Taking Steroids Long Term? Don't Overlook This Important Step

If you've been on steroids for months or years, you've probably heard the standard warnings: watch your bone density, monitor your blood sugar, keep an eye on your weight.

What you may not have heard is that one of the most effective tools for managing all of those risks is something you can start this week, and it doesn't require a prescription. A Sports Medicine narrative review1 makes a compelling case that structured exercise isn't just beneficial for people on long-term steroid therapy. It may be essential.

What the review looked at

Glucocorticoids (the class of steroids commonly prescribed for conditions like rheumatoid arthritis and lupus) are used by roughly 1–3% of adults in high-income countries each year, with a substantial proportion remaining on treatment beyond two years.

Despite how widely they're prescribed, current exercise guidelines rarely account for patients who are taking them long-term.

This review set out to change that.

Researchers searched three major databases for randomized controlled trials examining exercise interventions in glucocorticoid-treated patients, ultimately including 19 studies involving 663 participants, predominantly women with rheumatoid arthritis, systemic lupus erythematosus, or inflammatory muscle conditions.

Exercise consistently improved muscle strength & physical function

Across the included studies, people who exercised while on steroids moved better, got stronger, and functioned at a higher level than those who didn't.

Muscle performance and physical function improved consistently, with functional test improvements often meeting or exceeding clinically meaningful thresholds.

Evidence on bone health, heart health, and cognitive outcomes was more limited and, in some cases, mixed. That's not necessarily because exercise doesn't help in those areas, but because the research in this specific population is still catching up.

What's already clear is that the case for exercise here is strong, and the full picture will likely become clearer as more studies are done.

Why steroids make exercise harder & why that makes it more important

Here's the frustrating reality: the same conditions that make exercise most necessary also make it harder to do.

Long-term steroid use affects the body in five key ways, and exercise directly targets all five:

Exercise works directly on each of these. Strength training helps rebuild muscle and supports healthy blood sugar.

Regular physical activity also appears to support mood and brain function in ways that may help counteract some of the mental and emotional effects of steroids, though this hasn't yet been confirmed in large-scale trials focused specifically on people taking steroids.

The two pillars: strength training & cardio

The review identifies resistance training and aerobic exercise as the two essential components for people on long-term steroids, and both are needed. Strength training is especially important for counteracting steroid-related muscle loss.

Progressive loading (gradually increasing the challenge over time) helps rebuild muscle and restore the energy-producing capacity of muscle cells that steroids can impair. For people experiencing steroid myopathy (muscle weakness and wasting caused by long-term steroid use), this is the most direct intervention available. Aerobic exercise addresses the heart health and metabolic side of the equation.

It supports healthy blood pressure, contributes to better mood and energy, and for people managing conditions like rheumatoid arthritis or lupus where fatigue is already a significant burden, building aerobic fitness can help restore stamina for everyday life.

Based on current evidence, combining both types of exercise is what the review recommends for this population. Strength training alone won't fully address heart and metabolic risk. Cardio alone won't prevent muscle loss.

The combination appears to offer the most comprehensive protection, though researchers note that additional studies are still needed to establish definitive clinical guidelines.

Getting started safely when your baseline is lower than expected

The review doesn't just make the case for exercise; it also acknowledges the real barriers.

Fatigue, pain, reduced stamina, and low motivation (partly a side effect of steroids themselves) all make getting started harder. That's why the authors emphasize individualized programs and strategies that support consistency.

A few principles worth keeping in mind:

Supervised sessions, structured programs, and regular check-ins all significantly improve outcomes, according to the review.

The takeaway

For people managing chronic inflammatory conditions with long-term steroids, structured exercise isn't something to consider once you feel better; it's part of what can help you get there.

Talk to your doctor about incorporating a structured exercise program (resistance training and aerobic exercise combined) as part of your overall treatment plan.