Comparative effectiveness of exercise and drug interventions on mortality outcomes: metaepidemiological study.
Comparative effectiveness of exercise and drug interventions on mortality outcomes: metaepidemiological study.
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DOI：
10.1136/bmj.f5577
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发表时间：
2013-10-01
期刊：
影响因子：
--
通讯作者：
Ioannidis JP
中科院分区：
文献类型：
--
作者：
Naci H;Ioannidis JP
目的比较运动与药物干预对死亡率的影响。设计元流行病学研究。合格标准：对随机对照试验进行荟萃分析，比较运动和药物干预相互之间或与对照（安慰剂或常规护理）的有效性。数据来源Medline和科克伦系统评价数据库，2013年5月。主要结局指标死亡率。我们使用随机效应网络荟萃分析结合了运动和药物试验的研究水平死亡结果。结果我们纳入了16项（4项运动和12项药物）荟萃分析。除了最近的三项运动试验外，我们的综述共包括305项随机对照试验，共有339274名参与者。在所有四种有证据表明运动对死亡率结果有效的条件下（冠心病的二级预防，中风的康复，心力衰竭的治疗，糖尿病的预防），14716名参与者在57项试验中随机接受身体活动干预。在冠心病和前驱糖尿病的二级预防中，运动和药物干预之间没有明显的统计学差异。在卒中患者中，体力活动干预比药物治疗更有效（比值比，运动vs抗凝剂0.09，95%可信区间0.01 - 0.70，运动vs抗血小板0.10，0.01 - 0.62）。在心力衰竭中，利尿剂比运动更有效（运动vs利尿剂4.11，1.17 - 24.76）。直接和间接比较之间的不一致性不显著。结论：尽管数量有限，但现有的运动干预随机试验证据表明，运动和许多药物干预在冠心病二级预防、卒中后康复、心力衰竭治疗和糖尿病预防方面的死亡率获益往往是相似的。
Objective To determine the comparative effectiveness of exercise versus drug interventions on mortality outcomes. Design Metaepidemiological study. Eligibility criteria 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). Data sources Medline and Cochrane Database of Systematic Reviews, May 2013. Main outcome measure Mortality. Data synthesis We combined study level death outcomes from exercise and drug trials using random effects network meta-analysis. Results 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 v anticoagulants 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. Conclusions 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.
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DOI：
10.1136/bmj.e70
发表时间：
2012-01-30
期刊：
BMJ (Clinical research ed.)
影响因子：
--
作者：
Fong DY;Ho JW;Hui BP;Lee AM;Macfarlane DJ;Leung SS;Cerin E;Chan WY;Leung IP;Lam SH;Taylor AJ;Cheng KK
通讯作者：
Cheng KK
影响因子：
2
作者：
Cooper, Nicola J.;Sutton, Alex J.;Welton, Nicky J.
通讯作者：
Welton, Nicky J.
DOI：
10.1016/0197-2456(86)90046-2
发表时间：
1986-09-01
期刊：
CONTROLLED CLINICAL TRIALS
影响因子：
--
作者：
DERSIMONIAN, R;LAIRD, N
通讯作者：
LAIRD, N
影响因子：
168.9
作者：
Flather, MD;Yusuf, S;Braunwald, E
通讯作者：
Braunwald, E
影响因子：
120.7
作者：
Cleeman, JI;Grundy, SM;Murray, EZ
通讯作者：
Murray, EZ