A recent publication in the British Medical Journal titled Comparative effectiveness of exercise and drug interventions on mortality outcomes: metaepidemiological study looked at the literature comparing the benefits of exercise as compared to drug therapies for secondary prevention of coronary heart disease, rehabilitation of stroke, treatment of heart failure, prevention of diabetes. The findings are summarized as pulled directly from the abstract as: “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.”
So here we are again with significant information to support non-drug interventions in older adults, with the exception of diuretics in heart failure, thus avoiding possibly harmful medications known to cause hospitalization and increase mortality when not used properly. Now I must confess, not everyone can benefit from non-drug interventions, and many medications are known to improve function, quality of life and reduce mortality. But it stands to reason that we can use fewer medications if we altered our lifestyles. Add this information to the work of Doron Garfinkel (medication minimization) and we can greatly reduce medication use in older adults thereby lowering health care costs and avoiding unnecessary adverse drug events. The big question is, how do most people get to where they need to go? There’s so much conflicting information that people receive from prescribers, the Internet, magazines, TV, etc. that confusion and fear reigns supreme, with people surrendering by taking more drugs than necessary. Professional expertise in the area of medication minimization can help solve that problem.
Here’s the link to the abstract: http://www.bmj.com/content/347/bmj.f5577