Naci Huseyin, Ioannidis John P A
LSE Health, London School of Economics and Political Science, London, UK Drug Policy Research Group, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA.
Drug Policy Research Group, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA.
Br J Sports Med. 2015 Nov;49(21):1414-22. doi: 10.1136/bjsports-2015-f5577rep.
To determine the comparative effectiveness of exercise versus drug interventions on mortality outcomes.
Metaepidemiological study.
Meta-analyses of randomised controlled trials with mortality outcomes comparing the effectiveness of exercise and drug interventions with each other or with control (placebo or usual care).
Medline and Cochrane Database of Systematic Reviews, May 2013.
Mortality.
We combined study level death outcomes from exercise and drug trials using random effects network meta-analysis.
We included 16 (four exercise and 12 drug) meta-analyses. Incorporating an additional three recent exercise trials, our review collectively included 305 randomised controlled trials with 339,274 participants. Across all four conditions with evidence on the effectiveness of exercise on mortality outcomes (secondary prevention of coronary heart disease, rehabilitation of stroke, treatment of heart failure, prevention of diabetes), 14,716 participants were randomised to physical activity interventions in 57 trials. No statistically detectable differences were evident between exercise and drug interventions in the secondary prevention of coronary heart disease and prediabetes. Physical activity interventions were more effective than drug treatment among patients with stroke (odds ratios, exercise vanticoagulants 0.09, 95% credible intervals 0.01 to 0.70 and exercise v antiplatelets 0.10, 0.01 to 0.62). Diuretics were more effective than exercise in heart failure (exercise v diuretics 4.11,1.17 to 24.76). Inconsistency between direct and indirect comparisons was not significant.
Although limited in quantity, existing randomised trial evidence on exercise interventions suggests that exercise and many drug interventions are often potentially similar in terms of their mortality benefits in the secondary prevention of coronary heart disease, rehabilitation after stroke, treatment of heart failure, and prevention of diabetes.
确定运动与药物干预对死亡率结局的相对有效性。
Meta流行病学研究。
对随机对照试验进行Meta分析，这些试验的死亡率结局用于比较运动与药物干预相互之间或与对照（安慰剂或常规护理）的有效性。
2013年5月的Medline和Cochrane系统评价数据库。
死亡率。
我们使用随机效应网络Meta分析合并了运动和药物试验的研究水平死亡结局。
我们纳入了16项（4项运动和12项药物）Meta分析。纳入另外3项近期的运动试验后，我们的综述共纳入了305项随机对照试验，涉及339274名参与者。在运动对死亡率结局有效的所有4种情况下（冠心病二级预防、中风康复、心力衰竭治疗、糖尿病预防），14716名参与者在57项试验中被随机分配至体力活动干预组。在冠心病二级预防和糖尿病前期，运动与药物干预之间没有明显的统计学差异。在中风患者中，体力活动干预比药物治疗更有效（优势比，运动对比抗凝剂为0.09，95%可信区间为0.01至0.70；运动对比抗血小板药物为0.10，0.01至0.62）。在心力衰竭中，利尿剂比运动更有效（运动对比利尿剂为4.11，1.17至24.76）。直接和间接比较之间的不一致性不显著。
尽管数量有限，但现有关于运动干预的随机试验证据表明，在冠心病二级预防、中风后康复、心力衰竭治疗和糖尿病预防方面，运动和许多药物干预在死亡率获益方面通常可能相似。
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