Heart Attacks, Diabetes, Stroke: Meds or Exercise-Which is Better?

You have your first episode of chest pain and end up in the cardiologist’s office. Shockingly, you leave with a statin prescription.  But was this THE best option?

If you’re lucky, there’s some basic dietary advice or you’re pushed off onto a nutritionist. If you’re not lucky, you’re scheduled for a non-emergency cardiac procedure.

The exercise prescription, however, seems to get pushed to the back of the list of recommendations. I mean, sure–we all know that exercise is good for our heart, but it gets to the point where medications and cardiac procedures are pushed as the only answer.

But medications ARE the best answer, right?

Not even close. I have always held firm in the position that NOTHING is more powerful for the prevention and management of all chronic diseases than lifestyle. Granted, if you’re in the middle of a heart attack, it’s not the time for short-burst aerobic exercise and downing some fish oil capsules and vitamin D. But if you don’t want to end up there in the first place, or want to keep from having a second heart attack, lifestyle is the answer.

This particular study takes a hard look at the effects of exercise on the risks of having a second heart attack, recovering from stroke, surviving heart failure as well as preventing diabetes and compares these results to the effect of medications for the same conditions. While the results should not come as a surprise, the idea that the benefits of exercise get pushed to the back of the line of recommendations should infuriate us as a society.

Here are some of the details:

  • Researchers looked at 305 studies with 339,274 participants; this included 16 meta-analyses (4 exercise and 12 drug) .

  • They looked at prevention of a second heart attack, rehabilitation of stroke, treatment of heart failure and prevention of diabetes.

  • Sadly, only 57 of the 305 studies looked at the benefits of exercise (clearly, there is little interest in seeing whether exercise is important compared to drugs).

  • “Exercise” consisted of cardiac rehabilitation for patients with coronary heart disease. Physical activity was a part of lifestyle modification interventions to prevent diabetes. Patients with stroke did a mix of cardiorespiratory and muscle-strengthening exercises to protect against further disability, dependence, and death.  Those with chronic heart failure did aerobic and resistance training.

And here are the results when exercise was pitted against typical medications to treat various conditions:

  • Exercise was as effective as drug interventions (statins, β-blockers, angiotensin-converting enzyme (ACE) inhibitors or antiplatelets)  in preventing a 2nd heart attack or prediabetes.

  • Exercise was about 90% more effective than drugs for preventing death post-stroke (versus anticoagulants 91%, versus antiplatelets 90%).

  • The only time drugs were more effective was for the use of diuretics in heart failure.

The sad part about all of this is that it is clear that researchers are far more interested in running studies on drugs instead of exercise for these chronic diseases.  Because the studies get the publicity, doctors then focus on drug treatments and give exercise little heed.  You can see the problem here.  The potent treatment found in exercise with no side effects is not used.  Many times this may be because doctors don’t even truly understand how and what type of exercise to recommend because they get so little training in using exercise as medicine, beyond the standard recommendation to “walk more.”


James Bogash

For more than a decade, Dr. Bogash has stayed current with the medical literature as it relates to physiology, disease prevention and disease management. He uses his knowledge to educate patients, the community and cyberspace on the best way to avoid and / or manage chronic diseases using lifestyle and targeted supplementation.