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PubMed2004

Mechanics and control of the flat versus normal foot during the stance phase of walking.

OBJECTIVE: To compare walking stance phase rearfoot and forefoot motion, ankle joint moments and extrinsic foot muscle EMG profiles between normal and pes planus feet. DESIGN: A cross-sectional comparative study. BACKGROUND: Musculoskeletal conditions are often attributed to pes planus, in which motion is assumed to be excessive and the muscle control inadequate. However, many of the speculated differences in mechanics and control between the normal and the pes planus foot have not been quantified. METHODS: Kinematic and kinetic data were obtained from video recordings of skin surface markers and a force plate, and EMG was recorded with surface electrodes. Analysis of variance was carried out to compare the group profiles. RESULTS: In the pes planus group: the forefoot was less adducted (P < .05) at toe-off, and total transverse plane range of motion, at 8 degrees versus 10 degrees, was less (P < .01); the peak plantarflexor ankle moment at push-off was greater (P < .05); the invertor moment was greater at foot flat (P < .05); for the EMG profiles, activity early in stance, relative to the mean stance phase activity was higher (P < .01) in tibialis anterior and lower (P < .05) in the peronei, soleus and medial and lateral gastrocnemius. CONCLUSIONS: Despite reaching statistical significance, the group differences were small for the task of laboratory walking at a natural pace. The main implications of the differences were for restraint of motion. The expectations of excessive motion and muscle effort in the pes planus group were therefore not substantiated. RELEVANCE: Symptomatic pes planus subjects did not reveal the expected biomechanical differences from normal subjects. The underlying causes of symptoms were not identifiable.

Adaptation, Physiological↗
PubMed2002

Predictors of lower extremity injury among recreationally active adults.

OBJECTIVE: To identify gender-specific predictors of lower extremity injury among a sample of adults engaging in running, walking, or jogging (RWJ) for exercise. DESIGN: Prospective cohort study. SETTING: Cooper Clinic Preventive Medicine Center, Dallas, Texas. PARTICIPANTS: Participants were 2,481 men and 609 women who underwent a physical examination between 1970 and 1981 and returned a follow-up survey in 1986. Predictor variables measured at baseline included height, weight, and cardiorespiratory fitness. At follow-up, participants recalled information about musculoskeletal injuries, physical activity levels, and other predictors for lower extremity injury over two time periods, 5 years and 12 months. MAIN OUTCOME MEASURES: An injury was defined as any self-reported lower extremity injury that required a consultation with a physician. Cox proportional hazards regression (HR) was used to predict the probability of lower extremity injury for the 5-year recall period, and unconditional logistic regression was used for the 12-month recall period. RESULTS: Among men, previous lower extremity injury was the strongest predictor of lower extremity injury (HR = 1.93-2.09), regardless of recall period. Among women, RWJ mileage >20 miles/wk was the strongest predictor for the 5-year period (HR = 2.08), and previous lower extremity injury was the strongest predictor for the 12-month period (HR = 2.81). CONCLUSIONS: For healthy adults, walking at a brisk pace for 10-20 miles per week accumulates adequate moderate-intensity physical activity to meet national recommendations while minimizing the risk for musculoskeletal lower extremity injury. Clinicians may use this information to provide appropriate injury prevention counseling to their active patients.

Adult↗
PubMed2006

The reaction strategy of lower extremity muscles when slips occur to individuals with trans-femoral amputation.

The aim of this study is to investigate the surface electromyography (sEMG) responses of lower extremity muscles for both healthy people and individuals with trans-femoral amputation (TFA), when slip events occur during level walking. Six male individuals with unilateral TFA and five healthy subjects participated in this study. Each subject was required to walk at a self-selected comfortable pace along a 5m plastic walkway, and to perform walking trials on dry and oily conditions respectively. The sEMG signals of muscles on legs and around waist were recorded in each trial and the normalized instantaneous muscle power (IMP) values were employed to quantify the response intensity. The IMP profiles of each muscle in oily-surface walking trials were compared quantitatively with that in dry-surface trials. There are three main findings in this study. (1) Different muscle reaction strategies are employed in slip events by the healthy persons and the individuals with TFA, respectively. Moreover, when the slip event occurs on the prosthetic leg and the intact leg of the individuals with TFA respectively, the muscle reaction strategies are also different. (2) The individuals with TFA face higher risks of fall than the healthy persons no mater slips occur on the prosthetic side or the intact side. (3) The hip muscles, especially the gluteus maximus (GMA) muscles, always enormously contribute to posture adjustment and balance recovery in slip events.

