Solid organ transplantation is the gold-standard treatment for many with end-organ failure and can offer a new independence from the burden of disease. However solid organ transplant recipients (SOTRs) remain at high risk of cardiovascular disease (CVD), poor quality of life and physical functioning. Increasing physical activity and exercise can improve the health of the general population, however the effects on those with a transplant remain unclear. Intensive exercise and sporting activity has the potential to be beneficial, although there remain concerns particularly around the effects on immune function and the CV system. This review summarises what is known about the effects of exercise on determinants of health in SOTR and then collates the available literature investigating the consequences of intensive exercise and sport on the health of SOTR. There is a paucity of high-quality research, with most evidence being case-studies or anecdotal; this is understandable given the relatively few numbers of SOTR who are performing sport and exercise at a high level. However if suitable evidence-based guidelines are to be formed and SOTR are to be given reassurances that their activity levels are not detrimental to their transplanted organ and overall health, then more high-quality studies are required
