The return to a normal life is the aim of medicine in general and of any organ transplantation. As outlined by my colleague transplant surgeon above, before undergoing OLT, most patients experience severe fatigue, protein-energy malnutrition due to hypercatabolism and consequently sarcopenia and deconditioning (decreased muscle strength, endurance and oxygen uptake) [
9]. Importantly, even patients who are obese before OLT suffer from these conditions, presenting with so-called “sarcopenic obesity” [
10]. Recovery of muscle mass and function after transplantation is favored by the normalization of liver function. However, without specific measures, this takes a long time, during which patients are limited in their daily life. In addition, studies demonstrate that even in the setting of successful transplantation, deconditioning persists long term for not yet fully clarified reasons [
11,
12]. Post-transplant, patients may go back to taking on a sedentary life, something which by most may be perceived as “normal.” Currently, life expectancy of patients after OLT is excellent, with a 90% 1-year and over 70% 5-year survival. Five-year survival is expected to further improve in the near future, given that effective therapies for hepatitis C virus (representing the main negative prognostic factor after OLT) are now available [
7]. Long-term complications after OLT are mostly related to cardiovascular events and cancer. Up to 58% of patients develop cardiovascular risk factors or metabolic syndrome (elevated arterial blood pressure, diabetes, atherogenic dyslipidemia and obesity) [
13], which are in part due to the use of immunosuppressant medication such as calcineurin inhibitors and/or mTOR inhibitors [
14]. Not surprisingly, and similarly to what is observed in the general population, the presence of obesity and a metabolic syndrome increases the risk of stroke, myocardial infarction as well as chronic renal failure and de novo malignancies in OLT patients [
15]. Modifying these risk factors thus favorably impacts the long-term prognosis of patients post-OLT. Importantly, exercise alone proved effective in reducing the onset of metabolic syndrome after OLT in two studies [
13,
16]. In addition, physical activity dramatically improves quality of life in this setting, with a strong correlation between level of fitness/physical activity and quality of life [
16‐
20]. Nonetheless, only one quarter of patients are physically active after transplantation [
16]. Large randomized controlled studies in this field are lacking. However, in view of the existing evidence, the European Association for the Study of the Liver (EASL) recommends that physical activity should be proposed as part of the therapeutic regimen after OLT [
21].