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Why Exercise is the Best Medicine Ever!

Author: Stan Reents, PharmD
Original Posting: 10/19/2012 09:41 AM
Last Revision: 04/05/2020 12:29 PM

In 2017, the RAND Corporation released a report summarizing the prevalence of chronic disease in the US. Based on health statistics from 2014, it reveals:

  • 60% of adults in the US have at least one chronic disease.
  • 42% of adults have more than one chronic disease.
  • In adults 65 years and older, 81% have more than one chronic disease.

Most of these health problems are due to a person's lifestyle: smoking, not exercising, poor diet. Thus, "lifestyle"-related illnesses now represent the largest percentage of health care expenses in the US.

HEALTH CARE EXPENSES

It's not news that the US spends more money on health care per person than any country on earth:

The December 1, 2008 issue of TIME magazine contained an evaluation of health care in various countries:


COUNTRY
(rank)
ANNUAL HEALTH CARE COSTS
PER CAPITA
(1) USA $7026
(4) Switzerland $5878
(7) France $4056
(8) Canada $3912
(9) Britain $3361
(10) Japan $2690

Yet, we aren't getting the best results. (That explains the title of their article: "The Sorry State of American Health"). Consider our 2 biggest chronic health problems: cardiovascular disease and obesity.

Cardiovascular Disease

Cigarette smoking has been declining steadily and is now down to 19%, its lowest level in decades. LDL-cholesterol levels and the death rate due to cardiovascular disease (CVD) have also declined steadily during the past 2 decades in the US. But, CVD is still the #1 cause of death of adults.

Why haven't we had better success in managing cardiovascular disease in the US?

In 2005, an analysis of the management of cardiovascular disease in 661 medical centers in 15 countries revealed that the country with the worst blood pressure control, medication compliance, and follow-up rate was.....the US! (Black HR, et al. 2005.)

Another answer to that question is that pounding away at cholesterol with cholesterol-lowering drugs isn't as effective for preventing cardiovascular disease as many people believe:

• In the November 8, 2010 issue of the Archives of Internal Medicine, John Pippin, MD, critiqued the JUPITER trial, and summarized a meta-analysis of studies of statin drugs: "These findings suggest that three-fourths of patients who take statins to prevent a first cardiovascular event do not benefit from this treatment." A separate analysis revealed that a disturbingly high 41% of patients had an LDL-cholesterol level of < 100 mg/dL at the time of their first heart attack (myocardial infarction) (Sachdeva A, et al. 2009). This LDL-cholesterol value is generally considered acceptable. In other words, people with "acceptable" cholesterol levels can still have a heart attack.

People with diabetes, hypertension, or elevated cholesterol often have more than one of these chronic conditions concurrently. Thus, they need multiple drugs. But, regardless of the effectiveness of drug therapy, patient compliance with cardiovascular medications is often poor:

• Antihypertensive Drugs: An analysis of 4783 patients revealed that almost half had discontinued their blood pressure medication at the end of the first year (Vrijens B, et al. 2008.)

• Cholesterol-Lowering Drugs: Numerous studies have documented poor long-term compliance with statins. In one, only 25-40% of patients took their drugs as prescribed during the 2 years they were monitored (Jackevicius CA, et al. 2002.)

• Post-MI Drugs: 12% of patients who suffered a myocardial infarction (heart attack) and who were discharged on aspirin, a beta-blocker, and a statin-type cholesterol drug had stopped taking all 3 drugs within the first month! (Ho PM, et al. 2006.)

Many patients with coronary artery disease undergo a procedure where a stent (tube) is placed inside the coronary artery to keep it open. Medical terms for this include "intracoronary stent implantation" or "percutaneous coronary intervention" (PCI). Some research shows that performing a PCI procedure isn't very effective:

• In 2007, the prestigious New England Journal of Medicine published a report stating "...PCI did not reduce the risk of death, myocardial infarction, or other major cardiovascular events when added to optimal medical therapy." (Boden WE, et al. 2007).

• The January 23, 2012 issue of the Archives of Internal Medicine included a study showing that nearly 1 in 10 cardiac patients who undergo a PCI required readmission to the hospital within 30 days (Khawaja FJ, et al. 2012).

Obviously, those aren't glowing endorsements of this procedure!

