Exercise and Physical Activity in the Prevention and Treatment of Atherosclerotic Cardiovascular Disease: A Statement From the Council on Clinical Cardiology (Subcommittee on Exercise, Rehabilitation, and Prevention) and the Council on Nutrition, Physical Activity, and Metabolism (Subcommittee on Physical Activity)

In the paper

“In contrast to the prior analyses, however, these recent results suggest that the exercise component is a critical aspect of the rehabilitation process.”

What the sources say

• Supported

  The Discussion reports a reduction in total mortality with exercise-only cardiac rehabilitation, in contrast to previous reviews. The Authors’ Conclusions say exercise-based rehabilitation reduces cardiac deaths. The claim’s cautious wording is consistent with those findings; the review does not establish that exercise-only rehabilitation is better than comprehensive rehabilitation. (LLM, conf=0.87)

  cites [25] 25. Jolliffe JA, Rees K, Taylor RS, et al. Exercise-based rehabilitation for coro- nary heart disease. Cochrane Database Syst Rev. 2001;(1):CD001800. source

In the paper

“The most recent and comprehensive meta-analysis identified 51 randomized controlled trials of exercise-based cardiac rehabilitation.25”

What the sources say

• Partly supported

  The Effects of interventions section reports 36 exercise-based cardiac rehabilitation trials found and 32 included. Subdividing some included trials produced 51 separate studies, not 51 randomized controlled trials. The Discussion describes this review as including more trials and patients than earlier meta-analyses. (LLM, conf=0.90)

  cites [25] 25. Jolliffe JA, Rees K, Taylor RS, et al. Exercise-based rehabilitation for coro- nary heart disease. Cochrane Database Syst Rev. 2001;(1):CD001800. sourceExperimental — accuracy not yet measured

In the paper

“These findings suggest that exercise training altered the coronary vasomotor response to exercise.32”

What the sources say

• Partly supported

  In the Results/Discussion (page not supplied), the paper considers an exercise-specific coronary vasomotor response as one possible explanation for the higher angina threshold after conditioning. It also offers an alternative involving myocardial oxygen consumption and says it lacked the measurements during exercise needed to distinguish the two. The findings therefore do not specifically establish an altered vasomotor response. (LLM, conf=0.85)

  cites [32] 32. Sim DN, Neill WA. Investigation of the physiological basis for increased exercise threshold for angina pectoris after physical conditioning. J Clin Invest. 1974;54:763-770. sourceExperimental — accuracy not yet measured

In the paper

“The incidence of injury can be as high as 55% in 8 weeks among women undergoing US Army basic training.52”

What the sources say

• Supported

  The Abstract (p. 111) reports an approximately 55% cumulative incidence of injuries among women during the eight weeks of US Army basic training. It specifies that these were injuries requiring an outpatient visit. (LLM, conf=0.94)

  cites [52] 52. Jones BH, Knapik JJ. Physical training and exercise-related injuries: sur- veillance, research and injury prevention in military populations. Sports Med. 1999;27:111-125. source

In the paper

“Vigorous physical activity acutely increases the risk of sudden cardiac death 56,57 and myocardial infarction 58,59 among individuals with both diagnosed and occult heart disease.”

What the sources say

• Supported

  The Results (p. 1) report an increased risk of myocardial infarction in the hour after heavy exertion. The Discussion (p. 5) says patients with known coronary artery disease did not have a higher relative risk after heavy exertion than those without such a history, supporting the claim’s distinction between diagnosed and unrecognized disease. (LLM, conf=0.85)

  cites [58] 58. Mittleman MA, Maclure M, Tofler GH, et al. Triggering of acute myocardial infarction by heavy physical exertion. Protection against triggering by regular exertion. Determinants of Myocardial Infarction Onset Study Investigators. N Engl J Med. 1993;329:1677-1683. source
• ?Not checked — no full text of the sourcecites [59] 59. Giri S, Thompson PD, Kiernan FJ, et al. Clinical and angiographic charac- teristics of exertion-related acute myocardial infarction. JAMA. 1999;282: 1731-1736. source

In the paper

“Approximately 5% to 10% of myocardial infarctions are associated with vigorous physical activity.”

