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Effect of Antihypertensive and Statin Medication Use on Muscle Performance in Community-Dwelling Older Adults Performing Strength Training

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Abstract

Objectives

Antihypertensive drugs (AHTD) and statins have been shown to have effects beyond their primarily designed purpose; here we investigate their possible effect on muscle performance and strength in older adults following a physical exercise programme.

Design

The Senior PRoject INtensive Training (SPRINT) study is a randomised, controlled clinical trial designed to evaluate the effects of physical exercise on the immune system and muscle performance in older adults.

Participants

In this secondary analysis, we included 179 independent participants (aged 65 years and above). We applied further categorisation based on medication use: AHTD (including, angiotensin-converting enzyme inhibitors [ACEI], angiotensin II receptor blockers [ARB], β-blockers, and other AHTD) and statins.

Intervention

Participants were allocated randomly to one of the three exercise protocols: intensive strength training 3 times/week (3 × 10 repetitions at 80% of one-repetition maximum), strength endurance training (2 × 30 repetitions at 40% of one-repetition maximum), or control (passive stretching exercise) for 6 weeks.

Measurements

The change in maximal hand grip strength (GS), muscle fatigue resistance (FR), Muscle Strength Index (MSI), the 6-min walk test (6MWT), and Timed Up and Go Test (TUG) were assessed before and after 6 weeks of training.

Results

After 6 weeks, muscle strength (MSI and TUG) improved significantly in all training groups compared to baseline, independently of AHTD use. Moreover, AHTD had no effect on exercise improvements, with no significant differences between medication groups, except for TUG in ARB users, which exhibited a significantly lower performance. On the other hand, statin users presented a significantly longer FR time, indicating better performance compared to non-users. Finally, medication did not affect the participants’ commitment to the training programme.

Conclusion

Our study showed that statins and ARB usage might affect participant’s response to strength training. Nevertheless, 6 weeks of training significantly improved muscle strength and performance irrespective of AHTD or statin use.

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References

  1. Dent E, Morley JE, Arai H, Kritchevsky SB, Guralnik J, Bauer JM, et al. International clinical practice guidelines for sarcopenia (ICFSR): screening, diagnosis and management. J Nutr Health Aging. 2018;22:1148–61.

    Article  CAS  PubMed  Google Scholar 

  2. Cruz-Jentoft AJ, Bahat G, Bauer J, Boirie Y, Bruyère O, Cederholm T, et al. Sarcopenia: revised European consensus on definition and diagnosis. Age Ageing. 2019;48:16–31.

    Article  PubMed  Google Scholar 

  3. Mijnarends DM, Schols JMGA, Halfens RJG, Meijers JMM, Luiking YC, Verlaan S, et al. Burden-of-illness of Dutch community-dwelling older adults with sarcopenia: health related outcomes and costs. Eur Geriatr Med. 2016;7:276–84.

    Article  Google Scholar 

  4. Brotto M, Abreu EL. Sarcopenia: pharmacology of today and tomorrow. J Pharmacol Exp Ther. 2012;343:540–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Coelho VA, Probst VS, Nogari BM, Teixeira DC, Felcar JM, Santos DC, et al. Angiotensin-II blockage, muscle strength, and exercise capacity in physically independent older adults. J Phys Ther Sci. 2016;28:547–52.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Chang Y, Wei W. Angiotensin II in inflammation, immunity and rheumatoid arthritis. Clin Exp Immunol. 2015;179:137–45.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Corsonello A, Garasto S, Abbatecola AM, Rose G, Passarino G, Mazzei B, et al. Targeting inflammation to slow or delay functional decline: where are we? Biogerontology. 2010;11:603–14.

    Article  CAS  PubMed  Google Scholar 

  8. Antonopoulos AS, Margaritis M, Lee R, Channon K, Antoniades C. Statins as anti-inflammatory agents in atherogenesis: molecular mechanisms and lessons from the recent clinical trials. Curr Pharm Des. 2012;18:1519–30.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Cruz-Jentoft AJ, Landi F, Schneider SM, Zúñiga C, Arai H, Boirie Y, et al. Prevalence of and interventions for sarcopenia in ageing adults: a systematic review. Report of the International Sarcopenia Initiative (EWGSOP and IWGS). Age Ageing. 2014;43:748–59.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Gleeson M, Bishop NC, Stensel DJ, Lindley MR, Mastana SS, Nimmo MA. The anti-inflammatory effects of exercise: mechanisms and implications for the prevention and treatment of disease. Nat Rev Immunol. 2011;11:607–15.

    Article  CAS  PubMed  Google Scholar 

  11. Alturki M, Beyer I, Mets T, Bautmans I. Impact of drugs with anti-inflammatory effects on skeletal muscle and inflammation: a systematic literature review. Exp Gerontol [Internet]. 2018;114:33–49. https://doi.org/10.1016/j.exger.2018.10.011.

    Article  CAS  Google Scholar 

  12. Cesari M, Kritchevsky SB, Atkinson HH, Penninx BW, Di Bari M, Tracy RP, et al. Angiotensin-converting enzyme inhibition and novel cardiovascular risk biomarkers: results from the Trial of Angiotensin Converting Enzyme Inhibition and Novel Cardiovascular Risk Factors (TRAIN) study. Am Heart J. 2009;157:334-e1.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Cesari M, Pedone C, Incalzi RA, Pahor M. ACE-inhibition and physical function: results from the Trial of Angiotensin-Converting Enzyme Inhibition and Novel Cardiovascular Risk Factors (TRAIN) study. J Am Med Dir Assoc. 2010;11:26–32.

    Article  PubMed  Google Scholar 

  14. Cao Dinh H, Njemini R, Onyema OO, Beyer I, Liberman K, De Dobbeleer L, et al. Strength endurance training but not intensive strength training reduces senescence-prone T-cells in peripheral blood in community-dwelling elderly women. J Gerontol Ser A. 2018;74:1870–8.

    Article  Google Scholar 

  15. Cao Dinh H, Bautmans I, Beyer I, Onyema OO, Liberman K, De Dobbeleer L, et al. Six weeks of strength endurance training decreases circulating senescence-prone T-lymphocytes in cytomegalovirus seropositive but not seronegative older women. Immun Ageing. 2019;16:17.

    Article  PubMed  PubMed Central  Google Scholar 

  16. WHO Colaborating Center for Drugs Statistics Methodology. 2020. https://www.whocc.no/atc_ddd_index/. Accessed 23 Oct 2020.

  17. Bautmans I, Mets T. A fatigue resistance test for elderly persons based on grip strength: reliability and comparison with healthy young subjects. Aging Clin Exp Res. 2005;17:217–22.

    Article  PubMed  Google Scholar 

  18. Dinh HC, Bautmans I, Beyer I, Mets T, Onyema OO, Forti LN, et al. Association between immunosenescence phenotypes and pre-frailty in older subjects: does cytomegalovirus play a role? J Gerontol A Biol Sci Med Sci. 2019;74:480–8.

    Article  CAS  Google Scholar 

  19. Peeters P, Mets T. The 6-minute walk as an appropriate exercise test in elderly patients with chronic heart failure. J Gerontol Ser A Biol Sci Med Sci. 1996;51:147–51.

    Article  Google Scholar 

  20. Savva GM, Donoghue OA, Horgan F, O’Regan C, Cronin H, Kenny RA. Using timed up-and-go to identify frail members of the older population. J Gerontol Ser A Biol Sci Med Sci. 2013;68:441–6.

    Article  Google Scholar 

  21. Ligthart GJ, Corberand JX, Fournier C, Galanaud P, Hijmans W, Kennes B, Müller-Hermelink HK, Steinmann GG. Admission criteria for immunogerontological studies in man: the SENIEUR protocol. Mech Ageing Dev. 1984;28:47–55.

    Article  CAS  PubMed  Google Scholar 

  22. Bautmans I, Lambert M, Mets T. The six-minute walk test in community dwelling elderly: influence of health status. BMC Geriatr. 2004;4:6.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Onder G, Della C, Pahor M. Effects of ACE inhibitors on skeletal muscle. Curr Pharm Des. 2006;12:2057–64.

