Betablocker, weight gain and effects on sport performance

Hi

 

I am 78, very active ( I run 5-6  km about 3 times a week and go to the gym in the winter).

I feel great and I have a lot of energies for my age.

 

Last year, though, I had to run to the emergency ward of a local hospital because my heart was racing at 180 bpm at rest, just before starting my usual running session.

But for the cardio watch I wouldn’t have known, because I was feeling perfectly OK.

 

The cardiologist diagnosed atrial fibrillation and put me on betablocker ( Metaprolol) and  Eliquis  as a precaution, while encouraging  me to continue running as usual, even though the betablocker will reduce my heart rate, but no problem!.Really ?

 

Well, this is exactly the point: I found that after going on Metaprolol my calories expenditure for the same duration of the  running session ( about one hour on the same track as before) has been cut down by  half and my weight is steadily increasing, most visibly( and annoyingly!) around the waist.

To be precise, over the last few years my weight has increased from around 80 kg to about 87 kg, with an accelerated pace over the last year

 

Aside from the esthetic aspect (my self image)  and the  fact that excess weight hampers  the mobility required by some of my favorite activities, like windsurfing, it is well known that  excess weight also  translates in turn into insulin resistance, hypertension and high cholesterol,  for all of  which I am already on medication, at  borderline levels.  

 

It is an ironic vicious circle: excess weight worsens (if it does not  create !) the very same conditions for which I am already on medication.

 

I’ll speak to my GP and to my cardiologist about adjusting the medication, especially Metaprolol which is known for causing weight gain and slowing down metabolism

.In the meantime, I’d like to have your take on this

 

Thanks

 

Ittiandro

 


10 Comments

sounds about right

by Tracey_E - 2020-07-30 23:07:49

Metoprolol can do a great job with afib and preventing racing, but it can definitely cause weight gain and while it's preventing racing, it's also preventing us from getting our rate up on exertion. I was able to work out on a beta blocker, but it was definitely more of a struggle. 

medication for Atrial Fibrillation

by Gemita - 2020-07-31 05:56:21

Yes AF control and heart rate control can be difficult to achieve without severe side effects and the side effects can sometimes be worse than the problem we are trying to solve.  Beta blockers are known to slow us down and to have a calming affect on an arrhythmia like AF and to control high heart rates but this may come at the cost of weight gain which is a risk factor for so many diseases as you say.  A vicious circle.  

What to do about it?  I would consider trying to stop the AF as well as reviewing/changing your medication.  Trying to stop the cause for your increase in heart rate might be better than trying to control your heart rate with more and ever increasing doses of meds.  If your AF is out of control, I would speak to your doctors about all your options.  

It is all about finding the lowest medication dose to do the job or switching to a different med, perhaps a calcium channel blocker instead of a beta blocker, or trying another beta blocker.  It is so trial and error until we find what works best for us.  At 78 you sound incredibly healthy and I am sure your doctors will do everything possible for you to continue to remain well.  

Just a word of caution, strenuous exercise or pushing ourselves to our limits can I believe be a trigger for Atrial Fibrillation too, so maybe look to modify what you are doing to try to prevent increased episodes.

 

Not a smart choice of medication for *you*

by crustyg - 2020-07-31 13:29:19

During my seven year journey from ever-improving mature runner to SSS+CI Senior post two ablations for AFlut and a PM, I've lost count of the docs - young and old - who have suggested a beta-blocker to me.

My responses (retired pathologist, practiced longer than many of my medical advisors) have been 'are you mad' with varying degrees of politeness and charm.

The side-effect profile for beta-blockers really isn't great.  When I started back in the 1970s they were a major improvement in the management of hypertension, but over time we've become more aware of their limitations.

But established AF isn't easy to fix - the apixaban is great - and there are a lot of contributors here who can talk with considerable personal experience about attempts to fix their AF permanently without drugs.  I don't know the literature for established AF and drug therapy to fix/control this, but *I* would take a lot of convincing that beta-blockers were part of the answer for an athletic Senior.

