The influence of alcohol on physiologic processes and exercise
Ethanol, or alcohol, is one of the most commonly used and abused drugs in the world. Alcohol can have many effects on exercise physiological performance, so it is important to distinguish between chronic use, moderate use, and abuse. Alcohol is a mind-altering drug that reduces thinking ability, distorts judgment, and acts as a depressant on the body. Research has suggested that alcohol leads to increased dopamine release in the human brain, bringing on feelings of relaxation and happiness. Although this drug is often used during recreation for the purpose of feeling good, it should not be used in combination with exercise because of the serious negative physiological effects it has on the body.
One of the most easily observable effects of alcohol on the body is dehydration. When alcohol is consumed, anti-diuretic hormone (ADH) is inhibited, causing less water to be absorbed back into the nephrons in the kidneys when urine is cycling through. This causes urine levels to increase, leading to more frequent urination. With higher levels of water exiting the body, dehydration is likely to occur. This is especially a problem during exercise, when the body is also expelling water in the form of sweat. It is important to be fully hydrated for a workout; therefore, it is dangerous to consume alcohol before or during exercise. Although beverages containing below 2% alcohol have shown no negative effects to rehydration, research has suggested that beverages containing over 4% alcohol can delay the recovery process from dehydration to rehydration. This prevention from reaching rehydration in a timely manner could be dangerous in a situation regarding exercise.
Another important physiological effect that alcohol has on the body deals with blood pressure. Alcohol consumption increases blood and plasma volume, which in turn increases blood pressure. Exercise has a similar effect; the sympathetic immune system is stimulated, leading to vasoconstriction and ultimately increasing blood pressure. To practice safe exercise, it is important to not have an elevated blood pressure beforehand. Research has recommended that alcohol consumption be reduced in order to maintain healthy and safe blood pressure levels. Likewise, it is unsafe to consume alcohol before or during exercise because blood pressure levels may rise to dangerous levels.
Perhaps the most important physiological effect that alcohol has on the body is that which concerns the heart. Research has shown that intoxication by alcohol directly relates to impairment of cardiac contractility. Depending on how much alcohol was consumed, cardiac contractility was impaired at varying levels; a lighter intoxication lead to minimal impairment, while higher levels of intoxication lead to greater impairment. Exercise causes heart rate to increase, requiring a great deal of cardiac contractility. If the heart is impaired because of alcohol intoxication, blood may not be pumped sufficiently throughout the body during exercise. Alcohol can also induce oxidative stress resulting in cardiac dysfunction. However, with exercise the oxidative damage can be reduced by use of the antioxidant system. Therefore, if a person plans on exercising, they should either drink lightly or not at all in an attempt to keep their heart working properly.
According to O'Brien and Lyons, medical hazards for athletes can be related to alcohol consumption prior to an exercise activity or performance. A specific health hazard created by alcohol is the reduction in the contraction strength of the left ventricle of the heart resulting in a decreased ability to pump blood to the body. In addition, alcohol consumption has also been found to potentially cause cardiac arrhythmias, which could lead to a major health issue for an athlete.
Research has shown that alcohol consumed post-exercise has many adverse effects on the body’s ability to recover. Reserach has shown delays in the normal return of plasma viscosity and plasma fibrinogen when a moderate dose of alcohol was consumed one hour post-exercise , and significant delays in the return of platelet aggregation levels to a normal state when alcohol was consumed post exercise.
Additionally, alcohol negatively affects the skeletal muscle substrate utilization. By decreasing glucose and amino acid utilization, there is decreased energy supply available to the muscle. Alcohol has also been shown to prevent muscle function by impairing the excitation/contraction coupling because the inhibition of calcium channels in the sarcolemma. Furthermore, post-exercise alcohol intake has been shown to inhibit the necessary recovery and adaptation process. For muscles to hypertrophy (enlarge) and generate adaptations following exercise, production of myofibrillar proteins must supersede the breakdown of myofibrillar proteins. Research shows that consuming large amounts of alcohol inhibits the synthesis of myofibrillar proteins during recovery from resistance, continuous, or intermittent high-intensity exercise. This suppression of the skeletal muscle's anabolic response necessary for muscle adaptation, repair, and regeneration is likely caused by the oxidative stress and inflammation generated by alcohol consumption. This stress disturbs the endoplasmic reticulum's homeostasis, therefore disrupting its ability to properly fold and ship proteins around the cell.
The American College of Sports Medicine (ACSM) maintains a position related to alcohol consumption and exercise, stating that alcohol use will not increase exercise performance. Use of alcohol before performing a physical activity can affect an athlete by decreasing "reaction time, hand-eye coordination, accuracy, balance, and complex coordination". While some athletes partake in alcohol consumption to help with reducing nervousness or increasing confidence before an athletic performance, the ACSM argues that an athletes psychomotor skills and ability to process information, for rapid adaptations, will be negatively affected. Ingestion of alcohol will also affect many of the body's natural response mechanisms to exercise. Blood glucose levels can be affected during exercise due to consumption of alcohol prior to activity, which can lead to hypoglycemia. According to the ACSM, alcohol "will not improve and may decrease strength, power, local muscular endurance, speed, and cardiovascular endurance". There is evidence suppporting ACSM's proposal that alcohol may decrease power in exercise. Lecoultre and Schutz (2009) studied a group of well-trained male cyclists to determine the effects of an acute consumption of alcohol on cyclists during a 60-minute cycling endurance performance test. The results showed a significant decrease of power output (PO) in the ethanol group from the second 10-minute mark to the end of the test when compared to the PO of the control group .