What the sources say

• Supported

  The Results (p. 2) report that 4.4% of patients engaged in heavy physical exertion in the hour before myocardial infarction. The introduction (p. 1) also says previous studies found exertion immediately preceded symptoms in approximately 5% of patients, supporting the lower end of the claimed approximate range. (LLM, conf=0.88)

  cites [58] 58. Mittleman MA, Maclure M, Tofler GH, et al. Triggering of acute myocardial infarction by heavy physical exertion. Protection against triggering by regular exertion. Determinants of Myocardial Infarction Onset Study Investigators. N Engl J Med. 1993;329:1677-1683. source
• ?Not checked — no full text of the sourcecites [59] 59. Giri S, Thompson PD, Kiernan FJ, et al. Clinical and angiographic charac- teristics of exertion-related acute myocardial infarction. JAMA. 1999;282: 1731-1736. source

In the paper

“The most common risk of physical activity in adults is musculoskeletal injury.50,51”

What the sources say

• ?Not checked — no full text of the sourcecites [50] 50. Hootman JM, Macera CA, Ainsworth BE, et al. Epidemiology of musculo- skeletal injuries among sedentary and physically active adults. Med Sci Sports Exerc. 2002;34:838 -844. source
• Partly supported

  The Discussion says sports and physical activity increase the risk of knee injury, and the Abstract says most reported injuries occurred during physical activities. Neither passage compares musculoskeletal injury with other risks of physical activity or establishes that it is the most common risk in adults. (LLM, conf=0.86)

  cites [51] 51. Sutton AJ, Muir KR, Mockett S, et al. A case-control study to investigate the relation between low and moderate levels of physical activity and osteoar- thritis of the knee using data collected as part of the Allied Dunbar National Fitness Survey. Ann Rheum Dis. 2001;60:756 -764. sourceExperimental — accuracy not yet measured

In the paper

“Exercise also transiently increases the risk of acute myocardial infarction.58,59”

What the sources say

• Partly supported

  The Discussion (p. 4) reports a transient increase in myocardial-infarction risk during the hour after heavy physical exertion. The citing sentence says “exercise” without that intensity qualifier; the Discussion (p. 6) says triggering by moderate exertion remains uncertain. (LLM, conf=0.87)

  cites [58] 58. Mittleman MA, Maclure M, Tofler GH, et al. Triggering of acute myocardial infarction by heavy physical exertion. Protection against triggering by regular exertion. Determinants of Myocardial Infarction Onset Study Investigators. N Engl J Med. 1993;329:1677-1683. sourceExperimental — accuracy not yet measured
• ?Not checked — no full text of the sourcecites [59] 59. Giri S, Thompson PD, Kiernan FJ, et al. Clinical and angiographic charac- teristics of exertion-related acute myocardial infarction. JAMA. 1999;282: 1731-1736. source

In the paper

“The relative risk of both exercise-related myocardial infarction and sudden death is greatest in individuals who are the least physically active and who were performing unaccustomed vigorous physical activity.[57][58][59]”

What the sources say

• ?Not checked — no full text of the sourcecites [57] 57. Siscovick DS, Weiss NS, Fletcher RH, et al. The incidence of primary cardiac arrest during vigorous exercise. N Engl J Med. 1984;311:874 -877. source
• Supported

  The Results (p. 1) report that the relative risk of myocardial infarction after heavy exertion was highest among those who exercised least often. The Discussion (p. 4) reports a similar pattern for exertion-related sudden cardiac death, citing studies that found lower relative risk among people who exercised regularly. The paper defines heavy exertion as activity of at least 6 METs, so the claim’s description of vigorous activity is consistent with its measure. (LLM, conf=0.90)

  cites [58] 58. Mittleman MA, Maclure M, Tofler GH, et al. Triggering of acute myocardial infarction by heavy physical exertion. Protection against triggering by regular exertion. Determinants of Myocardial Infarction Onset Study Investigators. N Engl J Med. 1993;329:1677-1683. source
• ?Not checked — no full text of the sourcecites [59] 59. Giri S, Thompson PD, Kiernan FJ, et al. Clinical and angiographic charac- teristics of exertion-related acute myocardial infarction. JAMA. 1999;282: 1731-1736. source

In the paper

“Studies using the best designs and measurement instruments tend to show the strongest relationships between physical activity and decreased CAD events, probably because superior assessment techniques limit inaccuracies in categorizing physical activity levels.10”

What the sources say

• ?Not checked — no full text of the sourcecites [10] 10. Blair SN, Jackson AS. Physical fitness and activity as separate heart disease risk factors: a meta-analysis. Med Sci Sports Exerc. 2001;33:762-764. source

In the paper

“At least 44 randomized controlled trials including 2674 participants have studied the effect of exercise training on resting blood pressure.19”

What the sources say

• ?Not checked — no full text of the sourcecites [19] 19. Fagard RH. Exercise characteristics and the blood pressure response to dynamic physical training. Med Sci Sports Exerc. 2001;33(6 suppl): S484 -S492. source

In the paper

“The results are strong, with the most physically active subjects generally demonstrating CAD rates half those of the most sedentary group.”

