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Exercise has the potential to be as effective as drug intervention

The British Medical Journal has published a new study by Huseyin Naci and John P. A. Ioannidis on the ‘Comparative effectiveness of exercise and drug interventions on mortality outcomes’. The study incorporates 16 meta-analyses which included 305 randomised controlled trials with 339,274 participants. (Accessible: http://www.bmj.com/content/347/bmj.f5577)

Background

Physical activity has been ranked as the fifth largest cause of disease burden in Western Europe by the Global Burden of Disease study. Evidence has previously shown that physical activity and exercise have beneficial impacts on a person’s health and quality of life, and that a positive correlation exists between physical activity and exercise and arthritis, diabetes, heart disease, cancer and respiratory conditions among others. The importance of this particular study is clear given that, in England for example, the use of prescription drugs is rising. “... utilisation rates of prescription drugs continue to rise sharply, increasing to an average of 17.7 prescriptions for every person in England in 2012, compared with 11.2 in 2000.” On this basis, if exercise has a similar effect to drug interventions on health and mortality outcomes, it will be important to ensure that physical activity and exercise become more prominent in a person’s healthcare and in society on general. In the UK, only around a third of people achieve the recommend levels of physical activity, while, as highlighted by the authors, only 14% of people exercise on a regular basis.

Findings:

In relation to coronary heart disease, both drug and exercise interventions were found to reduce mortality odds. However, the authors did not find any statistically detectable differences between the impact of drug interventions and exercise on mortality outcomes in such cases.

In cases of stroke, it was found that exercise was more effective than the use of drugs in terms of reducing the mortality outcomes of patients. However, it was only possible to study a small amount of cases where exercise interventions were utilised, therefore, the authors have made the point that there is a large degree of uncertainty in the exact estimate of treatment in this regard.

The research on this topic into heart failure found that, overall, diuretics had the most positive impact on mortality odds when compared with all other possible interventions. In addition to this, the results provided evidence to show that neither drug nor exercise interventions proved to be particularly effective when it comes to being effective in reducing the mortality odds for patients with prediabetes. However, the authors pointed out that a moderate amount of uncertainty exists in relation to the findings in cases of heart disease and prediabetes.

Overall, this study has provided evidence to suggest that exercise and drug interventions can have a similar impact on mortality outcomes. Two exceptions exist in this analysis. The first is that, in the case of heart disease, neither exercise nor other types of drugs had such a positive an impact on health outcomes as diuretics. The second exception is that, exercise proved to more beneficial in terms of mortality outcomes than drugs in cases of stroke rehabilitation.

Taking these two exceptions into account, it appears that exercise has the potential to be as effective as drug interventions in the treatment of many conditions.