Exercise guide
After a kidney, liver, heart or lung transplant, walking starts in the first days, and most people are encouraged to start moderate exercise, such as brisk walking, cycling or swimming, from about 6 to 8 weeks if their recovery is going well. In trials, exercise after a transplant improved fitness, strength and quality of life, and transplant athletes compete in 26 events at the British Transplant Games.
The early limits protect your wound, not your fitness: no heavy lifting or straining for 6 weeks to 3 months, depending on the organ and the transplant centre, and no swimming until the wound has completely healed. These timings are expert advice and vary between centres, so your own transplant team's advice comes first.
This guide sets out what the National Health Service (NHS), NHS Blood and Transplant and transplant centres say, side by side, why a new heart needs a longer warm-up, what the medicines mean for your muscles, bones and skin, the moves and workouts for each stage, and the warning signs that need your transplant team.
NHS Blood and Transplant says walk a little every day to prevent blood clots, keeping distances short at first and building up slowly. In hospital, physiotherapists start breathing and leg exercises, and you sit out in a chair the day after surgery.
NHS Blood and Transplant says avoid strenuous activity that strains your tummy or chest, including cycling, jogging, weightlifting and heavy shopping: for 4 to 6 weeks after a kidney or lung transplant, 6 to 8 weeks after a liver and 8 to 12 weeks after a heart transplant. Heavy lifting limits run from 6 weeks (nothing over 10 kg after a kidney transplant) to 3 months in some centres. No trial has tested these timings, so your own centre's advice comes first.
If your recovery is going well, NHS Blood and Transplant says moderate exercise such as walking, jogging, swimming or cycling is usually encouraged from 6 to 8 weeks (8 weeks on its kidney and liver activity pages). After a heart transplant, exercise starts under supervision in hospital and builds over 6 to 8 weeks. Imperial College Healthcare's kidney team suggests jogging, swimming and low-impact strength training from about 3 months.
Across 29 trials, exercise training after a transplant improved fitness and leg strength by small to moderate amounts. A Canadian position statement recommends aerobic exercise, or aerobic and strength training together, 3 to 5 times a week for at least 8 weeks, supervised in the first 6 months, and the UK Kidney Association asks for 150 minutes a week. Exercise didn't change how well a new kidney worked.
A transplanted heart has lost its nerve supply, so it doesn't speed up for the first few minutes of exercise and takes longer to settle afterwards. Royal Papworth Hospital asks for a 10-minute warm-up and cool-down and an effort of about 13 on the Borg scale of perceived effort, judged by how it feels and whether you can talk, not by heart rate. Cardiac rehabilitation is recommended.
Skin cancer is much more common after a transplant, and outdoor sport counts as sun exposure all year round. NHS Blood and Transplant advises avoiding heavy contact sports such as rugby, martial arts and boxing. Contact your transplant team for a temperature of 38C or above, feeling hot and shivery, or the other warning signs on this page.
In the year to March 2026, 4,666 organ transplants were done in the UK: 3,278 kidney, 948 liver, 214 heart, 187 lung and 4 heart and lung transplants. About 64,800 people in the UK live with a working transplant, 47,200 of them with a kidney and 12,800 with a liver.
Source 23
NHS Blood and Transplant describes them:
You take anti-rejection medicines (immunosuppressants) for life. NHS Blood and Transplant says tacrolimus can raise blood sugar and cause a tremor, and steroids such as prednisolone can raise blood pressure, appetite and blood sugar and thin the skin. Kidney disease and some of these medicines can thin your bones, especially after the menopause, and your team may offer a bone scan. Everyone with a heart transplant takes a statin, and 70 to 80 in 100 need blood pressure medicines.
In the first year, rejection happens in 10 to 15 in 100 people after a kidney transplant, up to 30 in 100 after a liver, 20 to 30 after a lung and 30 to 40 after a heart transplant. It's usually mild and treated with different medicines, and it's often found on blood tests at clinic before you notice anything. Infections are very common straight after surgery and can happen months or years later, most often in the chest or urine.