I couldn't agree more Crusty

by IAN MC - 2020-07-31 15:09:56

I had to smile at your response , because 10 yrs ago I presented to my cardiologist with a resting heart-rate of 140 bpm ( atrial flutter )  and he threatened to put me on beta-blockers 

I know him very well and actually said to him " No Way "  . I was a very keen runner and had a few running friends who did really badly on beta blockers. ... fatigue, weight gain, erectile dysfunctiion, sleeplessness . You name it , they had it.

We eventually agreed on verapamil, a calcium channel blocker, and it did the trick without any side-effects. I wasn't that keen on the warfarin ,though , which was part of the package so I had a flutter ablation  and have enjoyed normal sinus rhythm ever since.

Beta-blockers have come a long way since then with 3 separate generations , offering different benefits and side-effect profiles  but I've always been glad that I avoided them.

With hindsight , I do realise that I probably had an illogical bias against them and that many people take them without any problems.

Ian

Sleep apnea and atrial fibrillation

by Ittiandro - 2020-07-31 19:30:06

In my post, I forgot to mention that months after  my AF episode, I had been diagnosed with sleep apnea , for which I have been wearing a CPAP mask   for little over a month.

It has  reduced the number of sleep apnea episodes per hour. to within the the normal range  and I am quite happy..   .

From what I read,  S.A.  could have well  been a contributing factor, if not the cause of my A.F.  as well of other conditions for which I am on medcation and which  are normally considered  as the inevitable lot of age: hypertension, cholesterol and glycemia, all of which at threshold levels, though...

I will mention the sleep apnea condition  to my cardiologist.

Perhaps, if it was S.A.,  Metaprolol  is no longer  necessary, but I doubt that my cardiologist will take the chance to discontinue it, just in case....

At best, he will reduce the dose. .,, or replace it with another betablocker, like Carvedilol.., which reportedly doesn't cause as much weight gain.

Perhaps people will benefit from knowing about S.A., because the symptoms can often go unnoticed or atttributed to other causes, like fatigue, stress or age. But SA is more widespread than what we think .

 

Ittiandro

 

Not a fan of Metoprolol

by Aztraildude - 2020-07-31 19:46:29

Being an active person who has been on metoprolol, I share your dislike for the side effects.

At one point I was on metoprolol and flecainide for my AF and every day it was like trudging through wet cement. I also gained weight, and had other unpleasant side effects.

The only lasting fix for AF is ablation; anti-arrhythmia meds eventually quit working, and some of them have really scary side effects. It took three ablations, two with an EP who is arguably the best on the planet. I have been in normal rhythm for two years now and expect that to continue. I did have vagus nerve damage that led to tachycardia, which took nearly two years to resolve completely. During that time I carried metoprolol to take as needed when the HR got up to 150.

One of the questions I would ask is if you can take it as needed rather than daily. And if they tell you, as they did me, that you also need it for high blood pressure, I've been really happy with the lack of side effects I get from amlodipine.

In cardiology I have run across a lot of doctors who are quite happy and think, "job done," if you can fog a mirror. I've had to make it crystal clear that quality of life matters to me, and I won't settle for a couch potato existence. It's in this area where we often need to make ourselves heard.

Metoprolol

by AgentX86 - 2020-08-01 00:12:03

I've been on metoprolol since January 2007, at times up to 200mg a day.  I'm on 2x25 now and it's not a problem.   In 2014 I had a Maze procedure that traded proxymal Afib for permanent Aflutter (not a good trade).  After all sorts of rhythm control meds, including ameoderone and three ablations, I was still in AFL, finally agreed to the AV ablation.  But I'm still on apixaban and metoprolol and will be for life (even though I had my LAA clipped at the same time as the Maze/CABG). 

Beta blockers have been a lot better for me than calcium channel blockers. There are a lot of beta blockers.  Some don't have the weight gain issue and some aren't performance killers to the degree of metoprolol.  For most, the side effects of beta blockers is temporary.  Just like any drug, though, there are some who have serious reactions.  There are usually many more alternatives.