Accidental Falls↗
PubMed1985

Swing phase control with knee friction in juvenile amputees.

Above-knee amputees have a slower than normal walking velocity. In conventional prostheses the solution has been to apply knee friction to attempt to match the cadence of the prosthetic limb to the sound limb. Using kinematic data, we investigated the effect of variable knee friction on the swing phase of gait in juvenile amputees. The subjects were instructed to walk at a comfortable pace and were tested repeatedly with varying amounts of knee friction. We found that the excursion of the prosthetic shank as measured by knee range of motion was altered by changing the amount of knee friction. The period of the prosthetic shank remained constant when measured as a physical pendulum and when measured dynamically during gait. Therefore, knee friction is an effective means of providing the amputee with a more symmetrical appearing gait by matching the heel rise of the prosthetic limb to the sound limb. It is not an effective means, however, of matching the cadence of the prosthetic limb to the sound limb.

Artificial Limbs↗
PubMed1991

Telemeterized in vivo hip joint force data: a report on two patients after total hip surgery.

Two telemeterized femoral components were implanted in two patients as part of normal total hip replacement procedures. The two components were instrumented to measure the three force components directed along: (a) the neck axis, (b) transverse to the neck axis and in the plane of the prosthesis, and (c) transverse to the neck axis and perpendicular to the plane of the prosthesis. Data were collected at multiple sessions during the early postoperative period for a number of standard activities, including gait, stair climbing, rising from a chair, single leg stance, double leg stance, ipsilateral and contralateral straight leg lifts while supine, ipsilateral flexion and extension while standing, and ipsilateral abduction while standing and lying on the contralateral side. These data are summarized and compared with the published results from analytic studies and with the results from previous studies using instrumented femoral components. Peak loads for gait during the period of study were roughly 2.7 body weights (BW) when the patients walked at their normal pace. Contact forces at the hip during stationary single leg stance approximated the peak loads during gait with values ranging from 2.1 to 2.8 BW. The highest forces recorded reached values approaching 5.5 BW and occurred during periods of instability while the patient engaged in stationary single leg stance. Our in vivo data indicate that forces generated during the above activities increase in magnitude quite rapidly during the early postoperative period and that during this period the patients have the ability to perform the activities of daily living without generating the high amplitude joint contact forces suggested by the results of dynamic studies. Joint contact forces during gait were found to depend on speed, but the high absolute magnitudes predicted by model studies were not supported by the in vivo data.

Aged↗
PubMed1990

Enhanced sexual behavior in exercising men.

The effects of 9 months of aerobic exercise on aerobic work capacity (physical fitness), coronary heart disease risk factors, and sexuality were studied in 78 sedentary but healthy men (mean age, 48 years). The men exercised in supervised groups 60 min per day, 3.5 days per week on average. Peak sustained exercise intensity was targeted at 75-80% of maximum aerobic working capacity. A control group of 17 men (mean age, 44 years) participated in organized walking at a moderate pace 60 min per day, 4.1 days per week on average. Each subject maintained a daily diary of exercise, diet, smoking, and sexuality during the first and last months of the program. Beneficial effects of chronic, vigorous exercise on fitness and coronary heart disease risk factors were obtained in close agreement with prior studies. Analysis of diary entries revealed significantly greater sexuality enhancements in the exercise group (frequency of various intimate activities, reliability of adequate functioning during sex, percentage of satisfying orgasms, etc.). Moreover, the degree of sexuality enhancement among exercisers was correlated with the degree of their individual improvement in fitness.

Anxiety↗
PubMed2001

Effect of type II diabetic peripheral neuropathy on gait termination in the elderly.

