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Many runners have experienced what can happen when they are deep in training–perhaps performing at their peak–only to contract an upper respiratory infection or suffer a serious injury requiring prescription medication.
While modern medicine has improved quality of life (and lifespans), it can also presents new challenges for runners due to side effects. These can be trivial, or they can be significant enough to necessitate stopping the medication–despite its miracle-working benefits. And, sometimes, those side effects may impact our ability to train and race.
In many cases, the medications we take are necessary to manage an acute or chronic illness or prevent something worse. In other cases, we may have a choice about whether we take something. That is when we need to be particularly thoughtful about the risk/benefit equation.
This article reviews some of the more common classes of medications that doctors might prescribe to runners and explains the potential ways that they impact performance. It’s not intended to encourage non-compliance with a prescribed medication. Rather, I’m presenting this information so that you may better understand why your medications are making you feel or perform differently, and also so that you can talk with your healthcare provider to determine if those medications are truly necessary, if there are alternatives, or if there are ways that you can manage those undesirable effects.
This is not an exhaustive review but will cover some of the most prescribed classes of drugs. (This article will not address over-the-counter analgesics. I recently wrote about NSAID alternatives for athletes.)
Running and High Blood Pressure Medication (Antihypertensives)
Blood pressure-lowering medications are vitally important to managing hypertension and preventing the morbidity and mortality associated with it. There are several classes of antihypertensives and fortunately, while they all have potential side effects, most do not impact performance.
The one important exception is the class of drugs known as beta-blockers. While most antihypertensives exert their effects on the peripheral blood vessels or the kidneys, beta-blockers have the additional important therapeutic effect of working on the heart. These drugs both slow the rate at which the heart beats and reduce the force with which it contracts on each beat. This can be very valuable to a patient with hypertension, especially one who has had a previous cardiac event. But for a runner, it can be a potential problem.
Running Impacts
Runners who take beta-blockers may find themselves unable to exert themselves at more than low intensity because of the limits that these drugs put on cardiac output.
Runners who are affected in this way may wish to talk to their provider about possible alternative medication classes. However, in some cases, there may not be a better choice, requiring the runner to adapt to the reality of being on these drugs.
Antidepressants and Running
Mental health is increasingly recognized as a major contributor to well-being. With this recognition has come a host of medications that are regularly prescribed to help people who suffer from myriad ailments that fall under the umbrella of mental illness.
There is no doubt that these medications have resulted in real benefits to many who use them, but there is also concern that many of these medications are overprescribed and being used to treat patients with fewer symptoms. Overall the net effects of these medications are clearly beneficial, but there is a subset of users who are being exposed to side effects with minimal or no benefits.
The most common class of these medications in use today is the selective serotonin reuptake inhibitors (SSRI). SSRIs have a long track record of safety and that is in part what has led to their overprescription.
Running Impacts
All antidepressants are mood stabilizers. They work by altering the brain’s chemistry to prevent the devastating effects of depression. However, the side effect of that is that the changes that these drugs bring about can also prevent mood swings in the other direction. As many as 40-60 percent of those who take these medications will complain of being unable to experience significant elation or happiness.
For runners taking SSRIs, this can manifest as a lack of motivation or of feeling joy when achieving performance-related goals. Runners who are affected in this way should discuss with their provider whether they need to be on these medications. And if they do, inquire into alternative drug classes. All antidepressants act as mood stabilizers, but different people react differently to the various classes, and sometimes trial and error can determine which is best suited to any one individual.
Running and Cholesterol Medication (Lipid-lowering Agents)
Heart attacks remain the leading cause of premature non-traumatic morbidity and mortality in the Western world. There are numerous modifiable risk factors related to lifestyle that can reduce the risk of heart disease, and running regularly is one of the important ones.
For many though, diet and exercise are insufficient to alter one of the major determinants of heart disease: cholesterol levels. The link between elevated cholesterol and heart disease has been understood for several decades, and the advent of medications that lower lipid levels was a real game changer for prevention.
