A patient admitted to the hospital while waiting for a heart transplant faces a problem that has nothing to do with their heart. Every day spent in bed erodes muscle. Enough days, and the frailty score that determines transplant eligibility crosses a line, and the patient is no longer a candidate for the operation they were admitted to wait for.
Radha Gopalan, a heart transplant cardiologist at Banner University Medical Center Phoenix, built a gym on a telemetry floor to interrupt that sequence. The team began testing the approach in 2023, and the early results were presented in April at the International Society for Heart and Lung Transplantation meeting in Toronto.
"Some of the patients didn't even get to transplant," Gopalan told STAT in an interview published Monday. "They developed other complications, and they never qualified."
The Arithmetic of Hospital Bed Rest
The physiology behind the problem is not subtle. Gopalan described a ratio drawn from studies in athletes: for every day of bed rest, it takes roughly three days to recover the muscle strength lost. A patient bedbound for 10 days is looking at about 30 days to return to baseline.
For someone on a transplant waitlist admitted with worsening heart failure, an abnormal heart rhythm, or coronary artery disease, that math runs the wrong direction. The longer the wait for a donor organ, the weaker the candidate becomes, and weakness is itself a disqualifier because frail patients face higher risk of postoperative complications.
Cardiac rehabilitation already exists, but it is designed for recovery after a heart attack or surgery. Cardiac prehab also exists, but it has generally been an outpatient effort for people preparing at home. The gap Gopalan identified was the patient who never goes home before transplant and therefore never has access to either.
The Program and the Numbers So Far
The equipment is deliberately modest. The unit has a recumbent bicycle that works arms and legs at once, a sit-down bicycle, and an arm bicycle. Gopalan said the team specifically left out a treadmill because they did not want to put patients at risk of falling.
Across two years, 56 percent of pretransplant patients in the first year and 62 percent in the second year met transplant listing criteria after improving, with no reported adverse events. Gopalan clarified an important point about that figure: every patient entering the program started out as not qualified from a frailty perspective, so the percentages describe how many became eligible rather than how many stayed eligible.
Average frailty scores moved from about 2.5 out of 5 to about 1.5 during sessions with an exercise physiologist. In transplant selection, Gopalan said, a score of 2 or lower is encouraging, and 3 is the cutoff at which a patient must be rehabilitated one way or another.
He listed three findings from the work. It was safe, with no deaths, no complications and no falls. It improved frailty scores. And it improved metabolic equivalent scores, a standard measure of exercise capacity.
MedicalDaily Evidence Check
This is a single-center program evaluation, not a randomized trial. There was no control group of similar patients who did not receive prehab, which means the improvement cannot be separated from the natural course of some patients stabilizing on medical therapy during their admission. Gopalan told STAT the results so far cover 45 patients.
The findings were presented at a scientific meeting rather than published in a peer-reviewed journal, and conference presentations have not gone through the same review process as journal articles. Related research supports the general direction. A Spanish pilot program published in the European Journal of Preventive Cardiology found multimodal prehabilitation feasible and safe in a small group of heart transplant candidates, though the authors noted the tiny sample and absence of a control group as limitations. UPMC has run a formalized prehab program for lung transplant candidates since 2020 and extended it to heart transplant candidates in 2023.
What this program does not establish is whether prehab improves survival after transplant, whether the eligibility gains hold up over time, or whether the model works in hospitals without a dedicated exercise physiologist. A review of prehabilitation in transplant candidates published in Current Transplantation Reports found the underlying literature thin and dominated by small pilot studies.
The Funding Question Behind It
Gopalan said the program was paid for through philanthropic funding secured via the hospital foundation. He proposed to the hospital that if he brought the money, it would provide space on a telemetry floor, and the hospital agreed. The Banner Health Foundation has described the resulting inpatient center as supported by philanthropic gifts, with clinical exercise physiologists working with patients before and after surgery.
That detail matters more than it might appear. Inpatient prehabilitation is not a reimbursed service the way outpatient cardiac rehab is, which means a hospital cannot simply bill for it. Gopalan noted that applying for National Institutes of Health funding would require collecting more data first.
For families, the practical implication is narrow but real. If a relative is admitted while waiting for a heart transplant, it is reasonable to ask the transplant team whether any structured mobility or conditioning program is available during the admission, and what the patient's current frailty score is. Those are questions the transplant coordinator can answer. Patients should not attempt an exercise program on their own while hospitalized for advanced heart failure, because the supervision is what makes it safe.
The Next Steps for the Model
Whether this approach spreads depends on data that does not yet exist. A multicenter study with a comparison group would be required to demonstrate that inpatient prehab changes transplant rates rather than reflecting who was going to improve anyway.
The team will need to publish the results in a peer-reviewed journal and expand the sample before the program can compete for federal research funding. Until then, similar programs will likely depend on philanthropy and individual hospital decisions, which means access will vary by institution rather than by patient need.
The finding worth carrying forward is smaller and more portable than the program itself. Time in a hospital bed is not neutral for a transplant candidate, and the loss it causes is measurable, trackable, and at least partly reversible.
requently Asked Questions
What is inpatient cardiac prehab? A supervised conditioning program run inside the hospital for patients admitted while waiting for a heart transplant, intended to slow or reverse the muscle loss that occurs during a long admission.
Why does fitness affect transplant eligibility? Transplant teams use frailty scores because frail patients face higher risk of complications after surgery. At Banner Phoenix, a score of 3 on a 5-point scale is the cutoff that triggers a requirement for rehabilitation.
What were the results? Over two years, 56 percent of pretransplant patients in the first year and 62 percent in the second year met listing criteria after improving. All participants had started out not qualified on frailty grounds.
Does this prove prehab works? No. This is a single-center program without a control group, presented at a conference rather than published in a peer-reviewed journal. Larger comparative studies would be needed.
What equipment does the program use? A recumbent bicycle that exercises arms and legs together, a sit-down bicycle, and an arm bicycle. A treadmill was deliberately excluded because of fall risk.
Who paid for it? Philanthropic funding raised through the hospital foundation, with the hospital providing the space. Inpatient prehab is not a routinely reimbursed service.
What can families ask about? Whether a structured mobility or conditioning program is available during a transplant admission, and what the patient's current frailty score is. The transplant coordinator can answer both.