AIMS/HYPOTHESIS: Healthy elderly people can have difficulties in precisely terminating gait due to age-related decline. Diabetes mellitus accelerates the neurodegenerative process, which results in an additional decline in motor control. This biomechanical study investigated goal-oriented gait termination in healthy elderly and elderly diabetic subjects. The trajectories of the centre of pressure and the centre of mass during the gait termination process were analysed in particular. It was hypothesised that the pathology results in an unstable gait termination, expressed in larger overshoots of the centre of pressure and the centre of mass than in healthy control subjects. METHODS: A total of 15 subjects with Type II (non-insulin-dependent) diabetes mellitus with impaired foot sensitivity due to polyneuropathy (median, 66 years) were matched according to age, gender and body mass index with 15 healthy elderly subjects (median, 67 years). The participants walked at their own pace along the walkway and stopped in front of a marked stopping line while kinetic and kinematic data were recorded. RESULTS: The diabetic subjects approached the stopping line more slowly (p = 0.002) than the healthy elderly subjects. They also exhibited a weaker maximal braking force (p = 0.011) and a prolonged relative time to develop this force (p = 0.023). Despite this slower motion, the centre of pressure overshoots were larger in the diabetic subjects than in the healthy elderly (p = 0.027). CONCLUSION/INTERPRETATION: The results show differences between healthy elderly and diabetic subjects during easy goal-oriented stopping tasks. Changes in gait termination parameters and the increased overshoots in particular document the pathology-related decline in postural stability.

Aged↗
PubMed2001

Vaccines--a wonderful tool for equity in health.

Equity is a word representing one of the most important concerns for planners, politicians and the academia. It comes as an answer to the permanent rediscovery of inequity in the benefits of progress among the peoples of the world. Inequity in the distribution of risks for health and disease is a finding that comes on and on again in real life and in the literature. Inequity in disease burden is clearly related to poverty and the eradication of poverty is the mission for every government and international assistance organisations. Development is also not only a precondition for justice but for peace and stability. Health is seen more and more as preceding development and not only as a consequence of wealth. Therefore many things can and must be done in health to achieve development and of course, equity. This concept has been crucial in the new orientation of WHO and our agency is working hard on its promotion at every level. Vaccines are with us as a simple and effective tool for two centuries. The research and development of new vaccines and all in the underlining knowledge has been much faster than its utilization and there is a huge gap to fill in accessibility and actual coverage. World Health Organization (WHO) has been involved all its life in the promotion of disease control and eradication through the use of immunisation techniques. Presently we are part of GAVI and our Vaccines and Biologicals Department has undergone an important modernisation in order to achieve better performance in pursuing three main objectives: Innovation, Immunisation Systems improvement and Accelerated Disease Control. Therefore in order to walk at a faster pace in the better utilisation of vaccines as a tool for equity, we must join forces and participate actively in all the initiatives that are underway.

Humans↗
PubMed2002

Chasing the dragon, related to the impaired lung function among heroin users.

AIM: To describe the pulmonary function and prevalence of dyspnoea among methadone patients and to study the relation with exposure to heroin by inhaling. STUDY POPULATION: A sample of 100 patients from methadone maintenance treatment (84% male, average age 42 years). MEASUREMENTS: Questionnaires were used to measure life-time exposure to heroin, cocaine, cannabis, tobacco, and symptoms of dyspnoea. Spirometry was performed and residual difference of measured FEV(1) from the age, sex, height and ethnicity predicted value (delta FEV(1)) was used as a main outcome parameter. FINDINGS: The median delta FEV(1) was -0.26 l (inter quartile range -0.70; +0.12). Twenty per cent experienced dyspnoea while 'walking at a normal pace with someone of their own age'. History of cigarette smoking was reported by 98%; heroin smoking by 88%. Multiple linear regression analysis showed a statistically significant association between heroin-smoking and delta FEV(1), logistic regression analysis showed an association between heroin-smoking and prevalence of dyspnoea. CONCLUSIONS: Chronic heroin smoking seems to be related to an impaired lung function and higher prevalence of dyspnoea. However, part of the observed lung function impairment will be caused by tobacco smoking. Further research is needed to quantify the effect of heroin smoking and disentangle the effect of smoking heroin and tobacco.

Adult↗
PubMed2001

Gait variability and fall risk in community-living older adults: a 1-year prospective study.

