Wednesday, April 17, 2024

Strong Leg Muscles Linked to Better Outcomes After Heart Attack

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People with strong leg muscles are more likely to be active, which can help reduce the risk of obesity, diabetes, and other chronic diseases, said Dr A Ravikanth, senior cardiologist, Kamineni Hospitals, Hyderabad.

Can better muscle strength aid heart health, especially after a heart attack? A new study, yet to be peer-reviewed, suggests that a higher level of leg muscle strength appears to be “strongly associated” with a lower risk of developing heart failure after a heart attack. The study was presented in May at the Heart Failure 2023 scientific congress of the European Society of Cardiology, in Prague.

It further pointed out that regular exercise and maintaining muscle strength in old age, as muscle mass can diminish with age, possibly affects cardiovascular health, said authors of the research — Kensuke Ueno and Dr Kentaro Kamiya — both researchers in the Department of Rehabilitation at Kitasato University School of Allied Health Sciences in Japan.

Kamiya said that after a heart attack, medically known as a myocardial infarction, the heart can go through a process called myocardial or cardiac remodelling in which fibrous tissue accumulates, causing an enlargement of the heart. “Cardiac remodelling is the main cause of the onset of heart failure after myocardial infarction,” Kamiya said, adding that myokines, which are peptides or chains of amino acids released by muscle fibres, may play a role.

The study analysed the strength of the quadricep muscles – in the fronts of the thighs – of 932 people ages 57 to 74 who had been hospitalised due to heart attack between 2007 and 2020.

The press release stated that maximal quadriceps strength was measured as an indicator of leg strength. It noted, “Patients sat on a chair and contracted the quadriceps muscles as hard as possible for five seconds. A handheld dynamometer attached to the ankle recorded the maximum value in kg. The measurement was performed on each leg and the researchers used the average of both values. Strength was expressed relative to body weight, meaning that quadriceps strength in kg was divided by body weight in kg and multiplied by 100 for a percentage body weight value.”

Notably, the median value for women was 33 per cent body weight and the median value for men was 52 per cent body weight. “A total of 451 patients had low quadriceps strength and 481 had high strength. During an average follow-up of 4.5 years, 67 patients (7.2 per cent) developed heart failure,” it read.

The study found that the incidence rate of subsequent heart failure was higher, at 22.9 per 1,000 person-years, among the patients whose quadriceps were measured as having low strength, compared with an incidence rate of 10.2 per 1,000 person-years among those with high quadriceps strength. Person-years are a measurement that represents the number of people in a study multiplied by the years following them.

strong leg muscle

How does heart health get affected by strong leg muscles? (Source: Getty Images/Thinkstock)

“Quadriceps strength is easy and simple to measure accurately in clinical practice. Our study indicates that quadriceps strength could help to identify patients at a higher risk of developing heart failure after myocardial infarction who could then receive more intense surveillance,” Ueno said in a press release. “The findings need to be replicated in other studies, but they do suggest that strength training involving the quadriceps muscles should be recommended for patients who have experienced a heart attack to prevent heart failure,” added the author.

Interestingly, this isn’t the first time scientists have studied the association between muscle strength and the prognosis for people with cardiovascular disease. In 2016, Kamiya and his colleagues, in a study published in the American Journal of Cardiology, said that muscle mass in the upper arms could be associated with rates of surviving heart disease.

So, do quadricep muscles play a part in preventing heart attacks?

Dr Shrey Srivastav, MD (Internal Medicine), Sharda Hospital, Noida suggested that exercise could help reduce the force of changes post-cardiac issues. “In addition, recent studies have shown that skeletal muscle itself also releases myokines, and cytokines that have various effects, such as preventing the progression of atherosclerosis (the buildup of fats, cholesterol, and other substances in and on the artery walls), controlling blood pressure and preventing the development of age-related diseases,” he said.

According to him, maintaining skeletal muscle itself could be associated with a reduced risk of developing heart failure via myokine. “Quadriceps strength could help to identify patients at a higher risk of developing heart failure after myocardial infarction because it’s a strong and long muscle which produces more myokines and helps to reduce heart failure risk, especially after heart attack,” Dr Srivastav told

People with strong leg muscles are more likely to be active, which can help reduce the risk of obesity, diabetes, and other chronic diseases, mentioned Dr A Ravikanth, senior cardiologist, Kamineni Hospitals, Hyderabad. “There are many ways to do this including walking, running, biking, and swimming,” said Dr Ravikanth.

However, Dr Subhendu Mohanty, interventional cardiologist, Sharda Hospital, Noida pointed out that the study is new and needs to be corroborated by more data. “The study points out that people with stronger quadriceps had a better outcome, which means that patients who used to exercise regularly before a heart attack had a better outcome than others. This is a well-known fact. However, how much leg exercise will be better after a heart attack, and whether this relates to just leg exercises or exercises of any body part, needs to be validated by more trials,” he emphasised.

Nevertheless, experts suggest that even if you have already had a heart attack, strengthening your leg muscles will only improve health and well-being. “Talk to your doctor about a safe and effective exercise program for you,” said Dr Ravikanth.

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