A very interesting meta-analysis was published online in the British Medical Journal by H. Naci (BMJ 2013:347:f5577) this month. It compared the benefits of drug therapy vs.exercise in the secondary prevention of new or worsening conditions in 4 diseases: coronary heart disease, stroke, heart failure, and adult-onset Type II diabetes. They disallowed studies in which both drugs and exercise were prescribed and because a head-to-head study of exercise vs. drug therapy was the desired goal.
It is well-known and documented that exercise has health benefits. There is an enhanced quality of life, fewer hospital admissions, and enhanced all-cause mortality in those who exercise. The study here reviewed meta-analyses to try to compare the benefits of drug therapy vs. exercise in mortality.
The author reviewed 4 sets of patients: those receiving a statin for elevated cholesterol, those receiving a diuretic for chronic heart failure, those receiving anti-coagulation because of a stroke, and those receiving metformin or a similar drug for pre-diabetes. Over 339,000 patients in over 350 meta-analyses were reviewed. The results can be simply summarized, but should not be taken as a reason to stop medication.
No difference was found in mortality for secondary prevention of heart disease between drugs and exercise in patients with elevated cholesterol.
No difference was found in mortality or progression to full diabetes between drug therapy and exercise.
There was a slight advantage in exercise rather than anticoagulation or anti-platelet therapy in patients with a stroke.
But diuretics were definitely superior to exercise in patients with chronic heart failure.
The conclusion would seem to be that if you have any of these four conditions, be sure to start exercising if you are not already doing so, For further details, the full report is available online, whether or not you are a subscriber to the British Medical Journal.
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