%!PS-Adobe-3.0
%%Title: CHAP4.PDF
%%BoundingBox: 19 9 593 784
%%CreationDate: 09/27/96 16:03:48
%%Pages: 1
%%Requirements: None
%%LanguageLevel: 1
%%EndComments
%%BeginProlog
%%BeginProcSet: Pscript_Win_Driver_Min 2.0 0
userdict/Pscript_Win_Driver_Min 10 dict dup begin put/b{bind def}bind def/|{
def}b/LH{showpage}b/initialize{begin userdict begin}b/terminate{pop end end}b
/setjn{{statusdict/jobname known{statusdict/jobname 3 -1 roll put}if}stopped
cleartomark}b/colspRefresh{}b end
%%EndProcSet
%%BeginResource: file Pscript_Win_Utils 2.0 0
/|/def load def/,/load load |/~/exch , |/?/ifelse , |/!/pop , |/`/begin , |/^
/index , |/@/dup , |/+/translate , |/$/roll , |/U/userdict , |/M/moveto , |/-
/rlineto , |/&/currentdict , |/:/gsave , |/;/grestore , |/F/false , |/T/true ,
|/N/newpath , |/E/end , |/Ac/arc , |/An/arcn , |/A/ashow , |/D/awidthshow , |
/C/closepath , |/V/div , |/O/eofill , |/L/fill , |/I/lineto , |/-C/rcurveto ,
|/-M/rmoveto , |/+S/scale , |/Ji/setfont , |/Lc/setlinecap , |/Lj/setlinejoin
, |/Lw/setlinewidth , |/S/show , |/LH/showpage , |/K/stroke , |/W/widthshow ,
|/R/rotate , |/b{bind |}bind |/bd{bind |}bind |/xd{~ |}bd/ld{, |}bd/lw/Lw ld
/lc/Lc ld/lj/Lj ld/sg/setgray ld/L2? F/languagelevel where{! languagelevel 2
ge{! T}if}if |/g{@ not{U/DefIf_save save put}if U/DefIf_bool 2 ^ put}b
/DefIf_El{if U/DefIf_bool get not @{U/DefIf_save get restore}if}b/e{DefIf_El !
}b/self & |/reinitialize{[/TextInit/GraphInit/UtilsInit counttomark{@ where{
self eq}{F}?{cvx exec}{!}?}repeat cleartomark}b/initialize{`{/ADO_mxRot ~ |
/TextInitialised? F | reinitialize E}{U/Pscript_Win_Data 200 dict @ ` put
/ADO_mxRot ~ |/TextInitialised? F | reinitialize}?}b/terminate{!{& self eq{
exit}{E}?}loop E}b/suspend/terminate , |/resume{` Pscript_Win_Data `}b/snap{
transform 0.25 sub round 0.25 add ~ 0.25 sub round 0.25 add ~ itransform}b
/dsnap{dtransform round ~ round ~ idtransform}b<04>cvn{}|/setjn{{statusdict
/jobname known{statusdict/jobname 3 -1 $ put}if}stopped cleartomark}b/solid{[]
0 setdash}b/setdsh{0 setdash}b/colspRefresh{}b/rp{4 2 $ M 1 ^ 0 - 0 ~ - neg 0
-}b/rr{1 ^ 0 - 0 ~ - neg 0 - C}b
%%EndResource
%%BeginResource: file Pscript_Win_Utils_L1 2.0 0
L2? not g{/rf{N rp L}b/fx{1 1 dtransform @ 0 ge{1 sub 1}{1 add -0.25}? 3 -1 $
@ 0 ge{1 sub 1}{1 add -0.25}? 3 1 $ 4 1 $ idtransform 4 -2 $ idtransform}b/BZ{
4 -2 $ snap + +S fx rf}b/rs{N rp C K}b/rc{N rp clip N}b/sg{setgray}b/sco{
setrgbcolor}b/sgco{{sg}{sco}?}b}e
%%EndResource
%%BeginResource: file Pscript_Win_Utils_L2 2.0 0
L2? g{/colspA/DeviceGray |/colspABC/DeviceRGB |/setAorABC{{colspA}{colspABC}?
setcolorspace}b/rf/rectfill , |/fx{1 1 dtransform @ 0 ge{1 sub 0.5}{1 add -0.5
}? 3 -1 $ @ 0 ge{1 sub 0.5}{1 add -0.5}? 3 1 $ 4 1 $ idtransform 4 -2 $
idtransform}b/BZ{4 -2 $ snap + +S fx rf}b/rs/rectstroke , |/rc/rectclip , |/sg
{@ @ setcolor}b/sco{setcolor}b/colspRefresh{colspABC setcolorspace}b/sgco{{sg
}{sco}?}b/UtilsInit{F setglobal}b/definecolorrendering{/ColorRendering
defineresource !}b/findcolorrendering{@/ColorRendering resourcestatus{! !
/ColorRendering findresource T}{! F}?}b/selectcolorrendering{@/ColorRendering
resourcestatus{! !/ColorRendering}{!/DefaultColorRendering/ColorRendering}?
findresource setcolorrendering}b}e
%%EndResource
%%EndProlog
%%BeginSetup
Pscript_Win_Driver_Min dup /initialize get exec
[{0
/languagelevel where{pop languagelevel}{1}ifelse 2 ge{1 dict dup/JobTimeout 4 -1 roll put setuserparams}{statusdict/setjobtimeout get exec}ifelse
} stopped cleartomark
[{240
/languagelevel where{pop languagelevel}{1}ifelse 2 ge{1 dict dup/WaitTimeout 4 -1 roll put setuserparams}{statusdict/waittimeout 3 -1 roll put}ifelse
} stopped cleartomark
[{
statusdict /manualfeed false put
} stopped cleartomark
[{
%%BeginFeature: *InputSlot AutoSelect Tray
%%EndFeature
} stopped cleartomark
[{
%%BeginFeature: *PageSize US Letter
letter
%%EndFeature
} stopped cleartomark
/mysetup [ 1.000 0 0 1.000 0 0 ] |
%%EndSetup
%%Page: 1 1
%%BeginPageSetup
[{
%%BeginFeature: *Resolution 300dpi
%%EndFeature
} stopped cleartomark
[{
%%BeginFeature: *Duplex
%%EndFeature
} stopped cleartomark
mysetup concat colspRefresh
: 1.000 1.000 1.000 sco 19 -8 612 792 rf ; %%EndPageSetup
%%BeginDocument: Pscript_Win_PassThrough
%%BeginFont: Optima-Bold
%!FontType1-1.0: Optima-Bold 1
13 dict begin
/FontName /Optima-Bold def
/FontType 1 def
/FontBBox {-97 -271 1000 921} readonly def
/FontMatrix [0.001 0 0 0.001 0 0] readonly def
/PaintType 0 def
/FontInfo 12 dict dup begin
/version (001.001) readonly def
/Notice (Optima is a trademark of Allied Corporation.) readonly def
/FullName (Optima Bold) readonly def
/FamilyName (Optima) readonly def
/ItalicAngle 0 def
/isFixedPitch false def
/UnderlinePosition -141 def
/UnderlineThickness 38 def
/Weight (Bold) def
/BaseFontName (Optima-Bold) def
end def
/Encoding StandardEncoding def
currentdict end
currentfile eexec
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cleartomark
%%EndFont
%%BeginFont: Berkeley-Medium
%!FontType1-1.0: Berkeley-Medium 1
13 dict begin
/FontName /Berkeley-Medium def
/FontType 1 def
/FontBBox {-93 -255 1083 842} readonly def
/FontMatrix [0.001 0 0 0.001 0 0] readonly def
/PaintType 0 def
/FontInfo 12 dict dup begin
/version (001.000) readonly def
/Notice (Copyright (c) 1989 Adobe Systems Incorporated. All Rights Reserved.ITC Berkeley Oldstyle is a trademark of International Typeface Corporation.) readonly def
/FullName (ITC Berkeley Oldstyle Medium) readonly def
/FamilyName (Berkeley) readonly def
/ItalicAngle 0 def
/isFixedPitch false def
/UnderlinePosition -100 def
/UnderlineThickness 50 def
/Weight (Medium) def
/BaseFontName (Berkeley-Medium) def
end def
/Encoding StandardEncoding def
currentdict end
currentfile eexec
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cleartomark
%%EndFont
%%BeginFont: Optima
%!FontType1-1.0: Optima 1
13 dict begin
/FontName /Optima def
/FontType 1 def
/FontBBox {-78 -271 1000 919} readonly def
/FontMatrix [0.001 0 0 0.001 0 0] readonly def
/PaintType 0 def
/FontInfo 12 dict dup begin
/version (001.001) readonly def
/Notice (Optima is a trademark of Allied Corporation.) readonly def
/FullName ( Optima.Oblique ) readonly def
/FamilyName (Optima) readonly def
/ItalicAngle -11 def
/isFixedPitch false def
/UnderlinePosition -141 def
/UnderlineThickness 38 def
/Weight (Roman) def
/BaseFontName (Optima) def
end def
/Encoding StandardEncoding def
currentdict end
currentfile eexec
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cleartomark
%%EndFont
%%BeginFont: GDDEZZ+Berkeley-Bold
%!FontType1-1.0: INHJAA+Berkeley-Bold 1
13 dict begin
/FontName /INHJAA+Berkeley-Bold def
/FontType 1 def
/FontBBox {-102 -250 1129 847} readonly def
/FontMatrix [0.001 0 0 0.001 0 0] readonly def
/PaintType 0 def
/FontInfo 12 dict dup begin
/version (001.000) readonly def
/Notice (Copyright (c) 1989 Adobe Systems Incorporated. All Rights Reserved.ITC Berkeley Oldstyle is a trademark of International Typeface Corporation.) readonly def
/FullName (ITC Berkeley Oldstyle Bold) readonly def
/FamilyName (Berkeley) readonly def
/ItalicAngle 0 def
/isFixedPitch false def
/UnderlinePosition -100 def
/UnderlineThickness 50 def
/Weight (Bold) def
/BaseFontName (Berkeley-Bold) def
end def
/Encoding StandardEncoding def
currentdict end
currentfile eexec
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cleartomark
%%EndFont
%%BeginFont: CGFAAZ+Berkeley-BoldItalic
%!FontType1-1.0: INIJFA+Berkeley-BoldItalic 1
13 dict begin
/FontName /INIJFA+Berkeley-BoldItalic def
/FontType 1 def
/FontBBox {-158 -260 1022 844} readonly def
/FontMatrix [0.001 0 0 0.001 0 0] readonly def
/PaintType 0 def
/FontInfo 12 dict dup begin
/version (001.000) readonly def
/Notice (Copyright (c) 1989 Adobe Systems Incorporated. All Rights Reserved.ITC Berkeley Oldstyle is a trademark of International Typeface Corporation.) readonly def
/FullName (ITC Berkeley Oldstyle Bold Italic) readonly def
/FamilyName (Berkeley) readonly def
/ItalicAngle -8 def
/isFixedPitch false def
/UnderlinePosition -100 def
/UnderlineThickness 50 def
/Weight (Bold) def
/BaseFontName (Berkeley-BoldItalic) def
end def
/Encoding StandardEncoding def
currentdict end
currentfile eexec
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cleartomark
%%EndFont
%%BeginFont: Berkeley-Italic
%!FontType1-1.0: Berkeley-Italic 1
13 dict begin
/FontName /Berkeley-Italic def
/FontType 1 def
/FontBBox {-130 -260 1019 839} readonly def
/FontMatrix [0.001 0 0 0.001 0 0] readonly def
/PaintType 0 def
/FontInfo 12 dict dup begin
/version (001.000) readonly def
/Notice (Copyright (c) 1989 Adobe Systems Incorporated. All Rights Reserved.ITC Berkeley Oldstyle is a trademark of International Typeface Corporation.) readonly def
/FullName (ITC Berkeley Oldstyle Italic) readonly def
/FamilyName (Berkeley) readonly def
/ItalicAngle -8 def
/isFixedPitch false def
/UnderlinePosition -100 def
/UnderlineThickness 50 def
/Weight (Medium) def
/BaseFontName (Berkeley-Italic) def
end def
/Encoding StandardEncoding def
currentdict end
currentfile eexec
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cleartomark
%%EndFont
/currentpacking where{pop currentpacking true setpacking}if
userdict /PDF 75 dict put
%%BeginFile: pdfvars.prc
%%Copyright: Copyright 1987-1994 Adobe Systems Incorporated. All Rights Reserved.
userdict /PDFVars 59 dict dup begin put
/_save 0 def
/_cshow 0 def
/InitAll 0 def
/TermAll 0 def
/_lp /none def
/_doClip 0 def
%% old (PDFVars was 51, not 59)
%% % paint operators
%% /_fc 0 def % set color before fill occurs
%% /_sc 0 def % set color before stroke occurs
%% % color operands
%% /_gf null def % gray fill color
%% /_cf 4 array def % cmyk fill color
%% /_rgbf 3 array def % rgb fill color
%% /_gs null def % same for stroke
%% /_cs 4 array def
%% /_rgbs 3 array def
%% end old
%% new
/_sfcs 0 def
/_sfc 0 def
/_sscs 0 def
/_ssc 0 def
/_fcs 0 def
/_scs 0 def
/_f1 1 array def
/_f3 3 array def
/_f4 4 array def
/_fc null def
/_s1 1 array def
/_s3 3 array def
/_s4 4 array def
/_sc null def
%% end new
/_inT false def
/_tr -1 def
/_rise 0 def
/_ax 0 def
/_cx 0 def
/_ld 0 def
/_tm matrix def
/_ctm matrix def
/_mtx matrix def
/_hy (-) def
/_fScl 0 def
/_hs 1 def
/_pdfEncodings 2 array def
/Tj 0 def
/_italMtx[1 0 .212557 1 0 0]def
/_basefont 0 def
/_basefonto 0 def
end
%%EndFile
PDFVars begin PDF begin
%%BeginFile: pdfutil.prc
%%Copyright: Copyright 1993 Adobe Systems Incorporated. All Rights Reserved.
/bd {bind def} bind def
/ld {load def} bd
/dd { PDFVars 3 1 roll put } bd
/xdd { exch dd } bd
/Level2?
/languagelevel where { pop languagelevel 2 ge } { false } ifelse
def
/here {
dup currentdict exch known
{ currentdict exch get true }
{ pop false }
ifelse
} bd
/isdefined? { where { pop true } { false } ifelse } bd
/StartLoad { dup dup not { /_save save dd } if } bd
/EndLoad { if not { _save restore } if } bd
/npop { { pop } repeat } bd
%%EndFile
%%BeginFile: l2compat
%%Copyright: Copyright 1987-1993 Adobe Systems Incorporated. All Rights Reserved.
/cshow isdefined? not StartLoad {
/cshow {
exch /_cshow xdd
{ 0 0 _cshow exec } forall
} bd
} EndLoad
/setcmykcolor isdefined? not StartLoad {
/setcmykcolor {
1 sub 4 1 roll
3 {
3 index add neg dup 0 lt { pop 0 } if
3 1 roll
} repeat
setrgbcolor
pop
} bd
} EndLoad
/rectclip isdefined? not StartLoad {
/re 0 def
/rectclip { newpath re clip newpath } bd
} EndLoad
/execform isdefined? not StartLoad {
/execform {
gsave dup begin
Matrix concat
BBox aload pop
exch 3 index sub
exch 2 index sub
rectclip
PaintProc end grestore
} def
} EndLoad
%%EndFile
%%BeginFile: pdf.prc
%%Copyright: Copyright 1987-1994 Adobe Systems Incorporated. All Rights Reserved.
/initialize {
PDF begin
PDFVars begin
newpath
} bd
/terminate {
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[(Introduction)-353 ( . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .\
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[(Arrhythmia)-358 ( . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .\
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-1 -1.409 TD
[(Conclusions)-526 ( . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .\
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-1 -2.818 TD
[(Cancer)-131 ( . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .\
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1 -1.409 TD
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. . . . . . . . . . . . . . . . . . . .)-447 (113)]TJ
1 -1.409 TD
[(Colon )-8 (Cancer)-475 ( . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .\
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T*
[(Rectal )-13 (Cancer)-489 ( . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .\
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-1 -1.409 TD
0.001 Tc
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[(Hormone-Dependent Cancers in Women)-476 ( . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .\
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0 Tc
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[(Breast )-10 (Cancer)-516 ( . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .\
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T*
0.001 Tc
[(Other Hormone-Dependent Cancers in Women)-407 ( . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .)-459 (120)]TJ
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[(Cancers in Men)-193 ( . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .\
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[(Prostate )-9 (Cancer)-216 ( . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .\
. . . . . . . . . . . . . . . . . . . .)-447 (121)]TJ
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[(Testicular )-13 (Cancer)-429 ( . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .\
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-1 -1.409 TD
0.001 Tc
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[(Other Site-Specific Cancers)-550 ( . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .\
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T*
[(Biologic Plausibility)-501 ( . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .\
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[(Conclusions)-526 ( . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .\
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-1 -2.818 TD
0.001 Tc
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[(Non\320Insulin-Dependent Diabetes Mellitus)-398 ( . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .\
. .)-497 (125)]TJ
1 -1.409 TD
[(Physical Activity and NIDDM)-559 ( . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .\
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T*
[(Biologic Plausibility)-501 ( . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .\
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[(Conclusions)-526 ( . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .\
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[(Osteoarthritis)-467 ( . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .\
. . . . . . . . . . . . . . . . . . . . . . . . .)-447 (129)]TJ
1 -1.409 TD
0.001 Tc
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[(Physical Activity in Persons with Arthritis)-98 ( . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .\
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T*
[(Biologic Plausibility)-501 ( . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .\
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[(Conclusions)-526 ( . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .\
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[(Osteoporosis)-239 ( . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .\
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0.001 Tc
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[(Biologic Plausibility)-501 ( . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .\
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T*
0.002 Tc
[(Physical Activity and the Prevention of Fractures and Falling)-468 ( . . . . . . . . . . . . . . . . . . . . .)-484 (132)]TJ
T*
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[(Conclusions)-526 ( . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .\
. . . . . . . . . . . . . . . . . . . . . . . .)-465 (132)]TJ
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[(Obesity)-449 ( . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .\
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .)-448 (133)]TJ
1 -1.409 TD
0.001 Tc
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[(Physical Activity and Obesity)-218 ( . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .\
. . . . . . . . . . .)-471 (133)]TJ
T*
[(Biologic Plausibility)-501 ( . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .\
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T*
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[(Conclusions)-526 ( . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .\
. . . . . . . . . . . . . . . . . . . . . . . .)-465 (135)]TJ
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[(Mental Health)-285 ( . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .\
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[(Physical Activity and Mental Health)-554 ( . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .\
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T*
[(Biologic Plausibility)-501 ( . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .\
. . . . . . . . . . . . . . . . . .)-482 (141)]TJ
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0 Tc
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[(Conclusions)-526 ( . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .\
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[(Health-Related Quality of Life)-440 ( . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .\
. . . . . . . . . . . .)-453 (141)]TJ
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[(Conclusions)-526 ( . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .\
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[(Musculoskeletal )-10 (Injuries)-146 ( . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .\
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T*
[(Metabolic )-12 (Abnormalities)-128 ( . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .\
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T*
0.001 Tc
[(I)15 (nfectious, Allergic, and Inflammatory Conditions)-396 ( . . . . . . . . . . . . . . . . . . . . . . . . . . . . .)-432 (143)]TJ
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0.001 Tc
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[(Occurrence of Adverse Effects)-373 ( . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .\
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[(Conclusions)-526 ( . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .\
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[(Nature of the Activity/Health Relationship)-494 ( . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .\
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[(Population Burden of Sedentary Living)-358 ( . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .\
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[(should be understood to refer to endur)-11 (ance-type)]TJ
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0 -1.182 TD
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0.182 Tw
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1.636 -1.227 TD
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-1.636 -1.182 TD
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(Three types of physical activity measures have been)Tj
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(used in observational studies over the last 40 years.)Tj
0 -1.182 TD
0.145 Tw
(Most studies have relied on self-reported level of)Tj
T*
-0.033 Tw
(physical activity, as recalled by people prompted by)Tj
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(\(also referred to as cardiorespiratory endurance\))Tj
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(for more information on measurement issues\). Some)Tj
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25.591 42.455 TD
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(occurrence or death. In case-control studies, groups)Tj
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(association between physical activity and a health)Tj
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(outcome. Two such measures used in this chapter)Tj
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(\(CI\) reported with estimates of association indicate)Tj
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T*
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0.003 Tc
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0 -1.227 TD
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0 -1.182 TD
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T*
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0 -1.227 TD
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(< 1 hour/week\). Most importantly, there was a signifi-)Tj
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1.636 -1.227 TD
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0.109 Tw
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T*
0.103 Tw
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0 -1.182 TD
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0 Tw
(tive effect of high levels of activity lasted only until)Tj
0 -1.182 TD
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1.636 -1.227 TD
-0.09 Tw
(The studies cited thus far in this section assessed)Tj
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0.018 Tc
0.259 Tw
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0 -1.227 TD
0.003 Tc
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0.005 Tw
(stronger test for a causal relationship is to examine)Tj
0 -1.227 TD
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T*
-0.024 Tw
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(such evidence. Among middle-aged Harvard male)Tj
0 -1.182 TD
0.009 Tw
(alumni who were sedentary in 1962 or 1966, those)Tj
0 -1.227 TD
-0.055 Tw
(who took up moderately intense sports activity dur-)Tj
0 -1.182 TD
-0.103 Tw
(ing the study\325s 11 years of follow-up had a 23 percent)Tj
T*
-0.113 Tw
(lower death rate \(RR = 0.77; 95% CI, 0.58\3200.96\) than)Tj
0 -1.227 TD
0.013 Tc
-0.013 Tw
(those who remained sedentary \(Paffenbarger et al.)Tj
0 -1.182 TD
0.183 Tw
(1993\). \(By comparison, men who quit smoking)Tj
0 -1.227 TD
0.113 Tw
(during the interval had a 41 percent decrease in)Tj
0 -1.182 TD
0.061 Tw
(death rate [RR = 0.59; 95% CI, 0.43\3200.80].\) Men)Tj
T*
-0.082 Tw
(45\32084 years of age who took up moderately intense)Tj
0 -1.227 TD
-0.032 Tw
(sports extended their longevity on average by 0.72)Tj
0 -1.182 TD
0.053 Tc
0.022 Tw
(years; added years of life were observed in all)Tj
0 -1.227 TD
0.009 Tc
0.259 Tw
[(a)-50 (g)-50 (e)-49 ( groups, including men 75\32084 years of age)]TJ
0 -1.182 TD
0.003 Tc
0 Tw
(\(Paffenbarger et al. 1993\).)Tj
1.636 -1.227 TD
-0.011 Tw
(Similar reductions in death rates with increases)Tj
-1.636 -1.182 TD
-0.084 Tw
(in cardiorespiratory fitness were reported for men in)Tj
T*
0.075 Tw
(the Aerobics Center Longitudinal Study. Blair and)Tj
0 -1.227 TD
-0.122 Tw
(colleagues \(1995\) reported a reduction in death rates)Tj
0 -1.182 TD
0.152 Tw
(among healthy men \(aged 20\32082 years\) who im-)Tj
0 -1.227 TD
-0.028 Tw
(proved their initially low levels of cardiorespiratory)Tj
0 -1.182 TD
0.078 Tw
(fitness. The men performed two maximal exercise)Tj
T*
0.164 Tw
(tests an average of 4.8 years apart; follow-up for)Tj
0 -1.227 TD
-0.106 Tw
(mortality after the second test occurred an average of)Tj
0 -1.182 TD
-0.079 Tw
(4.7 years later. Among men in the bottom fifth of the)Tj
0 -1.227 TD
0.006 Tc
0.259 Tw
(cardiorespiratory fitness distribution, those who)Tj
0 -1.182 TD
0.003 Tc
-0.079 Tw
(improved to at least a moderate fitness level had a 44)Tj
T*
0.104 Tw
(percent lower death rate than their peers who re-)Tj
0 -1.227 TD
-0.096 Tw
(mained in the bottom fifth \(RR = 0.56; 95% CI, 0.41\320)Tj
0 -1.182 TD
0.005 Tc
0.259 Tw
(0.75\). After multivariate adjustment, those who)Tj
0 -1.227 TD
0.003 Tc
-0.022 Tw
(became fit had a significant 64 percent reduction in)Tj
0 -1.182 TD
0.188 Tw
(their relative mortality rate. In comparison, men)Tj
T*
-0.04 Tw
(who stopped smoking reduced their adjusted RR by)Tj
0 -1.227 TD
0 Tw
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0 Tr
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0.008 Tc
(87)Tj
/F5 1 Tf
-0.409 63.727 TD
0.003 Tc
0 Tw
(The Effects of Physical Activity on Health and Disease)Tj
12 0 0 12 66 710.5 Tm
0 Tc
(Conclusions)Tj
/F7 1 Tf
11 0 0 11 66 695.5 Tm
0.003 Tc
-0.078 Tw
(The data reviewed here suggest that regular physical)Tj
0 -1.182 TD
0.002 Tc
-0.127 Tw
(activity and higher cardiorespiratory fitness decrease)Tj
0 -1.227 TD
0.003 Tc
0.098 Tw
(overall mortality rates in a dose-response fashion.)Tj
0 -1.182 TD
-0.082 Tw
(Whereas most studies of physical activity and health)Tj
0 -1.227 TD
-0.002 Tw
(address specific diseases and health conditions, the)Tj
0 -1.182 TD
-0.053 Tw
(studies in this chapter provide more insight into the)Tj
T*
-0.073 Tw
(biologic mechanisms by which mortality rate reduc-)Tj
0 -1.227 TD
0.002 Tw
(tion occurs.)Tj
/F5 1 Tf
14 0 0 14 66 563.5 Tm
-0.001 Tc
0.001 Tw
(Cardiovascular Diseases)Tj
/F7 1 Tf
11 0 0 11 66 547.5 Tm
0.003 Tc
0.07 Tw
(Despite a progressive decline since the late 1960s,)Tj
0 -1.182 TD
-0.073 Tw
(cardiovascular diseases \(CVDs\), including coronary)Tj
T*
0.002 Tc
-0.127 Tw
(heart disease \(CHD\) and stroke, remain major causes)Tj
0 -1.227 TD
0.003 Tc
-0.016 Tw
(of death, disability, and health care expenditures in)Tj
0 -1.182 TD
0.136 Tw
(the United States \(NCHS 1994; Gillum 1994\). In)Tj
0 -1.227 TD
-0.083 Tw
(1992, more than 860,000 deaths in the United States)Tj
0 -1.182 TD
0.04 Tw
(were attributed to heart disease and stroke \(DHHS)Tj
T*
0.024 Tw
(1994\). High blood pressure, a major risk factor for)Tj
0 -1.227 TD
-0.041 Tw
[(CVD, affects about 50 million Americans \(National)]TJ
0 -1.182 TD
-0.016 Tw
(Institutes of Health [NIH] 1993\), including an esti-)Tj
0 -1.227 TD
0.16 Tw
(mated 2.8 million children and adolescents 6\32017)Tj
0 -1.182 TD
-0.018 Tw
(years of age \(Task Force on Blood Pressure Control)Tj
T*
0.001 Tc
-0.064 Tw
[(in Children 1987\). The preval)12 (ence of CVD increases)]TJ
0 -1.227 TD
0 Tc
-0.111 Tw
(with age and is higher among African Americans than)Tj
0 -1.182 TD
-0.086 Tw
(whites. The majority of population-based research in)Tj
0 -1.227 TD
-0.106 Tw
(the area of physical activity and health has focused on)Tj
0 -1.182 TD
0 Tw
(some aspect of CVD.)Tj
/F5 1 Tf
12 0 0 12 66 308 Tm
0.001 Tw
(Cardiovascular Diseases Combined)Tj
/F7 1 Tf
11 0 0 11 66 293 Tm
0.003 Tc
-0.127 Tw
(Most of the reported studies relating physical activity)Tj
T*
-0.112 Tw
(to CVD have reported CVD mortality as an endpoint;)Tj
0 -1.227 TD
0.064 Tw
(two also reported on nonfatal disease, and one re-)Tj
0 -1.182 TD
0.09 Tw
[(ported on CVD hospitalization \(Table)-7 ( 4-1\). Seven)]TJ
T*
0.196 Tw
(cohort studies evaluated the association between)Tj
0 -1.227 TD
0.057 Tw
(level of physical activity and the risk of total CVD)Tj
0 -1.182 TD
0.071 Tw
(\(Kannel and Sorlie 1979; Paffenbarger et al. 1984;)Tj
0 -1.227 TD
-0.058 Tw
(Kannel et al. 1986; Lindsted, Tonstad, Kuzma 1991;)Tj
0 -1.182 TD
-0.007 Tc
-0.13 Tw
(Arraiz, Wigle, Mao 1992; Sherman et al. 1994; LaCroix)Tj
T*
0.003 Tc
0.198 Tw
(et al. 1996\). All relied on a single point-in-time)Tj
0 -1.227 TD
-0.018 Tw
(estimate of physical activity, in some cases assessed)Tj
