Prescription: One Pair Nikes, Use PRN by Pat Conrad MD


Like many of you, despite formal training to the contrary, my brain tends toward the anecdotal when considering clinical situations.  And like many of you – admit it! – esteemed readers, I too especially like studies that confirmed what I already thought to begin with.  And so with those disqualifiers dispensed…

Last week the British Medical Journal reported on a study comparing the effectiveness of drugs to that of exercise.  Researchers from the London School of Economics, Harvard Medical School and Stanford University considered four processes “where evidence has shown that exercise can have lifesaving benefits: secondary prevention of heart disease, stroke rehabilitation, treatment of heart failure and prevention of diabetes.”

“Researchers then compiled a list of the different classes of drugs people commonly take to manage these conditions, and ultimately came up with 305 randomized clinical trials to analyze..  The study involved 339,274 people, 15,000 of whom received physical intervention for their health conditions while the rest were included in drug trials.”

And what did they conclude?  That exercise was as good as drug interventions for the people with coronary heart disease and for the prevention of diabetes; that exercise was more effective than drugs post-stroke; but diuretics, were more effective [than exercise] for treatment of heart failure.

The study authors were quick to state: “The results of our study by no means imply that people should stop taking their medications, especially without consulting their doctors.”
  They also did not note any evidence suggesting that exercise reduces mortality.   The summary comment:  “Exercise should be considered as “viable alternative to, or alongside, drug therapy.”

No, this study is not the slam-dunk I (unscientifically) wish for.  And since I don’t know the funding source(s) for the research, I’m immediately suspicious that an overspent government would love to push this in a way to cut drug costs, inasmuch as some pharmaceutical syndicate is already hiring operatives to discredit the work.  But what I have seen again and again in primary, urgent, and emergency care, is that regular vigorous exercise makes patients feel better, with less cost and a lower side effect profile.  Lawyers, core measures, silly ass quality/patient satisfaction scores notwithstanding, I think this study suggests a way to add a little actual authentic medicine to improve quality of life.

Douglas Farrago MD

Douglas Farrago MD is a full-time practicing family doc in Forest, Va. He started Forest Direct Primary Care where he takes no insurance and bills patients a monthly fee. He is board certified in the specialty of Family Practice. He is the inventor of a product called the Knee Saver which is currently in the Baseball Hall of Fame. The Knee Saver and its knock-offs are worn by many major league baseball catchers. He is also the inventor of the CryoHelmet used by athletes for head injuries as well as migraine sufferers. Dr. Farrago is the author of four books, two of which are the top two most popular DPC books. From 2001 – 2011, Dr. Farrago was the editor and creator of the Placebo Journal which ran for 10 full years. Described as the Mad Magazine for doctors, he and the Placebo Journal were featured in the Washington Post, US News and World Report, the AP, and the NY Times. Dr. Farrago is also the editor of the blog Authentic Medicine which was born out of concern about where the direction of healthcare is heading and the belief that the wrong people are in charge. This blog has been going daily for more than 15 years Article about Dr. Farrago in Doximity Email Dr. Farrago – [email protected] 

  1 comment for “Prescription: One Pair Nikes, Use PRN by Pat Conrad MD

  1. Harriet Squier
    October 10, 2013 at 8:05 am

    One of the most difficult barriers to getting patients to take better care of themselves is the resistance of the patients themselves. So often they would rather take a pill than actually make any personal effort to control their disease. It can help to be able to say that in this study of over 300,000 patients, it showed that exercise works better than medications. It might not help much, but anything you can add to your arguments in favor of self care might improve one’s ability to persuade…

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