Physical exercise reduces the adverse effects of corticosteroid treatments

Corticosteroid-based treatments are widely used to treat inflammatory and autoimmune diseases. Although effective, their prolonged use leads to side effects that weaken physical abilities and limit the benefits of sports activity. A recent analysis examined the interactions between these drugs and exercise, as well as the available evidence on training programs adapted for patients on corticosteroids.

Corticosteroids cause a variety of complications such as diabetes, musculoskeletal disorders, hypertension, weight gain, cognitive difficulties, and neuropsychiatric disorders. These problems reduce the ability to exercise, motivation, and physiological adaptations to effort. A search across multiple databases identified 19 studies, primarily conducted on women with rheumatoid arthritis or lupus. The methodological quality of these studies was judged to be moderate to high.

The results show that resistance training and aerobic exercise systematically improve muscle performance and functional capacities. However, evidence regarding the effects on bone, cardiometabolic, cognitive, and mental health remains limited or contradictory. To optimize sports programs, it is recommended to combine muscle strengthening and aerobic activity, while implementing strategies to promote adherence and ensure safety.

Integrating a structured exercise program alongside corticosteroids could mitigate their adverse effects and reduce the need for multiple medications. However, further research is needed to establish precise clinical guidelines. The underlying mechanisms include increased insulin resistance, muscle degradation, mitochondrial dysfunction, and impaired endothelial function, all of which disrupt the normal response to exercise.

Corticosteroids also disrupt the balance between bone formation and resorption, increasing the risk of fractures. They also affect blood pressure, cognition, and mood, making exercise more difficult to practice and maintain. Despite these challenges, studies show that targeted interventions, such as progressive muscle strengthening and aerobic exercises, can counteract some of these effects.

Current recommendations emphasize the importance of an individual assessment before starting a program, taking into account the specific risks associated with corticosteroids. Resistance exercises should target the main muscle groups, while aerobic activities should be adapted to the patient’s tolerance. Professional supervision and regular monitoring are essential to adjust intensity and avoid complications.

In summary, physical exercise appears to be a promising complementary tool for patients on corticosteroids, provided it is personalized and supervised.

Information and Sources

Scientific Reference

DOI: https://doi.org/10.1007/s40279-026-02469-6

Title: Physical Exercise as an Adjuvant to Glucocorticoid Therapy: Clinical Recommendations and Evidence Review

Journal: Sports Medicine

Publisher: Springer Science and Business Media LLC

Authors: Paula Etayo-Urtasun; Mikel L. Sáez de Asteasu; Mikel Izquierdo