    Article  CAS  PubMed  Google Scholar 

  24. Sumukadas D, Struthers AD, McMurdo MET. Sarcopenia - a potential target for angiotensin-converting enzyme inhibition? Gerontology. 2006;52:237–42.

    Article  CAS  PubMed  Google Scholar 

  25. Rolland Y, Onder G, Morley JE, Gillette-guyonet S. Current and future pharmacologic treatment of sarcopenia. Clin Geriatr Med. 2011;27:423–47.

    Article  PubMed  Google Scholar 

  26. Campins L, Camps M, Riera A, Pleguezuelos E, Yebenes JC, Serra-Prat M. Oral drugs related with muscle wasting. Pharmacology. 2017;99:1–8.

    Article  CAS  PubMed  Google Scholar 

  27. Sumukadas D, Witham MD, Struthers AD, Mcmurdo MET. ACE inhibitors as a therapy for sarcopenia—evidence and possible mechanisms. J Nutr Health Aging. 2008;12:480.

    Article  CAS  PubMed  Google Scholar 

  28. Zi M, Carmichael N, Lye M. The effect of quinapril on functional status of elderly patients with diastolic heart failure. Cardiovasc Drugs Ther. 2003;17:133–9.

    Article  CAS  PubMed  Google Scholar 

  29. George CJ, Verghese J. Gait performance in hypertensive patients on angiotensin-converting enzyme inhibitors. J Am Med Dir Assoc. 2016;17:737–40.

    Article  PubMed  Google Scholar 

  30. Gray SL, Aragaki AK, Lamonte MJ, Cochrane BB, Kooperberg C, Robinson JG, et al. Statins, angiotensin-converting enzyme inhibitors and physical performance in older women. Am Geriatr Soc. 2012;60:2206–14.

    Article  Google Scholar 

  31. Spira D, Walston J, Buchmann N, Nikolov J, Demuth I, Steinhagen-Thiessen E, et al. Angiotensin-converting enzyme inhibitors and parameters of sarcopenia: relation to muscle mass, strength and function: data from the Berlin Aging Study-II (BASE-II). Drugs Aging. 2016;33:829–37.

    Article  PubMed  Google Scholar 

  32. Buford TW, Manini TM, Hsu F-C, Cesari M, Anton SD, Nayfield S, et al. Angiotensin-converting enzyme inhibitor use by older adults is associated with greater functional responses to exercise. J Am Geriatr Soc [Internet]. 2012;60:1244–52. https://doi.org/10.1111/j.1532-5415.2012.04045.x.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Baptista LC, Machado-Rodrigues AM, Veríssimo MT, Martins RA. Exercise training improves functional status in hypertensive older adults under angiotensin converting enzymes inhibitors medication. Exp Gerontol. 2018;109:82–9.

    Article  CAS  PubMed  Google Scholar 

  34. Sumukadas D, Band M, Miller S, Cvoro V, Witham M, Struthers A, et al. Do ACE inhibitors improve the response to exercise training in functionally impaired older adults? A randomized controlled trial. J Gerontol Ser A Biol Sci Med Sci. 2014;69:736–43.

    Article  CAS  Google Scholar 

  35. Gerdts E, Björnstad H, Devereux RB, Lund-Johansen P, Davidsen ES, Omvik P. Exercise performance during losartan- or atenolol-based treatment in hypertensive patients with electrocardiographic left ventricular hypertrophy (a LIFE substudy). Blood Press. 2006;15:220–6.

    Article  CAS  PubMed  Google Scholar 

  36. Multicenter A, Trial PC, Dore A, Houde C, Chan K, Ducharme A, et al. Angiotensin receptor blockade and exercise capacity in adults with systemic right ventricles. Circulation. 2005;112:2411–6.

    Article  Google Scholar 

  37. Kurklinsky AK, Levy M. Effect of ramipril on walking times and quality of life among patients with peripheral artery disease and intermittent claudication: A randomized controlled trial. Vasc Med. 2013;18:234–6.