What the sources say

• ?Not checked — no full text of the sourcecites [9] 9. Lee IM, Paffenbarger RS Jr, Hennekens CH. Physical activity, physical fitness and longevity. Aging (Milano). 1997;9:2-11. source
• ?Not checked — no full text of the sourcecites [10] 10. Blair SN, Jackson AS. Physical fitness and activity as separate heart disease risk factors: a meta-analysis. Med Sci Sports Exerc. 2001;33:762-764. source

In the paper

“In many studies, the lower frequency of CAD was independent of other known atherosclerotic risk factors.”

What the sources say

• ?Not checked — no full text of the sourcecites [9] 9. Lee IM, Paffenbarger RS Jr, Hennekens CH. Physical activity, physical fitness and longevity. Aging (Milano). 1997;9:2-11. source
• ?Not checked — no full text of the sourcecites [10] 10. Blair SN, Jackson AS. Physical fitness and activity as separate heart disease risk factors: a meta-analysis. Med Sci Sports Exerc. 2001;33:762-764. source

In the paper

“During the past half-century, prospective epidemiological studies of occupational and leisure-time physical activity have consistently documented a reduced incidence of CAD events in the more physically active 9 and fit 10 subjects.”

What the sources say

• ?Not checked — no full text of the sourcecites [9] 9. Lee IM, Paffenbarger RS Jr, Hennekens CH. Physical activity, physical fitness and longevity. Aging (Milano). 1997;9:2-11. source
• ?Not checked — no full text of the sourcecites [10] 10. Blair SN, Jackson AS. Physical fitness and activity as separate heart disease risk factors: a meta-analysis. Med Sci Sports Exerc. 2001;33:762-764. source

In the paper

“The Diabetes Prevention Program demonstrated the powerful effect that physical activity and weight loss can exert in preventing the onset of type II diabetes in individuals at high risk for this disease.1”

What the sources say

• ?Not checked — no full text of the sourcecites [1] 1. Knowler WC, Barrett-Connor E, Fowler SE, et al, for the Diabetes Prevention Program Research Group. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002;346:393-403. source

In the paper

“Compared with usual care, there was a 58% reduction in the onset of type II diabetes over 2.8 years among individuals randomized to a lifestyle intervention that produced an average 4-kg decrease in body weight and an 8-MET-h/wk increase in physical activity.”

What the sources say

• ?Not checked — no full text of the sourcecites [1] 1. Knowler WC, Barrett-Connor E, Fowler SE, et al, for the Diabetes Prevention Program Research Group. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002;346:393-403. source

In the paper

“Multiple studies were prospective and thereby demonstrate appropriate sequencing because the lower physical activity levels preceded the development of CAD rather than resulted from the disease itself.”

What the sources say

• ?Not checked — no full text of the sourcecites [9] 9. Lee IM, Paffenbarger RS Jr, Hennekens CH. Physical activity, physical fitness and longevity. Aging (Milano). 1997;9:2-11. source
• ?Not checked — no full text of the sourcecites [10] 10. Blair SN, Jackson AS. Physical fitness and activity as separate heart disease risk factors: a meta-analysis. Med Sci Sports Exerc. 2001;33:762-764. source

In the paper

“The National Weight Control Registry enrolled 3000 individuals who lost Ͼ10% of their body weight and maintained this weight loss for at least 1 year.3”

What the sources say

• ?Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  cites [3] 3. Wing RR, Hill JO. Successful weight loss maintenance. Annu Rev Nutr. 2001;21:323-341.

