Many athletes routinely take ibuprofen before they exercise in hopes that it will enable them to work out more intensely and will head off muscle soreness. Sounds reasonable and harmless, right? Wrong. Ibuprofen (Advil, for example) and other nonsteroidal anti-inflammatory drugs (NSAIDs) are known to damage the lining of the gastrointestinal tract, which can result in bleeding and ulcers over time. Strenuous exercise itself can also harm the lining, at least in the short term. And as accumulating research is revealing, the combination of ibuprofen and strenuous exercise may amplify the damage.
A Dutch study in Medicine & Science in Sports & Exercise in late 2012 found that men who took ibuprofen (800 milligrams) before vigorous cycling had a greater rise in a blood marker that indicates increased intestinal permeability, compared to those who just took the drug or just cycled. This could allow toxins and other byproducts from bacteria to seep into the bloodstream, though the consequences, if any, are not fully clear.
This study is one of several that have shown potential damage from combining strenuous exercise and ibuprofen. For example, a 2006 study found that ultramarathoners who took ibuprofen before a race had higher levels of intestinal permeability and inflammation, as indicated by compounds in the blood, compared to athletes who didn’t take the drug. Moreover, ibuprofen use did not reduce muscle damage or soreness.
That’s not all: Some research has shown that taking ibuprofen before exercise may increase the risk of musculoskeletal injuries and delay healing by impairing the synthesis of collagen, a key component of muscles, bones, and connective tissue. Ibuprofen may also reduce the response of muscles to exercise and decrease bone formation (thus lessening some of exercise’s benefits).
And, of course, if you have pain that’s caused by exercise, your body is sending you a message that you probably shouldn’t ignore by masking it with pain relievers.
It’s too early to say whether the above risks—other than gastrointestinal bleeding and ulcers—will prove to be significant, but here are some things to keep in mind:
- There’s no good reason to take ibuprofen before you exercise, unless you take it for arthritis or another painful musculoskeletal condition that would otherwise prevent you from exercising.
- There’s little research as to whether other NSAIDs (such as aspirin or naproxen) have the same adverse effects when taken before exercise. But it’s probably wise to avoid these also, unless really needed.
- If you do need to take something to be able to exercise without discomfort, try acetaminophen first, since it doesn’t pose the same risk to the digestive tract as NSAIDs do. If that doesn’t work well for you and you do need to take an NSAID in order to exercise, talk to your health care provider about whether you should also take a proton pump inhibitor (such as omeprazole, brand name Prilosec) to decrease the risk of ulcers and bleeding.
- What about taking NSAIDs after exercising, in case you overdo it? That would pose less of a risk, but wait until you have actual pain and/or inflammation (not anticipated pain), and take the lowest effective dose for the shortest time.