Many commonly prescribed medications can have a significant impact on your clients’ responses to exercise and, thus, their overall fitness journeys. For this reason, it is essential to understand the potential effects of a wide range of medications to provide the best possible guidance to your clients as they work toward achieving their health and fitness goals.

While you may know how cardiovascular-related medications such as statins, ACE inhibitors and diuretics can affect the exercise response, other drugs your clients may be taking could have an impact as well, such as antidepressants, over-the-counter pain relievers, sleep aids and anticonvulsants, which are frequently used to address conditions such as diabetic nerve pain. Although these medications are not typically associated with fitness, they can significantly affect clients’ overall health and energy levels, which can impact their ability to regularly exercise.

This article explores these four medication categories—antidepressants, anti-inflammatories, hypnotics and anticonvulsants—that may be overlooked but are crucial to discuss during the initial client interview and assessment and ongoing evaluation due to potential side effects that can significantly impact overall health. Armed with this knowledge, you will be well-equipped to help your clients exercise safely and effectively.

A Holistic Approach to Coaching and Training Clients

Consider this scenario: Your client complains of joint stiffness due to the statins they are taking to help manage their cholesterol levels. You might urge them to extend their warm-up times and give them some mobility exercises to incorporate into their daily routines, but it’s probably a good idea to ask how they are managing their discomfort. Are they using additional medications, such as over-the-counter pain relievers? What considerations does the usage of this combination of medications play in their function and recovery?

Asking questions like these can be viewed as a necessary part of taking a holistic approach to coaching and training clients. The term “holistic” emphasizes the interconnectedness of everything. Recognizing this interconnectedness is key to understanding and addressing the various factors that affect an individual's well-being, which, in turn, forms the foundation for a more comprehensive and practical approach to health and fitness practices.

To uncover the effects of any medications a client may be taking, it is important to ask critical questions and offer education and support. This proactive strategy can make a significant difference in keeping clients motivated and committed, which can help them aovid feeling frustrated and abandoning their fitness goals.

Antidepressants

Antidepressants are medications that are commonly prescribed to treat conditions such as depression, anxiety, chronic pain and sleep disorders. They work by altering the levels and activity of neurotransmitters in the brain, which are responsible for regulating mood, cognition and behavior. Antidepressants can affect levels of neurotransmitters such as serotonin, norepinephrine and dopamine to help regulate mood and motivation.

A wide range of antidepressants are currently available, each affecting brain chemistry differently. The most frequently prescribed antidepressants are selective serotonin reuptake inhibitors (SSRIs). These drugs work by preventing neurons from absorbing the neurotransmitter serotonin, which results in an increased amount of the chemical circulating in the brain. The increase in available serotonin elevates and regulates mood. SSRIs are the class of medication most frequently prescribed for treating depression. Common SSRIs include Lexapro, Prozac, Zoloft and Celexa. Given the nature of how these medications work, their effects usually take place in approximately four to six weeks.

Antidepressants are used not only for depression but also for mood and behavior-related diagnoses. It is important to be aware of less common medications that are prescribed regularly. Some examples include bupropion, which is used to treat seasonal affective disorder and help people quit smoking. Mirtazapine may be prescribed for those who have trouble sleeping or have lost their appetite due to depression, and trazodone is another medication that can be effective in treating insomnia and anxiety.

Antidepressants all take some time to work, and this will be helpful in communicating with clients. Understanding the duration of use is vital in understanding some of the potential side effects of these medications and how to provide knowledgeable guidance.

The most common side effect of antidepressants is weight gain; this is generally communicated by the prescribing healthcare provider, but it can still be a source of frustration to the individual. It’s helpful to understand the etiology of why weight gain occurs. Because antidepressants affect the brain to change mood, they also create a decrease in motivation and an increase in cravings by impacting the neurotransmitters that produce stress or emotional eating, as well as a lack of desire for exercise, activities or social engagement. While these changes may be subtle initially, prolonged use leads to a downregulation of serotonin receptors, which may lead to cravings for carbohydrate-rich foods such as bread, pasta and sweets.

Educating your clients about the mechanisms behind these possible side effects can help create a space for you to help counteract any discouragement or negativity they may feel about their exercise and weight-management efforts. Remind them that exercising regularly is essential, not only for minimizing weight gain, but also for bolstering mood and overall well-being, and consider providing a recommendation for obtaining nutrition support, if needed.

