Researchers looked at 19 different studies involving over 1,100 people waiting for liver transplants. They found that special training programs combining exercise, better nutrition, and mental health support are safe and actually work. About three-quarters of patients who started these programs finished them, and those who participated showed real improvements in their strength and fitness. The programs had very few safety problems. This research suggests that getting patients in better physical shape before their transplant surgery could help them have better outcomes and recover faster after the operation.

The Quick Take

  • What they studied: Whether special training programs that combine exercise, nutrition counseling, and mental health support help patients waiting for liver transplants get healthier and stronger before surgery.
  • Who participated: Over 1,100 adult patients from 19 different research studies who were on waiting lists for liver transplants. These patients were generally weak and malnourished before starting the programs.
  • Key finding: About 75% of patients who started these prehabilitation programs completed them successfully. Patients who participated showed significant improvements in their fitness levels, including better oxygen use during exercise and improved strength. Only 4% experienced any adverse events, showing these programs are very safe.
  • What it means for you: If you or a loved one is waiting for a liver transplant, participating in a structured exercise and nutrition program before surgery appears to be safe and could help you recover better after the transplant. Talk to your transplant team about whether such a program is available to you.

The Research Details

Researchers conducted a systematic review and meta-analysis, which means they searched five major medical databases for all published studies about exercise and nutrition programs for liver transplant patients. They found 19 studies that met their quality standards and combined the results from these studies to get a bigger picture of how well these programs work.

The programs they studied typically included three main components: supervised exercise sessions (like walking or cycling), nutrition counseling to help patients eat better and gain strength, and psychological support to help patients manage stress and anxiety about their upcoming surgery. Some programs were done in hospitals, while others were done at home or in community settings.

The researchers looked at three main questions: Could patients actually do these programs and stick with them? Were the programs safe? And did they actually improve patients’ fitness and strength? They also tracked what happened to patients after their transplant surgery to see if the programs helped with recovery.

This research approach is important because liver transplant patients are often in very poor health before surgery—they may be weak, malnourished, and have other serious health problems. By combining results from multiple studies, researchers can see the bigger picture of whether these programs really help, rather than relying on just one small study. This gives doctors and patients more confidence in recommending these programs.

This is a high-quality analysis because it included 19 different studies with over 1,100 total participants, making the results more reliable than any single study. The researchers used strict criteria to decide which studies to include, and they looked at studies from major medical databases. However, the individual studies varied in how they were designed and what they measured, which means some results are stronger than others. The researchers were transparent about these differences.

What the Results Show

The research found that these prehabilitation programs are both feasible and safe for liver transplant patients. About 66% of eligible patients chose to participate in the programs, and 75% of those who started actually completed them. This completion rate was similar to control groups, meaning patients didn’t drop out more often than expected.

Safety was excellent: only 4% of participants experienced any adverse events (unwanted side effects), and these were generally minor. This is important because doctors worry about pushing sick patients too hard, but the data shows these programs are well-tolerated.

The most exciting finding was the improvement in physical fitness. Patients who completed the programs showed significant improvements in multiple measures: they improved their oxygen use during exercise (a key measure of heart and lung fitness), they could walk farther in six minutes, their leg strength improved, and their overall physical function improved. These improvements were measured using standard medical tests that doctors use to assess fitness.

The studies also tracked what happened after patients received their transplants. While the analysis didn’t provide detailed post-transplant outcomes, the improvements in fitness before surgery suggest patients likely had better recovery. Patients who are stronger and healthier before major surgery typically bounce back faster and have fewer complications.

This research builds on earlier smaller studies that suggested exercise might help transplant patients. By combining all the available evidence, this analysis confirms what researchers suspected: these programs really do work and are safe. The findings align with general medical knowledge that getting patients in better physical condition before major surgery improves outcomes, though this is one of the first comprehensive reviews specifically for liver transplant patients.

The main limitation is that the 19 studies included weren’t all designed the same way—some used different types of exercise, different nutrition approaches, and different ways of measuring results. This variation makes it harder to say exactly which parts of the programs work best. Also, most studies were relatively small, and some didn’t have control groups to compare against. The research also didn’t provide detailed information about what happens to patients months or years after transplant, so we don’t know how long the benefits last. Finally, these programs may work better for some types of patients than others, but the analysis didn’t break down results by patient characteristics.

The Bottom Line

If you’re waiting for a liver transplant, ask your transplant team about prehabilitation programs. The evidence suggests these programs are safe and effective at improving your fitness before surgery. Start with whatever level of exercise you can tolerate and work with your healthcare team to gradually increase activity. Combine exercise with attention to nutrition and mental health support for the best results. Confidence level: Moderate to High—this is based on multiple studies showing consistent benefits.

This research is most relevant for adults waiting for liver transplants, their families, and their transplant care teams. It’s also important for doctors and hospitals deciding whether to offer these programs. People with other serious liver diseases might also benefit from similar programs, though this research specifically studied transplant patients. If you have severe heart or lung disease, talk to your doctor before starting any exercise program.

Improvements in fitness can appear within weeks of starting a program, though most studies lasted several weeks to months. The real benefits for transplant recovery may take several months to become fully apparent after surgery. Don’t expect overnight changes—think of this as a gradual process of getting stronger over time.

Want to Apply This Research?

  • Track weekly exercise minutes (aim for 150 minutes of moderate activity per week if approved by your doctor), nutrition quality (servings of fruits, vegetables, and protein), and a simple fitness test like how far you can walk in 6 minutes. Record these weekly to see your progress.
  • Set a specific, achievable exercise goal for this week (like a 20-minute walk three times) and log it in the app. Add one nutrition goal (like adding a protein source to each meal). Check off completed activities daily to build momentum and accountability.
  • Create a dashboard showing your exercise trends, nutrition patterns, and fitness improvements over weeks and months. Share progress with your transplant care team during appointments. Use the app to set reminders for exercise sessions and meal planning, and celebrate small wins to stay motivated.

This research summary is for educational purposes and should not replace medical advice from your transplant team. Prehabilitation programs should only be started under medical supervision and with approval from your transplant doctors. The safety and effectiveness of these programs may vary depending on your individual health condition, age, and other medical factors. Always consult with your healthcare provider before starting any new exercise or nutrition program, especially if you have serious liver disease or are awaiting transplant surgery. This summary reflects research published in February 2026 and may not include the most recent findings.