Heart diseases remain the number one cause for mortality and morbidity. One of the reasons for such a rise in cardiovascular issues has been wrong dietary habits and sedentary lifestyle. It means that professional fitness trainers and coaches have an essential role to play in the prevention of cardiovascular illnesses.
Presence of cardiovascular ailment is not a contraindication for exercise or physical training. In fact, heart specialists recommend regular exercise in most heart diseases, until or unless one is too seriously ill. Exercise helps improve heart function, respiratory capacity, and keeps the blood vessels healthy.
Since so many people around are on cardiovascular drugs, professional personal trainers need to know how these medications affect physical performance. What are the risks associated with such medications? Knowing all about cardiovascular drugs is a highly daunting task, as there are too many of them. Nonetheless, this article looks at some of the most commonly used medical drugs.
They reduce the risk of clot formation. These drugs are given in more severe conditions like those prone to deep vein thrombosis, or to treat the more severe disease of heart and lungs (pulmonary embolism). Some of the commonly used anticoagulants are rivaroxaban (Xarelto), Dabigatran (Pradaxa), Apixaban (Eliquis), Heparin, and Warfarin (Coumadin).
If anyone is on these drugs, it should be enough to raise the eyebrows of fitness trainers. These drugs say that a person is living with some severe conditions. Before starting any fitness program of such person, his or her disease history should be studied, and medical recommendations should be considered.
However, these drugs are not a contraindication for exercise; in fact, just the opposite is true. Increased physical activity will be useful for most of the people taking these drugs, as exercise is known to reduce the risk of clot formation, something these people are prone too.
Anticoagulants increase the risk of hemorrhage. Sudden bleeding is one of the most common complications of these drugs; it is something that fitness trainers must keep in mind. If they see any sign of bleeding like blood coming from the nose, training should be halted, and medical treatment should be sought immediately.
However, this does not mean that physical activity increases the risk of bleeding. Research shows that just the opposite is true. Exercise helps reduce the risk of bleeding in patients taking anticoagulants. Those receiving these drugs should not be allowed to take part in contact sports like wrestling, as that may lead to sub-dermal bleeding.
These drugs lower platelet aggregation and thus reduce the risk of clot formation. A person may regularly take low dose aspirin as a precaution, or it may be given to the high-risk groups. However, particular attention should be paid to those on dual antiplatelet therapy (DAPT). These are the people who are taking one more drug along with the aspirin, like clopidogrel (Plavix), prasugrel (Effient), and ticagrelor (Brilinta).
DAPT therapy is generally given in more severe conditions like to a person who has been treated for heart attack, or a person who has undergone cardiac surgery. DAPT is also given to those who have a stent placed in heart blood vessels.
Fitness trainers in such cases would need to know about the condition of the heart, how well the person is, when did he or she had a heart attack or cardiac intervention, or bypass surgery. One may need to plan a fitness program according to the condition of the heart. Nonetheless, it does not mean that physical activity is not allowed in such patients. Exercise is, in fact, recommended in such a situation. But it does suggest a need to practice extra caution; special attention must be paid to the intensity of the fitness program, with high-intensity workouts to be avoided.
In the US more than 10% of adults are living with hypertension, and another 30% have elevated blood pressure. It means that fitness trainers are most probable to see people taking one of the drugs to treat hypertension. Understanding the effects of antihypertensives is quite complicated as there are more than 100 different drugs in use. Nonetheless, things can be understood by understanding the group to which the drug belongs – and there are not many groups of blood pressure medications.
High blood pressure happens due to a combination of reasons like stiffening of blood vessels and vasoconstrictions (narrowing of blood vessels), overworking of the heart, retention of water and malfunctioning of kidneys. That is why there are so many drugs to treat hypertension, as they act on different organs. Let us look at some of the commonly used drugs.
- Diuretics– are also known as water pills as they increase diuresis. These drugs force the body to get rid of extra fluid and salt in the blood vessels by increasing urination. The lower amount of water in the blood vessels results in reduced blood pressure. Some of the commonly used drugs are chlorothiazide (Diuril), Chlorthalidone (Hygroton), Furosemide (Lasix), Indapamide (Lozol), Spironolactone (Aldactone).
Since these drugs reduce the amount of water in the body, they generally have an adverse effect on physical performance. Although, high-intensity workouts are not barred, but these drugs will certainly make things difficult. During warm season those taking these drugs may need to keep themselves well hydrated. Drinking water with these drugs will not reduce their effect.
- Beta-blockers – they have a calming effect on the heart, they act by reducing the cardiac capacity or output, thus reducing the blood pressure. They are preferred in some patients like those living abnormal heart rhythm or with a high risk of a heart attack. One of the ways to identify these drugs is that they have the suffix “-lol” at the end (Acebutolol, Atenolol, Bisoprolol, Metoprolol, Sotalol, and so on).
