Scientists claim that exercise may be just as effective as drugs for treating common conditions, such as coronary heart disease and stroke.
It has long been established that regular exercise is beneficial for health in general, but researchers now think exercise is "potentially as effective" as drug intervention, and they suggest it "should be considered as a viable alternative to, or alongside, drug therapy."
Physical activity has well-documented health benefits, yet in England, roughly one-third of adults meet the recommended levels of physical activity. And a recent survey revealed that the same is true in the US.
By contrast, prescription drug rates continue to skyrocket, sharply rising to an average of 17.7 prescriptions for every person in England in 2010, compared with 11.2 in 2000.
However, there is very little evidence on how exercise compares with drugs in reducing the risk of death for common diseases, researchers say.
While pharmaceutical companies spend millions researching and developing new drugs, they seldom test the drugs' efficacy against exercise alone. The report published on bmj.com today suggests pharmaceutical companies should include exercise intervention as an active comparator arm in drug trials.Huseyin Naci, a researcher from the London School of Economics, is hopeful that this will change. He says:
"I think there will likely be a culture shift in the coming years with exercise interventions gaining more interest. If such a shift occurs, patients and physicians may demand such evidence about the comparative life saving benefits of exercise and drugs.
Preventing diabetes and heart disease
Among stroke patients, exercise proved more effective than drug intervention.
Researchers at the London School of Economics, Harvard Pilgrim Health Care Institute at Harvard Medical School and Stanford University School of Medicine compared the effectiveness of exercise versus drugs on mortality across four conditions (secondary prevention of coronary heart disease, rehabilitation of stroke, treatment of heart failure and prevention of diabetes).
Secondary prevention refers to treating patients with existing disease before it causes significant illness.
They analyzed the results of 305 randomized controlled trials involving 339,274 individuals and found no statistically detectable differences between exercise and drug interventions for secondary prevention of heart disease and prevention of diabetes.
Among stroke patients, exercise was more effective than drug treatment, while for heart failure, diuretic drugs were more effective than exercise and all other types of drug treatment.
The authors point out that the amount of trial evidence on the mortality benefits of exercise is considerably smaller than that on drugs, and this may have had an impact on their results.
They argue that this "blind spot" in available scientific evidence "prevents prescribers and their patients from understanding the clinical circumstances where drugs might provide only modest improvement but exercise could yield more profound or sustainable gains in health."
Despite this uncertainty, they say that, based on the available data, physical activity is potentially as effective as many drug interventions, and they call for more trials to address the disparity between exercise and drug-based treatment evidence.
And while it is tempting to believe popping a pill will cure all ills, simple lifestyle changes have already proved effective in the treatment of arthritis of the knee, depression, and high blood pressure.
"In cases where drug options provide only modest benefit, patients deserve to understand the relative impact that physical activity might have on their condition," they conclude.