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BBC 2 October 2013: 'Exercise 'can be as good as pills'' for managing disease

Firestormm

Senior Member
Messages
5,055
Location
Cornwall England
Exercise 'can be as good as pills'

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Short, regular bouts of exercise could add years to your life, say experts
Exercise can be as good a medicine as pills for people with conditions such as heart disease, a study has found.

The work in the British Medical Journal (BMJ) [below] looked at hundreds of trials involving nearly 340,000 patients to assess the merits of exercise and drugs in preventing death.

Physical activity rivalled some heart drugs and outperformed stroke medicine.

The findings suggest exercise should be added to prescriptions, say the researchers.

Experts stressed that patients should not ditch their drugs for exercise - rather, they should use both in tandem.

Prescriptions rise

Too few adults currently get enough exercise. Only a third of people in England do the recommended 2.5 hours or more of moderate-intensity activity, such as cycling or fast walking, every week.

In contrast, prescription drug rates continue to rise.

There were an average of 17.7 prescriptions for every person in England in 2010, compared with 11.2 in 2000.

For the study, scientists based at the London School of Economics, Harvard Pilgrim Health Care Institute at Harvard Medical School and Stanford University School of Medicine trawled medical literature to find any research that compared exercise with pills as a therapy.

They identified 305 trials to include in their analysis. These trials looked at managing conditions such as existing heart disease, stroke rehabilitation, heart failure and pre-diabetes.

When they studied the data as a whole, they found exercise and drugs were comparable in terms of death rates.

But there were two exceptions.

Drugs called diuretics were the clear winner for heart failure patients, while exercise was best for stroke patients in terms of life expectancy.

Health benefits

Doing exercise regularly:
  • Can reduce your risk of major illnesses, such as heart disease, stroke, diabetes and cancer by up to 50%
  • Can lower your risk of early death by up to 30%
  • Can boost self-esteem, mood, sleep quality and energy as well as keep weight off
  • Moderate activity, such as cycling or fast walking, gives your heart and lungs a work-out
Source: NHS Choices

Amy Thompson, senior cardiac nurse at the British Heart Foundation, said that although an active lifestyle brings many health benefits, there is not enough evidence to draw any firm conclusions about the merit of exercise above and beyond drugs.

"Medicines are an extremely important part of the treatment of many heart conditions and people on prescribed drugs should keep taking their vital meds. If you have a heart condition or have been told you're at high risk of heart disease, talk to your doctor about the role that exercise can play in your treatment."

Dr Peter Coleman of the Stroke Association said exercise alongside drugs had a vital role that merited more research.

"We would like to see more research into the long-term benefits of exercise for stroke patients.
"By taking important steps, such as regular exercise, eating a balanced diet and stopping smoking, people can significantly reduce their risk of stroke."

"Moderate physical activity, for example, can reduce the risk of stroke by up to 27%."

Research

Comparative effectiveness of exercise and drug interventions on mortality outcomes: metaepidemiological study

Abstract

Objective

To determine the comparative effectiveness of exercise versus drug interventions on mortality outcomes.

Design

Metaepidemiological study.

Eligibility criteria

Meta-analyses of randomised controlled trials with mortality outcomes comparing the effectiveness of exercise and drug interventions with each other or with control (placebo or usual care).

Data sources

Medline and Cochrane Database of Systematic Reviews, May 2013.

Main outcome measure

Mortality.

Data synthesis

We combined study level death outcomes from exercise and drug trials using random effects network meta-analysis.

Results

We included 16 (four exercise and 12 drug) meta-analyses. Incorporating an additional three recent exercise trials, our review collectively included 305 randomised controlled trials with 339 274 participants.

Across all four conditions with evidence on the effectiveness of exercise on mortality outcomes (secondary prevention of coronary heart disease, rehabilitation of stroke, treatment of heart failure, prevention of diabetes), 14 716 participants were randomised to physical activity interventions in 57 trials. No statistically detectable differences were evident between exercise and drug interventions in the secondary prevention of coronary heart disease and prediabetes.

Physical activity interventions were more effective than drug treatment among patients with stroke (odds ratios, exercise v anticoagulants 0.09, 95% credible intervals 0.01 to 0.70 and exercise v 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). Inconsistency between direct and indirect comparisons was not significant.

Conclusions

Although limited in quantity, existing randomised trial evidence on exercise interventions suggests that exercise and many drug interventions are often potentially similar in terms of their mortality benefits in the secondary prevention of coronary heart disease, rehabilitation after stroke, treatment of heart failure, and prevention of diabetes.
 

alex3619

Senior Member
Messages
13,810
Location
Logan, Queensland, Australia
There is no question that exercise is beneficial in a wide range of illnesses and problems. Exercise and good diet are key to health. Yet this message, particularly in its more simplistic form, is over-sold, as are dietary messages. Simplistic interpretations of these messages can create problems, as we well know for ME and exercise.
 

alex3619

Senior Member
Messages
13,810
Location
Logan, Queensland, Australia
Lol peggy-sue, me too. I used to get running dreams long before Forrest Gump came on the seen. I miss exercise. If I could figure out a way to do it safely I would be exercising regularly. So many think we are exercise averse ... I dispute that, I think most of us are just averse to the bad consequences we get from exercise.
 

Firestormm

Senior Member
Messages
5,055
Location
Cornwall England
Shouldn't this be in the 'other' research news section? It's got nothing to do with ME.

Maybe not, but I think it does have a lot to say about the way in which medical advice is proceeding; and about the tsunami we are up against when it comes to advocating that ME is different or needs more personalised consideration.

