Staying alive: Does exercise works as well as meds after a heart attack, stroke?

ExerciseAsGoodAsMeds_Page_01You don’t see many randomized controlled trials of exercise.  One reason may be — no one needs to get exercise approved by the FDA.

But, two researchers, working with the few studies they could find, compared the impact of exercise on death rates for four groups of patients, including those recovering from strokes and heart attacks.

Here’s what they found, from the BBC:

Exercise can be as good a medicine as pills for people with conditions such as heart disease, a study has found.

The work in the British Medical Journal(BMJ) looked at hundreds of trials involving nearly 340,000 patients to assess the merits of exercise and drugs in preventing death.

Physical activity rivalled some heart drugs and outperformed stroke medicine.

The findings suggest exercise should be added to prescriptions, say the researchers.

Experts stressed that patients should not ditch their drugs for exercise – rather, they should use both in tandem.

Take note of the two authors. John Ioannidis — now of Stanford, formerly of Tufts —  is noted for challenging the validity of randomized clinical trials. Or in his own words:  “Why Most Research Findings are False.”

The lead author is still in town. for the moment. Huseyin Naci  is a doctoral cadidate at the London School of Economics and currently a fellow at Drug Policy Research Group at Harvard Medical School and the Harvard Pilgrim Health Care Institute.  BHN ran a few questions by him via email. Below find his response.

Q: What led you to do this research?

HN: When we looked at the existing scientific studies, we found that there is a lot of information on the life-saving benefits of drugs, and there is also some (limited) information on the life-saving benefits of exercise. But these two separate subsets of scientific evidence had never been combined. We wanted to compare the mortality benefits of exercise and drugs using this existing evidence.

Q: Do you think your findings will change the way doctors treat these conditions? Do you think they should?

HN: One thing I would like to highlight is that patients should not stop taking their medications without consulting with their doctors. In the short-run, I think doctors can give advice about the benefits of exercise to their patients, and refer patients to rehabilitation programs that include exercise interventions. In the long-run, we need more research to understand the situations where exercise can be used as an alternative to drug therapy or in combination with drug therapy.

Q: Do you think your finding are strong enough to change established guidelines for treatment of  secondary prevention of coronary heart disease, rehabilitation of stroke, and prevention of diabetes?

HN: I think there is an opportunity to start having important conversations about the role of exercise in treatment guidelines and identify areas where we need further evidence. In particular, we need more information about the specific types of exercise interventions that may work best for different types of individuals depending on their disease severity and fitness levels.

Q: You suggest that “patients deserve to understand the relative impact that physical activity might have on their condition.” Do you have any thoughts on how the growing patient empowerment movement might lead to increased awareness of your findings outside of the medical community?  For example, more patients are now consulting the medical literature themselves, rather than relying on doctors to adjust the way they practice medicine in response to new findings?

HN: Hard for me to speculate. I do think that patients and doctors are getting shortchanged with the current state of medical research. There may be conditions for which exercise is potentially as effective (or even more effective) than drugs, but these will remain unknown unless there is considerably more research in this area.

More clips here on the study and the work of Dr. Ioannidis.

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