Table 6.

Conclusions Regarding Statin Use in Exercising Adults

ConclusionSORT CategorizationReferences
Myopathy is a significant adverse outcome of exposure to statins.A40
Addition of statins in exercising adults significantly increases myopathy risk.B18
Addition of statins may present special risk for reduction in physical activity in:
    Very high levels of activityC43
    The elderlyB40, 44, 49
    High-dose statin therapyB18
Statins added to exercise can provide additional protection against cardiovascular events and mortality.B21
A stable level of physical activity should be established before starting a statin.B58, 59
If statins are used, low doses can provide similar protection to high doses in primary prevention.B60, 61
Fluvastatin may be the least myotoxic of the statins and the least likely to cause myalgia with exercise.B18, 35
Ezetimibe and colesevelam do not cause myopathy and may be useful in combination or when added to a statin.B82, 86
Other measures to improve statin tolerance may be useful, but evidence is of low quality and confounded by a considerable nocebo effect.C53, 62, 63, 69, 70
If a choice needs to be made between drug and exercise interventions, continued exercise is the better option.B21
  • SORT, Strength of Recommendation Taxonomy.22