Medicine

Module 3: Understanding the Risks of Exercise

Lecture Overview

• Presented by: James Forsyth, PhD, University of Wollongong, Australia
• Key Topics:
  1. Effects of Medications
  2. Medications in Sport

Importance of Client Medication Awareness

• Client Communication:
  • Understand if clients are on medications during initial consultations.
  • Clients should provide information on:
  • Type of medication
  • Expected effects of the medication
  • Instructions for exercise while medicated
  • Proactive Inquiry:
  • It's important for trainers to ask clients about their medications if not disclosed.

Common Medications and Their Effects

β-Blockers

• Mechanism of Action:

  • Block beta-receptors of the sympathetic nervous system (SNS)
  • Reduces:
  • Heart Rate (HR)
  • Blood Pressure (BP)
  • Force of heart contraction

• Conditions Treated:

  • Coronary Artery Disease (CAD)
  • Hypertension
  • Angina
  • Arrhythmias

• Effects at Rest:

  • Decreased HR and BP
  • Possible symptoms for clients:
  • Dizziness
  • Fainting

• Impacts During Exercise:

  • Improved exercise capacity with angina
  • Decreased capacity without angina
  • Requires recalibration of HRmax for workouts
  • Considerations:
  • Adjust training intensity accordingly

ACE Inhibitors

• Mechanism of Action:

  • Blocks the conversion of Angiotensin I to Angiotensin II, which typically constricts blood vessels

• Condition Treated:

  • Primarily hypertension

• Effects at Rest:

  • Lowered BP, with potential dizziness and fainting as symptoms.

• Impacts During Exercise:

  • Further reduction in BP
  • Requires gradual cooldown to avoid post-exercise hypotension

Diuretics

• Mechanism of Action:

  • Increases urine output, reducing plasma volume and BP

• Effect at Rest:

  • Decrease in both BP and blood plasma volume
  • Similar symptoms as previous medications: dizziness and faintness.

• Impacts During Exercise:

  • Reduced BP
  • Importance of checking client’s weight regularly for compliance

Sulfonylureas (for Type II Diabetes)

• Mechanism of Action:

  • Oral hypoglycemics increase insulin release.

• Effects at Rest:

  • Lowers blood sugar
  • Client symptoms of low blood sugar:
  • Dizziness, sweating, confusion, nervousness, nausea

• Impacts During Exercise:

  • Increased insulin secretion
  • Considerations:
  • Monitor medication and glucose levels closely
  • Have simple carbohydrates available to manage hypoglycemic events

Practical Strategies for Managing Medicated Clients

• Always verify with clients:
  • If they have taken their medications
  • If they are prepared to exercise
• Avoid working with uncontrolled clients without GP clearance
• Emphasize on proper warm-ups and cool-downs to avoid complications
• Follow recommendations for gradual exercise intensity increase.

Origins and Management of Medications in Sport

• Historical Context:

  • Doping originated with Olympic athletes using substances as early as 300 B.C.
  • Key regulatory developments:
  • 1928: IAAF bans stimulants
  • 1990: ASDA introduced by Australian government
  • 1999: Establishment of WADA
  • 2006: ASDA becomes ASADA
  • 2020: Merger with NISU into Sport Integrity Australia

• Substance and Method Regulation:

  • WADA identifies prohibited substances and methods to maintain integrity in sport (e.g., anabolic agents, stimulants, diuretics).
  • Therapeutic Use Exemptions (TUE):
  • Allow athletes to use prohibited medications for legitimate medical conditions if certain criteria are met:
    1. Necessary for a diagnosed medical condition
    2. Unlikely to enhance performance significantly
    3. No reasonable permitted alternative exists
    4. Not a result of prior prohibited use

Summary

• Overall Considerations:
  • Unmanaged medications can interfere with normal physiological responses to exercise
  • Important to check and manage any medications clients may be taking before exercise
  • Doping regulations also affect the sporting field, emphasizing the need for awareness among athletes.