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Stanford University School of Medicine

The exercise pill: A better prescription than drugs for patients with heart problems?

Last week, my colleague wrote about a six-nation survey from the World Heart Organization showing that a majority of adults walk for less than half an hour each day. September 29 was World Heart Day, and this year’s theme was changing lifestyles to prevent and control cardiovascular disease, the number one cause of death in the United States and worldwide.

Both common sense and medical science increasingly point to regular physical activity as a simple and effective way to decrease the risk of cardiovascular disease and a host of other ailments. But what about patients who have already had a stroke or heart failure, or those with coronary heart disease or prediabetes? Can exercise help keep these patients alive? How do the outcomes of exercise interventions compare with those of drug treatments?

Stanford professor John Ioannidis, MD, DSc, addresses these questions in a meta-analysis published today in the British Medical Journal. In collaboration with Huseyin Naci, a researcher and fellow at the London School of Economics and Harvard Medical School, Ioannidis culled data from more than 300 clinical trials, representing more than 300,000 individual patients. Ioannidis and Naci compared the effectiveness of exercise with various drug interventions to prevent mortality for patients recovering from stroke or heart failure, as well as those with coronary heart disease or prediabetes.

For patients with coronary heart disease or prediabetes, exercise and drug interventions appeared to have similar effects on mortality. However, for those recovering from a stroke, exercise led to better outcomes than drugs, while for those with previous heart failure, diuretics in particular prevented deaths more effectively than exercise or other drugs.

Still, Ioannidis and Naci emphasize that not enough trials have been done on the mortality benefits of exercise – only 57 of the 305 trials they analyzed included exercise interventions – and that in future trials, exercise should be directly compared to drug treatments. They caution that “the lopsided nature of modern medical research may fail to detect the most effective treatment for a given condition if that treatment is not a prescription drug.”

While Centers for Disease Control and Prevention statistics show that about one-third of primary care physicians prescribe an “exercise pill” to their patients, these prescriptions may be more effective when supervised by a rehabilitation program. Further studies are needed to understand the types of exercise that are most effective for different conditions, as well as the potential harmful side effects of exercise interventions as compared with drug treatments.

“Exercise has been quite neglected to-date,” Ioannidis told me. “There is plenty of room to reap more benefits from something that is both effective and enjoyable. The pendulum may need to swing back [from drug treatments to lifestyle interventions] for many reasons, including the intolerable cost of many medications and their potential toxicities.”

Molly Sharlach is a writing intern in the medical school’s Office of Communication & Public Affairs. She is a student in the Science Communication Program at the University of California-Santa Cruz.

Previously: Global survey highlights the need for people to keep track of walking distanceStanford preventive-medicine expert: Lay off the meat, get out the sneaksMore evidence that boosting Americans’ physical activity alone won’t solve the obesity epidemic and Ask Stanford Med: Answers to your questions about heart health and cardiovascular research

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