The research itself may not be about ME, but if you were to do a similar analysis of what has been published, I wonder if the results would be any different? The exception being of course that there aren't any 'pills' for ME.

It was Mum that alerted me to this BBC report (it had been repeated on the TV) and they do love to sensationalise. Of course for Mum - with her Rheumatiod Arthritis - this was anathema. Just as I suspect it is to every single person living and struggling with a chronic (largely untreated) health condition that prevents them from doing what they want to do.

Her concern - and mine - was that when she sees her doctor this evening, not only will be try to reduce her medications, but that he will do so whilst trying to encourage her to exercise more to compensate.

She said how it the days before medications people would suffer and do even less, and now we have medications (for some things) to help with management, the powers that be are so focused on cost that they will as often as not 'negotiate' with the patient before prescribing - or before issuing a repeat.

'Just GET out and exercise' is now the mantra for all chronic complaints, not just ME, but we have an enormous battle and one that might need more than repeat exercise testing.

Happy days :cry:
 
Messages
13,774
I wonder if the results would be any different? The exception being of course that there aren't any 'pills' for ME.

I've not read this paper, but perhaps it could be read as showing how ineffective a lot of drug treatments are. Over the last few years, I've come to suspect that a lot of the claims made about the efficacy of treatments are pretty exaggerated/spun/dishonest.
 

peggy-sue

Senior Member
Messages
2,623
Location
Scotland
Recent research I read was saying the antidepressants should only be used in very severe cases - that that is the only situation where they do help a lot. They're not particularly effective in mild cases, for which counselling (I did not say CBT)
and exercise:rolleyes: are better.

However, exercise is only fun when you are fit. Getting fit isn't much fun.

Not only that, but the mechanisms of antidepressants are not known, serotonin is not the "happy chemical" and they (all types) have vile side-effects.
 

Artstu

Senior Member
Messages
279
Location
UK
However, exercise is only fun when you are fit. Getting fit isn't much fun.

despite a 90% reduction in what I could do, I actually found I could embrace the challenge of increasing that 10% ability I had.
 

peggy-sue

Senior Member
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2,623
Location
Scotland
I'm somewhere between 60% - 70% reduction from when I was well.
I can do slow stuff. I cannot do anything aerobic without serious consequences.

I once ran 25 yards to catch a bus. (early on, before I knew better)
It laid me out for three weeks.

I need "exercises" that get housework and laundry and cooking done....
 

Artstu

Senior Member
Messages
279
Location
UK
I'm somewhere between 60% - 70% reduction from when I was well.
I can do slow stuff. I cannot do anything aerobic without serious consequences.

I once ran 25 yards to catch a bus. (early on, before I knew better)
It laid me out for three weeks.

I need "exercises" that get housework and laundry and cooking done....

If a short run like that had that effect on me I'd be saying I had a 99% reduction in my ability.
 

Keela Too

Sally Burch
Messages
900
Location
N.Ireland
Oh..... I find even a 25m walk a problem later. :( Meh.

Edit - BUT I am grateful that I CAN still walk, that I CAN get out for coffee, and that I have an amazing MOBILITY SCOOTER so that I can "walk" my dogs!!
 

peggy-sue

Senior Member
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2,623
Location
Scotland
Artstu, if somebody is at 99% reduction, they are bed-bound and tube-fed in a dark silent room - if they are lucky enough to have somebody to care for them in that position.
I am, realistically, at somewhere between 60-70% reduction.
 

Artstu

Senior Member
Messages
279
Location
UK
I don't see it like that at all, 25 yards multiplied by 100 is only 1.4 miles, so perhaps I should have said a 99.9% reduction in ability. That's more like it actually 0.1% ability at 25 yards is 14.2 miles if my maths is correct.
 

peggy-sue

Senior Member
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2,623
Location
Scotland
So how reduced would a bed-bound, tube-fed PWME be?

80% of all the food a normal-weight normally-active person eats, fuels keeping the body going.

Only 20% of that calorie load fuels everything they do.

So, most of humans' "activity" is involved in just the running of the body.

You need to take that into account when calculating % reductions.

Somebody at 99.9% reduction is probably already dead.:rolleyes:
 

Artstu

Senior Member
Messages
279
Location
UK
OK, a 99.9% reduction in walking ability. other living activities are not so easily measured are they.
 

Bob

Senior Member
Messages
16,455
Location
England (south coast)
I've never found percentages helpful, precisely because of the issues raised in the discussion here. I think it's impossible to define our disability by a percentage. And any percentage we use can be misleading.

I agree with Artstu that saying we have a 70% reduction in capacity can give a misleading picture of health, suggesting that we have full capacity for 30% of the day, or that we can do normal things but we can only walk 30% of the distance that we used to be able to.

I used to be able to do a 75 mile cycle in a day, and now I can't cycle any distance without experiencing symptom exacerbation, so what does that mean in terms of a percentage reduction in capacity?

Equally, I agree with peggy-sue, in that saying we have a 99% reduction does tend to suggest that we are bed bound.

Maybe we need to invent another system for defining disability?
 

peggy-sue

Senior Member
Messages
2,623
Location
Scotland
The problem is if we are trying to pace we need to take ALL the effort our bodies struggle with, just to stay alive, into consideration.

I used to shower and wash my hair every morning.
Now, I can only manage once a week - it is a major activity.
I could do it every day, but I wouldn't be able to do other essential things - such as get a meal together.

That does not make me one 7th of what I used to be - just 6 times dirtier than I used to be.:p

Life is balancing this business of "robbing Peter to pay Paul.":devil: