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300 250 200 150 100 50 0. Normal. 50% Lesion. Coronary Blood Flow. 75%. 90%. Rest. 10,000 20,000 30,000. 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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  1. 300 250 200 150 100 50 0 Normal 50% Lesion Coronary Blood Flow 75% 90% Rest 10,000 20,000 30,000 Work of the Heart (double product)

  2. Percentage reduction in fatal heart attacks Paffenbarger et al Am Journal of Epidemiology 105:200-213, 1877.

  3. PHYSICAL FITNESS & CARDIOVASCULAR DISEASE Blair, SN, et al, JAMA 276:205-210, 1996

  4. Tri State Study, 1973

  5. Multiple Risk Factor Intervention Trial Mr Fit Study , 1982

  6. Multiple Risk Factor Intervention Trial

  7. Multiple Risk Factor Intervention Trial

  8. Multiple Risk Factor Intervention Trial

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

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

  11. DISEASE PROGRESSION WITH EXERCISE Haskell et al. Circulation 89:975-990, 1994

  12. PROGRESSION OF DISEASE WITH EXERCISE TRAINING Selvester, R. et al Annals of New York Academy of Science 301: 495-508, 1977.

  13. DISEASE PROGRESSION WITH EXERCISE Haskell et al. Circulation 89:975-990, 1994

  14. DISEASE PROGRESSION WITH EXERCISE Haskell et al. Circulation 89:975-990, 1994

  15. 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

  16. CAN ATHEROSCLEROSIS BE REVERSED?

  17. 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

  18. Effectiveness of Cardiac Rehabilitation Oldridge, N.B., JAMA 260:945-950, 1988.

  19. Effectiveness of Cardiac Rehabilitation O'Connor, G.T et al Circulation 80:234-244, 1989.

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