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Exercise can be as effective as many frequently prescribed drugs in
treating some of the leading causes of death, according to a new report.
The study raises important questions about whether our health care
system focuses too much on medications and too little on activity to
combat physical ailments.
For the study, which was published in October in BMJ,
researchers compared how well various drugs and exercise succeed in
reducing deaths among people who have been diagnosed with several common
and serious conditions, including heart disease and diabetes.
Comparative effectiveness studies are a staple of science, of course,
especially in pharmaceutical research. Scientists often track how well
one drug treats a condition compared with the outcome if they use a
different drug. But few studies have directly compared drugs with
exercise, and even fewer have compared outcomes in terms of mortality or
whether the intervention significantly lessens the chance that someone
with a disease will die from it, despite treatment.
So Huseyin Naci, a graduate student at the London School of Economics
and Political Science, and Dr. John Ioannidis, the director of the
Stanford Prevention Research Center at the Stanford University School of
Medicine, decided to create a comprehensive comparison of the
effectiveness of drugs and exercise in lessening mortality among people
who had been diagnosed with one of four diseases: heart disease, chronic
heart failure, stroke or diabetes. They chose these particular
conditions because those were the only ones for which they could find
studies that had examined whether exercise lessened the risk of death
among patients with that disease, Mr. Naci said.
He and Dr. Ioannidis then gathered all of the recent randomized
controlled trials, as well as previous reviews and meta-analyses of
older experiments relating to mortality among patients with those
diseases, whether they had been treated with drugs or exercise.
They ended up with data covering 305 past experiments that,
collectively, involved almost 340,000 participants, which is an
impressive total. But most of the volunteers had received drugs. Only 57
of the experiments, involving 14,716 volunteers, had examined the
impact of exercise as a treatment.
Still, the numbers were large enough that Mr. Naci and Dr. Ioannidis
could create an elaborate network of cross-references, comparing the
outcomes when people received certain drugs, followed exercise regimens
or, occasionally, both. The exercise routines, typically part of
rehabilitation programs, usually involved walking or other aerobic
routines but sometimes consisted of weight training or other exercises.
The researchers compared mortality risks for people following any of the treatment options.
The results consistently showed that drugs and exercise produced
almost exactly the same results. People with heart disease, for
instance, who exercised but did not use commonly prescribed medications,
including statins, angiotensin-converting-enzyme inhibitors or
antiplatelet drugs, had the same risk of dying from — or surviving —
heart disease as patients taking those drugs. Similarly, people with
diabetes who exercised had the same relative risk of dying from the
condition as those taking the most commonly prescribed drugs. Or as the
researchers wrote in statistics-speak, “When compared head to head in
network meta-analyses, all interventions were not different beyond
On the other hand, people who once had suffered a stroke had
significantly less risk of dying from that condition if they exercised
than if they used medications — although the study authors note that
stroke patients who can exercise may have been unusually healthy to
Only in chronic heart failure were drugs noticeably more effective
than exercise. Diuretics staved off mortality better than did exercise.
Over all, Dr. Ioannidis said, “our results suggest that exercise can
be quite potent” in treating heart disease and the other conditions,
equaling the lifesaving benefits available from most of the commonly
prescribed drugs, including statins. Statins are at the center of a debate about new treatment guidelines that could vastly expand the number of people taking the drugs.
The results also underscore how infrequently exercise is considered
or studied as a medical intervention, Dr. Ioannidis said. “Only 5
percent” of the available and relevant experiments in his new analysis
involved exercise. “We need far more information” about how exercise
compares, head to head, with drugs in the treatment of many conditions,
he said, as well as what types and amounts of exercise confer the most
benefit and whether there are side effects, such as injuries. Ideally,
he said, pharmaceutical companies would set aside a tiny fraction of
their profits for such studies.
But he is not optimistic that such funding will materialize, without widespread public pressure.
For now, Mr. Naci said, he hopes that this new study will prompt
smaller-scale negotiations. “We are not suggesting that anyone stop
taking their medications,” he said. “But maybe people could think long
and hard about their lifestyles and talk to their doctors” about whether
exercise could and should be incorporated into their care.