Friday, 4 October 2013

It's the quality, not just the length

Today's British Medical Journal publishes an important review indicating that exercise is just as effective as drugs in helping people who have had stroke, heart failure, heart disease or are at risk of diabetes. They live just as long if exercise is prescribed rather than drugs, and in the case of stroke longer.
Which is quite a stunning conclusion, particularly since 305 randomised controlled trials informed the study. What makes it all the more remarkable is that this study looked at length of life, not quality of life. 
What would be the results of a study that also took into consideration the life-inhibiting side effects of the drugs here being compared with exercise? The drugs most commonly used to prevent heart attack, heart failure and stroke – beta blockers, ACE-inhibitors, anticoagulants, diuretics, statins – are pretty blunt instruments which are not easily tolerated. GPs often struggle to find the right dosages and combinations that enable people to lives not feeling woozy, sick, worried or rushing to the toilet every few minutes. Exercise, on the other hand, usually improves quality of life.
The conclusion to be drawn isn’t that we stop using drugs, and get everyone to run round the block instead. It’s that drugs, particularly those known to have problematic side effects, should not always be the first port of call. Length of life doesn’t necessarily suffer if you put quality of life first.