MEDICATIONS AND EXERCISE

Medication is a common part of our life and with the continuous process of development and validation of new drug-based treatments, it is very likely that we’ll need to gain a better understanding of the effect that these pharmaceuticals have over different aspects of our lives if we want to avoid taking medication blindly. In the US and other developed countries, almost half (῀46%) of the population uses some form of prescription medication, which suggests that the use of non-prescription medication might be even higher [1].

Some of the most common drugs prescribed to the general population (statins, β-blockers, diuretics, anticholinergics, among others) have been suspected to have effects over physical performance during sports and exercise, which in some cases can increase the danger associated to these practices [2]. In this article, we’ll cover the most common of these drugs and their effect over your body during exercise.

Diuretics

Examples: chlorothiazide, acetazolamide, amiloride, ethacrynic acid, etc.

Diuretics are meant to promote urine production and are usually recommended to treat fluid retention and improve blood pressure [3]. As it will be the case with most of the drugs in this article, diuretics bring a lot of health benefits even when some of their side effects might require you to adjust certain practices in your life.

Depending on their exact mechanism of action, diuretics can have the following exercise-relevant effects [2, 4, 5]:

• Fatigue
• Dizziness
• Hypotension
• Hyperthermia
• Arrhythmia
• Unexpected weight gain
• Decreased blood supply to the muscles
• Cramps
• Altered metabolism
• A decrease of up to 25% in exercise endurance*
• Low potassium levels**

*more relevant for individuals over 50 years old

**some diuretics don’t have this effect

β-blockers

Examples: Acebutolol, Atenolol, Bisoprolol, etc

These drugs are characterized by their effect over the heart. They are used to reduce the heart rate and increase exercise tolerance.

Some of the exercise relevant effects for this family of drugs include [2, 6, 7]:

• Decrease of physical performance in people with portopulmonary hypertension
• Bradicardia
• Loss of pulmonary vascular resistance

Statins

Examples: atorvastatin, fluvastatin, lovastatin, pravastatin, simvastatin, etc

Statins are a family of drugs mainly used to reduce the levels of cholesterol by inhibiting its production and promoting the reabsorption of cholesterol deposits that might be in arterial walls. In general, they are considered very effective and safe [8, 9].

Research about statins has been controversial. So far, the opinion within the scientific community is that there are a few potential side effects of a statins-based treatment that could in some cases have a negative effect for physical performance, like less exercise tolerance, muscular pain, cramps, etc, however, the benefits of this treatment far outweigh any side effect. Overall, statins are considered as an important part of a treatment aimed at improving and extending life [8]

Anticholinergics

Examples: hyoscyamine, propantheline, methscopolamine, etc

This is a family of drugs that have their effect by interfering with the action of acetylcholine and preventing involuntary contractions in the smooth muscle. They are often used to prevent spasms and treat several gastrointestinal and respiratory conditions [10].

Some of the exercise relevant effects for this family of drugs include [11, 12, 13]:

• Age-dependent decrease of physical performance (older individuals will experience more of this effect)
• Reduced effectiveness while performing simple physical tasks
• Inhibition of sweat secretion, which makes people more vulnerable to heat strokes

Antihistamines

Examples:  fexofenadine, cetirizine, terfenadine, etc.

These drugs have the main effect of inhibiting the release of histamines, which under certain conditions can promote a severe allergic reaction. It is known that many athletes consume high amounts of this medication, which has motivated many researchers to seek for positive or negative effects of these drugs, however, after decades of research, it seems that antihistamines have no positive or negative effect during exercise [14, 15].

Some researchers consider that this medication might have an effect 24h after an exercise routine by helping preserve muscle strength and reduce pain, but more information needs to be collected about those claims [15].

Decongestants

Examples: pseudoephedrine, ephedrine, phenylephrine, naphazoline, etc

Decongestants, in general, have the side effect of increasing blood pressure, which is why people with hypertension are warned not to use them. This increase in heart rate could be relevant for people with a propensity to high blood pressure, however, healthy individuals taking normal doses of decongestants should not experience a noticeable decrease in endurance while running or practicing other kinds of exercise [16, 17].

Unusually high doses of decongestants can be dangerous, leading to:

• Severe hypertension
• Intracerebral hemorrhage
• Myocardial injury
• Arrhythmias
• Delirium.