In the paper

“although results from the Harvard Alumni Study suggest that college athletic activity is not protective in later years without lifelong physical activity.13”

What the sources say

• ?Not checked — no full text of the sourcecites [13] 13. Paffenbarger RS Jr, Hyde RT, Wing AL, et al. A natural history of athleticism and cardiovascular health. JAMA. 1984;252:491-495. source

In the paper

“A review of 9 trials examining the effect of exercise training in 337 patients with type II diabetes reported an average reduction of hemoglobin (Hgb) A1c of 0.5% to 1%. 20”

What the sources say

• ?Not checked — no full text of the sourcecites [20] 20. Thompson PD, Crouse SF, Goodpaster B, et al. The acute versus the chronic response to exercise. Med Sci Sports Exerc. 2001;33(6 suppl):S438 -S445. source

In the paper

“For example, studies on cardiorespiratory fitness, measured as treadmill performance times, and CAD show stronger associations than are seen in activity studies, probably because of the better classification by objective measures of fitness in comparison to the relatively imprecise assessments of selfreported physical activity.10”

What the sources say

• ?Not checked — no full text of the sourcecites [10] 10. Blair SN, Jackson AS. Physical fitness and activity as separate heart disease risk factors: a meta-analysis. Med Sci Sports Exerc. 2001;33:762-764. source

In the paper

“The average reduction in systolic and diastolic blood pressure was 3.4 and 2.4 mm Hg, respectively.”

What the sources say

• ?Not checked — no full text of the sourcecites [19] 19. Fagard RH. Exercise characteristics and the blood pressure response to dynamic physical training. Med Sci Sports Exerc. 2001;33(6 suppl): S484 -S492. source

In the paper

“The largest and most carefully controlled exercise trial, the HEalth, RIsk factors, exercise Training, And GEnetics (HERITAGE) study, included 675 normolipidemic subjects who participated in 5 months of exercise training.17”

What the sources say

• ?Not checked — no full text of the sourcecites [17] 17. Leon AS, Rice T, Mandel S, et al. Blood lipid response to 20 weeks of supervised exercise in a large biracial population: the HERITAGE Family Study. Metabolism. 2000;49:513-520. source

In the paper

“Baseline blood pressure was an important determinant of the exercise effect.”

What the sources say

• ?Not checked — no full text of the sourcecites [19] 19. Fagard RH. Exercise characteristics and the blood pressure response to dynamic physical training. Med Sci Sports Exerc. 2001;33(6 suppl): S484 -S492. source

In the paper

“The average weight loss of 30 kg was maintained for an average of 5.5 years.”

What the sources say

• ?Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  cites [3] 3. Wing RR, Hill JO. Successful weight loss maintenance. Annu Rev Nutr. 2001;21:323-341.

In the paper

“Available data do not provide clear evidence that withdrawal of physical activity increases CAD risk, although results from the Harvard Alumni Study suggest that college athletic activity is not protective in later years without lifelong physical activity.13”

What the sources say

• ?Not checked — no full text of the sourcecites [13] 13. Paffenbarger RS Jr, Hyde RT, Wing AL, et al. A natural history of athleticism and cardiovascular health. JAMA. 1984;252:491-495. source

In the paper

“The data demonstrate a graded relationship of decreasing CAD rates with increasing levels of activity.”

What the sources say

• ?Not checked — no full text of the sourcecites [9] 9. Lee IM, Paffenbarger RS Jr, Hennekens CH. Physical activity, physical fitness and longevity. Aging (Milano). 1997;9:2-11. source
• ?Not checked — no full text of the sourcecites [10] 10. Blair SN, Jackson AS. Physical fitness and activity as separate heart disease risk factors: a meta-analysis. Med Sci Sports Exerc. 2001;33:762-764. source

In the paper

“The frequency, duration, and intensity varied among the trials, but all showed an increase in the average peak V ˙O2 between 12% and 31%.35”

What the sources say

• ?Not checked — no full text of the sourcecites [35] 35. Piña IL, Apstein CS, Balady GJ, et al. Exercise and heart failure: a statement from the American Heart Association Committee on Exercise, Rehabilitation, and Prevention. Circulation. 2003;107:1210 -1225. source

In the paper

“Of the exercisers, 19.4% achieved at least 2 months of continuous abstinence at the end of the 12-week intervention, compared with 10.2% of the controls.”