Fitness improves after a transplant, but a Canadian position statement says it stays at 40% to 70% of the expected level for most people, because of time in hospital, low activity and the medicines. A sports medicine review describes a shortfall of 40% to 60%. That gap is what exercise training aims at.
Across 29 trials, exercise training improved fitness and leg strength by small to moderate amounts, and lowered the lower blood pressure figure a little, compared with no training. Most of the trials had some risk of bias, but the Canadian position statement rates the evidence as high quality for fitness, leg strength and quality of life after kidney, liver, heart and lung transplants.
In 6 trials, training improved peak fitness by 2.42 mL/kg/min (a standard measure of fitness) and quality of life, without changing how well the new kidney worked. A 2026 review of 25 studies found aerobic and strength training together did best, but rated the certainty of its findings low or very low.
In a Cochrane review of 10 trials (300 people), cardiac rehabilitation raised peak fitness by 2.49 mL/kg/min after a median of 12 weeks, from moderate-quality evidence. Quality of life was no different in the short term, and one adverse event was reported.
Source 45
In one trial of 81 people who started a mean of 11 weeks after a heart transplant, 9 months of supervised high-intensity intervals (4 bouts of 4 minutes at 85% to 95% of peak effort) raised fitness by 1.8 mL/kg/min more than moderate training, about half a MET (a unit of exercise intensity), with no serious exercise-related problems. A 2026 review of 13 trials (473 people) ranked intervals and combined training highest. Starting this early rests on that one trial, and every session was supervised.
In a trial of 40 people, 3 months of supervised training straight after leaving hospital meant 26 more minutes of walking a day a year later, with stronger thighs, a longer walking distance and lower blood pressure. A Cochrane review of 8 trials (438 people) called the overall evidence very uncertain.
In 8 trials (334 people), exercise improved the physical function part of a quality of life questionnaire, while fitness and strength only tended to improve. A Cochrane review of 3 trials (241 people) rated all its findings very low certainty; no harm from exercise was reported.
Steroids thin bones fastest in the first 6 to 12 months after a heart transplant, and 14% to 40% of heart recipients develop osteoporosis. In a trial of 25 heart recipients, a bone medicine (alendronate) plus strength training restored spinal bone density to within 3.4% of the level before the transplant; the medicine alone only stopped further loss.
Most trials are small and short, in stable, middle-aged people, and none was big enough to show effects on rejection, the new organ or survival. The Canadian statement found too little evidence to set training details for children. Medicines prevent rejection and treat bone loss; exercise adds to them, not instead of them.
Aerobic training, or aerobic and strength training together, at a moderate to vigorous effort, 3 to 5 times a week for at least 8 weeks. In the first 6 months, or if you're not medically stable, programmes should be supervised; after 6 months they can be done on your own, at home or in a gym.
Source 15
After a kidney transplant: 150 minutes of activity a week, with structured exercise at least 3 times a week that combines aerobic and strength training, and strength training at least twice a week. It asks for careful thought before contact sports and extreme endurance events such as marathons, and advises against sport supplements: grapefruit extract, for example, can change tacrolimus levels.
Source 16
A European consensus starts aerobic training in the second or third week, below half of peak capacity, and strength training after 6 to 8 weeks at 40% to 70% of the most you could lift once. Royal Papworth's programme: warm up at about 9 on the Borg scale, exercise at about 13 ("somewhat hard") but no higher, cool down at 7 to 9, and try to exercise 5 times a week.
The UK guidelines for disabled adults: at least 150 minutes of moderate activity a week, where you can talk but not sing, and strength and balance activities on at least 2 days. Even a little movement is better than nothing.
Source 53
This plan is our editorial starting point, built from the sources above. For the first 6 weeks, walk several times a day, adding a few minutes at a time, and do your hospital exercises once or twice a day. From about 6 to 8 weeks, if your team agrees, do 20 to 30 minutes of walking or an exercise bike on most days at a talk-but-not-sing effort, and light leg strength on 2 or 3 days. From about 3 months, build to 150 minutes a week with strength training on 2 or 3 days. After 6 to 12 months, exercise as anyone would, including harder intervals or events if your team agrees.
