By Jennifer Green, MS

Jennifer Green, NCHPAD Visiting Information Specialist

It seems like these days there are more and more medications for more and more conditions. Many of these medications, both over-the-counter and prescription, can cause side-effects while exercising. The physiological response to exercise is complex; it involves integration of multiple systems and varies depending on the type, intensity, and duration of the activity. When medications are added to this response, it becomes more complex, and even dangerous, if the effects are not understood or known. While it is not necessary to memorize hundreds of medications, fitness professionals, especially those working with people with disabilities and chronic conditions, should be knowledgeable about how certain common medications affect and are affected by exercise, and where to go to find more information.

This article will highlight some common medication groups that are used by people with disabilities and chronic conditions and how they may affect or be affected by exercise.

VASODILATORS: Vasodilators cause widening of blood vessels resulting from relaxation of smooth muscle cells within the vessel walls, particularly in the large arteries, arterioles, and veins. The sudden increase or cessation of exercise can cause a client to become dizzy if taking a vasodilator; and as a result, a longer warm-up and cool-down should be done to prevent this. Vasodilators are commonly used in individuals with cardiovascular disease or those that have suffered from a stroke.

ANTI-COAGULENTS/ANTI-THROMBICS: These medications are common to prevent blood clots. One of the most common is Coumadin (Warfarin). These medications tend to cause increased likelihood of bruising, and trainers should be cautious of their clients bumping into equipments or utilizing workouts that may cause bruising.

ANTI-CONVULSANTS: Anti-convulsants are typically used to treat seizures, but are also used for individuals who have cerebral palsy, intellectual disability, or have had an amputation or a stroke. More commonly, physicians have been using these medications to treat bipolar disorder as well. Common side effects may include dizziness, drowsiness, fatigue, nausea, tremor, rash, and weight gain.

ANTI-SPASTICITY/SPASMOLYTICS: These medications are muscle relaxants and commonly used for individuals who have multiple sclerosis, spinal cord injury, cerebral palsy, or who have had a stroke. The most common spasmolytics include Baclofen, Diazepam (Valium), Dantrolene, and Tizanidine (Zanaflex). If your client is taking a spasmolytic, he or she may experience bradycardia (slow heart rate), hypotension (low blood pressure), sedation, dizziness, weakness, and/or incoordination. Spasmolytics may also be used for clients with bladder dysfunction to relax the smooth muscle of the bladder to help facilitate bladder filling and emptying, especially in individuals with spinal cord injuries. Specifically, you may see phenoxybenzamine (dybenzaline) and oxybutynin hydrochloride (ditropan), which may cause tachycardia (fast heart rate), hypotension, and palpitations.

ANTI-DEPRESSANTS: Anti-depressants are prescribed for a wide variety of reasons. Some anti-depressants are known to cause rapid heart rate and dizziness with the onset of exercise. To counter act these side effects, a longer warm-up or cool-down may be necessary. Other side effects may include restlessness, insomnia, headache, tremor, dry mouth, confusion, nausea, bowel problems, and rash.

BETA BLOCKERS: Beta blockers are commonly prescribed for individuals with cardiovascular disease. The most common exercise-related side effect of beta blockers is that they can severely reduce heart rate, and therefore may cause a cap on the maximum heart rate and, as a result, may put restrictions on clients' exercise and stamina. Additional side effects that result from a decrease in heart rate include dizziness and fatigue.

ANTI-PARKINSONIAN DRUGS: These drugs are used to slow the progress of Parkinson's disease; however, they are sometimes prescribed for individuals with cerebral palsy to help treat dystonia, specifically the drug commonly known as Levodopa. Side effects of these medications include bradycardia, GI upset, orthostatic hypotension, tachycardia, arrhythmia, dry mouth, blurred vision, headaches, Insomnia, ataxia, cognitive or psychiatric disturbances, and edema.

It is important to keep in mind that this article is not all-encompassing. There are many more medications that you may see on a health history form other than the ones listed above - these just tend to be more commonly prescribed. It is important to recognize that when a client does list a medication on an initial entrance form, you may not know the effects it may have on his or her participation in a physical activity program. The following resources may be helpful in researching medications:

http://www.drugs.com/sfx/

http://www.rxlist.com/script/main/hp.asp

http://www.drugwatch.com/

Understanding side effects of medications clients may be taking can be helpful in creating an exercise program. You may need to make modifications to the warm-up and cool-down, the intensity of the program, or how the intensity is monitored, the time of day at which you schedule a training session or class, etc. Making small adaptations such as these can allow for a program to become more tailored, safe and effective for your clients.

Sources:
Drug Side Effects. (2011). Retrieved February 3, 2011, from
http://www.drugs.com/sfx/

Drug Watch. (2011). Retrieved February 3, 2011, from
http://www.drugwatch.com/

Durstine, J. L., & Moore, G. E. (2003). ACSM exercise management for persons with chronic diseases and disabilities (2nd ed.). Champaign, IL: Human Kinetics.

National Alliance on Mental Illness. (n.d). Medications. Retrieved August 17, 2009, From
http://www.nami.org/template.cfm?section=about_medications

The Internet Drug Index. (2011). Retrieved February 3, 2011, from
http://www.rxlist.com/script/main/hp.asp

 

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Please send any questions or comments to Jennifer Green at Jennifer Green.