There is a moment on the transplant list that nobody really prepares you for. You have done the tests, met the team, signed the paperwork, and now you are just waiting. It feels so passive, like your only job is to hang on and hope the phone rings.
But here’s what I have learnt, both from my own experience, and from the growing body of research behind it. The waiting list isn’t a waiting room, it’s a training ground.
What Prehab Actually is
Prehabilitation, or “prehab” is exercise and movement before your transplant, while you’re still on the list. It is building strength, fitness and function before you have the surgery, not waiting until afterwards to start.
That distinction matters more than it sounds. Surgery is trauma, whatever else it also is. Your body has to survive it, then rebuild from it. A stronger baseline going in means a safer, faster recovery coming out. Your body simply copes better with the trauma of surgery when it has more reserve to draw on.
What the Research Says
This isn’t just something I believe because it worked for me. There’s real evidence behind it. Exercise capacity while on the waiting list has been shown to be associated with survival on that list, which tells you just how much this matters before you even get to surgery.
A recent update to a major review pooled 23 clinical trials involving more than 1,100 kidney transplant recipients, and found structured exercise programmes consistently improved fitness, strength, blood pressure, body composition and quality of life.
The evidence isn’t limited to kidney recipients either. Reviews of exercise training in lung transplant recipients have found real improvements in muscle strength, walking distance, bone density and quality of life, addressing the reduced exercise capacity and muscle impairment that often persists even after lung function itself has improved. Similar research in heart transplant recipients has looked at how exercise training can improve exercise capacity and rebuild muscle strength, addressing the muscle wasting and exercise intolerance that’s common after transplant surgery.
Prehabilitation itself is increasingly being recognised as a genuine non-pharmacological therapy in its own right, not just a “nice to have” alongside your medical care, and that holds true across organ types.
And yet, despite this, only a small percentage of people on transplant waiting lists are engaged in any kind of structured exercise. There’s a real gap between what the evidence says helps and what people are actually doing. I don’t think that’s because people don’t care. I think it’s because nobody’s telling them, clearly and directly, that this is something they can do.
The Real Barrier isn’t your Body
If I’m honest, the biggest barrier for me was never really physical. It was the what ifs. What if I over do it? What if I get hurt? What if something happens and I’m not near a hospital? What if my body just can’t?
Those feels are real, and I’m not dismissing them. Physical barriers exist too, fatigue, symptoms that change day to day, genuine limitations depending on your failing organ. But so much of what held me back wasn’t my body, it was my mind running through every worst case scenario before I’d even tried.
My challenge to you is the same one I try to live by now. Instead of asking “what if this happens,” ask “what if I just did it?” What if you tried and it actually helped. What if you surprised yourself?
I think about a sea plane ride I took around Vancouver, about two months before I got listed. It was something I’d always wanted to do, and the barrier wasn’t the flight, it was walking to the terminal. I knew how hard that would be for me. I almost didn’t go, but I knew I would regret it more than I’d regret trying, so off I went. It’s still one of my favourite memories.
What Prehab Actually Looks Like
Prehab doesn’t have to mean the gym. It also doesn’t mean personal trainers or perfect programmes. It can be as simple as:
- A 10 minute walk around the block
- A few minutes of stretching on the lounge floor
- Slow, deep breaths when your chest feels tight
- Standing up and sitting down from a chair a few times, if that’s all you’ve got that day
That’s the starting point. You don’t need equipment, you don’t need to feel ready. You need to start where you actually are, not where you wish you were. Small and consistent beats bit and occasional, every time.
Your Care Team is part of this, not Separate from it
None of this replaces your care team. Your transplant coordinator your physio, your specialists know your body, your organ, and your specific risks better than anyone. Before you start anything, even as simple as a daily walk, talk to them.
But it’s worth commenting on the other side of this too. Sometimes medical professionals can be overly cautious, especially if exercise and prehab isn’t something they specialise in. Don’t be afraid to ask questions, push for specifics, and advocate for yourself if something feels too restrictive without a clear reason. It’s a partnership. Their expertise, and you listening to your own body. Nobody knows how you are feeling on any given day better than you do.
Were this leaves you
Prehab isn’t about guessing, and it isn’t about blindly following either. It’s about moving with the right information, and enough self-awareness to know what is and isn’t working for you.
If you’re on the list right now, you’re not just waiting, you’re preparing, whether you’ve realised it yet or not. Every small walk, every stretch, every deep breath is doing something.
My next post will be about the other side of this journey, the first weeks after transplant, and why those small movements matter even more than you’d think.
