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300 250 200 150 100 50 0. Normal. 50% Lesion. Coronary Blood Flow. 75%. 90%. Rest. 10,000 20,00030,000. Work of the Heart (double product). Percentage reduction in fatal heart attacks. Paffenbarger et al Am Journal of Epidemiology 105:200-213, 1877.

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300

250

200

150

100

50

0

Normal

50% Lesion

Coronary Blood Flow

75%

90%

Rest

10,000 20,00030,000

Work of the Heart (double product)


Percentage reduction in fatal heart attacks

Paffenbarger et al Am Journal of Epidemiology 105:200-213, 1877.


PHYSICAL FITNESS & CARDIOVASCULAR DISEASE

Blair, SN, et al, JAMA 276:205-210, 1996


Tri State Study, 1973


Multiple Risk Factor Intervention Trial

Mr Fit Study , 1982


Multiple Risk Factor Intervention Trial


Multiple Risk Factor Intervention Trial


Multiple Risk Factor Intervention Trial


Multiple risk factor intervention trial. Risk factor changes and mortality results. Multiple Risk Factor Intervention Trial Research GroupJAMA. 1982;248:1465-1477.


CLINICAL TRIALS

Kramsch et al. New Eng J Med 305:1483-1489, 1981.


DISEASE PROGRESSION WITH EXERCISE

Haskell et al. Circulation 89:975-990, 1994


PROGRESSION OF DISEASE WITH EXERCISE TRAINING

Selvester, R. et al Annals of New York Academy of Science 301: 495-508, 1977.


DISEASE PROGRESSION WITH EXERCISE

Haskell et al. Circulation 89:975-990, 1994


DISEASE PROGRESSION WITH EXERCISE

Haskell et al. Circulation 89:975-990, 1994


Arterial Wall

Arterial Lymphatics

Plasma

[(

(

)] dt

)

-

-

-

Amount

Accumulating in artery wall

+

Removal of atheromic material

=

Artery to lymphatics

Rate of atherosclerosis

Plasma to artery

Artery to plasma


CAN ATHEROSCLEROSIS BE REVERSED?


ANGINA THRESHOLD

*

Ferguson, JR, et al Circulation 58:41-47, 1978.

  • Non-signficance

  • Heart Rate

  • Heart Work

  • Systolic Ejection Period

  • Left Ventricular Oxygen Uptake

  • a-v O2 difference of heart


Effectiveness of Cardiac Rehabilitation

Oldridge, N.B., JAMA 260:945-950, 1988.


Effectiveness of Cardiac Rehabilitation

O'Connor, G.T et al Circulation 80:234-244, 1989.


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