OBJECTIVE: To test the hypothesis that increased gait variability predicts falls among community-living older adults attending an outpatient clinic. DESIGN: Prospective, cohort study. SETTING: Three outpatient geriatric clinics. PARTICIPANTS: Fifty-two community-living, ambulatory men and women aged > or = 70 years. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Subjects walked at a normal pace for up to 6 minutes wearing force-sensitive insoles that measured the gait rhythm on a stride-to-stride basis. Afterward, subjects reported fall status on a weekly basis for 1 year. The primary outcomes were the association between measures of the stride-to-stride fluctuations in gait rhythm and (1) subsequent falls during a 12-month follow-up period and (2) potential contributing factors. RESULTS: Almost 40% of the subjects reported falling during the 12-month follow-up period. Stride time variability was 106 +/- 30 ms in subjects who subsequently fell (n = 20) and 49 +/- 4 ms in those who did not experience a fall (n = 32) during the 12-month follow-up period (p <.04). Logistic regression also showed that stride time variability predicted falls (p <.05). Stride time variability correlated significantly with multiple factors including strength, balance, gait speed, functional status, and even mental health, but these other measures did not discriminate future fallers from nonfallers. CONCLUSIONS: These findings show both the feasibility of obtaining stride-to-stride measures of gait timing in the ambulatory setting and the potential use of gait variability measures in augmenting the prospective evaluation of fall risk in community-living older adults.

Accidental Falls↗
PubMed1995

Lower-extremity function in persons over the age of 70 years as a predictor of subsequent disability.

BACKGROUND: Functional assessment is an important part of the evaluation of elderly persons. We conducted this study to determine whether objective measures of physical function can predict subsequent disability in older persons. METHODS: This prospective cohort study included men and women 71 years of age or older who were living in the community, who reported no disability in the activities of daily living, and who reported that they were able to walk one-half mile (0.8 km) and climb stairs without assistance. The subjects completed a short battery of physical-performance tests and participated in a follow-up interview four years later. The tests included an assessment of standing balance, a timed 8-ft (2.4-m) walk at a normal pace, and a timed test of five repetitions of rising from a chair and sitting down. RESULTS: Among the 1122 subjects who were not disabled at base line and who participated in the four-year follow-up, lower scores on the base-line performance tests were associated with a statistically significant, graduated increase in the frequency of disability in the activities of daily living and mobility-related disability at follow-up. After adjustment for age, sex, and the presence of chronic disease, those with the lowest scores on the performance tests were 4.2 to 4.9 times as likely to have disability at four years as those with the highest performance scores, and those with intermediate performance scores were 1.6 to 1.8 times as likely to have disability. CONCLUSIONS: Among nondisabled older persons living in the community, objective measures of lower-extremity function were highly predictive of subsequent disability. Measures of physical performance may identify older persons with a preclinical stage of disability who may benefit from interventions to prevent the development of frank disability.

Activities of Daily Living↗
PubMed2002

The relationship between cognitive and physical performance: MacArthur Studies of Successful Aging.

BACKGROUND: The relationship between change in cognitive and physical performance has yet to be fully understood. Because aging decreases the ability to learn new information while preserving more established knowledge, this article examines whether the association between change in cognitive and physical performance depends on the nature of the physical task. METHODS: Data from the MacArthur Research Network on Successful Aging Community Study--a longitudinal three-site, cohort study of high-functioning, disability-free Americans aged 70 to 79 in 1988 (reinterviewed in 1991 and 1995)--are used for this investigation. We examine the association between change in cognitive performance and two categories of physical performance: novel/attentional demanding physical tasks (e.g., standing on a single leg) or routine physical tasks (e.g., walking at a normal pace). Change in physical performance (over 7 years) is regressed on change in cognitive performance (over the same period) controlling for baseline cognitive ability, demographic factors, health status, and behavioral characteristics. RESULTS: The findings suggest that declines in cognitive performance are associated with declines in both novel/attentional demanding and routine physical tasks. In addition to decline in cognition, gender, prevalent health conditions (e.g., cancer, high blood pressure, and the fracture of a hip), and smoking behavior are associated with decline in performance on some physical tasks. CONCLUSIONS: The findings suggest that the successful execution of physical tasks demands cognitive processes regardless of the nature of the task. Researchers using performance-based measures of physical functioning should pay particular attention to the cognitive capacities of their subjects and how these might influence their assessment.

Aged↗
PubMed2001

From bipedalism to bicyclism: evolution in energetics and biomechanics of historic bicycles.

