Effect of exercise training in patients with cardiac sarcoidosis after induction of oral corticosteroid therapy
Keywords:
Rehabilitation, Corticosteroid, Exercise, Muscle strength, SarcoidosisAbstract
Background and aim: To our knowledge, no study has investigated altered muscle strength in patients with cardiac sarcoidosis (CS). This retrospective observational study investigated the relationship between quadriceps isometric strength (QIS) and exercise training (ET) in patients with CS.
Methods: Eighteen patients who participated in a 4-month ET programme immediately after initiating oral corticosteroids were studied. They underwent 3–5 ET sessions per week during hospitalisation and 1–2 sessions per week after discharge. We measured their QIS at the beginning of the ET programme and at 1 and 4 months after programme enrolment. The patients received 29±4 mg/day prednisolone during the corticosteroid induction period and 15±4 mg/day prednisolone during the corticosteroid tapering period.
Results: They continued ET and showed significant QIS weakness in the early corticosteroid induction period (0.52±0.12 to 0.48±0.11 kgf/kg, P=.048) and no significant improvement during the corticosteroid tapering period (0.53±0.08 to 0.58±0.06 kgf/kg, P=.099). Patients who received ≤12.5 mg/day prednisolone reported an improved QIS-to-body weight ratio.
Conclusions:Patients with CS treated with 30 mg/day prednisolone showed poor QIS early in the corticosteroid induction period, even with ET. Patients with CS who receive corticosteroids may be more susceptible to developing corticosteroid myopathy.
References
1. Marcellis RG, Lenssen AF, Elfferich MD, et al. Exercise capacity, muscle strength and fatigue in sarcoidosis. Eur Respir J. 2011;38:628–34. doi:10.1183/09031936.00117710.
2. Ammenwerth W, Wurps H, Klemens MA, et al. Reduced oxygen uptake efficiency slope in patients with cardiac sarcoidosis. PLoS One. 2014;9:e102333. doi:10.1371/journal.pone.0102333.
3. Terasaki F, Azuma A, Anzai T, et al. JCS 2016 guideline on diagnosis and treatment of cardiac sarcoidosis - digest version. Circ J. 2019;83:2329–88. doi:10.1253/circj.CJ-19-0508.
4. Bowyer SL, LaMothe MP, Hollister JR. Steroid myopathy: incidence and detection in a population with asthma. J Allergy Clin Immunol. 1985;76:234–42. doi:10.1016/0091-6749(85)90708-0.
5. Marcellis R, Van der Veeke M, Mesters I, et al. Does physical training reduce fatigue in sarcoidosis? Sarcoidosis Vasc Diffuse Lung Dis. 2015;32:53–62.
6. Naz I, Ozalevli S, Ozkan S, Sahin H. Efficacy of a structured exercise program for improving functional capacity and quality of life in patients with Stage 3 and 4 sarcoidosis: a randomized controlled trial. J Cardiopulm Rehabil Prev. 2018;38:124–0. doi:10.1097/HCR.0000000000000307.
7. Taylor RS, Sagar VA, Davies EJ, et al. Exercise based rehabilitation for heart failure. Cochrane Database Syst Rev. 2004;3:CD003331. doi:10.1002/14651858.CD003331.pub4.
8. Yanagi H, Konishi H, Omae K, et al. Association between adherence to a 3-month cardiac rehabilitation program and long-term clinical outcomes in Japanese patients with cardiac implantable electronic devices. J Cardiopulm Rehabil Prev. 2024;44:248–56. doi:10.2340/jrm-cc.v8.42483.
9. Kamiya K, Masuda T, Tanaka S, et al. Quadriceps strength as a predictor of mortality in coronary artery disease. Am J Med. 2015;128:1212–9. doi:10.1016/j.amjmed.2015.06.035.
10. Yanagi H. Safety of exercise tests before and after cardiac rehabilitation in patients with implantable cardioverter defibrillators or cardiac resynchronization therapy defibrillators. Eur J Cardiovasc Nurs. 2025. doi:10.1093/eurjcn/zvaf081.
11. Yanagi H, Konishi H, Yamada S, et al. Effects of exercise training on physical activity in heart failure patients treated with cardiac resynchronization therapy devices or implantable cardioverter defibrillators. J Rehabil Med. 2020;52:jrm00111. doi:10.2340/16501977-2728.
12. Yanagi H, Nakanishi M, Konishi H, et al. Effect of exercise training in heart failure patients without echocardiographic response to cardiac resynchronization therapy. Circ Rep. 2019;1:55–60. doi:10.1253/circrep.CR-18-0015.
13. Caplan A, Fett N, Rosenbach M, Werth VP, Micheletti RG. Prevention and management of glucocorticoid-induced side effects: a comprehensive review: ocular, cardiovascular, muscular, and psychiatric side effects and issues unique to pediatric patients. J Am Acad Dermatol. 2017;76:201–7. doi:10.1016/j.jaad.2016.02.1241.
14. Middlekauff HR. Making the case for skeletal myopathy as the major limitation of exercise capacity in heart failure. Circ Heart Fail. 2010;3:537–46. doi:10.1161/CIRCHEARTFAILURE.109.903773.
15. Schakman O, Gilson H, Thissen JP. Mechanisms of glucocorticoid-induced myopathy. J Endocrinol. 2008;197:1–10. doi:10.1677/JOE-07-0606.
Downloads
Published
Issue
Section
License
Copyright (c) 2025 Hidetoshi Yanagi, Harumi Konishi, Yukihiro Shimada, Hiroyuki Miura , Tatsuo Aoki, Teruo Noguchi

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Transfer of Copyright and Permission to Reproduce Parts of Published Papers.
Authors retain the copyright for their published work. No formal permission will be required to reproduce parts (tables or illustrations) of published papers, provided the source is quoted appropriately and reproduction has no commercial intent. Reproductions with commercial intent will require written permission and payment of royalties.

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.