Implications for Physical Therapy
When working with a patient who consumes alcohol, it is critical for physical therapists to be mindful of the effects alcohol has on blood pressure, blood glucose, heart rate, cognitive function and skeletal muscle substrate utilization. If a patient is thought to have consumed alcohol, it is important to try to determine how much and when the alcohol was last ingested in order to determine actions or interventions appropriate for the client. Hydration is also critical for patients who drink alcohol to avoid becoming dehydrated, particularly if the patient is working out in a hot or humid environment. Patient blood pressure should be checked before beginning exercise to ensure it is within appropriate limits and should be monitored throughout the duration of exercise. Athletic patients should be informed of the negative effects alcohol has on performance, as well as the hindrance on post-exercise muscular adaptation and repair caused by post-exercise alcohol consumption.
It is important to also note that hangover effects, with generally the same- or diminished- effects as alcohol, should receive attention as well. Research shows that the majority of hangover-related impairments are pscyhological rather than physiological, but risk is still involved. Learning to recognize and work with patients that abuse alcohol can benefit the patient not only through physical rehabilitation, but through psychological rehabilitation as well.
- Pesta, H. D., Angadi, S. S., Burtscher, M., Roberts, K. C. The effects of caffeine, nicotine, ethanol, and tetrahydrocannabinol on exercise performance. Nutr Metab 2013;10:71. http://link.springer.com/article/10.1186%2F1743-7075-10-71 (accessed 15 Sept 2015).
- Boileau I, Assaad J, Pihl R, Benkelfat C, Leyton M, Diksic M, et al. Alcohol promotes dopamine release in the human nucleus accumbens. Synapse 2003;49:226-31. http://www.ncbi.nlm.nih.gov/pubmed/12827641 (accessed 15 Sept 2015).
- Shirreffs S, Maughan R. Restoration of fluid balance after exercise-induced dehydration: Effects of alcohol consumption. Journal of Applied Physiology 1997;83:1152-8. http://jap.physiology.org/content/83/4/1152 (accessed 15 Sep 2015).
- Xin X, He J, Frontini M, Ogden L, Motsamai O, Whelton P. Effects of alcohol reduction on blood pressure: A meta-analysis of randomized controlled trials. Hypertension 2001; 38:1112-7. http://hyper.ahajournals.org/content/38/5/1112.full (accessed 21 Sept 2015).
- Kelbaek H, Gjørup T, Brynjolf I, Christensen N, Godtfredsen J. Acute effects of alcohol on left ventricular function in healthy subjects at rest and during upright exercise. The American Journal of Cardiology 1985;55:164-7. http://www.sciencedirect.com/science/article/pii/0002914985903200 (accessed 15 Sep 2015).
- Husain. K., Somani. M. Response of cardiac antioxidant system to alcohol and exercise training in the rat. Alcohol 1996; 14(3):301-307. http://www.alcoholjournal.org/article/S0741-8329(96)00211-X/abstract (accessed 1 Oct 2015).
- O'Brien C, Lyons F. Alcohol and the Athlete. Sports Medicine [serial on the Internet]. (2000, May), [cited November 17, 2015]; 29(5): 295-300. Available from: SPORTDiscus with Full Text.
- El-Sayed MS. Adverse effects of alcohol ingestion post exercise on blood rheological variables during recovery. Clinical Hemorheology and Microcirculation 2001:24(4):227-232.
- El-Sayed MS. Effects of alcohol ingestion post-exercise on platelet aggregation. Thrombosis Research 2002;105(2):147-151.
- Parr EB, Camera DM, Areta JL, Burke LM, Phillips SM, et al. Alcohol ingestion impairs maximal post-exercise rates of myofibrillar protein synthesis following a single bout of concurrent training. PLoS ONE 2014;9(2):e88384.
- American College of Sports Medicine. American College of Sports Medicine position statement on: The use of alcohol in sports. Medicine; Science in Sports; Exercise 1982;14(6):ix-xi.
- Juhlin-Dannfelt A, Ahlborg G, Hagenfeldt L, Jorfeldt L, Felig P. Influence of ethanol on splanchnic and skeletal muscle substrate turnover during prolonged exercise in man. Am J Physiol Gastrointest Liver Physiol. 1977;233:195-202 http://ajpendo.physiology.org/content/233/3/E195 (accessed 5 Nov 2015).
- Lecoultre, V., Schutz, Y. Effect of a small dose of alcohol on the endurance performance of trained cyclists. Alcohol Alcoholism 2009;44:278-83. http://alcalc.oxfordjournals.org/content/44/3/278 (accessed 1 Oct 2015).
- Kruisselbrink L, Martin K, Megeney M, Fowles J, Murphy R. Physical and psychomotor functioning of females the morning after consuming low to moderate quantities of beer. J Stud Alcohol. 2006;67, 416-420.
- Mäki T, Toivonen L, Koskinen P, Näveri H, Härkönen M, Leinonen H. Effect of ethanol drinking, hangover, and exercise on adrenergic activity and heart rate variability in patients with a history of alcohol-induced atrial fibrillation. Am J Cardiol, 1998;82(3), 317-322.