Push-ups and your pumper

Dear Doctor Ninja,

I’m a guy in his mid-30’s. I just heard about a study that says if you can do 40 push-ups that your risk of a heart attack is much lower. I can’t do 40 push-ups. If I train myself to do 40 push-ups, can I prevent a heart attack?


C. Hesturts

This study really made the headlines, Mr. Hesturts, didn’t it? Some of devil is in the details here—mostly having to do with “What is a push-up?”

Most people know what a push-up should look like. But for firefighters, the test that is performed has some pretty specific parts:

  1. your chin has to touch a 5-inch tall object (this seems pretty mean for tall people)

  2. your back has to be neutral (no sagging)

  3. you have to do them to an 80beats-per-minute metronome

  4. you have to do the push-ups within 2 minutes

But that’s not all, you also cannot:

  1. Do more than 3 incorrect push-ups

  2. Fail to maintain continuous motion with the metronome cadence

  3. Have any joint or muscular pain, or dizziness or unsteadiness or chest pain while you are doing the test.

So what does this all mean? Let’s break down what it really takes to do 40 push-ups:

To do ONE push-up, you have to have:

  1. the ability to stand or kneel

  2. the ability to get into push-up position (bend over, support weight with hands)

  3. the ability to keep your body straight

  4. the ability to lower yourself to the 5-inch object

  5. the ability to push back up

  6. the balance to support yourself on two hands and feet together

  7. the coordination to get down and up as well as to keep time with the metronome

To do FORTY push-ups, you have to have, in addition:

  1. muscular endurance in your chest, triceps, shoulders

  2. the ability to hold the rest of your body (some might call it your “core”) in a specific position

  3. sufficient strength to do one push-up

A push-up defined in this way isn’t a simple movement. In the end, this has more to do with exercise capability and the ability to exercise at all, than it does directly to do with heart health. Certainly the two are linked—the ability to exercise has to be satisfied before one can exercise and THEN exercise is linked with lower rates of heart attacks. But really, this study is one that compares people with higher-than-average exercise condition with people with much-lower-than-average exercise condition within a group of people (firefighters) who generally have better-than-average exercise condition.

What’s interesting is that we aren’t told of those men in the 0-10 push-up group, how many could do 0 push-ups vs any non-zero number. The kinds of things that would prevent you from doing a single push-up range from being extraordinarily weak, to a wide range of medical problems that are already linked with bad outcomes of all kinds, including heart attacks.

The other interesting number in this study is that of 1104 participants, the number of heart-related events was 37. In the general population, over 10 years, we would expect there to be about 55 first-time heart attacks (both fatal and non-fatal), so taking this into consideration, firefighters, no matter how many push-ups they can do seem to be at lower risk for heart-related events than the general population. However, amongst the firefighters who could only do 0-10 push-ups there were 8 heart-related events, which is almost 2 times higher than the general population rate which we would expect to be around 3 or 4.

The main message of this paper is that a push-up test doesn’t require a lot of fancy equipment (you need a 5-inch tall thing that will stand on its own, a metronome, and enough floor space to do a push-up without touching any walls) and that there might be a link between being able to do 40 push-ups and not being able to do 40 push-ups within 2 minutes and your first heart attack. Oddly, I think the floor space is more the barrier, given how tiny examination rooms are in doctors’ offices.

If you can’t do 40 push-ups now, then there’s going to be a certain amount of work that has to be done to get to 40. It might be a lot of work if your current number is less than 10 but more than 0. That work would be exercise. So can you prevent a heart attack if you train yourself to do 40 push-ups? Well, if exercise is linked with a lower risk of heart attacks, and you have to exercise enough to have a body that can do 40 push-ups, then yes, you’ll reap the rewards that come with that, because to get to 40 push-ups and stay there, you have to develop a habit of exercise.

Whether or not it will prevent a heart attack depends entirely if you were going to have one in the first place.