A 5k a day may keep the doctor away

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1. As compared with drug interventions, exercise significantly reduced the odds of mortality among patients with stroke.

2. No statistically detectable differences were evident between exercise and drug interventions in the secondary prevention of coronary heart disease and prediabetes. 

Evidence Rating Level: 2 (Good)

Study Rundown: The mortality benefit of exercise has been well-documented, though the majority of this evidence comes from observational studies. In contrast, the evidence in favor of most drug interventions comes from randomized controlled trials. This study aimed to determine the comparative effectiveness of exercise versus drug interventions on mortality outcomes and found that exercise offers comparable mortality benefits in a number of common medical conditions. The findings bolster the promise of exercise as a viable alternative, or at least a supplement to, drug interventions. It also highlights the relative lack of data on exercise interventions as compared to pharmacologic interventions. In part because exercise interventions are more difficult to accurately administer and quantify, few high-quality trials of exercise exist. As a result, there is still substantial uncertainty as to which types of exercise are most beneficial for given conditions and how to effectively encourage patients to exercise.

As with any meta-analysis, this study is limited by the existing evidence it draws from. The exercise intervention trials included in this analysis did not always clearly outline the “support factors” in place and the settings in which physical interventions were undertaken. Such information is imperative to determine the cost-effectiveness of exercise interventions and to assess whether these interventions could be practically carried out by patients outside of a controlled setting.

Click to read the study in BMJ

Relevant Reading: Total mortality after changes in leisure time physical activity in 50 year old men: 35 year follow-up of population based cohort

In-Depth [meta-epidemiologic study]: This study analyzed 16 (four exercise and 12 drug) meta-analyses to determine the comparative effectiveness of exercise versus drug interventions on mortality outcomes. The study collectively included 305 randomized controlled trials with 339,274 participants. The primary outcome studied was mortality across four conditions for which exercise has proven mortality benefit – secondary prevention of coronary heart disease, rehabilitation of stroke, treatment of heart failure, prevention of diabetes. The study included four meta-analyses of exercise interventions reporting mortality outcomes. Authors identified eligible meta-analyses of drug interventions by considering those that analyzed relevant drug options for each of the four conditions (for example, statins, β blockers, angiotensin converting enzyme inhibitors, and antiplatelets for the secondary prevention of coronary heart disease).  They then combined study level death outcomes from exercise and drug trials using random effects network meta-analysis to generate odds ratios.

For coronary heart disease, there were no statistically detectable differences among any of the exercise and drug interventions in terms of their effects on mortality outcomes. Neither exercise nor drug interventions were clearly effective in reducing the odds of mortality in prediabetes. Among patients with stroke, exercise was significantly more effective in reducing odds of mortality (odds ratios, exercise vs anticoagulants 0.09, 95% credible intervals 0.01 to 0.70 and exercise vs antiplatelets 0.10, 0.01 to 0.62). Diuretics were more effective than exercise in heart failure (exercise v diuretics 4.11, 1.17 to 24.76).

By Elizabeth Kersten and Andrew Bishara

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