We measured the metabolic cost (C) and mechanical work of riding historic bicycles at different speeds: these bicycles included the Hobby Horse (1820s), the Boneshaker (1860s), the High Wheeler (1870s), the Rover (1880s), the Safety (1890s) and a modern bicycle (1980s) as a mean of comparison. The rolling resistance and air resistance of each vehicle were assessed. The mechanical internal work (W(INT)) was measured from three-dimensional motion analysis of the Hobby Horse and modern bicycle moving on a treadmill at different speeds. The equation obtained from the modern bicycle data was applied to the other vehicles. We found the following results. (i) Apart from the Rover, which was introduced for safety reasons, every newly invented bicycle improved metabolic economy. (ii) The rolling resistance decreased with subsequent designs while the frontal area and, hence, aerodynamic drag was fairly constant (except for the High Wheeler). (iii) The saddle-assisted body weight relief (which was inaugurated by the Hobby Horse) was responsible for most of the reduction in metabolic cost compared with walking or running. Further reductions in C were due to decreases in stride/pedalling frequency and, hence, W(INT) at the same speeds. (iv) The introduction of gear ratios allowed the use of pedalling frequencies that optimize the power/contraction velocity properties of the propulsive muscles. As a consequence, net mechanical efficiency (the ratio between the total mechanical work and C) was almost constant (0.273 +/- 0.015s.d.) for all bicycle designs, despite the increase in cruising speed. In the period from 1820 to 1890, improved design of bicycles increased the metabolically equivalent speed by threefold compared with walking at an average pace of ca. + 0.5 ms(-1) per decade [corrected]. The speed gain was the result of concurrent technological advancements in wheeled, human-powered vehicles and of 'smart' adaptation of the same actuator (the muscle) to different operational conditions.

Adult↗
PubMed1991

A simultaneous, noninvasive comparison with sinus rhythm, of two activity sensing, rate adaptive pacemakers, in an elderly population.

We compared the rate response to low level work, arm exercise, step testing, and treadmill exercise between the Siemens Sensolog 703 S (Sg) and the Medtronic Activitrax (Ax) pacemakers, and simultaneous sinus rhythm (SR) in an elderly population. In ten subjects mean age 70.6 years, range 49-81 years, the pacemaker responses were noninvasively compared by strapping the units to the chest wall under constant and equal pressure applied by an adjustable belt. Pacemaker rates and SR were recorded simultaneously on a three-channel ECG recorder. The units were programmed in situ to give an increase in rate from 70 beats/min sitting, to 100 beats/min after walking at a normal pace for 30 seconds. Programming took three times longer for Sg (P less than 0.02). The response to standing and bending was poor for both units (Ax mean 75.7 beats/min, Sg mean 77.6 beats/min), when compared to SR (mean 90.3 beats/min). A 20-step test resulted in a greater rate response from Ax (mean 105.3 beats/min) than from Sg (mean 96.3 beats/min [P = 0.09]), though both were still less than SR (116.3). There were significant differences between the two pacemakers on treadmill testing, at peak rate achieved (Ax mean 112.5 beats/min; Sg mean 102.7 beats/min [P less than 0.005], SR mean 122.5 beats/min) and at end exercise (Ax mean 112.5 beats/min; Sg mean 92.9 beats/min [P less than 0.002], SR mean 121.3 beats/min). Arm exercise, however, resulted in a significantly greater response from Sg than Ax (105.1 and 88.5 beats/min, respectively; P less than 0.01, SR 98.7 beats/min).(ABSTRACT TRUNCATED AT 250 WORDS)

Activities of Daily Living↗
PubMed1991

Effects of withdrawal of antiparkinson medication on gait and clinical score in the Parkinson patient.

Objective testing of medication is needed in Parkinson's disease. Gait analysis and clinical evaluation were done before and after a 24-h withdrawal of Parkinson medication. Twelve patients with stable, mild to moderate idiopathic parkinsonism (Hoehn and Yahr 1-3; seven men and five women mean age 59.9 years, mean duration of disease 6 years) were tested with gait analysis walking in five different paces. Velocity of gait, stride length and stride frequency, as well as stride length at constant velocity were calculated. Regression coefficients for the relation between stride length and stride frequency were also calculated. Clinical scoring according to the Webster rating scale and Hoehn and Yahr were performed for each test. Clinical functional assessment with a specially designed rise and gait test, an arm cycle test and the wooden rods test were done. Evaluated clinical score increased significantly (p less than 0.05) using both clinical tests. Maximum gait velocity (p less than 0.01), stride length at max. velocity (p less than 0.01), and stride length at constant velocity (p less than 0.03) were significantly decreased without medication. Stride frequency did not change. In the functional assessment tests only performance on the arm cycle test (p less than 0.03) was less well performed without medication. There was correlation between clinical score, gait and clinical functional assessment. The methods used detected significant changes in variables of gait as well as clinical scoring and some of the clinical functional assessments when medication was withdrawn for a 24-h period. The methods were useful in evaluation of pharmacological treatment.

