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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)


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Percentage reduction in fatal heart attacks

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


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PHYSICAL FITNESS & CARDIOVASCULAR DISEASE

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


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Tri State Study, 1973


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Multiple Risk Factor Intervention Trial

Mr Fit Study , 1982


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Multiple Risk Factor Intervention Trial


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Multiple Risk Factor Intervention Trial


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Multiple Risk Factor Intervention Trial


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


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CLINICAL TRIALS

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


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DISEASE PROGRESSION WITH EXERCISE

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


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PROGRESSION OF DISEASE WITH EXERCISE TRAINING

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


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DISEASE PROGRESSION WITH EXERCISE

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


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DISEASE PROGRESSION WITH EXERCISE

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


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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


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CAN ATHEROSCLEROSIS BE REVERSED?


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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


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Effectiveness of Cardiac Rehabilitation

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


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Effectiveness of Cardiac Rehabilitation

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


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