Author(s): Lee YC
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.
Referred From: https://www.bmj.com/content/347/bmj.f5577
Author(s): Naci, Huseyin, Ioannidis, John PA
Author(s): Rosenbaum S, Vancampfort D, Steel Z, Newby J, Ward PB, et al.
Author(s): Center for Behavioral Health Statistics and Quality (2015). Behavioral health trends in the United States: Results from the 2014 National Survey on Drug Use and Health
Author(s): Ross CE, Hayes D
Author(s): Stephens T
Author(s): Galper DI, Trivedi MH, Barlow CE, Dunn AL, Kampert JB
Author(s): Lawlor DA, Hopker SW
Author(s): Ann HRM, Collins KA, Fitterling HL
Author(s): Hare BS, Raglin JS
Author(s): Breus MJ, O’Connor PJ
Author(s): Berra K, Rippe J, Manson JE
Author(s): McKenna J, Naylor PJ, McDowell N
Author(s): Daley A
Author(s): Thompson PD, Funk EJ, Carleton RA
Author(s): Siscovick DS, Weiss NS, Fletcher RH
Author(s): Thompson PD, Franklin BA, Balady GJ, Blair SN, Corrado D, et al.
Author(s): Duvivier BMFM, Schaper NC, Bremers MA, Crombrugge G, Menheere PPCA, et al.
Author(s): DeBusk RF, Stenestrand U, Sheehan M, Haskell WL
Author(s): Murphy MH, Hardman AE
Author(s): Jakicic JM, Wing RR, Butler BA
Author(s): Osterberg L, Blaschke T
Author(s): Frank E, Breyan J, Elon L
Author(s): Hillsdon M, Thorogood M, White I, Foster C