The Scottish Liver Transplant Unit encourages people waiting for a transplant to stay active: about 10,000 steps a day with some brisker walking, strength exercises 2 to 3 times a week on alternate days, and an effort of about 13 ("somewhat hard") on its breathlessness scale. The Canadian statement found exercise before a transplant safe in adults, though there's too little evidence to set exact amounts.
These timings come from NHS Blood and Transplant and individual NHS transplant centres. They're expert advice, not trial results, and they vary between centres, so your own team's advice comes first.
Cambridge University Hospitals' physiotherapists ask for one to two sets of three deep breaths every waking hour, ankle pumps 10 to 20 times every 30 minutes and gentle neck and shoulder movements. Huffing and coughing won't harm your wound: hold a pillow over it. You sit out in a chair the day after surgery and walk a little further each day, and after a heart or lung transplant Royal Papworth may start you on an exercise bike on the ward.
NHS Blood and Transplant: short walks and plenty of rest and sleep. Walk a little every day to prevent blood clots, keeping distances short at first and building up as you recover.
What the sources say about strenuous activity and lifting:
If your recovery is going well, NHS Blood and Transplant says moderate exercise such as walking, jogging, swimming or cycling. After a heart transplant, the European consensus adds strength training at this point.
Imperial College Healthcare's kidney team: walking, jogging, cycling, swimming and low-impact strength training. Cambridge University Hospitals: heavy housework, lifting and heavy gardening after 3 months, and swimming about 3 months after a liver transplant. Leeds Teaching Hospitals: no heavy lifting for 3 months after a kidney transplant. After a heart transplant the breastbone takes about 3 months to heal, and Royal Papworth says no pedal bicycle for 12 weeks (an exercise bike is fine).
Rejection becomes less likely and medicine doses usually come down after 3 to 6 months (6 months after a liver transplant), NHS Blood and Transplant says. The Canadian statement says exercise can be unsupervised after 6 months. At a year, Imperial College Healthcare says there are generally no limits, but check with your team before extreme exercise or heavy contact sports.
Cambridge University Hospitals' doses: three deep breaths, one to two sets every waking hour; ankle pumps 10 to 20 times every 30 minutes; 5 sit-to-stands, 10 steps of marching, 10 small knee bends and 10 heel raises, building up. The ankle circles page's dose is 10 slow circles each way with each foot. After a heart or lung transplant, push on your thighs to stand, not on the chair arms, unless your physiotherapist says otherwise (our suggestion).
3D demoLateral breathing (Pilates breathing)Beginner · No equipment
3D demoAnkle circlesBeginner · No equipment
3D demoSeated knee extension (chair)Beginner · A bench or box + Something with weight
3D demoSit to stand, pushing on the thighsBeginner · A bench or box
3D demoStanding marchBeginner · No equipment
3D demoBodyweight squatBeginner · No equipment
3D demoSlow calf raiseBeginner · A wall
3D demoShoulder rollsBeginner · No equipment
3D demoTreadmill walkingBeginner · Cardio machineThe limits differ, and no trial has compared them:
Our summary: most centres say no heavy lifting for 6 weeks to 3 months. After that, build up gradually, breathing out as you lift. Your own centre's limit comes first, because it depends on your operation and how you're healing.
NHS Blood and Transplant says a hernia through the scar happens in 5 to 10 in 100 people after a kidney transplant. Two reviews put it lower, at about 3 to 4 in 100: a mean of 3.2% across 8 case series, and 4% across 20 studies of 16,018 people. After a liver transplant, reviews put it at about 15 in 100. NHS Blood and Transplant says heavy lifting soon after the transplant, being overweight and smoking make one more likely.
NHS Blood and Transplant says no strain on your tummy muscles for 4 to 6 weeks after a kidney and 6 to 8 weeks after a liver transplant. Our suggestion: leave out sit-ups, crunches, leg raises and planks until then, build up through gentler core work, and stop if you notice a bulge near the scar.
