300

250

200

150

100

50

0

10,000 20,000 30,000

Rest

Normal

50% Lesion

90%

75%

Work of the Heart (double product)

Cor

onar

y B

lood

Flo

w

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

Percentage reduction in fatal heart attacks

PHYSICAL FITNESS & CARDIOVASCULAR DISEASE

PHYSICAL FITNESS & CARDIOVASCULAR DISEASE

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

Tri State Study, 1973

Mr Fit Study , 1982

Multiple Risk Factor Intervention Trial

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 TRIALSCLINICAL TRIALS

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

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

DISEASE PROGRESSION WITH EXERCISE

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

PROGRESSION OF DISEASE WITH EXERCISE TRAINING

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

DISEASE PROGRESSION WITH EXERCISE

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

DISEASE PROGRESSION WITH EXERCISE

AmountAccumulating

in artery wall

=∫ [(Plasma to artery - Artery to

plasmaArtery to

lymphatics- ) +( Rate of atherosclerosis - Removal of

atheromic material )] dt

Plasma Arterial

WallArterial

Lymphatics

CAN ATHEROSCLEROSIS BE REVERSED?

*

Non-signficance•Heart Rate•Heart Work•Systolic Ejection Period•Left Ventricular Oxygen Uptake•a-v O2 difference of heart

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

ANGINA THRESHOLD

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

Effectiveness of Cardiac Rehabilitation

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

Effectiveness of Cardiac Rehabilitation