What the sources say

• ?Not checked — no full text of the sourcecites [22] 22. Marcus BH, Albrecht AE, King TK, et al. The efficacy of exercise as an aid for smoking cessation in women: a randomized controlled trial. Arch Intern Med. 1999;159:1229 -1234. source

In the paper

“This hypothesis is supported by recent angiographic studies documenting that exercise training reduces the abnormal vasoconstrictive response to acetylcholine in patients with CAD and documented endothelial dysfunction.33”

What the sources say

• ?Not checked — no full text of the sourcecites [33] 33. Hambrecht R, Wolf A, Gielen S, et al. Effect of exercise on coronary endothelial function in patients with coronary artery disease. N Engl J Med. 2000;342:454 -460. source

In the paper

“Several meta-analyses have concluded that comprehensive, exercise-based cardiac rehabilitation reduces mortality rates in patients after myocardial infarction.23,24”

What the sources say

• ?Not checked — no full text of the sourcecites [23] 23. O'Connor GT, Buring JE, Yusuf S, et al. An overview of randomized trials of rehabilitation with exercise after myocardial infarction. Circulation. 1989; 80:234 -244. source
• ?Not checked — no full text of the sourcecites [24] 24. Oldridge NB, Guyatt GH, Fischer ME, et al. Cardiac rehabilitation after myocardial infarction: combined experience of randomized clinical trials. JAMA. 1988;260:945-950. source

In the paper

“Exercise training has also been shown to improve quality of life in both men and women with moderate, chronic HF. 40”

What the sources say

• ?Not checked — no full text of the sourcecites [40] 40. Tyni-Lenne R, Gordon A, Europe E, et al. Exercise-based rehabilitation improves skeletal muscle capacity, exercise tolerance, and quality of life in both women and men with chronic heart failure. J Card Fail. 1998;4:9 -17. source

In the paper

“At 12-month follow-up, 11.9% of the exercisers and 5.4% of the controls remained continuously abstinent.”

What the sources say

• ?Not checked — no full text of the sourcecites [22] 22. Marcus BH, Albrecht AE, King TK, et al. The efficacy of exercise as an aid for smoking cessation in women: a randomized controlled trial. Arch Intern Med. 1999;159:1229 -1234. source

In the paper

“Serum triglycerides are reduced by vigorous exercise for up to 72 hours.20”

What the sources say

• ?Not checked — no full text of the sourcecites [20] 20. Thompson PD, Crouse SF, Goodpaster B, et al. The acute versus the chronic response to exercise. Med Sci Sports Exerc. 2001;33(6 suppl):S438 -S445. source

In the paper

“The Exercise Training Intervention after Coronary Angioplasty (ETICA) trial 34 randomized 118 consecutive patients to 6 months of exercise training or control.”

What the sources say

• ?Not checked — no full text of the sourcecites [34] 34. Belardinelli R, Paolini I, Cianci G, et al. Exercise training intervention after coronary angioplasty: the ETICA trial. J Am Coll Cardiol. 2001;37: 1891-1900. source

In the paper

“Women and men, respectively, reported expending 2445 and 3298 kcal weekly in such activities as walking, cycling, weight lifting, aerobics, running, and stair climbing.”

What the sources say

• ?Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  cites [3] 3. Wing RR, Hill JO. Successful weight loss maintenance. Annu Rev Nutr. 2001;21:323-341.

In the paper

“HDL-C is also transiently increased by exercise.20”

What the sources say

• ?Not checked — no full text of the sourcecites [20] 20. Thompson PD, Crouse SF, Goodpaster B, et al. The acute versus the chronic response to exercise. Med Sci Sports Exerc. 2001;33(6 suppl):S438 -S445. source

In the paper

“Exercise also has favorable acute effects on glucose homeostasis.20”

What the sources say

• ?Not checked — no full text of the sourcecites [20] 20. Thompson PD, Crouse SF, Goodpaster B, et al. The acute versus the chronic response to exercise. Med Sci Sports Exerc. 2001;33(6 suppl):S438 -S445. source

In the paper

“The mean increase in peak V ˙O2 in 15 randomized controlled trials of exercise training that included 426 HF patients was 20.5%.”

What the sources say

• ?Not checked — no full text of the sourcecites [35] 35. Piña IL, Apstein CS, Balady GJ, et al. Exercise and heart failure: a statement from the American Heart Association Committee on Exercise, Rehabilitation, and Prevention. Circulation. 2003;107:1210 -1225. source

In the paper

“However, referral to and participation in exercise rehabilitation is less frequent for older patients, especially for older women.48”

What the sources say

• ?Not checked — no full text of the sourcecites [48] 48. Ades PA, Waldmann ML, Polk DM, et al. Referral patterns and exercise response in the rehabilitation of female coronary patients aged greater than or equal to 62 years. Am J Cardiol. 1992;69:1422-1425. source

