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

Glucocorticoids are extensively prescribed for managing immune-mediated and inflammatory diseases. While clinically effective, prolonged glucocorticoid therapy induces adverse effects that compromise physical function and may attenuate the benefits of exercise interventions. Current exercise guidelines, however, inadequately address the complexities of concurrent glucocorticoid treatment. This narrative review, which includes a systematic review, examines interactions between glucocorticoid therapy and physical exercise, evaluates existing evidence on exercise interventions in glucocorticoid-treated populations, and provides evidence-based exercise recommendations tailored to this clinical population. Glucocorticoid-induced complications-including diabetes mellitus, musculoskeletal disorders, hypertension, weight gain, cognitive impairment, and neuropsychiatric disturbances-substantially impair exercise capacity, patient engagement, and physiological adaptations to training. After searching PubMed, Scopus, and Web of Science databases from 1 January, 2000 to 10 May, 2025 for exercise interventions in glucocorticoid-treated patients, 19 studies were included (18 unique trials; n = 663, predominantly women), mainly involving rheumatoid arthritis and systemic lupus erythematosus. Overall, the methodological quality, as assessed using the Risk of Bias 2 tool, was rated as moderate to high. Exercise interventions consistently improved muscle performance and functional outcomes, whereas evidence regarding bone, cardiometabolic, cognitive, and mental health outcomes was limited or inconsistent. For optimal exercise prescription in this population, resistance training and aerobic exercise emerge as essential components, complemented by targeted strategies to enhance adherence and ensure safety. Integrating structured exercise as adjuvant therapy in long-term glucocorticoid treatment holds considerable promise for mitigating adverse effects and reducing polypharmacy burden; however, additional research is warranted to establish definitive clinical guidelines.