This is a bit of a niche one, but thought it was worth a try…
I take beta-blockers (propanalol) to prevent pretty severe migraines. I also train twice a day and as the beta-blockers suppress my HR this is an issue for the second workout of the day which is typically 9-10 hours later if I take the propanalol after my morning workout. It feels like the brakes are on, which makes sense and that’s what the meds are meant to do.
Beta-blockers are mostly taken by people with heart problems, so not the most likely to be training hard, and I’ve not been able to find other endurance athletes in a similar position to me. Does anyone on here know anyone/ people that train for endurance and take daily beta-blockers? Keen to compare notes on timing, dosage, impact on adaptations, approach during race periods etc
I’ve asked doctors and they surprisingly have no referencable examples of people in my position, which seems surprising.
There are a few people on the forum who use BBs. Be patient, they will chime in, I’m sure.
My doc wanted to put me on BB a year ago for cautionary measures while I waited to have a heart issue resolved (still mostly unresolved). I did not take them but did self-regulate HR during workouts (and all other times of exertion). It mostly sucked but was probably healthy for me in the long run. (In the end I did not require either BB or the also prescribed statins, which I also did not take.)
Is there a specific reason you are on this specific drug? Have you talked to you doc about alternate forms of BBs? There are more athlete friendly forms (names escape me atm, sorry).
That’s not surprising at all. As a growing number of us are discovering, the medical system is, thankfully, designed to treat ‘sick unhealthy’ people (acute injury notwithstanding). When a ‘sick healthy’ person gets into the system, they get treated like a ‘sick unhealthy’ patient. The ‘sick healthy’ cohort is not a large one (for lots of reasons). Un/fortunately, that puts a lot of onus on us to do a lot of the work ourselves.
What I’ve read about betablockers is while they reduce your HR (esp in exercise; took them for htn for a while so I’m well aware), they increase your stroke volume. So in the end, it’s a wash: cardiac output is about the same.
As you’re taking it for migraine, just curious if you’ve tried lowcarb/keto. I hear wonderful things about this approach.
I used to take propanalol as a migraine prophylactic as well. It worked, but I could not get my HR up at all. This was pre-cycling, when I was doing crossfit and playing hockey. I had to discontinue at the advice of my doctor, and we simply treated the migraines with a Triptan at the onset.
Fast forward to last year, my PCM recommended I try a relatively new prophylactic, Aimovig. It’s a self-injectable medicine that’s pretty new to the market. It’s cut my migraines down to 3-5/month from 3-5/week. No side effects so far after several months use.
Might be worth inquiring about as a solution to beta blockers!
I am on Bystolic, an older Beta blocker. In my experience it is limiting the gains I can make on TR. My FTP is stuck at about 2.6 to 2.8 W/kg. At 57 I am not complaining. I am still one of the faster guys on the group ride. I am tending to go for riding that’s not so intense. Long days at fast pace. Not everyone can go forever at sweet spot. I can and the Beta blocker isn’t an issue.
I spent ~15 years on one Sotalol among other heart meds. (flecainide, digoxin, and one or two I don’t remember)
While I did not experience any “symptoms” at the time I can say that now,4 months after my last dose, my poor athletic performance was a symptom. Don’t get me wrong, the meds did their job and I had few if any bad side effects over the years, but now that I am no longer taking them my performance on the bike has improved greatly.
Seldom did two a days. I took a sotalol after my workout each morning and at dinner. Basically 5:30 am and pm. Blood thinner was at lunch until they put me on Eliquis, then everything was on the 5:30 marks. Doing my morning workout before my dose seemed to help with being able to get my HR up, but I wouldn’t say I have hard data.
Thanks all, these are really useful replies. I should have added… I live in the UK and our healthcare system only prescribe Propanalol. My brother in law works in Neuro in the US and can recommend loads of alternative options, sadly I can’t get them here.
Long story that’s probably worthy of a complete blog post, but I am on a light dose of a beta blocker (acebutolol) to control PVCs and keep my blood pressure low after having open heart surgery to correct a congenital defect with my ticker. 40 y/o, male, 168 lbs with a 3.6 w/kg FTP.
I take my pill after I do my morning training, which takes place early because of kids and work commitments. I can get my heart rate up to where I want it, though it does keep a ceiling on my max.
If I ride after I take my pill, I can still get my hard efforts in, but it’s not as much fun. However, I can motor along at 70-80% of FTP and have a 110 BPM heartrate… lol.
