Prednisone and Exercise: What You Need to Know About Muscle and Tendon Safety

It can be safe to exercise while taking prednisone, but a few precautions are advisable because corticosteroids can affect muscles, bones, and tendons. Prednisone (a systemic corticosteroid) is linked to side effects such as muscle weakness, steroid myopathy, bone loss, and less commonly tendon rupture, especially with longer-term or higher-dose use. ^[1] These risks don’t mean you must avoid activity; in fact, regular, moderate exercise is generally encouraged to help maintain bone, heart, and metabolic health. ^[2] The key is to choose the right intensity, watch for warning signs, and tailor your plan to your dose and duration of therapy. ^{[1] [2]}

---

How Prednisone Can Affect Muscles and Tendons

• Muscle effects: Prednisone can cause muscle weakness and loss of muscle mass (steroid myopathy), particularly with higher doses or prolonged use. ^[1] This may make intense workouts feel harder and increase the chance of strain if you push too aggressively. ^[1]

• Tendon risks: Tendon rupture has been reported with corticosteroid therapy, both systemic (like oral prednisone) and local steroid injections. ^[1] Case series and reports have linked Achilles and other large-tendon ruptures to ongoing steroid treatment, suggesting the tendon tissue can be more vulnerable. ^{[3] [4]} Ruptures have even been reported bilaterally in people on systemic steroids. ^[5] While these events are not common, risk appears higher with longer duration, cumulative dose, and in the presence of other musculoskeletal steroid effects. ^{[6] [3]}

• Bone and joint considerations: Prednisone increases the risk of osteoporosis and vertebral fractures, which influences the type and intensity of weight-bearing exercise you should choose. ^[1]

---

Is Exercise Recommended on Prednisone?

Yes with modifications. Regular, moderate aerobic exercise (like walking) is generally recommended and can help counteract steroid-related issues such as bone loss, high blood pressure, and metabolic changes. ^[2] For most people on short-term, low-to-moderate doses, light-to-moderate activity is reasonable, provided you listen to your body and avoid sudden spikes in intensity. ^{[2] [7]}

---

Practical Safety Tips for Exercising on Prednisone

• Start low, go slow: Build volume and intensity gradually, especially if you’re new to exercise or starting steroids. Abrupt high-intensity or explosive workouts can stress vulnerable tendons. ^[4]

• Prioritize tendon-friendly training: Focus on controlled movements, limit heavy eccentric loading (slow lowering under heavy weight), and be cautious with plyometrics or sprinting, which raise tendon strain. ^[4]

• Warm-up and mobility: Spend extra time warming up and include calf, hamstring, quadriceps, and shoulder mobility work to support common rupture sites. ^[4]

• Strength training adjustments: Use moderate loads, slower progressions, and higher-repetition ranges with good form; avoid “max testing” while on higher doses or long courses. ^{[4] [1]}

• Footwear and surfaces: Supportive shoes and even surfaces reduce sudden tendon stress, particularly for the Achilles and patellar tendons. ^[4]

• Rest and recovery: Allow more recovery between sessions; prednisone can alter tissue repair processes, so extra rest may reduce overuse injuries. ^[1]

• Monitor warning signs: New or worsening tendon pain, swelling, stiffness, or a “pop” sensation warrants prompt evaluation and stopping the activity. Early immobilization of a painful Achilles tendon can be protective if rupture is suspected. ^{[8] [4]}

• Coordinate with your clinician: If you’re on long-term or high-dose prednisone, or have other risk factors (history of tendon issues, osteoporosis, fluoroquinolone antibiotics), consider a personalized exercise prescription and possibly temporary limits on high-tendon-load activities. ^{[1] [4]}

---

Who Is at Higher Risk?

• Higher or prolonged doses of corticosteroids (cumulative exposure). ^[1]
• Pre-existing musculoskeletal issues (prior tendinopathy, deforming arthritis). ^[6]
• Concomitant factors that degrade tendon quality (age-related changes, systemic illnesses). ^[4]
• History of tendon pain under steroid therapy, which may indicate early or partial tears. ^[8]

If you fall into these categories, exercise selection and intensity should be more conservative, with attention to tendon-friendly programming. ^{[4] [8]}

---

Suggested Exercise Plan While on Prednisone

• Aerobic training: 20–40 minutes of low-to-moderate intensity walking, cycling, or swimming most days; this supports cardiometabolic health without excessive tendon load. ^[2]

• Strength training: 2–3 days per week of full-body training using moderate loads, controlled tempo, and higher reps (e.g., 8–15), avoiding deep, fast, or heavy eccentrics (like heavy downhill running or Nordic hamstring drops). ^[4]

• Flexibility and balance: Daily gentle stretching and balance drills help maintain joint motion and reduce falls and compensatory strain. ^[4]

• Progression: Increase no more than 5–10% per week in volume or intensity, and reduce/modify any movement that causes focal tendon pain. ^[4]

---

When to Seek Medical Advice

• Acute tendon symptoms: A sudden “pop,” sharp pain, visible deformity, or immediate weakness especially in the Achilles, patellar, biceps, or shoulder needs urgent assessment. Early protection can limit further injury. ^{[8] [4]}

• Persistent muscle weakness: Notable or progressive weakness may reflect steroid myopathy, and your regimen may need adjustment. ^[1]

• Bone pain or height loss: Could indicate steroid-related fractures and warrants imaging and exercise modification. ^[1]

---

Bottom Line

Exercise is usually safe and beneficial while taking prednisone when it is properly scaled, but corticosteroids can increase the risk of muscle weakness and, in some cases, tendon rupture particularly with higher doses, long-term use, or existing tendon problems. ^[1] Align your routine toward moderate, controlled training, avoid sudden high-load eccentric or explosive activities, and stop and get evaluated if tendon pain or injury signs appear. ^{[4] [8]} Pair this with regular movement for overall health benefits, and work with your clinician to tailor an exercise plan to your specific dose and medical context. ^{[2] [1]}

---

Key References Summarized

• Corticosteroids can cause muscle weakness, steroid myopathy, osteoporosis, and tendon rupture among musculoskeletal side effects. ^[1]
• Moderate aerobic exercise is encouraged during corticosteroid treatment to support bone and heart health. ^[2]
• Tendon ruptures have been reported with systemic corticosteroid use, including Achilles and bilateral cases, and clinicians emphasize careful diagnosis and management in at-risk individuals. ^{[3] [5] [4]}
• Chronic steroid therapy in systemic conditions (e.g., lupus) is associated with increased tendon rupture risk, especially with long duration and other steroid-induced musculoskeletal complications. ^[6]
• Early immobilization and caution are advised when tendon pain emerges under steroid therapy to prevent progression to rupture. ^[8]