Fitness

Philip A. Ades, MD, is Medical Director of Cardiac Rehabilitation at the University of Vermont Medical Center and a Professor at the Larner College of Medicine at UVM.

Philip A. Ades, MD, is Medical Director of Cardiac Rehabilitation at the University of Vermont Medical Center and a Professor at the Larner College of Medicine at UVM. This article is co-authored by Patrick Savage, MS, senior exercise physiologist at the UVM Medical Center.

Doctors treating patients for a variety of different medical conditions need to remember to provide a prescription for what is probably the most important medicine of all: exerciseA recent study from the London School of Economics and Stanford University (1) compared the benefits of exercise with several well accepted drug therapies in the treatment of four clinical situations:

  • Coronary artery disease (CAD), such as after a heart attack;
  • Stroke;
  • Chronic heart failure; and
  • Pre-Diabetes Mellitus.

For the treatment of CAD, exercise was compared to the use of four commonly used medications: statins, beta blockers, ACE-Inhibitors and aspirin each of which is prescribed systematically after a heart attack. The focus of the study was to look at which was more effective at lowering mortality rates, exercise or medications. Exercise was just as effective as each of these medications at improving survival in patients with CAD. Thus, exercise should be recommended to heart patients, right alongside these medications to maximize survival in CAD.

For long-term treatment after a stroke, the researchers found that an exercise program was more effective than drugs such as anti-coagulants and anti-platelet drugs (such as aspirin) in terms of maximizing survival. Unfortunately, although long-term exercise programs are covered by insurance for patients with CAD (cardiac rehabilitation), no such coverage exists after a stroke. Exercise training can be initiated in the setting of physical therapy which is covered by health insurance. Stroke survivors would benefit from exercise programs that could then be continued in the community or in a Phase III cardiac rehabilitation program.

In the clinical situation of chronic heart failure (CHF), diuretic drugs were shown to be the most effective way to prolong life. However, exercise training and other medications including ACE-Inhibitors and Beta-blockers have their own lesser, but independent beneficial effects on mortality. Thus, to optimally treat patients with CHF, exercise should be prescribed alongside diuretics and betas-blockers and ACE-Inhibitors.

Finally, for individuals with pre-diabetes, sometimes called “Insulin Resistance Syndrome” or “Metabolic Syndrome,” neither exercise nor diabetic medications led to a decrease in mortality. Importantly, however, exercise combined with weight loss was more effective than medication alone in terms of preventing the onset of Type 2 diabetes.

Commentary:

Exercise was equal to or better than medications for all 4 different medical conditions; CAD, Pre-Diabetes, Stroke and CHF. No other single medication has a similar breadth of benefits. Moreover, exercise provides a therapeutic and preventive benefit for many other chronic disease conditions including arthritis, obesity, cancer and dementia. Furthermore, your quality of life improves and you feel more energetic.

Just like medications, for exercise to be an effective treatment for a medical condition it needs to be “dosed” in the right amount.  The type of exercise evaluated in these studies was mostly  aerobic training such as walking and cycling. If you go with the recommendation of 30 minutes of moderate intensity aerobic activity 5 days per week, that would cover most bases.

None of the above studied dealt with prevention of the conditions discussed other than the treatment of pre-diabetes. The studies examined treatment after the onset of the condition. In terms of treating or preventing the risk factors for these medical conditions, exercise gives a major bang for your buck (the buck being spent to purchase of sneakers rather than ever-increasing longer term costs of pharmaceuticals):

The prevention of CAD and Stroke involves optimally managing risk factors, including:

  • High blood pressure
  • High cholesterol
  • Obesity
  • Diabetes
  • Smoking
  • Physical inactivity
  • Family history

Exercise is well known to favorably affect nearly all of these factors. A heart healthy diet and weight control also play an important role.

The prevention of CHF is complex, but avoiding the onset of  high blood pressure, obesity and diabetes with exercise would decrease its prevalence.

Finally, the best evidence for the prevention of diabetes (Type 2 diabetes) is with a combination of exercise and sustained weight loss.

Check out a very entertaining video on the benefits of exercise.

Exercise as medicine? You bet! Instead of taking a pill, take a walk and do it daily, like a pill.

Philip A. Ades, MD, is Medical Director of Cardiac Rehabilitation at the University of Vermont Medical Center and a Professor at the Larner College of Medicine at UVM. Patrick Savage, MS, is a Senior Exercise Physiologist in Cardiac Rehabilitation at the University of Vermont Medical Center. 

1. Naci H, Ioannidis JPA. Comparative effectiveness of exercise and drug interventions on mortality outcomes: metaepidemiological study. Brit Med J 2013;347:5577.

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