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

Abstract

ObjectiveTo determine the comparative effectiveness of exercise versus drug interventions on mortality outcomes.DesignMetaepidemiological study.Eligibility criteriaMeta-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 sourcesMedline and Cochrane Database of Systematic Reviews, May 2013.Main outcome measureMortality.Data synthesisWe combined study level death outcomes from exercise and drug trials using random effects network meta-analysis.ResultsWe 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 vanticoagulants 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 4.11,1.17to 24.76). Inconsistency between direct and indirect comparisons was not significant.ConclusionsAlthough 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.

How sedentary are people with psychosis? A systematic review and meta-analysis

“…The increased prevalence of metabolic syndrome (Vancampfort et al, 2015), type two diabetes (Stubbs et al, 2015b) and cardiovascular disease (Gardner-Sood et al, 2015) in people with psychosis are of great concern. In the general population there is evidence that physical activity and exercise are broadly as effective as pharmacological interventions in preventing cardiovascular disease and mortality (Naci and Ioannidis, 2013). However, people with psychosis experience a range of barriers to engage in physical activity such as negative symptoms, pain and the side effects of medication (Soundy et al, 2014a;Vancampfort et al, 2012a;Vancampfort et al, 2011).…”

High-Intensity Interval Exercise and Cerebrovascular Health: Curiosity, Cause, and Consequence

“…[1][2][3][4] Evidence from randomized controlled trials indicates that exercise is as effective as drug interventions in terms of mortality benefits in the secondary prevention of coronary heart disease, treatment of heart failure and prevention of diabetes, and is more beneficial than drug treatment in stroke rehabilitation. 5 Thus, exercise has a significant role to play in both the prevention and treatment of disease. However, despite its clear benefits, more than one-third of the global adult population, and four-fifths of adolescents, fail to meet current public health guidelines for physical activity 6,7 (i.e., ⩾ 30 minutes of moderate-intensity exercise on at least 5 days of the week (⩾150 min/week), or 20 minutes of vigorous-intensity aerobic exercise training on at least 3 days of the week (⩾75 min/week)).…”

Sitting time, physical fitness impairments and metabolic abnormalities in people with bipolar disorder: An exploratory study

“…The higher premature mortality rates are largely attributable to cardiovascular disease (Goldstein et al, 2015). In the general population there is evidence that physical activity and exercise are broadly as effective as pharmacological interventions in preventing cardio-metabolic diseases and consequently premature mortality (Naci and Ioannidis, 2013). Data in people with bipolar disorder are however inconsistent with some studies finding a strong association between the level of physical activity participation and the risk for cardio-metabolic diseases (Salvi et al, 2011), while others in a mixed study including people with bipolar disorder and schizophrenia did not (Bly et al, 2014).…”