0 -1.182 TD
-0.12 Tw
(as long as 26 years before the end of the observational)Tj
0 -1.227 TD
-0.086 Tw
(period, and four had follow-up periods of )Tj
ET
0 G
1 i
0 J
0 j
0.55 w
10 M
[]0 d
259 133.4 m
253 133.4 l
S
BT
/F7 1 Tf
11 0 0 11 253 134.5 Tm
[(>)-23 ( 14 years.)]TJ
-17 -1.182 TD
0.176 Tw
(Four of the seven studies found both an inverse)Tj
T*
0.119 Tw
(association and a dose-response gradient between)Tj
0 -1.227 TD
0.043 Tw
(level of physical activity and risk of CVD outcome)Tj
0 -1.182 TD
0.071 Tw
(\(Kannel and Sorlie 1979; Paffenbarger et al. 1984;)Tj
23.955 57.182 TD
-0.003 Tw
(Kannel et al. 1986; LaCroix et al. 1996\). One study)Tj
0 -1.182 TD
-0.054 Tw
(among men found an inverse association among the)Tj
T*
0.026 Tw
(moderately active group but less of an effect in the)Tj
0 -1.227 TD
-0.028 Tw
(vigorously active group \(Lindsted, Tonstad, Kuzma)Tj
0 -1.182 TD
-0.122 Tw
(1991\). One study of women 50\32074 years of age found)Tj
0 -1.227 TD
0.018 Tw
(no relationship of physical activity with CVD mor-)Tj
0 -1.182 TD
0 Tw
(tality \(Sherman et al. 1994\).)Tj
1.636 -1.227 TD
-0.051 Tw
(Five large cohort studies have related cardiores-)Tj
-1.636 -1.182 TD
-0.058 Tw
(piratory fitness to the risk of CVD mortality \(Arraiz,)Tj
T*
0.028 Tw
(Wigle, Mao 1992; Ekelund et al. 1988; Blair, Kohl,)Tj
0 -1.227 TD
0.063 Tw
(Paffenbarger 1989; Sandvik et al. 1993; Blair et al.)Tj
0 -1.182 TD
-0.041 Tw
(1995\), but only one provided a separate analysis for)Tj
0 -1.227 TD
0.156 Tw
(women \(Blair, Kohl, Paffenbarger 1989\). Each of)Tj
0 -1.182 TD
0.002 Tc
-0.127 Tw
(these studies demonstrated an inverse dose-response)Tj
T*
0.003 Tc
0.08 Tw
(relationship between level of cardiorespiratory fit-)Tj
0 -1.227 TD
0.09 Tw
(ness and CVD mortality. Three of the five studies)Tj
0 -1.182 TD
-0.076 Tw
(relied on a maximal or near-maximal exercise test to)Tj
0 -1.227 TD
0.014 Tw
(estimate cardiorespiratory fitness. One study \(Blair)Tj
0 -1.182 TD
-0.066 Tw
(et al. 1995\) demonstrated that men with low cardio-)Tj
T*
-0.092 Tw
(respiratory fitness who became fit had a lower risk of)Tj
0 -1.227 TD
0 Tw
(CVD mortality than men who remained unfit.)Tj
1.636 -1.182 TD
-0.079 Tw
(Taken together, these major cohort studies indi-)Tj
-1.636 -1.227 TD
-0.035 Tw
(cate that low levels of physical activity or cardiores-)Tj
0 -1.182 TD
0.008 Tc
0.259 Tw
(piratory fitness increase risk of CVD mortality.)Tj
0 -1.227 TD
0.003 Tc
0.038 Tw
(Findings seem to be more consistent for studies of)Tj
0 -1.182 TD
0.008 Tc
0.259 Tw
(cardiorespiratory fitness, perhaps because of its)Tj
T*
0.003 Tc
-0.01 Tw
(greater precision of measurement, than for those of)Tj
0 -1.227 TD
0.025 Tw
(reported physical activity. The demonstrated dose-)Tj
0 -1.182 TD
0.035 Tw
(response relationship indicates that the benefit de-)Tj
0 -1.227 TD
-0.124 Tw
(rived from physical activity occurs at moderate levels)Tj
0 -1.182 TD
0.026 Tw
(of physical activity or cardiorespiratory fitness and)Tj
T*
0.029 Tw
(increases with increasing levels of physical activity)Tj
0 -1.227 TD
0 Tw
(or higher levels of fitness.)Tj
/F5 1 Tf
12 0 0 12 329.5 260 Tm
0 Tc
(Coronary Heart Disease)Tj
/F7 1 Tf
11 0 0 11 329.5 245 Tm
0.003 Tc
0.07 Tw
(Numerous studies have examined the relationship)Tj
0 -1.182 TD
-0.105 Tw
(between physical activity and CHD as a specific CVD)Tj
T*
0.171 Tw
(outcome. Reviews of the epidemiologic literature)Tj
0 -1.227 TD
0.065 Tw
(\(Powell et al. 1987; Berlin and Colditz 1990; Blair)Tj
0 -1.182 TD
-0.006 Tc
-0.129 Tw
(1994\) have concluded that physical activity is strongly)Tj
0 -1.227 TD
0.003 Tc
-0.116 Tw
(and inversely related to CHD risk. Although physical)Tj
0 -1.182 TD
-0.097 Tw
(exertion may transiently increase the risk of an acute)Tj
T*
-0.044 Tw
(coronary event among persons with advanced coro-)Tj
0 -1.227 TD
-0.001 Tw
(nary atherosclerosis, particularly among those who)Tj
0 -1.182 TD
0.161 Tw
(do not exercise regularly \(Mittleman et al. 1993;)Tj
0 -1.227 TD
-0.065 Tw
(Willich et al. 1993; Siscovick et al. 1984\), physically)Tj
0 -1.182 TD
-0.018 Tw
(active people have a substantially lower overall risk)Tj
T*
0 Tw
(for major coronary events.)Tj
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0.005 Tc
0 Tw
[(T)60 (able 4-1.)-970 (Population-based studies of association of physical activity or cardiore\
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5.4 -1.2 TD
0.001 Tw
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10 M
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48 695.75 m
1181 695.75 l
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/F5 1 Tf
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[(Definition of physical activity)-3732 (Definition of)]TJ
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48 665.25 m
1181 665.25 l
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/F5 1 Tf
10 0 0 10 48 669 Tm
-0.001 Tw
[(Study)-7130 (Population)-7224 (or cardiorespiratory fitness)-4842 (cardiovascular disease)]TJ
0 -1.8 TD
0 Tw
(Physical activity)Tj
/F9 1 Tf
0 -1.85 TD
-0.001 Tw
[(Kannel and)-4659 (1,909 Framingham \(MA\))-1338 (Physical activity index based)-4263 (CVD fatal and nonfatal)]TJ
0 -1.2 TD
0 Tw
[(Sorlie \(1979\))-4033 (men and 2,31)63 (1 women)-1908 (on hours per day spent at)-5782 (in men \(n = 140 deaths,)]TJ
9.6 -1.25 TD
[(aged 35\32064 years at)-3289 (activity-specific intensity)-6052 (n = 435 total cases\) and)]TJ
0 -1.2 TD
0.002 Tw
[(14-year follow-up)-20988 (women)]TJ
10 0 1.944 10 464.5 596 Tm
( )Tj
10 0 0 10 467.5 596 Tm
-0.001 Tw
(\(n = 101 deaths\))Tj
-41.95 -1.85 TD
[(Paffenbarger et al.)-1727 (16,936 US male college)-1498 (Physical activity index estimated)-2632 (Death due to CVD)]TJ
0 -1.2 TD
0.001 Tw
[(\(1984\))-6789 (alumni who entered)-3238 (from reports of stairs climbed,)-3806 (\(n = 640\))]TJ
9.6 -1.25 TD
0 Tw
[(college between 1916)-2338 (city blocks walked, and sports)]TJ
T*
0.001 Tw
[(and 1950; followed)-3458 (played each week)]TJ
0 -1.2 TD
(from 1962\3201978)Tj
-9.6 -1.85 TD
0 Tw
[(Kannel et al.)-4144 (1,166 Framingham \(MA\))-1338 (Physical activity index based on)-2857 (Death due to CVD)]TJ
0 -1.2 TD
[(\(1986\))-6789 (men aged 45\32064 years;)-1893 (hours per day at activity-specific)-2682 (\(n = 325\))]TJ
9.6 -1.25 TD
0.001 Tw
[(24-year follow-up)-4188 (intensity; occupational physical)]TJ
12 -1.2 TD
-0.001 Tw
(activity classified by physical)Tj
0 -1.25 TD
(demand of work)Tj
-21.6 -4.3 TD
0 Tw
[(Lindsted, T)129 (onstad,)-1802 (9,484 Seventh-Day)-3634 (Self-report to single physical)-4477 (Death due to CVD)]TJ
0 -1.2 TD
-0.001 Tw
[(Kuzma)-6575 (Adventist men aged)-3408 (activity question)-9658 (\(ICD-8 410\320458\))]TJ
0 -1.25 TD
(\(1991\))Tj
/F10 1 Tf
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0 -1.182 TD
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0.231 Tw
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0.029 Tw
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0.219 Tw
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0 -1.182 TD
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0 -1.182 TD
0.003 Tc
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T*
0.019 Tw
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0.23 Tw
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1.636 -1.227 TD
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(The Effects of Physical Activity on Health and Disease)Tj
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0.001 Tw
[(Dose)-4355 (Adjustment for confounders)]TJ
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-564 677.25 m
558 677.25 l
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/F5 1 Tf
10 0 0 10 66 681 Tm
0.002 Tw
[(Main findings)-15604 (response)]TJ
/F9 1 Tf
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/F5 1 Tf
10 0 0 10 348 681 Tm
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[(and o)20 (t)-62 (her comments)]TJ
/F9 1 Tf
-28.2 -1.8 TD
[(Inverse association; relative to highest fitness)-2130 (No)-5255 (Point estimates adjusted for age, BMI, sex, and)]TJ
0 -1.25 TD
[(level, persons in \322moderate\323 and \322low\323)-11116 (smoking)]TJ
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[(Inverse association; relative to men in lowest)-2085 (Y)65 (e)0 (s)-5151 (Extensive control for confounding influences)]TJ
0 -1.25 TD
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0 -1.2 TD
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0 -1.25 TD
-0.002 Tw
(0.41, respectively)Tj
0 -1.8 TD
0 Tw
[(Inverse association; relative to men who)-4116 (Y)65 (e)0 (s)-5151 (For each minute of improvement in exer)27 (cise test)]TJ
0 -1.25 TD
[(remained unfit \(lowest 20% of distribution\),)-9249 (time, adjusted CVD mortality risk was reduced)]TJ
0 -1.2 TD
[(those who improved had an age-adjusted RR)-8711 (8.6%)]TJ
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558 499.75 l
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/F9 1 Tf
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[(of 0.48 )-24 (\(95% CI, 0.31\3200.74\))]TJ
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0.01 Tc
(Abbreviations: BMI = body mass index \(wt [kg] /ht [m])Tj
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-0.002 Tw
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-0.042 Tw
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0.146 Tw
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0.202 Tw
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-0.057 Tw
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-0.004 Tc
-0.13 Tw
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0.003 Tc
0.015 Tw
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0 Tw
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1.636 -1.182 TD
0.03 Tw
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0.057 Tw
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0.049 Tw
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0.137 Tw
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T*
0.235 Tw
(exercise testing. None of these studies included)Tj
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0.1 Tw
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0.015 Tw
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0.175 Tw
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0 -1.182 TD
0.011 Tc
-0.119 Tw
[(during )12 (the follow-up period. Most controlled statis-)]TJ
T*
0.013 Tc
-0.127 Tw
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0.021 Tc
0.201 Tw
[(studies )25 (showed an inverse association between)]TJ
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0.025 Tc
0.232 Tw
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0.014 Tc
-0.126 Tw
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0.013 Tc
0.257 Tw
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T*
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(dose-response gradient.)Tj
25.5 28.773 TD
-0.005 Tc
-0.011 Tw
[( Two recent meta-analyses of studies of physical)]TJ
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-0.084 Tw
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0.13 Tw
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0.058 Tw
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0.21 Tw
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0.119 Tw
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0.149 Tw
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T*
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-0.127 Tw
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0.04 Tw
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0 -1.227 TD
0.128 Tw
(was 1.8 among the studies judged to be of higher)Tj
0 -1.182 TD
0.071 Tw
(quality. In contrast, the pooled relative risk for the)Tj
T*
-0.063 Tw
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0 Tw
(CVD Risk Factors in Children)Tj
/F7 1 Tf
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0.024 Tw
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0.123 Tw
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0.201 Tw
(through the relationship of physical activity with)Tj
T*
0.041 Tw
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0.129 Tw
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0.258 Tw
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[(Morris et al.)-4368 (31,000 male employees)-1558 (Occupational classification of job)-2121 (First clinical episode of)]TJ
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[(\(1953\))-6789 (of London T)131 (ransport)-3309 (duties: sedentary drivers and)-4372 (CHD)]TJ
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[(Morris and)-4884 (3,731 case necropsy)-3068 (Physical activity at work defined)-2687 (Necropsy evaluation of)]TJ
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[(Crawford \(1958\))-2468 (studies \(decedents aged)-1713 (by coding of last known job title)-2736 (IMF among persons)]TJ
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[(45\32070 years\) conducted)-1553 (before death \(light, active, heavy\))-2287 (dying from)]TJ
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[(T)110 (aylor et al.)-4533 (191,609 US white male)-1668 (Physical activity at work defined)-2687 (Death due to)]TJ
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0.001 Tw
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-9.6 -1.85 TD
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[(Kahn \(1963\))-4264 (2,240 Postal Service)-3173 (Physical activity at work defined)-2687 (Death due to CHD)]TJ
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[(employees in the)-4583 (by job title for clerks and carriers)]TJ
0 -1.25 TD
0.001 Tw
[(W)54 (ashington, D.C., Post)]TJ
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-9.6 -1.8 TD
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[(Morris et al.)-4368 (667 London bus)-4924 (Occupational classification of job)-2121 (Incidence of CHD)]TJ
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[(\(1966\))-6789 (conductors and drivers)-2053 (duties as sedentary drivers)-5382 (\(n = 47\))]TJ
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[(aged 30\32069 years;)-4079 (and active conductors)]TJ
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-9.6 -1.8 TD
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[(Cassel et al.)-4424 (3,009 male residents)-2953 (Occupational classification of job)-2121 (Incidence of CHD)]TJ
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[(\(1971\))-6789 (of Evans County)71 (,)-4767 (duties as active or sedentary)-4542 (\(n = 337\))]TJ
9.6 -1.25 TD
[(Geor)36 (gia, aged over 40)]TJ
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[(232 heart attack case-)-2443 (7.5 kcal/min were defined as)]TJ
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[(Paffenbarger and)-2243 (6,351 San Francisco)-3178 (W)54 (ork-years according to)-6128 (CHD death \(ICD-7 420\))]TJ
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-0.001 Tw
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0 -1.2 TD
0 Tw
[(\(1978\))-6789 (executive-grade civil)-2948 (activity recall; activities capable)-2842 (CHD attack \(n = 268\))]TJ
9.6 -1.25 TD
0.001 Tw
[(servants aged 40\32064)-3124 (of reaching 7.5 kcal/min defined)]TJ
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[(followed for up to 8.25)-1932 (specific intensity)]TJ
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0.001 Tw
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[(Seccareccia)-4435 (railroad employees)-3688 (\(heavy)63 (, moderate, sedentary\))-4332 (\(n = 614\))]TJ
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[(\(1985\))-6789 (aged 40\32059 years;)]TJ
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[(Kannel et al.)-4144 (1,166 Framingham \(MA\))-1338 (Physical activity index based on)-2857 (Death due to CHD)]TJ
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-0.001 Tw
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(demand of work)Tj
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[(\(1987\))-6789 (men at high risk for)-3562 (index; ener)38 (gy expenditure)-5490 (\(n = 781; 368 fatal\))]TJ
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[(Pekkanen et al.)-2969 (636 apparently healthy)-1943 (Occupational and transport/)-4547 (Death due to CHD)]TJ
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9.6 -1.2 TD
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0 -1.2 TD
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0 -3.05 TD
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0 -1.25 TD
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0 -1.2 TD
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0 -1.25 TD
0.001 Tw
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0 -1.8 TD
0 Tw
[(Inverse association; adjusted RR for men)-4006 (NA)-5145 (Association limited to second half)]TJ
0 -1.25 TD
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0 -1.2 TD
0.001 Tw
(\(p = 0.17\))Tj
0 -4.3 TD
0 Tw
[(Null association for both leisure-time and)-3550 (No)-5255 (One of two studies to simultaneously)]TJ
0 -1.25 TD
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/F9 1 Tf
0 -1.8 TD
0 Tw
[(Donahue et al.)-3139 (7,644 Hawaiian men of)-1668 (Self-report of 24-hour habitual)-3586 (Incident cases of fatal)]TJ
0 -1.25 TD
[(\(1988\))-6789 (Japanese ancestry aged)-1944 (physical activity in 1965\3201968;)-3082 (and nonfatal CHD)]TJ
9.6 -1.2 TD
[(45\32064 years with no)-3123 (3-point scale defined by tertiles)-3131 (\(n = 444\))]TJ
0 -1.25 TD
-0.001 Tw
[(history of heart disease;)-1762 (of distribution)]TJ
T*
0.002 Tw
(12-year follow-up)Tj
-9.6 -1.8 TD
0 Tw
[(Salonen et al.)-3694 (15,088 Eastern Finnish)-2108 (Self-reported leisure-time and)-3926 (Death due to CHD)]TJ
0 -1.25 TD
-0.001 Tw
[(\(1988\))-6789 (men and women aged)-2298 (occupational physical activity)-3812 (\(ICD-8 410\320414\))]TJ
9.6 -1.2 TD
0 Tw
[(30\32059 years; 6-year)-3403 (\(4 levels collapsed into 2)-5942 (\(n = 102)]TJ
0 -1.25 TD
[(follow-up)-7784 (categories each\))-9774 (90 men, 12 women\))]TJ
-9.6 -3.05 TD
[(Johansson et al.)-2793 (7,495 G\232teburg men)-2908 (Physical activity at work and)-4317 (Incident cases of fatal)]TJ
0 -1.2 TD
0.001 Tw
[(\(1988\))-6789 (aged 47\32055 years at)-3289 (physical activity during leisure)-3522 (and nonfatal CHD)]TJ
9.6 -1.25 TD
0 Tw
[(entry; 1)69 (1.8-year)-5154 (time \(4-point scale for each\))]TJ
T*
0.002 Tw
(average follow-up)Tj
-9.6 -1.8 TD
0.001 Tw
[(Slattery)56 (, Jacobs,)-2791 (3,043 US male)-5489 (Leisure-time physical activity)-4147 (Death due to CHD)]TJ
0 -1.25 TD
-0.001 Tw
[(Nichaman)-5059 (railroad employees;)-3403 (index \(kcal/week\))-9159 (\(ICD-8 410\320414\))]TJ
0 -1.2 TD
0.002 Tw
[(\(1989\))-6789 (followed for)]TJ
9.6 -1.25 TD
(17\32020 years)Tj
-9.6 -3 TD
0 Tw
[(Morris et al.)-4368 (9,376 British male)-4018 (Leisure-time physical activity)-4147 (Fatal and nonfatal CHD)]TJ
0 -1.25 TD
[(\(1990\))-6789 (middle grade)-6274 (reported over previous 4 weeks;)-2862 (\(ICD-8 410\320414\))]TJ
9.6 -1.2 TD
[(executives aged 45\32064)-2059 (ener)8 (gy expenditure values)-5404 (\(n = 474\))]TJ
0 -1.25 TD
0.001 Tw
[(years; 9.3-year)-5589 (ascribed to reported activities)]TJ
0 -1.2 TD
0.002 Tw
(average follow-up)Tj
-9.6 -2.45 TD
0 Tw
[(Lindsted,)-5664 (9,484 Seventh-Day)-3634 (Self-report to single physical)-4477 (Ischemic heart disease)]TJ
0 -1.2 TD
0.003 Tc
0.001 Tw
[(T)108 (onstad,)-6006 (Adventist men aged)-3410 (activity question)-9660 (mortality)]TJ
0 -1.25 TD
0.005 Tc
(Kuzma)Tj
/F10 1 Tf
9.6 0 TD
(\263)Tj
/F9 1 Tf
0.55 0 TD
0.001 Tc
0.004 Tw
[( 30 years; 26-year)-20441 (\(ICD-8 )9 (410\320414\))]TJ
-10.15 -1.25 TD
0.005 Tc
0 Tw
[(\(1991\))-6789 (follow-up)-24584 (\(n = 1,351\))]TJ
0 -1.8 TD
[(Shaper and)-4714 (7,735 British men aged)-1887 (Self-report of physical activity at)-2786 (Fatal and nonfatal heart)]TJ
0 -1.25 TD
[(W)54 (annamethee)-3320 (40\32059 years; 8.5-year)-2558 (baseline; 6-point scale)-7013 (attack \(n = 488\))]TJ
0 -1.2 TD
[(\(1991\))-6789 (follow-up)]TJ
0 -6.75 TD
0.001 Tw
[(Seccareccia and)-2524 (1,712 men from)-4983 (Occupational physical activity)-3532 (Death due to CHD)]TJ
0 -1.25 TD
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[(Inverse association; statistically significant)-3605 (Y)65 (es/No)-3526 (In hypertensive men, the protective)]TJ
0 -1.25 TD
[(trend among nonhypertensive participants,)-9901 (effect of physical activity was eliminated)]TJ
T*
[(U-shaped association among hypertensive)-10131 (with vigorous activity)]TJ
0 -1.2 TD
(participants)Tj
0 -1.85 TD
[(Inverse association when adjusted only for)-3406 (No)-5255 (Follow-up report to that of )6 (Y)65 (ano, Reed,)]TJ
0 -1.2 TD
[(age; null association when adjusted for)-11521 (McGee \(1984\) and Donahue et al. \(1988\))]TJ
0 -1.25 TD
(cholesterol, blood pressure, BMI, diabetes,)Tj
0 -1.2 TD
(etc.)Tj
0 -3.65 TD
[(Inverse association; RR for CHD incidence in)-2230 (N)34 (A)-5180 (Similar results seen when men with)]TJ
0 -1.25 TD
[(low fitness group was 2.2 \(95% CI, 1.1\3204.7\))-9440 (electrocardiogram evidence of heart)]TJ
0 -1.2 TD
0.001 Tw
[(compared with high fitness)-16752 (disease were excluded)]TJ
0 -4.3 TD
0 Tw
[(Inverse association; point estimates and)-4691 (Y)65 (e)0 (s)-5151 (No adjustment for confounding variables)]TJ
0 -1.25 TD
0.001 Tw
(significance not reported)Tj
0 -4.25 TD
0 Tw
[(Inverse association; point estimates and)-4691 (Y)65 (e)0 (s)-5151 (No adjustment for confounding variables)]TJ
0 -1.25 TD
0.001 Tw
(significance not reported)Tj
0 -4.25 TD
0 Tw
[(Inverse association; RR for myocardial)-5261 (Y)65 (e)0 (s)-5151 (One of two studies to simultaneously)]TJ
0 -1.25 TD
[(infar)19 (ction and sudden death in low fit)-12153 (evaluate associations of activity)75 (, fitness,)]TJ
T*
[(group was 1.6 relative to high fit)-14381 (and CHD)]TJ
0 -3.05 TD
[(Inverse association; adjusted risk estimate of)-2665 (Y)65 (e)0 (s)-5151 (Extensive control for confounding)]TJ
0 -1.2 TD
[(3.2-fold increased risk of CHD death for a)-10225 (influences)]TJ
0 -1.25 TD
(35 beat/min increase in heart rate for stage II)Tj
0 -1.2 TD
[(of exer)29 (cise test)]TJ
0 -1.85 TD
[(Inverse association; adjusted risk estimate for)-2325 (Y)65 (e)0 (s)-5151 (Risk estimate attenuated substantially after)]TJ
0 -1.2 TD
[(highest heart rate response group relative to)-9490 (adjustment for other CHD risk factors)]TJ
0 -1.25 TD
(lowest was 1.20 \(95% CI, 1.10\3201.26\))Tj
0 -1.8 TD
[(Inverse association; relative to more fit men,)-2665 (Y)65 (e)0 (s)-5151 (One of two studies to simultaneously)]TJ
0 -1.25 TD
[(least fit men had an adjusted risk of 1.46)-10835 (evaluate activity and fitness in relation)]TJ
T*
[(\(95% CI, 0.94\3202.26\))-19678 (to CHD mortality)]TJ
ET
-564 163.75 m
564 163.75 l
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/F9 1 Tf
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(Abbreviations: BMI = Body mass index \(wt [kg] /ht [m])Tj
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(2)Tj
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(Classification of Diseases \(8 and 9 refer to editions\); IMF = ischemic\
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(*)Tj
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-0.002 Tw
(A dose-response relationship requires more than 2 levels of comparison. \
In this column, \322NA\323 means that there were only)Tj
-0.312 -1.187 TD
0 Tw
[(2 levels of comparison; \322No\323 means that there were more than 2 le\
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(102)Tj
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-21.864 63.727 TD
0.003 Tc
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(Physical Activity and Health)Tj
/F7 1 Tf
0 -2.818 TD
-0.015 Tc
0.016 Tw
(lipids in children \(Lee, Lauer, Clarke 1986\), and that)Tj
0 -1.182 TD
-0.014 Tc
0.142 Tw
[(CHD risk factor patterns persist from childhood )-10 (to)]TJ
T*
-0.005 Tc
-0.092 Tw
(adulthood \(Webber et al. 1991; Mahoney et al. 1991\).)Tj
1.636 -1.227 TD
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(Recently, Armstrong and Simons-Morton \(1994\))Tj
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0.003 Tc
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(reviewed the research literature on physical activity)Tj
0 -1.227 TD
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(and blood lipids in children and adolescents, includ-)Tj
0 -1.182 TD
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(ing over 20 observational and 8 intervention studies.)Tj
0 -1.227 TD
0.185 Tw
(They concluded that the cross-sectional observa-)Tj
0 -1.182 TD
0.172 Tw
(tional studies did not demonstrate a relationship)Tj
T*
0.013 Tw
(between physical activity level or cardiorespiratory)Tj
0 -1.227 TD
0.243 Tw
(fitness and total cholesterol, LDL-C, or HDL-C,)Tj
0 -1.182 TD
0.128 Tw
(especially when differences in body weight or fat)Tj
0 -1.227 TD
-0.104 Tw
(were taken into account, suggesting that activity and)Tj
0 -1.182 TD
0.195 Tw
(body fat are not independently related to serum)Tj
T*
-0.009 Tw
(lipids. However, highly physically active or fit chil-)Tj
0 -1.227 TD
-0.02 Tw
(dren and adolescents tended to have higher HDL-C)Tj
0 -1.182 TD
0.026 Tw
(than their inactive or unfit peers. The intervention)Tj
0 -1.227 TD
0.063 Tw
(studies generally showed favorable effects of exer-)Tj
0 -1.182 TD
0.258 Tw
(cise on LDL-C or HDL-C only in children and)Tj
T*
-0.025 Tw
(adolescents who were at high risk for CHD because)Tj
0 -1.227 TD
0.07 Tw
(of obesity, insulin-dependent diabetes mellitus, or)Tj
0 -1.182 TD
-0.094 Tw
(having a parent with three or more CHD risk factors.)Tj
1.636 -1.227 TD
0.104 Tw
(Alpert and Wilmore \(1994\) recently reviewed)Tj
-1.636 -1.182 TD
-0.093 Tw
(the research literature on physical activity and blood)Tj
0 -1.227 TD
0.045 Tw
(pressure in children and adolescents, including 18)Tj
0 -1.182 TD
0.207 Tw
(observational and 11 intervention studies. These)Tj
T*
0.024 Tw
(authors found evidence in studies of normotensive)Tj
0 -1.227 TD
-0.058 Tw
(children and adolescents that higher levels of physi-)Tj
0 -1.182 TD
0.239 Tw
(cal activity tended to be related to lower blood)Tj
0 -1.227 TD
-0.104 Tw
(pressure. The associations were generally reduced in)Tj
0 -1.182 TD
0.089 Tw
(magnitude in those studies that adjusted for BMI,)Tj
T*
0.152 Tw
(suggesting that lower body fat mass may at least)Tj
0 -1.227 TD
0.186 Tw
(partly explain why physical activity is related to)Tj
0 -1.182 TD
-0.103 Tw
(lower blood pressure. Intervention studies tended to)Tj
0 -1.227 TD
-0.102 Tw
(show that training programs lowered blood pressure)Tj
0 -1.182 TD
-0.094 Tw
(by 1\3206 mm Hg in normotensive children and adoles-)Tj
T*
-0.121 Tw
(cents, although the effects were inconsistent for boys)Tj
0 -1.227 TD
0.055 Tw
(and girls and for systolic and diastolic blood pres-)Tj
0 -1.182 TD
-0.004 Tc
-0.129 Tw
(sure. In hypertensive children and adolescents, physi-)Tj
0 -1.227 TD
0.003 Tc
-0.023 Tw
(cal activity interventions lowered blood pressure to)Tj
0 -1.182 TD
0.013 Tc
0.039 Tw
(a greater degree than in their normotensive peers)Tj
T*
0.003 Tc
0.011 Tw
[(\()-10 (b)-10 (y)8 ( approximately 10 mm Hg\), although statistical)]TJ
0 -1.227 TD
0.219 Tw
(significance was not always achieved because of)Tj
0 -1.182 TD
-0.001 Tw
(small sample sizes.)Tj
1.636 -1.227 TD
-0.005 Tc
0.174 Tw
[(I)9 (nterpreting these studies on lipids and blood)]TJ
-1.636 -1.182 TD
0.046 Tw
(pressure in children and adolescents is hindered by)Tj
0 -1.227 TD
0.216 Tw
(several factors. Studies used a variety of physical)Tj
0 -1.182 TD
0.133 Tw
(activity categorizations, and the interventions cov-)Tj
T*
0.003 Tc
-0.004 Tw
(ered a wide range of frequency, type, duration, and)Tj
23.955 57.591 TD
-0.035 Tw
