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 kmlh) 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.Initial observation that middle aged men in jobs that require physical activity have a lower incidence of heart attack than comparable men in sedentary jobs' prompted the hypothesis that high totals of physical activity in leisure time would protect sedentary workers.2 Prospective survey of such men in the civil service, however, did not corroborate this. Only those reporting vigorous aerobic exercise showed substantially less coronary heart disease.Vigorous exercise included the most strenuous activities of these men, so it was well above their normal levels of activity, and it was further defined as being liable to entail peaks of energy expenditure of 7 5 kcal/min, 31-5 kJ/min (say > 6-0 resting equivalents (METS) and > 65% of maximum oxygen uptake). This is usually adequate, it may be postulated, to produce and maintain a cardiorespiratory training effect in such a population.'It is hazardous, however, to generate a new hypothesis post hoc from the same data set.Furthermore, in an admittedly different population of American men, though players of vigorous sports showed the lowest coronary rates, there was some protection also in a minority who took less intense aerobic exercise, and thus had high totals of leisure activity (> 2000 kcal per week)9"0 (and Paffenbarger et al, 1988, personal communication). As well as questions about the kind of exercise that is protective against heart disease, of a po...
Bulpitt, C. J., Hodes, C., and Everitt, M. G. (1976). British Journal of Preventive and Social Medicine, 30,[158][159][160][161][162]. The relationship between blood pressure and biochemical risk factors in a general population. The relationship between blood pressure, ponderal index, sex, blood glucose, haemoglobin, serum uric acid, calcium, cholesterol and creatinine, and albumin has been examined in 698 subjects aged between 44 and 49 years from the register of a group general practice. Sixty per cent of the variation in systolic pressure could be explained by statistically significant associations with diastolic pressure, sex, blood glucose, serum calcium, and cholesterol. The diastolic blood pressure (not corrected for systolic pressure) was significantly related only to ponderal index, haemoglobin in men, and cholesterol in women. Pulse pressure was also positively related to the risk factors blood glucose, serum cholesterol, and calcium. The possibility is discussed that one or more of these variables reduce aortic compliance and that the serum calcium contributes to this end. Diastolic, but not systolic pressure, had a prime association with relative weight, obesity being only basically associated with an increase in diastolic pressure.Both systolic and diastolic pressure are good predictors of subsequent mortality and morbidity (Kannel and Dawber, 1974). Diastolic blood pressure is more dependent on peripheral resistance than systolic pressure and the systolic pressure is determined to a larger extent by the compliance of the aorta and large arteries. A raised systolic pressure not only predicts subsequent disease but itself results from vascular damage which has already occurred, the compliance of the aorta being reduced by atherosclerotic disease. On the other hand, peripheral resistance arises mainly in the smaller arteries and arterioles and would be little affected by this condition. It must be noted that diastolic pressure is closely correlated with systolic pressure and factors that increase diastolic pressure may thereby increase systolic pressure.This paper examines the relationship in a general population between systolic and diastolic blood pressure, a weight-height index and biochemical results, some of which are known to be risk factors for atherosclerotic disease. Also assessed are the factors influencing mean blood pressure, pulse pressure, and systolic pressure adjusted for diastolic pressure. The analyses are intended to identify risk factors affecting systolic or diastolic pressure alone and which may operate by reducing aortic compliance or raising peripheral resistance. METHODS POPULATION STUDIEDThe subjects studied were taken from 16 000 patients on the list of a group practice near London, covering mainly an urban area. The middle-aged subjects were screened for hypertension and other abnormalities as previously described (Hodes, 1968a).The subjects were included in a computer file (Hodes, 1968b) and letters were sent to those aged between 44 and 49 years inviting them to attend f...
paralysis had started with an attack six months earlier for which he had been admitted to hospital and which recovered spontaneously after two days with no diagnosis being made. Subsequently he had had several attacks. His mother was told to bring him as soon as the next attack began and the diagnosis of "pulled elbow" was immediately obvious. Other cases were those of young children with episodes of painful arm whose families were suspected of causing non-accidental injury.Altogether 30 children had symptoms for 12 hours or more before being treated. There was no indication that parents of children who had had previous episodes were quicker in coming for medical help than those whose children had not had an earlier attack. A girl of 5k years who had had at least five earlier episodes was not brought for 12 hours and a 4-year-old with two previous attacks arrived after 48 hours. The striking exceptions were the twin sisters who between them had had pulled elbows at least six times and who both came half an hour after the onset. Apart from these twin sisters there was no evidence that siblings of patients were at increased risk of pulled elbow. Even when symptoms had been present for up to four days the child obtained immediate and complete relief with the first manipulation. The exceptional child who needed six manipulations had had symptoms for only two hours before being seen. After the sixth manipulation the mother, when the child was seen a few minutes later, said, "I knew it was all right this time -she forgot about it straight away."Just as pain in the knee may be referred from a hip and vice versa, pain from an elbow may be referred to the wrist or shoulder; 15 children had pain only in the wrist, and a further six had pain predominantly in the shoulder. If this is not realized by doctors it may cause difficulty in diagnosis.
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