    Article  PubMed  Google Scholar 

  38. Witham MD, Sumukadas D, McMurdo MET. ACE inhibitors for sarcopenia—as good as exercise training? Age Ageing. 2008;37:363–5.

    Article  PubMed  Google Scholar 

  39. McAvay G, Allore HG, Cohen AB, Gnjidic D, Murphy TE, Tinetti ME. Guideline-recommended medications and physical function in older adults with multiple chronic conditions. J Am Geriatr Soc. 2017;65:2619–26.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Reid JL, Rubin PC, Whiting B. Lecture notes on clinical pharmacology. 6th ed. Hoboken: Wiley; 2001.

    Google Scholar 

  41. Lee DSH, Markwardt S, Goeres L, Christine G, Eckstrom E, Williams C, et al. Statins and physical activity in older men: the osteoporotic fractures in men study. JAMA Intern Med. 2014;174:1263–70.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Parker BA, Capizzi JA, Grimaldi AS, Clarkson PM, Cole SM, Keadle J, et al. The effect of statins on skeletal muscle function. Circulation. 2013;127:96–103.

    Article  CAS  PubMed  Google Scholar 

  43. Villafrádez-díaz M, Santiago-casas Y, Nieves-plaza M, Vilá LM. Association of the use of statins with disease activity and functional status in Puerto Ricans with rheumatoid arthritis. P R Health Sci J. 2014;33:3–8.

    PubMed  PubMed Central  Google Scholar 

  44. Dumurgier J, Singh-Manoux A, Tavernier B, Tzourio C, Elbaz A. Lipid-lowering drugs associated with slower motor decline in the elderly adults. J Gerontol Ser A Biol Sci Med Sci. 2014;69(A):199–206.

    Article  CAS  Google Scholar 

  45. Galindo-Ocaña J, Bernabeu-Wittel M, Formiga F, Fuertes-Martín A, Barón-Franco B, Murcia-Zaragoza JM, et al. Effects of renin-angiotensin blockers/inhibitors and statins on mortality and functional impairment in polypathological patients. Eur J Intern Med [Internet]. 2012;23:179–84. https://doi.org/10.1016/j.ejim.2011.06.004.

    Article  CAS  PubMed  Google Scholar 

  46. Kawai H, Ihara K, Kera T, Hirano H, Fujiwara Y, Tanaka M, et al. Association between statin use and physical function among community-dwelling older Japanese adults. Geriatr Gerontol Int [Internet]. 2017;18:623–30. https://doi.org/10.1111/ggi.13228.

    Article  Google Scholar 

  47. van Boheemen L, Tett SE, Sohl E, Hugtenburg JG, van Schoor NM, Peeters GMEE. Associations between statin use and physical function in older adults from the Netherlands and Australia: Longitudinal Aging Study Amsterdam and Australian Longitudinal Study on Women’s Health. Drugs Aging. 2016;33:437–45.

    Article  PubMed  Google Scholar 

  48. Woo J, Leung J, Sham A, Kwok T. Defining sarcopenia in terms of risk of physical limitations: a 5-year follow-up study of 3,153 Chinese men and women. J Am Geriatr Soc. 2009;57:2224–31.

    Article  PubMed  Google Scholar 

  49. Onder G, Vedova CD, Landi F. Validated treatments and therapeutics prospectives regarding pharmacological products for sarcopenia. JNHA J Nutr Health Aging. 2009;13:746–57.

    Article  CAS  PubMed  Google Scholar 

  50. Noyes AM, Thompson PD. The effects of statins on exercise and physical activity. J Clin Lipidol [Internet]. 2017;11:1134–44. https://doi.org/10.1016/j.jacl.2017.07.003.

    Article  PubMed  Google Scholar 

  51. Bahls M, Groß S, Ittermann T, Busch R, Gla S, Felix SB, et al. Statins are related to impaired exercise capacity in males but not females. PLoS ONE. 2017;12:e0179534.

    Article  PubMed  PubMed Central  Google Scholar 

  52. Robinson MM, Hamilton KL, Miller BF. The interactions of some commonly consumed drugs with mitochondrial adaptations to exercise. J Appl Physiol. 2009;107:8–16.