(intensity, which were not all specified. The difficul-)Tj
0 -1.182 TD
0.112 Tw
(ties of assessing physical activity by self-report in)Tj
T*
0.058 Tw
(children and adolescents, together with the highly)Tj
0 -1.227 TD
-0.113 Tw
(self-selected population in the observational studies,)Tj
0 -1.182 TD
-0.107 Tw
(may account for the less consistent findings on lipids)Tj
0 -1.227 TD
-0.058 Tw
(and physical activity that were reported for children)Tj
0 -1.182 TD
0.154 Tw
(and adolescents than for adults. The relationship)Tj
T*
0.175 Tw
(between dose of physical activity and amount of)Tj
0 -1.227 TD
-0.016 Tw
(effect on blood pressure or serum lipids in children)Tj
0 -1.182 TD
0 Tw
(has not been adequately addressed.)Tj
1.636 -1.227 TD
-0.078 Tw
(Nonetheless, there appears to be some evidence,)Tj
-1.636 -1.182 TD
-0.096 Tw
(although not strong, of a direct relationship between)Tj
0 -1.227 TD
0.09 Tw
(physical activity and HDL-C level in children and)Tj
0 -1.182 TD
0.12 Tw
(adolescents. There is also evidence that increased)Tj
T*
0.138 Tw
(physical activity can favorably influence the lipid)Tj
0 -1.227 TD
0.013 Tw
(profile in children and adolescents who are at high)Tj
0 -1.182 TD
0.09 Tw
(risk of CHD. Similarly, the evidence suggests that)Tj
0 -1.227 TD
0.078 Tw
(physical activity can lower blood pressure in chil-)Tj
0 -1.182 TD
-0.095 Tw
(dren and adolescents, particularly in those who have)Tj
T*
0 Tw
(elevated blood pressure.)Tj
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12 0 0 12 311.5 432 Tm
0 Tc
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/F7 1 Tf
11 0 0 11 311.5 417 Tm
0.003 Tc
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(A major cardiovascular problem in developed coun-)Tj
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0.003 Tc
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T*
0.152 Tw
(\(NCHS 1994\). Atherosclerosis of the extracranial)Tj
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-0.071 Tw
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0 -1.182 TD
0.035 Tw
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0 -1.227 TD
0.002 Tw
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0 -1.182 TD
0.023 Tw
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T*
0.045 Tw
(whereas high blood pressure is the major determi-)Tj
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0 -1.182 TD
0.007 Tw
(section examined the association between reported)Tj
0 -1.227 TD
0.065 Tw
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0 -1.182 TD
-0.027 Tw
(studies have examined the association between car-)Tj
T*
0 Tw
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1.636 -1.227 TD
0.218 Tw
(Fourteen population-based studies \(four that)Tj
-1.636 -1.182 TD
0.006 Tc
-0.07 Tw
[(include women\) relate physical activit)-11 (y )-9 (to )-9 (risk )-9 (of )-9 (all)]TJ
0 -1.227 TD
0.013 Tc
0.204 Tw
(types of stroke; these closely parallel the study)Tj
0 -1.182 TD
0.008 Tw
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(cohort studies \(follow-up range, 5\32026 years\). Only)Tj
T*
0.194 Tw
(eight found an inverse association. As with the)Tj
0 -1.227 TD
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0 -1.182 TD
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0.05 Tw
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0.014 Tw
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0.006 Tc
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0.003 Tc
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0.106 Tw
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0.022 Tw
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-0.005 Tc
-0.086 Tw
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0 -1.227 TD
-0.046 Tw
(than active men to have a hemorrhagic stroke; physi-)Tj
0 -1.182 TD
0.079 Tw
(cal activity was also associated with a lower risk of)Tj
0 -1.227 TD
0 Tw
(ischemic stroke in smokers but not in nonsmokers.)Tj
1.636 -1.182 TD
0.003 Tc
0.217 Tw
(Thus the existing data do not unequivocally)Tj
-1.636 -1.227 TD
-0.099 Tw
(support an association between physical activity and)Tj
0 -1.182 TD
0.001 Tw
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/F5 1 Tf
12 0 0 12 66 484.5 Tm
0 Tc
0 Tw
(High Blood Pressure)Tj
/F7 1 Tf
11 0 0 11 66 469.5 Tm
0.003 Tc
0.004 Tw
(High blood pressure is a major underlying cause of)Tj
T*
0.032 Tw
(cardiovascular complications and mortality. Organ)Tj
0 -1.227 TD
-0.051 Tw
(damage and complications related to elevated blood)Tj
0 -1.182 TD
0.002 Tc
-0.127 Tw
(pressure include left ventricular hypertrophy \(which)Tj
T*
0.003 Tc
0.094 Tw
(can eventually lead to left ventricular dysfunction)Tj
0 -1.227 TD
0.088 Tw
(and congestive heart failure\), hemorrhagic stroke,)Tj
0 -1.182 TD
-0.012 Tw
(aortic aneurysms and dissections, renal failure, and)Tj
0 -1.227 TD
0.058 Tw
(retinopathy. Atherosclerotic complications of high)Tj
0 -1.182 TD
0.046 Tw
(blood pressure include CHD, ischemic stroke, and)Tj
T*
-0.105 Tw
(peripheral vascular disease. Although rates of hyper-)Tj
0 -1.227 TD
0.172 Tw
(tension have been declining in the United States)Tj
0 -1.182 TD
0.151 Tw
(since 1960, nearly one in four Americans can be)Tj
0 -1.227 TD
0 Tw
(classified as being hypertensive \(DHHS 1995\).)Tj
1.636 -1.182 TD
0.004 Tc
-0.127 Tw
(Prospective observational studies relating physi-)Tj
-1.636 -1.227 TD
0.013 Tc
-0.054 Tw
(cal activity level or cardiorespiratory fitness to risk)Tj
0 -1.182 TD
0.023 Tc
0.235 Tw
(of hypertension are summarized in Table 4-4.)Tj
T*
0.013 Tc
0.027 Tw
[(S)-10 (e)-10 (v)7 (eral cohort studies have followed male college)]TJ
0 -1.227 TD
-0.006 Tw
(alumni after graduation. One found later develop-)Tj
0 -1.182 TD
-0.034 Tw
(ment of hypertension to be inversely related to the)Tj
0 -1.227 TD
-0.106 Tw
(reported number of hours per week of participation)Tj
0 -1.182 TD
-0.084 Tw
(in sports or exercise while in college \(Paffenbarger,)Tj
T*
0.123 Tw
(Thorne, Wing 1968\). In a later follow-up of the)Tj
0 -1.227 TD
0.033 Tc
0.05 Tw
(same cohort, using information on physical ac-)Tj
0 -1.182 TD
0.024 Tc
-0.005 Tw
[(tivity)-27 ( during mid-life, vigorous sports were asso-)]TJ
0 -1.227 TD
0.023 Tc
0.058 Tw
(ciated with a 19\32030 percent reduction in risk of)Tj
0 -1.182 TD
0.01 Tw
(developing hypertension over the 14-year period)Tj
T*
0.013 Tc
-0.046 Tw
(\(Paffenbarger et al. 1991\). Follow-up of a different)Tj
0 -1.227 TD
-0.077 Tw
(cohort of male college alumni similarly showed the)Tj
0 -1.182 TD
-0.064 Tw
(least active men to have a 30 percent increased risk)Tj
0 -1.227 TD
0.254 Tw
(of developing hypertension \(Paffenbarger et al.)Tj
23.955 56.773 TD
0.012 Tc
-0.128 Tw
(1983\). In a study of 55- through 69-year-old women)Tj
0 -1.182 TD
0.013 Tc
0.02 Tw
(followed for 2 years, the most active women were)Tj
T*
-0.083 Tw
(found to have a 30 percent reduced risk of develop-)Tj
0 -1.227 TD
0 Tw
(ing hypertension \(Folsom et al. 1990\).)Tj
1.636 -1.182 TD
0.003 Tc
-0.11 Tw
(One randomized trial for the primary prevention)Tj
-1.636 -1.227 TD
-0.106 Tw
(of hypertension has been conducted. A 5-year trial of)Tj
0 -1.182 TD
0.002 Tc
-0.127 Tw
(a nutrition and physical activity intervention showed)Tj
0 -1.227 TD
0.003 Tc
-0.013 Tw
(that the incidence of hypertension for the interven-)Tj
0 -1.182 TD
-0.126 Tw
(tion group was less than half that of the control group)Tj
T*
-0.117 Tw
(\(Stamler et al. 1989\). Participants in the intervention)Tj
0 -1.227 TD
0.12 Tw
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0 -1.182 TD
0.104 Tw
(group, reduced more of their sodium and alcohol)Tj
0 -1.227 TD
-0.052 Tw
(intake, and were more likely to become more physi-)Tj
0 -1.182 TD
0.046 Tw
(cally active. Although the effects of the nutritional)Tj
T*
0.07 Tw
(and physical activity components of this interven-)Tj
0 -1.227 TD
0.02 Tw
(tion cannot be separated, the study does show that)Tj
0 -1.182 TD
-0.076 Tw
(the risk for developing hypertension among persons)Tj
0 -1.227 TD
-0.097 Tw
(who are at high risk for the disease can be lowered by)Tj
0 -1.182 TD
-0.044 Tw
(weight loss and improvements in dietary and physi-)Tj
T*
0.001 Tw
(cal activity practices.)Tj
1.636 -1.227 TD
0.134 Tw
(Like physical inactivity, low cardiorespiratory)Tj
-1.636 -1.182 TD
-0.109 Tw
(fitness in middle age is associated with increased risk)Tj
0 -1.227 TD
0.094 Tw
(for high blood pressure. After adjustment for sex,)Tj
0 -1.182 TD
0.005 Tw
(age, baseline blood pressure, and body mass index,)Tj
0 -1.227 TD
-0.003 Tw
(persons with low cardiorespiratory fitness had a 52)Tj
0 -1.182 TD
0.076 Tw
(percent higher risk of later developing high blood)Tj
T*
0 Tw
(pressure than their fit peers \(Blair et al. 1984\).)Tj
1.636 -1.227 TD
0.158 Tw
(Taken together, the cohort studies show that)Tj
-1.636 -1.182 TD
0.116 Tw
(physical inactivity is associated with an increased)Tj
0 -1.227 TD
0.111 Tw
(risk of later developing hypertension among both)Tj
0 -1.182 TD
-0.091 Tw
(men and women. Three of the studies had more than)Tj
0 -1.227 TD
0.061 Tw
(two categories of physical activity for comparison,)Tj
0 -1.182 TD
0.209 Tw
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T*
-0.07 Tw
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0 -1.227 TD
0.095 Tw
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0 -1.182 TD
-0.038 Tw
(tion of risk suggest that those least physically active)Tj
0 -1.227 TD
0.007 Tw
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0 -1.182 TD
-0.002 Tw
(tension than their most active counterparts. Unfor-)Tj
T*
0.148 Tw
(tunately, none of these studies was conducted in)Tj
0 -1.227 TD
0.021 Tw
(minority populations, which have a disproportion-)Tj
0 -1.182 TD
0 Tw
(ate burden of hypertensive disease \(DHHS 1995\).)Tj
1.636 -1.227 TD
0.031 Tw
(Several randomized controlled trials have been)Tj
-1.636 -1.182 TD
0.116 Tw
(conducted to determine the effects of exercise on)Tj
0 -1.227 TD
0.028 Tw
(blood pressure in people with elevated blood pres-)Tj
0 -1.182 TD
-0.095 Tw
(sure levels. The reduction of elevated blood pressure)Tj
T*
0.178 Tw
(is important for preventing stroke and CHD, for)Tj
0 -1.227 TD
0.129 Tw
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0 -1.182 TD
0.208 Tw
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[(Definition of)-11158 (Definition of)]TJ
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1176 677.25 l
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[(Study)-7130 (Population)-7224 (physical activity)-9658 (stroke)]TJ
/F9 1 Tf
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[(Paffenbarger and)-2243 (> 50,000 US male)-4033 (Participation in college varsity)-3637 (Hemorrhagic and)]TJ
0 -1.25 TD
0.001 Tw
[(W)54 (illiams \(1967\))-2686 (college alumni)-5539 (athletics \(yes/no\))-9538 (ischemic stroke death)]TJ
9.6 -1.2 TD
0 Tw
[(aged 30\32070years)-21444 (\(n = 171\))]TJ
-9.6 -3.05 TD
[(Paffenbarger)-4152 (3,991 US longshoremen)-1448 (Occupational activity \(cargo)-4434 (Hemorrhagic and)]TJ
0 -1.25 TD
0.001 Tw
[(\(1972\))-6789 (aged 35 years and older;)-1263 (handler or not\))-10333 (ischemic stroke death)]TJ
9.6 -1.25 TD
-0.001 Tw
[(18.5-year follow-up)-20148 (\(n = 132\))]TJ
0 -1.2 TD
(from 1951)Tj
-9.6 -1.85 TD
0 Tw
[(Kannel and)-4659 (1,909 Framingham \(MA\))-1338 (Physical activity index based on)-2857 (Cerebrovascular accident)]TJ
0 -1.2 TD
[(Sorlie \(1979\))-4033 (men aged 35\32064 at)-3634 (hours per day spent at activity-)-3412 (\(n = 87\))]TJ
9.6 -1.25 TD
0.001 Tw
[(4th biennial examina-)-2448 (specific intensity)]TJ
0 -1.2 TD
-0.003 Tc
0 Tw
[(tion;)-25 ( 14-year follow-up)]TJ
-9.6 -1.85 TD
0.005 Tc
-0.001 Tw
[(Salonen et al.)-3694 (3,829 women and)-4033 (Dichotomous assessment of)-4727 (Cerebral stroke)]TJ
0 -1.2 TD
0 Tw
[(\(1982\))-6789 (4,1)54 (10 men aged 30\32059)-1949 (occupational physical activity)]TJ
38.4 0 TD
-0.013 Tc
(\(ICD-8 430\320437\) morbidity)Tj
-28.8 -1.25 TD
0.005 Tc
[(years from Eastern)-4078 (\(low/high\))-12414 (and mortality among men)]TJ
T*
[(Finland; 7-year)-22223 (\(n = 71\) and women)]TJ
0 -1.2 TD
[(follow-up)-24584 (\(n = 56\))]TJ
-9.6 -1.85 TD
0.002 Tc
0.003 Tw
[(Herman et al.)-3646 (132 hospitalized Dutch)-1776 (Leisure-time physical activity)-4150 (Rapidly )8 (developed )8 (clinical)]TJ
0 -1.2 TD
0.005 Tc
0 Tw
[(\(1983\))-6789 (stroke case-patients and)-1598 (\(greatest portion of one\325)50 (s lifetime\))-2277 (signs of focal or global)]TJ
9.6 -1.25 TD
[(239 age- and sex-)-4248 (ranging from little to regular)59 (-heavy)-1731 (disturbance of cerebral)]TJ
0 -1.2 TD
0.001 Tw
[(matched controls; men)-18803 (function lasting more)]TJ
0 -1.25 TD
0 Tw
[(and women aged)-21284 (than 24 hours or leading)]TJ
T*
0.001 Tw
[(40\32074 years)-23519 (to)-6 ( )-16 (death with no apparent)]TJ
28.8 -1.2 TD
(cause other than)Tj
0 -1.25 TD
(vascular origin)Tj
-38.4 -1.8 TD
0 Tw
[(Paffenbarger et al.)-1727 (16,936 US male college)-1498 (Physical activity index estimated)-2632 (Death due to stroke)]TJ
0 -1.25 TD
[(\(1984\))-6789 (alumni who entered)-3238 (from reports of stairs climbed, city)-1950 (\(n = 103\))]TJ
9.6 -1.2 TD
[(college between 1916)-2338 (blocks walked, and sports played)]TJ
0 -1.25 TD
[(and 1950; followed)-3458 (each week)]TJ
T*
0.001 Tw
(from 1962\3201978)Tj
-9.6 -1.8 TD
0 Tw
[(Menotti and)-4319 (99,029 Italian males)-3118 (Classification of occupational)-3922 (Fatal stroke \(n = 187\))]TJ
0 -1.25 TD
-0.001 Tw
[(Seccareccia)-4435 (railroad employees)-3688 (physical activity \(heavy)77 (, moderate,)]TJ
0 -1.2 TD
0 Tw
[(\(1985\))-6789 (aged 40\32059 years;)-4079 (sedentary\))]TJ
9.6 -1.25 TD
-0.002 Tw
(5-year follow-up)Tj
-9.6 -1.8 TD
0 Tw
[(Lapidus and)-4319 (1,462 Swedish women)-2068 (W)54 (ork and leisure physical activity)-2067 (Fatal and nonfatal stroke)]TJ
0 -1.25 TD
[(Bengtsson)-5219 (aged 38\32060; follow-up)-2113 (assessed via 4-scales for lifetime)-2791 (\(n = 13\))]TJ
0 -1.2 TD
[(\(1986\))-6789 (between 1968 and 1981)-1333 (and for the time before 1968)]TJ
21.6 -1.25 TD
(baseline)Tj
-21.6 -4.3 TD
0.001 Tw
[(Menotti et al.)-3803 (8,287 men aged 40\32059)-1893 (Classification of occupational)-3922 (Fatal stroke)]TJ
0 -1.2 TD
-0.001 Tw
[(\(1990\))-6789 (years in six of seven)-3283 (physical activity \(heavy)77 (, moderate,)-1756 (\(cohort analysis\))]TJ
9.6 -1.25 TD
0 Tw
[(countries from Seven)-2843 (sedentary\))]TJ
0 -1.2 TD
-0.002 Tw
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0.002 Tw
(20-year follow-up)Tj
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548 87 131 -61 re
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564 677.25 l
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/F5 1 Tf
10 0 0 10 66 681 Tm
0.002 Tw
[(Main findings)-15604 (response)]TJ
/F9 1 Tf
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/F5 1 Tf
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(and other comments)Tj
/F9 1 Tf
-28.5 -1.8 TD
[(Inverse association; nondecedents were 2.2)-2661 (NA)-5445 (Results adjusted for age only)]TJ
0 -1.25 TD
(times as likely to have participated in varsity)Tj
0 -1.2 TD
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0 -1.25 TD
(strokes = 2.1, occlusive strokes = 2.5)Tj
0 -1.8 TD
[(Noncargo handlers were 1.1)107 (1 times as likely)-2325 (NA)-5445 (Results adjusted for age only)]TJ
0 -1.25 TD
[(as car)29 (go handlers to die from stroke)]TJ
0 -4.3 TD
[(Inverse association between physical activity)-2091 (Y)65 (e)0 (s)-5451 (No statistical significance after controlling)]TJ
0 -1.2 TD
[(index and 14-year incidence of stroke)-12032 (for several confounding variables)]TJ
0 -4.3 TD
[(Inverse association with statistically significant)-1395 (NA)-5445 (Evidence for inverse association for low)]TJ
0 -1.2 TD
[(RRs for men and women with low levels of)-9795 (activity during leisure time, but no statistical)]TJ
0 -1.25 TD
[(physical activity at work were 1.5 \(95% CI,)-9720 (significance after adjustment for other factors)]TJ
T*
(1.2\3202.0\) for men and 2.4 \(95% CI, 1.5\3203.7\))Tj
0 -1.2 TD
-0.002 Tw
(for women)Tj
0 -1.85 TD
0 Tw
[(Inverse association; relative to lowest)-5401 (Y)65 (e)0 (s)-5451 (Adjusted for a variety of potential)]TJ
0 -1.2 TD
[(physical activity category)70 (, risk estimates were)-8778 (confounding influences)]TJ
0 -1.25 TD
(0.72 \(95% CI, 0.37\3201.42\) for moderate and)Tj
0 -1.2 TD
(0.41 \(95% CI, 0.21\3200.84\) for high categories)Tj
0 -6.75 TD
[(Inverse association; relative to highest)-5116 (Y)65 (e)0 (s)-5451 (Significant dose-response trend after adjusting)]TJ
0 -1.25 TD
[(category of index \(2,000+ kcal/week\), risk)-10231 (for differences in age, cigarette smoking, and)]TJ
0 -1.2 TD
[(estimates in next two lower categories were)-9500 (hypertension prevalence)]TJ
0 -1.25 TD
(1.25 and 2.71, respectively)Tj
0 -3.05 TD
[(Nonlinear \322U\323 shape association; relative to)-2430 (No)-5555 (Age-adjusted only)]TJ
0 -1.25 TD
[(sedentary category)96 (, men in moderate and)]TJ
0 -1.2 TD
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0 -1.25 TD
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0 -1.8 TD
[(Inverse association; women with low physical)-1595 (NA)-5445 (Age-adjusted only)]TJ
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(\(95% CI, 3.8\32027.1\))Tj
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[(Definition of)-11158 (Definition of)]TJ
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[(Harmsen et al.)-3253 (7,495 Swedish men)-3413 (Physical activity at work and)-4317 (Fatal stroke)]TJ
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[(\(1990\))-6789 (aged 47\32055 years at)-3289 (leisure hours \(low)58 (, high\))-6342 (\(all and subtypes\))]TJ
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[(baseline examination;)-19248 (\(n = 230\))]TJ
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[(Lindsted,)-5664 (9,484 male Seventh-)-3013 (Self-report of physical activity)-3857 (Fatal stroke \(n = 410\))]TJ
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[(T)110 (onstad,)-6004 (Day )25 (Adventists aged)-3151 (level in 1960 \(highly active,)]TJ
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0.55 0 TD
[( 30 years; 26-year)-3637 (moderately active, low activity\))]TJ
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[(\(1991\))-6789 (follow-up)]TJ
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[(W)54 (annamethee)-3320 (7,735 British men aged)-1887 (Self-report of physical activity at)-2786 (Fatal and nonfatal stroke)]TJ
0 -1.25 TD
[(and Shaper)-4714 (40\32059 years; 8.5-year)-2558 (baseline; 6-point scale defined on)-2067 (\(n = 128\))]TJ
0 -1.2 TD
[(\(1992\))-6789 (follow-up)-7784 (the basis of type and frequency)]TJ
21.6 -1.25 TD
0.002 Tw
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-21.6 -1.8 TD
0 Tw
[(Abbott et al.)-4254 (7,530 Hawaiian men of)-1668 (Self-report of 24-hour habitual)-3586 (Fatal and nonfatal)]TJ
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-0.001 Tw
[(\(1994\))-6789 (Japanese ancestry aged)-1944 (physical activity in 1965\3201968)-3367 (neurologic deficit)]TJ
9.6 -1.25 TD
0 Tw
[(45\32068 years; 22-year)-2843 (\(inactive, partially active, active\))-2672 (with sudden)]TJ
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0.001 Tw
[(follow-up)-24584 (occurrence and remaining)]TJ
28.8 -1.25 TD
0 Tw
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(\(n = 537\))Tj
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[(Kiely et al.)-4984 (Four cohorts of)-5423 (Self-report of daily activity level;)-2671 (Fatal and nonfatal)]TJ
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[(\(1994\))-6789 (Framingham \(MA\) men)-1958 (composite score formulated from)-2421 (first occurrence of)]TJ
9.6 -1.25 TD
[(and women: cohort I\321)-1898 (index and categorized into high,)-2687 (atherothrombotic brain)]TJ
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0.001 Tw
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0 Tw
[(years; cohort II\3212,299)-18798 (embolism, or other stroke)]TJ
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/F9 1 Tf
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[(activity category)91 (, slightly elevated estimates)-10179 (for risk factors)]TJ
0 -1.2 TD
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-0.001 Tw
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0 -1.25 TD
0 Tw
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0 -1.8 TD
[(Inverse association; statistically significant)-4205 (Y)65 (e)0 (s)-5151 (Linear trend observed in men both with and)]TJ
0 -1.25 TD
[(linear trend of lower risk of stroke with higher)-9184 (without existing ischemic heart disease)]TJ
0 -1.2 TD
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0 -3.05 TD
[(Null association seen for all strokes and all)-3880 (Y)65 (es, in)-3741 (No association of physical activity to risk)]TJ
0 -1.25 TD
[(subtypes for men aged 45\32054 years)-7162 (older)-4354 (of stroke in older smokers)]TJ
0 -2.45 TD
[(Inverse association seen for all strokes and)-4051 (No in)]TJ
0 -1.25 TD
[(subtypes for men aged 55\32068 years)-7162 (younger)]TJ
0 -4.25 TD
0.001 Tw
[(Risk estimate relative to low)-16897 (Control for many confounding factors;)]TJ
0 -1.25 TD
0 Tw
[(physical activity group:)-18978 (nonlinear association in women only)]TJ
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[(cohort I\321nonsignificant inverse association)-10101 (\(cohorts III and IV\); suggestion of threshold)]TJ
0 -1.2 TD
[(for medium group = 0.90 \(0.62\3201.31\))-6211 (Y)65 (es, C I)-3346 (relationship \(cohort III\))]TJ
0 -1.25 TD
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0 -1.2 TD
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0.005 Tc
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T*
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0 -1.2 TD
[(cohort III\321significant inverse association)-4616 (Y)65 (es, C III)]TJ
0 -1.25 TD
(for medium group = 0.41 \(0.24\3200.69\))Tj
0 -1.2 TD
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0 -1.25 TD
-0.002 Tc
-0.001 Tw
[(cohort IV\321nonsignificant nonlinear association)-2217 (No, )-8 (C )-8 (IV)]TJ
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0 Tw
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1176 677.25 l
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/F9 1 Tf
0 -1.8 TD
[(Paffenbarger)97 (,)-3967 (7,685 men who)-5098 (Reported hours per week of)-4777 (Self-reported incidence of)]TJ
0 -1.25 TD
[(Thorne,)-6229 (attended the University)-1598 (participation in sports or exer)19 (cise)-2363 (physician-diagnosed)]TJ
0 -1.2 TD
0.001 Tw
[(W)54 (ing)-7302 (of Pennsylvania)-5144 (in college)-12524 (hypertension from mail-)]TJ
0 -1.25 TD
[(\(1968\))-6789 (between 1931 and)-20659 (back health questionnaire)]TJ
9.6 -1.25 TD
0 Tw
[(1940 and who)-22459 (\(n = 671\))]TJ
0 -1.2 TD
(responded to a)Tj
0 -1.25 TD
0.001 Tw
(questionnaire in 1962)Tj
-9.6 -1.8 TD
0 Tw
[(Paffenbarger et al.)-1727 (14,998 US male college)-1498 (Physical activity index \(kcal/week\))-1842 (Self-reported incidence of)]TJ
0 -1.25 TD
[(\(1983\))-6789 (alumni who entered)-3238 (estimated from reports of stairs)-3471 (physician-diagnosed)]TJ
9.6 -1.2 TD
0.001 Tw
[(college between 1916)-2338 (climbed, city blocks walked, and)-2412 (hypertension from mail-)]TJ
0 -1.25 TD
[(and 1950; followed)-3458 (sports played each week, assessed)-1907 (back health questionnaire)]TJ
T*
0 Tw
[(from 1962\3201972)-4703 (by mail-back questionnaire in)-3817 (\(n = 681\))]TJ
0 -1.2 TD
-0.001 Tw
[(\(for 6\32010 years\))-5253 (1962 or 1966)]TJ
-9.6 -2.45 TD
0 Tw
[(Blair et al.)-5148 (4,820 US men and)-3803 (Maximal aerobic capacity)-5513 (Self-reported incidence)]TJ
0 -1.25 TD
-0.001 Tw
[(\(1984\))-6789 (1,219 US women)-4373 (estimated by exer)42 (cise tests,)-5087 (of physician-diagnosed)]TJ
9.6 -1.25 TD
0 Tw
[(patients of a preventive)-1878 (categorized into \322high\323 fitness)-3697 (hypertension \(n = 240\))]TJ
0 -1.2 TD
[(medical clinic aged)-3458 (\()]TJ
/F10 1 Tf
12.3 0 TD
(\263)Tj
/F9 1 Tf
0.55 0 TD
0.001 Tw
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-12.85 -1.25 TD
[(20\32065 years at baseline)-1768 (fitness)]TJ
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0.001 Tw
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9.6 -1.2 TD
0 Tw
[(pressure 85\32089 mm Hg)-18643 (elevation of diastolic)]TJ
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28.8 0 TD
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0.001 Tw
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-0.001 Tw
[(Folsom et al.)-4033 (41,837 Iowa women)-2968 (Self-reported frequency of)-5502 (Self-reported incidence of)]TJ
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0 Tw
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0.001 Tw
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9.6 -1.25 TD
0 Tw
[(University of)-23233 (hypertension from mail-)]TJ
0 -1.2 TD
0.001 Tw
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(in 1976 \(n = 739\))Tj
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545 177 132 -86 re
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0.002 Tw
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/F9 1 Tf
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0 -1.25 TD
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T*
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0 -1.25 TD
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0 -1.2 TD
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0 -1.25 TD
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T*
0.002 Tw
[(to others)-17529 (men)]TJ
0 -3.65 TD
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[(Patients in low fitness category were 1.52)-3250 (NA)-5745 (Extensive control for confounding variables;)]TJ
0 -1.25 TD
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T*
-0.001 Tw
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0 -1.2 TD
-0.002 Tw
(fitness category)Tj
0 -3.05 TD
0 Tw
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0 -1.25 TD
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0 -1.2 TD
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0 -9.2 TD
[(Inverse association; relative to women)-4661 (Y)65 (e)0 (s)-5751 (Adjustment for BMI, waist-to-hip ratio,)]TJ
0 -1.25 TD
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T*
[(at high and moderate levels had 30% and)-10351 (the association with physical activity)]TJ
0 -1.2 TD
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0 -1.25 TD
(hypertension \(RR high = 0.70, 95% CI,)Tj
0 -1.2 TD
(0.6\3200.9; RR moderate = 0.90, 95% CI,)Tj
0 -1.25 TD
(0.7\3201.1\))Tj
0 -1.8 TD
[(V)71 (igorous sports play in 1962 was associated)-2148 (Y)65 (e)0 (s)-5751 (Adjusted for age, BMI, weight gain)]TJ
0 -1.25 TD
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T*
[(hypertension)-22884 (hypertension)]TJ
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/F9 1 Tf
8 0 0 8 66 143 Tm
0.01 Tc
(Abbreviations: BMI = body mass index \(wt [kg] /ht [m])Tj
4.7 0 0 4.7 257.5 146 Tm
(2)Tj
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( \); CI = confidence interval; RR = relative risk.)Tj
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(*)Tj
8 0 0 8 68.5 129.5 Tm
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0 Tw
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0 Tr
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(110)Tj
/F5 1 Tf
-21.864 63.727 TD
0.003 Tc
-0.001 Tw
(Physical Activity and Health)Tj
/F7 1 Tf
0 -2.818 TD
-0.027 Tw
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0 -1.182 TD
-0.017 Tw
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T*
-0.046 Tw
(Beaglehole \(1992\), and nine randomized controlled)Tj
0 -1.227 TD
-0.056 Tw
(trials of aerobic exercise using the lower extremities)Tj
0 -1.182 TD
-0.018 Tw
(\(e.g., walking, jogging, cycling\) and blood pressure)Tj
