- Statin therapy does not increase the risk of muscle injury, pain, or fatigue when engaging in moderate-intensity exercise.
- The researchers examined individuals who took part in the 4Days Marches, an event in the Netherlands where people walk between 18 and 30 miles every day for four days in the city of Nijmegen.
- The study’s results indicate that statins did not worsen muscle injury, pain, and fatigue, as these symptoms increased similarly in all groups.
Statin therapy does not increase the risk of muscle injury, pain, or fatigue when engaging in moderate-intensity exercise, according to a new study published in the Journal of the American College of Cardiology.
The participants of the study included 100 people. This included 35 people taking statins with statin-associated muscle symptoms, 34 people taking statins who did not exhibit any muscle issues and 31 people not taking statins as a control group.
Those taking statins had been doing so for at least three months before the study. People with certain health conditions including diabetes, hypo or hyperthyroidism, hereditary skeletal muscle disease were excluded from the study:
People using CoQ10 supplements were also excluded.
At the start of the study, body mass index (BMI), waist circumference, physical activity levels, and vitamin D3 levels were similar. Muscle pain and fatigue scores were higher in symptomatic participants at the beginning of the study.
The researchers examined individuals who took part in the 4Days Marches, an event in the Netherlands where people walk between 18 and 30 miles every day for four days in the city of Nijmegen.
“The participants walk 30, 40, or 50 km [18mi, 24mi or 31mi] daily for four consecutive days. This means that participants walk between 120 (74 miles) and 200 (124 miles) km in four days’ time,” explained Dr. Neeltje A.E. Allard, of the Radboud Institute for Health Sciences and the department of physiology at Radboud University Medical Center in the Netherlands and the lead author of the study. “It is indeed a lot of walking, and people train in advance. In fact, it started as a military event in 1909 and now has grown into the world’s largest walking event, in which both military and recreational walkers participate.”
The researchers compared the impact of walking on muscle injury in symptomatic participants to those who were asymptomatic.
The study’s results indicate that statins did not worsen muscle injury, pain, and fatigue, as these symptoms increased similarly in all groups.
In an accompanying editorial, Dr. Robert S. Rosenson,director of metabolism and lipids for the Mount Sinai Health System and professor of medicine in cardiology at the Icahn School of Medicine at Mount Sinai, stated, “exercise is an essential component of restoring fitness for maintaining health and fitness in all patients at increased risk for an atherosclerotic cardiovascular disease event, particularly those with a disabling event, such as myocardial infarction, and treatment of major cardiovascular risk factors, such as hypertension, prediabetes, or diabetes and dyslipidemia.”
“Many patients who develop muscle injury and fatigue symptoms may engage in a moderately intensive walking program without concern for worsened muscle biomarkers or performance,” Rosenson said in the piece.
“Although the exercise was accompanied by more fatigue in symptomatic vs. asymptomatic statin users in this short-term study, it remains uncertain from this study whether sustained exercise in SAMS [statin-associated muscle symptoms] patients” will help improve key biomarkers and exercise capacity in the long term.
The study does have some limitations.
“The sample size, for instance, is large, but we must consider that not all participants took the same statin,” said Michael Masi, DPT, OCS, CSCS, CISSN, CMTPT, USAW-1, a strength and sports doctor at Masi Fitness. “The researchers also discuss how the inclusion criteria for the study required participants to be able to walk at least 30km/day, which is tough on its own and may exclude a large portion of people considering statin use.
Masi point out that statin use increases with age
Statins are drugs used to lower cholesterol and can reduce the risk of heart attack, stroke, and the need for surgery, angioplasty, or stenting in people with heart disease, according to the Health and Human Services Division (HHS) of the United States. They not only help by reducing cholesterol, but they might also help reduce inflammation in artery walls.
The higher your risk of a heart attack, the more benefit you receive from statins.
Around 29% of people taking statins experience side effects, including muscle aches or weakness. Although adjusting the dose or choosing a different statin drug can reduce side effects, many people stop taking statins, increasing their risk of heart attack or stroke.
HHS notes that “people who have had a heart attack or stroke, who have diabetes or very high ‘bad’ cholesterol levels, and who are at high risk for heart disease or stroke due to other factors like high blood pressure will live healthier and longer lives by taking a statin.”
Still, some people can experience muscle symptoms, such as myalgia or muscle aches. These symptoms can worsen during physical activity.
“The current recommendations for people taking statins are that patients should continue to take their statins at their maximally tolerated dose after discussion with their healthcare providers,” says Dr. Michael Broukhim, an interventional cardiologist at Providence Saint John’s Health Center in Santa Monica, California. “They should implement a regular exercise program, with preference to a moderate intensity exercise program.”
“I feel comfortable recommending moderate-intensity exercise and encourage my patients to engage in at least 150 minutes per week of this exercise,” Broukhim told Healthline. “If patients cannot exercise 150 minutes a week, I recommend exercising as much as the individual patient can.”
“People who take statins and are starting an exercise program should be more cautious in high-intensity exercise, which can increase muscle enzyme levels to a greater extent and may result in muscle damage,” Broukhim continued. “If patients have significant pain while exercising, they should stop their exercises and consult with their physicians.”
Examples of moderate-intensity exercises include:
- Brisk walking
- Water aerobics
- General calisthenics
- Doubles tennis
- Ballroom dancing
Masi said for people who want to start working out, experts recommend a combination of resistance training and cardiovascular exercise. Masi said everyone should start out at their own pace and ability and increase both duration and resistance gradually.
“If exercise is new to someone, the best thing they can do is try a few different options. It’s less about finding what’s optimal and more about finding what’s ideal,” Masi said. “Find exercise that is enjoyable so it can feasibly be performed throughout the foreseeable future.”