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Exercise has always been part of primary prevention programs to reduce one’s risk for disease. Recent studies show that exercise may also be as effective as drugs for reducing complications and death from chronic disease.

Chronic diseases such as heart disease, stroke, and diabetes are becoming more common today, causing more deaths and disabilities as well as higher cost of healthcare. The US Centers for Disease Control and Prevention (CDC) reports that about seven out of ten Americans die from chronic disease each year.

It is also alarming to know that in the last decade, one out of two adults suffers from at least one type of chronic disease

It is also estimated that more than 75% of healthcare costs in the US is spent on treating people with chronic disease.

What are the Most Common Chronic Diseases?

The most common chronic diseases include heart disease, stroke, diabetes, cancer, obesity, respiratory diseases, and arthritis.  Heart disease, cancer, and stroke rank first, second, and third as the leading cause of death in the USA while arthritis is the leading cause of disability. It is estimated that one out of three individuals born in 2000 will develop diabetes sometime in their life.

One in three adults and one in five children are obese, increasing their risk for other chronic conditions such as heart disease and diabetes.

Chronic obstructive pulmonary disease (or COPD) is the third leading cause of deaths related to smoking.

Estimates show that the US spends approximately $7,000 per person on healthcare, most of which is directed towards treatment of chronic conditions.

Causes of Chronic Diseases

Studies show that there are four common risk factors that may lead to chronic disease. These include poor nutrition, excessive alcohol drinking, tobacco smoking, and lack of exercise. According to the World Health Organization (WHO), if these risky lifestyle factors were eliminated, about 80% of most chronic diseases (heart disease, diabetes, and stroke) would be prevented.

Lack of physical activity is one factor that increases one’s risk for obesity, diabetes, heart disease, and stroke.

Studies show that one in three adults and one in four adolescents do not meet the national guidelines for daily exercise, putting them at an increased risk for chronic disease.

To reduce one’s risk factors and prevent chronic disease, the U.S. Department of Health and Human Services has issued the Physical Activity Guidelines for Americans, which complements the Dietary Guidelines for Americans, issued by the U.S. Department of Agriculture.

The guidelines advise adults to do moderate-intensity exercises at least 150 minutes weekly, or vigorous aerobic exercise at least 75 minutes weekly. One can also combine these activities at an equivalent rate.

With the high cost of drugs used to prevent or treat chronic diseases, experts recommend that people focus more on modifying their lifestyles to prevent chronic disease than relying just on their medications.

Recent studies suggest that one way to improve one’s risk for developing fatal complications from any of these burdensome conditions is to increase one’s level of physical activities.

How Effective Is Exercise For Chronic Disease?

Can simply being active be as effective as clinically proven drug therapies in preventing or managing chronic disease?  Researchers from Harvard Medical School and Stanford University School of Medicine conducted extensive research to compare the effects of exercise against those of drugs in the treatment of patients with existing heart disease, in stroke rehabilitation, in heart failure therapy, and diabetes prevention.

After analyzing the results of more than 300 clinical trials that involved close to 340,000 adult participants, they found that:

  • Medications such as statins, beta blockers, ACE inhibitors, and antiplatelet used for the treatment coronary heart disease reduced the risk for death in patients with coronary heart disease compared with controls. The researchers found that exercise interventions had a similar effect and that there were no statistical differences among drug and exercise interventions in regards to their effects on death outcomes.
  • Exercise interventions used in the rehabilitation of stroke were found to be significantly more effective in reducing the risk of death compared to both drugs (antiplatelet and anticoagulant medications) and controls.
  • Among the drugs used for patients with heart failure (diuretics, β blockers, and ACE inhibitors), diuretics were most effective in reducing death risk. These were also found to be linked to fewer deaths than exercise or control.
  • In people who were diagnosed as prediabetic, neither exercise nor drugs had a significant effect on reducing mortality outcomes.
  • When data for all these chronic diseases were pooled together, researchers found no significant statistical differences between exercise intervention and drugs in decreasing the odds of death.
The meta-analysis suggests that physical activity is just as important as pharmaceutical interventions in the treatment of major chronic diseases.

Clinical Implications

Many health care providers advocate increasing physical activity as a part of primary prevention programs, which aim to prevent the onset of disease. However, the recent findings show that exercise can be an important part of secondary prevention programs as well.

This means that doctors can prescribe the “exercise pill” as a strategy to reduce the risk of death from chronic diseases such as heart disease, diabetes, and stroke. 

This has been shown to be especially effective in the rehabilitation of patients suffering from stroke and heart disease.

Exercise regimens may differ as to type of exercise, duration, and intensity. It is important to tailor physical activity to individual needs, with particular concern for one’s degree of mobility and disease severity. The national guidelines for physical activity advocate that all adults should avoid inactivity, and it is best to have some amount of activity to reap health benefits.

To gain substantial benefits, adults are encouraged to do moderate-intensity activities at a minimum of 150 minutes/week, or vigorous-intensity aerobic exercises at least 75 minutes a week.

Aerobic exercises include walking, jogging, biking, swimming, and similar activities. Muscle-strengthening exercises of moderate to high intensity involving major muscle groups must also be done at least two days a week because these activities also provide many health benefits.

Older adults and adults with chronic diseases and disabilities who may not be able to meet these guidelines are urged to do as much physical activity that suits them. The goal is to avoid inactivity, which could increase their risk for complications and death due to chronic disease.

Read full article

  • Naci, H and Ioannidis, J. Comparative effectiveness of exercise and drug interventions on mortality outcomes: metaepidemiological study. BMJ 2013
  • 347:f5577
  • CDC. The Power of Prevention. http://www.cdc.gov/chronicdisease/pdf/2009-power-of-prevention.pdf
  • HHS. Physical Activity Guidelines for Americans. http://www.health.gov/paguidelines/guidelines/summary.aspx
  • Photo courtesy of Michael Dougherty by Flickr : www.flickr.com/photos/md888/5864695971/
  • Photo courtesy of Neil T by Flickr : www.flickr.com/photos/neilt/5866403108/
  • Photo courtesy by ceiling on Flickr: www.flickr.com/photos/ceiling/2461157879/

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