Cardiovascular disease is the number one killer across the globe, according to the World Health Organization (WHO). It take the lives of some 17 million people a year, a number that is predicted to rise to more than 23 million by 2030.

Currents treatments are costly and include statins, beta blockers, anticoagulants, antiplatelets and diuretics – among other drugs. But now a new review conducted by researchers at the London School of Economics, Harvard and Stanford have another course of action to suggest.

In a review of 16 meta-analyses including 305 studies involving 339,274 participants, they found no statistically detectable difference between exercise and drug treatment for patients with coronary heart disease.

In addition, the researchers found that exercise was more effective than drugs for patients recovering from a stroke.

The review supports previous research showing the benefits of behavior and lifestyle changes when it comes to disease. The authors Huseyin Naci of Harvard and John Ioannidis of Stanford go so far as to say that given the cost of drug treatment, regulators should consider requiring pharmaceutical companies to include exercise as a comparison in clinical trials of new medicines.

“In cases where drug options provide only modest benefit, patients deserve to understand the relative impact that physical activity might have on their condition,” Naci and Ioannidis note in the paper. They add, “exercise interventions should therefore be considered as a viable alternative to, or, alongside, drug therapy.”

The types of exercise varied across the studies in the review, leaving the authors unable to make a generalized recommendation for specific forms of physical activity. But the WHO notes that moderate intensity physical activity – like walking, cycling or participating in sports – can reduce the risk of cardiovascular diseases; it also can reduce the risk of diabetes, some cancers, depression and obesity.

The study did find one area in which medication outperformed exercise. For those recovering from heart failure, diuretics were more effective. But for all the rest? Clearly a little exercise can’t hurt, and it’s a lot less expensive than a trip to the pharmacy.

The review was published in the British Medical Journal.

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