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Effect of Yearly Exercise on Medication Expense in Metabolic Syndrome
Quick Takes
- Combining exercise with standard medical therapy for MetS improves clinical outcomes.
- Long-term supervised exercise may impart an economic benefit.
Study Questions:
Does long-term exercise training restrain the increased pharmacological cost of the clinical management of metabolic syndrome (MetS)?
Methods:
Fifty-one middle-aged adults with MetS, and receiving standard medical care, were randomized to exercise (1 hour, 3 days per week, for 4 consecutive months per year, of high-intensity interval cycling, n = 25) or controls (no exercise, n = 26). The groups were assessed at preintervention, 2 years, and 5 years, at the same time of year (in November, 8 months after the last training session for the exercise group) for chronic (versus acute) effects of exercise on indices of MetS, including body weight, fat-free mass, blood pressure, serum levels for glucose, lipids, and insulin, a MetS z score (compound score for evolution of MetS indices), and 10-year risk of atherosclerotic cardiovascular disease (ASCVD). The 5-year evolution of medication costs to treat MetS (hypertension, hyperlipidemia, and hyperglycemia) were analyzed for each group and compared, as well as the benefit-cost ratio of the supervised exercise program (personnel, facility, insurance) for the exercise group.
Results:
At baseline, both groups had similar use and cost of medications. Over 5 years, total medication cost increased 160% for controls, while there was no significant increase for exercisers. Also, annual medication cost and use was 60% and 74% higher, respectively, for controls compared to exercisers. Both groups experienced similar decreases in MetS z score over time; however, the estimated 10-year ASCVD risk increased significantly (15%) for the control group, but not the exercisers. The medication savings of exercisers was three times that of the estimated cost of the supervised exercise program.
Conclusions:
Over 5 years, an exercise program in middle-aged adults with MetS prevented the increase in medication use and cost that was observed in controls. The savings in medications for exercisers far outweighed the cost of the supervised exercise program. Exercise also prevented an increase in the estimated 10-year ASCVD risk experienced by controls, thus demonstrating both cost and clinical benefits.
Perspective:
The therapeutic benefits of regular exercise in the treatment of hypertension, hyperlipidemia, hyperglycemia, and obesity (components of MetS) are well-established. This study, which is small but well-controlled, suggests that incorporating exercise with usual medical therapy is also economically beneficial. Of note, spin-cycling is a recommended mode for overweight adults and, with the right equipment, could be done remotely; plus, the commitment to 1-hour classes, 3 days a week for 12 weeks, seems reasonable for many adults.
Clinical Topics: Diabetes and Cardiometabolic Disease, Dyslipidemia, Prevention, Sports and Exercise Cardiology, Lipid Metabolism, Exercise, Hypertension
Keywords: Atherosclerosis, Bicycling, Body Weight, Cost-Benefit Analysis, Dyslipidemias, Exercise, Glucose, Hyperglycemia, Hyperlipidemias, Hypertension, Insulin, Lipids, Metabolic Syndrome, Obesity, Overweight, Patient Care Team, Prescription Drugs, Primary Prevention, Sports
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