Drugs or Exercise - New Research

Drugs or exercise: is that the question? Researchers based at the London School of Economics, and Harvard Pilgrim Health Care Institute at Harvard Medical School and Stanford University School of Medicine set out to compare the effectiveness of exercise versus drugs on mortality across four conditions: *secondary prevention of coronary heart disease, rehabilitation of stroke, treatment of heart failure and prevention of diabetes.

The study, published in the October 2013 British Medical Journal analyzed the results of 305 randomized, controlled trials involving 339,274 individuals. Their findings:

  • no statistically detectable differences between exercise and drug interventions for secondary prevention of heart disease and prevention of diabetes.
  • Among stroke patients, exercise was more effective than drug treatment, while for heart failure, diuretic drugs were more effective than exercise and all other types of drug treatment.

The authors of the study** point out that the amount of trial evidence on the mortality benefits of exercise is considerably smaller than that on drugs, and this may have had an impact on their results.

From the Study

Practical Implications

“The findings of our review suggest that exercise and many drug interventions are often potentially similar in terms of their mortality benefits; exercise interventions should therefore be considered as a viable alternative to, or alongside, drug therapy. Indeed, an increasing number of experts recommend prescribing an “exercise pill” as a preventive strategy to reduce morbidity and mortality.53”…

Conclusions

“Although limited in quantity, existing randomized trial evidence on exercise interventions suggests that exercise and many drug interventions are often potentially similar in terms of their mortality benefits in the secondary prevention of coronary heart disease, rehabilitation after stroke, treatment of heart failure, and prevention of diabetes.”

Recommendations For Future Directions

“Despite its limitations, this meta-epidemiological review is the first to compare the mortality benefits of exercise and drug interventions. This comprehensive look at the existing body of evidence highlights the need to perform randomized trials on the comparative effectiveness of exercise and drug interventions. Given the scarcity of financial resources to fund future trials of exercise interventions, one option would be to require such evidence from pharmaceutical companies that a are under increasing pressure to perform active-comparator trials for market entry.67” …

*Secondary prevention refers to treating patients with existing disease before it causes significant illness.

**Study authors: John P. Ionnadis, MD, DSc, Stanford University, Huseyin Naci, researcher from the London School of Economics and colleagues

Click here for the full study Comparative effectiveness of exercise and drug interventions on mortality outcomes: metaepidemiological study

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