Can you take beta blockers and exercise?

High blood pressure (also called hypertension) is known as the “silent killer.” According to the U.S. Centers for Disease Control and Prevention (CDC), nearly half of adults in the U.S. have the condition. Still, many aren’t aware of it because there are no apparent symptoms until a heart attack or stroke happens.

Beta blockers, also called beta-adrenergic blocking agents, are widely-prescribed medications to decrease high blood pressure and prevent heart disease. While exercise can lower your blood pressure, overexertion can be dangerous. This guide will help people with hypertension learn how to safely mix beta blockers and exercise.

How do beta blockers work?

Beta blockers block the effects of the hormones epinephrine (also known as adrenaline) and norepinephrine. Beta blockers slow the heartbeat and cause it to beat with less force, which lowers blood pressure. They also help to open up veins and arteries to boost blood flow. 

There are different types of beta blockers; some mainly affect the heart, while others impact both the heart and blood vessels. You and your healthcare provider will work together to choose the right beta blocker for your condition. Examples of oral beta blockers include:

• Bystolic (nebivolol)
• Corgard (nadolol)
• Inderal, Innopran XL (propranolol)
• Lopressor, Toprol XL (metoprolol) 
• Sectral (acebutolol)
• Tenormin (atenolol)
• Zebeta (bisoprolol)

Unless other prescriptions like diuretics (which treat hypertension and heart disease) are ineffective, beta blockers aren’t typically a first-line treatment for people who only have high blood pressure. Healthcare providers prescribe these medications to prevent and treat hypertension alongside:

• Irregular heart rhythm (arrhythmia)
• Heart failure
• Chest pain (angina)
• Coronary artery disease
• Heart attacks
• Migraine prevention
• Some types of tremors

Beta blockers relieve symptoms like chest pain, sweating, and trembling, making them unique to other medications for high blood pressure. 

Side effects of beta blockers

Unfortunately, they may not work as well for Black people and older adults, especially when taken without other blood pressure drugs. Certain beta blockers can trigger an asthma attack in people with severe asthma and may mask low blood sugar symptoms in those with diabetes.  

General side effects of beta blockers include:

• Cold hands or feet
• Fatigue
• Weight gain

Some people may also experience less common side effects, such as:

• Depression
• Shortness of breath
• Trouble sleeping

Often, healthcare providers will prescribe beta blockers along with one or more additional medications to lower blood pressure.

Do beta blockers affect exercise?

Beta blockers and exercise can both be helpful to lowering blood pressure levels. If you have high blood pressure, your healthcare provider might recommend exercising more as one way to help lower it naturally. Is it safe to exercise if you have to take medication? Since most beta blockers lower your blood pressure, and slow your heart rate and cardiac output (how much blood the heart pumps in one minute), they can affect your exercise goals. 

“Whether the effect is significant enough to limit exercise is usually patient-specific,” says Joanna Lewis, Pharm.D., the founder of The Pharmacist’s Guide. “Many studies have shown that people can exercise as normal, but it really depends on the athletic state of the individual.”

Your healthcare provider may recommend an exercise stress test, which checks heart blood flow during exercise and measures how hard the heart pumps on beta blockers. They can then use this information to figure out your target heart rate. 

Experts also suggest the Borg scale (Borg Rating of Perceived Exertion, or RPE) as a simple way to measure how hard someone is exercising. The scale matches how hard you feel you’re working (“not at all” to “very, very hard”) with numbers from six to 20. The higher the number, the harder you’re working. Then, multiply the number by 10 for a rough heart rate estimate. People who take beta blockers run the risk of being unaware when they’re exercising too hard; they can use the scale to prevent overexertion. 

“Typically, if you’re doing an aerobic exercise, you should be able to talk but not sing. If you can’t talk, then you’re probably pushing a little too hard,” says Jessalyn Adam, MD, a sports medicine physician at Mercy Medical Center. “In my line of work, that’s usually what gets people into my office—doing too much too quickly. Make sure that you’re slow and steady, gradually building, and not pushing yourself too hard.”

If you feel lightheaded, dizzy, have chest pain, fatigue, or trouble breathing, it could mean a drop in heart rate or blood pressure, and you may need to see a healthcare provider. They may prescribe a different beta blocker or medication that has less of an impact on heart rate. 

  Beta blockers can also interact with other medications and supplements. Drugs that dilate blood vessels, like nitrates, should be used with caution while taking a beta blocker. And, though supplements are promoted as natural, they may still pose a risk. 

“Hawthorn is an herbal that should be avoided when taking beta blockers,” says Dr. Lewis. “Any supplement should be run by your health professional as you don’t want any interactions with your heart medicine.”

People with diabetes who also take a beta blocker may also be less sensitive to hypoglycemia symptoms or a dip in blood sugar (glucose) level, the body’s primary energy source.

How to stay in shape while taking beta blockers

People who take beta blockers can still exercise regularly and see the cardiovascular benefits of working out. Those who aim for a target heart rate should keep in mind that their new target heart rate may be different while on a beta blocker. Lewis says cardioselective beta blockers (such as atenolol, bisoprolol, and metoprolol), which only block beta receptors in heart cells, may affect exercise less than the non-cardioselective kind (such as nadolol, carvedilol, and propranolol).

Since beta blockers slow the heart rate to deceptively low levels, it’s important to avoid overexertion while exercising. Before starting a new workout program, talk to your healthcare provider first. Your physician can tell you what your target heart rate should be and create a custom exercise plan.

The Centers for Disease Control and Prevention (CDC) has some general exercise tips for people who haven’t been active in a while: 

• Find ways to get active. Take a walk after dinner instead of watching TV. 
• Create a routine. Set aside time every day for physical activity.
• Do something you like. There are many ways to stay physically active—walking, bicycling, an exercise class. Finding an activity you enjoy at a time when you’re more likely to stick with it is your best bet whether that’s first thing in the morning or after work.
• Partner up. Work out with friends or family members to keep each other motivated and encouraged.
• Start slowly. You may be tempted to dive into a new exercise plan at full speed, but it’s best to start slowly and build up to more strenuous activities. The CDC recommends 150 minutes of physical activity a week; break the time up into 25 minutes a day.

And if you’re exercising to help keep your blood pressure in check, keep in mind that (plus medication) are only two strategies that work. Experts also suggest eating a low-sodium diet, limiting alcohol intake, lowering stress levels, and quitting smoking.