Exercise or medicines – what to prefer?

Overweight, obesity and inactivity are emerging as a pandemic and are major risk factors for type-2 diabetes and cardiovascular disease (CVD). According to World Health Organization the prevalence of obesity in Europe has tripled in the last two decades, and in line with this, the latest figures from the Health Survey of Nord-Trøndelag (HUNT) show that 60 % of the population can be classified as overweight. Of those, 20 % can be classified as obese. The proportion of obese men in Norway has tripled in the recent 20 years and the incidence of type-2 diabetes has consequently increased. This is expected to result in increased incidence of CVD in the general population.

Additionally, an excessively high level of lipids in your blood (hyperlipidemia) can also have an effect on your health. High cholesterol itself does not cause any symptoms, but it increases your risk of serious health conditions. Alltogether, this and similar risk factors are called metabolic syndrome. Therapeutic lifestyle changes, including exercise, are the first line of treatment for patients with the metabolic syndrome. The health benefits of exercise have been exhaustively studied by our group, and the most notable of which is an increase in cardiorespiratory fitness. Importantly, cardiorespiratory fitness has been identified as the strongest independent predictor of both all cause and cardiovascular disease mortality in nearly every population in which it has been examined. Large-scale epidemiological studies demonstrate that aerobic fitness is the single best predictor for future cardiovascular mortality in healthy individuals and in patients with cardiovascular disease.

But, when lifestyle changes (such as exercise or diet) fail to achieve cholesterol reduction in patients with the metabolic syndrome or those with multiple cardiovascular disease risk factors (diabetes, obesity, high blood pressure, etc), medicines to lower cholesterol are prescribed to reduce the risk of coronary heart disease morbidity and mortality. Indeed, statins are the most widely prescribed drug around the world and can lower your cholesterol.

iStock_000007580283XSmallHowever, a scientific paper published this month in the Journal of the American College of Cardiology examined the effects of statin treatment on changes in cardiorespiratory fitness induced by exercise and shows some interesting results. Obese volunteers performed a supervised exercise training program: 45 minutes of treadmill walking or jogging at 60-75 % of heart rate reserve, 5 days per week for a total period of 12 weeks or the combination of exercise and simvastatin. The results actually showed that statins attenuated the benefits of exercise in the cardiorespiratory fitness when combined with exercise training in overweight or obese patients at risk of the metabolic syndrome.

Interestingly, statins also seem to be poorly tolerated among elite athletes. Another scientific study published few years ago monitored 22 professional athletes through 8 years in whom, because of familial hypercholesterolemia, treatment with different statins was attempted. These findings indicated that in top sports performers, only 2 of 10 tolerated statin treatment without side-effects. Among others, the medicine increased the susceptibility to muscle damage during exercise.

It is no doubt that statins lower too high cholesterol levels, but as observed, it may have negative side effects as well. Our recommendation is rather to try exercise first – it is free, gives energy and has no side effects.

Natale Rolim, researcher at CERG.

This entry was posted in Cardiovascular disease, Fitness, In English and tagged , , , by CERG. Bookmark the permalink.

About CERG

The Cardiac Exercise Research Group (CERG) at the Norwegian University of Science and Technology (NTNU) seeks to identify the key mechanisms underlying the beneficial effects of physical on cardiac health in the context of disease prevention and treatment. Named the K.G. Jebsen Center for Exercise in Medicine under Professor Ulrik Wisløff's leadership in 2011, CERG uses both top-down and bottom-up approaches to combat lifestyle-related disease.

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