300 250 200 150 100 50 0 10,000 20,00030,000 Rest Normal 50% Lesion 90% 75% Work of the Heart (double product) Coronary Blood Flow.

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Presentation transcript:

,000 20,00030,000 Rest Normal 50% Lesion 90% 75% Work of the Heart (double product) Coronary Blood Flow

Paffenbarger et al Am Journal of Epidemiology 105: , Percentage reduction in fatal heart attacks

PHYSICAL FITNESS & CARDIOVASCULAR DISEASE Blair, SN, et al, JAMA 276: , 1996

Tri State Study, 1973

Mr Fit Study, 1982 Multiple Risk Factor Intervention Trial

Multiple risk factor intervention trial. Risk factor changes and mortality results. Multiple Risk Factor Intervention Trial Research Group JAMA. 1982;248:

CLINICAL TRIALS Kramsch et al. New Eng J Med 305: , 1981.

Haskell et al. Circulation 89: , 1994 DISEASE PROGRESSION WITH EXERCISE

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

Haskell et al. Circulation 89: , 1994 DISEASE PROGRESSION WITH EXERCISE

Haskell et al. Circulation 89: , 1994 DISEASE PROGRESSION WITH EXERCISE

Amount Accumulating in artery wall = ∫ [( Plasma to artery - Artery to plasma Artery to lymphatics - ) + ( Rate of atherosclerosis - Removal of atheromic material )] dt Plasma Arterial Wall Arterial Lymphatics

CAN ATHEROSCLEROSIS BE REVERSED?

* Non-signficance Heart Rate Heart Work Systolic Ejection Period Left Ventricular Oxygen Uptake a-v O 2 difference of heart Ferguson, JR, et al Circulation 58:41-47, ANGINA THRESHOLD

Oldridge, N.B., JAMA 260: , Effectiveness of Cardiac Rehabilitation

O'Connor, G.T et al Circulation 80: , Effectiveness of Cardiac Rehabilitation

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