• Education

Second to tobacco control, a case can be made that physical activity and/or structured exercise is the best medicine for many of most prevalent non-communicable diseases in the developed world.1 This is especially true for metabolic and cardiovascular disease (CVD), in a preventive and therapeutic context. Although still limited in quantity, currently available evidence based on randomised trials indicates that exercise and many drug interventions are often potentially similar in terms of their mortality benefits in the secondary prevention of CVD, rehabilitation after stroke, treatment of heart failure and prevention of diabetes.2 A recent meta-analysis of trials investigating the effect of exercise on CVD risk factors in patients with the metabolic syndrome reported a 10% drop-out from the exercise programmes,3 whereas those taking medications for CVD prevention are more likely to discontinue medication compared with placebo or one drug component (20% vs 14%).4 Exercise training is associated with an overall decline in glycosylated haemoglobin (HbA1c) levels,5 which …