0 -1.227 TD
0.25 Tw
(were analyzed in a meta-analysis by Kelley and)Tj
0 -1.182 TD
-0.02 Tw
(McClellan \(1994\). The two meta-analyses indepen-)Tj
T*
0.216 Tw
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0 -1.227 TD
0.166 Tw
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0 -1.182 TD
0.026 Tw
(proximately 6\3207 mm Hg. Some of the studies were)Tj
0 -1.227 TD
0.011 Tw
(conducted with persons with defined hypertension)Tj
0 -1.182 TD
-0.058 Tw
(\(> 140/90 mm Hg\), and others were conducted with)Tj
T*
0.06 Tw
(persons with high normal blood pressure. Most of)Tj
0 -1.227 TD
-0.013 Tw
(the studies tested aerobic training of 60\32070 percent)Tj
0 -1.182 TD
0.105 Tw
(maximum oxygen uptake, 3\3204 times/week, 30\32060)Tj
0 -1.227 TD
0 Tw
(minutes per session.)Tj
1.636 -1.182 TD
-0.101 Tw
(Three trials have specifically examined the effect)Tj
-1.636 -1.227 TD
-0.083 Tw
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0 -1.182 TD
0.005 Tw
(Hagberg et al. \(1989\) randomly assigned 33 hyper-)Tj
T*
-0.127 Tw
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0 -1.227 TD
-0.029 Tw
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0 -1.182 TD
0.054 Tw
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/F12 1 Tf
19.5 0.182 TD
0.05 Tc
0 Tw
( \372)Tj
/F7 1 Tf
0.136 -0.182 TD
0.003 Tc
(VO)Tj
6.4 0 0 6.4 279 430.5 Tm
(2)Tj
11 0 0 11 48 420.5 Tm
-0.11 Tw
[(m)9 (a)9 (x)-6 (\) for 9 months. Both exercise groups had compa-)]TJ
0 -1.182 TD
0.085 Tw
(rable decreases in diastolic blood pressure \(11\32012)Tj
T*
-0.101 Tw
(mm Hg\), and the lower-intensity group had a greater)Tj
0 -1.227 TD
-0.021 Tw
(decrease in systolic blood pressure than the higher-)Tj
0 -1.182 TD
0.061 Tw
(intensity group \(20 mm Hg vs. 8 mm Hg\). All the)Tj
0 -1.227 TD
0.129 Tw
(decreases were statistically significant when com-)Tj
0 -1.182 TD
-0.034 Tw
(pared with the control group\325s blood pressure level,)Tj
T*
0.242 Tw
(except the 8 mm Hg decrease in systolic blood)Tj
0 -1.227 TD
0.136 Tw
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0 -1.182 TD
-0.042 Tw
(and colleagues \(1992\) randomly assigned 26 mildly)Tj
0 -1.227 TD
-0.056 Tw
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0 -1.182 TD
-0.108 Tw
(\(50 percent)Tj
/F12 1 Tf
4.955 0.182 TD
-0.084 Tc
0 Tw
( \372)Tj
/F7 1 Tf
-0.046 -0.182 TD
0.003 Tc
(VO)Tj
6.4 0 0 6.4 117.5 272 Tm
(2 )Tj
11 0 0 11 122 275.5 Tm
-0.108 Tw
[(m)9 (a)9 (x)39 ( and 75 percent)]TJ
/F12 1 Tf
8.182 0.182 TD
-0.13 Tc
0 Tw
( \372)Tj
/F7 1 Tf
-0.046 -0.182 TD
0.003 Tc
(VO)Tj
6.4 0 0 6.4 226.5 272 Tm
(2 )Tj
11 0 0 11 231 275.5 Tm
-0.108 Tw
[(m)9 (a)9 (x)-6 (\) for 10)]TJ
-16.636 -1.182 TD
0.02 Tw
(weeks. The pretest-to-posttest decreases in systolic)Tj
0 -1.227 TD
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0 -1.182 TD
0.119 Tw
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0 -1.227 TD
-0.031 Tw
(those in the higher-intensity group were not \(3 mm)Tj
0 -1.182 TD
-0.034 Tw
(Hg/5 mm Hg\). Marceau and colleagues \(1993\) used)Tj
T*
0.012 Tw
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0 -1.227 TD
-0.126 Tw
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/F12 1 Tf
13.182 0.182 TD
-0.13 Tc
0 Tw
( \372)Tj
/F7 1 Tf
-0.046 -0.182 TD
0.003 Tc
(VO)Tj
6.4 0 0 6.4 208 179.5 Tm
(2 )Tj
11 0 0 11 212 183 Tm
-0.126 Tw
[(m)9 (a)9 (x)-6 ( training on)]TJ
-14.909 -1.182 TD
-0.042 Tw
(24-hour ambulatory blood pressure in persons with)Tj
0 -1.227 TD
-0.027 Tw
(hypertension. A similar reduction in 24-hour blood)Tj
0 -1.182 TD
0.042 Tw
(pressure was observed for both training intensities)Tj
T*
-0.008 Tw
(\(5 mm Hg decrease\), but diurnal patterns of reduc-)Tj
0 -1.227 TD
-0.001 Tw
(tion were different.)Tj
1.636 -1.182 TD
-0.015 Tc
-0.063 Tw
[(These trials provide some evidence that moderate)-7 (-)]TJ
-1.636 -1.227 TD
0.003 Tc
0.031 Tw
(intensity activity may achieve a similar, or an even)Tj
23.955 56.409 TD
0.055 Tc
0.258 Tw
(greater, blood-pressure-lowering effect than)Tj
0 -1.182 TD
0.032 Tc
(vigor)Tj
2.273 0 TD
0.002 Tc
-0.127 Tw
(ous-intensity activity. Because few studies have)Tj
-2.273 -1.182 TD
0.003 Tc
0.017 Tw
(directly addressed the intensity question, however,)Tj
0 -1.227 TD
-0.088 Tw
(the research base is not strong enough to draw a firm)Tj
0 -1.182 TD
0.179 Tw
(conclusion about the role of activity intensity in)Tj
0 -1.227 TD
-0.067 Tw
(lowering blood pressure. It is not clear, for example,)Tj
0 -1.182 TD
-0.082 Tw
(how the findings could have been affected by several)Tj
T*
-0.037 Tw
(issues, such as use of antihypertensive medications,)Tj
0 -1.227 TD
-0.034 Tw
(changes in body weight, lack of direct intervention-)Tj
0 -1.182 TD
-0.109 Tw
(control comparisons, dropout rates, and total caloric)Tj
0 -1.227 TD
(expenditure.)Tj
/F5 1 Tf
12 0 0 12 311.5 550.5 Tm
0 Tc
0 Tw
(Biologic Plausibility)Tj
/F7 1 Tf
11 0 0 11 311.5 536 Tm
0.003 Tc
-0.013 Tw
(Multiple physiological mechanisms may contribute)Tj
T*
0.038 Tw
(to the protective effects of physical activity against)Tj
0 -1.182 TD
0 Tc
-0.128 Tw
(CVDs. Postulated mechanisms involve advantageous)Tj
0 -1.227 TD
0.003 Tc
0.076 Tw
(effects on atherosclerosis, plasma lipid/lipoprotein)Tj
0 -1.182 TD
0.139 Tw
(profile, blood pressure, availability of oxygenated)Tj
T*
-0.079 Tw
(blood for heart muscle needs \(ischemia\), blood clot-)Tj
0 -1.227 TD
0.11 Tw
(ting \(thrombosis\), and heart rhythm disturbances)Tj
0 -1.182 TD
0.041 Tw
(\(arrhythmias\) \(Haskell 1995; Leon 1991a; Gordon)Tj
0 -1.227 TD
-0.001 Tw
(and Scott 1991\).)Tj
1.636 -1.182 TD
0.013 Tc
-0.023 Tw
(Other effects of activity that may be associated)Tj
-1.636 -1.227 TD
0.133 Tw
(with modifications of CVD risk include reduced)Tj
0 -1.182 TD
0.033 Tc
0.22 Tw
(incidence of obesity, healthier distribution of)Tj
T*
[(body)6 ( )]TJ
2.571 0 TD
0.013 Tc
0.117 Tw
(fat, and reduced incidence of non\320insulin-)Tj
-2.571 -1.227 TD
0.182 Tw
(dependent diabetes. These other effects are dis-)Tj
0 -1.182 TD
0 Tw
(cussed in later sections of this chapter.)Tj
/F5 1 Tf
11 0 2.138 11 311.5 323 Tm
0.003 Tc
(Atherosclerosis)Tj
/F7 1 Tf
11 0 0 11 311.5 308.5 Tm
0.192 Tw
(Atherosclerosis begins when cholesterol is trans-)Tj
T*
-0.117 Tw
(ported from the blood into the artery wall by lipopro-)Tj
T*
-0.074 Tw
(teins, particularly LDL \(Getz 1990; Yanowitz 1992\).)Tj
0 -1.227 TD
-0.128 Tw
(The formation of atherosclerotic plaques is increased)Tj
0 -1.182 TD
0.189 Tw
(at sites where the blood vessel lining is injured,)Tj
0 -1.227 TD
-0.124 Tw
(which may occur in areas where blood flow is uneven)Tj
0 -1.182 TD
-0.048 Tw
(\(e.g., near the origin or branching of major vessels\).)Tj
T*
0.002 Tw
(An inflammatory reaction leads to the formation of)Tj
0 -1.227 TD
0 Tw
(atherosclerotic plaques in the wall of the artery.)Tj
1.636 -1.182 TD
0.218 Tw
(In animal studies, exercise has been seen to)Tj
-1.636 -1.227 TD
0.004 Tw
(protect against the effects of excess cholesterol and)Tj
0 -1.182 TD
0.013 Tc
0.082 Tw
(other contributors to the development of athero-)Tj
0 -1.227 TD
-0.033 Tw
(sclerosis \(Kramsch et al. 1981\). In addition, longi-)Tj
0 -1.182 TD
-0.078 Tw
(tudinal studies of men with coronary artery disease)Tj
T*
0.004 Tc
-0.088 Tw
[(have)12 ( shown that endurance training, together with a)]TJ
0 -1.227 TD
0.003 Tc
-0.128 Tw
[(cho)-18 (lesterol-)30 (lowering diet and interventions for other)]TJ
0 -1.182 TD
-0.124 Tw
(CVD risk factors, can help prevent the progression or)Tj
0 -1.227 TD
-0.109 Tw
(reduce the severity of atherosclerosis in the coronary)Tj
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/F9 1 Tf
11 0 0 11 305 41 Tm
0 Tr
0 g
0.006 Tc
(111)Tj
/F5 1 Tf
-0.136 63.727 TD
0.003 Tc
0 Tw
(The Effects of Physical Activity on Health and Disease)Tj
/F7 1 Tf
-21.591 -2.818 TD
0.187 Tw
(arteries \(Ornish et al. 1990; Schuler et al. 1992;)Tj
0 -1.182 TD
-0.055 Tw
(Hambrecht et al. 1993; Haskell et al. 1994\). There is)Tj
T*
0.025 Tw
(also an inverse relationship between cardiorespira-)Tj
0 -1.227 TD
0.226 Tw
(tory fitness and ultrasound-measured severity of)Tj
0 -1.182 TD
-0.01 Tw
(atherosclerosis in neck arteries to the head \(carotid)Tj
0 -1.227 TD
0 Tw
(arteries\) \(Rauramaa et al. 1995\).)Tj
/F5 1 Tf
11 0 2.138 11 66 617.5 Tm
0.001 Tw
(Plasma Lipid/Lipoprotein Profile)Tj
/F7 1 Tf
11 0 0 11 66 603 Tm
0.003 Tw
(The relationships of physical activity to blood lipid)Tj
0 -1.182 TD
-0.061 Tw
(and lipoprotein levels in men and women have been)Tj
0 -1.227 TD
0.059 Tw
(reviewed extensively \(Leon 1991a; Krummel et al.)Tj
0 -1.182 TD
0.158 Tw
(1993; Superko 1991; Durstine and Haskell 1994;)Tj
0 -1.227 TD
-0.058 Tw
(Stefanick and Wood 1994\). Of more than 60 studies)Tj
0 -1.182 TD
0.035 Tw
(of men and women, about half found that exercise)Tj
T*
-0.074 Tw
(training is associated with an increase in HDL. HDL,)Tj
0 -1.227 TD
-0.087 Tw
(a lipid scavenger, helps protect against atherosclero-)Tj
0 -1.182 TD
-0.031 Tw
(sis by transporting cholesterol to the liver for elimi-)Tj
0 -1.227 TD
0.002 Tc
-0.128 Tw
(nation in the bile \(Tall 1990\). Cross-sectional studies)Tj
0 -1.182 TD
0.012 Tc
0.258 Tw
(show a dose-response relationship between the)Tj
T*
0.003 Tc
-0.113 Tw
(amount of regular physical activity and plasma levels)Tj
0 -1.227 TD
0.148 Tw
(of HDL \(Leon 1991c\). In these studies, the HDL)Tj
0 -1.182 TD
-0.092 Tw
(levels of endurance-trained male and female athletes)Tj
0 -1.227 TD
-0.057 Tw
(were generally 20 to 30 percent higher than those of)Tj
0 -1.182 TD
0 Tw
(healthy, age-matched, sedentary persons.)Tj
1.636 -1.227 TD
0.009 Tw
(Moderate-intensity exercise training appears to)Tj
-1.636 -1.182 TD
0.148 Tw
(be less likely to increase HDL levels in young to)Tj
T*
-0.081 Tw
(middle-aged women than men in the same age range)Tj
0 -1.227 TD
0.191 Tw
(\(Leon 1991a; Kummel et al. 1993; Durstine and)Tj
0 -1.182 TD
-0.103 Tw
(Haskell 1994\). Moderate-intensity exercise was seen)Tj
0 -1.227 TD
-0.021 Tw
(to increase HDL as much as more vigorous exercise)Tj
0 -1.182 TD
0.026 Tc
0.259 Tw
(in one randomized controlled trial of women)Tj
T*
0.003 Tc
0 Tw
(\(Duncan, Gordon, Scott 1991\).)Tj
1.636 -1.227 TD
-0.06 Tw
[( Studies have found that even a single episode of)]TJ
-1.636 -1.182 TD
0.135 Tw
(physical activity can result in an improved blood)Tj
0 -1.227 TD
0.001 Tc
-0.127 Tw
(lipid profile that persists for several days \(Tsopanakis)Tj
0 -1.182 TD
0.003 Tc
0.079 Tw
(et al. 1989; Durstine and Haskell 1994\). Evidence)Tj
0 -1.227 TD
0.007 Tw
(also shows that exercise training increases lipopro-)Tj
0 -1.182 TD
-0.018 Tw
(tein lipase activity, an enzyme that removes choles-)Tj
T*
0.037 Tw
(terol and fatty acids from the blood \(Stefanick and)Tj
0 -1.227 TD
-0.098 Tw
(Wood 1994\). Exercise training also reduces elevated)Tj
0 -1.182 TD
0.166 Tw
(levels of triglycerides \(Leon 1991c; Durstine and)Tj
0 -1.227 TD
0.042 Tw
(Haskell 1994\), another blood lipid associated with)Tj
0 -1.182 TD
0 Tw
(heart disease.)Tj
/F5 1 Tf
11 0 2.138 11 66 126.5 Tm
(Blood Pressure)Tj
/F7 1 Tf
11 0 0 11 66 112 Tm
0.033 Tc
-0.049 Tw
(The mechanisms by which physical activity low-)Tj
0 -1.227 TD
-0.061 Tw
(ers blood pressure are complicated \(Leon 1991a;)Tj
0 -1.182 TD
0.17 Tw
(American College of Sports Medicine [ACSM])Tj
23.955 56.864 TD
0.034 Tw
[(1993; Fagard)10 ( )30 (e)30 (t)30 ( )]TJ
7.22 0 TD
0.003 Tc
[(al. )-34 (1990\) and are mentioned only)]TJ
-7.22 -1.182 TD
0.03 Tw
(briefly here \(see also Chapter 3\). Blood pressure is)Tj
T*
0.206 Tw
(directly proportional to cardiac output and total)Tj
0 -1.227 TD
0.092 Tw
(resistance in the peripheral blood vessels. An epi-)Tj
0 -1.182 TD
0.231 Tw
(sode of physical activity has the immediate and)Tj
0 -1.227 TD
-0.098 Tw
(temporary effect of lowering blood pressure through)Tj
0 -1.182 TD
0.095 Tw
(dilating the peripheral blood vessels, and exercise)Tj
T*
0.132 Tw
(training has the ongoing effect of lowering blood)Tj
0 -1.227 TD
-0.095 Tw
(pressure by attenuating sympathetic nervous system)Tj
0 -1.182 TD
0.216 Tw
(activity \(Leon 1991a; ACSM 1993; Fagard et al.)Tj
0 -1.227 TD
-0.103 Tw
(1990\). The reduced sympathetic activity may reduce)Tj
0 -1.182 TD
0.068 Tw
(renin-angiotensin system activity, reset barorecep-)Tj
T*
-0.007 Tc
-0.129 Tw
(tors, and promote arterial vasodilatation\321all of which)Tj
0 -1.227 TD
0.003 Tc
-0.105 Tw
(help control blood pressure. Improved insulin sensi-)Tj
0 -1.182 TD
0.187 Tw
(tivity and the associated reduction in circulating)Tj
0 -1.227 TD
-0.032 Tw
(insulin levels may also contribute to blood pressure)Tj
0 -1.182 TD
0.153 Tw
(reduction by decreasing insulin-mediated sodium)Tj
T*
0 Tw
(reabsorption by the kidney \(Tipton 1984\).)Tj
/F5 1 Tf
11 0 2.138 11 329.5 459 Tm
(Ischemia)Tj
/F7 1 Tf
11 0 0 11 329.5 444.5 Tm
0.201 Tw
(Clinical symptoms of atherosclerotic CHD occur)Tj
T*
0.072 Tw
(when the heart muscle \(myocardium\) needs more)Tj
0 -1.227 TD
0.149 Tw
(oxygen than can be supplied from blood flowing)Tj
0 -1.182 TD
0.145 Tw
(through narrowed coronary arteries. This oxygen)Tj
T*
-0.079 Tw
(shortage leads to ischemia in the heart muscle\321that)Tj
0 -1.227 TD
0.071 Tw
(is, to inadequate oxygenated blood for myocardial)Tj
0 -1.182 TD
-0.116 Tw
(demand. Adaptations to a gradual reduction in blood)Tj
0 -1.227 TD
0.151 Tw
(flow may reduce the likelihood of myocardial is-)Tj
0 -1.182 TD
0.001 Tc
-0.122 Tw
[(chemia.)19 ( For example, new blood vessels may develop)]TJ
T*
-0.019 Tw
(from other coronary arteries to provide an auxiliary)Tj
0 -1.227 TD
-0.109 Tw
(blood supply \(Cohen 1985\). A person with advanced)Tj
0 -1.182 TD
-0.114 Tw
(atherosclerotic CHD may remain free of symptoms at)Tj
0 -1.227 TD
0.117 Tw
(rest but may develop ischemic chest pain \(angina)Tj
0 -1.182 TD
0.002 Tc
0.258 Tw
(pectoris\) or electrocardiographic changes during)Tj
T*
0.001 Tc
0.096 Tw
(physical exertion, which generally result from too)Tj
0 -1.227 TD
0.191 Tw
(high a myocardial oxygen demand for the blood)Tj
0 -1.182 TD
-0.127 Tw
(supply available through partially occluded coronary)Tj
0 -1.227 TD
-0.128 Tw
(arteries and collateral vessels \(Smith and Leon 1992\).)Tj
0 -1.182 TD
0.186 Tw
(Less commonly, angina pectoris may result from)Tj
T*
0.123 Tw
(transient constriction \(spasm\) of a large coronary)Tj
0 -1.227 TD
0.223 Tw
(artery, generally at the site of an atherosclerotic)Tj
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0.037 Tw
(plaque, or from spasm of small arterial vessels that)Tj
0 -1.227 TD
0 Tw
(have no evidence of plaque formation.)Tj
1.636 -1.182 TD
0.003 Tc
-0.007 Tw
(A recent review has summarized adaptations in)Tj
-1.636 -1.227 TD
-0.023 Tw
(the coronary circulation that are induced by endur-)Tj
0 -1.182 TD
0.204 Tw
(ance exercise training and that can decrease the)Tj
T*
0.141 Tw
(likelihood of ischemia \(Laughlin 1994\). Data ob-)Tj
0 -1.227 TD
0.258 Tw
(tained primarily from research on animals have)Tj
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0.006 Tc
(112)Tj
/F5 1 Tf
-21.864 63.727 TD
0.003 Tc
-0.001 Tw
(Physical Activity and Health)Tj
/F7 1 Tf
0 -2.818 TD
-0.123 Tw
(demonstrated that exercise leads to a greater capacity)Tj
0 -1.182 TD
0.115 Tw
(to increase coronary blood flow and an improved)Tj
T*
-0.036 Tw
(efficiency of oxygen exchange between blood in the)Tj
0 -1.227 TD
0.079 Tw
(capillaries and the heart muscle cells. These func-)Tj
0 -1.182 TD
-0.071 Tw
(tional changes are the result of a remodeled vascular)Tj
0 -1.227 TD
(structure)Tj
/F12 1 Tf
3.773 0 TD
(,)Tj
/F7 1 Tf
0.273 0 TD
-0.097 Tw
[( improved control of blood flow dynamics,)]TJ
-4.045 -1.182 TD
-0.038 Tw
(and promotion of biochemical pathways for oxygen)Tj
T*
(transfer.)Tj
1.636 -1.227 TD
-0.013 Tw
(The first and most consistent structural adapta-)Tj
-1.636 -1.182 TD
-0.1 Tw
(tion to exercise is an increase in the interior diameter)Tj
0 -1.227 TD
0.195 Tw
(of the major coronary arteries and an associated)Tj
0 -1.182 TD
-0.037 Tw
(increase in maximal coronary blood flow \(Leon and)Tj
0 -1.227 TD
0.112 Tw
(Bloor 1968, 1976; Scheuer 1982; Laughlin 1994\).)Tj
0 -1.182 TD
0.023 Tw
(The second vascular adaptation is the formation of)Tj
T*
-0.03 Tw
(new myocardial blood vessels \(capillaries and coro-)Tj
0 -1.227 TD
0.175 Tw
(nary arterioles\) \(Tomanek 1994; Leon and Bloor)Tj
0 -1.182 TD
-0.076 Tw
(1968\). Animal studies also have shown that exercise)Tj
0 -1.227 TD
0.015 Tc
0.259 Tw
(training alters coronary vascular reactivity and)Tj
0 -1.182 TD
0.003 Tc
-0.101 Tw
(thereby improves control of blood flow and distribu-)Tj
T*
-0.005 Tc
-0.126 Tw
[(tion \(Overholser, Laughlin, Bhatte )22 (1994; )10 (Underwood,)]TJ
0 -1.227 TD
-0.004 Tc
-0.013 Tw
(Laughlin, Sturek 1994\). This adaptation may reduce)Tj
0 -1.182 TD
0.156 Tw
(the incidence of spasms in the proximal coronary)Tj
0 -1.227 TD
0.033 Tw
(arteries and arterioles \(Laughlin 1994\). In addition,)Tj
0 -1.182 TD
-0.088 Tw
(exercise training results in a reduced workload on the)Tj
T*
0.085 Tw
(heart due to both an increase in compliance of the)Tj
0 -1.227 TD
-0.109 Tw
(heart and a relative reduction in peripheral resistance;)Tj
0 -1.182 TD
0.141 Tw
(together, these reduce myocardial oxygen demand)Tj
0 -1.227 TD
0 Tw
(\(Jorgensen et al. 1977\).)Tj
/F5 1 Tf
11 0 2.138 11 48 327 Tm
0.003 Tc
(Thrombosis)Tj
/F7 1 Tf
11 0 0 11 48 312.5 Tm
0.015 Tw
(An acute coronary event is usually initiated by dis-)Tj
0 -1.182 TD
-0.087 Tw
(ruption of an)Tj
/F14 1 Tf
5.318 0 TD
( )Tj
/F7 1 Tf
0.182 0 TD
(atherosclerotic plaque within an artery)Tj
-5.5 -1.227 TD
-0.084 Tw
(\(Smith and Leon 1992\). Platelet accumulation at the)Tj
0 -1.182 TD
-0.04 Tw
(injury site initiates a cascade of processes leading to)Tj
0 -1.227 TD
-0.026 Tw
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0.254 Tw
(or completely obstructs coronary flow. A major)Tj
T*
-0.026 Tw
(obstruction of flow in a coronary artery may lead to)Tj
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-0.055 Tw
(the death of heart muscle \(myocardial infarction\) in)Tj
0 -1.182 TD
-0.004 Tc
-0.092 Tw
(the area served by that artery. These obstructions can,)Tj
0 -1.227 TD
0.206 Tw
(in addition, trigger potentially lethal disturbances)Tj
0 -1.182 TD
0 Tw
(in the rhythm of the heart \(cardiac arrhythmia\).)Tj
1.636 -1.227 TD
0.003 Tc
0.244 Tw
(Thrombosis, usually occurring at the site of)Tj
-1.636 -1.182 TD
0.011 Tw
(rupture or fissuring of an atherosclerotic plaque, is)Tj
T*
0.016 Tw
(the precipitating event in the transition of silent or)Tj
0 -1.227 TD
0.251 Tw
[(s)-17 (table)14 ( coronary artery disease to acute ischemic)]TJ
0 -1.182 TD
0.105 Tw
[(events, such as unstable)14 ( angina, acute myocardial)]TJ
0 -1.227 TD
-0.117 Tw
(infarction, or sudden cardiac death, and in the occur-)Tj
0 -1.182 TD
-0.029 Tw
(rence of ischemic stroke \(Davies and Thomas 1985;)Tj
23.955 56.636 TD
-0.058 Tw
(Falk 1985\). Endurance training reduces thrombosis)Tj
0 -1.182 TD
0.159 Tw
(by enhancing the enzymatic breakdown of blood)Tj
T*
-0.003 Tw
(clots \(fibrinolysis\) and by decreasing platelet adhe-)Tj
0 -1.227 TD
0.009 Tw
(siveness and aggregation \(which helps prevent clot)Tj
0 -1.182 TD
0 Tw
(formation\) \(Kramsch et al. 1981; Leon 1991b\).)Tj
/F5 1 Tf
11 0 2.138 11 311.5 630.5 Tm
(Arrhythmia)Tj
/F7 1 Tf
11 0 0 11 311.5 616 Tm
-0.054 Tw
(Although persons with coronary artery disease have)Tj
T*
0.093 Tw
(an increased risk of ventricular fibrillation \(a life-)Tj
T*
-0.062 Tw
(threatening heart rhythm disturbance\) during acute)Tj
0 -1.227 TD
0.014 Tw
(physical activity, persons with a healthy cardiovas-)Tj
0 -1.182 TD
0 Tc
-0.128 Tw
(cular system do not incur this elevated risk \(Siscovick)Tj
0 -1.227 TD
0.003 Tc
-0.1 Tw
(et al. 1984; Mittleman et al. 1993; Willich et al. 1993;)Tj
0 -1.182 TD
-0.029 Tw
(Thompson and Mitchell 1984; Thompson, Funk, et)Tj
T*
-0.103 Tw
(al. 1982; Haskell 1995; Dawson, Leon, Taylor 1979\).)Tj
0 -1.227 TD
-0.023 Tw
(Exercise training may reduce the risk of ventricular)Tj
0 -1.182 TD
-0.11 Tw
(fibrillation in healthy persons and in cardiac patients)Tj
0 -1.227 TD
0.181 Tw
(by improving myocardial oxygen supply and de-)Tj
0 -1.182 TD
-0.013 Tw
(mand and by reducing sympathetic nervous system)Tj
T*
-0.081 Tw
(activity \(Leon 1991c\). Evidence from epidemiologic)Tj
0 -1.227 TD
0.126 Tw
(studies shows that a physically active lifestyle re-)Tj
0 -1.182 TD
0.032 Tw
(duces the risk of sudden cardiac death \(Leon et al.)Tj
0 -1.227 TD
-0.055 Tw
(1987\). A meta-analysis of studies that examined use)Tj
0 -1.182 TD
-0.09 Tw
(of physical activity for cardiac rehabilitation showed)Tj
T*
-0.07 Tw
(that endurance exercise training reduced the overall)Tj
0 -1.227 TD
0.109 Tw
(risk of sudden cardiac death even among persons)Tj
0 -1.182 TD
0.005 Tw
(with advanced coronary atherosclerosis \(O\325Connor)Tj
0 -1.227 TD
-0.001 Tw
(et al. 1989\).)Tj
/F5 1 Tf
12 0 0 12 311.5 323.5 Tm
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(Conclusions)Tj
/F7 1 Tf
11 0 0 11 311.5 309 Tm
0.003 Tc
0.207 Tw
(The epidemiologic literature supports an inverse)Tj
T*
0.119 Tw
(association and a dose-response gradient between)Tj
0 -1.182 TD
0.169 Tw
(physical activity level or cardiorespiratory fitness)Tj
0 -1.227 TD
0.01 Tw
(and both CVD in general and CHD in particular. A)Tj
0 -1.182 TD
0.073 Tw
(smaller body of research supports similar findings)Tj
T*
0.208 Tw
(for hypertension. The biological mechanisms for)Tj
0 -1.227 TD
-0.073 Tw
(these effects are plausible and supported by a wealth)Tj
0 -1.182 TD
0.125 Tw
(of clinical and observational studies. It is unclear)Tj
0 -1.227 TD
0.241 Tw
(whether physical activity plays a protective role)Tj
0 -1.182 TD
0.002 Tw
(against stroke.)Tj
/F5 1 Tf
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-0.002 Tc
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/F7 1 Tf
11 0 0 11 311.5 134.5 Tm
0.003 Tc
0.144 Tw
(Cancer, the second leading cause of death in the)Tj
T*
0.057 Tw
(United States, accounts for about 25 percent of all)Tj
0 -1.227 TD
0.202 Tw
(deaths, and this percentage is increasing \(NCHS)Tj
0 -1.182 TD
0.079 Tw
(1996; American Cancer Society [ACS] 1996\). The)Tj
T*
0.253 Tw
(ACS has estimated that 1,359,150 new cases of)Tj
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/F9 1 Tf
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0 Tr
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0.006 Tc
(113)Tj
/F5 1 Tf
-0.136 63.727 TD
0.003 Tc
0 Tw
(The Effects of Physical Activity on Health and Disease)Tj
/F7 1 Tf
-21.591 -2.818 TD
-0.07 Tw
(cancer and 554,740 cancer-related deaths will occur)Tj
0 -1.182 TD
-0.127 Tw
(among Americans during 1996 \(ACS 1996\). Physical)Tj
T*
0.047 Tw
(inactivity has been examined as an etiologic factor)Tj
0 -1.227 TD
-0.001 Tw
(for some cancers.)Tj
/F5 1 Tf
12 0 0 12 66 643 Tm
0 Tc
0 Tw
(Colorectal Cancer)Tj
/F7 1 Tf
11 0 0 11 66 628 Tm
0.003 Tc
0.217 Tw
(Colorectal cancer has been the most thoroughly)Tj
0 -1.182 TD
0 Tc
-0.129 Tw
(investigated cancer in epidemiologic studies of physi-)Tj
T*
0.003 Tc
-0.127 Tw
(cal activity. To date, nearly 30 published studies have)Tj
0 -1.227 TD
0.014 Tw
(examined the association between physical activity)Tj
0 -1.182 TD
0 Tw
(and risk of developing colon cancer alone.)Tj
1.636 -1.227 TD
0.004 Tw
(Studies that combined colon and rectal cancers)Tj
-1.636 -1.182 TD
0.119 Tw
(as a single endpoint\321colorectal cancer\321are only)Tj
0 -1.227 TD
-0.113 Tw
(briefly reviewed here because current research, sum-)Tj
0 -1.182 TD
0.075 Tw
(marized in this section, suggests that the relation-)Tj
T*
0.212 Tw
(ship between physical activity and risk of colon)Tj
0 -1.227 TD
0.011 Tw
(cancer may be different from that for rectal cancer.)Tj
0 -1.182 TD
-0.118 Tw
(Among nine studies that have examined the relation-)Tj
0 -1.227 TD
-0.095 Tw
(ship between physical activity and colorectal cancer,)Tj
0 -1.182 TD
0.249 Tw
(one reported an inverse relationship \(Wu et al.)Tj
T*
-0.022 Tw
(1987\), and three reported positive associations that)Tj
0 -1.227 TD
0.011 Tc
0.259 Tw
(were not statistically significant \(Garfinkel and)Tj
0 -1.182 TD
0.003 Tc
-0.026 Tw
(Stellman 1988; Paffenbarger, Hyde, Wing 1987 [for)Tj
0 -1.227 TD
-0.097 Tw
(analysis of two cohorts]\). One \(Kune, Kune, Watson)Tj
0 -1.182 TD
0.107 Tw
(1990\) reported no significant associations, and in)Tj
T*
0.007 Tw
(the four other studies \(Albanes, Blair, Taylor 1989;)Tj
0 -1.227 TD
0.033 Tw
(Ballard-Barbash et al. 1990; Markowitz et al. 1992;)Tj
0 -1.182 TD
0.072 Tw
(Peters et al. 1989\), the associations lacked consis-)Tj
0 -1.227 TD
-0.034 Tw
(tency in subpopulations within the study, anatomic)Tj
0 -1.182 TD
-0.003 Tw
(subsites of the large bowel, or measures of physical)Tj
T*
-0.036 Tw
(activity. Colorectal adenomas are generally thought)Tj
0 -1.227 TD
-0.083 Tw
(to be precursors to colorectal cancers. A single study)Tj
0 -1.182 TD
0.093 Tw
(of colorectal adenomatous polyps has reported an)Tj
0 -1.227 TD
0.03 Tw
(inverse relationship between risk of adenomas and)Tj
0 -1.182 TD
0.113 Tw
(level of total physical activity \(Sandler, Pritchard,)Tj
T*
0.05 Tw
(Bangdiwala 1995\). Another study of colorectal ad-)Tj
0 -1.227 TD
0.012 Tw
(enomas also found an inverse association, but only)Tj
0 -1.182 TD
0.03 Tw
(for running or bicycling, and only with one of two)Tj
0 -1.227 TD
0 Tw
(different comparison groups \(Little et al. 1993\).)Tj
/F5 1 Tf
11 0 2.138 11 66 178 Tm
0.001 Tw
(Colon Cancer)Tj
/F7 1 Tf
11 0 0 11 66 163.5 Tm
-0.072 Tw
(Of the 29 studies of colon cancer, 18 used job title as)Tj
0 -1.182 TD
0.071 Tw
(the only measure of physical activity and thus ad-)Tj
0 -1.227 TD
0.092 Tw
(dressed only occupational physical activity. These)Tj
0 -1.182 TD
-0.053 Tw
(studies are a mix of mortality and incidence studies,)Tj
0 -1.227 TD
0.186 Tw
(and few have evaluated possible confounding by)Tj
0 -1.182 TD
0.048 Tw
(socioeconomic status, diet, and other possible risk)Tj
T*
-0.052 Tw
(factors for colon cancer. Nonetheless, findings from)Tj
23.955 56.955 TD
-0.116 Tw
(these 18 studies have been remarkably consistent: 14)Tj
0 -1.182 TD
-0.086 Tw
(studies \(Brownson et al. 1989; Brownson et al. 1991;)Tj
T*
0.006 Tw
(Chow et al. 1993; Dosemeci et al. 1993; Fraser and)Tj
0 -1.227 TD
-0.046 Tw
(Pearce 1993; Fredriksson, Bengtsson, Hardell 1989;)Tj
0 -1.182 TD
-0.09 Tw
(Garabrant et al. 1984; Gerhardsson et al. 1986; Kato,)Tj
0 -1.227 TD
0.097 Tw
(Tominaga, Ikari 1990; Lynge and Thygesen 1988;)Tj
0 -1.182 TD
-0.1 Tw
(Marti and Minder 1989; Peters et al. 1989; Vena et al.)Tj
T*
0.045 Tw
(1985; Vena et al. 1987\) reported a statistically sig-)Tj
0 -1.227 TD
0.013 Tw
(nificant inverse relationship between estimated oc-)Tj
0 -1.182 TD
-0.093 Tw
(cupational physical activity and risk of colon cancer.)Tj
0 -1.227 TD
-0.055 Tw
(Four studies \(Arbman et al. 1993; Vetter et al. 1992;)Tj
0 -1.182 TD
0.024 Tw
(Vlajinac, Jarebinski, Adanja 1987; Vineis, Ciccone,)Tj
T*
0.185 Tw
(Magnino 1993\) found no significant relationship)Tj
0 -1.227 TD
0.079 Tw
(between occupational physical activity and risk of)Tj
0 -1.182 TD
0.084 Tw
(colon cancer. The 18 studies were conducted in a)Tj
0 -1.227 TD
0.176 Tw
(variety of study populations in China, Denmark,)Tj
0 -1.182 TD
0.006 Tw
(Japan, New Zealand, Sweden, Switzerland, Turkey,)Tj
T*
0 Tw
(and the United States.)Tj
1.636 -1.227 TD
0.013 Tc
0.212 Tw
[( )29 (Eleven studies assessed the association be-)]TJ
-1.636 -1.182 TD
0.164 Tw
(tween leisure-time or total physical activity and)Tj
0 -1.227 TD
-0.047 Tw
(colon cancer risk in 13 different study populations)Tj
0 -1.182 TD
0.005 Tc
-0.056 Tw
[(\(Table )-9 (4-)-15 (5\). These studies either measured physical)]TJ
0 -1.227 TD
0.003 Tc
-0.018 Tw
(activity and tracked participants over time to ascer-)Tj
0 -1.182 TD
0.13 Tw
(tain colon cancer outcomes or compared recalled)Tj
T*
0.166 Tw