Conclusion:

Some of the most used drugs can have negative effects over physical performance and exercise tolerance, however, most of these are significant mainly during the final stages of a person’s life, also, their helpful effects should not be underappreciated.

Cessation of treatment is not recommended. If you’d like to manage any negative effects of these drugs over your performance, seeking professional medical advice is the best route available.

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Reference

• [1] Centers for Diseaase Control and Prevention. (2019, June 7). Products - Data Briefs - Number 332 - February 2019. Retrieved from https://www.cdc.gov/nchs/products/databriefs/db334.htm
• [2] Heartonline. (2014, November). Exercise response to cardiac medications. Retrieved from https://www.heartonline.org.au/media/DRL/Exercise_response_to_cardiac_medications.pdf
• [3] Centers for Desease Control and Prevention. (2019, June 7). Products - Data Briefs - Number 332 - February 2019. Retrieved from https://www.cdc.gov/nchs/products/databriefs/db334.htm
• [4] Caldwell, J. E. (1987). Diuretic Therapy and Exercise Performance. Sports Medicine, 4(4), 290-304. doi:10.2165/00007256-198704040-00005
• [5] Finimundi, H. C., Caramori, P. A., & Parker, J. D. (2007). Effect of Diuretic Therapy on Exercise Capacity in Patients With Chronic Angina and Preserved Left Ventricular Function. Journal of Cardiovascular Pharmacology, 49(5), 275-279. doi:10.1097/fjc.0b013e3180385ad7
• [6] Beta-adrenergic blocking agents. (n.d.). Retrieved from https://www.drugs.com/drug-class/beta-adrenergic-blocking-agents.html
• [7] Provencher, S., Herve, P., Jais, X., Lebrec, D., Humbert, M., Simonneau, G., & Sitbon, O. (2006). Deleterious Effects of β-Blockers on Exercise Capacity and Hemodynamics in Patients With Portopulmonary Hypertension. Gastroenterology, 130(1), 120-126. doi:10.1053/j.gastro.2005.10.013
• [8] Franklin, B. A., & Lavie, C. J. (2015). Impact of Statins on Physical Activity and Fitness: Ally or Adversary?. Mayo Clinic Proceedings, 90(10), 1314-1319. doi:10.1016/j.mayocp.2015.08.014
• [9] Statins: Are these cholesterol-lowering drugs right for you?. (2018, November 9). Retrieved from https://www.mayoclinic.org/diseases-conditions/high-blood-cholesterol/in-depth/statins/art-20045772
• [10] Anticholinergics/antispasmodics. (n.d.). Retrieved from https://www.drugs.com/drug-class/anticholinergics-antispasmodics.html
• [11] Landi, F., Russo, A., Liperoti, R., Cesari, M., Barillaro, C., Pahor, M., … Onder, G. (2006). Anticholinergic Drugs and Physical Function Among Frail Elderly Population. Clinical Pharmacology & Therapeutics, 81(2), 235-241. doi:10.1038/sj.clpt.6100035
• [12] Cao, Y., Mager, D., Simonsick, E., Hilmer, S., Ling, S., Windham, B., … Abernethy, D. (2007). Physical and Cognitive Performance and Burden of Anticholinergics, Sedatives, and ACE Inhibitors in Older Women. Clinical Pharmacology & Therapeutics, 83(3), 422-429. doi:10.1038/sj.clpt.6100303
• [13] Cafasso, J. (n.d.). Anticholinergics. Retrieved from https://www.healthline.com/health/anticholinergics#uses
• [14] Antihistamines. (n.d.). Retrieved from https://www.drugs.com/drug-class/antihistamines.html
• [15] Luttrell, M. J., & Halliwill, J. R. (2017). The Intriguing Role of Histamine in Exercise Responses. Exercise and Sport Sciences Reviews, 45(1), 16-23. doi:10.1249/jes.0000000000000093
• [16] Questions and Answers. (1988). JAMA: The Journal of the American Medical Association, 260(4), 553. doi:10.1001/jama.1988.03410040125043
• [17] Chester, N., Reilly, T., & Mottram, D. R. (2003). Physiological, Subjective and Performance Effects of Pseudoephedrine and Phenylpropanolamine During Endurance Running Exercise. International Journal of Sports Medicine, 24(1), 3-8. doi:10.1055/s-2003-37193

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