Anti-inflammatory Drugs

Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used to alleviate pain and inflammation in the body. These medications are available in varying doses, both over the counter and by prescription. An estimated 30 million individuals use NSAIDs on a daily basis to alleviate pain. NSAIDS work by reducing the impact of inflammation on pain-nerve stimulation and sensitivity. Inflammation occurs in the body for both good and bad reasons and may be experienced as sore muscles after exercising, due to chronic conditions like arthritis or during illnesses such as a fever.

When there is inflammation in the body, nerve receptors send signals of pain to the brain. These signals are the result of complex interactions between cells and chemicals in the body. NSAIDs help to reduce inflammation and swelling, which, in turn, provides relief from pain. They are often preferred over other painkillers because they do not contain opioids and are, therefore, less addictive.

Three common over-the-counter NSAIDs can be purchased without a prescription: ibuprofen, sodium naproxen and aspirin. Aspirin is also known as an antiplatelet and has been recommended for ongoing usage in people who have a history of blood clots or are at risk of stroke. Prescription NSAIDs include Celebrex and Meloxicam. All of these medications are known to cause gastrointestinal distress, particularly with long-term use.

As a health and exercise professional, it is important to recognize that the inflammation caused by rigorous exercise is necessary for the body to rebuild, repair and strengthen soft tissues. While NSAIDs are often used to counter the pain of muscle soreness, regular usage of these medications can blunt and potentially delay the recovery process and muscle repair. This may increase the recovery time and impede progress for your clients.

It's important to keep in mind that some of your clients may require regular use of certain medications. In such cases, it's highly recommended to have conversations with them about the potential drawbacks of regularly using symptom-relief medications, and instead explore alternative ways of managing inflammation, including diet and mind-body techniques.   

Hypnotics and Sleep Medications

Hypnotics are medications used to treat chronic insomnia. Prescription sleep medications are prescribed for individuals who have trouble falling asleep, experience restless sleep or report insomnia for more than three months on more than three nights per week.

Many adults today are aware of the importance of getting enough quality sleep. However, chronic insomnia is a common issue that affects around one-third of the general population and has been on the rise in recent decades, mainly due to increasing stress levels. In fact, surveys conducted by the American Psychological Association in 2023 revealed that nearly a quarter of American adults rated their stress level between 8 and 10 on a 1-to-10 scale (with 1 being the little-to-no stress and 10 being a great deal of stress). Given these numbers, it’s not at all surprising that so many people struggle to get a good night’s sleep.

Fortunately, disrupted sleep can be addressed with better sleep hygiene and, for some, with prescription medications or over-the-counter supplements such as melatonin.

Sleep medications are categorized based on their primary goal of inducing sleep or maintaining it. Benzodiazepines (BZD) are a type of sleeping medication that work by increasing the GABA neurotransmitters in the brain, which leads to feelings of calmness. However, these medications may have some side effects, such as dizziness, fatigue and irritability, and long-term use can result in more severe side effects, such as depression. Moreover, this class of medications is addictive and stopping their use can be challenging. The four most prescribed BZD medications are Valium, Ativan, Xanax and Klonopon.

Non-Benzodiazepines (non-BZD) are a type of fast-acting medication that help calm down anxieties, which may lead to feelings of being wired, making it difficult to relax and fall asleep. These medications take effect within 30 minutes and can last for up to eight hours. They are commonly used they have more minor side effects than BZDs and because they are less likely to be addictive. Ambien is the most common non-BZD medication.

In addition, many antidepressants are used prescriptively in managing insomnia due to their benefits on neurotransmitters in the brain that can contribute to good sleep without some of the side effects of hypnotics.

It is common for healthcare professionals to recommend melatonin, which is an over-the-counter supplement, before prescribing BZD or non-BZD medications. Melatonin is a hormone that regulates sleep and is naturally produced by the pineal gland in low-light or nighttime conditions. Melatonin supplements mimic this hormone and help people relax and fall asleep.

As a person ages or if they encounter too much light during sleep hours, the body’s natural production of melatonin reduces, resulting in inconsistent sleep and often insomnia. Using melatonin supplements is typically perceived as less harmful to the body because it has the benefit of being non-addictive and having fewer side effects compared to prescription sleep aids. It’s also available without a prescription, making it more accessible. While melatonin is generally considered safe when used as directed, it can cause side effects such as headaches, dizziness, nausea, and drowsiness the next day. While long-term effects are still being studied, it is often preferred for long-term use due to its safety profile, especially in managing circadian rhythm disorders. However, its effectiveness can vary greatly among individuals.

