Active Voice: Statins and Physical Activity – Friends or Foes?

Gregory A. Panza, M.S.Linda S. Pescatello, Ph.D., FACSM, FAHAPaul D. Thompson, M.D., FACSM

Statins are the most widely prescribed medications in the world and are used to treat hyperlipidemia and reduce the risk of atherosclerotic cardiovascular disease (ASCVD). Statins are well tolerated, but approximately 10 percent of statin users report myalgia or “muscle pain,” cramps and weakness. These symptoms appear to be more frequent following physical activity and in physically active individuals. This is a concern because statin side effects could reduce physical activity in those who would benefit most, i.e., those with an increased ASCVD risk. 

We examined the relationship between maximal dose statin treatment and physical activity levels in 418 healthy, statin naïve adults in our six month, double blinded, randomized controlled trial: The Effect of Statins on Skeletal Muscle Function and Performance or the STOMP study. In a STOMP sub-study, published in the January 2016 issue of MSSE, we measured physical activity using accelerometers before and after six months of either atorvastatin 80 mg daily or placebo treatment. Accelerometers objectively measure activity counts, time spent in sedentary behavior, and time spent in light, moderate and vigorous physical activity. Surprisingly, we found that both the statin and placebo groups increased their sedentary behavior time and decreased their total physical activity! 

Why might this be the case? There are several possible explanations why both the placebo and statin groups decreased their physical activity. First, STOMP was conducted in New England where a seasonal effect might be suspected to modify the results. But, statistically controlling for season did not change the result. Another possibility might be an “alerting reaction,” which could have prompted the subjects to be more active when they first wore the accelerometers at baseline. However, this explanation is unlikely given that high test-retest reliability of repeated accelerometer assessments has been well established in the literature. Yet, another possibility is that subjects could have decreased their physical activity levels to avoid side effects of statin that occur more frequently during or following physical activity. This explanation also is unlikely, since both groups decreased their activity levels similarly and still exceeded the ACSM’s recommendations of at least 30 minutes of moderate intensity physical activity per day during six months of either placebo or statin treatment. Finally, regression to the mean could have accounted for our findings. According to this statistical phenomenon, higher than average physical activity levels at baseline should decrease over time and be closer to the mean, or “average out” at the second measurement. However, subjects were not recruited for high baseline activity, thus making this explanation unlikely. 

We concluded that statin use does not reduce habitual physical activity levels of healthy adults? at least, not during the six months of our study. Physical activity should be encouraged as lifestyle therapy in conjunction with statins for the treatment of hyperlipidemia and the prevention of heart disease. Our findings support ACSM’s Exercise is Medicine® campaign that encourages health care providers to prescribe exercise along with the patient’s other medicines.

Viewpoints presented on the SMB blog reflect opinions of the authors and do not necessarily reflect positions or policies of ACSM. 

Gregory A. Panza, M.S., is an exercise physiologist researcher in the Division of Cardiology at Hartford Hospital, Hartford, Conn. He currently is pursuing a doctoral degree in Kinesiology at the University of Connecticut in Storrs, Conn. His research focuses on the effects of statins on muscle strength, cognitive function, and physical activity habits. He also has research interests in the implications of exercise for individuals at risk for or diagnosed with Alzheimer’s dementia. 

Linda S. Pescatello, Ph.D., FACSM, FAHA, is a distinguished professor within the Department of Kinesiology at the University of Connecticut in Storrs, Conn. She was senior editor for the 9th Edition of ACSM’s Guidelines for Exercise Testing and Prescription and a member of the expert panel and writing team that recently updated ACSM’s recommendations for exercise preparticipation health screening. Her research focuses on the clinical and genetic determinants of the response of health/fitness phenotypes to acute and chronic exercise. 

Paul D. Thompson, M.D., FACSM, is chief of cardiology at Hartford Hospital in Hartford, Conn. He has authored more than 400 scientific articles on such topics as the effects of exercise in preventing and treating heart disease, the cardiovascular risks of vigorous exercise, the effects of exercise on lipid metabolism and the effects of statins on skeletal muscle. Dr. Thompson has held numerous leadership roles in ACSM, including serving as ACSM president in 1998-99. He also was the principal investigator of the STOMP study (see commentary text for details).

This commentary presents the viewpoints of Mr. Panza and Drs. Pescatello and Thompson on the topic of a research article that they and other colleagues published in the January 2016 issue of Medicine & Science in Sports & Exercise® (MSSE). 

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