Prehabilitation Intervention to Maximize Early Recovery (PRIMER) in Liver Transplantation

Inclusion Criteria: 1. Participants must be wait-listed, in transplant evaluation, or "Penn Ready" with a MELD-Na score less than or equal to 25; 2. Patients must be English speaking and own/use a smartphone and cognitively able to consent; 3. Patient and physician feel that individual can safely participate in an exercise program; 4. Meeting at least one 'at risk' criterion for impaired physical performance, frailty, or malnutrition (by SPPB, abPG-SG, dynamometer measured grip strength), or physical deconditioning as determined by physical therapist, or treating clinician. Exclusion Criteria: 1. The patient is unable to provide informed consent; 2. The patient has been hospitalized within the last 30 days; 3. A score of 0-3 points on the SPPB assessment indicating inability to participate in a physical activity program or a score of 12 in the absence of frailty or malnutrition (indicating low risk for poor physical or performance or malnutrition); 4. The patient is at risk for falling as defined by clinician assessment results or if the patient states that he/she has a history of falling (record of a fall(s) in the past 30 days); 5. The patient is already enrolled in a financial incentive-based exercise program using a wearable device; 6. Any other medical conditions that would prohibit participation in a physical activity program as determined by transplant clinicians or severe vision, hearing, or mobility impairment precluding participation.