I’m happy with where things are at and so is my cardiologist.
Anyway, I would look at timing things with respect to when you take your daily medicine.
I’m in the uk. I take 5mg of bisoprolol daily for pvcs. My HRmax prior to going on them was around 160bpm with a HRrest of 60bpm. Now it’s around 130bpm. The bonus is that my HRrest is 36bpm so I still have a reasonable range. My FTP is 220w (I’m 55) and happily ride along at 220w with my HR at about 110bpm. I also have no problems doing my weekly vo2max and sweetspot intervals. Feel free to pm me if you want to discuss further.
I also suffer from migraines (2-3/week) and the doctor is suggesting beta blockers as a preventative (UK as well). I’ve used Sumaritriptan to treat them with good results, but they are getting to frequent now and there is a worry of overuse headaches for more than 10 days a month.
I was wondering how you have found them whist training and if you still use them. My max HR has always been pretty high (203 at the age of 39) so will be interested to see what effect they have on me and how I might have to adapt my training.
Happy to share my experiences and things I’ve learnt, but I should stress I’m no medical expert and you should seek your own advice
I was specifically looking for an alternative to beta blockers because they suppressed my HR a lot. So much so that I couldn’t really workout at any point in the day after I’d taken them. Zone 2 runs/ rides were a slog.
After my original post (in July 2020) I switched to Nortriptyline which is a popular 2nd line treatment in UK GP, after beta blockers. Initially my HR was VERY high on relatively light efforts, but I had been on beta blockers for 18 months which artificially lowers ones HR. I’ve adjusted to this new HR though and as fitness has improved my HR is more “normal”, but I also have a high HR (206 bpm in a recent Zwift race). FYI I’m 35.
My partner is a GP and she has advised me to discuss Candesartan as an alternative to Nortriptyline. I believe UK GPs generally won’t advise Candesartan, but her practice does and they have patients who have seen great outcomes (reduced migraines). FWIW Nortriptyline only has one real side effect for me… let’s just say that it can block you up! Especially troublesome if you eat a large volume of whole foods which are high in fibre!
My partner’s brother in law is a Neurologist in the US and they have many more options. He’s advised me to see the “headache and migraine clinic” in the UK and ask about injectable preventive medications, which I believe are more common in the US but are also available to us in the UK if we ask and other methods aren’t working for us.
Finally, I was advices that taking Riboflavin and Magnesium can also have positive effects so I take those supplements daily. You can find advised does online.
I also use Sumatriptan but only once an attack happens. I also take 800mg Ibuprofen and 1000mg paracetamol as soon as I feel a migraine coming on.
Hope some of this is useful. Migraines are the worst!
Thank you so much for your reply James, that is really helpful! Migraines are the bane of my life the last few years, and I’m really hopeful that I can find a prophylactic that reduces the frequency, without reducing my ability to do the things I enjoy!
The information you provided will be really useful to discuss with my doctor if the beta blockers have too many adverse side effects or don’t have the desired results.
Hi All, my 15 year old daughter has always been a strong runner and able to run endurance at a fast pace. Last year she ran 1.5 mile cross country races in under 10 min. She is currently taking 300mg of Lebatalol twice a day. She
has not been able to get good times in her HS races which are 3.1 miles. In practice she does well for sprinting workouts but not able to keep up with varsity in the longer runs 4-6 miles. It has been super frustrating. Her doctor had me take her RHR 72 and then have her do jumping jacks and running in place for 2:00 minutes her HR never went above 100. She has renal artery stenosis so other meds aren’t an option. She also takes 100mg of amlodipine 2x a day. She has had angioplasty 2x first time was successful and last 3 years most recent in March and didn’t hold. The good thing is her BP has been lower and stable and no symptoms which has been headaches in the past. Any thoughts or suggestions for her running??
Sorry to hear this Erin. I feel the frustration and that’s exactly how I was feeling when I first posted years back.
I’m in the UK and my partner is a GP (primary care). She tells me you should speak to your daughters renal consultant. If you say this is impacting your daughters quality of life there’s an obligation to offer alternative medications, assuming you haven’t exhausted these already. Especially as this is a life long decision. Apparently there are other non-beta blocker medications which could work, eg diuretics, but of course you should take your renal consultants guidance first
I’ve been taking Beta blockers for about 4 years now. I had 3 ablations none of which sorted out my irregular heart beat, and I had two holes between the chambers of my heart closed which did work. After the third failed ablation my cardiologist put me on beta blockers and they work very well, I no longer have palpitations, shortness of breath, etc. This was all in my mid-late 30’s. I’m now 42.