After a heart transplant, the breastbone heals in about 3 months, and heavy lifting too soon can stop it healing. After the clamshell incision used in some lung transplants, a US pilot study of 40 people found no more wound or breastbone problems with lighter arm limits (2.3 kg for 4 weeks, then rising each week, all lifted at 8 weeks): 1 of 24 people had a problem, against 3 of 16 with the usual 8-week limits. It's one small study, so follow the precautions your physiotherapist sets.
From about 6 to 8 weeks, or earlier on an exercise bike if your team agrees. The recumbent bike and elliptical trainer pages' dose is 10 to 20 minutes at a moderate effort to start, building towards 30. Keep your hands on the fixed rails of the elliptical, not the moving arms, until your arm limits are lifted, and leave rowing until then too (our suggestion). Swim once your wound has completely healed and your team agrees.
3D demoRecumbent exercise bikeBeginner · Cardio machine
3D demoStationary cyclingBeginner · Cardio machine
3D demoElliptical trainerBeginner · Cardio machine
3D demoStep jack (low-impact jumping jack)Beginner · No equipment
3D demoIndoor rowing (rowing machine)Beginner · Cardio machine
Front crawl (freestyle swimming)Intermediate · Other / check instructionsLegs first; arm and tummy moves once your team's limits allow. Our editorial starting point: 2 sets of 8 to 12, 2 or 3 days a week, breathing out on each effort, with machines from about 3 months. The band row page's dose is 3 sets of 10 to 15, stopping 2 to 3 reps short of failure, and the heel drop page's is 20 to 30 drops at first, building towards about 50 impacts on most days, for bones, once your wound has healed and your team agrees.
3D demoSit to stand from a chairBeginner · A bench or box
3D demoLow step-upBeginner · A step
3D demoGlute bridgeBeginner · No equipment
3D demoWall push-upBeginner · A wall
3D demoBand rowBeginner · A band + An anchor point
3D demoLeg pressBeginner · Strength machine
3D demoChest press machineBeginner · Strength machine
3D demoSeated cable rowBeginner · A cable machine
3D demoLat pulldownBeginner · A cable machine
3D demoHeel drop (impact for bone)Beginner · No equipmentThe transplanted heart has lost its nerves. The European consensus says it doesn't speed up for the first few minutes of exercise, then rises less than normal as hormones in the blood take over. Royal Papworth tells its patients that these hormones begin to be produced in the first 8 minutes of exercise and take another 10 to 15 minutes to clear afterwards, so your heart rate settles slowly. Some people partly regain the nerve supply over time.
Royal Papworth asks for about 10 minutes of warm-up and 10 of cool-down every time, building to a steady effort rather than starting hard. The European consensus also recommends a warm-up and steady exercise at first.
Use the Borg scale (6 to 20) or the talk test rather than a heart rate target: aim for about 13, "somewhat hard", but no higher in the early months (Royal Papworth). You should be able to talk while you walk or cycle; if you're too breathless to speak, slow down. Beta blockers, if you take them, also delay the heart rate response.
High-intensity intervals were safe in supervised trials and raised fitness more than moderate exercise. The one trial that started early began a mean of 11 weeks after the transplant, with 81 people. Do them only if your team offers or agrees to them.
The British Heart Foundation says it's important to go to cardiac rehab after heart transplant surgery, and the European consensus recommends long-term rehab. Only about half of heart recipients take part.
A narrowing of the new heart's arteries, called cardiac allograft vasculopathy (CAV), affects about half of heart recipients within 10 years, and most people have no symptoms until it's severe. Royal Papworth: if you're more breathless at rest, or doing an exercise you previously found fine, tell your transplant team.
No pedal bicycle for 12 weeks while the wound heals; an exercise bike is fine. Start with a low resistance, and increase the time before the resistance.
