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Exercise vs. Medications on Mortality Outcomes

Dec 12, 2013
 

Researchers may be concentrating so much on pharmaceutical interventions that they are neglecting the health benefits of exercise….

A low percentage of adults exercise regularly but prescription medications utilization is on the rise. In this meta-epidemiological study, researchers studied the comparative effectiveness of exercise versus drug interventions on mortality outcomes.

The authors included meta-analyses of randomized controlled trials with mortality outcomes comparing the effectiveness of exercise and drug interventions with each other or with control. A total of 16 (four exercise and 12 drug) meta-analyses were included. In additional three recent exercise trials were also included. These meta-analyses collectively included 305 randomized controlled trials with 339,274 participants; however, only 57 of these trials, representing 14,716 participants, looked at exercise. The characteristics of the exercise interventions varied across treatment areas. Exercise based cardiac rehabilitation was typically a component of comprehensive cardiac care of patients with coronary heart disease. Patients with stroke received a mix of cardiorespiratory and muscle strengthening exercises. Similarly, exercise interventions targeting patients with chronic heart failure included aerobic and resistance training.

In the results, researchers found no statistically detectable differences between exercise and drug interventions in the secondary prevention of coronary heart disease and prediabetes. Physical activity interventions were more effective than drug treatment among patients with stroke. In heart failure, diuretics outperformed all comparators, including exercise.

Based on these findings, the authors conclude 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.

Practice Pearls:
  • There were no statistically detectable differences between exercise and drug interventions in the secondary prevention of coronary heart disease and prediabetes.
  • Physical activity interventions were more effective than drug treatment among patients with stroke.
  • In heart failure, diuretics outperformed all comparators, including exercise.

BMJ, October 2013