EXERCISE AND HEPATITIS C
BY: Mary Jan Detroyer, MS, RD, CDN
Hepatitis C (HCV) is a virus that attacks the liver. Because the
virus grows very slowly, it can take 30 years or more before you
get sick. But you don't want to wait until you get sick to start
fighting the virus. There are drug therapies and lifestyle changes
you can initiate that can slow down or stop the progress of
hepatitis C before it does any damage. Eliminating alcohol, eating
a healthful diet, avoiding stress, finding time for relaxation and
performing moderate exercise are ways to fight the virus.
Fatigue is the most common symptom associated with HCV. It has
various causes. It occurs secondary to medications used to treat
both HCV and cryoglobulinemia, an inflammation to suffer more from
fatigue compared with those who have hepatitis B or alcoholic liver
disease. Of 239 patients questioned about fatigue, 23% thought
general overall body pain caused their fatigue. Fatigue could be
related to the severity of liver disease or to autoimmune disorders
often seen with chronic hepatitis. One study looked at these
parameters; it found no such correlation, but it did find that
people with chronic HCV felt that their fatigue had a major effect
on their quality of life. One of the most important steps you can
take to lessen fatigue is to exercise. I know that sounds crazy,
and exercise is the last thing you feel like doing when you are
tired, but the physiological changes your body goes through during
exercise will actually make you feel better.
Renee is a real person who has been living with HCV for 25
years. She hopes that by sharing her experience, others will find
encouragement and strategies for coping with their symptoms. At the
time of infection, Renee was a competitive athlete training at the
Olympic level with 29 male cyclists. She feels her athleticism
slowed the progression of the virus and allowed her to train at a
high intensity for many years. She has undergone three courses of
drug therapy since 1993. Working out and staying fit help her cope
with the side effects of therapy. She has experienced fatigue,
nausea, vomiting, taste alterations, loss of appetite, hair loss,
sleep disturbances, and pain. The most difficult symptom for Renee
is constant fatigue, which can be all-encompassing.
Exercising through the fatigue will be challenging. Diminished
liver function can cause insufficient levels of oxygen in the
blood. Oxygen is crucial for energy production, and exercise
increases the need for oxygen. Studies show that people with
reduced liver function have poorer oxygen delivery during exercise.
They also experience fatigue at lower exercise intensities and have
difficulty using energy stored in muscle. People with cirrhosis
respond differently to exercise. Some have normal aerobic capacity,
while others experience reduced capacity. This means that some
people will have to choose exercises like T'ai chi or yoga that
require less oxygen delivery. Renee finds she needs a longer
warm-up and modifies her routine based on how she feels each day.
On some days, she jogs the whole distance; on others she alternates
jogging and walking; sometimes all she can handle is walking. She
focuses on how good her body feels during exercise, not on her
limitations. She even competed in a lower intensity triathlon where
the swimming element took place in a pool. She chuckled when she
told me how some children cheered her on, yelling "Keep going lady,
you're doing great." When Renee feels too ill to run or walk, she
uses stretching as a way of staying in tune with her body.
Pain is another symptom associated with chronic hepatitis. When
patients with HCV were asked about the kinds of pain that they
experienced, back pain was reported most often. Other types of pain
reported were morning stiffness, neck pain, general pain, joint
swelling, and joint and muscle pain. Current guidelines for
managing back pain emphasize exercise and activity rather than
rest. Women with neck pain experienced a larger reduction in pain
when they participated in three different forms of exercise as
compared to nonexercising patients in the control group. Renee has
less aches and pains and sleeps better when she exercises.
Depression, anxiety, and irritability are all associated with
HCV. Renee told us that the hardest time for her was when she
started treatment and realized she would never again be able to
compete at the level she was used to. This adjustment was made even
more difficult because many of her friends were competitive
athletes.
"When your body is sick, it is very easy to disconnect from it,"
she commented. Exercise helps Renee stay positive and connected
with her body. Current methods used to treat depression include
exercise, psychotherapy and drugs. Research confirms that people
who suffer from depression, anxiety, and panic disorders receive
similar symptom relief from aerobic exercise and weight training as
they do from meditation and relaxation techniques.
Portal hypertension (increased pressure in the portal vein that
delivers blood to the liver) can occur with liver disease. Portal
hypertension increases the risk of bleeding in the abdomen and
esophagus. Research has shown that venous pressure increases with
low-intensity exercise and intensifies as exercise workload
increases. Medication can be used prior to exercise to reduce
portal hypertension. If you know you have portal hypertension, or
are not sure, discuss this with your doctor before beginning any
type of exercise program.
There is usually no restriction from exercise for people with
hepatitis C, but your choice should be discussed with your doctor.
The type of exercise you choose will depend on how fit you were
before you became ill, how your body reacts, and what you enjoy.
Appropriate activities for beginners are walking, swimming, cycling
or low-impact aerobics. T'ai chi and yoga are good for reducing
stress and calming the body and work well for those who suffer from
anxiety and irritability. However, some yoga techniques are very
rigorous, so ask beforehand to determine whether they are
appropriate. Don't forget to include resistance training a couple
of times a week to maintain or build muscle. Beginners should start
slowly with lower weights, gradually adding weight as they get
stronger. If you have questions, consult an exercise professional
who has experience working within the parameters of HIV and HCV and
who understands the limitations and modifications associated with
both diseases.
One message that rang clear throughout my interview with Renee
was that you will feel tired all the time and you will put off
exercising until you have more energy. She emphasized that you
shouldn't wait until you feel good enough because you never feel
good enough! You have to force yourself off the sofa and out the
door. Have faith in yourself, don't become frustrated, and don't
give up!
Mary Jane Detroyer is a registered dietitian and exercise
physiologist whohas been working with clients for over 14 years to
improve their health through diet, exercise, and simple lifestyle
changes. She has a private practice in Manhattan specializing in
HIV/AIDS, Women's Wellness, Weight Management, and
Prevention.
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