Table 4.

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

Type/class of medication	Exercise considerations	Safety/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