by Huseyin Naci, LSE Health

Physical activity has indisputable health benefits. It is no surprise, then, that an increasing number of experts now recommend prescribing exercise in primary care as a strategy to ward off the emerging burden of chronic conditions including heart disease and diabetes. The hoped-for advantages of prescribing an “exercise pill” are to promote health and save lives. According to previous surveys, roughly one third of clinicians prescribe exercise in primary care.

Yet, population-wide physical activity levels are discouraging. Roughly one third of adults in England meet recommended levels of physical activity. In contrast, prescription drug utilisation rates continue to skyrocket, sharply rising in recent years to a whopping 17.7 prescriptions for every person in England in 2010.

In a new study published in the BMJ, Professor John Ioannidis from the Stanford University School of Medicine and I compare the mortality benefits associated with drug and exercise interventions in coronary heart disease, stroke, heart failure and pre-diabetes. As our review of the existing clinical evidence shows, physical activity is potentially as effective as many drug interventions based on available data in the secondary prevention of coronary heart disease, rehabilitation following stroke, treatment of heart failure and prevention of diabetes. Based on these findings, we conclude that exercise can be considered either as a viable alternative to or alongside drug therapy in clinical practice.

So should we simply stop taking our pills, empty our medicine cabinets, and hit the gym instead? Not quite. Our study is not without limitations. Most importantly, there is a significant asymmetry in the existing body of scientific evidence on the mortality benefits of drug and exercise interventions for common diseases, demonstrating the paucity of data on the effectiveness of exercise interventions in scientific studies. It is possible that such an asymmetry influenced our findings. As suggested in the discussion section of our paper:

“Our findings reflect the bias against testing exercise interventions and highlight the changing landscape of medical research, which appears to increasingly favor pharmaceutical interventions over lifestyle modification strategies”.

Consistent with the medicalisation of common conditions and remedies, the current body of medical literature largely constricts clinicians to pharmaceutical options. This blind spot in our medical research enterprise prevents doctors and their patients from understanding the situations where exercise and drugs could work equally well.

This is concerning. The current state of medical research gives the false impression to patients, clinicians, and other decision makers that pharmacological interventions are superior to non-pharmacological alternatives, and hence hinders evidence-based decision-making in clinical practice.

So what be done to fix this problem? In previous studies, 1, 2 my colleagues at LSE Health and I advocated for testing all new drugs against existing alternatives to ensure that they are at least as effective as what we currently have on offer (Sorenson et al. 2011; Naci et al. 2012). One policy option would be to require such evidence from pharmaceutical companies. For example, drug regulators should consider requiring pharmaceutical sponsors of new drugs to include exercise interventions as a comparator in their new drug trials.

We hope that the findings of our paper prompt increased discussion and data collection to eventually foster improved comparisons between pharmacological and non-pharmacological treatments. Until then, clinicians and patients should consider this additional piece of evidence in support of the life-saving benefits of physical activity.

Further information 

For the full article, see Naci H, Ioannidis JPA (2013) Comparative effectiveness of exercise and drug interventions on mortality outcomes: A meta-epidemiological studyBritish Medical Journal, 347, f5577.


Naci H, Cylus J, Vandoros S, Sato A, Perampaladas K (2012) Raising the bar for market authorisation of new drugsBritish Medical Journal, 345, e4261.

Sorenson C, Naci H, Cylus J, Mossialos E (2011) Evidence of comparative efficacy should have a formal role in European drug approvals, British Medical Journal, 343, d4849.

About the author 

Huseyin Naci is a doctoral candidate in Pharmaceutical Policy and Economics within LSE Health, and Thomas O. Pyle Fellow in Population Medicine at Harvard University.