The fitness industry is constantly evolving and redirecting itself to accommodate the customers who keep it afloat. For trainers and coaches, it can be quite overwhelming to keep up with our many clients both in personal training and in group fitness. While many variables can affect our clients’ health, over-the-counter (OTC) medications, may play a very large role in the overall results and experience our clients have.
According to the FDA there are more than 300,000 OTC medications currently marketed to consumers. 1 The Consumer Healthcare Products Association (CHPA) tells us that 240 million Americans use these drugs annually, and nearly one-third of Americans use OTCs on a regular basis.2,3 In short, many of our clients come to their workout having taken some form of OTC medication and they rarely tell us about it. In some cases, these medications are sabotaging their workouts. These medications are generally safe, if used according to the dosing on the package, which is why they do not require a prescription. However, there are still risks involved such as drug-drug interactions and adverse side effects when not taken properly. Let’s dive into the most commonly used types of OTCs and what you need to know to ensure your clients have the most optimal experience and get the best results.
Regardless of the age or population you work with, you will have clients who self-treat their health condition, and most will take some sort of OTC medication for relief.
The four top classes of OTC’s most commonly used include allergy, cough/cold, heartburn and analgesics.
Currently in the United States, as many as 30% of adults and 40% of children suffer from allergies annually.4 Whether it’s a decongestant, antihistamine or a nasal corticosteroid, some of your clients will experience adverse side effects while working out and taking these medications. Some of the most common side effects that you as a practitioner should be aware of are: dizziness, dry mouth or “cotton mouth,” loss of appetite, excessive sweating, increased heart rate and motion sensitivity.
Second, we have cough and/or cold medications. This class is especially interesting and contains many different medications that are used depending on the cold symptoms. The two OTC options for treatment of a cough are expectorants and antitussives. The OTC cold treatments include antihistamines, decongestants and products that combine these two classes with a cough medicine and an analgesic, like acetaminophen. The interesting part is that if a client is taking some sort of medication for high blood pressure and/or heart disease they should not take OTC products containing decongestants without consulting their physician or pharmacist first.
The caution here lies in the interaction of the two drugs, which can negatively affect their blood pressure control, leading to dizziness, loss of balance and motor control during a workout. It can be dangerous and in some cases decongestants have been known to cause hallucinations. Ever had a client suffer from that mid-squat? Not a good idea. Case in point – we must periodically ask them about their OTC consumption.
Next, and by far the most often consumed OTC, would be medications to treat heartburn. While allergies, cold and cough are often out of our control, heartburn is something that most often is self-induced. The most common cause of heartburn is excessive weight. Wrap your head around that for a moment. To make matters more interesting, about 60 million Americans are affected by heartburn or acid reflux at least once a month.5 Of course, there are other non-weight factors that may cause someone to have heartburn.
Chances are your clients regularly or have occasionally suffered from symptoms of heartburn, taken some sort of antacid, acid reducer, or a combination of the two on the days they have worked out with you. What to look for in a client: mostly complaints of upset stomach, dizziness, and in some cases, they may experience leg cramps. If leg cramps are a complaint of the client, have them walk and hydrate. If it persists, nix the compound movements and go to more simple exercises or work on flexibility. Some clients may complain of stomachaches so avoid too much core work.
Lastly, we have analgesics. This is one of the most commonly used OTC medications. We use them to treat sore muscles, headache, arthritis, menstrual pain and other minor pains. Options for analgesics include acetaminophen, non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen and salicylates such as aspirin. More than 80% of American adults report using one of the four main OTC analgesics and most keep them on hand at all times.6
The most commonly reported side effects of analgesics are nausea, upset stomach, vomiting, restless sleep, shakiness and bruising. The NSAIDs can decrease kidney function and lead to the body retaining fluids, which may increase blood pressure, leading to decreased motor control and increased sweating. What you should remember about analgesics is that more often than not, your clients never think of telling you they took an aspirin.
Let’s play this out:
Your client takes aspirin a few days in a row for a nagging headache. The client comes in to workout, and you two have a wonderful session working legs. The client leaves feeling like a rock star and will think of you nonstop for the next three days. They come back in three days, say they are sore but no issues, meanwhile you notice bruising on their legs. After a brief conversation, you can rule out DOMS (Delayed Onset Muscle Soreness) but can’t for the life of you figure out where the bruising came from. The point is this, if you had full disclosure on what they take on a daily or weekly basis you could truly optimize their training programs and their experiences while they are with you.
Again, while OTC medications are generally safe, they can, and often do have adverse side effects that may impact your client’s workout. Any client who requires OTC medication on a regular basis should be instructed to see their physician for evaluation. While they are with us, it is our opportunity to take care of them; this gives us good reason to ask them to be transparent with us about medications, especially OTC medications. In addition to providing a safe and efficient workout, the fact that you know about what happens when they take OTCs gives you instant credibility. We must make it a priority to listen, ask and know. Your client’s success very well could depend on it.
FOR A PRINTABLE REFERENCE TABLE OF COMMON OTC DRUGS, SIDE EFFECTS AND TRAINING TIPS, VISIT WWW.FIT-PRO.COM.
Brandi Binkley M.S. NSCA-CPT is founder of PhysioFit in Nashville. She is an awardee of the NSCA Trainer of the Year Award. She is also a partner in ErgoVicis.
Dr. Tracy M. Hagemann, PharmD., FCCP, FPPAG, is Professor and Associate Dean at the University of Tennessee College of Pharmacy in Nashville. She is a client of Physiofit, and a partner in ErgoVicis.
1. Drug applications for over-the-counter (OTC) drugs. Food and Drug Administration website. http://www.fda.gov/drugs/developmentapprovalprocess/howdrugsaredevelopedandapproved/approvalapplications/over-the-counterdrugs/default.htm. Accessed January 7, 2017
2. OTC value. Consumer Healthcare Products Association website. www.chpa.org/OTCvalue.aspx. Accessed January 6, 2017
3. Deloitte 2012 Survey of U.S. Health Care Consumers: The performance of the health care system and health care reform. https://www2.deloitte.com/content/dam/Deloitte/us/Documents/life-sciences-health-care/us-lshc-2012-survey-of-us-consumers-health-care.pdf. Accessed January 7, 2017
4. American Colllege of Allergy, Asthma & Immunology. Allergy Facts. acaai.org/news/facts-statistics/allergies. Accessed January 7, 2017
5. American Gastroenterological Association. GERD. http://www.chpa.org/OTCSalesVolume.aspx. Accessed January 7, 2017
6. Kaufman DW, Kelly JP, Rosenberg L, Anderson TE, Mitchell AA. Recent patterns of medication use in the ambulatory adult population of the United States: the Slone survey. JAMA. 2002; 287:337–344.