(histories of physical activity among colon cancer)Tj
0 -1.227 TD
0.041 Tw
(patients with those among controls. In eight study)Tj
0 -1.182 TD
0.215 Tw
(populations, an inverse association was reported)Tj
0 -1.227 TD
0.039 Tw
(between physical activity and risk of colon cancer,)Tj
0 -1.182 TD
0.084 Tw
(and results were generally consistent for men and)Tj
T*
-0.11 Tw
(women. The three studies that examined the effect of)Tj
0 -1.227 TD
0.025 Tw
(physical activity during early adulthood \(Polednak)Tj
0 -1.182 TD
0.013 Tc
0.259 Tw
(1976; Paffenbarger, Hyde, Wing 1987; Marcus,)Tj
0 -1.227 TD
0.001 Tc
-0.127 Tw
(Newcomb, Storer 1994\) found no effect, which could)Tj
0 -1.182 TD
0.003 Tc
-0.048 Tw
(indicate that the earlier activity did not affect risk of)Tj
T*
0.009 Tw
(colon cancer later in life. In studies that used more)Tj
0 -1.227 TD
-0.061 Tw
(than two categories of physical activity, 10 potential)Tj
0 -1.182 TD
-0.018 Tw
(dose-response relationships between level of physi-)Tj
0 -1.227 TD
0.15 Tw
(cal activity or cardiorespiratory fitness and colon)Tj
0 -1.182 TD
0.037 Tw
(cancer risk were evaluated. Five of these showed a)Tj
T*
-0.025 Tw
(statistically significant inverse dose-response gradi-)Tj
0 -1.227 TD
0.018 Tw
(ent, one showed an inverse dose-response gradient)Tj
0 -1.182 TD
-0.115 Tw
(that was not statistically significant, three showed no)Tj
0 -1.227 TD
-0.117 Tw
(gradient, and one showed a positive relationship that)Tj
0 -1.182 TD
0.001 Tw
(was not statistically significant.)Tj
1.636 -1.227 TD
0.013 Tc
0.031 Tw
(Two studies of colon adenomas \(Giovannucci)Tj
-1.636 -1.182 TD
0.003 Tc
0.084 Tw
[(e)-10 (t)2 ( )-18 (a)-10 (l)-10 (.)9 ( 1995; Kono et al. 1991\) reported an inverse)]TJ
T*
0.086 Tw
(relationship between leisure-time physical activity)Tj
0 -1.227 TD
0 Tw
(and risk of colon adenomas.)Tj
ET
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T*
-0.053 Tw
(tically significant association with rectal cancer risk)Tj
0 -1.227 TD
0.234 Tw
(\(Garabrant et al. 1984; Vena et al. 1985, 1987;)Tj
0 -1.182 TD
-0.128 Tw
(Gerhardsson et al. 1986; Jarebinski, Adanja, Vlajinac)Tj
0 -1.227 TD
0.097 Tw
(1988; Lynge and Thygesen 1988; Brownson et al.)Tj
0 -1.182 TD
0.116 Tw
(1991; Marti and Minder 1989; Peters et al. 1989;)Tj
T*
0.028 Tw
(Dosemeci et al. 1993\), two reported significant in-)Tj
0 -1.227 TD
-0.008 Tc
-0.129 Tw
(verse associations \(Kato, Tominaga, Ikari 1990; Fraser)Tj
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0.003 Tc
0.138 Tw
(and Pearce 1993\), and one reported a significant)Tj
23.864 33.636 TD
-0.029 Tw
(direct association \(i.e., increasing risk with increas-)Tj
0 -1.182 TD
0 Tw
(ing physical activity\) \(Arbman et al. 1993\).)Tj
1.636 -1.227 TD
0.013 Tc
-0.028 Tw
(Six of the studies that investigated the associa-)Tj
-1.636 -1.182 TD
-0.023 Tw
(tion between leisure-time or total physical activity)Tj
T*
0.089 Tw
(and the risk of developing rectal cancer failed to)Tj
0 -1.227 TD
0.054 Tc
0.258 Tw
(find a significant association \(Gerhardsson,)Tj
0 -1.182 TD
0.037 Tc
(Floderus, Norell 1988; Severson et al. 1989;)Tj
0 -1.227 TD
0.012 Tc
-0.128 Tw
(Gerhardsson et al. 1990; Kune, Kune, Watson 1990;)Tj
0 -1.182 TD
0.013 Tc
0.101 Tw
(Lee, Paffenbarger, Hsieh 1991; Longnecker et al.)Tj
T*
0.007 Tc
-0.127 Tw
(1995\). In another study, Whittemore and colleagues)Tj
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0.013 Tc
0.091 Tw
(\(1990\) observed a statistically significant inverse)Tj
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-0.103 Tw
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0 -1.227 TD
0.136 Tw
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0 -1.182 TD
0.023 Tw
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T*
0.001 Tw
(direct relationship in the other.)Tj
1.636 -1.227 TD
0.003 Tc
0.071 Tw
(Taken together, study results on both occupa-)Tj
-1.636 -1.182 TD
0.258 Tw
(tional and leisure-time or total physical activity)Tj
0 -1.227 TD
0.199 Tw
(suggest that risk of rectal cancer is unrelated to)Tj
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-0.001 Tw
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/F5 1 Tf
12 0 0 12 311.5 202 Tm
0 Tc
0 Tw
(Hormone-Dependent Cancers in Women)Tj
/F7 1 Tf
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0.003 Tc
-0.118 Tw
(Of the epidemiologic studies examining the relation-)Tj
T*
0.034 Tc
0.259 Tw
(ship between physical activity and hormone-)Tj
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0.003 Tc
0.016 Tw
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0.22 Tw
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0 -1.227 TD
0.248 Tw
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-0.127 Tw
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T*
0.022 Tw
(cancers. It should be noted that studies of physical)Tj
0 -1.227 TD
0.183 Tw
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0.013 Tc
0.19 Tw
(misclassification problems because they did not)Tj
/F5 1 Tf
10 0 0 10 48 711 Tm
0.005 Tc
0.027 Tw
[(T)60 (able 4-5.)]TJ
/F9 1 Tf
8.5 0 1.652 8.5 102 711 Tm
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0 G
1 i
0 J
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48 706.75 m
1170 706.75 l
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[(Definition of)-11158 (Definition of)]TJ
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48 676.25 m
1170 676.25 l
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/F5 1 Tf
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[(Study)-7130 (Population)-7224 (physical a)54 (ctivity)-9693 (cancer)]TJ
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[(Mar)35 (cus,)-6158 (W)54 (isconsin women)-3977 (T)110 (otal strenuous physical activity)-2962 (Colon cancer incidence)]TJ
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[(Newcomb,)-4779 (aged up to 74 years,)-3173 (during ages 14\32022 years)]TJ
0 -1.2 TD
0.001 Tw
[(Storer)-7069 (536 cases and)]TJ
0 -1.25 TD
[(\(1994\))-6789 (2,315 controls)]TJ
0 -1.8 TD
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[(Giovannucci et al.)-1563 (47,723 US male health)-1948 (W)54 (eekly recreational physical)-4213 (Colon cancer incidence)]TJ
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[(\(1995\))-6789 (professionals aged)-4018 (activity index based on 8)-5893 (\(n = 201\))]TJ
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[(40\32075 years)-6719 (categories of moderate and)]TJ
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0.002 Tw
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-21.6 -1.85 TD
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48 523.25 m
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558 737 102 -105 re
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0.006 Tc
(117)Tj
/F5 1 Tf
-0.136 63.727 TD
0.003 Tc
0 Tw
(The Effects of Physical Activity on Health and Disease)Tj
/F7 1 Tf
-21.545 -28.682 TD
0.233 Tw
[(i)-10 (n)-14 (clude household work and child care in their)]TJ
0 -1.227 TD
-0.021 Tw
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0 -1.182 TD
-0.027 Tw
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0 -1.227 TD
0.001 Tw
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/F5 1 Tf
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-0.002 Tw
(Breast Cancer)Tj
/F7 1 Tf
11 0 0 11 66.5 344.5 Tm
-0.064 Tw
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0 -1.182 TD
-0.034 Tw
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0 -1.227 TD
0.087 Tw
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0 -1.182 TD
-0.086 Tw
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0 -1.227 TD
0.194 Tw
(no significant association \(Dosemeci et al. 1993;)Tj
0 -1.182 TD
-0.119 Tw
(Pukkala et al. 1993\). Only two \(Dosemeci et al. 1993;)Tj
T*
0.204 Tw
(Pukkala et al. 1993\) adjusted for socioeconomic)Tj
0 -1.227 TD
-0.018 Tw
(status, and none gathered information about repro-)Tj
0 -1.182 TD
-0.025 Tw
(ductive factors and thus could not control for those)Tj
0 -1.227 TD
-0.001 Tw
(potential confounding variables.)Tj
1.636 -1.182 TD
0.249 Tw
(The epidemiologic studies of leisure-time or)Tj
-1.636 -1.227 TD
0.118 Tw
(total physical activity and breast cancer risk have)Tj
0 -1.182 TD
-0.048 Tw
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T*
0.066 Tw
(studies, two reported a significant inverse associa-)Tj
0 -1.227 TD
0.015 Tw
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0 -1.182 TD
0.084 Tw
(three reported an inverse association that was not)Tj
0 -1.227 TD
0.007 Tc
0.259 Tw
(statistically significant \(Frisch et al. 1985,1987;)Tj
0 -1.182 TD
0.003 Tc
0.108 Tw
(Friedenreich and Rohan 1995\), three reported no)Tj
T*
0.032 Tc
0.259 Tw
(relationship \(Paffenbarger, Hyde, Wing 1987;)Tj
0 -1.227 TD
0.003 Tc
-0.046 Tw
(Albanes, Blair, Taylor 1989; Taioli, Barone, Wynder)Tj
0 -1.182 TD
0.009 Tw
(1995\). The other two reported a direct association,)Tj
24 31.318 TD
-0.022 Tw
(although in one this did not reach statistical signifi-)Tj
0 -1.182 TD
0.245 Tw
(cance \(Dorgan et al. 1994\), and in the other it)Tj
T*
0.117 Tw
(remained statistically significant \(after adjustment)Tj
0 -1.227 TD
-0.1 Tw
(for confounding\) only for physical activity at age 30\320)Tj
0 -1.182 TD
0 Tw
(39 years \(Sternfeld et al. 1993\).)Tj
1.636 -1.227 TD
0.036 Tw
[(Even among the studies that controlled for po)-8 (-)]TJ
-1.636 -1.182 TD
0.143 Tw
(tential confounding by reproductive factors, find-)Tj
0 -1.227 TD
-0.1 Tw
(ings were inconsistent \(Bernstein et al. 1994; Dorgan)Tj
0 -1.182 TD
0.062 Tw
(et al. 1994; Sternfeld et al. 1993; Friedenreich and)Tj
T*
0.01 Tw
(Rohan 1995; Mittendorf et al. 1995; Taioli, Barone,)Tj
0 -1.227 TD
0.182 Tw
(Wynder 1995\). Results were inconsistent as well)Tj
0 -1.182 TD
0.144 Tw
[(among studies that included primarily postmeno)-9 (-)]TJ
0 -1.227 TD
-0.119 Tw
(pausal women \(i.e., all but the study by Bernstein and)Tj
0 -1.182 TD
0.002 Tw
(colleagues [1994]\).)Tj
1.636 -1.227 TD
0.023 Tc
-0.022 Tw
(Nonetheless, it is possible that physical activ-)Tj
-1.636 -1.182 TD
-0.017 Tw
(ity during adolescence and young adulthood may)Tj
T*
-0.101 Tw
(protect against later development of breast cancer.)Tj
0 -1.227 TD
0.012 Tw
(Five of the studies cited here have examined this)Tj
0 -1.182 TD
-0.047 Tw
(possibility. Among these five studies, two found a)Tj
0 -1.227 TD
0.207 Tw
(strong and statistically significant reduction in)Tj
0 -1.182 TD
0.017 Tc
-0.032 Tw
[(risk )-9 (\(Bernstein )-9 (et)-11 ( al. 1994 [RR = 0.42]; Mittendorf)]TJ
T*
0.013 Tc
-0.022 Tw
(et al. 1995 [RR = 0.5]\), one found a nonsignificant)Tj
0 -1.227 TD
0.023 Tw
(reduction in risk \(Frisch et al. 1985 [RR = 0.54]\),)Tj
0 -1.182 TD
0.192 Tw
(and two found a null association \(Paffenbarger,)Tj
0 -1.227 TD
0.008 Tc
0.098 Tw
[(Hyde, Wing 1987; Taioli, )10 (Barone, )10 (Wynder )10 (1995\).)]TJ
0 -1.182 TD
0.003 Tc
0.066 Tw
(These studies thus lend limited support to the hy-)Tj
T*
0.15 Tw
(pothesis that physical activity during adolescence)Tj
ET
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0 J
0 j
0.5 w
10 M
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558 706.75 l
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/F5 1 Tf
10 0 0 10 291 692 Tm
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0.001 Tw
[(Dose)-3755 (Adjustment for confounders)]TJ
ET
-564 676.25 m
558 676.25 l
S
BT
/F5 1 Tf
10 0 0 10 66 680 Tm
0.002 Tw
[(Main findings)-16504 (response)]TJ
/F9 1 Tf
7 0 0 7 330 683 Tm
(\240)Tj
/F5 1 Tf
10 0 0 10 351 680 Tm
0 Tw
(and other comments)Tj
/F9 1 Tf
-28.5 -1.8 TD
[(Any strenuous activity relative to none:)-5516 (No)-4655 (Adjusted for age, family history)54 (, screening)]TJ
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[(RR = 1.0 \(95% CI, 0.8\3201.3\))-16702 (sigmoidoscopy)61 (, BMI; population based)]TJ
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[(active quintile, RR = 0.53 \(95% CI,)-13266 (colorectal cancer)80 (, history of endoscopic)]TJ
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28.5 -1.2 TD
(aspirin use, and diet)Tj
-28.5 -1.85 TD
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/F10 1 Tf
7.55 0 TD
(\263)Tj
/F9 1 Tf
0.55 0 TD
[( 2 hours/week relative)-4788 (Y)65 (e)0 (s)-4551 (Adjusted for BMI, family history)81 (, income,)]TJ
-8.1 -1.2 TD
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558 523.25 l
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[(fat, fiber)56 (, and calcium)]TJ
8 0 0 8 66 510.5 Tm
0.01 Tc
(Abbreviations: BMI = body mass index \(wt [kg] /ht [m])Tj
4.7 0 0 4.7 257.5 513.5 Tm
(2)Tj
8 0 0 8 260 510.5 Tm
( \); CI = confidence interval; OR = odds ratio; RR = relative risk.)Tj
5.6 0 0 5.6 66 498.5 Tm
(*)Tj
8 0 0 8 68.5 496 Tm
(Excludes studies where only occupational physical activity was measured.\
)Tj
5.6 0 0 5.6 66 488.5 Tm
(\240)Tj
8 0 0 8 69 486 Tm
-0.002 Tw
(A dose-response relationship requires more than 2 levels of comparison. \
In this column, \322NA\323 means that there were only 2 levels of)Tj
-0.375 -1.187 TD
0 Tw
[(comparison; \322No\323 means that there were more than 2 levels but no d\
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(more than 2 levels and a dose-response gradient was found.)Tj
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0.005 Tc
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1176 695.75 l
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[(Definition of)-11158 (Definition of)]TJ
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48 665.25 m
1176 665.25 l
S
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/F5 1 Tf
10 0 0 10 48 669 Tm
[(Study)-7130 (Population)-7224 (physical activity)-9658 (cancer)]TJ
0 -1.8 TD
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21.9 -1.25 TD
0.002 Tw
[(direction\))-2139 (and alcohol)]TJ
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T*
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0.095 Tw
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0.197 Tw
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0 Tw
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1.636 -1.182 TD
-0.123 Tw
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0.257 Tw
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0.134 Tw
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0.126 Tw
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0.114 Tw
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0.083 Tw
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1.636 -1.182 TD
0.127 Tw
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T*
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1.636 -1.182 TD
0.253 Tw
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0.228 Tw
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T*
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0.077 Tw
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0 -1.227 TD
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48 677.25 m
1176 677.25 l
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[(Study)-7130 (Population)-7224 (physical activity)-9658 (cancer)]TJ
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[(Levi et al.)-5379 (Switzerland/Northern)-2673 (Categories of leisure-time and)-3812 (Endometrial cancer)]TJ
0 -1.2 TD
[(\(1993\))-6789 (Italy; 274 cases and 572)-1428 (occupational activity)-7693 (incidence)]TJ
9.6 -1.25 TD
(controls aged 31\32075)Tj
-9.6 -3.05 TD
[(Shu et al.)-5549 (W)54 (omen in Shanghai,)-2908 (Occupational and nonoccupa-)-3438 (Endometrial cancer)]TJ
0 -1.2 TD
[(\(1993\))-6789 (China aged 18\32074)-4029 (tional physical activity index)-4312 (incidence)]TJ
9.6 -1.25 TD
(years, 268 cases)Tj
T*
(and 268 controls)Tj
-9.6 -3.05 TD
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0 -1.2 TD
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[(\(1993\))-6789 (20\32074 years;)-6439 (activity categories)-8983 (incidence)]TJ
9.6 -1.25 TD
0.002 Tw
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0 -1.2 TD
0 Tw
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/F5 1 Tf
-9.6 -3.05 TD
-0.001 Tw
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/F9 1 Tf
0 -1.85 TD
0 Tw
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-0.111 Tw
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0.22 Tw
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-0.028 Tw
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0.002 Tw
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0 Tw
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0 Tw
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0 Tw
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9.6 -1.2 TD
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-9.6 -2.9 TD
0 Tw
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21.6 -1.15 TD
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/F9 1 Tf
T*
0 Tw
[(Oliveria et al.)-3633 (Cohort of 12,975)-4528 (Maximal exercise test)-7415 (Prostate cancer incidence)]TJ
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-0.001 Tw
[(\(1996\))-6789 (T)110 (exas men)-24254 (or mortality \(n = 94\))]TJ
9.6 -1.15 TD
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0 -2.3 TD
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1179 99.75 l
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(The Effects of Physical Activity on Health and Disease)Tj
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10 M
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567 695.75 l
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/F5 1 Tf
10 0 0 10 291 681 Tm
0.005 Tc
0.001 Tw
[(Dose)-3455 (Adjustment for confounders)]TJ
ET
-564 665.25 m
567 665.25 l
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/F5 1 Tf
10 0 0 10 66 669 Tm
0.002 Tw
[(Main findings)-16504 (response)]TJ
/F9 1 Tf
7 0 0 7 330 672 Tm
(*)Tj
/F5 1 Tf
10 0 0 10 348 669 Tm
0 Tw
(and other comments)Tj
/F9 1 Tf
-28.2 -3.3 TD
[(Major athletes relative to nonathletes,)-6131 (No)-4355 (None)]TJ
0 -1.15 TD
(RR = 1.64 \(p < 0.05\))Tj
0 -1.75 TD
(Sports play )Tj
/F10 1 Tf
5.05 0 TD
(\263)Tj
/F9 1 Tf
0.55 0 TD
[( 5 relative to < 5 hours/week,)-4141 (NA)-4245 (Adjusted for age \(2 levels of activity\))]TJ
-5.6 -1.15 TD
(RR = 1.66; \(p < 0.05\))Tj
0 -2.65 TD
(Comparing )Tj
/F10 1 Tf
5.1 0 TD
(\263)Tj
/F9 1 Tf
0.55 0 TD
[( 2,000 with < 500 kcal/week,)-4042 (No)-4355 (Adjusted for age, BMI, and smoking)]TJ
-5.65 -1.15 TD
(RR = 0.57; p = 0.33)Tj
0 -1.75 TD
[(Most sedentary relative to most active)-6081 (Y)65 (e)0 (s)-4251 (Adjusted for age; in multivariate analysis,)]TJ
0 -1.15 TD
[(menduring leisure time,)-17862 (findings no longer significant for whites;)]TJ
T*
[(RR = 1.3 \(95% CI, 1.0\3201.6\) for whites,)-11560 (hospital based)]TJ
T*
(RR = 1.4 \(95% CI, 0.8\3202.6\) for blacks)Tj
0 -1.75 TD
[(Least active relative to most)-16162 (Adjusted for age; further adjustment for)]TJ
0 -1.2 TD
[(active individuals,)-20268 (confounders said to not affect results)]TJ
0 -1.15 TD
[(RR = 1.3 \(95% CI, 0.7\3202.4\);)-10417 (No)]TJ
T*
0.002 Tw
(for nonrecreational)Tj
T*
0 Tw
[(RR = 1.8 \(95% CI, 1.0\3203.3\);)-10417 (Y)65 (e)0 (s)]TJ
T*
(for recreational)Tj
0 -1.2 TD
[(RR = 1.8 \(95% CI, 1.0\3203.3\))-10702 (No)]TJ
0 -1.75 TD
[(Most active relative to least active men,)-10991 (Adjusted for age, BMI)]TJ
0 -1.15 TD
[(RR = 1.05 \(95% CI, 0.73\3201.51\);)-8736 (NA)]TJ
T*
-0.002 Tw
(for occupation,)Tj
T*
0 Tw
[(RR = 0.77 \(95% CI, 0.58\3201.01\);)-8736 (No)]TJ
0 -1.2 TD
[(high heart rate relative to low)74 (,)]TJ
0 -1.15 TD
-0.001 Tw
[(RR = 0.97 \(95% CI, 0.69\3201.36\))-9022 (NA)]TJ
0 -1.75 TD
0 Tw
[(Overall no association found)-15612 (For agressive tumors, physical activity was)]TJ
28.2 -1.15 TD
(associated with increased risk, but this was)Tj
T*
0.001 Tw
(not statistically significant)Tj
-28.2 -1.75 TD
0 Tw
(Men aged )Tj
/F10 1 Tf
4.6 0 TD
(\263)Tj
/F9 1 Tf
0.55 0 TD
[( 70 years: comparing > 4,000)-4487 (No)-4355 (Adjusted for age; no effect of activity at)]TJ
-5.15 -1.15 TD
[(with < 1,000 kcal/week; RR = 0.53)-12981 (2,500 kcal, the level found protective)]TJ
0 -1.2 TD
[(\(95% CI, 0.29\3200.95\); men aged < 70 years,)-9436 (for colon cancer)]TJ
0 -1.15 TD
(RR = 1.21 \(95% CI, 0.8\3200.18\))Tj
0 -1.75 TD
[(Heavy occupational activity relative to)-5687 (No)-4355 (Adjusted for age, BMI, and geographic region)]TJ
0 -1.15 TD
[(sedentary)56 (, RR = 0.81 \(95% CI, 0.50\3201.30\);)]TJ
T*
(regular training in leisure time relative to)Tj
T*
[(sedentary)56 (, RR = 0.87 \(95% CI, 0.57\3201.34\))]TJ
0 -3.5 TD
[(Among men < 60 years, most fit relative to)-3955 (Y)65 (e)0 (s)-4251 (Adjusted for age, BMI, and smoking)]TJ
0 -1.2 TD
(least fit, RR = 0.26 \(95% CI, 0.10\3200.63\);)Tj
0 -1.15 TD
[(among men > 60 years, no effect, RR not given)-2050 (No)-4355 (Adjusted for age, BMI, and smoking)]TJ
/F10 1 Tf
0 -2.3 TD
(\263)Tj
/F9 1 Tf
0.55 0 TD
[( 3,000 kcal/week relative to < 1,000)-6155 (No)-4355 (Adjusted for age, BMI, and smoking)]TJ
ET
-564 99.75 m
567 99.75 l
S
BT
/F9 1 Tf
10 0 0 10 66 104 Tm
(kcal/week, RR = 0.37 \(95% CI, 0.14\3200.98\))Tj
8 0 0 8 66 87.5 Tm
0.01 Tc
(Abbreviations: BMI = body mass index \(wt [kg]/ht [m])Tj
4.7 0 0 4.7 255 90 Tm
(2)Tj
8 0 0 8 257.5 87.5 Tm
( \); CI = confidence interval; RR = relative risk.)Tj
5.6 0 0 5.6 66 76.5 Tm
(*)Tj
8 0 0 8 68.5 74 Tm
0 Tc
(A dose-response relationship requires more than 2 levels of comparison. \
In this column, \322NA\323 means that there were only 2 levels of)Tj
-0.312 -1.187 TD
0.001 Tc
-0.001 Tw
[(comparison; \322No\323 means that there were )16 (more )-10 (than )-55 (2 levels but no dose-response gradient was found; \322Y)92 (es\323 means that there were more)]TJ
T*
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0 Tr
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(124)Tj
/F5 1 Tf
-21.864 63.727 TD
0.003 Tc
-0.001 Tw
(Physical Activity and Health)Tj
/F7 1 Tf
0 -2.818 TD
-0.007 Tw
(Lund 1994\), but these were not statistically signifi-)Tj
0 -1.182 TD
0.061 Tw
(cant, and one of the four \(Thune and Lund 1994\))Tj
T*
-0.114 Tw
(showed this relationship only for those aged 60 years)Tj
0 -1.227 TD
-0.049 Tw
(or older. Two studies found that men who had been)Tj
0 -1.182 TD
0.185 Tw
(athletically active in college had significantly in-)Tj
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0.215 Tw
(creased risks of later developing prostate cancer)Tj
0 -1.182 TD
0.066 Tw
(\(Polednak 1976; Paffenbarger, Hyde, Wing 1987\).)Tj
T*
0.2 Tw
(One study found no overall association between)Tj
0 -1.227 TD
-0.017 Tw
(physical activity and prostate cancer risk but found)Tj
0 -1.182 TD
0.005 Tw
(a higher risk \(although not statistically significant\))Tj
0 -1.227 TD
0.002 Tc
-0.128 Tw
(of more aggressive prostate cancer \(West et al. 1991\).)Tj
1.636 -1.182 TD
0 Tc
-0.087 Tw
(The two studies of the association of cardiorespi-)Tj
-1.636 -1.227 TD
0.13 Tw
(ratory fitness with prostate cancer incidence were)Tj
0 -1.182 TD
0.159 Tw
(also inconsistent. Severson and colleagues \(1989\))Tj
T*
-0.02 Tw
(found no association between resting pulse rate and)Tj
0 -1.227 TD
-0.034 Tw
[(subsequent risk of prostate cancer. Oliv)12 (eria and col-)]TJ
0 -1.182 TD
-0.072 Tw
(leagues \(1996\) found a strong inverse dose-response)Tj
0 -1.227 TD
0.097 Tw
(relationship between fitness assessed by time on a)Tj
0 -1.182 TD
0 Tw
(treadmill and subsequent risk of prostate cancer.)Tj
1.636 -1.227 TD
0.003 Tc
0.145 Tw
(Thus the body of research conducted to date)Tj
-1.636 -1.182 TD
0.058 Tw
(shows no consistent relationship between prostate)Tj
T*
0.001 Tw
(cancer and physical activity.)Tj
/F5 1 Tf
11 0 2.138 11 48 406 Tm
-0.002 Tw
(Testicular Cancer)Tj
/F7 1 Tf
11 0 0 11 48 391.5 Tm
-0.11 Tw
(Two studies investigated physical activity and risk of)Tj
T*
0.099 Tw
(developing testicular cancer; again, results are in-)Tj
0 -1.227 TD
0.066 Tw
(consistent. A case-control study in England found)Tj
0 -1.182 TD
0.068 Tw
(that men who spent at least 15 hours per week in)Tj
T*
-0.12 Tw
(recreational physical activity had approximately half)Tj
0 -1.227 TD
-0.114 Tw
(the risk of sedentary men, and a significant trend was)Tj
0 -1.182 TD
-0.061 Tw
(reported over six categories of total time spent exer-)Tj
0 -1.227 TD
0.181 Tw
(cising \(United Kingdom Testicular Cancer Study)Tj
0 -1.182 TD
-0.094 Tw
(Group 1994\). A cohort study in Norway \(Thune and)Tj
T*
-0.008 Tw
(Lund 1994\) was limited by few cases. It showed no)Tj
0 -1.227 TD
0.173 Tw
(association between leisure-time physical activity)Tj
0 -1.182 TD
0.246 Tw
(and risk of testicular cancer, but heavy manual)Tj
0 -1.227 TD
0.212 Tw
(occupational activity was associated with an ap-)Tj
0 -1.182 TD
0.018 Tw
(proximately twofold increase in risk, although this)Tj
T*
0.001 Tc
-0.127 Tw
(result was not statistically significant. Thus no mean-)Tj
0 -1.227 TD
0.003 Tc
0.254 Tw
(ingful conclusions about a relationship between)Tj
0 -1.182 TD
-0.069 Tw
(physical activity and testicular cancer can be drawn.)Tj
/F5 1 Tf
12 0 0 12 48 152 Tm
0 Tc
0 Tw
(Other Site-Specific Cancers)Tj
/F7 1 Tf
11 0 0 11 48 137 Tm
0.003 Tc
-0.043 Tw
(Few epidemiologic studies have examined the asso-)Tj
T*
0.089 Tw
(ciation of physical activity with other site-specific)Tj
0 -1.227 TD
-0.125 Tw
(cancers \(Lee 1994\). The totality of evidence provides)Tj
0 -1.182 TD
0 Tw
(little basis for a suggestion of a relationship.)Tj
/F5 1 Tf
12 0 0 12 311.5 710.5 Tm
0 Tc
(Biologic Plausibility)Tj
/F7 1 Tf
11 0 0 11 311.5 695.5 Tm
0.003 Tc
0.056 Tw
(Because the data presented in this section demon-)Tj
T*
0.012 Tw
(strate a clear association only between physical ac-)Tj
0 -1.227 TD
0.032 Tw
(tivity and colon cancer, the biologic plausibility of)Tj
0 -1.182 TD
0.145 Tw
(this relationship is the focus of this section. The)Tj
0 -1.227 TD
-0.096 Tw
(alteration of local prostaglandin synthesis may serve)Tj
0 -1.182 TD
-0.118 Tw
(as a mechanism through which physical activity may)Tj
T*
-0.063 Tw
(confer protection against colon cancer \(Shephard et)Tj
0 -1.227 TD
0.061 Tw
(al. 1991; Lee 1994; Cordain, Latin, Beanke 1986\).)Tj
0 -1.182 TD
-0.008 Tw
(Strenuous physical activity increases prostaglandin)Tj
0 -1.227 TD
(F)Tj
6.4 0 0 6.4 318 573 Tm
(2)Tj
11 0 0 11 321 576.5 Tm
0.007 Tw
[( alpha, which strongly increases intestinal motil-)]TJ
-0.864 -1.182 TD
0.071 Tw
(ity, and may suppress prostaglandin E)Tj
6.4 0 0 6.4 490.5 560 Tm
(2)Tj
11 0 0 11 494 563.5 Tm
(, which re-)Tj
-16.591 -1.182 TD
0.197 Tw
(duces intestinal motility and, released in greater)Tj
0 -1.227 TD
0.073 Tw
(quantities by colon tumor cells than normal cells,)Tj
0 -1.182 TD
-0.042 Tw
(accelerates the rate of colon cell proliferation \(Thor)Tj
0 -1.227 TD
0.103 Tw
(et al. 1985; Tutton and Barkla 1980\). It has been)Tj
0 -1.182 TD
0.133 Tw
(hypothesized that physical activity decreases gas-)Tj
T*
0.1 Tw
(trointestinal transit time, which in turn decreases)Tj
0 -1.227 TD
-0.068 Tw
(the length of contact between the colon mucosa and)Tj
0 -1.182 TD
-0.031 Tw
(potential carcinogens, cocarcinogens, or promoters)Tj
0 -1.227 TD
0.037 Tw
(contained in the fecal stream \(Shephard 1993; Lee)Tj
0 -1.182 TD
0.158 Tw
(1994\). This hypothesis could partly explain why)Tj
T*
0.055 Tw
(physical activity has been associated with reduced)Tj
0 -1.227 TD
0.21 Tw
(cancer risk in the colon but not in the rectum.)Tj
0 -1.182 TD
0.16 Tw
(Physical activity may shorten transit time within)Tj
0 -1.227 TD
-0.047 Tw
(segments of the colon without affecting transit time)Tj
0 -1.182 TD
-0.029 Tw
(in the rectum. Further, the rectum is only intermit-)Tj
T*
0.088 Tw
(tently filled with fecal material before evacuation.)Tj
0 -1.227 TD
-0.001 Tw
(Despite these hypothetical mechanisms, studies on)Tj
0 -1.182 TD
0.147 Tw
(the effects of physical activity on gastrointestinal)Tj
0 -1.227 TD
0.151 Tw
(transit time in humans have yielded inconsistent)Tj