Source 19
NHS Blood and Transplant says problems are often first noticed as increasing breathlessness, and the main symptoms of rejection are breathlessness and tiredness. Use your home spirometer as your team asks.
Your physiotherapist will teach you to clear your chest with huffs and coughs, which Cambridge University Hospitals says won't harm your wound. Chest infections affect 40 to 70 in 100 people in the first week after a lung transplant.
In one trial, 3 months of supervised training straight after leaving hospital meant more walking a year later, but the evidence overall is very uncertain. Our suggestion: ask your team about a pulmonary rehabilitation programme.
NHS Blood and Transplant says don't go to a swimming pool until your wound has completely healed, because of the risk of infection. Cambridge University Hospitals' physiotherapists say discuss it at your follow-up clinic, its liver team says about 3 months, and Imperial College Healthcare's kidney team lists swimming from 3 months. Our summary: often about 2 to 3 months, once your team agrees. Try not to swallow the water, and put sunscreen on again when you get out.
NHS Blood and Transplant advises avoiding heavy contact sports such as rugby, martial arts and boxing, which risk damaging the new organ or, after a heart transplant, the chest wound; after a heart transplant, talk to your team first. Imperial College Healthcare says check with your team before heavy contact sports even at a year. The UK Kidney Association says contact sports should be thought about carefully, and that the risk of damage to a transplanted kidney is low. Kidney Research UK adds football, hockey and wrestling and says padding can help, and Bristol's kidney service says avoid contact sports.
Cambridge University Hospitals' physiotherapists say start running when you can walk briskly with ease. Most sports and activities are possible, NHS Blood and Transplant says, and Plymouth's kidney leaflet points to the NHS's Couch to 5K for building up to running.
AboutKidsHealth, from SickKids in Toronto, gives teenagers after a kidney transplant this advice: gentle exercise from about a week, running and light weights after about 3 weeks if you feel up to it, nothing heavier than a bag of milk for 4 to 6 weeks, and normal exercise usually after 6 weeks. It lists higher-risk sports, including rugby, hockey, wrestling, tackle football, gymnastics, martial arts and mountain biking, and says don't take up a risky sport after a transplant if you've never played it. The Canadian statement recommends exercise for children but found too little evidence to set amounts.
The British Transplant Games have run every year since 1978, with over 1,000 transplant athletes competing in 26 events. The World Transplant Games accept competitors from a year after the transplant with a stable new organ (or 6 months with medical approval), aged 4 to over 80.
Steroids and tacrolimus can raise blood sugar. If you take prednisolone, the NHS says call a doctor or NHS 111 straight away if you're sleepy or confused, very thirsty or hungry, peeing more often, flushing, breathing quickly or your breath smells fruity: these can be signs of high blood sugar.
Anti-rejection medicines, especially steroids, can thin your bones. If you take prednisolone for a long time, the NHS suggests regular exercise and enough calcium, and your team may offer a bone scan. In one small trial of heart recipients, strength training plus a bone medicine restored spinal bone density. Our suggestion: once your wound has healed and your team agrees, follow the strength and impact amounts in our osteoporosis guide, and ask your specialist before impact exercise if you have osteonecrosis (avascular necrosis), which steroids make more likely.
Weight gain is common in the first year, partly from steroids and a better appetite. NHS Blood and Transplant suggests losing it by doing more exercise and taking extra care with your diet.
The Medicines and Healthcare products Regulatory Agency (MHRA) warns that fluoroquinolone antibiotics, such as ciprofloxacin and levofloxacin, can damage tendons, especially the Achilles tendon, and more often after an organ transplant or with steroids. It can happen within 48 hours of starting or months after stopping. If you get tendon pain or swelling, rest it and contact your doctor straight away.
Source 73
The UK Kidney Association advises against sport supplements after a transplant, and Queensland Health warns that echinacea and other immune boosters can cause rejection. NHS Blood and Transplant asks you not to take any medicines from a shop without speaking to your transplant team first.
