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Beta blockers: How do they affect exercise?
By Mayo Clinic staffOriginal Article: http://www.mayoclinic.com/health/beta-blockers/AN01224
- With Mayo Clinic emeritus hypertension specialist
Sheldon G. Sheps, M.D.
read biographyclose windowBiography of
Sheldon G. Sheps, M.D.
Sheldon Sheps, M.D.
Dr. Sheldon Sheps, emeritus professor of medicine and former chair of the Division of Nephrology and Hypertension in the Department of Medicine at Mayo Clinic, has been with Mayo Clinic since 1960.
Dr. Sheps, a Winnipeg, Manitoba, native, is board certified in internal medicine and specializes in hypertension and peripheral vascular diseases. He developed a multidisciplinary approach with specially trained nurses, dietitians, technicians and educators to help form a team approach to the treatment of patients with abnormal blood pressure.
"I have always believed in involving the patient and family in their health care," Dr. Sheps says. "I have asked for their understanding of the illness and issues and for participation in decisions. The Web is a natural extension of that, and now many more people can be informed."
Dr. Sheps chaired the sixth working group, and he participated in the fourth, fifth and seventh groups that developed the then-latest guidelines for hypertension under the auspices of the National Heart, Lung, and Blood Institute (NHLBI). He helped write the latest American Heart Association (AHA) report on blood pressure measurement. He chaired an AHA group that produced an online accreditation for blood pressure measurement for health professionals.
Dr. Sheps has co-authored books, newsletters, CD-ROMs and other Mayo Clinic health information material. He joined Mayo Clinic's Web team in 1998. He was medical editor-in-chief of both editions of the "Mayo Clinic on High Blood Pressure" book; the last edition was published in 2003. He was also medical editor-in-chief of "Mayo Clinic 5 Steps to Controlling High Blood Pressure," published in 2008.
In addition, Dr. Sheps was section editor for each of the first three editions of "Hypertension Primer" for the American Heart Association.
Dr. Sheps was also chairman of the Science Base Subcommittee and the National High Blood Pressure Education Program, and he was a consultant to the Hypertension Initiative of the World Health Organization. In 1997, he was honored with the Individual Achievement Award on the 25th anniversary of the National High Blood Pressure Education Program of NHLBI. In 2009, he was honored as a Distinguished Mayo Alumnus.
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Question
Beta blockers: How do they affect exercise?
My doctor recently prescribed a beta blocker to lower my blood pressure. Now, when I exercise, I have trouble getting my heart rate higher than 135. Is this normal?
Answer
from Sheldon G. Sheps, M.D.
Beta blockers slow your heart rate, which can prevent the increase in heart rate that typically occurs with exercise. This means that it might not be possible for you to reach your target heart rate — the number of heartbeats per minute you should have to ensure you're exercising at the proper intensity level. No matter how hard you exercise when taking a beta blocker, you may never reach your target heart rate. However, being unable to reach your previous target heart rate doesn't mean you're not getting cardiovascular benefits from exercise.
There's no precise way to predict the effect of beta blockers on your heart rate. An exercise stress test, which checks blood flow through your heart while you exercise, can measure how hard your heart pumps while you're taking beta blockers. Your doctor can use this information to adjust the target heart rate you should work to.
You can also try lowering your target heart rate by the amount that your resting heart rate has been lowered by the beta blocker. For example, if your resting heart rate has decreased from 70 to 50, then try working at a target heart rate 20 beats per minute lower than what you used to do. This way of calculating your adjusted target heart rate isn't precise, and sometimes the peak exercise heart rate is affected much more than is the resting heart rate. An exercise stress test is the best way to establish a new target heart rate on beta blockers.
If you haven't had an exercise stress test, you can use a perceived exertion scale, such as the Borg scale, which relies on your own judgment of how hard you're working based on effort, breathlessness and fatigue. Ask your doctor for help finding and using an exertion scale. For most workouts, your best bet is to aim for moderate intensity.
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- Thompson WR. Exercise prescription for other clinical populations.American College of Sports Medicine. In: Thompson WR, et al. ACSM's Guidelines for Exercise Testing and Prescription. 8th ed. Philadelphia, Pa.: Wolters Kluwer Health Lippincott Williams & Wilkins; 2010;248.
- Perceived exertion (Borg Rating of Perceived Exertion Scale). Centers for Disease Control and Prevention. http://www.cdc.gov/physicalactivity/everyone/measuring/exertion.html. Accessed Oct. 26, 2011.
- Tabet JY, et al. Determination of exercise training heart rate in patients on beta-blockers after myocardial infarction. European Journal of Cardiovascular Prevention & Rehabilitation. 2006;13:538.
- Westhoff TL, et al. Beta-blockers do not impair the cardiovascular benefits of endurance training in hypertensives. Journal of Human Hypertension. 2007:21;486.
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