Pumping iron or popping pills – which is best?

Home » Health & Wellbeing » Pumping iron or popping pills – which is best?

How do you like to try to stay healthy? I find that people fall largely into two categories, those who believe in all things natural/preventative and avoid prescription medication – and any other medication – at all costs, all the while begging me (and probably a number of ‘alternative’ health practitioners) for some diet/exercise/lifestyle advice that will enable them to continue their pharmaceutical free existence for as long as possible, while equal numbers of people who value their health just as much will happily beat my door down on a regular, frequent basis on a mission to obtain a ‘pill for every ill’; all that thinking about what they eat and considering exercise is just too much hassle when a simple tablet will do the job just as well. And on the face of it, who could blame them? Life is busy and stressful enough, and as a profession that’s more or less what we have been advising for years.

But recently the opinion of both the public and the medical world has been changing. A great deal of research has been done looking at the relative benefits of lifestyle changes rather than pill popping as a means of keeping us healthy, and a large study published this week – http://www.bmj.com/content/347/bmj.f5577 – suggests that both camps have a point – the authors conclude that exercise and pills work equally well. But before we all get excited and cancel our gym membership and dump our trainers in the bin on the way to the pharmacy, let’s look a little deeper at what they did.

The study is ‘metaepidemiological’, which means that the authors did not do any new research themselves, but analysed all the existing studies comparing exercise with prescription medication and how likely they were to stop people dying in four situations; people at risk of coronary heart disease, those recovering after stroke, treatment of heart failure, and prevention of diabetes. And they found that regular exercise was just as effective as prescription medication in all four groups. They did not look at any other aspects of the patients’ lives, like quality of life, independence, mental wellbeing, for example; this study was simply about how long people lived. And it’s a great study – it’s big, and this kind of analysis is generally considered to be pretty compelling evidence.

So initially, this is good news whichever ‘camp’ you are in. If you have a high risk of having a heart attack or diabetes, or have had a stroke or have heart failure, then you can apparently either sit on the sofa and pop your pills or hit the gym and work up a sweat and be confident that you are going to live just as long as if you had made the other choice. But while we all generally want to live as long as possible, there’s more to life than the number of our days isn’t there? And what about all the people out there who don’t happen to fit into one of the four categories in the study (which is most of us!)?

While I love this study and will be certainly telling my own patients about it, I still have to say that I would choose exercise over pills every time I could. Pills come with long lists of side effects, and while they are undoubtedly life saving and life enhancing, a lot of people do not enjoy taking them and many find even the psychological effects of feeling that they have to take drugs to survive are very negative. Exercise, meanwhile, has so many beneficial effects beyond simple survival that it surely has to be the better choice when possible. I have given a few examples of great articles about how exercise benefits us at the end of this article (1-7), but this is just a selection and there are literally hundreds more, covering depression, other mental illness, cancer, neurological problems and beyond, as well as the topics mentioned in the recently published study.

So I think the take-home message is still that exercise is as important as it has ever been, and that with a lot more research to back this study up we could potentially celebrate a future with fewer pills rather than one with less exercise. The next logical step is to do an analysis of studies looking at exercise and pills combined…………….

As always, if you have any health problems then please don’t make any major changes because of this or any other individual article in the press, if you are considering increasing your activity levels in an effort to reduce your medication please talk this through with your doctor who knows you – most of us don’t like prescribing pills unless we have to and will be delighted to help you in your efforts! Most areas of the UK have access to prescribed exercise, essentially heavily discounted gym membership and assessment with a personal trainer – an excellent place to start. If you have any questions or need further advice please contact myself or Sue Ruff through the website and we will try and point you in the right direction.

Reference List

  (1)    Singh Joy SD. Exercise benefits patients with depression. Am J Nurs 2013 Oct;113(10):67.

(2)    Hogan CL, Mata J, Carstensen LL. Exercise holds immediate benefits for affect and cognition in younger and older adults. Psychol Aging 2013 Jun;28(2):587-94.

(3)    Maddux DW, West C. The benefits of exercise for CKD patients. Nephrol News Issues 2012 Nov;26(12):44, 46, 48.

(4)    Yeo TP. Exercise improves fatigue during and after breast and prostate cancer treatment, with benefits seen for aerobic exercise. Evid Based Nurs 2013 Oct;16(4):101-2.

(5)    Guiney H, Machado L. Benefits of regular aerobic exercise for executive functioning in healthy populations. Psychon Bull Rev 2013 Feb;20(1):73-86.

(6)    Motl RW, Pilutti LA. The benefits of exercise training in multiple sclerosis. Nat Rev Neurol 2012 Sep;8(9):487-97.

(7)    Vina J, Sanchis-Gomar F, Martinez-Bello V, Gomez-Cabrera MC. Exercise acts as a drug; the pharmacological benefits of exercise. Br J Pharmacol 2012 Sep;167(1):1-12.


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