Ask the Doc: If exercise works as well as medicine, can I ditch the pills?

Oct. 16, 2013 @ 12:43 PM

Dear Doc Littleton,

I saw this article that said exercise was as good as medicine. Can I stop all these pills now?

Not quite.  At least not yet. But there is good evidence that exercise may reduce the need for more pills in the future.  

From the buzz generated by the British Medical Journal article last week, it clearly is something a lot of people think about.

Some think about it with a sense of accomplishment.

Some think about it with a sense of dread or guilt.

The study was conducted by the London School of Economics, Harvard Pilgrim Health Care Institute at Harvard Medical School and Stanford University School of Medicine and the examined 305 trials of nearly 340,000 patients comparing exercise to pills.

This wasn’t just a testimonial by a person on a television ad trying to sell the latest steel and foam exercise torture contraption that looks like the frame of a ‘67 Camaro. These are intelligent individuals who are interested in the facts.

Specifically, they looked for the effects of exercise and medications on the outcomes of heart disease, heart failure, stroke recovery, and pre-diabetes (we used to call that ‘borderline’ diabetes, but the border isn’t well controlled there, either).

One simple question they wished to answer was whether exercise or medicine reduced death rates. In other words, “what will help a patient live longer?”

They were about the same with two exceptions: diuretics were superior for treating heart failure (water pills) and exercise was clearly better for stroke rehabilitation.

I have seen this. It is incredibly satisfying to see a young patient (young is up to age 59, middle age is now 60-80 according to my aging assessment scale) work like a professional athlete in stroke recovery. To see a patient go from the ER bed where they can barely talk and move half their body, to walking daily and public speaking with hardly a deficit, is incredibly powerful recovery to watch.

It is a patient’s sheer will in the environment of good medicine and physical therapy support.

Why is this so important? Well, the number one risk for anyone over the age 40 of dying is cardiovascular disease, meaning heart attack or stroke.

And now we are seeing one of the best treatments doesn’t involve calling that busy doctor’s office with that sweet, frazzled lady who answers 400-500 calls a day, sitting in a lobby filling out (again) an information form which they should have but some corporate executive said must be done again…

It is more than that. We have very strong evidence that medicines can reduce cholesterol, blood pressure, improve diabetes, reduce complications and increase the years we may live. There is over 50 years of data.

But remember, a lot of research is done in order to justify a new medicine which may make a profit. A lot of research is funded by the government to study things which may not be financially driven. Studying the two together, though, needs to be done.

Please don’t stop your medications over one article that splashes across the news. Do consider talking to your doctor about how exercise might improve your health or reduce the number of medications.

More importantly, what really matters? Your health and the years you live, or the football game, or fictional television drama, or social media post on new nine bladed razors, or any of a hundred excuses to sit and decline?

Do what you can do while you can do it, because health care access and costs are going to change dramatically in the next few years. Health activity monitoring, too.