Due to their calming and tranquilizing effects, all the hypnotic drugs listed here may have some adverse effects on the following day. The most commonly reported side effects are feeling fatigued or drowsy, especially in the morning, and experiencing difficulties in getting started the next day. This can curtail a person's ability to exercise, limit their routine, and affect the time, manner and place of their exercise sessions.

It is essential to discuss with clients how to manage potential side effects of sleep aids and medications. Although prescriptions need to be addressed by the physician, clients should be encouraged to communicate if the use of medication is impacting their day-to-day life. When it comes to using melatonin, be sure to discuss the importance of using a low dosage to reduce the morning-after side effects. It’s not uncommon for people to think that more is better when taking melatonin, which inevitably leads to morning grogginess, so this is an important discussion to have with your clients.

Anticonvulsants

Gabapentin, an anticonvulsant medication used to treat nerve pain, is the tenth most prescribed medication in the United States. A similar medication called Lyrica is also a common anticonvulsant. Given their prevalence, it is essential that health and exercise professionals are aware of these medications and their effects on the body.

Both medicines work by modifying electrical activity in the brain and influencing the activity of neurotransmitters. While the two medications belong to the same family of drugs, gabapentin is the preferred option, as it has longer-lasting benefits and fewer side effects. On the other hand, Lyrica is absorbed more rapidly in the body, offering immediate relief.

Various medical conditions lead to nerve pain, but the most common ones are diabetic neuropathy, which is a result of uncontrolled blood glucose levels, and chemotherapy-induced neuropathies, which are usually lingering side effects of a specific type of IV medication used in cancer treatment. It is common for individuals managing multiple chronic conditions to receive anticonvulsant therapy in combination with anti-inflammatory and pain medications.

Anticonvulsant medications can cause side effects such as fatigue, dizziness and drowsiness. These side effects can lead to slower movements and lower energy levels, which can make it difficult to exercise. These effects occur because the medication reduces nerve signals, which can also affect balance. This is particularly concerning when nerve damage is already present due to the condition that the medicine is being used to treat.

Be sure to pay close attention to how a client responds to exercise and adapt their program accordingly. Incorporate exercises that safely improve balance and coordination, which can help counteract the effects of dizziness or balance issues, and use equipment that supports stability, at least initially, to minimize the risk of falls. If training in a gym environment, consider scheduling the session at a time when it is less crowded and choose a location where the client feels comfortable and secure.

While this category of medications may be less familiar to you than others discussed in this article, given the increasing prevalence of type 2 diabetes, you will likely encounter more clients who are taking these medications.

Your Role as a Health and Exercise Professional

As a health and exercise professional, adopting a kind, empathetic and educational approach when asking your clients questions is essential. Clients may feel uncomfortable sharing personal information, particularly about topics that make them feel embarrassed or awkward. Your role is to build their confidence and provide them with educational support and actionable strategies that can offer them the assistance they need.

It's important to remember that lifestyle and behavior modifications, such as exercise, are powerful tools to help clients manage their health and medication use. Many individuals want to reduce their medication intake, and you can support them in their efforts to communicate with their medical teams about their goals of deprescribing. You should also provide a supportive ear to listen to their concerns.

It should be noted that there are significant overlaps among the four categories outlined in this article. Furthermore, due to the rising rates of obesity and chronic diseases, there has been an increase in the number of individuals with complex medical conditions, many of whom are seeking out the guidance of health and exercise professionals. As a result, your role has become increasingly important in helping these individuals address their health, quality of life and longevity.

In the video below, Mansfield discusses the impact of two common medications—antidepressants and anti-inflammatory drugs—on the regulation of blood glucose. Learn why building muscle mass, in addition to other healthy lifestyle changes, are essential for managing blood glucose and maximizing your clients' health.

The ACE Mover Method^TM in Action

In the following scenario, a personal trainer is engaged in a session with their client, Ryan, a 53-year-old male who has been a personal-training client for two months. Ryan is a busy healthcare executive and wants to commit to making time for himself to exercise. He enjoys lifting weights and participating in exercise. He noticed that he has gained some weight, especially in the abdomen, over the past few years. While he doesn’t care about losing weight, he does want to reshape his body.