Statins have been used both preventatively and after primary cardiac events to decrease the risk of heart attack and death in those who have higher blood cholesterol levels. Over time, research has helped better inform who should be taking these drugs because their benefits seem to be restricted to certain types of patients.
The current recommendations are for patients who have previously had a cardiac event or who have an estimated risk of a cardiac event greater than 10 percent in the next 10 years to be on a statin if their LDL-cholesterol is elevated. (Determining 10-year cardiovascular risk is done by weighing several risk factors. See this calculator for reference.)
Running Impacts
The major side effects of statins that runners need to be concerned with are muscle soreness, weakness, fatigue, and in exceedingly rare cases, rhabdomyolysis–a breakdown of muscle tissue with potentially serious effects on the kidneys. Muscle soreness and fatigue can be highly problematic for some. This is why it so important to talk to your provider to ensure that these medications are right for you.
Not everyone who is taking these medications needs to be. If you do need to be on them and are having these symptoms, you may benefit from changing to a different statin as it is possible that a different drug will not produce the same side effects. Staying hydrated and gradually increasing intensity are also useful strategies. Supplementing with L-carnitine or CoQ has been purported to help with side effects, but studies have failed to consistently support that.
Antibiotics and Exercise
Patients commonly ask: Can you exercise on antibiotics? The short answer is yes. But you might find it harder to exercise due to the gastrointestinal side effects antibiotics can have due to their gut microbiome disruptions.
Of all the classes of medications listed in this article, none are more misunderstood and more inappropriately utilized than antibiotics. Since the discovery of penicillin, antibiotics have revolutionized our ability to combat infections and defeat illnesses that for millennia were uniformly fatal. However, antibiotics have come to be thought of as a solution for every infection that befalls us and nothing could be further from the truth.
Antibiotics (penicillins, sulfonamides, erythromycins, quinolones, etc.) are only effective against bacterial infections. The reality is that the vast majority of infections are viral and will not respond to antibiotics. As many as one in two antibiotic prescriptions written by primary care providers are inappropriate and represent the use of these drugs in cases of viral infections. When asked why they prescribe them in these cases, most providers will say that their patients pressured them to do so.
The misuse of antibiotics in this fashion has very real consequences in driving up antibiotic resistance rates. In addition, when you take these medications when you have a viral infection you get only the adverse effects without any benefits. This includes most commonly diarrhea but most worrisome for runners is a complete destruction of the microbiome and how that impacts performance.
Running Impacts
The microbiome is the collection of bacteria that normally live in our large intestine. These bacteria are vitally important to our health. They metabolize some of our essential vitamins, contribute to our digestion by helping break down long-chain polysaccharides, and contribute positively to our immune system among other functions.
Being bacteria, these organisms are susceptible to antibiotics and so when you take a course of antibiotics your microbiome is destroyed. Studies have shown that a healthy microbiome is highly impactful on performance in endurance sports. They showed that once the microbiome was destroyed by antibiotics (in the absence of a bacterial infection) endurance performance took weeks to recover to pre-antibiotic levels.
For this reason, it is very important that when you take antibiotics you do so only because they are absolutely necessary to combat a true bacterial infection. Do not go to your provider seeking antibiotics. Instead, go with the mindset that you want to know what is wrong with you but do not want antibiotics unless necessary, and make that clear to your provider. If you do need to take these drugs, do what you can to restore your microbiome as soon as possible by eating foods that are known to help in that regard. Yogurt, cottage cheese, pickles, kimchi, sauerkraut, and kombucha are all microbiome-building foods.
There is no question that modern medicine has provided hope to many and extended life expectancy dramatically, in part through the development of effective medicines. Understanding when those medicines are necessary, what their potential side effects are for runners, and knowing about possible alternatives can all help patients make educated choices and ensure that they stay healthy on the medications they need and keep doing the running that they love.
