Statins and Physical Activity in Older Men: The Osteoporotic Fractures in Men Study

Lee DS, Markwardt S, Goeres L et al.
JAMA Intern Med. 2014 Jun 9. doi: 10.1001/jamainternmed.2014.2266

Background

Because physical activity is vital for older adults to maintain health and physical functioning, it is important to understand factors that influence physical activity. Several short-term studies have suggested that initiation or continued use of statins is linked to less physical activity in older adults [1,2], which may be linked to the most common adverse effects seen with statin use: muscle symptoms. Other studies linked initiation of moderate physical activity to muscle pain and symptoms in statin users [2-4]. A 12-week aerobic exercise study showed improved cardiorespiratory fitness and respiratory markers in muscles in statin nonusers, but not in patients receiving 40 mg of simvastatin [5].
Using data of the observational Osteoporotic Fractures in Men Study (MrOS), the relationship between self-reported or objectively measured (accelerometer during a 7-day period) physical activity and statin use up to 6.9 years after baseline (2 follow-up visits). Data of 4137 men were included in a cross-sectional analysis, of whom 989 were statin users. Mean age was 72.9 (SD: 5.3) for statin users and 72.9 (5.5) for nonusers. For longitudinal analysis, 3039 men were included, of whom 727 were prevalent users, and of whom 1467 never used a statin during follow-up. 845 men first reported statin use during follow-up. Self-reported physical activity was assessed by using the Physical Activity Scale for the Elderly (PASE) questionnaire.

Main results

• The decline in PASE score per year was roughly the same for statin users and nonusers (0.3 points, 95%CI: -0.5 – 1.1). In new users, PASE score declined faster than in nonusers, with a difference in rate of 0.9 points/year (95%CI: 0.1-1.7).
• 3071 men wore the accelerometer for at least 90% of the time, 1542 of whom were statin users. Daily metabolic equivalents (METs) was lower in statin users by 0.03 (95%CI: 0.02-0.04) METs as compared with nonusers.
• Statin users did 9.6% (95%CI: 3.1-16.4) fewer minutes per day of moderate physical activity, meaning 5.4 (95%CI: 1.9-8.8) fewer minutes per day (median: 62.0 minutes per day in nonusers).
• Statin users engaged in 9.0% (95%CI: 1.7-16.8) fewer minutes of vigorous activity than nonusers (0.6, 95%CI: 0.1-1.1 minutes per day less, median: 7.4 minutes in nonusers).
• Statin users were involved in 0.6% (95%CI: 0.2-1.0) longer sedentary behaviour as compared with nonusers, meaning 7.6 (95%CI: 2.6-12.4) more minutes per day (median: 21.7 hours per day in nonusers). 

Conclusion

This large observational study in community-living older men showed that statin use is associated with modestly lower physical activity for as long as statins are used. Although physical activity declined more rapidly in new statin users, physical activity declined at a similar rate in prevalent users and non-users. Hence, the more rapid decline in statin users as compared to nonusers does not continue over time.

Editorial comment [6]

Inherent to observational studies, the association between statins and less activity may be overstated. However, the fact that new statin users were not less active prior to statin therapy initiation suggests that this was not the case. The association may, however, be understated, due to healthy tolerator, healthy complier and healthy user biases.
“ Benefits of activity and fitness extend beyond metabolic and cardiovascular outcomes, to mood, cognition, behaviour, sleep, bone, respiration, functional preservation, resilience in settingsof injury, illness, or surgery, as well as death from all causes.These considerations serve as a reminder that all medications bear risks and prescribing them involves tradeoffs. When considering statin use in a given patient, effects on function and the spectrum of outcomes, not merely cause-specific ones, should be considered, recognizing effect modification by age, sex, comorbidities, and functional stateand taking patients’ preference centrally into account.”

Find this article on Pubmed

References

1. Parker BA, Capizzi JA, Grimaldi AS, et al. Effect of statins on skeletal muscle function. Circulation. 2013;127(1):96-103.
2. Bruckert E, Hayem G, Dejager S, et al. Mild to moderate muscular symptoms with high-dosage statin therapy in hyperlipidemic patients—the PRIMO study. Cardiovasc Drugs Ther. 2005;19(6):403-414.
3. Meador BM, Huey KA. Statin-associated myopathy and its exacerbation with exercise. Muscle Nerve. 2010;42(4):469-479.
4. Semple SJ. Statin therapy, myopathy and exercise—a case report. Lipids Health Dis. 2012; 11(1):40.
5. Mikus CR, Boyle LJ, Borengasser SJ, et al. Simvastatin impairs exercise training adaptations. J AmColl Cardiol. 2013;62(8):709-714.
6. Golomb, BA. Statins and Activity Proceed With Caution. JAMA Internal Medicine Published online June 9, 2014