Table 4

Exercise considerations for diabetes, hypertension, and cholesterol medications and recommended safety and dose adjustments

Type/class of medicationExercise considerationsSafety/dose adjustments
Diabetes
 Insulin
  • Deficiency: hyperglycemia, ketoacidosis

  • Excess: hypoglycemia during and after exercise

  • Increase insulin dose pre- and postexercise for deficiency

  • Decrease prandial and/or basal doses for excess insulin

 Insulin secretagogues
  • Exercise-induced hypoglycemia

  • If exercise-induced hypoglycemia has occurred, decrease dose on exercise days to reduce hypoglycemia risk

 Metformin
  • None

  • Generally safe; no dose adjustment for exercise

 Thiazolidinediones
  • Fluid retention

  • Generally safe; no dose adjustment for exercise

 Dipeptidyl peptidase 4 inhibitors
  • Slight risk of congestive heart failure with saxagliptin and alogliptin

  • Generally safe; no dose adjustment for exercise

 Glucagon-like peptide 1 receptor agonists
  • May increase risk of hypoglycemia when used with insulin or sulfonylureas but not when used alone

  • Generally safe; no dose adjustment for exercise but may need to lower insulin or sulfonylurea dose

 Sodium–glucose cotransporter 2 inhibitors
  • May increase risk of hypoglycemia when used with insulin or sulfonylureas but not when used alone

  • Generally safe; no dose adjustment for exercise

Hypertension
 β-Blockers
  • Hypoglycemia unawareness and unresponsiveness; may reduce maximal exercise capacity

  • Check blood glucose before and after exercise; treat hypoglycemia with glucose

 Other agents
  • Regular exercise training may lower blood pressure; some agents increase risk of dehydration

  • Doses may need to be adjusted to accommodate the improvements from training and avoid dehydration

Cholesterol
 Statins
  • Muscle weakness, discomfort, and cramping in a minority of users

  • Generally safe; no dose adjustment for exercise

 Fibric acid derivatives
  • Rare myositis or rhabdomyolysis; risk increased with gemfibrozil and statin combination

  • Avoid exercise if these muscle conditions are present