Moderate Exercise Safe For People With Muscle Pain From Statins

Statin therapy does not exacerbate muscle injury, pain or fatigue in people engaging in moderate-intensity exercise, such as walking, according to a study published April 3 in JACC.

Neeltje A.E. Allard, MD, et al., sought to compare the impact of moderate-intensity exercise on muscle injury in symptomatic and asymptomatic statin users, plus nonstatin-using controls. Symptomatic vs. asymptomatic was determined by the presence, localization and onset of muscle cramps, pain and/or weakness using the statin myalgia clinical index score. Researchers also examined the association between leukocyte CoQ10 levels on muscle injury and muscle complaints, since statins may lower CoQ10 levels and reduced levels can predispose people to muscle injury.

All study participants walked 30, 40 or 50 km (18.6, 24.8 or 31 miles, respectively) per day at a self-selected pace for four consecutive days. Statin users had all been on the medication for at least three months. The researchers excluded those with diabetes, hypo- or hyperthyroidism, known hereditary skeletal muscle defects, other diseases known to cause muscle symptoms or those using CoQ10 supplementation. There were no differences in body mass index, waist circumference, physical activity levels or vitamin D3 levels among the three groups at baseline.

Researchers found that statins did not exacerbate muscle injury or muscle symptoms after moderate-intensity exercise. Further, the researchers did not find a correlation between leukocyte CoQ10 levels and muscle injury markers at baseline or after exercise nor was there a correlation between CoQ10 levels and muscle fatigue resistance or muscle pain scores.

“Even though muscle pain and fatigue scores were higher in symptomatic statin users at baseline, the increase in muscle symptoms after exercise was similar among the groups,” said Allard. “These results demonstrate that prolonged moderate-intensity exercise is safe for statin users and can be performed by statin users to maintain a physically active lifestyle and to derive its cardiovascular health benefits.”

In an accompanying editorial comment, Robert S. Rosenson, MD, FACC, agrees that “[Based on the study], many patients who develop statin-associated muscle symptoms may engage in a moderately intensive walking program without concern for worsened muscle biomarkers or performance.” However, he adds that “it remains uncertain … whether sustained exercise [in these patients] will effectuate improved metabolic biomarkers or exercise capacity in the long term.”

Clinical Topics: Cardiovascular Care Team, Diabetes and Cardiometabolic Disease, Dyslipidemia, Prevention, Lipid Metabolism, Nonstatins, Novel Agents, Statins, Diet, Exercise

Keywords: Dietary Supplements, Vitamins, Hyperthyroidism, Leukocytes, Biomarkers, Life Style, Walking, Muscular Diseases, Muscle Cramp, Cholecalciferol, Body Mass Index, Waist Circumference, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Myalgia

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