Aged↗
PubMed2005

Numerical validation of linear accelerometer systems for the measurement of head kinematics.

The purpose of this study was to analytically exploit the capabilities of head-mounted systems instrumented with linear accelerometers (ACs) for field use in redundant configurations. We simulated different headsets equipped with uni-, bi- or triaxial sensors with a number of axes that lie in the range of 12-24; the ACs were located on a hemispherical surface by adopting a priori criterion while their orientation was randomized. In addition, for a comparative purpose the nine accelerometer scheme (one triaxial AC and three biaxial ACs addressed in the following as "3-2-2-2 configuration") was also analyzed in the present paper. We simulated and statistically assessed the performances of hemispherical headsets in the test case of a healthy subject walking freely at normal pace over level ground. The numerical results indicated that a well designed instrumented headset can retrieve the angular acceleration and (a0-g) component with rms errors of about 2% and 0.5%, respectively, and angular velocity with a drift error of about 20% in a 6 s trial. On the contrary, the pose of the headset cannot be evaluated because of the drift induced by the integration process. In general, we can state that headsets with uni-, bi- or triaxial ACs have comparable performances. The main implications of the above-mentioned observations are (a) neither expensive triaxial ACs nor assembling procedure based on the use of orthogonal mounting blocks are needed; (b) redundant arrays of low-cost uni- or biaxial ACs can effectively be used to reach adequate performances in biomechanical studies where head acceleration and velocity are investigated; (c) while estimates of angular acceleration with accelerometers are accurate, estimations of angular velocities, linear velocities and pose are not.

Acceleration↗
PubMed2003

Dynamic force distribution during level walking under the feet of patients with chronic ankle instability.

OBJECTIVES: To examine changes in the pattern of force transfer between the foot and the floor associated with chronically sprained ankles by measuring the peak forces and their timing under several regions of the feet during level walking. METHODS: Twelve young male subjects (mean (SD) age 21 (2) years) with recurrent ankle sprains were studied. Seven of them had unilateral and bilateral chronic instability and laxity, and five had bilateral instability. Twelve healthy men (without orthopaedic or medical disease) served as a control group. Subjects walked at their own pace along a 7 m walkway, which included a Mini-EMED pressure distribution measuring system. The variables measured were relative peak force (fraction of body weight) and relative timing (fraction of stance time). These variables were measured under six regions of interest in each foot print: heel, midfoot, medial, central, and lateral forefoot, and toes. RESULTS: (a) A significant delay to the time of peak force under the central and lateral forefoot and toes in subjects with chronic ankle instability. (b) A significant decrease in the relative forces under the heel and toes and an increase in the relative forces under the midfoot and lateral forefoot in subjects with chronic ankle instability. (c) In the patients with unilateral instability, there were no significant differences in any of the variables between the injured and non-injured foot. CONCLUSIONS: In patients with chronic ankle instability, there is a slowing down of weight transfer from heel strike to toe off, a reduced impact at the beginning and end of the stance phase, and a lateral shift of body weight.

Adult↗
PubMed1990

Exercise in leisure time: coronary attack and death rates.

Nine thousand three hundred and seventy six male civil servants, aged 45-64 at entry, with no clinical history of coronary heart disease, were followed for a mean period of 9 years and 4 months during which 474 experienced a coronary attack. The 9% of men who reported that they often participated in vigorous sports or did considerable amounts of cycling or rated the pace of their regular walking as fast (over 4 mph, 6.4 km/h) experienced less than half the non-fatal and fatal coronary heart disease of the other men. In addition, entrants aged 55-64 who reported the next lower degree of this vigorous aerobic exercise had rates less than two thirds of the remainder; entrants of 45-54 did not show such an effect. When these forms of exercise were not vigorous they were no protection against the disease, nor were other forms of exercise or high totals of physical activity per se. A history of vigorous sports in the past was not protective. Indications in these men are of protection by specific exercise: vigorous, aerobic, with a threshold of intensity for benefit and "dose response" above this threshold, exercise that has to be habitual, and continuing, which suggests that protection is against the acute phases of the disease. Those men who took vigorous aerobic exercise were demonstrably a favourably "selected" group; they suffered less of the disease, however, whether at low risk or high by the several risk factors that were studied. Men with exercise-related reduction in coronary heart disease also had lower death rates from the total of other causes, and so lower total death rates than the rest of the men.

Coronary Disease↗