Programming for Exercise and Medications

As a fit pro, chances are good that you have exercise clients who take prescription medications. According to the CDC (2021), 48.6% of people have taken at least one prescription drug in the past 30 days. Prescription and over-the-counter medications provide relief for aches and pains, allergies, gastrointestinal problems, sleeplessness, and many other health conditions that impair the quality of life.

It’s prudent to research medications your clients are taking so you can understand the possible unwanted side effects from the drug and/or its effects during and after exercise. This is especially true for your active agers. Older adults (≥65 years) visit emergency departments almost 450,000 times each year due to an adverse drug event (i.e., some physical harm caused by a drug). That’s more than twice as often as younger persons (CDC 2017).

You may also find it helpful to discuss the client’s medications and exercise plan with their primary care provider to make sure you’re implementing the proper exercise program.

Fuentes, Pineda & Venkata (2018) summarized the top 200 prescription drugs using information from drug bank resources. Seven of the top eight medications are in the following groups: blood pressure medications, thyroid medications, cholesterol medications and diabetes medications. (See “Top Eight Prescriptions in the U.S.,” below.)

It’s likely that one or more of these medication classes is prescribed to some of your clients, especially those over 40. Here’s a look at these groups, followed by specific exercise recommendations.

Anti-Hypertensive Medications

Hypertension, or high blood pressure (HBP), is the overall top risk factor of cardiovascular disease (Sabbahi et al. 2016). It’s the most common condition of the circulatory system, diagnosed in more than 40% of all cardiovascular diseases (Sharman et al. 2019).

There are multiple types of hypertension medications. Three common classes are angiotensin converting enzyme (ACE) inhibitors, calcium channel blockers and beta blockers.

ACE inhibitors relax veins and arteries to lower blood pressure by preventing formation of angiotensin II, a strong vasoconstrictor (i.e., something that narrows blood vessels). ACE inhibitors are typically the first drug of choice to treat hypertension, especially for people who have a diabetes diagnosis (Niedfeldt 2002).

Calcium channel blockers prevent too much calcium from entering the cells of the heart and arteries. Excess calcium triggers more forceful contractions and more vasoconstriction, so reducing its entry results in vasodilation (widening of blood vessels), decreased resistance to blood flow and a lower blood pressure (Niedfeldt 2002).

Beta blockers block the action of hormones like adrenaline, causing the heart to beat more slowly and with less contractile force, resulting in lower blood pressure (Klibanov 2020).

Exercise Recommendations

The American College of Sports Medicine recommends that individuals who are taking hypertension medications follow the regular recommendations to engage in moderate-intensity aerobic exercise 5–7 days a week, supplemented by resistance exercise 2–3 days a week (Zaleski 2019).

Zaleski notes that regular aerobic exercise lowers elevated resting systolic blood pressure up to 5–7 mm Hg, while resistance exercise lowers it up to 2–3 mm Hg among individuals with hypertension. People with hypertension should avoid heavy weight training because it may lead to acute, undesirable increases in blood pressure (Sharman et al. 2019).

See also: Training People With Disabilities

Hypothyroid Medications

Hypothyroidism (an underactive thyroid) is a condition in which the thyroid gland doesn’t produce enough thyroid hormones. This can lower body temperature and heart rate and disrupt all aspects of metabolism. Symptoms of hypothyroidism include fatigue, cold sensitivity, constipation, dry skin and weight gain.

Levothyroxine is second on the list of the top 200 most-prescribed medications (Fuentes, Pineda & Venkata 2018). This medication manages hypothyroidism by shoring up levels of the hormone thyroxine, a major regulator of energy and metabolism. This medication, prescribed in varying doses, is used for mild, moderate and severe cases of hypothyroidism. Levothyroxine replacement has also been shown to improve submaximal exercise capacity (Mainenti et al. 2009).

Exercise Recommendations

Physical activity is safe for patients on hypothyroid medications. An increase in physical activity can improve aerobic capacity and muscular strength and lessen fatigue in persons with hypothyroidism. However, Lankhaar et al. (2021) report that many people with hypothyroidism limit their physical activity due to common exercise-related constraints (e.g., lack of time, lack of energy, lack of willpower, fear of injury, lack of skill, and lack of facilities or equipment).

An initial exercise guideline is to progress steadily with the exercise program. For substantial health benefits, the WHO (2020) recommends adults strive throughout the week to do 150–300 minutes of moderate-intensity aerobic physical activity; and/or gradually progress to include at least 75–150 minutes of vigorous-intensity aerobic physical activity; or an equivalent combination of moderate- and vigorous-intensity activity.

For resistance exercise, the WHO recommends that adults should also do muscle-strengthening activities at moderate or higher intensity for all major muscle groups on 2 or more days a week.

Antilipidemic Medications

High cholesterol can put people at higher risk of heart disease, heart attack and stroke. Antilipidemic drugs act to prevent these conditions by lowering the “bad” cholesterol, i.e., low-density lipoprotein (LDL) cholesterol (Fuentes, Pineda & Venkata 2018).

Statins are the most common prescription. Statins inhibit HMG-CoA reductase, an enzyme that produces cholesterol. By inhibiting this enzyme, unhealthy cholesterol can be reduced (Schweitzer et al. 2020). Symptomatic statin users have approximately a 28% decrease in energy production, as statins reduce mitochondrial (i.e., aerobic) respiration during exercise (Schweitzer et al. 2000). Interestingly, a new study has shown that most (>90%) of the reports of statin users reporting muscle-related concerns are not due to the statin (Reith et al. 2022).

Exercise Recommendations

For clients taking statins, physical activity is integral for delaying age-related functional declines. Regular moderate aerobic activity is recommended (Schweitzer et al. 2020). Schweitzer et al. indicate that extreme high-intensity exercise should be avoided.

Clients on antilipidemic medications may need a longer recovery time between resistance exercises and sets. However, resistance training should be encouraged for clients on antilipidemic medications because the benefits (improved functional capacity, insulin sensitivity, glucose metabolism and cardiovascular health) far outweigh the risks. Fit pros can follow the WHO exercise guidelines and gradually progress clients taking antilipidemic medications.

See also: How Resistance Training Affects Metabolism

Antidiabetic Medications

It’s important to highlight that regular physical activity is recommended to prevent and manage type 2 diabetes (Das et al. 2018). With consistent exercise training, the working skeletal muscles become more efficient in utilizing blood glucose and stored muscle glycogen to fuel the workout. Physical activity also causes muscles to increase their sensitivity to insulin, thus facilitating the consumption of glucose from the blood (Das et al. 2018). Antidiabetic medications help control blood sugar (glucose) levels.

Metformin is number four on the top 200 medications list (Fuentes, Pineda & Venkata 2018) and one of the most commonly prescribed drugs for managing type 2 diabetes. Clients taking metformin may periodically experience indigestion, nausea, bloating, abdominal cramping and diarrhea (Das et al. 2018).