Though amlodipine has been fine, for me, Micardis just about killed me.  CCBs aren't the end-all either.

Metoprolol would be fine, except for serious cardio training

by Ittiandro - 2020-08-01 13:14:46

Thank you for your input, Agent X86.

I am, too, on 2X25 Metoprolol.  You say it is OK for you. I am sure it is, but are you exercising?  

 

It would be OK for me, too, but for the fact that, as I stated in my post, my target is cardio training and

Metoprolol depresses my rest H.R. to the extent that I can no longer raise it to the level required for effective training, even at moderate intensity.

 

What is this level for me ?

To give you an idea, before going on Metoprolol, up to last fall, I used to do my running between 70-80% of the nominal  HR rate prescribed by the age charts, based on  the formula:  HR=220 bpm  minus -age  X  0.70% or .80%, which means, in theory, . 106-115 bpm.

I had however to to adjust it upward to 120-130 bpm, because I was very fit and my rest H.R. had come down, in time, as low as about 65 bpm,  which gives me a good reserve for safely increasing the HR.

 

After eight months of Metoprolol, I am unable to raise my HR above 100 bpm, which means thst, because of Metaprolol, the effectiveness of my cardio training has decreased to the level of walking or brisk walking. I may still lose weight, in the long run, because at this low intensityI level we burn more fat, but it does absolutely nothing for cardio training.

 

Exercise

by AgentX86 - 2020-08-01 17:56:18

Before Covid, I walked 20mi per day, half on a treadmill at the gym.  I've since dropped that back to 10mi, around the neighborhood, first thing in the morning before it gets too hot.  Is that exercise?  BTW, since I've been on metoprolol, I've lost weight (~150 lbs).  OTOH, I sure can't say it had anything to do with metoprolol.  I can say that seven years without AF was attributable to metoprolol.

Yes, my heart rate is limited but that was the whole point of it, to tame Afib/flutter.  After my AV ablation I did ask my cardiologist if I could get off it (and Eliquis) and the answer was a very firm "Are you nuts?!".

Second thoughts about metaprolol and cardiovascular training

by Ittiandro - 2020-08-03 12:57:29

After doing some more in-depth research, I'd like to share some new insights on  betablockers and sport performance, particularly in what concerns cardiovascular training. 

My original assumption was that  by putting a ceiling on the  h.r. with  the betablocker,  we  could not sustain the  effort intensity required for effective cardio training, even at a moderate level., I was ignoring the difference between aerobic and anaerobic exercise.

Mine  was a sort of extrapolation from the principle " if you don't use it, you lose it" which certainlly applies to muscles,

From a number of websites  staffed by  sport medecine  specialists and even M.D's , it appears that this  is not true. when it comes to  cardiovascular training. .In fact, both walking and running are  beneficial to  the heart,  the difference being  that if you walk, it takes longer to attain an optimal heart condition., but in the end the effect is the same.

In addition, even athletes wqho are on betablocker find their performance  improved by a slower H.R. 

In some sports, likle archery and sharp shooting, betablockers are restricted ,because their calming effects  ( lower adrenalin) makes the hands steadier, with an obvious unfair advantage..

Now I see why  in spite of all my physical activity, I could not lose  weight ( Iam am about 8-10 kg  over ).

It could be in part a because of the slower metabolism  of  age, but I also thonk that   I have been exercising  on the lower anaerobic  range , with my energies supplied more by blood sugar than body fat.

My cardio watch after each session gives the total  calories expenditure with the  % of calories from fat.

Traditionally,  before I went on Metaprolol, the mix was 30/70.

Now,  with a slower h.r., due to Metaprolol ,  it is 50/50, for the same time and duration.

TEven though te total calories expenditure is about half, as expected,  the mix, significantly,  is  now 50/50.  So, I am burning more fat!.  

This is a different outlook, which I'd like to share.

 

Ittiandro

 

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