In the paper

“A metaanalysis of 21 exercise programs for patients with claudication demonstrated that, after exercise training, average walking distance to pain onset increased 179% or 225 m, and average distance to maximal tolerated pain increased 122% or 397 m. 42”

What the sources say

• ?Not checked — no full text of the sourcecites [42] 42. Gardner AW, Poehlman ET. Exercise rehabilitation programs for the treatment of claudication pain: a meta-analysis. JAMA. 1995;274:975-980. source

In the paper

“In contrast, injuries are rare in research studies of supervised exercise training among older adults when individuals at high risk of injury are excluded.53”

What the sources say

• ?Not checked — no full text of the sourcecites [53] 53. Buchner DM, Coleman EA. Exercise considerations in older adults: intensity, fall prevention and safety. Phys Med Rehabil Clin N Am. 1994;5:357-375. source

In the paper

“No significant complications or adverse outcomes of exercise training in older patients have been described in any study.”

In the paper

“although in the British Regional Heart Study, men with CAD and a mean age of 63 years who engaged in light-to-moderate physical activity had a significantly lower all-cause mortality over the 5-year follow-up than did their sedentary counterparts.49”

What the sources say

• ?Not checked — no full text of the sourcecites [49] 49. Wannamethee SG, Shaper AG, Walker M. Physical activity and mortality in older men with diagnosed coronary heart disease. Circulation. 2000;102: 1358 -1363. source

In the paper

“In addition, no trials have examined the effect of exercise training on the need for revascularization or on subsequent cardiovascular events or mortality in patients with claudication.”

In the paper

“Physical activity is also an important adjunct to diet for achieving and maintaining weight loss.”

What the sources say

• ?Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  cites [3] 3. Wing RR, Hill JO. Successful weight loss maintenance. Annu Rev Nutr. 2001;21:323-341.

In the paper

“These findings may underestimate the absolute decrease in Hgb A1C because of concomitant reductions in diabetic medications.”

In the paper

“These epidemiological studies, combined with studies providing biological plausibility, provide conclusive evidence that physical activity reduces the incidence of CAD.”

In the paper

“The magnitude of the exercise effect is influenced by characteristics of the exercise intervention, individual variation, and whether exercise produces concomitant reductions in body weight.”

In the paper

“The data satisfy the criteria required to infer a causal relationship from epidemiological evidence.11,12”

What the sources say

• ?Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  cites [11] 11. US Department of Health, Education, and Welfare. Smoking and Health: Report of the Advisory Committee to the Surgeon General of the Public Health Service. Washington, DC: US Department of Health, Education, and Welfare, Public Health Service; 1964. PHS Publication No. 1103. Available at: http://www.cdc.gov/tobacco/sgr/sgr_1964/sgr64.htm. Accessed May 9, 2003.
• ?Not checked — no full text of the sourcecites [12] 12. Powell KE, Thompson PD, Caspersen CJ, et al. Physical activity and the incidence of coronary heart disease. Annu Rev Public Health. 1987;8: 253-287. source

In the paper

“suggesting that exercise may serve as the only therapy required in some mildly hypertensive subjects.”

What the sources say

• ?Not checked — no full text of the sourcecites [19] 19. Fagard RH. Exercise characteristics and the blood pressure response to dynamic physical training. Med Sci Sports Exerc. 2001;33(6 suppl): S484 -S492. source

In the paper

“The aforementioned studies support the use of physical activity to improve exercise capacity after coronary revascularization procedures, including coronary bypass surgery and percutaneous interventions.”

In the paper

“Exercise training benefits HF in several ways.”

In the paper

“Thus, it is not clear that exercise therapy after myocardial infarction would have as great an impact on mortality rates in the present era of cardiovascular disease management.”

In the paper

“Such results are preliminary, but they suggest that physical activity facilitates long-term smoking cessation by increasing the initial quit rate.”

What the sources say

• ?Not checked — no full text of the sourcecites [22] 22. Marcus BH, Albrecht AE, King TK, et al. The efficacy of exercise as an aid for smoking cessation in women: a randomized controlled trial. Arch Intern Med. 1999;159:1229 -1234. source

In the paper

“Some of the effect of physical activity on cardiovascular risk factors is an acute effect of recent exercise and is not dependent on prolonged exercise training or improvement in fitness.20”

What the sources say

• ?Not checked — no full text of the sourcecites [20] 20. Thompson PD, Crouse SF, Goodpaster B, et al. The acute versus the chronic response to exercise. Med Sci Sports Exerc. 2001;33(6 suppl):S438 -S445. source

In the paper

“Exercise training is also useful for patients with angina pectoris who are not candidates for revascularization therapy because of disease not amenable to intervention, angiographically noncritical stenoses, or patient preference.”

