Moderate exercise safe for people with muscle pain from statins Statins do not increase muscle injury after prolonged walking, important for heart health in statin users

Statin therapy does not exacerbate muscle pain or fatigue in people engaging in moderate-intensity exercise, such as walking. Also, no additional degree of muscle injury occurs, according to research conducted by the Radboud university medical center among participants of the 4Days Marches in Nijmegen. These findings show that statin users can engage in a physically active lifestyle. This contributes to prevention of cardiovascular disease (CVD). 

Statins are cholesterol-lowering drugs used daily by more than 1.5 million Dutch people. They are one of the drugs most commonly prescribed. Statins lower blood cholesterol, which lowers the risk of cardiovascular disease. However, they can also cause side effects, of which muscle pain and fatigue are the most frequently reported 

Whether muscle symptoms associated with statin use worsen with moderate-intensity exercise was unknown until now. Researchers at the Radboudumc are now answering this question. 100 walkers of the Nijmegen 4Daagse participated in the study about muscle complaints. They formed three groups: participants without statins, participants with statins and without muscle complaints and participants with statins and with muscle complaints. They were followed prior to and during the Four-Day Week by means of blood tests and questionnaires. 

No more symptoms with cholesterol-lowering drugs

The results show that statins did not worsen muscle damage and muscle complaints after one day of walking. This was also not the case after three days of walking. Eline Allard, physician-researcher at the Department of Physiology and first author: 'Everyone develops mild muscle damage and complaints such as fatigue and muscle pain after a day of walking 30, 40 or 50 kilometers. We measure muscle damage by signaling substances in the blood that are indicative of muscle damage. Higher concentrations of these signaling substances in the blood imply more damage. In this study, we examined both damage to skeletal muscles, which are responsible for movement, and damage to the heart muscle. 

The researchers wanted to know if more damage and symptoms occurred in people taking statins. That turned out not to be the case. 'Although the scores for muscle pain and fatigue before walking were higher in the people on statins who already had such complaints prior to the 4Days Marches, the increase in complaints and muscle damage after exercise was similar between the groups,' says Allard. This means that even this long-term moderate-intensity exercise is safe for statin users.

Head researcher and Professor of Physiology Maria Hopman has been conducting research during the 4Days Marches in Nijmegen for many years. In 2023 even for the fifteenth year. She adds: 'We know that an active lifestyle contributes to a lower risk of cardiovascular disease. The fact that statin users can safely walk the Four Days Marches is good news. I certainly encourage people to maintain an active lifestyle. Walking can contribute to that enormously!

About this publication

This article is published in the Journal of the American College of Cardiology: Prolonged Moderate-Intensity Exercise Does Not Increase Muscle Injury Markers in Symptomatic or Asymptomatic Statin Users - Neeltje A.E. Allard, Lando Janssen, Bart Lagerwaard, Malou A.H. Nuijten, Coen C.W.G. Bongers, Richard J. Rodenburg, Paul D. Thompson, Thijs M.H. Eijsvogels, Willem J.J. Assendelft, Tom J.J. Schirris, Silvie Timmers, Maria T.E. Hopman. J Am Coll Cardiol. 2023 Apr, 81 (14) 1353–1364

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