By Sheri R. Colberg, PhD, FACSM
If you take any other medications to help lower your blood cholesterol, manage your blood pressure, or control other health problems, be aware that some of them can potentially impact your ability to be physically active. Although most drugs do not affect exercise, several common nondiabetes medications with such potential effects are statins, beta-blockers, diuretics, vasodilators, and blood thinners (1).
Statins are a class of medications prescribed to lower cholesterol levels or abnormal levels of blood fats to reduce your risk of having a heart attack or stroke. Brand names include Altoprev, Crestor, Lescol, Lipitor, Livalo, Mevacor, Pravachol, and Zocor. If you are someone who is unwilling or unable to change your diet and lifestyle sufficiently to lower your cholesterol enough or you have genetically high levels of cholesterol or triglycerides (another blood fat), then the benefit of statins on lowering your cardiovascular risk may exceed its risks. Given that cardiovascular disease (leading to heart attack and stroke) is the leading cause of death in adults with diabetes of any type, doctors often prescribe statins to people with perfectly normal cholesterol levels.
Although undesirable muscular effects are not that common, statins potentially can cause unexplained muscle pain and weakness with exercise, likely related to these medications compromising the ability of the muscles to generate energy. Other muscular conditions like myalgia, mild or severe myositis, and rhabdomyolysis, although relatively rare, are doubled in people with diabetes, along with an increased susceptibility to exercise-induced muscle injury. Other symptoms, such as muscle cramps during or after exercise, nocturnal cramping, and general fatigue, generally resolve when you stop taking statins. If you experience any of these symptoms, talk with your doctor about potentially switching to another statin or a different cholesterol-lowering medication.
About one-third of the athletes surveyed (of all ages) reported taking or having taken a statin. Many take the lowest possible dose of a statin as a heart disease preventative. Some reported getting side effects such as more frequent and severe leg cramps, muscle pain, and weakness, and others have complained of dizziness and foggy memories. Although people in the survey did not report any negative side effects, a few had to either stop taking statins or switch to another drug. (Examples of athletes’ use of statins and issues encountered are included in Chapter 3 in The Athlete’s Guide to Diabetes).
Another class of medications called beta-blockers (e.g., Corgard, Inderal, Levatol, Lopressor, Tenormin, and Zebeta) are used to treat heart disease and hypertension (high blood pressure). They lower both your resting and your exercise heart rate. If you are taking one, your heart rate will not reach an age-expected value at any intensity of exercise, and you may not be able to work out as hard as you would like to. Be aware that your exercise responses may differ from normal when taking one of these drugs, that they can blunt your hormone response to hypoglycemia, and that they can increase your risk of more severe lows during activities.
Diuretics—or “water pills”—such as Lasix, Microzide, Enduron, and Lozol reduce the amount of water in your body and thereby lower your blood pressure. They can also lead to dehydration if you lose too much fluid. They are unlikely to affect your blood glucose, but using diuretics can cause dehydration with associated low blood pressure and dizziness during exercise.
Taking a vasodilator like nitroglycerin allows more blood to flow to your heart during exercise, which can keep you from having to treat chest pain (angina) both at rest and during exercise. Be forewarned that vasodilators can also induce a drop in your blood pressure (hypotension), which can cause you to faint or feel light-headed during or after an activity.
If you have a high stroke risk, your doctor may put you on a blood thinner to keep clots from forming. However, aspirin and other blood thinners like Coumadin have the potential to make you bruise more easily or extensively in response to athletic injuries or to bleed longer before clotting if you get a cut or scrape while working out. If you take aspirin chronically to reduce your risk of stroke, you may only need a dose equivalent to a baby aspirin a day to limit these possible side effects. Luckily, none of these blood thinners usually have any direct impact on your ability to exercise.
Medications Without Exercise Effects
You may be prescribed a number of medications to treat a variety of health conditions. Luckily, many of these have no impact on your ability to exercise. For example, if you take an angiotensin-converting enzyme (ACE) inhibitor (e.g., Capoten, Accupril, Vasotec, Lotensin, or Zestril) or angiotensin II–receptor blocker (such as Cozaar, Benicar, or Avapro) to reduce your blood pressure or protect your kidneys from possible damage, you should not expect it to have any impact on your being physically active. In fact, certain ACE inhibitors may lower your risk of a heart attack during exercise if you have heart disease. Other medications that treat heart disease and high blood pressure (calcium-channel blockers like Procardia, Sular, Cardene, Cardizem, and Norvasc), depression (such as Wellbutrin and Prozac), or chronic pain (Celebrex) also have no known effect on exercise.
1. Excerpted from Colberg, SR, Chapter 3, “Ups and Downs of Insulin and Other Medications” in The Athlete’s Guide to Diabetes: Expert Advice for 165 Sports and Activities. Champaign, IL: Human Kinetics, 2019.
Sheri R. Colberg, PhD, is the author of The Athlete’s Guide to Diabetes: Expert Advice for 165 Sports and Activities (the newest edition of Diabetic Athlete’s Handbook), which is now available through Human Kinetics (https://us.humankinetics.com/products/athlete-s-guide-to-diabetes-the), Amazon (https://amzn.to/2IkVpYx), Barnes & Noble, and elsewhere. She is also the author of Diabetes & Keeping Fit for Dummies. A professor emerita of exercise science from Old Dominion University and an internationally recognized diabetes motion expert, she is the author of 12 books, 28 book chapters, and over 415 articles. She was honored with the 2016 American Diabetes Association Outstanding Educator in Diabetes Award. Contact her via her websites (SheriColberg.com and DiabetesMotion.com).