After I started on them and after I had the two holes closed I noticed that my cycling got better. I became one of/the fastest guy in our leisure cycling club. I bought a high end aero bike and went faster again. I’ve dropped my weight from 107kg to 91kg and I have been down to 88kg during racing season.
Anyway it was all going so well that I quit the leisure club and joined a racing club. After a few weeks I was able to keep up with any of those guys on the flat. Hills are still an issue but at 90kgs I suspect that’s not going away.
However! I really struggle with sustained efforts. Time trials, FTP tests, these are the stuff of nightmares. Intervals are fine (“fine”…I mean normal amounts of horrible). I find it incredibly hard to hold a high sustained threshold effort. In a race I hit my best 20 minute power numbers, routinely higher than anything I can do for 20 mins in training. I think adrenaline has something to do with it of course but also the stop start nature of bunch racing, you’re never really fully on for 20 mins, there’s always some drafting, some downhill, but made up for by super-intense spikes.
The guys around me in the club at the same age bracket routinely get their heart rates into the high 170’s. I tap out at 160 and it starts to feel hard above 140.
Is this a common thing for others on Beta blockers? - and I’m assuming, logic leap, that the lower heart rate means less blood flowing, therefore less O2 in the muscles. So I feel like I’m at say 140bpm but the chap beside me is maybe at 150 and getting more blood around his muscles, and of course he has more room to go up than I do.
If that’s all true, is there a solution? I’m not coming off the meds, they are keeping me alive and very healthy but I do wish that I could exercise the way I want.
I realise it’s some time since the original post, James, but there’s a great Facebook group - Cardiac Athletes - that has many sportsmen and sportswomen (5000+) of all levels (average Joe to international standing) that are prescribed beta blockers for cardiac issues. They continue to compete in endurance events; cycling, running, etc., and other forms of exercise. There are many reports and discussions on the effects of beta blockers in the forum. I’m a runner and, prior to a heart attack, ran in races and competed at distances up to marathons (competed against my PB times, at least!) Post HA, I’ve been on betablockers and feel the effects. Their impact on the body’s production of adrenaline has had an effect on my running, and it varies according to which beta blocker it is, and varies from person to person. Bisoprolol had my legs feeling like lead, like I was in the last mile of a marathon, as soon as I started out on a run. I found being on them and continuing to run to be incompatible. I’m on carvedilol now and it’s an improvement. My times are slower and I need a 15 minute warm-up to trigger my body into getting into exercise mode. I find any incline to be akin to one of those remote controlled cars with a discharged battery - chugging along reasonably on the flat, but try to go uphill and I pretty much slow to a crawl! It’s such hard work! What I don’t feel like with Carvedilol is marathon-tired as soon as I set off out the door. So, I’d say to you that beta blockers will have an effect, but go and check out the Facebook group to see the variety of experiences that athletes have on this medication.
Hi Ed- just diving into this thread and came across your post here. Your experience is exactly mine. I’ve been on beta blockers for 8 years, a low dose of bisoprolol.
I am 90kgs, just did a ramp test and hit 300 watts FTP, with max HR of 163 there. So not a racer or anything, but at the same time can do intervals with recovery much better than an all-out effort like an FTP or ramp test. We have amazing cycling hills nearby and I have no problem hitting them one after the other for a few hours with the descents in between.
165 is as high as my HR will ever go. Resting while I sleep is around 39-40. I am very curious about switching from bisoprolol to perhaps nebivolol, or even going off them completely, even if just for this summer riding season to see how my body reacts to this level of fitness. When I went on the betablockers 8 years ago, I was in objectively bad shape.
A little improvement, I can push my heart rate a little higher than previously and I expect that is a result of consistent training.
I can spike now to 170 but I cant stay there and its not repeatable. My five minute goes to 155 and falls gradually to 151 for a 20 minute effort.
I still struggle with extended steady state efforts. Races with a sustained climb are a problem for me. Part of it is weight of course but its also an inability to pump the o2 I jeer around my system.
I havent changed my meds. My cardiologist is thinking of making a change maybe next year, hes not convinced I need them but I was hesistant to make a change because in the bigger picture everything is going well.