In the paper

“Atherosclerotic CAD is the overwhelming cause of exerciserelated deaths in adults.56,57”

What the sources say

• ?Not checked — no full text of the sourcecites [56] 56. Thompson PD, Funk EJ, Carleton RA, et al. Incidence of death during jogging in Rhode Island from 1975 through 1980. JAMA. 1982;247: 2535-2538. source
• ?Not checked — no full text of the sourcecites [57] 57. Siscovick DS, Weiss NS, Fletcher RH, et al. The incidence of primary cardiac arrest during vigorous exercise. N Engl J Med. 1984;311:874 -877. source

In the paper

“Although there are few direct comparisons of therapeutic exercise programs versus pharmacological or surgical interventions, these increases in walking distance are greater than those reported for the most widely used agents for claudication, pentoxyphyline and cilostazol.”

In the paper

“Supervised exercise may serve as a primary therapy for many individuals with claudication if such a program is available and if claudication is the primary functional limitation.”

In the paper

“These incidence rates are based on only 10 56 and 9 57 exercise-related deaths, which gives these figures wide confidence limits.”

What the sources say

• ?Not checked — no full text of the sourcecites [56] 56. Thompson PD, Funk EJ, Carleton RA, et al. Incidence of death during jogging in Rhode Island from 1975 through 1980. JAMA. 1982;247: 2535-2538. source
• ?Not checked — no full text of the sourcecites [57] 57. Siscovick DS, Weiss NS, Fletcher RH, et al. The incidence of primary cardiac arrest during vigorous exercise. N Engl J Med. 1984;311:874 -877. source

In the paper

“The incidence has been estimated to be 1 exertion-related death per year for every 15 000 56 to 18 000 57 ostensibly healthy men.”

What the sources say

• ?Not checked — no full text of the sourcecites [56] 56. Thompson PD, Funk EJ, Carleton RA, et al. Incidence of death during jogging in Rhode Island from 1975 through 1980. JAMA. 1982;247: 2535-2538. source
• ?Not checked — no full text of the sourcecites [57] 57. Siscovick DS, Weiss NS, Fletcher RH, et al. The incidence of primary cardiac arrest during vigorous exercise. N Engl J Med. 1984;311:874 -877. source

In the paper

“Progressive physical activity is an effective treatment for improving walking distance in patients with peripheral arterial disease and exercise-induced claudication.”

What the sources say

• ?Not checked — no full text of the sourcecites [42] 42. Gardner AW, Poehlman ET. Exercise rehabilitation programs for the treatment of claudication pain: a meta-analysis. JAMA. 1995;274:975-980. source

In the paper

“A review of randomized controlled trials suggests that the evidence favoring exercise training outweighs that for peripheral angioplasty in improving exercise tolerance in claudication patients.43”

What the sources say

• ?Not checked — no full text of the sourcecites [43] 43. Whyman MR, Ruckley CV. Should claudicants receive angioplasty or just exercise training? Cardiovasc Surg. 1998;6:226 -231. source

In the paper

“Among participants in cardiac rehabilitation programs, the average incidence of cardiac arrest, nonfatal myocardial infarction, and death is Ϸ1 for every 117 000, 220 000, and 750 000 patient-hours of participation, 64 respectively.”

What the sources say

• ?Not checked — no full text of the sourcecites [64] 64. Franklin BA, Bonzheim K, Gordon S, et al. Safety of medically supervised outpatient cardiac rehabilitation exercise therapy: a 16-year follow-up. Chest. 1998;114:902-906. source

In the paper

“Among high school and college athletes, an estimated 1 death per year occurs during or within an hour after athletic activity for every 133 333 male and 769 230 female participants.60”

What the sources say

• ?Not checked — no full text of the sourcecites [60] 60. Van Camp SP, Bloor CM, Mueller FO, et al. Nontraumatic sports death in high school and college athletes. Med Sci Sports Exerc. 1995;27:641-647. source

In the paper

“Because atherosclerotic CAD is the most frequent cause of exercise-related events, the incidence of such events is higher among patients with known atherosclerotic coronary disease.”

