Safety considerations and adverse events associated with exercise across medical disciplines

Abstract

Exercise (Ex) is widely recommended across medical specialties as a core component of disease prevention and management. However, Ex prescription is frequently generalized, with limited consideration of disease-specific contraindications, baseline fitness, comorbidities, and potential adverse effects. This gap increases the risk of overlooked complications, particularly in patients with chronic, multisystem, or advanced disease. This narrative review synthesizes available evidence on Ex-related adverse effects across cardiovascular, respiratory, renal, hepatic, rheumatic, neurological, psychiatric, and endocrine, and pediatric conditions. Reported complications range from musculoskeletal injury and disease flares to serious events including arrhythmias, myocardial infarction, sudden cardiac death, exercise-induced hypertension, hypoglycemia, rhabdomyolysis, hypoxemia, bronchoconstriction, seizures, and neurovascular symptoms. Special populations including children, transplant recipients, patients with advanced organ failure, and those receiving anticoagulation or psychotropic therapy, exhibit narrower safety margins. Across specialties, adverse outcomes are inconsistently reported, contraindications are poorly defined, and high-risk patient groups are frequently excluded from clinical trials, limiting the generalizability of existing recommendations. Exercise is a powerful therapeutic intervention that requires individualized prescription to maximize benefits and minimize potential risks. Safe implementation depends on structured pre-exercise evaluation, condition-specific risk stratification, recognition of absolute and relative contraindications, appropriate supervision, and ongoing monitoring. A coordinated, multidisciplinary approach and improved communication between physicians and exercise professionals are essential to maximize benefit while minimizing harm. Further research is urgently needed to establish evidence-based, disease-specific exercise safety frameworks. Exercise prescription across medical disciplines requires individualized, condition-specific risk stratification. Adverse events range from musculoskeletal injury to life-threatening arrhythmias, hypoglycemia, and rhabdomyolysis. Special populations—children, transplant recipients, elderly with comorbidities—warrant narrower safety margins. Structured pre-exercise evaluation, absolute and relative contraindication recognition, and multidisciplinary coordination are essential. Substantial evidence gaps exist in hepatology, advanced ILD, and rare neurological conditions, necessitating urgent RCT data.