Preparing for a kidney transplant can be a challenging time. Remaining physically active, eating well, and supporting good mental health can become more difficult as kidney function declines.

But research shows that being in the best shape possible can reap significant benefits as a way to prepare for your transplant and to recover after it, as Juliet Briggs, Physiotherapist at King’s College NHS Trust, explains.

In the spirit of ‘use it, or lose it’ we are frequently reminded of the value of remaining as active as possible. Yet, more than 30% of the global population are not physically active, and this percentage is even higher among kidney patients.

Stay active

We know symptoms of kidney disease include tiredness, breathlessness and reduced muscle strength, making resting more appealing than half an hour of exercise.

We also know that many people living with kidney disease are unsure of what types of exercise are safe for them, especially if they are receiving dialysis, or have recently received a transplant. And throughout the kidney journey, time constraints around hospital appointments and treatments such as dialysis, also erode time available for exercise.

Regular physical activity and structured exercise is fundamental to good health. It can improve blood pressure, bone density, reduce inflammation and promote good mental health.

The World Health Organisation recommends 150–300 minutes (2.5-5 hours) of moderate level physical activity per week. Additionally, strength training twice a week, balance work, and reducing the amount of time spent sitting are also recommended. This might feel like a lot to do, but the good news is that even small increases in physical activity, such as taking a short walk or doing some gardening, can make a tangible difference.

There is evidence to suggest some people living with kidney disease can benefit from kidney-specific exercise programmes, which can have a positive effect on both their physical health and quality of life.

Eat well to remain well

It can also be difficult to eat well with advanced kidney disease, particularly when advice from a kidney dietitian means that certain food groups (such as those high in potassium or phosphate) need to be eaten in moderation and if fluid intake is limited. Some people with advanced kidney disease may also find their appetite reduces as their kidney function decreases.

As part of a work-up for a kidney transplant, kidney care teams may recommend losing weight. We know that having a healthy body weight reduces the risks associated with surgery and benefits the overall health and lifespan of the new kidney following transplantation.

Mind matters

Living with a long-term health condition like kidney disease can also lead to feelings of low mood or anxiety. Preparing for surgery, and being on the waiting list for a transplant, can also lead to feelings of uncertainty, worry and loss of control.

What is 'prehabilitation' and how can it help?

While a kidney transplant is not suitable for all people, it is considered to be the best treatment for people with kidney failure. The term ‘prehabilitation’ means pro-actively preparing physically, nutritionally and mentally in advance of your surgery to give the best chance of a successful surgical outcome and a smoother, often speedier, recovery.

Prehabilitation, or prehab, involves three important aspects:

• Physical activity and exercise
• Eating well
• Mental health and wellbeing

Additional healthy lifestyle changes, such as quitting smoking and reducing alcohol intake, are also important components of your transplant work-up.

What evidence is there that prehabilitation works?

To date, there have been a small number of research studies focusing on prehabilitation prior to kidney transplantation.

These have shown that:

• Prehabilitation is safe.
• Prehabilitation may improve strength and fitness.
• Prehabilitation may have a positive influence on mental health and quality of life.

In other clinical areas, for example prior to hip or knee replacement surgery, or before starting cancer treatment, prehabilitation has been shown to improve levels of physical activity, exercise capacity, and quality of life. There are also potential benefits around how long people stay in hospital after surgery, as well as their long-term wellbeing.

How accessible is prehabilitation before surgery?

A key aspect of prehabilitation is to provide the right support for you to enjoy and commit to a programme. Some key factors to think about are:

• What type of activity do you enjoy?
• Do you need support, or would you prefer to do this activity by yourself?
• When can you schedule activity in your diary?
• Can you build physical activity into your day? (For example, taking the stairs rather than the lift.)
• What healthy choices/changes to your diet can you make?

Are there any professionals in your kidney team – such as a kidney physiotherapist, counsellor or kidney dietitian – you could be referred to?

Currently, there are limited specialist kidney prehabilitation services across the UK. More research is needed in this area, particularly around what specific support needs to be developed to help people who are preparing for a kidney transplant.

The key takeaway is that keeping active and eating well to support your physical, nutritional and mental health can have benefits as you plan for your transplant.

This article first appeared in the Summer 2026 edition of Kidney Matters magazine.