Should doctors prescribe exercise?

A study recently published in the prestigious British Medical Journal would seem to indicate that the answer is “yes”.

To the layperson, the benefits of exercise would seem to be quite obvious but the scientific world needs data — and lots of it! Well, the treasure trove of encouraging evidence just got bigger. Using a meta-analysis of thousands of medical interventions against such chronic killers as heart failure, stroke and coronary artery disease, researchers from the London School of Economics and the medical schools of Harvard and Stanford concluded that exercise was a “viable alternative” to and at least as effective as medications in reducing mortality caused by the diseases studied.

The researchers admitted to limitations in the study, which involved 14,716 participants, including the fact that there were far fewer data on exercise than the medications studied, which included blood thinners, anti-hypertensives, ACE inhibitors and diuretics.

Nevertheless, the capacity of exercise to equal, and in the case of stroke, to surpass the reduction in mortality achieved by medications, was striking and deserving of more intensive research. Also encouraging is the lack of discernible harm caused by exercise therapy in the patient populations studied.

Cost savings of exercise

Considering the exorbitant costs of medications used today for many chronic conditions, and the distressing lack of insurance coverage for some of the most effective drugs, it would seem that a lower cost alternative is sorely needed.

To that end, the study’s authors suggest that pharmaceutical sponsors could be required to include exercise interventions as active comparison arms in future drug trials. In other words, drug companies would need to prove that their medication is more effective than exercise.

At first glance, this would seem to increase the cost of bringing a drug to market, yet, in the long run, wouldn’t this reduce the cost of health care? Scuttling a drug that performs no better than exercise could yield savings not only in the cost of new drug development but in the cost to insurance companies and patients. (Granted, not all patients are capable of exercise, but for those who are the cost savings could be substantial).

Indeed, we at Village Health have long prescribed exercise as a preventative strategy for all patients well enough to engage in it and as therapy in select chronic disease populations based on the growing evidence of its benefits.

Maybe it’s time to take it to the next level?

Link to article: “Comparative effectiveness of exercise and drug interventions on mortality outcomes: metaepidemiological study” http://www.bmj.com/content/347/bmj.f5577

photo credit: Ed Yourdon via photopin ccmedium_2594690838

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