Whether you love exercising or you try to avoid physical activity, your hepatologist may tell you that exercise would be good for you while living with primary biliary cholangitis (PBC).

If you’re not sure where to start, read on to discover whether an exercise routine may help improve your health and quality of life.

What Is PBC?

Primary biliary cholangitis (previously called primary biliary cirrhosis) is an autoimmune disease. It causes your immune system to attack cells lining the inside of your bile ducts. These ducts slowly experience damage, becoming oddly shaped or narrowed. This makes it hard for the bile to move through the ducts. It can get backed up inside your liver, where buildup will eventually damage additional tissue there.

Over time, your liver will contain more scar tissue from this liver damage. When this happens, your liver function can slowly get worse. You can end up in liver failure, or you may need a liver transplant. There are treatment options and lifestyle adjustments that may make this liver disease progress more slowly.

How Does Exercise Affect the Liver?

You’ve probably heard a lot about how physical activity can help the heart and the lungs, but it helps the liver, too. There are a number of positive effects that exercise can have, including:

• Decreasing inflammation in the liver
• Lowering the amount of fat in your liver
• Raising the amount of blood that flows to the liver
• Helping you lose body weight, which can help with scar tissue in your liver

Some of these, like lowering inflammation and improving scar tissue, are things that could directly affect your life with PBC.

Does Exercise Help With PBC?

A balanced diet and exercise are often the first treatments offered for some liver diseases. While PBC requires additional care, this doesn’t mean exercising and eating well with PBC won’t improve liver health. In one study done on people with a different liver disease, a healthy diet and exercise significantly improved the health of participants’ livers.

On myPBCteam, some members have experienced this with PBC. “Changing diet and some exercises have done some wonders for me,” one member shared. Another member added, “I have been feeling wonderful. I am careful about my diet and I exercise.”

There’s not a lot of research on exercise and PBC. But exercise may be helpful for some of the side effects and symptoms that accompany PBC.

Exercise and Fatigue

Fatigue and PBC often go hand in hand. In fact, fatigue is among the first symptoms of PBC in 65 percent of people. This can be an ongoing symptom that can become hard to treat.

Fatigue can make exercise harder, but exercising can help with fatigue. In one small study, more than 80 percent of people with PBC who completed an exercise program experienced less fatigue than they had before they started working out.

On myPBCteam, members talk regularly about exercise and fatigue. One shared, “I do get very tired and find exercise to be a savior. I attend a great Pilates class and also a keep fit class and do a fair bit of walking.”

Another member noted that their fatigue got worse when they stopped exercising. They shared, “I … have gotten lazy this summer and have been more challenged with fatigue.”

Exercise and Osteoporosis

About 30 percent of people diagnosed with PBC will eventually be diagnosed with osteoporosis, too. This means that their bones are gradually growing weaker. This is mainly because of poor absorption of vitamin D due to the disease itself as well as poor diet. Low vitamin D levels are commonly observed in patients with PBC. Regular exercise and a balanced diet with vitamin supplementation can help counteract this because it helps keep your bones strong. Experts recommend doing both aerobic exercise, where you get your heart rate up, and strength training, like lifting weights. This can help you build and retain bone density and muscle mass.

General Benefits of Exercise

People living with PBC get the benefits of exercise for their livers, but they also get the general benefits of exercise for overall health. They might see:

• Better mental health
• Better mood
• Stronger muscles
• Better sleep
• Better sexual health
• Longer lifespan
• Fewer falls
• Better glucose and insulin levels
• Lower risk for heart disease
• Better brain function as they age
• Lower chance of getting some types of cancer
• Better chance of weight loss or maintaining a healthy weight

Benefits like this can make exercise worthwhile when you’re living with PBC.

Exercising With PBC

Before you start a new exercise routine, it’s important to think through a few things.

Things To Consider Before You Exercise With PBC

As noted above, both fatigue and osteoporosis can come along with PBC. Fatigue tends to influence how much you exercise, while osteoporosis can influence which exercises are safe for you.

Additionally, some people might feel like their joints, bones, or muscles ache with PBC. This pain may make you less likely to exercise, too. You should talk to your hepatologist if you have any concerns about aches and exercise.

Safe Exercises for People With PBC

Unless you have significant or advanced osteoporosis, your provider may allow you to select the type of exercise most appealing to you, without any limitations. If bone health is a concern for you, your healthcare provider may tell you to focus on these types of movement:

• Weight-bearing exercise, like walking
• Aerobic exercise
• Stability exercises
• Balance exercises
• Stretching exercises
• Flexibility exercises
• Strength training exercises to increase muscle mass

People on myPBCteam enjoy all types of exercise. Some members have talked about what they do, saying:

• “I do walking DVDs daily. They incorporate strength training along with cardio.”
• “I take one day at a time and try to be as active as possible. I take short walks to get a little exercise.”
• “Went to our community pool to do some water exercise.”
• “At least three days a week, I do chair exercises and use a stretch band and light weights.”
• “Lightly bouncing on a rebounder is great exercise.”

Exercise and Liver Enzymes

Certain liver enzymes and other markers often tested in blood tests can go up after significant amounts of weightlifting exercise. If you want to do this kind of exercise, you'll need to talk to your doctor first.

If you’re asking, “Can exercise damage the liver?” the answer may be complicated. Certain elevated numbers in blood tests may indicate muscle damage, which is normal during weightlifting. Your doctor will want to monitor your blood test results to ensure you’re staying healthy if you choose to lift weights.

Starting an Exercise Routine With PBC

Always talk to your doctor before you start a new workout routine. You should also talk to them if exercise seems to make your PBC symptoms worse or if you notice new or additional flares of PBC when adding exercise.

Other than that, you’re more likely to be successful when starting a new exercise routine if you:

• Decide ahead of time how often you want to do certain exercises and for how long. Your ultimate goal should be 150 minutes a week.
• Schedule exercise on your calendar.
• Use the talk test to measure exercise intensity. You should be able to speak a full sentence but be a little breathless while doing it.
• Listen to your body and adjust your exercise accordingly. If you’re in a flare, you may need to back off.
• Set realistic goals based on where you are and where you want to be.
• Track your activity to recognize how much you’re exercising and how your body is changing. You can use a fitness tracker or an exercise diary to monitor your activity.
• Stay hydrated for liver health while exercising.

If setting up an exercise plan is new for you, talk to a healthcare professional about getting some help to create a plan that’s safe and will work for you.

Talk With Others Who Understand

On myPBCteam, the social network for people with primary biliary cholangitis and their loved ones, members come together to ask questions, give advice, and share their tips with others who understand life with primary biliary cholangitis.

Do you exercise while living with PBC? What kind of exercise plan works for you? Share your experiences in the comments below, or start a conversation by posting on your Activities page.