Physical activity may be as effective as drugs in treating heart disease and should be included as a comparison in the development of new medicines, according to a review published today in the British Medical Journal. No statistically detectable differences were evident between exercise and drug treatment for patients with coronary heart disease or prediabetes, and exercise was more effective among patients recovering from a stroke, according to a review of 16 meta-analyses that included 305 studies involving 339,274 participants. The analysis adds to evidence showing the benefit of non-medical approaches to disease through behavior and lifestyle changes. Given the cost of drug treatment, regulators should consider requiring pharmaceutical companies to include exercise as a comparator in clinical trials of new medicines, according to authors Huseyin Naci of Harvard and John Ioannidis of Stanford. Patients deserve to understand the relative impact that physical activity might have on their condition," Naci and Ioannidis said in the published paper. In the meantime, "exercise interventions should therefore be considered as a viable alternative to, or, alongside, drug therapy." A landmark study by Dean Ornish, founder of the Preventive Medicine Research Institute, found that a low-fat vegetarian diet, increased exercise and stress management can reduce heart disease more than standard medical care. Patients who receive training from medical professionals on Ornish's program for reversing heart disease have been reimbursed by Medicare since January 2011.