Friday, June 8, 2012

How About a Little Exercise?

In the previous post I talked about new evidence of how many serious injuries and deaths are caused by American medicine's love affair with treating every possible patient malady with prescription drugs. By way of illustrating what might make more sense, let me again thank Drs. Rick Bukata and Jerry Hoffman's Primary Care Medical Abstracts program, whose May 2012 issue just happened to include this reference:
http://www.sciencedirect.com/science/article/pii/S0140673611607496

This Taiwanese group of investigators report a prospective study that involved 416,175 healthy people with a mean follow-up of 8 years, which most people would regard as a sufficiently large sample to draw some reasonable conclusions.

They wanted to explore the conventional wisdom that you need at least 30 minutes of exercise a day to show any health advantage. They did in fact find that if you did 30 minutes of exercise a day, you had a 20% relative reduction in all-cause mortality, and a 15% reduction in cancer mortality. But the good news was that they also found that even 15 minutes a day led to 14% and 10% risk reductions, respectively, which is not all that shabby. There was a nice dose-response curve with added exercise leading to increased health benefits. So the authors conclude that it makes excellent sense to recommend even minimal exercise as a way to get patients some health benefits and hopefully they might find they can increase it over time.

Now I go into all this because in this blog we've seen example after example of a "wonder" drug that alters mortality rates by maybe 1% or 2% at best; and that's rare compared to drugs that change surrogate markers but have no impact on mortality at all; or then the drugs that reduce disease-specific mortality but not all-cause mortality. In short, the effects seen with even 15 minutes of exercise in this study are vastly superior to results shown with the majority of prescription drugs that are commonly used in "preventive" merdicine.

I used to joke about John Abramson's great book, Overdo$ed America, that my esteemed colleague must be in the pay of the exercise industry, because his entire book could be seen as one long appeal, "go get some exercise and forget all this other garbage." Well, he was right. And if American physicians spent half the time counseling patients about exercise as they do reaching for the prescription pad (or the computer equivalent) imagine how much healthier we'd be. (Then we could talk about health disparities and how exercise recommendations increase disparities between groups, but that's another discussion.)

2 comments:

Chuck said...

the problem i see with this study based on the summary i saw is it is based on questionnaires. they concluded that the people who exercised the most had the lowest mortality rates. problem is there are so many confounding factors to consider. people who regularly exercise also make other healthy lifestyle choices such as not smoking and eating right. there is no doubt in my mind that exercise is good for you but this study is only the tip of the healthy lifestyle iceberg.

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