300
Normal
Coronary Blood Flow
250
50% Lesion
200
75%
150
90%
100
Rest
50
0
10,000
20,000
Work of the Heart (double product)
30,000
Percentage reduction in fatal heart attacks
Inc PA, Stop Smoking, Control HTN
Stop Smoking, Control HTN
Inc PA, Control HTN
Inc PA, Stop Smoking
Control HTN
Stop Smoking
Increase Physical Activity
0
20
40
60
Paffenbarger et al Am Journal of Epidemiology 105:200-213, 1877.
80
100
PHYSICAL FITNESS & CARDIOVASCULAR
DISEASE
Blair, SN, et al, JAMA 276:205-210, 1996
Tri State Study, 1973
Multiple Risk Factor Intervention Trial
Mr Fit Study , 1982
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 Group
JAMA. 1982;248:1465-1477.
CLINICAL TRIALS
2
1.5
Sed-Norm
1
Sed-Athero
Ex-Athero
0.5
0
Lumen Size
Lesion Size
Kramsch et al. New Eng J Med 305:1483-1489, 1981.
DISEASE PROGRESSION WITH EXERCISE
Mean Artery Diameter (mm)
0
-0.005
-0.01
-0.015
-0.02
-0.025
-0.03
-0.035
-0.04
Usual Care
Risk Reduction
Haskell et al. Circulation 89:975-990, 1994
PROGRESSION OF DISEASE WITH EXERCISE
TRAINING
50
45
Percent of Vessels
40
35
30
25
20
15
10
5
0
Inactive
Low
Moderate
High
Selvester, R. et al Annals of New York Academy of Science 301: 495-508, 1977.
DISEASE PROGRESSION WITH EXERCISE
0.8
Percent Stenosis (%)
0.7
0.6
0.5
0.4
0.3
0.2
0.1
0
Usual Care
Risk Reduction
Haskell et al. Circulation 89:975-990, 1994
DISEASE PROGRESSION WITH EXERCISE
50
45
Number of Events
40
35
30
25
Usual Care
20
15
Risk
Reduction
10
5
0
Total
Sudden Nonfatal MI
Death
CABG
Haskell et al. Circulation 89:975-990, 1994
PTCA
Arterial
Wall
Plasma
Amount
Accumulating
in artery wall
∫[(
=
Plasma
to artery
-
Artery to
plasma
-
Artery to
lymphatics
Arterial
Lymphatics
) +(
Rate of
atherosclerosis
-
Removal of
atheromic
material
)] dt
CAN ATHEROSCLEROSIS BE REVERSED?
HARP
CLASS -11
SCOR
Intervention
Control
FATS
CLASS -1
0
10
20
30
Percent of Patients (%)
40
50
Kgm/min
ANGINA THRESHOLD
800
600
400
200
0
*
Pre
Post
Work Load
200
150
100
50
0
20
15
Pre
Post
Heart Rate
10
Pre
5
Post
0
Heart Work
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
Effectiveness of Cardiac Rehabilitation
Nonfatal Infarction
Cardiovascular Death
Treatment
Control
All - Cause Mortality
0
5
10
15
Percent of Patients
Oldridge, N.B., JAMA 260:945-950, 1988.
20
Effectiveness of Cardiac Rehabilitation
Non-Fatal MI
Fatal MI
Sudden Death
Exercise + Other
Exercise Only
CVD Mortality
All Interventions
Total Mortality
0
0.5
1
Odds Ratio
O'Connor, G.T et al Circulation 80:234-244, 1989.
1.5