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A pill that mimicked the effects of physical activity and exercise on the cardiovascular system would be the biggest blockbuster ever. It would be a poly-pill in its range of action with few serious adverse effects. On its patent expiry, the drug would be put in the water supply. Regrettably, there is no such pharmacological miracle in sight. Moreover, the current landscape is such that the dialogue around the expected benefits of exercise is omnipresent but doctors rarely ‘prescribe’ it and relatively few people initiate or adhere to it in the long term.
Naci and colleagues1 recently reported the outcomes of an elegant network meta-analysis, comparing exercise and drug interventions in lowering systolic blood pressure (SBP). They catalogued 391 randomised controlled trials (RCTs) involving nearly 40 000 subjects. After this mammoth effort, they conclude that there are modest but consistent reductions in SBP in exercise interventions across all populations and the SBP-lowering effects of exercise were similar to antihypertensives, particularly in hypertensive people.
In 2018, a BJSM editorial introduced the REAL framework2; incorporating simple principles to increase the usefulness of exercise research. REAL tapped into the global debate about how relevant clinical research really is.3 Here, we appraise the exercise trial literature reviewed by Naci and colleagues by retrofitting the four most relevant aspects of the taxonomy developed by John Ioannidis (Supplemental Table 1); REAL is a …
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