    Article  CAS  PubMed  Google Scholar 

  53. Scott D, Blizzard L, Fell J, Jones G. Statin therapy, muscle function and falls risk in community-dwelling older adults. QJM Int J Med. 2009;102:625–33.

    Article  CAS  Google Scholar 

  54. Joshi PH, Jacobson TA. Therapeutic options to further lower C-reactive protein for patients on statin treatment. Curr Atheroscler Rep. 2010;12:34–42.

    Article  CAS  PubMed  Google Scholar 

  55. Meredith KG, Horne BD, Pearson RR, Maycock CA, Lappe DL, Anderson JL, et al. Comparison of effects of high (80 mg) versus low (20 mg) dose of simvastatin on C-reactive protein and lipoproteins in patients with angiographic evidence of coronary arterial narrowing. Am J Cardiol. 2007;99:149–53.

    Article  CAS  PubMed  Google Scholar 

  56. Ding C, Hu M, Wu YJ, Tomlinson B. Achievement of specified lipid and high-sensitivity C-reactive protein levels with two statins in Chinese patients with hypercholesterolaemia. Lipid Health Dis [Internet]. 2015;14:1–7. https://doi.org/10.1186/s12944-015-0116-0.

    Article  CAS  Google Scholar 

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Acknowledgements

The authors acknowledge and greatly appreciate all participants for their contribution to science by participating in the SPRINT study.

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Authors and Affiliations

  1. Gerontology Department (GERO), Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090, Brussels, Belgium

    Mohammad Alturki, Keliane Liberman, Andreas Delaere, Liza De Dobbeleer, Veerle Knoop, Tony Mets, Siddhartha Lieten, Bert Bravenboer, Ingo Beyer & Ivan Bautmans

  2. Frailty in Aging Research Group (FRIA), Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090, Brussels, Belgium

    Mohammad Alturki, Keliane Liberman, Andreas Delaere, Liza De Dobbeleer, Veerle Knoop, Tony Mets, Siddhartha Lieten, Bert Bravenboer, Ingo Beyer & Ivan Bautmans

  3. Department of Geriatrics, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium

    Liza De Dobbeleer, Tony Mets, Siddhartha Lieten, Bert Bravenboer, Ingo Beyer & Ivan Bautmans

Authors
  1. Mohammad Alturki
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  2. Keliane Liberman
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  3. Andreas Delaere
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  4. Liza De Dobbeleer
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  5. Veerle Knoop
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  6. Tony Mets
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  7. Siddhartha Lieten
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  8. Bert Bravenboer
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  9. Ingo Beyer
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  10. Ivan Bautmans
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Corresponding author

Correspondence to Ivan Bautmans.

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Funding

This study was partly funded by the Wetenschappelijk Fonds Willy Gepts of the Universitair Ziekenhuis Brussel and Strategic Growth Funding from the Research Council of the Vrije Universiteit Brussel. M. Alturki was supported by the Custodian of ‘The Two Holy Mosques' Overseas Scholarship Program (no funding ID available).

Conflicts of interest

The authors have declared no other conflicts of interest for this article. The sponsors had no role in the design, methods, subject recruitment, data collections, analysis, or preparation of the article.

Ethics approval

The study protocol is in accordance with the Declaration of Helsinki and was approved from the local Ethics Committee (IRB 2011/257).

Consent to participate

All participants gave written informed consent to participate.

Consent for publication

All participants gave written informed consent for publication.

Availability of data and material

All data and material are available.

Code availability

Not applicable.

Author contributions

IB and TM designed the study. All authors contributed to the data collection. MA and IB analyzed and interpreted the data. MA wrote the first draft of the manuscript and structured the figures and tables. All the authors reviewed the draft, contributed to the revision of the manuscript, and approved the final version of the manuscript.

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Alturki, M., Liberman, K., Delaere, A. et al. Effect of Antihypertensive and Statin Medication Use on Muscle Performance in Community-Dwelling Older Adults Performing Strength Training. Drugs Aging 38, 253–263 (2021). https://doi.org/10.1007/s40266-020-00831-5

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