In the paper

“Vigorous physical activity acutely increases the risk of sudden cardiac death 56,57 and myocardial infarction 58,59 among individuals with both diagnosed and occult heart disease.”

What the sources say

• ?Not checked — no full text of the sourcecites [56] 56. Thompson PD, Funk EJ, Carleton RA, et al. Incidence of death during jogging in Rhode Island from 1975 through 1980. JAMA. 1982;247: 2535-2538. source
• ?Not checked — no full text of the sourcecites [57] 57. Siscovick DS, Weiss NS, Fletcher RH, et al. The incidence of primary cardiac arrest during vigorous exercise. N Engl J Med. 1984;311:874 -877. source

In the paper

“Although the absolute incidence of sudden death associated with exercise is quite low, exercise does acutely increase the rate of sudden death compared with more leisurely activities.56,57”

In the paper

“The low ratio of cardiac arrest to death is due to the availability of acute medical care.”

In the paper

“The evidence summarized above and more extensively presented in the 1996 Surgeon General's Report 65 attests to the value of exercise and physical activity in reducing the incidence of coronary heart disease.”

What the sources say

• ?Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  cites [65] 65. US Department of Health and Human Services. Physical Activity and Health: A Report of the Surgeon General. Atlanta, Ga: US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, 1996. Available at: http://www.cdc.gov/nccdphp/sgr/sgr.htm. Accessed May 30, 2003.

In the paper

“Overall, available information suggests that physical activity in the range recommended by recent public health guidelines, such as the CDC/ACSM guideline, 7 has quite an acceptable risk-to-benefit ratio.”

What the sources say

• ?Not checked — no full text of the sourcecites [7] 7. Pate RR, Pratt M, Blair SN, et al. Physical activity and public health: a recommendation from the Centers for Disease Control and Prevention and the American College of Sports Medicine. JAMA. 1995;273:402-407. source

In the paper

“Although the absolute incidence of sudden death associated with exercise is quite low, exercise does acutely increase the rate of sudden death compared with more leisurely activities.56,57”

What the sources say

• ?Not checked — no full text of the sourcecites [56] 56. Thompson PD, Funk EJ, Carleton RA, et al. Incidence of death during jogging in Rhode Island from 1975 through 1980. JAMA. 1982;247: 2535-2538. source
• ?Not checked — no full text of the sourcecites [57] 57. Siscovick DS, Weiss NS, Fletcher RH, et al. The incidence of primary cardiac arrest during vigorous exercise. N Engl J Med. 1984;311:874 -877. source

In the paper

“A variety of congenital and acquired conditions such as hypertrophic cardiomyopathy, coronary artery anomalies, aortic stenosis, and cardiomyopathies are associated with sudden death during vigorous activity in children and young adults.60,61”

What the sources say

• ?Not checked — no full text of the sourcecites [60] 60. Van Camp SP, Bloor CM, Mueller FO, et al. Nontraumatic sports death in high school and college athletes. Med Sci Sports Exerc. 1995;27:641-647. source
• ?Not checked — no full text of the sourcecites [61] 61. Maron BJ, Shirani J, Poliac LC, et al. Sudden death in young competitive athletes: clinical, demographic, and pathological profiles. JAMA. 1996;276: 199 -204. source

In the paper

“For example, 12 studies have studied increasing access to places for physical activity, with a median effect size of a 26% increase in persons exercising at least 3 days per week.”

What the sources say

• ?Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  cites [71] 71. Increasing physical activity: a report on recommendations of the Task Force on Community Preventive Services. MMWR Recomm Rep. October 26, 2001;50(RR-18):1-14.

In the paper

“The Task Force on Community Preventive Services has completed an evidence-based review of these community strategies.71”

What the sources say

• ?Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  cites [71] 71. Increasing physical activity: a report on recommendations of the Task Force on Community Preventive Services. MMWR Recomm Rep. October 26, 2001;50(RR-18):1-14.

In the paper

“There are also effective strategies to promote active lifestyles for whole communities that complement those designed for individuals.”

What the sources say

• ?Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  cites [71] 71. Increasing physical activity: a report on recommendations of the Task Force on Community Preventive Services. MMWR Recomm Rep. October 26, 2001;50(RR-18):1-14.

In the paper

“Although there is sufficient evidence to encourage increased physical activity for the public and most patient groups, multiple aspects of physical activity and health warrant additional investigation.”