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Side Effects of Immunosuppressant Medications as they Affect Physical Fitness:A Physical Therapist's Point of View

Martha Walker, DPT, CSCS
Chris L. Wells, PhD, PT, CCS, ATC

At the time of your organ transplant, you were placed on a regimen of immunosuppressant medications to prevent your immune system from rejecting the donor organ. There are many different immunosuppressant medications you may have been prescribed, including corticosteroids, tacrolimus, cyclosporine, mycophenolate, azathioprine, and sirolimus. These medications are vital for your new organ's survival; however, many of them come with mild to severe unwanted side effects. But there are steps you can take to lessen their impact.

One of the major side effects of corticosteroids is osteoporosis. Osteoporosis is when the density of your bones is decreased, increasing the risk for fractures. Any bone in your body can be affected; however, fractures are most commonly seen at the hip, spine, or wrist. To learn more about osteoporosis, please go and search under osteoporosis (select the first option followed by selecting "body" which will bring you to a pamphlet on osteoporosis).

The effects of osteoporosis can be lessened through exercise, supplemental Vitamin D and calcium, and medications such as Fosomax and Boneva, which you can ask your doctor about. It is important to engage in an exercise program that includes weight bearing activities and resistance training to maintain your bone density, and hopefully make your bones stronger and lessen the risk for fractures.

Weight bearing activities require your bones and muscles to work against gravity and absorb forces from the ground. This can be walking, jogging, stair climbing or dancing. Resistive training, which can include weight training with free weights, machines, or resistive bands, can also improve your muscle strength and therefore bone health particularly for the long thigh bone, femur. The benefits of resistance training do not end at osteoporosis. It can also improve your overall strength, balance and reaction time, putting you less at risk for falls.

Several immunosuppressant medications have been linked to a decrease in muscle function. Tacrolimus and cyclosporine derived medications have been linked to a delay in muscle contraction, decrease in coordination between the different types of muscle fibers to efficiently contract and relax, and a decrease in the adaptability of muscle fibers to change to meet the demands we place upon our muscles.

Corticosteroids also adversely affect muscle fibers, particularly the type two muscle fibers that contract rapidly to produce immediate force or power so we can respond quickly. Corticosteroids decrease muscle protein production and decrease the ability of the muscle to produce muscle energy in an effective manner. Participating in a general exercise program that includes aerobic and resistive training appears to improve muscle function and decreases the adverse effects on the muscles.

Another side effect of immunosuppressant medications is hyperglycemia (high blood sugar) and secondary diabetes because they may alter the way your body manages glucose (sugar). It is important to routinely check your blood sugar and work closely with an endocrinologist to establish an effective medication regimen to maintain stable blood sugar level that is close to normal, 80 to 120. Exercise can help lower your blood sugar and possibly decrease medications requirements. Aerobic exercise such as walking, biking and swimming for 30 minutes four-five days a week is very helpful and can lead to an improvement in your health, along with resistive training to increase your muscle mass, which will improve your body's ability to utilize glucose.

Another way to decrease the adverse effects of hyperglycemia or diabetes is to improve your diet. Most of us need to increase the amount of lean protein (chicken, fish and lean beef), vegetables, and whole grains that we eat. It is also important to limit your consumption of sweets.

As with starting any diet and exercise program, it is important to check first with your physician and health care providers to obtain their input and advice.

See the table below for suggested exercises to improve your health and decrease the risk of the medications adverse effects.

Table 1: Aerobic Exercise

Types: walking, jogging, biking, swimming, dancing

Duration: 30 minutes

Intensity: moderate level (experiencing shortness of breath but can still talk)

Frequency: 4-5 days a week

Table 2: Resistive Training

Upper Body

Lower body

Military Presses: Sitting with good posture, raise your arms over head.

Step Ups: Place one foot on a step, press up to transfer your weight onto the step, and then lower down slowly. Avoid using the other leg to push yourself up onto the step.

Shoulder Abduction: Sitting with good posture, raise your arms out to the side until shoulder height.

Hip Abduction: Standing with good posture, lift your leg out to the side while keeping your hip and knee straight and your foot pointing straight ahead.

Push Ups: either from the floor or against the wall, lower your straight body to the floor or wall, then press up to straighten your arms.

Hip Extension: Standing with good posture, lift your leg backwards while keeping your hip and knee straight, and your upper body still.


Heel Walking: while standing next to your kitchen counter for balance, lift your toes and front of foot off floor. Then walk the length of the counter on your heels.

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