Obesity

In terms of number of people affected, obesity is now the #1 chronic health problem in the US. The latest statistics reveal (Flegal KM, et al. 2016) (Ogden CL, et al. 2016):


GROUP PERCENT OBESE
Men 35% obese
Women 40% obese
Adolescents 20% obese

These are the worst obesity rates we've ever seen in the US.

A 2012 report from the Robert Wood Johnson Foundation ("F as in Fat: How Obesity Threatens America's Future 2012") projects that by 2030, obesity rates will exceed 44% in all 50 states and will add another $48-66 billion to the cost of treating obesity-related disease (Voelker R. 2012).

Cardiovascular disease and obesity affect tens of millions of Americans. Health care expenses for both are projected to continue to rise during the next several decades. We need to consider a different approach to chronic health problems like these...

THE POWER OF PREVENTION

One glaring deficit in the health care system in the US is how little time, money, and effort is placed on preventive care. The TIME magazine review from 2008 gave "Preventive Care" in the US a grade of D+.

Instead, we pursue a strategy based on drug therapy and expensive procedures which only address the symptoms of the problem.

Professor Steven Blair has recently concluded that "physical inactivity is the biggest public health problem of the 21st century." After analyzing nearly 54,000 patients, he shows that:

"Low cardiorespiratory fitness" was the biggest contributor to death than any of the other traditional risk factors that clinical medicine currently monitors.

In fact, "low cardiorespiratory fitness" was a substantially higher determinant of death than risk factors that currently get most of the attention such as obesity and elevated cholesterol (Blair SN. 2009.) What he is saying here is that your fitness level is more important than your cholesterol level!

EXERCISE REALLY IS A THERAPEUTIC AGENT!

The title of an editorial by William Roberts, MD, in the American Journal of Cardiology illustrates how versatile exercise is:

“An agent with lipid-lowering, antihypertensive, positive inotropic, negative chronotropic, vasodilating, diuretic, anorexigenic, weight-reducing, cathartic, hypoglycemic, tranquilizing, hypnotic and antidepressive qualities.”

That's pretty impressive, isn't it? The "agent" he is describing here is aerobic exercise.

What's also impressive is that this paper was published in 1984.... that was more than 30 years ago! Since then, a great deal of research now documents the effectiveness of exercise in a wide variety of human diseases (Pedersen BK, et al. 2006). Today, the title could also include: "memory-enhancing," "cancer-preventing," "anti-arthritic," and "clot-preventing" as well!

But is exercise really that effective?

Yes. Research shows that exercise is beneficial for dozens of medical conditions. Our Articles Library provides detailed reviews on many of them, but, briefly:

• Cardiovascular diseases: coronary artery disease, hypertension, stroke, heart failure, intermittent claudication.

• Metabolic diseases: metabolic syndrome, type-2 diabetes, elevated lipids, obesity.

• Musculoskeletal diseases: osteoarthritis, rheumatoid arthritis, osteoporosis, fibromyalgia.

• Mental health: dementia, depression, mental performance at work and in the classroom.

• Various forms of cancer.

IN SOME CASES, EXERCISE IS BETTER THAN DRUG THERAPY

In 2013, Huseyin Naci and John Ioannidis, MD, at Stanford analyzed 305 randomized controlled clinical trials involving over 339,000 patients. They compared the response to exercise versus the response to drug therapy (Naci H, et al. 2013):


MEDICAL CONDITION EXERCISE vs. DRUG THERAPY
Coronary Artery Disease
(secondary prevention of)
Exercise is as good as Drug Therapy
Diabetes
(prevention of)
Exercise is as good as Drug Therapy
Stroke
(rehab of)
Exercise is BETTER THAN Drug Therapy
Congestive Heart Failure
(treatment of)
Drug Therapy is better than Exercise

Exercise Prevents Atherosclerosis: The "Risk Factor Gap"

Atherosclerosis is not simply a problem of too much cholesterol. Rather, atherosclerosis is the result of a variety of physiologic and biochemical disruptions working together to damage the inside surface of the walls of arteries. In addition to the accumulation of cholesterol, other problems co-exist in most people: elevated glucose, elevated blood pressure, elevated triglycerides, and a prolonged state of low-grade inflammation. This is why cholesterol-lowering drugs are not as effective as aerobic exercise: statin-type cholesterol drugs only address 2 of those problems: elevated cholesterol, and they appear to reduce the intensity of low-grade inflammation. But, they do nothing for elevated glucose, they don't lower blood pressure...

