Q&A: Tai chi benefits; statin side-effects
Q: I have pain in both knees due to osteoarthritis. It’s not too bad, but I want to avoid surgery in the future. What are your thoughts about tai chi?
A: Osteoarthritis develops when cartilage — the tissue that covers bones and acts as a cushion — deteriorates over time, eventually leading to joint damage.
For the early stages of this condition, tai chi may very well decrease your pain and might help prevent the condition from getting worse.
Tai chi is a low-impact, slow-motion exercise you do without pausing through a series of movements. As you move, you breathe deeply and naturally, focusing your attention — as in some kinds of meditation — on your bodily sensations.
Tai chi differs from other types of exercise in several respects. The movements are usually circular and never forced, the muscles are relaxed rather than tensed, the joints are not fully extended or bent, and connective tissues are not stretched.
A study published in Arthritis & Rheumatism found that participants with knee osteoarthritis who practiced tai chi twice a week had less pain and better physical function compared with study participants enrolled in a wellness education and stretching program. The tai chi class lasted 12 weeks, but the improvements were sustained a year later. These participants also reported less depression and greater well-being.
Among other things, tai chi provides benefit by improving muscle strength and coordination, which leads to better joint stability. In addition, the mind-body aspects and breath control promote mental calmness, which may help to break the cycle of arthritis pain.
Taking a class may be the best way to learn tai chi. Watching a teacher in action, getting feedback, and experiencing the camaraderie of a group are all plusses.
Most teachers will let you observe the class first to see if you feel comfortable with the approach and atmosphere. Instruction can be individualized. Ask about classes at your local Y, senior or rec center, or community education center.
If you’d rather learn at home, you can view videos geared to your interests and fitness needs. There are some excellent tai chi books, but it can be difficult to appreciate the flow of movements from still photos or illustrations.
Most beginning programs and tai chi interventions tested in medical research last at least 12 weeks, with instruction once or twice a week and practice at home. By the end of that time, you should know whether you enjoy tai chi, and you may already notice positive physical and psychological changes.
Q: I take a statin to lower my cholesterol. I have been having muscle aches, but I don’t want to stop the statin. What causes the muscle pain? What can I do to minimize this side effect?
A: The true incidence of statin-induced muscle pain is hard to pin down. In clinical studies of people who are randomly assigned to take a statin or a placebo, about 5% to 7% of people in both groups report muscle-related side effects.
But in observational studies and in real-world settings (that is, clinics and doctor’s practices), more people taking statins say they have muscle aches or pains, with rates as high as 29%.
What causes muscle pain from statins has not been conclusively determined. However, according to a new study in the journal JACC: Basic to Translational Science, the answer may be related to abnormal calcium release in muscle cells.
Calcium ions are stored in a muscle cell compartment called the sarcoplasmic reticulum. Normally, the calcium is released into the rest of the cell only during muscle contractions.
However, the researchers found that statins lead to calcium leaks even when the muscles are at rest. Based on muscle biopsies in rats, the researchers found a link between calcium leakage and muscle cell damage.
The researchers could not say for certain that there was a direct cause and effect. But they suggest that people who experience muscle pain from statins may be more susceptible to spontaneous and irregular calcium leakage, perhaps because of genetic predisposition or lifestyle factors.
Although there are no proven remedies for statin-related muscle pain, the following may help.
Exercise. There is some evidence that people who regularly engage in light to moderate exercise before taking statins are less likely to experience muscle symptoms. Of interest, this recent study showed that exercise appeared to prevent calcium leakage in resting muscles, the possible reason for muscle aches.
Change your diet. In addition to regular exercise, adopt a heart-healthy eating plan such as the Mediterranean diet. Doing so may enable you to reduce your statin dosage.
Get a thyroid blood test. An underactive thyroid gland can cause muscle pain and raise your cholesterol level. If you have a low thyroid hormone level, taking replacement thyroid hormone pills may alleviate the muscle aches, as well as lowering your cholesterol.
Take a lower dose or a different statin. You and your doctor might consider going to a lower statin dose or switching to a different statin.
Adding another type of cholesterol-lowering drug called ezetimibe (Zetia), which hasn’t been associated with muscle pain, may also allow you to lower your statin dosage.
For additional consumer health information, visit health.harvard.edu.
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