Getting plenty of exercise should be considered a "viable alternative" to commonly used drugs, experts say today.
Although being fit can help cut cholesterol and blood pressure levels, researchers say very few studies have compared drugs and exercise.
Better evidence would help doctors and patients make "better" treatment decisions, they say.
The call comes as a second study shows how fitness activity in leisure time helps to cut blood pressure.
Writing for the British Medical Journal, the researchers report an analysis of trials of treatments for patients with known heart disease and diabetes.
More than 300 studies involving more than 300,000 people looked at the effects of drug treatments and physical fitness.
The researchers say the studies suggest exercise and drugs are equally effective at helping people with heart disease and diabetes.
And exercise was more effective than drugs in helping people with stroke – but less effective at helping those with heart failure.
* A second study, in the journal Hypertension, shows that physical activity in leisure time helps keep blood pressure healthy.
Researchers say it is activity outside of work time that is crucial in helping keep blood pressure down – while being active at work does not seem to have an effect.
Chinese researchers analysed the results of 13 pieces of research involving some 136,000 people in the USA, Europe and eastern Asia.
Researcher Dr Wei Ma, of the Shandong University School of Public Health, Jinan, China, said: "To try to lower your risk of high blood pressure, you should exercise more in your leisure time."
The findings were welcomed by the British Heart Foundation.
Doireann Maddock, from the foundation, said: "Current guidelines recommend that adults do at least two and a half hours of moderate intensity activity each week. You could aim for a minimum of 30 minutes on five days a week, but even ten minutes here or there will count.
“Keeping active doesn’t necessarily have to mean joining a gym either. A brisk lunchtime walk with a friend or getting off the bus a few stops earlier can make a difference, too.”
BMJ 1 October 2013 [abstract]
Bo Xi et al. Physical Activity and Risk of Hypertension: A Meta-Analysis of Prospective Cohort Studies. Hypertension 30 September 2013
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