...And they don't do the myriad of other things that aerobic exercise provides. It turns out that aerobic exercise (particularly when aerobic fitness is maintained!) is more beneficial for lowering the risk of coronary artery disease than is predicted by the changes in measurement of traditional risk factors (eg., cholesterol, blood pressure, glucose). This is called the "Risk Factor Gap". Aerobic exercise improves dozens of physiologic and biochemical variables, easily trouncing the benefits of cholesterol-lowering drugs.

Running: Paul T. Williams, PhD, at the Lawrence Berkeley National Laboratory in Berkeley, CA, analyzed health data on more than 107,000 runners in The National Runners' Health Study. Distance runners (Williams PT, et al. 2007) and marathon runners (Williams PT. 2009) required drug therapy for cholesterol, diabetes, and/or hypertension less frequently compared to those who ran much less.

Walking: Then, he discovered that walking reduced the risk of developing diabetes, hypertension, and elevated cholesterol similar to the benefits of running (Williams PT, et al. 2013), and that walkers were also less likely to require prescription drugs for these conditions (Williams PT. 2008).

IN SOME CASES, EXERCISE IS BETTER THAN MEDICAL PROCEDURES

A striking example where exercise is a more effective therapeutic option than a medical procedure is the setting of coronary artery disease:

Researchers in Germany have shown that it is more effective to put patients who have had a heart attack on an exercise program than to perform a PCI procedure:

• Patients were given 1 of 2 different treatments after routine coronary angiography: One group rode a stationary bicycle for 20-min per day, combined with one 60-min group exercise session per week. The other group underwent a PCI. After 12 months, the group that exercised had a higher "event-free survival" rate than the group that received the PCI. Further, health care costs in the group that exercised were half the costs in the group that received PCI (Hambrecht R, et al. 2004).

Yes, exercise IS good medicine!

MEDICAL GROUPS ENDORSE EXERCISE

Because of this, virtually all major medical advisory groups now endorse exercise as a viable health-promoting strategy:

November 2007: The American College of Sports Medicine (ACSM) and the American Medical Association (AMA) jointly launched the “Exercise Is Medicine” initiative. This campaign calls on all physicians to “prescribe” exercise as they would for other traditional therapeutic agents.

June 2008: The US Government's Dept. of Health and Human Services issued its first set of Physical Activity Guidelines.

May 2010: The National Physical Activity Plan was released.

Healthy People has been providing exercise / physical activity recommendations for decades.

"STEPS" YOU SHOULD TAKE

So, what can you do with all this information? The bottom line: Exercise or do some form of physical activity every day!

But, first, a couple precautionary statements:

1) If you have any pre-existing medical condition, check with your personal physician before beginning any new exercise routine.

2) If you are currently taking medications, do NOT stop taking them without conferring with your physician.

3) Then, consider starting by going for a walk....if not every day, then, 3-5 days per week. But, eventually try to do it every day. Walk briskly and swing your arms. Try to push your heart rate up a bit. Learn how to monitor your heart rate while you are exercising. Slow down if you get out of breath, and, certainly, stop immediately if you develop chest pain!

4) Periodically, assess your progress by determining your resting heart rate first thing when you wake up.

That's it! Yes, it really is that simple to improve your health. You may find that your blood pressure and your cholesterol start to improve, and, you just might lose a little weight.

SUMMARY

Exercise is one strategy that could make a huge impact on the health of Americans, and, in turn, health care costs, particularly for chronic diseases such as obesity, diabetes, hypertension, coronary artery disease, etc.

What would happen if we focused more attention on exercise as a therapeutic agent in health care? Answer: We might have a better impact on cardiovascular diseases, obesity, type-2 diabetes, the general health of our entire population, and, a reduction in health care expenses!

FOR MORE INFORMATION

An entire chapter in Reents' text Sport and Exercise Pharmacology is devoted to the concept of prescribing exercise to "treat" health problems. (This book was published 7 years before the ACSM/AMA "Exercise Is Medicine" initiative was launched!)

Readers may also be interested in these reviews:

EXPERT HEALTH and FITNESS COACHING

Stan Reents, PharmD, is available to speak on this and many other exercise-related topics. (Here is a downloadable recording of one of his Health Talks.) Contact him through the Contact Us page.

REFERENCES

American Heart Association. Heart Disease and Stroke Statistics - 2010 Update. American Heart Association, Dallas, TX, 2010.