In a UK study, 1 in 3 people with a transplant for more than 10 years had had a skin cancer, and around half have one by 20 years, the British Association of Dermatologists says. NHS Blood and Transplant puts it at 15 to 20 in 100 heart recipients, and about 40 in 100 over a lifetime after a liver transplant. Outdoor activities such as walking, gardening and sport all count as sun exposure, all year round.
The British Association of Dermatologists recommends sunscreen with a sun protection factor (SPF) of 50 and high protection against UVA (ultraviolet A) every day, put on 15 to 30 minutes before you go out and again every 2 hours and straight after swimming; a broad-brimmed hat and long sleeves; and planning outdoor exercise outside 11am to 3pm. NHS Blood and Transplant gives the same advice, and after a heart transplant suggests no more than 15 to 20 minutes in the sun at a time.
Wash your hands after gardening or touching animals, avoid changing cat litter, wear gloves and a mask for compost and mulch, wear shoes outdoors, and try not to swallow water when swimming or in a hot tub. Keep away from people who are unwell with colds, flu or other viruses.
After a kidney or liver transplant, while the tummy wound heals: at least 4 to 6 weeks after a kidney and 6 to 10 weeks after a liver transplant, depending on your centre.
Barbell lifts, kettlebell swings and heavy carries: until your centre's lifting limit has passed, between 6 weeks and 3 months, then build up.
After a heart or lung transplant through the breastbone: until your team lifts your arm precautions. The breastbone takes about 3 months to heal.
For 12 weeks after a heart or lung transplant, Royal Papworth says; an exercise bike is fine.
Source 19
Our suggestion: until your wound has healed and your team agrees. With osteonecrosis, ask your specialist first.
Only if your transplant team agrees.
NHS Organ Donation: go for a walk every day if you feel up to it. Most donors are back to normal activity within 4 to 6 weeks, but avoid vigorous exercise and heavy lifting for 8 to 12 weeks, and let your stamina and your wound guide you.
Source 75
University Hospitals Birmingham: no heavy lifting for the first 3 months, and no swimming until your wound has fully healed.
Source 76
Our suggested timings. In the first weeks: exercises after heart surgery (for a heart or lung transplant), exercises after lung surgery (ask your physiotherapist before the side bend and twist after a clamshell incision), exercises after aortic aneurysm repair (a gentle routine for a tummy wound after a kidney or liver transplant), or the in-room routine written for blood cancer treatment. From about 6 to 8 weeks, if your team agrees: the strength routine written for weight-loss surgery, the cardiac rehab session after a heart transplant (keep the arm moves inside your precautions), the walking intervals and the bike ride. Swim once healed, and add the gym, machine and bone workouts from about 3 months.
A gentle 15-minute routine for the first 6 weeks at home after heart surgery: breathing, circulation, shoulder and posture moves, and a building walk.
15 minBeginner9 movesA bench or box, A wallA gentle 15-minute routine for the first 6 weeks after lung surgery: deep breaths and a supported cough, shoulder and trunk moves, leg exercises and a walk.
15 minBeginner12 movesA bench or box, Something with weightA gentle routine for the first 4 weeks after aortic aneurysm repair: leg circulation exercises in a chair or bed, then a walk that builds week by week.
10 minBeginner7 movesA bench or box, Something with weightA gentle 15-minute routine for a hospital room or home during blood cancer treatment or after a stem cell transplant, with no jumping, twisting or floor work.
15 minBeginner10 movesA bench or box, Something with weightA 25-minute full-body strength routine from about 4 to 6 weeks after weight-loss surgery, to build strength as your weight falls: legs, push, pull, walk.
25 minBeginner12 movesA bench or box, A wallA 45-minute home session built like a UK cardiac rehab class: a 15-minute warm-up, 20 minutes of cardio mixed with light strength, and a 10-minute cool-down.
45 minBeginner14 movesA wall, A bench or boxA 40-minute heart failure workout you can do seated or standing: a long, gentle warm-up, cardio mixed with light strength, and a slow cool-down.
40 minBeginner13 movesA bench or box, A wallA 40-minute walk alternating 3 minutes fast and 3 minutes easy, five times over: the interval walking tested in Japanese trials, built up from three rounds.
