usually safe for school-aged children but should be discussed with your child’s transplant team for specific recommendations.

Regardless of your child’s age, living with a liver transplant will be a lifelong process. Your child will need to practice a number of healthy habits to ensure they have a good foundation for development into adulthood. One of these important health habits is physical activity.

Why be physically active after having a liver transplant?

Before their liver transplant, your child may have felt tired and weak, making it more difficult for them to be physically active. After transplant, children often find that they have more energy and want to be active again. Your child is encouraged to participate in regular physical activity, as it is an important part of staying healthy.

Regular physical activity can help to:

  • Build and strengthen muscles and bones, and improve the function of the heart and lungs
  • Minimize some of the potential side effects associated with post-transplant treatment such as high blood pressure
  • Decrease the risk of preventable chronic conditions such as diabetes, obesity and non-alcoholic fatty liver disease (NAFLD)
  • Increase energy and endurance for everyday activities
  • Improve self-esteem and school performance, and decrease depression and anxiety
  • Increase social opportunities and allow children “just to be kids!”

For more details on the benefits of physical activity, see Physical activity: Benefits of exercise for health and wellbeing.

The importance of learning how to play

Developing fundamental movement skills

It is important that children learn and improve their fundamental gross motor skills including running, jumping, hopping and skipping. Physical activity provides an opportunity to practice these skills and to spend time playing with family and friends. Learning these skills helps children to feel confident and competent while playing with their friends and family at home, in the park and at school.

It is important to remember that not all children will learn these skills at the same time or in the same way. However, given the opportunity to participate, children post-transplant can develop their motor skills like any other child, ensuring that they get the social, physical and mental health benefits of physical activity participation.

If your child is below the age of five, supervised floor- and home-based play provide opportunities to participate in physical activity. If your child is school aged, gym class, recess and after-school programs offer important opportunities to participate in physical activity. Your child’s transplant team can provide guidance to the school if staff have concerns or questions related to physical activity and transplant.

How soon should my child start exercising after having a liver transplant?

Infants who have a liver transplant can begin to move and practice their skills, such as sitting, rolling and standing in the first few days to weeks post-transplant. This is very important to ensure that your child continues to meet their developmental milestones. Involving an occupational therapist or physiotherapist can help give you an exercise plan.

Children are resilient and generally can do whatever they are comfortable doing after having a liver transplant. For the first few weeks of their recovery post-transplant, your child can do gentle aerobic exercises such as walking. Your child should avoid heavy lifting (10 lbs), pushing or pulling for the first six weeks after their transplant so that their incision (the wound from their surgery) has time to heal. Over time, your child can move onto more energetic activities, such as light chores around the house, riding their bike or playing active games. Some children are able to resume light physical activity as soon as 24-48 hours post-transplant, so try slowly adding activities to your child’s routine each day provided they are feeling well.

After eight weeks, your child can resume normal exercise and physical activities. Contact sports are usually safe, but discuss your child’s participation in full contact sports with their transplant team for specific recommendations. The transplant team is there to help, and you should check with them if you have questions or concerns about specific sports.

How much physical activity does my child need after having a liver transplant?

Current guidelines recommend that infants should have supervised floor-based play several times a day, while toddlers and preschoolers should participate in 180 minutes (3 hours) of physical activity throughout the day. Children between the ages of five and 17 years old should participate in 60 minutes of moderately-to-vigorously intense physical activity every day. This should include:

  • a variety of aerobic activities
  • muscle strengthening exercises at least 3 days per week
  • bone building exercises at least 3 days per week

The Canadian 24-Hour Movement Guidelines for the Early Years (0-4 years) and for Children and Youth (age 5 to 17 years) provide more detail on the recommended levels of physical activity, including rest and relaxation, for a child’s entire day.

What are aerobic activities?

Aerobic exercise, also called cardio, is physical activity that increases your breathing and heart rate over extended periods of time. This type of exercise gets the heart pumping and oxygen flowing through the bloodstream, which strengthens the heart and lungs, lowers blood pressure and helps keep body weight in check. Examples of aerobic activities for infants include tummy time, reaching and grasping, pushing and pulling, and crawling. Examples for toddlers and children include playing outside, dancing, running and swimming.

What types of activities strengthen muscles and bones?

Activities that strengthen muscles and bones force the body to bear weight and require muscles to work hard. Activities that help to build bone include running and jumping because of the impact the feet make when they hit the ground. Many sports such as running and skipping, or playing soccer or basketball, help to build both bone and muscle at the same time. Children also build muscle through activities like climbing in the schoolyard or active play. Weight lifting may be appropriate for some children. Speak to your physiotherapist for further guidelines.

Helping your child be physically active after transplant

It is natural to be protective of your child post-transplant. They have undergone a major procedure, and they will need time to heal. However, physical activity plays an important role in their recovery.

To establish a physical activity routine for your child post-transplant, make sure they are engaging in activities they enjoy. Enjoyment is one of the main motivators for physical activity participation in children, so encourage your child to try a variety of activities and sports to help them to discover what they enjoy the most.

Parents can support their child’s participation by:

  • setting an example—being physically active themselves, and playing/participating with their child
  • developing a family media (screen time) plan that prioritizes physical activity over screens
  • helping them with transportation to and from physical activities/sports
  • encouraging them to talk about their positive experiences and supporting their choices
  • giving them toys that promote physical activity (balls, hula hoops, skateboards, Frisbees, etc.) instead of video games
  • signing them up for a physical activity or sport with a friend at their school or in the community
  • encouraging them to walk to school or to the store, instead of getting a ride

For more ideas on getting school-aged children physically active, take a look at Health Canada's physical activity tips for five- to 11-year-olds and 12- to 17-year-olds.

Last updated: November 13th 2019