Effects of exercise on the efficacy and adverse effects of immunosuppressants: a systematic review and meta-analysis.

BACKGROUND

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.

METHODS

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.

RESULTS

Twenty-five RCTs involving 560 participants were included. Exercise significantly increased peak oxygen uptake (VO2peak; 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.

CONCLUSION

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.