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Exercise as good as drugs in treating heart disease

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LONDON -- Physical activity may be as effective as drugs in treating heart disease and should be included as a comparison in the development of new medicines, according to a review published recently in the British Medical Journal.

No statistically detectable differences were evident between exercise and drug treatment for patients with coronary heart disease or prediabetes, and exercise was more effective among patients recovering from a stroke, according to a review of 16 meta-analyses that included 305 studies involving 339,274 participants. The review was conducted by researchers at Harvard University and Stanford University.

The analysis adds to evidence showing the benefit of non-medical approaches to disease through behaviour and lifestyle changes. Given the cost of drug treatment, regulators should consider requiring pharmaceutical companies to include exercise as a comparator in clinical trials of new medicines, according to authors Huseyin Naci of Harvard and John Ioannidis of Stanford.

"In cases where drug options provide only modest benefit, patients deserve to understand the relative impact that physical activity might have on their condition," Naci and Ioannidis said in the published paper. In the meantime, "exercise interventions should therefore be considered as a viable alternative to, or alongside, drug therapy."

The definition of exercise and their frequency, intensity and duration varied across the list of studies included in the analysis, which limits the ability to generalize the findings to different forms of physical activity, said the authors, who received no funding for the review.

Drug treatments in the studies included statins and beta blockers for coronary heart disease; anticoagulants and antiplatelets for stroke; and diuretics and beta blockers for heart failure.

A landmark study by Dean Ornish, founder of the Preventive Medicine Research Institute, found a low-fat vegetarian diet, increased exercise and stress management can reduce heart disease more than standard medical care. Patients who receive training from medical professionals on Ornish's program for reversing heart disease have been reimbursed by Medicare since January 2011.

Cardiovascular disease is the leading cause of death globally, killing at least 17 million people a year with fatalities predicted to rise to more than 23 million by 2030, according to the World Health Organization.

Deaths linked to heart disease and stroke would be reduced by 25 per cent if people quit smoking, limited salt intake and adopted other healthy habits, the U.S. Centers for Disease Control and Prevention said last month.

Not all patients benefit more from exercise than from drugs. For those recovering from heart failure, diuretic medicines were more effective, according to the analysis.

-- Bloomberg News

Republished from the Winnipeg Free Press print edition October 12, 2013 D16

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