Push-ups not only provide a great workout but also may be predictive of future heart health. That’s the conclusion of a new study out of Harvard Medical School. It found that study participants who completed more than 40 push-ups were significantly less likely to suffer a heart problem over the next decade than those who completed fewer than 10. And there’s apparent benefit even for those who couldn’t do 40 - each additional 10 push-ups by study participants tended to result in a lower risk, even after taking into account factors like age and Body Mass Index.

We talked to a NorthShore cardiologist to get their thoughts on the study and the push-up:

What do you think of the study results?

This was a really interesting study that validates exercise capacity and cardiorespiratory fitness as markers of lower risk of cardiac events. Patients in this study who were able to perform 40 or more push-ups had a very low 10-year cardiac event rate. While this is not a new concept, this study validates push-up capacity as an objective marker of risk. 

This is great, as this assessment can be done quickly in the office in less than 2 minutes and with no equipment necessary other than a floor! Push-ups are a fantastic whole-body workout that combines strength and cardiovascular fitness. They engage a wide variety of muscles including the chest, shoulders, back, and core; and as anyone who has done push-ups knows, everyone gets their heart rate up when they reach their limit.

So will you start incorporating this into your exams?

There are some patients for whom this would be appropriate, but it is important to remember that this study covered a cohort of men between their 20s and 50s, which isn’t representative of all of my patients. This data would be reproducible in women. The push-up test could be a great way to reassure patients that their risk of events is low, and can also be a great motivator for patients looking to get themselves into better cardiovascular shape.

What currently do you do to assess heart health in your patients?

To evaluate cardiac risk in my patients really depends on what we're looking for, but let’s focus on the risk of coronary artery disease. I always start with a thorough history and physical exam to evaluate symptoms, risk factors and look for abnormalities on the exam. This helps me determine the patient’s level of risk. If I feel that the patient is at intermediate risk of significant disease, I typically will utilize non-invasive testing for further evaluation. I use functional testing such as treadmill stress tests to assess the patient’s functional capacity, see if there are inducible cardiac symptoms such as angina or shortness of breath, and look for objective evidence of ischemia (or lack of blood flow to the heart) on the echocardiographic or nuclear perfusion images, or on the ECG that is being monitored throughout the test.

Alternatively, we have anatomical studies where we are directly looking for evidence of coronary artery disease. CT coronary angiography is an excellent test that gives us a tremendous amount of information. This test does a CT reconstruction of the heart including an accurate assessment of the arteries and presence of a blockage.

One thing that CTs offer beyond stress tests is that they can identify the presence or absence of non-obstructive plaque, which is something that cannot be picked up on a stress test, as they are only assessing for significant blockages. This allows us to diagnose coronary disease earlier in the process, and guide patients on preventative measures such as blood pressure control, cholesterol management and lifestyle modifications. Of course if my suspicion for significant coronary disease is high from the history and physical, I will often refer the patient directly for the gold standard test – invasive coronary angiography.

Most folks probably can’t do 40 push-ups in a row, so should they be worried about a future heart event?

A better way to look at it is that the segment of patients who can perform 40 push-ups should be reassured that they are at low risk of events. The study did look at other ranges of push-up prowess and did find that the more push-ups that patients could do, the better the cardiovascular outcomes even if they did not reach 40, so the benefits of fitness were not all or nothing. The takeaway from this study is that higher levels of fitness are associated with lower levels of risk, and patients should strive to increase their strength and cardiovascular fitness.