Effects of exercise on the efficacy and adverse effects of immunosuppressants: a systematic review and meta-analysis
Year: 2026
Type: review
Study designs: Systematic Review, Meta-Analysis
Abstract: Lifelong immunosuppression is the standard care after solid organ transplantation; however, it is associated with a wide range of adverse effects. Emerging evidence indicates that structured exercise may help reduce these complications. Therefore, this review aimed to assess the effects of exercise interventions on the side effects of immunosuppressive treatment. A systematic search was conducted in PubMed, Web of Science, and Scopus following the PRISMA 2020 guidelines (PROSPERO CRD420251078616). Randomised controlled trials (RCTs) examining post-transplant exercise interventions were included. Two reviewers independently screened studies published since 2000 using the PICOS framework and assessed their quality with the PEDro scale. Pooled analyses employed random effects models. Twenty-five RCTs involving 560 participants were included. Exercise significantly increased peak oxygen uptake (VO 2 peak; standardised mean difference [SMD] = 0.749, 95% confidence interval [CI]: 0.225 to 1.274, p = 0.010) and decreased body fat percentage (SMD = −0.509, 95% CI: −0.899 to −0.118, p = 0.022). No significant effects were observed on blood pressure, muscle strength, or metabolism. Evidence on bone health and immunomodulatory efficacy remains limited. Exercise may partially mitigate adverse effects of immunosuppressants by improving cardiorespiratory fitness and body composition. However, gaps still exist regarding its impact on metabolic, skeletal, and immunological effects. • Structured exercise commenced at least six months after transplant, primarily involving combined aerobic and resistance training, which significantly enhanced VO₂peak and lowered body fat percentage. • No consistent effects were observed on blood pressure, glucose metabolism, lipid profile, or bone mineral density, and findings for muscle strength remained inconclusive. • Exercise was linked to a modest yet significant decrease in serum creatinine. • Integrating exercise into routine post-transplant care represents a paradigm shift with important clinical and public health implications. • By combining pharmacological management with tailored exercise interventions, clinicians can reduce polypharmacy burden, improve functional capacity, and ultimately enhance survival and quality of life in patients with a history of solid organ transplantation.
Source: Transplantation Reviews
Language: English
Subfield: Complementary and alternative medicine
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $4,380
OpenAlex ID: W7125181732