From JoNova
By Jo Nova
Image by DanaTentis from Pixabay
A new review of studies came out a few weeks ago pointing out that trials of 700 people with the most common kind of heart failure show they did better after an exercise program than they did with drugs.
I’d like to say “Big Pharma won’t be happy” but Big Pharma probably couldn’t care less. The money, the industry, the regulatory agencies, Hollywood, and a lifetime’s habit means most people will keep returning to largely well-meaning but busy doctors who will prescribe the latest something, whatever it is.
But ultimately the people who get out there and do supervised exercise of any kind a few times a week get more benefits than those taking the latest patented drug. They’ll also have a higher quality of life. In this study they’re looking at people with the most kind of common heart failure called HFpEF. The exercise is supervised because there is some risk in people who may be quite unfit or unhealthy.
How much of our lives is spend working to pay for a bloated health-care system that finds expensive ways to employ many people to do what we could have done better ourselves?
This, from the abstract, is medical-speak for “the drugs were useless”, and we already know exercise works much better:
Until recently, most pharmacological intervention trials for HFpEF [a common type of heart failure] yielded neutral primary outcomes. In contrast, trials of exercise-based interventions have consistently demonstrated large, significant, clinically meaningful improvements in symptoms, objectively determined exercise capacity, and usually quality of life.
Exercise therapy is safe and helps improve recovery, study finds
By Annie Lennon in Medical News Today
Heart failure occurs when the heart can no longer pump blood and oxygen around the body. The condition represents around 8.5% of heart disease deaths in the United States.
Heart failure with preserved ejection fraction (HFpEF) causes around half of heart failure cases in the U.S. It happens when the heart’s left ventricle stiffens, increasing pressure inside the heart.
For the study, the researchers analyzed results from 11 randomized controlled trials investigating supervised exercise therapy on HFpEF outcomes.
The studies included over 700 participants, mostly aged between 60 and 70 years old. Participants engaged in various activities, including walking, Greek dancing, and high intensity training three times per week for 1-8 months.
We can’t get exercise in a pill:
“The benefits of exercise cannot be duplicated by medication or procedures. Regular exercise of 2.5 hours weekly or that equivalent increases life expectancy, reduces the incidence of heart disease complications, and has been linked to reduced risk for some cancers, such as colon.
A similar review 5 years ago in Europe showed much the same thing. Except in that case, they studied mortality too and an increase in peak oxygen uptake of 13% translated into 11% lower all-cause mortality.
The European study saved lives: Mortality was down 11%
More than 14 million Europeans suffer from heart failure (HF). Despite significant improvements in the treatment of HF, morbidity and mortality remain unacceptably high [1]. In addition, the costs for HF care approach 2% of the healthcare expenditure in Western Europe. One of the hallmarks of HF is severe exercise intolerance with pronounced fatigue and dyspnoea, even at low workloads, resulting in a markedly decreased quality of life.
With regard to benefit on exercise capacity, a meta-analysis of 29 randomised controlled trials (RCT) including 848 patients revealed a mean improvement of VO2peak of 2.16 ml/kg/min [4]. Although modest in absolute terms, this means an increase of 13% which translates into a considerably better quality of life [5].
This study showed in an intention-to-treat analysis that exercise training was associated with an 11% lower adjusted risk for all-cause mortality or all-cause hospitalisation and a 15% lower adjusted risk for cardiovascular mortality or HF hospitalisation.
Any kind of exercise will help:
Supervised exercise called better than drugs for common type of heart failure
March 21 (UPI) — Supervised exercise like walking, stationary cycling and even dancing about three times per week was more effective than drugs in helping people with symptoms of one of the most common types of heart failure, according to a new scientific statement.
The studies that were examined looked at numerous types of exercise, from walking, stationary cycling, high-intensity interval training, strength training and dancing in facility settings and home-based training.
The statement characterized supervised exercise therapy as being conducted three times per week, and the duration of the programs varied from one month to eight months.
“Exercise capacity is an independent, clinically meaningful patient outcome, and research has indicated that guided exercise therapy is actually more effective at improving quality of life for people who have [heart failure with preserved ejection fraction] than most medications.”
From the paper itself: Peak oxygen capacity was improved in every study in this latest review:
Peak oxygen capacity is so important it actually predicts all cause mortality.
And the US study improved VO2 almost exactly the same amount as the European one, so presumably it would have saved lives too:
[The Review] found that supervised exercise training may lead to increased peak oxygen uptake 12 to 14%, increased total exercise time by 21% and improved quality-of-life scores on the Minnesota Living with Heart Failure questionnaire 4 to 9 points.
Earlier this month, a University of Cambridge study suggested that brisk 11-minute daily walks can be enough to lower a person’s risk of heart disease, stroke and cancer.
The kind of patients this study was aimed at were:
Dr. Hermel added: “Supervised exercise programs such as cardiac rehab have demonstrated significant benefit for patients with recent heart attack or another acute coronary syndrome, chronic stable angina, congestive heart failure, pulmonary hypertension, after stent placement, coronary artery bypass surgery, heart valve surgery or cardiac transplant.”
As usual, the most important scientific work is often done by volunteers:
This scientific statement was prepared by a volunteer writing group on behalf of the American Heart Association and the American College of Cardiology.
In the three weeks since this important review was released the article metrics tell us it was picked up by 24 news outlets, bogged by 2 and tweeted by 144. In other words, hardly anyone.
REFERENCE
Sachdev et al (2023) Supervised Exercise Training for Chronic Heart Failure With Preserved Ejection Fraction: A Scientific Statement From the American Heart Association and American College of Cardiology, Circulation