I’ve often written about exercise and its amazing impact on health. While I was in Tel Aviv, I made sure that I walked for a mile or two every day and even took several Pilates classes. The walking was both to avoid traffic and to see the beautiful beaches, the Pilates classes gave me the opportunity to compare this form of exercise in Israel to that which I do in LA. (Conclusion: the Pilates there was a bit more yoga-like and aerobic than that which I am used to… and I was probably the oldest one in the class.)
Upon my return this week, I was able to catch up on my JAMA journals and lo and behold there was a study about exercise and its impact on reduction of mortality from cardiovascular disease and diabetes. A metaepidimiological study (a descriptive word that my computer does not like, and frankly I had difficulty spelling) that examined a huge number of epidemiologic studies on exercise and medical therapies for chronic diseases was published online in October by the British Medical Journal and reviewed by the JAMA authors. They found that appropriately randomized trials have shown that exercise and drug interventions provide similar mortality benefits, especially for coronary heart disease and diabetes. Indeed exercise was more effective than drug treatment among patients recovering from stroke. Just so you have some numbers, the meta-analysis included 305 randomized controlled trials with 339,274 participants; however, only 57 of these trials representing 17,716 participants (still a significant number) closely examined the impact of exercise.
The researchers found that exercise interventions reduced mortality risk from coronary heart disease no less than statins, beta blockers, ACE inhibitors and antiplatelet medications. Exercise was significantly more effective than controls (no intervention or usual care) in reducing mortality risk among patients with stroke and actually outperformed anticoagulants and anti-platelet medication given to reduce risk of a second stroke.
The diehards (excuse the pun) would argue that more studies are necessary. The problem is that it’s difficult to design clinical trials that have the appropriate three arms of treatment in order to make final recommendations. They would have to include usual care, exercise training and separate drug therapy to see which worked. New trials are trying to do this. In the meantime it’s unlikely that your physician will say to you that you should exercise but don’t take your statin. On the other hand, for individuals who may be borderline for recommendations to receive medication, there’s now evidence that exercise may delay or prevent that need for medication.
Bottom line: We should all the exercises, especially if we are at risk for coronary heart disease, diabetes or stroke. And of course we should not forget that we have to establish good health behaviors (not smoking, weight control and appropriate screening). Remember we each have only one body that we can care for…