Exercise may be as effective as medication in preventing early death in people who've had heart attacks or strokes, a new study suggests.
"Doctors should give their patients advice about the lifesaving benefits of exercise, and when possible they should refer patients to rehabilitation programs with exercise programs," says the study's lead author, Huseyin Naci, a fellow at Harvard Medical School and a graduate student at the London School of Economics.
This adds to a large volume of research on the benefits of regular physical activity. Exercise has been shown to lower the risk of early death, help control weight and reduce the risk of heart disease, stroke, type 2 diabetes, depression, some types of cancer and a host of other conditions. It lowers the risk of cognitive decline and hip fractures.
But only about 21% of adults in the USA meet the government's recommendations for aerobic and muscle-strengthening exercise, recent data show.
Naci and a colleague at Stanford University School of Medicine analyzed the results of 305 studies involving 339,274 people. They looked at early death in patients who had had strokes, heart attacks or heart failure or were at risk for developing type 2 diabetes.
Only about 14,700 people participated in exercise trials. Exercise interventions varied among studies, but patients who had a stroke usually did a combination of aerobic and strength-training exercises.
Among the findings reported in BMJ, a British medical journal:
• Among stroke patients, exercise was more effective than drugs. However, stroke patients who are capable of exercising may have been healthier to begin with than those who couldn't exercise, Naci says.
• For people who had heart failure, diuretic drugs were more effective than exercise and all other types of drug treatment.
• For patients who had had heart attacks, exercise appeared to be as effective as drugs in preventing early deaths, Naci says.
• For people with prediabetes, neither exercise nor drugs reduced their risk of early death, but this may be due to the small number of people with this condition in the studies, he says. "We know from previous research that exercise is beneficial for this population.
"One limitation of this analysis is there were far fewer people who were exercising in these studies than taking medications. Exercise as treatment is something that has been under-researched," he adds.
He says more trials comparing the effectiveness of exercise and drugs are needed to help doctors and patients make the best treatment decisions. "Exercise should be considered as a viable alternative to, or in combination with medications."
New York cardiologist Richard Stein, a spokesman for the American Heart Association, says, "We are left with the same message we had before: Exercise therapy works. Drug therapy works. The combination of the two is the most reasonable approach."
Timothy Church, a physician and director of preventive medicine research at the Pennington Biomedical Research Center in Baton Rouge, says the latest findings make "sense to me when you consider that exercise strengthens all parts of the human machine — the heart, the liver, the brain, the blood vessels, the muscles."
"Health care providers struggle with the concept that exercise alone provides significant clinical benefit. This study is encouraging because we need more work and discussion on this, partly as it relates to healthy aging.
"The most powerful thing you can do for your health is become active," he says.
The government's physical activity guidelines recommend getting at least 2½ hours a week of moderate-intensity aerobic activity, such as brisk walking, or one hour and 15 minutes a week of vigorous-intensity aerobic activity, such as jogging.
The guidelines also recommend that adults do muscle-strengthening activities, such as push-ups, sit-ups or exercises using resistance bands or weights. These activities should involve all major muscle groups and be done on two or more days a week, the guidelines say.