0 -1.182 TD
0 Tw
(results \(Shephard 1993; Lee 1994\).)Tj
/F5 1 Tf
12 0 0 12 311.5 271 Tm
0 Tc
(Conclusions)Tj
/F7 1 Tf
11 0 0 11 311.5 256 Tm
0.008 Tc
0.102 Tw
(The relative consistency of findings in epidemio-)Tj
T*
0.009 Tc
-0.065 Tw
[(logic studies indicates)24 ( that physical activity is asso-)]TJ
0 -1.227 TD
0.008 Tc
0.185 Tw
(ciated with a reduced risk of colon cancer, and)Tj
0 -1.182 TD
0.022 Tw
(biologically plausible mechanisms underlying this)Tj
T*
0.059 Tw
(association have been described. The data consis-)Tj
0 -1.227 TD
-0.012 Tw
(tently show no association between physical activ-)Tj
0 -1.182 TD
0.003 Tc
0.011 Tw
[(ity )-18 (and )-18 (rectal )-18 (can)20 (cer.)-31 ( Data regarding)-7 ( a)-8 ( relationship)]TJ
0 -1.227 TD
0.007 Tc
0.042 Tw
[(between )11 (physical activity and breast, endometrial,)]TJ
0 -1.182 TD
0.008 Tc
0.214 Tw
(ovarian, prostate, and testicular cancers are too)Tj
T*
0.219 Tw
(limited or too inconsistent to support any firm)Tj
0 -1.227 TD
0.054 Tw
(conclusions. The suggestion that physical activity)Tj
0 -1.182 TD
0.174 Tw
(in adolescence and early adulthood may protect)Tj
0 -1.227 TD
0.071 Tw
(against later development of breast cancer clearly)Tj
0 -1.182 TD
-0.001 Tw
(deserves further study.)Tj
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0.003 Tc
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(The Effects of Physical Activity on Health and Disease)Tj
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0.007 Tc
[(Non)-18 (\320)42 (Insulin-Dependent)]TJ
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-0.002 Tw
(Diabetes Mellitus)Tj
/F7 1 Tf
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-0.005 Tc
-0.084 Tw
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0 -1.227 TD
-0.082 Tw
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0.006 Tw
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-0.083 Tw
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-0.118 Tw
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T*
-0.102 Tw
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-0.05 Tw
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0 -1.182 TD
-0.094 Tw
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0 -1.227 TD
0.002 Tw
(toll: in 1993, more than twice this number of deaths)Tj
0 -1.182 TD
-0.115 Tw
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T*
0.213 Tw
(as a secondary diagnosis on the death certificate.)Tj
0 -1.227 TD
-0.08 Tw
(Many of these deaths were the result of complications)Tj
0 -1.182 TD
-0.008 Tc
-0.13 Tw
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0 -1.227 TD
-0.005 Tc
-0.057 Tw
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0 -1.182 TD
0.081 Tw
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T*
0.163 Tw
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0.056 Tw
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-0.071 Tw
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0.072 Tw
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0.007 Tw
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T*
0 Tw
[(CVD \(Harris et al. 1987\))-17 (.)]TJ
1.636 -1.227 TD
0.07 Tw
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-1.636 -1.182 TD
-0.127 Tw
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0.004 Tc
0.247 Tw
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0 -1.182 TD
0.003 Tc
0.14 Tw
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0 -1.227 TD
0.024 Tw
(characterized by an absolute deficiency of circulat-)Tj
0 -1.182 TD
-0.026 Tw
(ing insulin caused by destruction of pancreatic beta)Tj
T*
0.176 Tw
(islet cells, thought to have occurred by an auto-)Tj
0 -1.227 TD
0.106 Tw
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0 -1.182 TD
-0.042 Tw
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0 -1.227 TD
0.254 Tw
(by elevated insulin levels that are ineffective in)Tj
0 -1.182 TD
-0.021 Tw
(normalizing blood glucose levels because of insulin)Tj
T*
0.001 Tw
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0 -1.227 TD
-0.04 Tw
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0 -1.182 TD
-0.033 Tw
(More than 90 percent of persons with diabetes have)Tj
0 -1.227 TD
-0.001 Tw
(NIDDM \(Krall and Beaser 1989\).)Tj
1.636 -1.182 TD
0 Tc
-0.07 Tw
(Nonmodifiable biologic factors implicated in the)Tj
-1.636 -1.227 TD
-0.119 Tw
(etiology of NIDDM include a strong genetic influence)Tj
0 -1.182 TD
0.108 Tw
(and advanced age, but the development of insulin)Tj
T*
0.197 Tw
(resistance, hyperinsulinemia, and glucose intoler-)Tj
0 -1.227 TD
-0.066 Tw
(ance are related to a modifiable factor: weight gain in)Tj
0 -1.182 TD
0.18 Tw
(adults, particularly in those persons in whom fat)Tj
0 -1.227 TD
-0.007 Tw
(accumulates around the waist, abdomen, and upper)Tj
0 -1.182 TD
0.083 Tw
(body and within the abdominal cavity \(this is also)Tj
T*
0.143 Tw
(called the android or central distribution pattern\))Tj
0 -1.227 TD
0.003 Tc
0.001 Tw
[(\(Harris et al. 1987\))7 (.)]TJ
/F5 1 Tf
12 0 0 12 329.5 710.5 Tm
0 Tc
0 Tw
(Physical Activity and NIDDM)Tj
/F7 1 Tf
11 0 0 11 329.5 695.5 Tm
0.003 Tc
0.096 Tw
(Considerable evidence supports a relationship be-)Tj
0 -1.182 TD
-0.085 Tw
(tween physical inactivity and NIDDM \(Kriska, Blair,)Tj
0 -1.227 TD
-0.001 Tw
(Pereira 1994; Zimmet 1992; King and Kriska 1992;)Tj
0 -1.182 TD
0.146 Tw
(Kriska and Bennett 1992\). Early suggestions of a)Tj
0 -1.227 TD
-0.102 Tw
(relationship emerged from the observation that soci-)Tj
0 -1.182 TD
-0.119 Tw
(eties that had discontinued their traditional lifestyles)Tj
T*
-0.064 Tw
(\(which presumably)Tj
/F12 1 Tf
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( )Tj
/F7 1 Tf
0.227 0 TD
(included large amounts of regu-)Tj
-8.227 -1.227 TD
-0.055 Tw
(lar physical activity\) experienced major increases in)Tj
0 -1.182 TD
0.019 Tw
(the prevalence of NIDDM \(West 1978\). Additional)Tj
0 -1.227 TD
-0.108 Tw
(evidence for the importance of lifestyle was provided)Tj
0 -1.182 TD
-0.077 Tw
(by comparison studies demonstrating that groups of)Tj
T*
0.01 Tw
(people who migrated to a more technologically ad-)Tj
0 -1.227 TD
0.015 Tc
0.258 Tw
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0 -1.182 TD
-0.001 Tc
-0.13 Tw
(NIDDM than their ethnic counterparts who remained)Tj
0 -1.227 TD
0.003 Tc
0.023 Tw
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0 -1.182 TD
0.027 Tw
(1979; Ravussin et al. 1994\) and that rural dwellers)Tj
T*
-0.013 Tw
(had a lower prevalence of diabetes than their urban)Tj
0 -1.227 TD
-0.042 Tw
(counterparts \(Cruz-Vidal et al. 1979; Zimmet 1981;)Tj
0 -1.182 TD
-0.124 Tw
(Taylor et al. 1983; King, Taylor, Zimmet, et al. 1984\).)Tj
1.636 -1.227 TD
-0.009 Tw
(Many cross-sectional studies have found physi-)Tj
-1.636 -1.182 TD
0.005 Tc
0.259 Tw
(cal inactivity to be significantly associated with)Tj
0 -1.227 TD
0.003 Tc
-0.073 Tw
(NIDDM \(Taylor et al. 1983; Taylor et al. 1984; King,)Tj
0 -1.182 TD
0.213 Tw
(Taylor, Zimmet, et al. 1984; Dowse et al. 1991;)Tj
T*
-0.084 Tw
(Ramaiya et al. 1991; Kriska, Gregg, et al. 1993; Chen)Tj
0 -1.227 TD
0.033 Tw
(and Lowenstein 1986; Frish et al. 1986; Holbrook,)Tj
0 -1.182 TD
0.01 Tc
0.259 Tw
(Barrett-Connor, Wingard 1989\). Cross-sectional)Tj
0 -1.227 TD
0.003 Tc
-0.098 Tw
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0 -1.182 TD
-0.025 Tw
(physical activity and glucose intolerance in persons)Tj
T*
0.089 Tw
(without diabetes have generally found that after a)Tj
0 -1.227 TD
0.192 Tw
(meal, glucose levels \(Lindg\212rde and Saltin 1981;)Tj
0 -1.182 TD
0.226 Tw
(Cederholm and Wibell 1985; Wang et al. 1989;)Tj
0 -1.227 TD
0.244 Tw
(Schranz et al. 1991; Dowse et al. 1991; Kriska,)Tj
0 -1.182 TD
0.012 Tw
(LaPorte, et al. 1993\) and insulin values \(Lindg\212rde)Tj
T*
0.022 Tw
(and Saltin 1981; Wang et al. 1989; McKeigue et al.)Tj
0 -1.227 TD
-0.005 Tc
-0.129 Tw
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0 -1.182 TD
0.003 Tc
0.052 Tw
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0 -1.227 TD
0.011 Tw
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0 -1.182 TD
-0.075 Tw
(sectional studies did not find that physical inactivity)Tj
T*
0.077 Tw
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0 -1.227 TD
0.206 Tw
(the entire population or in all subgroups \(King,)Tj
0 -1.182 TD
0.213 Tw
(Taylor, Zimmet, et al. 1984; Dowse et al. 1991;)Tj
0 -1.227 TD
0.197 Tw
(Kriska, Gregg, et al. 1993; Montoye et al. 1977;)Tj
0 -1.182 TD
-0.045 Tw
(Taylor et al. 1983; Fisch et al. 1987; Jarrett, Shipley,)Tj
T*
0.176 Tw
(Hunt 1986; Levitt et al. 1993; Harris 1991\). For)Tj
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-0.032 Tw
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0 -1.182 TD
0.119 Tw
(Examination Survey and the Hispanic Health and)Tj
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0.212 Tw
(Nutrition Examination Survey found that higher)Tj
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/F5 1 Tf
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0.003 Tc
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/F7 1 Tf
0 -2.818 TD
0.023 Tc
0.255 Tw
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0.013 Tc
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2.136 0 TD
-0.005 Tc
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-2.136 -1.182 TD
0.003 Tc
-0.095 Tw
(\(Harris 1991\). However, in contrast to findings from)Tj
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-0.121 Tw
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0 -1.182 TD
0.074 Tw
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0 -1.182 TD
0 Tw
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1.636 -1.227 TD
0.131 Tw
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-1.636 -1.182 TD
-0.087 Tw
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T*
0.01 Tw
(\(Kaye et al. 1991; Uusitupa et al. 1985\). One was a)Tj
0 -1.227 TD
-0.002 Tc
-0.129 Tw
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0 -1.182 TD
0.003 Tc
0.14 Tw
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0 -1.227 TD
0.069 Tw
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0 -1.182 TD
-0.111 Tw
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T*
0.11 Tw
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0 -1.227 TD
0.178 Tw
(95% CI, 0.4\3200.7\) \(Kaye et al. 1991\). Moderately)Tj
0 -1.182 TD
0.06 Tw
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0 -1.227 TD
-0.001 Tw
(95% CI, 0.5\3200.9\).)Tj
1.636 -1.182 TD
0.193 Tw
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-1.636 -1.227 TD
0.012 Tw
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-0.022 Tw
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T*
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23.909 25.182 TD
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0 -1.182 TD
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T*
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0 -1.227 TD
-0.049 Tw
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0.107 Tw
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-0.036 Tw
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0 -1.182 TD
0.229 Tw
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T*
0.057 Tw
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0 -1.227 TD
0.013 Tw
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0 -1.182 TD
-0.062 Tw
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0 -1.227 TD
0.001 Tw
(tal history of diabetes\) of developing NIDDM. This)Tj
0 -1.182 TD
-0.023 Tw
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T*
-0.056 Tw
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0 -1.227 TD
-0.104 Tw
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0 -1.182 TD
-0.058 Tw
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0 -1.227 TD
-0.012 Tw
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0 -1.182 TD
-0.124 Tw
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T*
-0.001 Tw
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0 -1.227 TD
0.005 Tw
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0 -1.182 TD
0.2 Tw
(Similar findings were observed between physical)Tj
0 -1.227 TD
0.092 Tw
(activity and incidence of NIDDM in a 5-year pro-)Tj
0 -1.182 TD
-0.072 Tw
(spective study of male physicians 40\32084 years of age)Tj
/F5 1 Tf
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0.005 Tc
0 Tw
[(T)60 (able 4-8.)-1321 (Cohort studies of association of physical activity with non\320insulin-d\
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5.7 -1.2 TD
(\(NIDDM\))Tj
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10 M
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48 368.25 m
1176 368.25 l
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/F5 1 Tf
10 0 0 10 264 353 Tm
[(Definition of)-11158 (Definition of)]TJ
ET
48 337.25 m
1176 337.25 l
S
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/F5 1 Tf
10 0 0 10 48 341 Tm
[(Study)-7130 (Population)-7224 (physical activity)-9658 (NIDDM)]TJ
/F9 1 Tf
0 -1.8 TD
[(Helmrich et al.)-3078 (Male college alumni)-3068 (Leisure-time physical activity)-4147 (Self-reported physician-)]TJ
0 -1.2 TD
[(\(1991\))-18789 (\(walking, stair climbing, and)-4427 (diagnosed diabetes)]TJ
21.6 -1.25 TD
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-21.6 -1.8 TD
[(Manson et al.)-3699 (Female nurses)-5824 (Single questions regarding number)-1742 (Self-reported diagnosed)]TJ
0 -1.25 TD
[(\(1991\))-18789 (of times per week of vigorous)-3982 (diabetes, confirmed by)]TJ
21.6 -1.25 TD
[(activity)-13649 (classic symptoms plus)]TJ
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0.001 Tw
(fasting plasma glucose)Tj
/F10 1 Tf
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(\263)Tj
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0 Tw
( 140 mg/dl; two elevated)Tj
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-38.4 -1.85 TD
-0.001 Tw
[(Manson et al.)-3699 (Male physicians)-4979 (Single questions regarding number)-1742 (Self-reported physician-)]TJ
0 -1.2 TD
0 Tw
[(\(1992\))-18789 (of times per week of vigorous)-3982 (diagnosed diabetes)]TJ
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0 Tr
0 g
0.006 Tc
(127)Tj
/F5 1 Tf
-0.136 63.727 TD
0.003 Tc
0 Tw
(The Effects of Physical Activity on Health and Disease)Tj
/F7 1 Tf
-21.591 -2.818 TD
0.169 Tw
(\(Manson et al. 1992\). Although the incidence of)Tj
0 -1.182 TD
-0.108 Tw
(diabetes was self-reported in these cohorts, concerns)Tj
T*
0.023 Tw
(about accuracy are somewhat mitigated by the fact)Tj
0 -1.227 TD
0.042 Tw
(that these were studies of health professionals and)Tj
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0.002 Tc
-0.128 Tw
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0 -1.227 TD
0.003 Tc
-0.019 Tw
(ies, two found an inverse dose-response gradient of)Tj
0 -1.182 TD
0.129 Tw
(physical activity and the development of NIDDM)Tj
T*
0 Tw
(\(Helmrich et al. 1991; Manson et al. 1992\).)Tj
1.636 -1.227 TD
-0.102 Tw
(In a feasibility study in Malmo, Sweden, physical)Tj
-1.636 -1.182 TD
0.24 Tw
(activity was included as part of an intervention)Tj
0 -1.227 TD
0.184 Tw
(strategy to prevent diabetes among persons with)Tj
0 -1.182 TD
-0.108 Tw
(impaired glucose tolerance \(Eriksson and Lindg\212rde)Tj
0 -1.227 TD
0.039 Tw
(1991\). At the end of 5 years of follow-up, twice as)Tj
0 -1.182 TD
0.133 Tw
(many in the control group as in the intervention)Tj
T*
0.015 Tw
(group had developed diabetes. The lack of random)Tj
0 -1.227 TD
0.014 Tc
0.258 Tw
(assignment of participants, however, limits the)Tj
0 -1.182 TD
0.003 Tc
-0.096 Tw
(generalizability of this finding. A study conducted in)Tj
0 -1.227 TD
-0.026 Tw
(Daqing, China, also included physical activity as an)Tj
0 -1.182 TD
-0.12 Tw
(intervention to prevent diabetes among persons with)Tj
T*
-0.111 Tw
[(impaired glucose tolerance \(Pan, Li, Hu 1995\). After)]TJ
0 -1.227 TD
-0.029 Tw
(6 years of follow-up, 8.3 cases per 100 person-years)Tj
0 -1.182 TD
-0.103 Tw
(occurred in the exercise intervention group and 15.7)Tj
0 -1.227 TD
0 Tw
(cases per 100 person-years in the control group.)Tj
25.591 26.409 TD
0.094 Tw
(It has been recommended that an appropriate)Tj
-1.636 -1.182 TD
0.215 Tw
(exercise program may be added to diet or drug)Tj
T*
0.098 Tw
(therapy to improve blood glucose control and re-)Tj
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-0.023 Tw
(duce certain cardiovascular risk factors among per-)Tj
0 -1.182 TD
-0.001 Tw
(sons with diabetes \(American Diabetes Association)Tj
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-0.083 Tw
(1990\). Diet and exercise have been found to be most)Tj
0 -1.182 TD
0.192 Tw
(effective for controlling NIDDM in persons who)Tj
T*
0.101 Tw
(have mild disease and are not taking medications)Tj
0 -1.227 TD
0.039 Tw
(\(Barnard, Jung, Inkeles 1994\). However, excessive)Tj
0 -1.182 TD
-0.017 Tw
(physical activity can sometimes cause persons with)Tj
0 -1.227 TD
0.191 Tw
(diabetes \(particularly those who take insulin for)Tj
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0.2 Tw
[(blood glucose control\) to expe)16 (rience )10 (detrimental)]TJ
T*
-0.005 Tc
-0.107 Tw
(effects, such as worsening of hyperglycemia and keto-)Tj
0 -1.227 TD
0.172 Tw
(sis from poorly controlled diabetes, hypoglycemia)Tj
0 -1.182 TD
0.244 Tw
(\(insulin-reaction\) either during vigorous physical)Tj
0 -1.227 TD
0.222 Tw
(activity or\321more commonly\321several hours after)Tj
0 -1.182 TD
-0.044 Tw
(prolonged physical activity, complications from pro-)Tj
T*
-0.039 Tw
(liferative retinopathy \(e.g., detached retina\), compli-)Tj
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0.103 Tw
(cations from superficial foot injuries, and a risk of)Tj
0 -1.182 TD
-0.055 Tw
(myocardial infarction and sudden death, particularly)Tj
0 -1.227 TD
-0.037 Tw
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0 -1.182 TD
0.097 Tw
(silent, coronary atherosclerosis. These risks can be)Tj
T*
0.003 Tc
-0.019 Tw
(minimized by a preexercise medical evaluation and)Tj
0 -1.227 TD
-0.005 Tc
-0.021 Tw
[(b)-8 (y)-3 ( taking proper precautions \(Leon 1989, 1992\). To)]TJ
ET
0 G
1 i
0 J
0 j
0.5 w
10 M
[]0 d
-564 368.25 m
564 368.25 l
S
BT
/F5 1 Tf
10 0 0 10 288 353 Tm
0.005 Tc
0 Tw
[(Dose)-4055 (Adjustment for confounder)]TJ
ET
-564 337.25 m
564 337.25 l
S
BT
/F5 1 Tf
10 0 0 10 66 341 Tm
0.002 Tw
[(Main findings)-16204 (response)]TJ
/F9 1 Tf
7 0 0 7 327 344 Tm
(*)Tj
/F5 1 Tf
10 0 0 10 351 341 Tm
0 Tw
(and other comments)Tj
/F9 1 Tf
-28.5 -1.8 TD
[(0.94 \(95% CI, 0.90\3200.98\) or 6% decrease in)-2980 (Y)65 (e)0 (s)-4851 (Adjusted for age, BMI, hypertension)]TJ
0 -1.2 TD
[(NIDDM for each 500 kcal increment)-12441 (history)74 (, parental history of diabetes)]TJ
0 -3.05 TD
(0.84 \(95% CI, 0.75\3200.94\) for )Tj
/F10 1 Tf
12.8 0 TD
(\263)Tj
/F9 1 Tf
0.55 0 TD
[( 1 time)-5814 (No)-4955 (Adjusted for age, BMI, family history)]TJ
-13.35 -1.25 TD
[(per week vs. < 1 time per week)-14852 (of diabetes, smoking, alcohol consumption,)]TJ
T*
[(vigorous activity)-21358 (hypertension history)75 (, cholesterol history)52 (,)]TJ
28.5 -1.2 TD
(family of history coronary heart disease)Tj
-28.5 -8 TD
(0.71 \(95% CI, 0.54\3200.94\) for )Tj
/F10 1 Tf
12.8 0 TD
(\263)Tj
/F9 1 Tf
0.55 0 TD
[( 1 time per)-4128 (Y)65 (e)0 (s)-4851 (Adjusted for age, BMI, smoking, alcohol)]TJ
-13.35 -1.2 TD
[(week vs. < 1 time per week vigorous)-12546 (consumption, reported blood pressure,)]TJ
0 -1.25 TD
[(activity)-25349 (hypertension history)75 (, cholesterol history)52 (,)]TJ
ET
-564 122.75 m
564 122.75 l
S
BT
/F9 1 Tf
10 0 0 10 351 127 Tm
[(parental history of myocardial infar)-6 (ction)]TJ
8 0 0 8 66 110.5 Tm
0.01 Tc
(Abbreviations: BMI = body mass index \(wt [kg]/ht [m])Tj
4.7 0 0 4.7 255 113 Tm
(2)Tj
8 0 0 8 257.5 110.5 Tm
( \); CI = confidence interval.)Tj
-23.937 -1.687 TD
-0.002 Tw
(*A dose-response relationship requires more than 2 levels of comparison.\
In this column, \322NA\323 means that there were only 2 levels of)Tj
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0 Tw
[(comparison; \322No\323 means that there were more than 2 levels but no d\
ose-response gradient was found; \322Y)102 (es\323 means that there were)]TJ
T*
(more than 2 levels and a dose-response gradient was found.)Tj
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0 Tr
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0.006 Tc
(128)Tj
/F5 1 Tf
-21.864 63.727 TD
0.003 Tc
-0.001 Tw
(Physical Activity and Health)Tj
/F7 1 Tf
0 -2.818 TD
-0.005 Tc
0.025 Tw
(reduce risk of hypoglycemic episodes, persons with)Tj
0 -1.182 TD
-0.094 Tw
(diabetes who take insulin or oral hypoglycemic drugs)Tj
T*
0.019 Tw
(must closely monitor their blood glucose levels and)Tj
0 -1.227 TD
0.006 Tw
(make appropriate adjustments in insulin or oral hy-)Tj
0 -1.182 TD
0.027 Tw
(poglycemic drug dosage, food intake, and timing of)Tj
0 -1.227 TD
-0.001 Tw
(physical activity sessions.)Tj
/F5 1 Tf
12 0 0 12 48 616.5 Tm
0 Tc
0 Tw
(Biologic Plausibility)Tj
/F7 1 Tf
11 0 0 11 48 602 Tm
0.013 Tc
0.216 Tw
(Numerous reviews of the short- and long-term)Tj
T*
0.003 Tc
-0.053 Tw
[(e)-10 (f)-17 (fects of physical activity on carbohydrate metabo-)]TJ
0 -1.182 TD
-0.019 Tw
(lism and glucose tolerance describe the physiologi-)Tj
0 -1.227 TD
-0.007 Tc
-0.129 Tw
(cal basis for a relationship \(Bj\232rntorp and Krotkiewski)Tj
0 -1.182 TD
0.027 Tc
0.259 Tw
(1985; Koivisto, Yki-J\212rvinen, DeFronzo 1986;)Tj
T*
0.013 Tc
(Lampman and Schteingart 1991; Horton 1991;)Tj
0 -1.227 TD
0.005 Tc
(Wallberg-Henriksson 1992; Leon 1992; Richter,)Tj
0 -1.182 TD
0.003 Tc
0.238 Tw
(Ruderman, Schneider 1981; Harris et al. 1987\).)Tj
0 -1.227 TD
-0.043 Tw
(During a single prolonged session of physical activ-)Tj
0 -1.182 TD
0.107 Tw
(ity, contracting skeletal muscle appears to have a)Tj
T*
-0.032 Tw
(synergistic effect with insulin in enhancing glucose)Tj
0 -1.227 TD
-0.118 Tw
(uptake into the cells. This effect appears to be related)Tj
0 -1.182 TD
0.192 Tw
(to both increased blood flow in the muscle and)Tj
0 -1.227 TD
0.162 Tw
(enhanced glucose transport into the muscle cell.)Tj
0 -1.182 TD
-0.003 Tw
(This enhancement persists for 24 hours or more as)Tj
T*
-0.066 Tw
(glycogen levels in the muscle are being replenished.)Tj
0 -1.227 TD
-0.104 Tw
(Such observations suggest that many of the effects of)Tj
0 -1.182 TD
-0.003 Tw
(regular physical activity are due to the overlapping)Tj
0 -1.227 TD
0.08 Tw
(effects of individual physical activity sessions and)Tj
0 -1.182 TD
0.113 Tw
(are thus independent of long-term adaptations to)Tj
T*
0.104 Tw
(exercise training or changes in body composition)Tj
0 -1.227 TD
0 Tw
(\(Harris et al. 1987\).)Tj
1.636 -1.182 TD
0.24 Tw
(In general, studies of exercise training have)Tj
-1.636 -1.227 TD
-0.006 Tc
-0.129 Tw
(suggested that physical activity helps prevent NIDDM)Tj
0 -1.182 TD
0.003 Tc
-0.127 Tw
(by increasing sensitivity to insulin \(Saltin et al. 1979;)Tj
0 -1.227 TD
0.007 Tc
0.259 Tw
(Lindg\212rde, Malmquist, Balke 1983; Krotkiewski)Tj
0 -1.182 TD
0.003 Tc
0.17 Tw
(1983; Trovati et al. 1984; Schneider et al. 1984;)Tj
T*
0.049 Tw
(R\232nnemaa et al. 1986\). These studies suggest that)Tj
0 -1.227 TD
-0.077 Tw
(physical activity is more likely to improve abnormal)Tj
0 -1.182 TD
-0.093 Tw
(glucose tolerance when the abnormality is primarily)Tj
0 -1.227 TD
-0.003 Tw
(caused by insulin resistance than when it is caused)Tj
0 -1.182 TD
0.001 Tc
-0.127 Tw
(by deficient amounts of circulating insulin \(Holloszy)Tj
T*
0.003 Tc
0.079 Tw
(et al. 1986\). Thus, physical activity is likely to be)Tj
0 -1.227 TD
0.207 Tw
(most beneficial in preventing the progression of)Tj
0 -1.182 TD
0.245 Tw
(NIDDM during the earlier stages of the disease)Tj
0 -1.227 TD
-0.111 Tw
(process, before insulin therapy is required. Evidence)Tj
0 -1.182 TD
0.136 Tw
(supporting this theory includes intervention pro-)Tj
T*
-0.081 Tw
(grams that promote physical activity together with a)Tj
0 -1.227 TD
0 Tc
-0.128 Tw
(low-fat diet high in complex carbohydrates \(Barnard,)Tj
0 -1.182 TD
0.003 Tc
0.016 Tw
(Jung, Inkeles 1994\) or programs that promote diet)Tj
23.955 56.727 TD
-0.11 Tw
(alone \(Nagulesparan et al. 1981\). These studies have)Tj
0 -1.182 TD
0.017 Tw
(shown that diet and physical activity interventions)Tj
T*
0.083 Tw
(are much less beneficial for persons with NIDDM)Tj
0 -1.227 TD
0.009 Tw
(who require insulin therapy than for those who do)Tj
0 -1.182 TD
-0.021 Tw
(not yet take any medication or those who take only)Tj
0 -1.227 TD
0 Tw
(oral medications for blood glucose control.)Tj
1.636 -1.182 TD
0.219 Tw
(Cross-sectional studies also show that, com-)Tj
-1.636 -1.227 TD
-0.043 Tw
(pared with their sedentary counterparts, endurance)Tj
0 -1.182 TD
0.093 Tw
(athletes and exercise-trained animals have greater)Tj
T*
0.034 Tw
(insulin sensitivity, as evidenced by a lower plasma)Tj
0 -1.227 TD
0.135 Tw
(insulin concentration at a similar plasma glucose)Tj
0 -1.182 TD
-0.011 Tw
(concentration, and increased )Tj
6.4 0 0 6.4 446.5 569.5 Tm
(I21)Tj
11 0 0 11 455.5 566 Tm
(I-insulin binding to)Tj
-13.091 -1.227 TD
0.18 Tw
(white blood cells and adipocytes \(Koivisto et al.)Tj
0 -1.182 TD
0.07 Tw
[(1979\). Insulin sensitivity and rate of glucose dis-)]TJ
T*
-0.05 Tw
(posal are related to cardiorespiratory fitness even in)Tj
0 -1.227 TD
-0.124 Tw
(older persons \(Hollenbeck et al. 1984\). Resistance or)Tj
0 -1.182 TD
-0.03 Tw
(strength-training exercise has also been reported to)Tj
0 -1.227 TD
-0.018 Tw
(have beneficial effects on glucose-insulin dynamics)Tj
0 -1.182 TD
-0.011 Tw
(in some, but not all, studies involving persons who)Tj
T*
0.026 Tw
(do not have diabetes \(Goldberg 1989; Kokkinos et)Tj
0 -1.227 TD
0.159 Tw
(al. 1988\). Much of the effect of physical activity)Tj
0 -1.182 TD
0.139 Tw
(appears to be due to the metabolic adaptation of)Tj
0 -1.227 TD
0.235 Tw
(skeletal muscle. However, exercise training may)Tj
0 -1.182 TD
-0.005 Tc
-0.093 Tw
[(contribute to improved glucose disposal and glucose)-6 (-)]TJ
T*
0.003 Tc
0.19 Tw
(insulin dynamics in both adipose tissue and the)Tj
0 -1.227 TD
-0.054 Tw
(working skeletal muscles \(Leon 1989, 1992; Gudat,)Tj
0 -1.182 TD
0 Tw
(Berger, Lef\217bvre 1994; Horton 1991\).)Tj
1.636 -1.227 TD
-0.007 Tw
(In addition, exercise training may reduce other)Tj
-1.636 -1.182 TD
0.246 Tw
(risk factors for atherosclerosis \(e.g., blood lipid)Tj
0 -1.227 TD
-0.117 Tw
(abnormalities and elevated blood pressure levels\), as)Tj
0 -1.182 TD
0.139 Tw
(discussed previously in this chapter, and thereby)Tj
T*
-0.117 Tw
(decrease the risk of macrovascular or atherosclerotic)Tj
0 -1.227 TD
0 Tw
(complications of diabetes \(Leon 1991a\).)Tj
1.636 -1.182 TD
-0.113 Tw
(Lastly, physical activity may prevent or delay the)Tj
-1.636 -1.227 TD
-0.127 Tw
(onset of NIDDM by reducing total body fat or specifi-)Tj
0 -1.182 TD
0.124 Tw
(cally intra-abdominal fat, a known risk factor for)Tj
0 -1.227 TD
-0.077 Tw
(insulin resistance. As discussed later in this chapter,)Tj
0 -1.182 TD
-0.053 Tw
(physical activity is inversely associated with obesity)Tj
T*
0.248 Tw
(and intra-abdominal fat distribution, and recent)Tj
0 -1.227 TD
-0.123 Tw
(studies have demonstrated that physical training can)Tj
0 -1.182 TD
0.075 Tw
(reduce these body fat stores \(Bj\232rntorp, Sj\232str\232m,)Tj
0 -1.227 TD
0.002 Tc
-0.127 Tw
(Sullivan 1979; Brownell and Stunkard 1980; Despr\216s)Tj
0 -1.182 TD
0.003 Tc
0 Tw
(et al. 1988; Krotkiewski 1988\).)Tj
/F5 1 Tf
12 0 0 12 311.5 128 Tm
0 Tc
(Conclusions)Tj
/F7 1 Tf
11 0 0 11 311.5 113 Tm
0.013 Tc
0.121 Tw
(The epidemiologic literature strongly supports a)Tj
T*
0.041 Tw
(protective effect of physical activity on the likeli-)Tj
0 -1.227 TD
0.204 Tw
(hood of developing NIDDM in the populations)Tj
