1. 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

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

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

6. Tri State Study, 1973

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

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

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

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

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

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

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

18. 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

19. CAN ATHEROSCLEROSIS BE REVERSED?

20. * 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, 1978. ANGINA THRESHOLD

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

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