People with strong legs are less likely to develop heart failure after a heart attack

Heart attack patients with strong legs have better prognosis.


Heart failure is most frequently caused by myocardial infarction, with 6-9% of heart attack victims eventually developing the illness. Previous studies have demonstrated that people with coronary artery disease who have powerful quadriceps have a lower risk of dying.

A new study tested the hypothesis that leg strength is associated with a lower risk of developing heart failure after acute myocardial infarction. The study found that people with strong legs are less likely to develop heart failure after a heart attack.

The study included 932 individuals with acute myocardial infarction hospitalized from 2007 to 2020 who did not have heart failure at the time of admission and did not experience heart failure problems while in the hospital. In this study, 753 participants (81%) were male, with a median age of 66.

As a gauge of leg strength, the maximum quadriceps strength was tested. Patients tightened their quadriceps muscles as much as they could for five seconds while sitting on a chair. A portable dynamometer fastened to the ankle captured the highest kilogram reading. 

The measurements were taken on both legs, and the researchers averaged the results. Strength was expressed as a percentage of body weight, calculated by dividing quadriceps strength in kg by body weight in kg and multiplying the result by 100. Depending on whether their value was higher than or lower than the median for their selves, patients were categorized as having “high” or “low” strength.

Men had a median body weight of 52%, while women had a median body weight of 33%. There were 481 patients with high quadriceps strength and 451 with low quadriceps strength. Sixty-seven individuals (7.2%) with an average follow-up of 4.5 years experienced heart failure. In patients with high quadriceps and poor quadriceps strength, the incidence of heart failure was 10.2 per 1,000 person-years and 22.9 per 1,000 person-years, respectively.

The researchers examined the relationship between quadriceps strength (low vs. high) and the chance of getting heart failure. Age, sex, body mass index, previous myocardial infarction or angina pectoris, diabetes, atrial fibrillation, chronic obstructive pulmonary disease, peripheral arterial disease, kidney function, and prior myocardial infarction or angina pectoris were all considered in the analysis. High quadriceps strength was linked to a 41% lower risk of having heart failure compared to low quadriceps strength (hazard ratio [HR]: 0.59; 95% confidence interval [CI] 0.35-1.00; p=0.048).

The investigators also analyzed the association between quadriceps strength as a continuous variable and the risk of developing heart failure. Each 5% body weight increment in quadriceps strength was associated with an 11% lower likelihood of heart failure.

Study author Mr. Kensuke Ueno, a physical therapist at the Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan, said: “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. The findings need to be replicated in other studies. Still, 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.”

References and notes:

  1. The abstract ‘Leg strength and incidence of heart failure in patients with acute myocardial infarction’ will be presented during the session ‘Rehabilitation and Sports Cardiology – Cardiovascular Rehabilitation,’ which takes place on 20 May at 16:00 CEST at Moderated ePosters 3.
  2. Jenča D, Melenovský V, Stehlik J, et al. Heart failure after myocardial infarction: incidence and predictors. ESC Heart Fail. 2021;8:222–237.
  3. Lewis EF, Moye LA, Rouleau JL, et al. Predictors of late development of heart failure in stable survivors of myocardial infarction: the CARE study. J Am Coll Cardiol. 2003;42:1446–1453.
  4. Spencer FA, Meyer TE, Gore JM, Goldberg RJ. Heterogeneity in the management and outcomes of patients with acute myocardial infarction complicated by heart failure. Circulation. 2002;105:2605–2610.
  5. Kamiya K, Masuda T, Tanaka S, et al. Quadriceps strength as a predictor of mortality in coronary artery disease. Am J Med. 2015;128:1212–1219. 
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