During the intake process, Ryan reported that he takes a cholesterol medication and was prescribed Lexapro (an antidepressant) by his primary care doctor during the height of the pandemic but stopped taking it after a few months. He takes no other prescription medicines at this time. Ryan is meeting with his trainer for an early morning training session before heading into work. They meet up as Ryan is warming up on the treadmill.

Personal Trainer: Hi, Ryan. Great to see you this morning. How are you feeling?

Ryan: Glad I made it! It’s been a really busy few weeks, and I definitely needed the alarm to get me going today.

Personal Trainer: I know that you have had a lot of meetings and stress lately, so I’m really glad you made the commitment to be here. How’s your energy today? Were you able to get some sleep?

Ryan: A little…I realized that I needed to focus on my sleep so I started taking melatonin again but it takes a while to kick in so I don’t really get quality sleep until after 1 a.m.

Personal Trainer: What specifically makes it difficult to wake up in the morning?

Ryan: When I get up, I feel sore from lifting weights but also from sitting in my office chair, which makes my lower back tight and stiff.

Personal Trainer: We did do a lot of deadlifts during our last session. Do you feel like this pain is something that means we went too heavy?

Ryan: No, I really enjoy the muscle soreness, and I want to keep working on getting stronger. I just have been taking some Aleve [naproxen, an NSAID] and that helps. I know I’m getting older but I really thought that by now I would be feeling much stronger and less sore day to day.

Personal Trainer: How often are you taking the Aleve?

Ryan: Pretty much every day. I know that the statins I have to take make my joints achy, so it just really helps.

Personal Trainer: You are already aware of a common side effect of taking statins. What else do you know about how Aleve may be affecting your body?

Ryan: Not much. I just know it seems to help with the aches and pains. Is there anything else I should be aware of?

Personal Trainer: Keep in mind that while Aleve helps you feel better in the short term, it actually can delay and slow down the muscle repair that your body needs to rebuild the muscle tissue breakdown that results from your workouts. This slows down the process of repair and getting stronger. Does that make sense?

Ryan: Wow, I had no idea. I have been taking this pretty much every morning because I feel like my body is slow to get started. I should probably stop doing that, huh?

Personal Trainer: Deciding to take medication as needed is definitely a personal decision. However, if you are relying on this medication to get you going in the morning, I recommend talking to your doctor about how and why you are using it. You mentioned you were taking melatonin. Do you know what the dosage is? Are you feeling groggy as well as sore in the mornings?

Ryan: I take 5 mg of melatonin. I thought that more would be better, and yes, I feel like I’m in a cloud for at least the first hour that I’m awake, but I just thought it was because I had a hard time falling asleep and that I was still tired. Do you think the melatonin is a good idea?

Personal Trainer: Quality sleep is important to you, and you are looking for ways to get more of it. Melatonin can be a helpful sleep aide but taking the right mount is important because the body naturally produces it. When you supplement with melatonin, your body's natural production decreases. Again, I would recommend talking with your doctor to be sure you are taking an appropriate dose., as well  I am curious to know about any steps you are taking to improve your sleep hygiene.

Ryan: Other than taking the melatonin, I am not really doing anything different.  Do you have any suggestions for improving my sleep environment?

Personal Trainer: It's important to sleep in a dark environment to enhance the natural production of melatonin. If needed, you might consider using a sleep mask. Also, let's ensure you have a good evening routine. At least an hour before bed, limit device use and engage in wind-down activities to calm your mind and body. Stretching can also be helpful for a good night's sleep.

Ryan: Those are great ideas. I have a bad habit of staying up late and checking my emails and catching up with the news since I don't have time during the day. I have noticed that my motivation in the evening is quite low, so I'm not very productive. Instead, I find myself getting lost in the bubble of distractions.

Personal Trainer: I recall during our first session that you have taken Lexapro in the past. This medication can affect motivation and, combined with feeling tired at the end of the day, it could be a reason why you feel this way. Although you have stopped taking it and the side effects have worn off, it is really common to create some habits while taking the medication that stick over the long term. These may be some of the issues that are slowing down your progress and influencing how you feel. I highly encourage you to make some small changes and keep checking in with me to monitor your energy levels and progress in the next few months. It looks like you’re pretty warmed up. Are you ready to lift some weights?

Ryan: Definitely. Let’s build some muscle!