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(The Effects of Physical Activity on Health and Disease)Tj
/F7 1 Tf
-21.591 -2.818 TD
0.004 Tc
-0.106 Tw
[(stud)-24 (ied. Several plausible biologic mechanisms exist)]TJ
0 -1.182 TD
0.003 Tc
0.23 Tw
(to explain this effect. Physical activity may also)Tj
T*
0.028 Tw
(reduce the risk of developing NIDDM in groups of)Tj
0 -1.227 TD
0.197 Tw
(people with impaired glucose tolerance, but this)Tj
0 -1.182 TD
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/F5 1 Tf
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/F7 1 Tf
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0.003 Tc
-0.098 Tw
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T*
-0.008 Tw
(characterized by both degeneration of cartilage and)Tj
0 -1.227 TD
0.102 Tw
(new growth of bone around the joint. Because its)Tj
0 -1.182 TD
0.073 Tw
(prevalence increases with age, osteoarthritis is the)Tj
0 -1.227 TD
0.241 Tw
(leading cause of activity limitation among older)Tj
0 -1.182 TD
-0.002 Tw
(persons. The etiology of osteoarthritis is unknown,)Tj
T*
-0.056 Tw
(and the risk factors and pathogenesis of osteoarthri-)Tj
0 -1.227 TD
0 Tw
(tis differ for each joint group.)Tj
1.636 -1.182 TD
0.005 Tc
0.259 Tw
(Whether an active lifestyle offers protection)Tj
-1.636 -1.227 TD
(against the development of osteoarthritis is not)Tj
0 -1.182 TD
0.003 Tc
-0.064 Tw
(known, but studies have examined the risk of devel-)Tj
0 -1.227 TD
0.242 Tw
(oping it in relation to specific athletic pursuits.)Tj
0 -1.182 TD
-0.007 Tc
-0.129 Tw
(Cross-sectional studies have associated competitive\321)Tj
T*
0.005 Tc
0.03 Tw
[(as opposed to recreational)8 (\321running at high levels)]TJ
0 -1.227 TD
0.003 Tc
0.109 Tw
(and for long periods with the development of os-)Tj
0 -1.182 TD
-0.031 Tw
(teoarthritis seen on x-rays \(Marti and Minder 1989;)Tj
0 -1.227 TD
0.006 Tw
(Kujala, Kaprio, Sarna 1994; Kujala et al. 1995\). On)Tj
0 -1.182 TD
0.247 Tw
(the other hand, both cross-sectional and cohort)Tj
T*
0.026 Tw
(studies have suggested that persons who engage in)Tj
0 -1.227 TD
-0.028 Tw
(recreational running over long periods of time have)Tj
0 -1.182 TD
-0.083 Tw
(no more risk of developing osteoarthritis of the knee)Tj
0 -1.227 TD
-0.103 Tw
(or hip than sedentary persons \(Lane 1995; Lane et al.)Tj
0 -1.182 TD
-0.008 Tw
(1986, 1993; Panush et al. 1995; Panush et al. 1986;)Tj
T*
0.022 Tw
(Panush and Lane 1994\). There is also currently no)Tj
0 -1.227 TD
0.101 Tw
(evidence that persons with normal joints increase)Tj
0 -1.182 TD
0 Tw
(their risk of osteoarthritis by walking.)Tj
1.636 -1.227 TD
0.013 Tc
0.256 Tw
(Studies of competitive athletes suggest that)Tj
-1.636 -1.182 TD
0.025 Tc
0.259 Tw
(some sports\321specifically soccer, football, and)Tj
0 -1.227 TD
0.013 Tc
0 Tw
(weight lifting\321are associated with developing os-)Tj
0 -1.182 TD
0.198 Tw
(teoarthritis of the joints of the lower extremity)Tj
T*
0.163 Tw
(\(Kujala, Kaprio, Sarna 1994; Kujala et al. 1995;)Tj
0 -1.227 TD
0.023 Tc
0.259 Tw
(Rall, McElroy, Keats 1964; Vincelette, Laurin,)Tj
0 -1.182 TD
0.013 Tc
0.159 Tw
(L\216vesque 1972; Lindberg, Roos, G\212rdsell 1993\).)Tj
0 -1.227 TD
0.095 Tw
(Other competitive sports activities in which spe-)Tj
0 -1.182 TD
0.219 Tw
(cific joints are used excessively have also been)Tj
T*
0.012 Tw
(associated with the development of osteoarthritis.)Tj
0 -1.227 TD
-0.075 Tw
(For example, baseball pitchers are reported to have)Tj
0 -1.182 TD
0.023 Tc
0.146 Tw
(an increased prevalence of osteoarthritis in the)Tj
0 -1.227 TD
0.068 Tw
(elbow and shoulder joint \(Adams 1965; Bennett)Tj
0 -1.182 TD
0.241 Tw
(1941\). These studies are limited because they)Tj
23.955 56.636 TD
0.013 Tc
0.115 Tw
[(i)-10 (n)6 (volve small sample sizes. Further confounding)]TJ
0 -1.182 TD
0.185 Tw
(these studies is the high incidence of fractures,)Tj
T*
-0.021 Tw
(ligamentous and cartilage injuries, and other inju-)Tj
0 -1.227 TD
0.021 Tw
(ries to joints that occur with greater-than-average)Tj
0 -1.182 TD
-0.054 Tw
(frequency among competitive participants in these)Tj
0 -1.227 TD
-0.123 Tw
(sports. Because joint injury is a strong risk factor for)Tj
0 -1.182 TD
-0.082 Tw
(the development of osteoarthritis, it may not be the)Tj
T*
0.018 Tw
(physical activity but rather the associated injuries)Tj
0 -1.227 TD
0.035 Tw
(that cause osteoarthritis in these competitive ath-)Tj
0 -1.182 TD
0.117 Tw
(letes. In a study by Roos and colleagues \(1994\),)Tj
0 -1.227 TD
0.021 Tw
(soccer players who had not suffered knee injuries)Tj
0 -1.182 TD
-0.085 Tw
(had no greater prevalence of osteoarthritis than did)Tj
T*
-0.054 Tw
(sedentary controls. Regular noncompetitive physi-)Tj
0 -1.227 TD
0.186 Tw
(cal activity of the amount and intensity recom-)Tj
0 -1.182 TD
-0.055 Tw
(mended for improving health thus does not appear)Tj
0 -1.227 TD
0 Tw
(harmful to joints that have no existing injury.)Tj
/F5 1 Tf
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0 Tc
(Physical Activity in Persons with Arthritis)Tj
/F7 1 Tf
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0.003 Tc
0.064 Tw
(Given the high prevalence of osteoarthritis among)Tj
T*
0.049 Tw
(older people, it is important to determine whether)Tj
0 -1.182 TD
0.196 Tw
(persons with arthritis can safely exercise and be)Tj
0 -1.227 TD
0.048 Tw
(physically active. Experimental work with animals)Tj
0 -1.182 TD
-0.08 Tw
(shows that use of injured joints inhibits tissue repair)Tj
T*
0.019 Tw
(\(Buckwalter 1995\). More specifically, several stud-)Tj
0 -1.227 TD
0.228 Tw
(ies have indicated that running accelerates joint)Tj
0 -1.182 TD
0.068 Tw
(damage in animal models where osteoarthritis has)Tj
0 -1.227 TD
-0.004 Tc
-0.129 Tw
(been experimentally induced \(Armstrong et al. 1993\).)Tj
1.636 -1.182 TD
0.003 Tc
-0.07 Tw
(In contrast, several short-term studies of human)Tj
-1.636 -1.227 TD
0.023 Tc
0.222 Tw
(subjects have indicated that regular moderate-)Tj
0 -1.182 TD
(exer)Tj
1.864 0 TD
0.003 Tc
0.204 Tw
(cise programs, whether including aerobic or)Tj
-1.864 -1.182 TD
0.059 Tw
(resistance training, relieve symptoms and improve)Tj
0 -1.227 TD
-0.046 Tw
(function among people with both osteoarthritis and)Tj
0 -1.182 TD
0.007 Tc
0.259 Tw
(rheumatoid arthritis \(Ettinger and Afable 1994;)Tj
0 -1.227 TD
0.003 Tc
-0.078 Tw
(Allegrante et al. 1993; Fisher et al. 1991; Fisher et al.)Tj
0 -1.182 TD
-0.071 Tw
(1994; Fisher and Pendergast 1994; Puett and Griffin)Tj
T*
0.125 Tw
(1994\). For example, it has been shown that after)Tj
0 -1.227 TD
-0.056 Tw
(regular physical activity, persons with arthritis have)Tj
0 -1.182 TD
-0.073 Tw
(a significant reduction in joint swelling \(Minor et al.)Tj
0 -1.227 TD
-0.013 Tw
(1988\). In other studies of persons with osteoarthri-)Tj
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-0.019 Tw
(tis, increased levels of physical activity were associ-)Tj
T*
0.021 Tw
(ated with improved psychosocial status, functional)Tj
0 -1.227 TD
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(status, and physical fitness \(Minor 1991; Minor and)Tj
0 -1.182 TD
-0.007 Tw
[(Brown 1993\). Furthermore, regular physical activ-)]TJ
0 -1.227 TD
-0.047 Tw
(ity of moderate intensity has been found to raise the)Tj
0 -1.182 TD
0.034 Tw
(pain threshold, improve energy level, and improve)Tj
T*
0.022 Tc
0.258 Tw
(self-efficacy among persons with osteoarthritis)Tj
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0.003 Tc
0.242 Tw
(\(Minor et al. 1989; Chow et al. 1986; Holman,)Tj
0 -1.182 TD
0.001 Tw
(Mazonson, Lorig 1989\).)Tj
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-0.085 Tw
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0 -1.182 TD
0.022 Tw
(loading on the metabolism of chondrocytes is not)Tj
0 -1.227 TD
0.249 Tw
(well described, but when loading is performed)Tj
0 -1.182 TD
0.008 Tc
-0.127 Tw
(within the physiologic range, chondrocytes increase)Tj
T*
0.013 Tc
-0.091 Tw
(proteoglycan synthesis \(Grodzinsky 1993\). In con-)Tj
0 -1.227 TD
0.149 Tw
(trast, high-intensity loading and repetitive high-)Tj
0 -1.182 TD
0.011 Tc
-0.128 Tw
(impact loads disrupt the cartilage matrix and inhibit)Tj
0 -1.227 TD
0.013 Tc
-0.001 Tw
(proteoglycan synthesis \(Lammi 1993\).)Tj
1.636 -1.182 TD
0.003 Tc
0.016 Tw
(The role of normal loading is confirmed by the)Tj
-1.636 -1.227 TD
-0.044 Tw
(effect of inactivity on articular cartilage. Immobility)Tj
0 -1.182 TD
-0.007 Tw
(leads to decreased cartilage proteoglycan synthesis,)Tj
T*
0.238 Tw
(increased water content, and decreased cartilage)Tj
0 -1.227 TD
0.009 Tw
(stiffness and thickness. Disuse may make the carti-)Tj
0 -1.182 TD
-0.111 Tw
(lage more vulnerable to injury, and prolonged disuse)Tj
0 -1.227 TD
0.189 Tw
(causes loss of normal joint function as the joint)Tj
0 -1.182 TD
0 Tw
(cavity is obliterated by fibrous tissue.)Tj
1.636 -1.227 TD
-0.106 Tw
(Studies of running on joint function in dogs with)Tj
-1.636 -1.182 TD
0.21 Tw
(normal joints have confirmed that running does)Tj
T*
-0.124 Tw
(affect the proteoglycan and water content of cartilage)Tj
0 -1.227 TD
0.05 Tw
(and does not lead to degeneration of articular sur-)Tj
0 -1.182 TD
-0.083 Tw
(faces or to degenerative joint disease \(Arokoski et al.)Tj
0 -1.227 TD
-0.021 Tw
(1993\). In contrast, in dogs with injured joints, run-)Tj
0 -1.182 TD
-0.009 Tw
(ning has been shown to cause arthritis \(Buckwalter)Tj
T*
(1995\).)Tj
/F5 1 Tf
12 0 0 12 48 205 Tm
0 Tc
(Conclusions)Tj
/F7 1 Tf
11 0 0 11 48 190 Tm
0.013 Tc
0.161 Tw
(Physical activity is essential for maintaining the)Tj
0 -1.227 TD
0.153 Tw
(health of joints and appears to be beneficial for)Tj
0 -1.182 TD
0.055 Tw
(control of symptoms among people with osteoar-)Tj
T*
-0.049 Tw
(thritis. Although there is no evidence that physical)Tj
0 -1.227 TD
0.218 Tw
(activity itself causes osteoarthritis, injuries sus-)Tj
0 -1.182 TD
-0.033 Tw
(tained during competitive sports have been shown)Tj
0 -1.227 TD
0 Tw
(to increase the risk of developing osteoarthritis.)Tj
/F5 1 Tf
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-0.002 Tc
(Osteoporosis)Tj
/F7 1 Tf
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0.003 Tc
0.238 Tw
(Osteoporosis is characterized by decreased bone)Tj
0 -1.182 TD
0.191 Tw
(mass and structural deterioration of bone tissue,)Tj
0 -1.227 TD
-0.072 Tw
(leading to bone fragility and increased susceptibility)Tj
0 -1.182 TD
0.083 Tw
(to fractures. Because bone mass and strength pro-)Tj
T*
0.07 Tw
(gressively decline with advancing age, this disease)Tj
0 -1.227 TD
0.182 Tw
(primarily affects older persons \(Cummings et al.)Tj
0 -1.182 TD
0 Tc
-0.129 Tw
[(1985\). Osteoporosis is more common among women)]TJ
0 -1.227 TD
0.003 Tc
-0.003 Tw
(than among men, for at least three reasons: women)Tj
0 -1.182 TD
0.024 Tw
(have lower peak bone mass than men, women lose)Tj
T*
0.112 Tw
(bone mass at an accelerated rate after menopause)Tj
0 -1.227 TD
0.152 Tw
(when estrogen levels decline, and women have a)Tj
0 -1.182 TD
0 Tw
(longer life span than men.)Tj
1.636 -1.227 TD
0.115 Tw
(The most common potential fracture sites are)Tj
-1.636 -1.182 TD
0.171 Tw
(vertebrae of the chest and lower back, the distal)Tj
0 -1.227 TD
0.143 Tw
(radius \(or wrist\), the hips, and the proximal hu-)Tj
0 -1.182 TD
0.152 Tw
(merus \(NIH 1984\). Vertebral fractures can occur)Tj
T*
-0.001 Tw
(spontaneously or with minimal trauma \(e.g., bend-)Tj
0 -1.227 TD
-0.07 Tw
(ing forward or coughing\); once deformed, the verte-)Tj
0 -1.182 TD
0.004 Tc
0.258 Tw
(brae never return to their normal shape. These)Tj
0 -1.227 TD
0.003 Tc
-0.05 Tw
(fractures may be asymptomatic and discovered only)Tj
0 -1.182 TD
-0.076 Tw
(incidentally on a chest or spine x-ray. Accumulation)Tj
T*
0.191 Tw
(of such vertebral fractures causes a bent-over or)Tj
0 -1.227 TD
0.178 Tw
(hunchbacked posture that is generally associated)Tj
0 -1.182 TD
-0.055 Tw
(with chronic back pain and often with gastrointesti-)Tj
0 -1.227 TD
-0.066 Tw
(nal and abdominal problems related to a lowering of)Tj
0 -1.182 TD
-0.001 Tw
(the rib cage.)Tj
1.636 -1.227 TD
-0.075 Tw
(In the United States, fractures of the hip account)Tj
-1.636 -1.182 TD
0.201 Tw
(for 250,000 of the 1.5 million fractures that are)Tj
T*
0.076 Tw
(attributed each year to osteoporosis. Hip fractures)Tj
0 -1.227 TD
0.023 Tc
-0.034 Tw
(are associated with more deaths \(a 15\32020 percent)Tj
0 -1.182 TD
0.003 Tc
0.229 Tw
[(1)-20 (-)-31 (year mortality rate\), permanent disability, and)]TJ
0 -1.227 TD
0.096 Tw
(medical and institutional care costs than all other)Tj
0 -1.182 TD
0.055 Tw
(osteoporotic fractures combined \(Cummings et al.)Tj
T*
0.037 Tw
(1985; Rankin 1993\). By age 90, about one-third of)Tj
0 -1.227 TD
0.06 Tw
(women and about one-sixth of men will have sus-)Tj
0 -1.182 TD
0 Tw
(tained a hip fracture.)Tj
1.636 -1.227 TD
0.113 Tw
(In both men and women, the development of)Tj
-1.636 -1.182 TD
0.006 Tw
(osteoporosis may be related to three factors: a defi-)Tj
0 -1.227 TD
0.036 Tw
(cient level of peak bone mass at physical maturity,)Tj
0 -1.182 TD
0.031 Tw
(failure to maintain this peak bone mass during the)Tj
T*
0.063 Tw
(third and fourth decades of life, and the bone loss)Tj
0 -1.227 TD
-0.002 Tw
(that begins during the fourth or fifth decade of life.)Tj
0 -1.182 TD
0.139 Tw
(Physical activity may positively affect all three of)Tj
0 -1.227 TD
0.002 Tw
(these factors.)Tj
1.636 -1.182 TD
0.06 Tw
(Physical activity may play a substantial role in)Tj
-1.636 -1.227 TD
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(the development of bone mass during childhood and)Tj
0 -1.182 TD
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0.006 Tc
(131)Tj
/F5 1 Tf
-0.136 63.727 TD
0.003 Tc
0 Tw
(The Effects of Physical Activity on Health and Disease)Tj
/F7 1 Tf
-21.591 -2.818 TD
0.047 Tw
(as a young adult. This inference is partly based on)Tj
0 -1.182 TD
0.161 Tw
(findings that athletic young adults have a higher)Tj
T*
-0.089 Tw
(density of bone mineral than sedentary young adults)Tj
0 -1.227 TD
-0.015 Tc
-0.095 Tw
(\(Kirchner, Lewis, O\325Connor 1996; Grimston, Willows,)Tj
0 -1.182 TD
0.003 Tc
-0.099 Tw
(Hanley 1993; Conroy et al. 1993; Nichols et al. 1994;)Tj
0 -1.227 TD
0.073 Tw
(Rubin et al. 1993\), on reports that athletes have a)Tj
0 -1.182 TD
0.033 Tw
(differential density of bones according to the sport)Tj
T*
-0.035 Tw
(they train for \(Robinson et al. 1995; Heinonen et al.)Tj
0 -1.227 TD
-0.094 Tw
(1995\), and on evidence that increase in bone mass in)Tj
0 -1.182 TD
0.224 Tw
(university students is related to higher levels of)Tj
0 -1.227 TD
0 Tw
(physical activity \(Recker et al. 1992\).)Tj
1.636 -1.182 TD
0.013 Tc
0.136 Tw
(Beyond this hypothesized function in youth,)Tj
-1.636 -1.227 TD
0.032 Tc
0.259 Tw
(physical activity plays a well-established role)Tj
0 -1.182 TD
0.015 Tc
-0.092 Tw
[(throughout )-28 (the life span in maintaining the normal)]TJ
T*
0.013 Tc
0.22 Tw
(structure and functional strength of bone. Pro-)Tj
0 -1.227 TD
0.18 Tw
(longed bed rest or immobility causes rapid and)Tj
0 -1.182 TD
-0.11 Tw
(marked reduction in bone mineral density \(Kr\277lner)Tj
0 -1.227 TD
-0.03 Tw
(et al. 1983; Chesnut 1993; Donaldson et al. 1970\).)Tj
0 -1.182 TD
-0.041 Tw
(Of particular public health interest is the degree to)Tj
T*
0.173 Tw
(which physical activity can prevent or slow the)Tj
0 -1.227 TD
0.198 Tw
(bone loss that begins occurring in women as a)Tj
0 -1.182 TD
0.108 Tw
(normal process after menopause. Cross-sectional)Tj
0 -1.227 TD
-0.106 Tw
(studies of postmenopausal women have shown that)Tj
0 -1.182 TD
0.222 Tw
(bone mineral density is correlated with muscle)Tj
T*
0.227 Tw
(strength \(Sinaki et al. 1986; Sinaki and Offord)Tj
0 -1.227 TD
0.065 Tw
(1988\), physical activity \(Sinaki and Offord 1988;)Tj
0 -1.182 TD
-0.097 Tw
(Shimegi et al 1994; Jacobson et al. 1984; Talmage et)Tj
0 -1.227 TD
-0.011 Tw
(al. 1986\), and cardiorespiratory fitness \(Pocock et)Tj
0 -1.182 TD
-0.091 Tw
(al. 1986; Chow et al. 1986\). Longitudinal studies of)Tj
T*
0.032 Tw
(postmenopausal women have attributed increases)Tj
0 -1.227 TD
-0.013 Tw
(in both cardiorespiratory fitness and bone mass to)Tj
0 -1.182 TD
0.082 Tw
(physical activity \(Chow et al. 1987; Dalsky et al.)Tj
0 -1.227 TD
-0.038 Tw
(1988\). There is some evidence that through physi-)Tj
0 -1.182 TD
0.01 Tc
-0.128 Tw
(cal activity, osteoporotic women can minimize bone)Tj
T*
0.013 Tc
-0.066 Tw
(loss or facilitate some gain in bone mineral content)Tj
0 -1.227 TD
0.012 Tw
(\(Kr\277lner et al. 1983; Kohrt et al. 1995\). However,)Tj
0 -1.182 TD
0.199 Tw
(other studies have failed to show such benefits)Tj
0 -1.227 TD
-0.075 Tw
(\(Nelson et al. 1991; Sandler et al. 1989; Cavanaugh)Tj
0 -1.182 TD
0.241 Tw
[(and Cann 1988\).)14 ( )13 (The intensity of the physical)]TJ
T*
-0.127 Tw
(activity and the degree to which it stresses the bones)Tj
0 -1.227 TD
-0.108 Tw
(may be crucial factors in determining whether bone)Tj
0 -1.182 TD
-0.051 Tw
(mass is maintained. Thus it is likely that resistance)Tj
0 -1.227 TD
0.084 Tw
(exercise may have more pronounced effects than)Tj
0 -1.182 TD
-0.04 Tw
(endurance exercise, although this has not yet been)Tj
T*
0.002 Tw
(unequivocally established.)Tj
1.636 -1.227 TD
0.003 Tc
0.068 Tw
(Several investigators have found that the posi-)Tj
-1.636 -1.182 TD
0.031 Tw
(tive effect of physical activity on the bones of both)Tj
0 -1.227 TD
-0.005 Tc
-0.129 Tw
(premenopausal and postmenopausal women depends)Tj
23.955 56.409 TD
0.003 Tc
0.232 Tw
(on the presence of estrogen. In postmenopausal)Tj
0 -1.182 TD
0.027 Tw
(women, greater gain in bone density accrues when)Tj
T*
0.029 Tw
(physical activity and estrogen replacement therapy)Tj
0 -1.227 TD
-0.1 Tw
(occur simultaneously \(Prince et al. 1991; Kohrt et al.)Tj
0 -1.182 TD
-0.003 Tw
(1995\). In young, premenopausal women, however,)Tj
0 -1.227 TD
(excessive amounts of vigorous training may lead to)Tj
0 -1.182 TD
-0.12 Tw
(a low estrogen level and secondary amenorrhea, with)Tj
T*
-0.032 Tw
(subsequent decreased bone mass and increased risk)Tj
0 -1.227 TD
-0.081 Tw
(of stress fractures \(Marcus et al. 1985; Drinkwater et)Tj
0 -1.182 TD
0.001 Tw
(al. 1984; Allen 1994\).)Tj
1.636 -1.227 TD
-0.117 Tw
(The exercise-associated changes in bone mineral)Tj
-1.636 -1.182 TD
0.087 Tw
(density observed over time among both premeno-)Tj
0 -1.227 TD
0.088 Tw
(pausal and postmenopausal women are much less)Tj
0 -1.182 TD
0.022 Tw
(pronounced than those differences observed cross-)Tj
T*
0.178 Tw
(sectionally between active and sedentary persons)Tj
0 -1.227 TD
-0.041 Tw
(\(Drinkwater 1993\). Cross-sectional studies demon-)Tj
0 -1.182 TD
0.004 Tw
(strate differences of 10\32015 percent in bone mineral)Tj
0 -1.227 TD
-0.039 Tw
(density at various sites \(Aloia et al. 1988; Lane et al.)Tj
0 -1.182 TD
-0.08 Tw
(1986; Michel, Bloch, Fries 1989; Recker et al. 1992\),)Tj
T*
0.013 Tc
-0.068 Tw
(whereas intervention studies show smaller gains of)Tj
0 -1.227 TD
0.003 Tc
-0.042 Tw
[(1)-23 (\3205 percent \(Kr\277lner et al. 1983; Dalsky et al. 1988;)]TJ
0 -1.182 TD
0.112 Tw
(Nelson et al. 1991; Pruitt et al. 1992; Drinkwater)Tj
0 -1.227 TD
-0.12 Tw
(1993\). These differences may be due to differences in)Tj
0 -1.182 TD
0.095 Tw
(comparison groups, to follow-up duration insuffi-)Tj
T*
-0.074 Tw
(cient to show large changes in bone mineral density,)Tj
0 -1.227 TD
-0.021 Tw
(or to measurement at different skeletal sites. Still to)Tj
0 -1.182 TD
-0.069 Tw
(be conducted are well-designed randomized clinical)Tj
0 -1.227 TD
0.247 Tw
(trials that are of sufficient size and duration to)Tj
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0.236 Tw
(determine definitively the longitudinal effects of)Tj
T*
0.023 Tc
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(physical activity change or the differential effects)Tj
0 -1.227 TD
0.003 Tc
-0.111 Tw
[(o)-20 (f)-23 ( resistance and endurance activity on bone mineral)]TJ
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(density.)Tj
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0 Tc
0 Tw
(Biologic Plausibility)Tj
/F7 1 Tf
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0.013 Tc
-0.013 Tw
(Bone is a dynamic tissue that is constantly remod-)Tj
T*
0.196 Tw
(eling its structure by resorption and formation.)Tj
0 -1.227 TD
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(Physical activity, through its load-bearing effect on)Tj
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0.134 Tw
(the skeleton, is likely the single most important)Tj
0 -1.227 TD
0.012 Tc
-0.128 Tw
(influence on bone density and architecture \(Lanyon)Tj
0 -1.182 TD
0.013 Tc
-0.102 Tw
(1996\). Bone cells respond to mechanical loading by)Tj
T*
-0.12 Tw
(improving the balance between bone formation and)Tj
0 -1.227 TD
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(bone resorption, which in turn builds greater bone)Tj
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(mass \(Lanyon 1987, 1993\). The higher the load, the)Tj
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0.019 Tw
(greater the bone mass; conversely, when the skel-)Tj
0 -1.182 TD
0.12 Tw
(eton is unloaded \(as with inactivity\), bone mass)Tj
T*
0.007 Tc
-0.128 Tw
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0 -1.227 TD
0.013 Tc
-0.091 Tw
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0 Tr
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0.006 Tc
(132)Tj
/F5 1 Tf
-21.864 63.727 TD
0.003 Tc
-0.001 Tw
(Physical Activity and Health)Tj
/F7 1 Tf
0 -2.818 TD
0.008 Tc
-0.127 Tw
(loading effect on bone \(Pitsillides et al. 1995; Turner)Tj
0 -1.182 TD
0.013 Tc
-0.001 Tw
(et al. 1995; Tang et al. 1995\). Because it is muscle)Tj
T*
-0.058 Tw
(that exerts the largest forces on bone during physi-)Tj
0 -1.227 TD
-0.07 Tw
(cal activity, the role of muscle mass and strength in)Tj
0 -1.182 TD
0.062 Tw
(maintaining skeletal integrity should be explored)Tj
0 -1.227 TD
-0.002 Tw
(more fully.)Tj
1.636 -1.182 TD
0.003 Tc
0.049 Tw
(Nonmechanical factors, such as age, hormonal)Tj
-1.636 -1.227 TD
0.029 Tw
(milieu, nutritional intake, and medications, are in-)Tj
0 -1.182 TD
0.081 Tw
(creasingly being recognized as important determi-)Tj
T*
0.012 Tw
(nants of the bone\325s response to mechanical loading)Tj
0 -1.227 TD
-0.093 Tw
(\(Lanyon 1996\). The relative contributions of each of)Tj
0 -1.182 TD
0.022 Tw
(these factors are currently under study and are not)Tj
0 -1.227 TD
0.172 Tw
[(yet clearly delineated. Animal studies confirm a)]TJ
0 -1.182 TD
0.061 Tw
(difference in bone response to mechanical loading)Tj
T*
0.106 Tw
(with age and by estrogen status \(Turner, Takano,)Tj
0 -1.227 TD
-0.053 Tw
(Owan 1995\). The potential clinical relevance of this)Tj
0 -1.182 TD
-0.006 Tw
(research is to better define the optimal amount and)Tj
0 -1.227 TD
0.012 Tw
(type of exercise for maintaining or increasing bone)Tj
0 -1.182 TD
0.101 Tw
(mass, particularly with aging or in the absence of)Tj
T*
0 Tw
(estrogen replacement therapy after menopause.)Tj
/F5 1 Tf
12 0 0 12 48 432 Tm
0 Tc
(Physical Activity and the)Tj
0 -1.208 TD
(Prevention of Fractures and Falling)Tj
/F7 1 Tf
11 0 0 11 48 402.5 Tm
0.013 Tc
0.024 Tw
(Studies of physical activity in relation to hip frac-)Tj
0 -1.182 TD
-0.059 Tw
(ture in women have generally found a lower risk of)Tj
0 -1.227 TD
0.098 Tw
(hip fracture among those who were more active.)Tj
0 -1.182 TD
0.003 Tw
(Three cohort studies have reported such a protec-)Tj
0 -1.227 TD
0.132 Tw
(tive effect. One showed a statistically significant)Tj
0 -1.182 TD
0.085 Tw
(protective effect among those reporting the most)Tj
T*
0.009 Tc
-0.127 Tw
(recreational activity at baseline \(Farmer et al. 1989\),)Tj
0 -1.227 TD
0.013 Tc
-0.045 Tw
(one showed inverse but not statistically significant)Tj
0 -1.182 TD
-0.019 Tw
(associations for both work and leisure-time physi-)Tj
0 -1.227 TD
-0.009 Tw
(cal activity \(Meyer, Tverdal, Falch 1993\), and one)Tj
0 -1.182 TD
-0.108 Tw
(showed a significant protective effect of walking for)Tj
T*
0.007 Tc
-0.127 Tw
(exercise \(Cummings et al. 1995\). Case-control stud-)Tj
0 -1.227 TD
0.013 Tc
0.231 Tw
(ies have been more equivocal. One such study)Tj
0 -1.182 TD
-0.114 Tw
(found a significant protective effect for two levels of)Tj
0 -1.227 TD
-0.005 Tw
(past activity, but for recent activity only moderate)Tj
0 -1.182 TD
-0.064 Tw
(amounts of activity showed a significant protective)Tj
T*
0.062 Tw
[(effect \(Jaglal, Kreiger, Darlington 1993\).)14 ( )16 (Another)]TJ
0 -1.227 TD
0.024 Tc
0.259 Tw
(case-control study showed inconsistent effects)Tj
0 -1.182 TD
0.013 Tc
0.047 Tw
(across a variety of physical activity classifications)Tj
0 -1.227 TD
0 Tw
(\(Cumming and Klineberg 1994\).)Tj
1.636 -1.182 TD
0.189 Tw
(Nonskeletal factors that increase the risk of)Tj
-1.636 -1.227 TD
0.027 Tw
(fractures due to falls include limitations in activi-)Tj
0 -1.182 TD
0.001 Tw
(ties of daily living \(e.g., dressing and feeding one-)Tj
T*
0.21 Tw
(self\); compromised gait, balance, reaction time,)Tj
23.955 55.636 TD
0.036 Tw
(and muscle strength; impaired vision; medication)Tj
0 -1.182 TD
-0.051 Tw
(use; and environmental hazards \(Dunn et al. 1992;)Tj
T*
0.005 Tc
-0.128 Tw
(Gilligan, Checovich, Smith 1993; Tinetti, Speechley,)Tj
0 -1.227 TD
0.013 Tc
-0.067 Tw
(Ginter 1988; Cummings et al. 1995\). Various exer-)Tj
0 -1.182 TD
0.047 Tw
(cises may help prevent falls by improving muscle)Tj
0 -1.227 TD
0.143 Tw
[(strength, functional capacity, gait, balance, and)]TJ
0 -1.182 TD
0.009 Tc
-0.128 Tw
(reaction time. Tinetti and colleagues \(1994\) showed)Tj
T*
0.006 Tc
-0.092 Tw
[(a )-9 (significant )-5 (decrease in falls in the elderly concomi-)]TJ
0 -1.227 TD
-0.006 Tc
-0.13 Tw
(tant with an improvement in balance and gait achieved)Tj
0 -1.182 TD
0.003 Tc
0.126 Tw
(through exercise. Province and colleagues \(1995\))Tj
0 -1.227 TD
0.002 Tc
-0.128 Tw
(demonstrated a protective effect against falls through)Tj
0 -1.182 TD
0.003 Tc
0.012 Tw
(general exercise and exercises designed to improve)Tj
T*
-0.073 Tw
(balance. Moreover, Fiatarone and colleagues \(1994\))Tj
0 -1.227 TD
-0.066 Tw
(have shown that even frail elderly persons who have)Tj
0 -1.182 TD
-0.038 Tw
(multiple chronic diseases benefit substantially from)Tj
0 -1.227 TD
0.203 Tw
(resistance training. This well-controlled random-)Tj
0 -1.182 TD
0.045 Tw
(ized trial demonstrated the importance of strength)Tj
T*
0.013 Tc
0.115 Tw
(training in improving stair-climbing power, gait,)Tj
0 -1.227 TD
0.003 Tc
-0.024 Tw
[(a)-10 (n)-10 (d)-25 ( other measures of physical function. Moderate)]TJ
0 -1.182 TD
0.012 Tc
-0.074 Tw
[(exer)24 (cise-training techniques, such as tai chi chuan,)]TJ
0 -1.227 TD
0.013 Tc
0.133 Tw
(have also been shown to decrease falling and to)Tj
0 -1.182 TD
0.042 Tw
(improve function in older adults by increasing or)Tj
T*
0.04 Tw
(maintaining aerobic power, strength, and balance)Tj
0 -1.227 TD
0.097 Tw
(\(Lai et al. 1995; Wolf et al. 1996; Wolfson et al.)Tj
0 -1.182 TD
(1996\).)Tj
/F5 1 Tf
12 0 0 12 311.5 366 Tm
0 Tc
(Conclusions)Tj
/F7 1 Tf
11 0 0 11 311.5 351 Tm
0.003 Tc
-0.028 Tw
(Physical activity appears to build greater bone mass)Tj
T*
0.234 Tw
(in childhood and early adolescence and to help)Tj
0 -1.227 TD
0.258 Tw
(maintain peak bone mass in adulthood. Among)Tj
0 -1.182 TD
-0.032 Tw
(women after menopause, physical activity may pro-)Tj
0 -1.227 TD
0.208 Tw
(tect against the rapid decline in bone mass, but)Tj
0 -1.182 TD
0.17 Tw
(findings are inconsistent in this regard, and it is)Tj
T*
0.018 Tw
(unclear whether muscle-strengthening \(resistance\))Tj
0 -1.227 TD
-0.068 Tw
(activity may be more effective than endurance activ-)Tj
0 -1.182 TD
0.052 Tw
(ity for this purpose. Estrogen replacement therapy)Tj
0 -1.227 TD
0.023 Tw