40 minBeginner3 movesCardio machine, A wallA steady bike ride for a first triathlon or fitness: 5 to 10 minutes easy, a ride you can talk through, optional short faster bursts and an easy cool-down.
45 minBeginner4 movesCardio machine, A wallA 30 to 45-minute beginner pool swim: a shoulder warm-up on the side, easy lengths, a main set of repeats with rests, and an easy swim down, any stroke.
35 minBeginner5 movesOther / check instructionsA 50-minute gym session for older adults and sarcopenia: 7 machines for the legs, chest and back from the UK prescription, then a short balance finish.
50 minBeginner12 movesCardio machine, A bench or boxA 45-minute full-body gym workout on machines: leg press, chest press, machine row, leg curl, shoulder press and arms, with sets, reps and rest.
45 minBeginner14 movesCardio machine, A bandImpact, strength and balance for stronger bones, following UK osteoporosis consensus advice, with options for every level.
40 minBeginner14 movesA kettlebell, Other / check instructionsOnce moderate exercise is allowed: the walking plan builds to 150 minutes a week, the couch to 5K plan builds to running, and the beginner plan adds strength.
A free 8-week walking plan for beginners: build to 150 minutes of brisk walking a week, with intervals, hills and two short strength sessions.
6 training days40 minBeginner3 days a weekA 9-week beginner plan with the same walk-to-run shape as Couch to 5K: three run-walk sessions a week, from 1-minute jogs to 30 minutes of running.
3 training days35 minBeginner2 days a weekYour first four weeks: two, then three short strength sessions a week at home plus walks, building gently to a full routine.
2 training days20 minBeginnerThis is general information, not a diagnosis. In the US, call 911 where this page says 999, and call your transplant centre where it says to contact your team.
NHS Blood and Transplant lists:
After a heart transplant: breathlessness, tiredness, fluid retention and weight gain, and sometimes a raised temperature. After a lung transplant: breathlessness and tiredness. After a liver transplant, Liver UK lists a fever, extreme tiredness, yellow eyes and skin, and a tender tummy. Rejection is often found on blood tests first, so keep every clinic appointment.
Source 80
Call 999 if a hernia becomes very painful, more swollen than usual or changes colour, or you're being sick, can't keep food down, or can't fart or poo. Our hernia guide has more.
In about 1 in 100 heart recipients the breastbone doesn't heal as expected, which can cause movement between its two halves and pain on coughing, moving or breathing deeply. Tell your team.
Source 37
Tendon pain or swelling while taking, or after taking, an antibiotic such as ciprofloxacin or levofloxacin: rest it and contact your doctor straight away.
Source 73
AboutKidsHealth says if you have intense pain or shortness of breath, stop exercising right away and get advice from your transplant team. Royal Papworth: don't exercise during treatment for rejection, but keep moving gently; with an infection, do only gentle exercise, then ease back in. Our suggestion, as in our heart guides: stop for chest pain, palpitations, dizziness or light-headedness, and get urgent advice if it doesn't settle quickly with rest.
Your transplant team first, using the number they gave you. The British Heart Foundation's heart helpline, staffed by cardiac nurses, is on 0808 802 1234, Monday to Friday, 9am to 5pm, and NHS 111 can tell you where to go.
Source 20
The Canadian position statement rates the evidence that exercise improves fitness, leg strength and quality of life as high, and recommends it after every kind of transplant. NHS Blood and Transplant says your transplant is more likely to work for longer if you keep to a healthy weight, exercise regularly and don't smoke.
In 6 trials, training improved fitness and quality of life without changing how well the new kidney worked. The UK Kidney Association says the risk of damage to a transplanted kidney is low. The exception is heavy contact sport, because of the risk of a direct blow.
It speeds up more slowly at first, which is why warm-ups are longer. But supervised high-intensity intervals were safe and raised fitness more than moderate training in a trial that started about 11 weeks after the transplant, and the European consensus says the old limits on hard training don't seem to rest on evidence.