Black HR, Elliott WJ, Grandits G, et al. Results of the Controlled ONset Verapamil INvestigation of Cardiovascular Endpoints (CONVINCE) trial by geographical region. J Hypertens 2005;23:1099-1106. Abstract

Blair SN. Physical inactivity: The biggest public health problem of the 21st century. Br J Sports Med 2009;43:1. Abstract

Boden WE, O'Rourke RA, Teo KK, et al. Optimal medical therapy with or without PCI for stable coronary disease. N Engl J Med 2007;356:1503-1516. Abstract

Flegal KM, Kruszon-Moran D, Carroll MD, et al. Trends in obesity among adults in the United States, 2005 to 2014. JAMA 2016;315:2284-2291. Abstract

Green DJ. Exercise training as vascular medicine: Direct impacts on the vasculature in humans. Exercise Sports Science Reviews 2009;37:196-202. Abstract

Hambrecht R, Walther C, Mobius-Winkler S, et al. Percutaneous coronary angioplasty compared with exercise training in patients with stable coronary artery disease. Circulation 2004;109:1371-1378. Abstract

Ho PM, Spertus JA, Masoudi FA, et al. Impact of medication therapy discontinuation on mortality after myocardial infarction. Arch Intern Med 2006;166:1842-1847. Abstract

Ioannidis JPA. More than a billion people taking statins? Potential implications of the new cardiovascular guidelines. JAMA 2014;311:463-464. Abstract

Jackevicius CA, Mamdani M, Tu JV. Adherence with statin therapy in elderly patients with and without acute coronary syndromes. JAMA 2002;288:462-467. Abstract

Khawaja FJ, Shah ND, Lennon RJ, et al. Factors associated with 30-day readmission rates after percutaneous coronary intervention. Arch Intern Med 2012;172:112-117. Abstract

Naci H, Ioannidis JPA. Comparative effectiveness of exercise and drug interventions on mortality outcomes: Metaepidemiological study. Br Med J 2013;347:f5577. Abstract

Ogden CL, Carroll MD, Lawman HG, et al. Trends in obesity prevalence among children and adolescents in the United States, 1988-1994 through 2013-2014. JAMA 2016;315:2292-2299. Abstract

Pedersen BK, Saltin B. Evidence for prescribing exercise as therapy in chronic disease. Scan J Med Sci Sports 2006;16(suppl. 1):3-63. Abstract

Roberts WC. An agent with lipid-lowering, antihypertensive, positive inotropic, negative chronotropic, vasodilating, diuretic, anorexigenic, weight-reducing, cathartic, hypoglycemic, tranquilizing, hypnotic and antidepressive qualities. Am J Cardiol 1984;53:261-262. Abstract

Sachdeva A, Cannon CP, Deedwania PC, et al. Lipid levels in patients hospitalized with coronary artery disease: An analysis of 136,905 hospitalizations in Get With The Guidelines. Am Heart J 2009;157:111-117. Abstract

Voelker R. Escalating obesity rates pose health, budget threats. JAMA 2012:308:1514. (no abstract)

Vrijens B, Vincze G, Kristanto P, et al. Adherence to prescribed antihypertensive drug treatments: Longitudinal study of electronically compiled dosing histories. Br Med J 2008;336:1114-1117. Abstract

Williams PT. Reduced diabetic, hypertensive, and cholesterol medication use with walking. Med Sci Sports Exerc 2008;40:433-443. Abstract

Williams PT. Lower prevalence of hypertension, hypercholesterolemia, and diabetes in marathoners. Med Sci Sports Exerc 2009;41:523-529. Abstract

Williams PT, Franklin B. Vigorous exercise and diabetic, hypertensive, and hypercholesterolemia medication use. Med Sci Sports Exerc 2007;39:1933-1941. Abstract

Williams PT, Thompson PD. Walking versus running for hypertension, cholesterol, and diabetes mellitus risk reduction. Arterioscler Thromb Vasc Biol 2013;33:1085-1092. Abstract

ABOUT THE AUTHOR




Stan Reents, PharmD, is a former healthcare professional. He is a member of the American College of Lifestyle Medicine (ACLM) and a member of the American College of Sports Medicine (ACSM). In the past, he has been certified as a Health Fitness Specialist by ACSM, as a Certified Health Coach by ACE, as a Personal Trainer by ACE, and as a tennis coach by USTA. He is the author of Sport and Exercise Pharmacology (published by Human Kinetics) and has written for Runner's World magazine, Senior Softball USA, Training and Conditioning and other fitness publications.




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