Unravelling the link between strong legs and a healthy heart

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Our heart is the engine that powers our body. Like any engine, it can sometimes break down, which can lead to a condition known as heart failure.

One common cause of heart failure is a heart attack, also known as a myocardial infarction.

In fact, between 6 to 9% of heart attack patients end up developing heart failure. It’s a worrying statistic. But there’s a light at the end of the tunnel.

New research suggests that something as simple as having strong legs might protect your heart. It’s an intriguing connection, and it all centers on one particular muscle group – the quadriceps.

The Study

Researchers presented their findings at Heart Failure 2023, a meeting organized by the European Society of Cardiology (ESC).

They shared the results of a study involving 932 individuals who had survived heart attacks.

These weren’t just any patients, though. They had to fit specific criteria. Firstly, they were admitted to the hospital between 2007 and 2020 because of a heart attack.

Importantly, they didn’t have heart failure before their hospital stay and didn’t develop it while they were there. The majority of these participants were men (81%), and the average age was 66 years.

Testing Quadriceps Strength

This study’s focus was to explore whether the strength of a patient’s legs, specifically their quadriceps, affected their risk of developing heart failure after a heart attack.

How did they measure this strength, you might ask? They did it with a device that sounds like it belongs in a superhero comic: a handheld dynamometer.

Patients sat on a chair and gave everything they got to flex their quadriceps for five seconds.

The dynamometer, attached to their ankle, measured their strength in kilograms. They repeated this process for both legs, and the researchers took the average value.

Calculating Strength to Body Weight Ratio

But the story didn’t end there. The researchers weren’t just interested in raw strength. They wanted to see how that strength compared to each patient’s body weight.

So, they took the kilogram strength value, divided it by the patient’s body weight in kilograms, and multiplied the result by 100. The resulting percentage gave them a strength-to-body weight ratio.

Based on these calculations, they divided the patients into two groups.

One group consisted of those with a strength-to-body weight ratio above the median for their sex (‘high strength’), and the other group had a ratio below the median (‘low strength’).


The results were eye-opening. Over a period of about 4.5 years, a total of 67 patients (7.2%) developed heart failure. When the researchers looked closer, they noticed a trend.

Patients with high quadriceps strength had a lower rate of heart failure, specifically, 10.2 per 1,000 person-years, compared to 22.9 per 1,000 person-years in the low strength group.

Even after considering other factors known to affect heart failure risk (like age, sex, BMI, prior heart issues, diabetes, atrial fibrillation, lung disease, peripheral arterial disease, and kidney function), the trend held up.

Patients with high leg strength had a 41% lower risk of developing heart failure.

Conclusions and Recommendations

The lead author of the study, Kensuke Ueno, a physical therapist from Japan, points out that quadriceps strength is a simple and reliable measure that clinicians can use to identify patients at higher risk of developing heart failure post-heart attack.

This ground-breaking research suggests that targeted strength training, specifically for the quadriceps, could be beneficial for heart attack survivors in warding off heart failure.

While further studies are required to cement these findings, the potential for a simple strength-building intervention to boost heart health is a promising step in the right direction.

If you care about heart health, please read studies about best time to take vitamins to prevent heart disease, and tongues of people with heart failure look totally different.

For more information about heart health, please see recent studies about how espresso coffee affects your cholesterol level, and results showing Vitamin K2 could help reduce heart disease risk.

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