After a heart transplant, the European consensus advises judging effort by how it feels rather than by heart rate ranges, and Royal Papworth uses the Borg scale and the talk test.
Rejection is often first found on blood tests, and narrowing of a transplanted heart's arteries usually causes no symptoms until it's severe. Keep every clinic appointment.
The British Association of Dermatologists says a tan is a sign of skin damage. Outdoor sport counts as sun exposure, all year round.
Source 21
The UK Kidney Association advises against sport supplements after a transplant (grapefruit extract changes tacrolimus levels), and Queensland Health warns that echinacea and other immune boosters can cause rejection.
Walking starts straight away: NHS Blood and Transplant says walk a little every day from the first weeks, keeping distances short at first. If your recovery is going well, moderate exercise such as walking, jogging, swimming or cycling is usually encouraged from about 6 to 8 weeks, though some centres say 3 months for jogging, swimming and strength training. Your transplant centre's advice comes first.
NHS Blood and Transplant says avoid lifting more than 10 kg for at least 6 weeks, and some centres say no heavy lifting for 3 months. Imperial College Healthcare's kidney team suggests low-impact strength training from about 3 months. Our suggestion: start light, breathe out as you lift, and build up once your team's limit has passed.
Not until your wound has completely healed, because of the risk of infection; some centres say about 3 months. Try not to swallow the water, and put SPF 50 sunscreen on again when you get out.
Yes, for most people, once moderate exercise is allowed. Cambridge University Hospitals' physiotherapists say start running when you can walk briskly with ease. Our suggestion is a run-walk plan such as couch to 5K, to build up gradually.
NHS Blood and Transplant advises avoiding heavy contact sports such as rugby, martial arts and boxing, which risk damaging the new kidney. Kidney Research UK adds football and hockey and says padding can help, and the UK Kidney Association says contact sports should be thought about carefully. Most other sports are fine, so talk to your team about the one you want to play.
The new heart has lost its nerve supply, so it doesn't speed up for the first few minutes of exercise and takes longer to settle afterwards. Royal Papworth Hospital asks for a 10-minute warm-up and cool-down, and to judge your effort by how it feels and whether you can talk, rather than by heart rate.
Yes. The British Heart Foundation says it's important to go to cardiac rehab after heart transplant surgery, and a European consensus recommends long-term rehab, though only about half of heart recipients take part.
Not at first. NHS Blood and Transplant says no strain on your tummy muscles for 4 to 6 weeks after a kidney and 6 to 8 weeks after a liver transplant, and Cambridge University Hospitals says 8 to 10 weeks after a liver transplant. Hernias through the scar happen in 3 to 10 in 100 people after a kidney transplant, depending on the source, so build up through gentle core work and stop if you notice a bulge.
They can raise blood sugar and blood pressure, add weight and appetite (steroids), cause a tremor (tacrolimus) and thin your bones. Regular exercise helps with weight, blood pressure and bones, so keep taking every medicine exactly as prescribed and ask your team about bone scans.
Skin cancer is much more common after a transplant, and outdoor sport counts as sun exposure all year round. Use SPF 50 sunscreen with high UVA protection, put it on again every 2 hours and after swimming, wear a hat and long sleeves, and avoid the sun between 11am and 3pm.
Royal Papworth advises stopping exercise until rejection treatment has finished, while still moving gently, and only gentle exercise with an infection. Contact your transplant team for a temperature of 38C or above, feeling hot and shivery, or any of the other warning signs on this page.
Walk every day if you feel up to it; most donors are back to normal activity within 4 to 6 weeks. NHS Organ Donation says avoid vigorous exercise and heavy lifting for 8 to 12 weeks, and let your stamina and your wound guide you.
Exercise education, not a diagnosis or treatment plan, and clinical review of these guides is pending. Stop and get advice for chest pain, unusual breathlessness, dizziness or fainting, or new pain, and check with your doctor or midwife first if they have told you to limit activity. Health disclaimer.