These drugs will certainly reduce exercise tolerance, as they slow down the heart. The heart may also react poorly to increased workload. Thus, people taking these drugs may get tired more readily. This does not mean that one should not do exercise with these drugs, but they will have a negative impact on physical performance.
- Calcium channel blockers – relax blood vessels both peripheral and cardiac. They are good at reducing chest pain in those living with angina; they may also help correct heart rhythm. Some of the commonly used drugs belonging to this class are amlodipine (Norvasc), diltiazem (Cardizem), felodipine (Plendil), Nifedipine (Nimotop), or verapamil (Calan).
These class of drugs will generally have minimal impact on physical performance. Thus, they are preferred over diuretics and beta-blockers in athletes.
- Drugs acting on the renin-angiotensin system – these are most commonly used drugs to treat hypertension, data shows that more than half of those living with hypertension are on this class of drugs. There is a reason why these drugs have become first-line treatment in many. They have minimum side effects; they help protect blood vessels; they reduce the risk of kidney diseases. They work by relaxing blood vessels, thus helping lower blood pressure and help hearth work more efficiently. These drugs almost have no impact on physical performance. That is why they are preferred drugs form competitive athletes.
These drugs are divided into two classes, one is ACE inhibitors, and most of the drugs belonging to this class have the suffix “-pril” like benazepril, captopril, enalapril, lisinopril, ramipril, and so on. Another class of drug is ARBs, and they are also called sartans, as they have the suffix “-sartan” like candesartan, irbesartan, losartan, telmisartan, valsartan, and so on.
Fitness trainers are most probable to be consulted by someone living with hypertension. Well-controlled hypertension is not a reason to refuse from physical activity. Most of the leading professional organizations recommend regular physical activity in those living with hypertension to reduce the risk of cardiac diseases. However, fitness trainers need to know about the medications that a person is taking, as some may indicate a severe underlying problem. Further, some of the medicines are more probable to influence physical performance than others.
These medications aim to reduce the levels of bad cholesterol and at the same time increasing good cholesterol, that way they reduce the risk of atherosclerosis or blockage of arteries. They cut the risk of heart attack, and stroke.
Statins (simvastatin, atorvastatin, rosuvastatin) are the most commonly used drugs to lower blood cholesterol. These drugs are effective. They have been subject to some criticism as they weaken skeletal muscles in some people, and cause myalgia (muscle aches). It means that they may negatively impact physical performance. Exercise, on the other hand, may help reduce the risk of such adverse effects. Physical training may even help reduce the dosage of these drugs, as it helps lower cholesterol levels.
Like digitoxin and digoxin may be used to increase the contraction power of the heart in the chronic heart failure, thus theoretically they may improve exercise tolerance by increasing cardiac output. However, fitness trainers need to be careful with people using these drugs. These are people with a fragile heart. Although, exercise may benefit by strengthening the failing heart, planning the right kind of fitness plan for such individuals is a challenge. Strenuous activities should be avoided in such people.
They are also known as nitrates; they act quickly; they help increase blood supply to the heart muscles. They are used to overcome chest pain caused by heart disease (angina). They come as sublingual tabs, chewable tabs, pills to be swallowed, and even as topical patches and creams.
Fitness experts need to know that people taking these drugs have weak heart and issues with blood supply to heart muscles. These are the people who may feel pain or heaviness in the heart on physical exertion.
Physical activity is good for the heart, but in this category of people, mild exercise is good. When the intensity of exercise is increased, it should be done under supervision. People taking these drugs should always carry their medications with themselves like sub-lingual nitrates for instant relief, in case heart pain occurs during the exercise.
Fitness expert may find it a bit challenging when working with individuals on medications for cardiovascular diseases. Fortunately, most of the individuals taking these drugs have benign conditions, and they are taking these medications to either control certain conditions or prevent cardiovascular events in the future.
Regular physical activity is indicated for all those living with various cardiovascular conditions. Exercise may help better control hypertension, reduce the risk of cardiovascular diseases, may increase cardiac and pulmonary capacity.
Nonetheless, it is a good idea to inquire about all the drugs that a person is taking, and special attention should be paid to the medications taken to treat heart conditions. If a person is young and living with mild to moderate hypertension, and regularly taking medications, there is generally no reason to worry.
Fitness experts should be cautious when working with individuals taking nitrated, anticoagulants, double anti-platelet therapy. As in most cases, these are the individuals who already have a weakened heart, and probably a history of a heart attack. It is not to say that one should not work with such people, but it is essential to know more about their disease history before making any fitness plan.
If as a fitness expert you are not sure that you should be working with a person or not, then better send a person for medical examination to exclude more severe conditions.
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