Saturday, June 27, 2015

Exercise as a Treatment Following Stroke

Bill Yates
Brain Posts
Posted 20th February 2014

Exercise appears to be therapeutic in treatment of a variety of medical conditions.

However, the relative magnitude of the effect of exercise is less well documented.

Comparing the magnitude of the therapeutic effect of exercise with that of common drug interventions can be quite informative.

Such comparisons provide insight into the relative value of exercise and the role of exercise in comprehensive treatment planning.

Huseyin Naci and John Ioannidis recently published a study of the comparative effectiveness of exercise in the British Medical Journal.

In this study, a meta-analysis was completed of randomized controlled trials with a primary outcome of mortality risk. Four exercise trials and twelve drug trials were examined and compared across four common diseases (drug treatment reference):
  • Coronary heart disease (statins, beta blockers, ACE inhibitors, antiplatelet therapy)
  • Stroke (anticoagulants, antiplatelets)
  • Heart failure (ACE inhibitors, diuretics, beta blockers, angiotensin receptor blockers)
  • Diabetes prevention (alpha glucosidase inhibitors, thiazolidinedones, biguanides, ACE inhibitors, glinides)
The findings from this analysis are quite informative.

Exercise post-stroke had the biggest comparative effectiveness compared to both anticoagulant or antiplatelet therapy. The exercise risk reduction estimate for post-stroke mortality was 91% (95% confidence interval 38% to 99%). Anticoagulants and antiplatelet therapy failed to demonstrate a statistically significant mortality reduction.

Mortality risk reduction for coronary heart disease and prediabetes were modest and failed to reach statistical significance. Exercise was estimated to reduce mortality risk during follow up for heart failure by about 20%, but this effect was much less than the most effective drug treatment of diuretics (80% risk reduction).

The study highlights the relative importance of exercise rehabilitation following stroke. Other current interventions have limited effects and exercise rehabilitation may currently be the most effective treatment available.

Readers with more interest in this study can access the free full-text manuscript by clicking on the PMID link below.

Photo of roseatted spoonbills at sunset is from the author's files.

Follow the author on Twitter WRY999.

Naci H, & Ioannidis JP (2013). Comparative effectiveness of exercise and drug interventions on mortality outcomes: metaepidemiological study. BMJ (Clinical research ed.), 347 PMID: 24473061.

See the original article:

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