(has been shown conclusively to decrease bone loss)Tj
0 -1.182 TD
0.201 Tw
(after menopause, and there is evidence that this)Tj
T*
-0.092 Tw
(effect is enhanced with physical activity. However, it)Tj
0 -1.227 TD
0.071 Tw
(is not clear whether physical activity alone, in the)Tj
0 -1.182 TD
(absence of estrogen replacement therapy, can pre-)Tj
0 -1.227 TD
0.001 Tw
(vent bone loss.)Tj
1.636 -1.182 TD
0.023 Tw
(Physical activity, including muscle-strengthen-)Tj
-1.636 -1.227 TD
0.126 Tw
(ing \(resistance\) exercise, appears to be protective)Tj
0 -1.182 TD
-0.116 Tw
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T*
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(ably by increasing muscle strength and balance.)Tj
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0 Tr
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0.006 Tc
(133)Tj
/F5 1 Tf
-0.136 63.727 TD
0.003 Tc
0 Tw
(The Effects of Physical Activity on Health and Disease)Tj
14 0 0 14 66 709 Tm
-0.002 Tc
(Obesity)Tj
/F7 1 Tf
11 0 0 11 66 693 Tm
0.003 Tc
-0.106 Tw
(Obesity, a major public health problem in the United)Tj
0 -1.182 TD
0.137 Tw
(States, plays a central role in the development of)Tj
0 -1.227 TD
(diabetes mellitus \(West 1978\) and confers an in-)Tj
0 -1.182 TD
-0.023 Tw
(creased risk for CHD, high blood pressure, osteoar-)Tj
T*
0.006 Tc
0.259 Tw
(thritis, dyslipoproteinemia, various cancers, and)Tj
0 -1.227 TD
0.003 Tc
0.053 Tw
(all-cause mortality \(Hubert et al. 1983; Bray 1985;)Tj
0 -1.182 TD
-0.005 Tw
(Albanes 1987; Lee et al. 1993; Manson et al. 1995\).)Tj
0 -1.227 TD
-0.085 Tw
(The progressive weight gain often observed between)Tj
0 -1.182 TD
0.156 Tw
(the third and sixth decades of life may be partly)Tj
T*
0.052 Tw
(explained by age-related changes: although energy)Tj
0 -1.227 TD
-0.119 Tw
(intake tends to decline after the second decade of life,)Tj
0 -1.182 TD
0.24 Tw
(this decrease is insufficient to offset the greater)Tj
0 -1.227 TD
0.095 Tw
(decline in the amount of energy that most people)Tj
0 -1.182 TD
0.177 Tw
(expend throughout their adult years \(Bray 1983;)Tj
T*
0.045 Tw
(Federation of American Societies for Experimental)Tj
0 -1.227 TD
-0.096 Tw
(Biology 1995\). In addition to these age trends, popu-)Tj
0 -1.182 TD
0.011 Tw
(lation surveys indicate that the age-adjusted preva-)Tj
0 -1.227 TD
0.21 Tw
(lence of overweight among adults in the United)Tj
0 -1.182 TD
0.097 Tw
(States has increased from about 25 percent in the)Tj
T*
-0.111 Tw
(1970s to 33 percent in 1988\3201991 \(Kuczmarski et al.)Tj
0 -1.227 TD
0.071 Tw
(1994\). The increase is evident for all race and sex)Tj
0 -1.182 TD
0.051 Tw
(groups. This phenomenon is believed to be due to)Tj
0 -1.227 TD
-0.067 Tw
(high rates of inactivity combined with easy access to)Tj
0 -1.182 TD
0 Tw
(energy-dense food \(Blackburn and Prineas 1983\).)Tj
1.636 -1.227 TD
0.013 Tc
-0.042 Tw
(Obesity, defined as an excess of adipose tissue,)Tj
-1.636 -1.182 TD
-0.054 Tw
(is difficult to measure in population-based studies.)Tj
T*
0.15 Tw
(Most investigations have therefore either used a)Tj
0 -1.227 TD
0.188 Tw
(relative weight index, such as percent desirable)Tj
0 -1.182 TD
0.022 Tc
0.259 Tw
(weight \(Metropolitan Life Insurance Company)Tj
0 -1.227 TD
0.013 Tc
0.172 Tw
(1959\), or have used BMI \(defined by a ratio of)Tj
0 -1.182 TD
-0.109 Tw
[(weight to height\) as a surrogate measure. Quetelet)28 (\325)10 (s)]TJ
T*
0.005 Tc
0.059 Tw
[(index)-18 ( \(weight [kg]/height[m])]TJ
6.4 0 0 6.4 204.5 287.5 Tm
(2)Tj
11 0 0 11 208 284 Tm
0.003 Tc
0.061 Tw
(\) has been the most)Tj
-12.909 -1.227 TD
-0.02 Tw
(frequently used BMI. Although these weight-height)Tj
0 -1.182 TD
0.247 Tw
(indices are strongly correlated with more direct)Tj
0 -1.227 TD
-0.11 Tw
(measures of adiposity, such as underwater weighing,)Tj
0 -1.182 TD
0.029 Tw
(they have limitations: fatty tissue cannot be distin-)Tj
T*
0.08 Tw
(guished from muscle mass or edema, and associa-)Tj
0 -1.227 TD
0.077 Tw
(tions between weight-height indices and adiposity)Tj
0 -1.182 TD
-0.127 Tw
(may be nonlinear or may differ by age or ethnic group)Tj
0 -1.227 TD
0.139 Tw
(\(Harrison et al. 1985; Garn, Leonard, Hawthorne)Tj
0 -1.182 TD
0.17 Tw
(1986; Lillioja and Bogardus 1988\). Despite these)Tj
T*
-0.082 Tw
(limitations, BMI has shown a monotonic association)Tj
0 -1.227 TD
-0.005 Tw
(with mortality in several recent cohort studies \(Lee)Tj
0 -1.182 TD
-0.02 Tw
(et al. 1993; Manson et al. 1995; Willett et al. 1995\).)Tj
1.636 -1.227 TD
0.097 Tw
(Using nationally representative data, the CDC)Tj
-1.636 -1.182 TD
0.013 Tc
0.019 Tw
(has defined overweight as a Quetelet\325s index at or)Tj
0 -1.227 TD
0.023 Tc
0.016 Tw
(above the 85th percentile for 20- to 29-year-olds)Tj
23.955 56.864 TD
(\()Tj
/F10 1 Tf
0.409 0 TD
(\263)Tj
/F7 1 Tf
0.591 0 TD
0.003 Tc
0.081 Tw
[( 27.3 kg/m)]TJ
6.4 0 0 6.4 391.5 715 Tm
(2)Tj
11 0 0 11 394.5 711 Tm
[( for women, )]TJ
/F10 1 Tf
5.591 0 TD
(\263)Tj
/F7 1 Tf
0.545 0 TD
[( 27.8 kg/m)]TJ
6.4 0 0 6.4 513 715 Tm
(2)Tj
11 0 0 11 516 711 Tm
[( for men\),)]TJ
-16.955 -1.182 TD
-0.004 Tc
-0.13 Tw
(corresponding to 120\320125 percent of desirable weight)Tj
T*
0.003 Tc
0.013 Tw
(\(NIH 1985; Kuczmarkski 1992; Kuczmarkski et al.)Tj
0 -1.227 TD
-0.088 Tw
[(1994\). The 95th percentile of Quetelet\325s index \(32.3)]TJ
0 -1.182 TD
(kg/m)Tj
6.4 0 0 6.4 353 662 Tm
(2)Tj
11 0 0 11 356 658.5 Tm
-0.102 Tw
[( for women, 31.1 kg/m)]TJ
6.4 0 0 6.4 456.5 662 Tm
(2)Tj
11 0 0 11 459.5 658.5 Tm
[( for men\), equivalent to)]TJ
-11.818 -1.227 TD
-0.004 Tw
(a relative weight of approximately 145 percent, has)Tj
0 -1.182 TD
-0.084 Tw
(been used to classify persons as severely overweight.)Tj
T*
0.101 Tw
(Between 1976 and 1991, the mean weight of U.S.)Tj
0 -1.227 TD
-0.096 Tw
(adults increased by 3.6 kg \(almost 8 pounds\), and 58)Tj
0 -1.182 TD
0.002 Tw
(million American adults \(33 percent\) are now con-)Tj
0 -1.227 TD
0 Tw
(sidered to be overweight \(Kuczmarski et al. 1994\).)Tj
1.636 -1.182 TD
-0.06 Tw
(Because substantial weight loss in adults is diffi-)Tj
-1.636 -1.227 TD
-0.1 Tw
(cult to achieve and maintain \(Dyer 1994\), childhood)Tj
0 -1.182 TD
0.064 Tw
(obesity and its prevention have received increased)Tj
T*
0.005 Tw
(attention. Overweight children are likely to remain)Tj
0 -1.227 TD
-0.004 Tc
-0.129 Tw
(overweight as adolescents and adults \(Johnston 1985\))Tj
0 -1.182 TD
0.003 Tc
-0.099 Tw
(and are subsequently at increased risk for high blood)Tj
0 -1.227 TD
0.234 Tw
(pressure, diabetes, CHD, and all-cause mortality)Tj
0 -1.182 TD
0.108 Tw
(\(Abraham, Collins, Nordsieck 1971; Nieto, Szklo,)Tj
T*
-0.06 Tw
(Comstock 1992; Must et al. 1992\). Moreover, paral-)Tj
0 -1.227 TD
-0.092 Tw
(leling the trend seen among adults, the prevalence of)Tj
0 -1.182 TD
-0.106 Tw
(overweight among U.S. children and adolescents has)Tj
0 -1.227 TD
-0.126 Tw
(increased substantially over the past decade \(Shear et)Tj
0 -1.182 TD
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(The Effects of Physical Activity on Health and Disease)Tj
/F7 1 Tf
-21.591 -2.818 TD
-0.061 Tw
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-0.097 Tw
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-0.037 Tw
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0 -1.182 TD
0.035 Tw
(\(DeVries 1981; DeVries and Adams 1972\). The re-)Tj
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0.208 Tw
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-0.064 Tw
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-0.11 Tw
(Petruzzello 1994; Raglin and Morgan 1987\). Regular)Tj
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-0.019 Tw
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0 -1.182 TD
-0.118 Tw
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-0.004 Tw
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0 -1.182 TD
-0.023 Tw
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T*
-0.005 Tw
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-0.103 Tw
(the maintenance of mental health over time \(Morgan)Tj
0 -1.182 TD
0 Tw
(1981; Morgan et al. 1980; Raglin 1990\).)Tj
1.636 -1.227 TD
-0.004 Tw
(A number of epidemiologic studies of noninsti-)Tj
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-0.086 Tw
(tutionalized populations have evaluated the associa-)Tj
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-0.121 Tw
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0.011 Tw
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T*
0.235 Tw
(retrospective self-reports of leisure-time physical)Tj
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-0.003 Tw
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0 -1.182 TD
0.013 Tw
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0 -1.227 TD
0.126 Tw
(respiratory fitness is unknown. The available evi-)Tj
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0.057 Tc
0.259 Tw
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T*
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0.051 Tw
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-0.099 Tw
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0 -1.227 TD
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(1994; Martinsen and Stephens 1994\).)Tj
1.636 -1.182 TD
0.006 Tc
0.259 Tw
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0.048 Tw
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0.131 Tw
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-0.028 Tw
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0.003 Tc
0.15 Tw
[(s)-10 (e)-10 (c)-12 (tional study using data generated from a state)]TJ
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0.002 Tc
-0.128 Tw
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0.2 Tw
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1.636 -1.227 TD
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0.132 Tw
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0.054 Tw
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0.005 Tw
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0.127 Tw
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0.252 Tw
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0.259 Tw
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T*
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0.009 Tw
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0.22 Tw
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1.636 -1.182 TD
0.025 Tc
0.259 Tw
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1.636 -1.227 TD
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0 -1.25 TD
-0.001 Tw
[(men/no exer)-6 (cise:)-20480 (and physical health)]TJ
0 -1.2 TD
0 Tw
[(1.15 \(95% CI, 0.30\3204.36\))-10527 (NA)]TJ
0 -1.25 TD
-0.001 Tw
[(men/occasional exer)34 (cise:)]TJ
0 -1.2 TD
0 Tw
[(0.27 \(95% CI, 0.03\3202.35\))-10527 (No)]TJ
0 -1.25 TD
0.001 Tw
[(women/no exer)39 (cise:)]TJ
T*
0 Tw
[(0.70 \(95% CI, 0.30\3201.62\))-10527 (NA)]TJ
0 -1.2 TD
[(women/occasional exer)29 (cise:)]TJ
0 -1.25 TD
[(0.65 \(95% CI, 0.26\3201.61\))-10527 (No)]TJ
0 -1.2 TD
0.001 Tw
[(T)110 (otal/no exer)23 (cise:)]TJ
0 -1.25 TD
0 Tw
[(0.88 \(95% CI, 0.44\3201.77\))-10527 (NA)]TJ
T*
0.001 Tw
[(T)110 (otal/occasional exer)14 (cise:)]TJ
0 -1.2 TD
0 Tw
[(0.70 \(95% CI, 0.30\3201.50\))-10527 (No)]TJ
0 -1.85 TD
(Relative to )Tj
/F10 1 Tf
4.9 0 TD
(\243)Tj
/F9 1 Tf
0.55 0 TD
[( 1 hour of sports play/week,)-4060 (Y)65 (e)0 (s)-4851 (Adjusted for age)]TJ
-5.45 -1.2 TD
(RR for 1\3202 hours = 0.96,)Tj
0 -1.25 TD
(RR for 3+ hours = 0.73)Tj
0 -2.45 TD
(Relative to < 1,000 kcal/week,)Tj
0 -1.25 TD
[(RR for 1,000\3202,499 kcal/week = 0.83)-5256 (Y)65 (e)0 (s)]TJ
ET
-564 198.25 m
564 198.25 l
S
BT
/F9 1 Tf
10 0 0 10 66 202.5 Tm
(RR for 2,500 kcal/week = 0.72)Tj
8 0 0 8 66 186 Tm
0 Tc
[(Abbreviations: )-35 (CI = confidence interval)6 (;)27 ( NA = not available;)-10 ( NHANES = National Health and Nutrition Examination Survey;)-35 ( RR = relative risk.)]TJ
5.6 0 0 5.6 66 175 Tm
(*)Tj
8 0 0 8 68.5 172.5 Tm
0.01 Tc
-0.002 Tw
(A dose-response relationship requires more than 2 levels of comparison. \
In this column, \322NA\323 means that there were only)Tj
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0 Tw
[(2 levels of comparison; \322No\323 means that there were more than 2 lev\
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T*
(that there were more than 2 levels and a dose-response gradient was foun\
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1 g
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0 Tr
0 g
0.006 Tc
(140)Tj
/F5 1 Tf
-21.864 63.727 TD
0.003 Tc
-0.001 Tw
(Physical Activity and Health)Tj
/F7 1 Tf
0 -2.818 TD
0.099 Tw
(at baseline. Among white men who had excessive)Tj
0 -1.182 TD
0.013 Tc
-0.044 Tw
(depressive symptoms at baseline, low levels of rec-)Tj
T*
0.139 Tw
(reational activity predicted continued depressive)Tj
0 -1.227 TD
0 Tw
(symptoms at follow-up.)Tj
1.636 -1.182 TD
0.003 Tc
-0.086 Tw
(A cross-sectional analysis \(Camacho et al. 1991\))Tj
-1.636 -1.227 TD
0.144 Tw
(of 1965 baseline data on 6,928 U.S. residents re-)Tj
0 -1.182 TD
-0.114 Tw
(vealed an inverse association between physical activ-)Tj
0 -1.227 TD
-0.121 Tw
(ity \(low, moderate, and high levels of participation in)Tj
0 -1.182 TD
-0.114 Tw
(active sports, swimming or walking, doing exercises,)Tj
T*
-0.042 Tw
(or gardening\) and depressive symptoms. Follow-up)Tj
0 -1.227 TD
-0.118 Tw
(study of the men and women who had few depressive)Tj
0 -1.182 TD
0.009 Tw
(symptoms in 1965 showed that those who had low)Tj
0 -1.227 TD
0.059 Tw
(levels of physical activity were at greater risk than)Tj
0 -1.182 TD
0.116 Tw
(their highly active counterparts for having a high)Tj
T*
0 Tw
(number of depressive symptoms in 1974.)Tj
1.636 -1.227 TD
0.025 Tc
0.259 Tw
(A 23- through 27-year follow-up study of)Tj
-1.636 -1.182 TD
0.023 Tc
-0.047 Tw
(10,201 Harvard alumni men revealed that level of)Tj
0 -1.227 TD
0.033 Tc
0.017 Tw
(physical activity reported at an initial interview)Tj
0 -1.182 TD
0.031 Tc
0.165 Tw
[(in)-11 ( )10 (1962 )10 (or )38 (1966 was inversely related to self)-28 (-)]TJ
0 -1.227 TD
-0.003 Tw
[(reported physi)-9 (cian)]TJ
8.318 0 TD
0.013 Tc
-0.005 Tw
(-diagnosed depression in 1988)Tj
-8.318 -1.182 TD
0.008 Tc
0.056 Tw
[(\(Paffenbarger, )-10 (Lee, )-10 (Leu)14 (ng 1994\). Physical activity)]TJ
T*
0.003 Tc
-0.118 Tw
(in 1962 and 1966 was defined as the number of hours)Tj
0 -1.227 TD
0.036 Tw
(per week spent doing physical activities \(e.g., golf,)Tj
0 -1.182 TD
-0.107 Tw
(gardening, carpentry, tennis, swimming, brisk walk-)Tj
0 -1.227 TD
0.054 Tw
(ing, jogging, or running\); from this information, a)Tj
0 -1.182 TD
-0.08 Tw
(physical activity index was computed as kilocalories)Tj
T*
-0.038 Tw
(of energy expended per week. In 1988, respondents)Tj
0 -1.227 TD
0.11 Tw
(were asked whether they had ever been told by a)Tj
0 -1.182 TD
-0.068 Tw
(physician that they had health problems \(e.g., CHD,)Tj
0 -1.227 TD
0.07 Tw
(emphysema\), including depression, and to list the)Tj
0 -1.182 TD
0.146 Tw
(year of onset. Incidence of depression was deter-)Tj
T*
-0.087 Tw
(mined by an attack first experienced \(at a known age)Tj
0 -1.227 TD
-0.123 Tw
[(of the respondent\) during the follow-up period. This)]TJ
0 -1.182 TD
0.063 Tw
(study was unique in that the relationship between)Tj
0 -1.227 TD
-0.053 Tw
(physical activity and deaths due to suicides was also)Tj
0 -1.182 TD
-0.061 Tw
(evaluated. The incidence of suicide \(as identified on)Tj
T*
-0.039 Tw
(death certificates\) was largely unrelated to the 1962)Tj
0 -1.227 TD
-0.002 Tc
-0.13 Tw
(or 1966 physical activity history of the college alumni.)Tj
0 -1.182 TD
0.003 Tc
0.228 Tw
(However, the relative risk of depression was 27)Tj
0 -1.227 TD
-0.102 Tw
(percent lower for men who had reported playing 3 or)Tj
0 -1.182 TD
0.031 Tw
(more hours of sports each week than for men who)Tj
T*
0.098 Tw
(had reported playing none. In addition, men who)Tj
0 -1.227 TD
0.005 Tw
(had expended 1,000 to 2,499 kilocalories per week)Tj
0 -1.182 TD
0.037 Tw
(and those who had expended 2,500 kilocalories or)Tj
0 -1.227 TD
-0.112 Tw
(more per week were at 17 percent and 28 percent less)Tj
0 -1.182 TD
-0.041 Tw
(risk for depression, respectively, than men who had)Tj
T*
0 Tw
(expended fewer than 1,000 kilocalories per week.)Tj
25.591 55.182 TD
0.216 Tw
[(In a study of rural Europeans \(n)-259 (=)-251 (1,536\), a)]TJ
-1.636 -1.182 TD
0.19 Tw
(cross-sectional association was observed between)Tj
T*
0.026 Tw
(inactivity \(no physical exercise or sports participa-)Tj
0 -1.227 TD
0.133 Tw
(tion\) and depression \(diagnosed by research psy-)Tj
0 -1.182 TD
0.036 Tw
(chiatrists\) \(Weyerer 1992\). However, low levels of)Tj
0 -1.227 TD
-0.074 Tw
(physical activity at baseline were not a risk factor for)Tj
0 -1.182 TD
-0.063 Tw
(depression at 5-year follow-up for men or women in)Tj
T*
0.001 Tw
(this study.)Tj
1.636 -1.227 TD
-0.005 Tc
-0.069 Tw
(Two of the epidemiologic studies reviewed above)Tj
-1.636 -1.182 TD
0.11 Tw
(examined a possible dose-response relationship. In)Tj
0 -1.227 TD
-0.028 Tw
(one study \(Camacho et al. 1991\), the baseline preva-)Tj
0 -1.182 TD
-0.003 Tw
(lence of symptoms of depression was higher for per-)Tj
0 -1.227 TD
-0.03 Tw
(sons reporting low levels of physical activity than for)Tj
0 -1.182 TD
0.07 Tw
(highly active persons; the risk was intermediate for)Tj
T*
0.043 Tw
(the moderately active group. At follow-up, the inci-)Tj
0 -1.227 TD
0.016 Tw
(dence of depressive symptoms revealed a significant)Tj
0 -1.182 TD
0.127 Tw
(difference only between persons in the lowest and)Tj
0 -1.227 TD
0.039 Tc
0.259 Tw
[(highest activity groups. )12 (In the second study)]TJ
0 -1.182 TD
-0.005 Tc
0.171 Tw
(\(Paffenbarger, Lee, Leung 1994\), an inverse dose-)Tj
T*
0.147 Tw
(response gradient was found between the baseline)Tj
0 -1.227 TD
-0.101 Tw
(self-reported amount of physical activity calculated as)Tj
0 -1.182 TD
-0.086 Tw
(kilocalories per week \(< 1,000, 1,000\3202,499, )Tj
/F10 1 Tf
17.909 0 TD
(\263)Tj
/F7 1 Tf
0.545 0 TD
[( 2,500\))]TJ
-18.455 -1.227 TD
0.003 Tc
-0.055 Tw
(and the follow-up incidence of physician-diagnosed)Tj
0 -1.182 TD
0.106 Tw
(depression. Men who at baseline had reported no)Tj
T*
-0.108 Tw
(hours of sports play per week had a similar follow-up)Tj
0 -1.227 TD
-0.027 Tw
(incidence of depression as men who reported 1 to 2)Tj
0 -1.182 TD
-0.059 Tw
(hours of weekly play; but men who had participated)Tj
0 -1.227 TD
-0.003 Tw
(in 3 or more hours of weekly play had a 27 percent)Tj
0 -1.182 TD
0.028 Tw
(lower risk for developing depression than the least)Tj
T*
0.001 Tw
(active group.)Tj
1.636 -1.227 TD
0.208 Tw
(The findings from these two studies provide)Tj
-1.636 -1.182 TD
0.252 Tw
(limited support for a dose-response relationship)Tj
0 -1.227 TD
0.02 Tw
(between levels of physical activity and measures of)Tj
0 -1.182 TD
-0.004 Tc
-0.129 Tw
(depressive symptoms or depression. However, among)Tj
0 -1.227 TD
0.003 Tc
0.119 Tw
(some endurance athletes, mood disturbances \(de-)Tj
0 -1.182 TD
0.179 Tw
(creased vigor and increased fatigue, anxiety, and)Tj
T*
0.041 Tw
(symptoms of depression\) have been observed with)Tj
0 -1.227 TD
0.018 Tw
(overtraining; mood improved after training was ta-)Tj
0 -1.182 TD
0.015 Tw
(pered \(Morgan et al. 1987\). It is therefore conceiv-)Tj
0 -1.227 TD
-0.051 Tw
(able that for the general population, too strenuous a)Tj
0 -1.182 TD
0.157 Tw
(physical activity regimen may lead to deleterious)Tj
T*
0 Tc
-0.13 Tw
(effects on mental health \(Morgan 1979b, 1994; Polivy)Tj
0 -1.227 TD
0.003 Tc
-0.013 Tw
(1994; Raglin 1990\). To date, research has not iden-)Tj
0 -1.182 TD
-0.066 Tw
(tified a threshold or an optimal frequency, duration,)Tj
0 -1.227 TD
-0.09 Tw
(or intensity of physical activity necessary to improve)Tj
0 -1.182 TD
-0.001 Tw
(mental health status.)Tj
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0.023 Tc
0.205 Tw
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0 -1.182 TD
0.003 Tc
-0.025 Tw
[(i)-20 (n)-4 (duced changes in brain neuroreceptor concentra-)]TJ
0 -1.227 TD
0.116 Tw
(tions of monoamines \(norepinephrine, dopamine,)Tj
0 -1.182 TD
0.046 Tw
(or serotonin\) \(Ransford 1982\) or endogenous opi-)Tj
0 -1.227 TD
0.134 Tw
(ates \(endorphins and enkephalins\) \(Moore 1982\))Tj
0 -1.182 TD
-0.112 Tw
(may help to favorably alter mood. The increased core)Tj
T*
-0.045 Tw
(body temperature that occurs from physical activity)Tj
0 -1.227 TD
0.062 Tw
(may also decrease muscle tension \(DeVries 1981\).)Tj
0 -1.182 TD
0.085 Tw
(Other hypothalamic, metabolic, hormonal, or car-)Tj
0 -1.227 TD
-0.089 Tw
(diorespiratory changes that result from training may)Tj
0 -1.182 TD
0 Tw
(eventually be linked to enhanced mental health.)Tj
1.636 -1.227 TD
-0.092 Tw
(Psychosocial aspects of physical activity, such as)Tj
-1.636 -1.182 TD
0.157 Tw
(having the opportunity for social interaction and)Tj
T*
0.044 Tw
(support \(Hughes, Casal, Leon 1986\), experiencing)Tj
0 -1.227 TD
0.118 Tw
(increased feelings of self-mastery and self-efficacy)Tj
0 -1.182 TD
-0.078 Tw
(\(Simons et al. 1985; Hughes, Casal, Leon 1986\), and)Tj
0 -1.227 TD
-0.042 Tw
(experiencing relief from daily stressors \(Bahrke and)Tj
0 -1.182 TD
-0.062 Tw
(Morgan 1978\), may improve mental health status in)Tj
T*
0.002 Tw
(some people.)Tj
/F5 1 Tf
12 0 0 12 66 429.5 Tm
0 Tc
(Conclusions)Tj
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(physical activity.)Tj
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[(H)18 (RQL requires a number of different types of)]TJ
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(measurements; however, few studies on physical)Tj
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(activity have used a multidimensional measure-)Tj
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[(\(Stewart et al. 1994\). In the clinical trial, healthy)]TJ
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(Bedell, Stone 1990; Morgan et al. 1970; Simons and)Tj
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(people already possessing good health.)Tj
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[(i)19 (e)19 (s)18 ( have shown a strong positive association be-)]TJ
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(Emmerson, Shearer 1994; Thomas et al. 1994\).)Tj
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(years\) are required to confirm whether aerobic)Tj
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[(intensity physical activity are simi)-11 (lar )10 (to )10 (those )10 (of)]TJ
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(Shearer 1994\).)Tj
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(Conclusions)Tj
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(Physical activity appears to improve psychological)Tj
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(physical activity is a straightforward matter. It is)Tj
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(dislocated shoulder. An attempt to accelerate for-)Tj
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(143)Tj
/F5 1 Tf
-0.136 63.727 TD
0.003 Tc
0 Tw
(The Effects of Physical Activity on Health and Disease)Tj
/F7 1 Tf
-21.591 -2.818 TD
0.013 Tc
-0.011 Tw
(the knee, ankle, and foot have the highest propor-)Tj
0 -1.182 TD
0.212 Tw
(tions of injuries \(e.g., torn cartilage, tendinitis,)Tj
T*
-0.012 Tw
(plantar fasciitis, neuromas, and shinsplints\). Inju-)Tj
0 -1.227 TD
-0.043 Tw
(ries are also seen in excessive bicycling \(e.g., ulnar)Tj
0 -1.182 TD
-0.107 Tw
(nerve palsies, ischial bursitis [Cohen 1993; Mellion)Tj
0 -1.227 TD
0.008 Tc
-0.128 Tw
(1991; Pfeiffer and Kronisch 1995]\), swimming \(e.g.,)Tj
0 -1.182 TD
0.013 Tc
-0.028 Tw
(shoulder pain [Allegrucci, Whitney, Irrgang 1994;)Tj
T*
0.124 Tw
(Johnson, Sim, Scott 1987]\), racquet sports \(e.g.,)Tj
0 -1.227 TD
0.005 Tc
-0.128 Tw
(epicondylitis [Kamien 1990]\), aerobic dancing \(e.g.,)Tj
0 -1.182 TD
0.003 Tc
(shin pain and plantar fasciitis [Richie, Kelso, Bellucci)Tj
0 -1.227 TD
0.013 Tc
0.089 Tw
(1985]\), and rowing \(e.g., back and knee injuries)Tj
0 -1.182 TD
0.001 Tw
([Howell 1984]\).)Tj
/F5 1 Tf
11 0 2.138 11 66 538.5 Tm
0.003 Tc
(Metabolic Abnormalities)Tj
/F7 1 Tf
11 0 0 11 66 524 Tm
0.018 Tw
(Severe exertion, particularly of prolonged duration)Tj
0 -1.227 TD
0.183 Tw
(and under hot or humid conditions, can lead to)Tj
0 -1.182 TD
0.056 Tw
(hyperthermia, electrolyte imbalance, and dehydra-)Tj
0 -1.227 TD
-0.005 Tc
-0.129 Tw
(tion \(England et al. 1982; Frizzell et al. 1986; Surgenor)Tj
0 -1.182 TD
0.003 Tc
-0.039 Tw
(and Uphold 1994\). Timely fluid intake and replace-)Tj
T*
0.018 Tw
(ment, with proper electrolyte and caloric composi-)Tj
0 -1.227 TD
-0.002 Tc
-0.13 Tw
(tion, can prevent or ameliorate such metabolic upsets.)Tj
0 -1.182 TD
0.003 Tc
0.002 Tw
(Hypothermia is a risk in many water sports and for)Tj
0 -1.227 TD
0.05 Tw
(any activities undertaken in cold weather \(or even)Tj
0 -1.182 TD
0.121 Tw
(cool weather if inadequate clothing is worn\). Ex-)Tj
T*
-0.113 Tw
(treme endurance training regimens can lead to endo-)Tj
0 -1.227 TD
0.006 Tc
0.259 Tw
(crine system alterations, sometimes resulting in)Tj
0 -1.182 TD
0.003 Tc
-0.014 Tw
(anovulation and amenorrhea in females, in associa-)Tj
0 -1.227 TD
-0.011 Tw
(tion with a decrease in body weight below a critical)Tj
0 -1.182 TD
0.044 Tw
(lean mass, as well as with a decrease in bone mass)Tj
T*
-0.103 Tw
(\(Shangold 1984\). Hypoglycemia can occur in people)Tj
0 -1.227 TD
0.14 Tw
(with diabetes if they do not develop a routine of)Tj
0 -1.182 TD
-0.121 Tw
(regular activity in conjunction with regular monitor-)Tj
0 -1.227 TD
0.131 Tw
(ing of their blood sugar \(and adjustment of their)Tj
0 -1.182 TD
0.001 Tw
(medication accordingly\).)Tj
/F5 1 Tf
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0 Tw
(Hematologic and Body Organ Abnormalities)Tj
/F7 1 Tf
11 0 0 11 66 231 Tm
-0.087 Tw
(Anemia is reported in athletes vigorously engaged in)Tj
0 -1.227 TD
0.021 Tw
(sports such as long-distance running; hemoglobin-)Tj
0 -1.182 TD
0.056 Tw
(uria can occur secondary to breakage of red blood)Tj
0 -1.227 TD
0.094 Tw
(cells during the repetitive impact of distance run-)Tj
0 -1.182 TD
0.029 Tw
(ning, and hematuria can occur when distance run-)Tj
T*
0.023 Tw
(ning traumatizes the bladder or other structures in)Tj
0 -1.227 TD
-0.118 Tw
(the genitourinary system. Rhabdomyolysis, the leak-)Tj
0 -1.182 TD
-0.036 Tw
(age of contents of muscle cells, can occur as a result)Tj
0 -1.227 TD
-0.003 Tw
(of strenuous activity, such as weight lifting or mili-)Tj
0 -1.182 TD
0.201 Tw
(tary basic training, and can lead to renal failure)Tj
T*
0 Tw
(\(Kuipers 1994; Sinert et al. 1994\).)Tj
/F5 1 Tf
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(Hazards)Tj
/F7 1 Tf
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-0.023 Tw
(Cyclists, runners, and walkers often face risks asso-)Tj
T*
-0.007 Tc
-0.129 Tw
(ciated with travel on roadways\321collisions with motor)Tj
T*
0.003 Tc
0.194 Tw
(vehicles, injuries from falls secondary to uneven)Tj
0 -1.227 TD
0.026 Tw
(surfaces, and attacks by animals or humans. Skiers)Tj
0 -1.182 TD
0.034 Tw
(and skaters must contend with falls at high veloci-)Tj
0 -1.227 TD
0.021 Tw
(ties. Baseball players may be struck by a thrown or)Tj
0 -1.182 TD
-0.024 Tw
(batted ball or injured by a spike-soled shoe. Basket-)Tj
T*
0.062 Tw
(ball and soccer entail collisions with other players)Tj
0 -1.227 TD
-0.09 Tw
(and frequent falls to hard surfaces. Football, hockey,)Tj
0 -1.182 TD
0.055 Tw
(and boxing, by their very nature, are sports where)Tj
0 -1.227 TD
-0.069 Tw
(sanctioned and moderately controlled interpersonal)Tj
0 -1.182 TD
0.004 Tc
-0.085 Tw
[(violence often leads to contusions, lacerations,)-17 ( )41 (mus-)]TJ
T*
0.013 Tc
0.22 Tw
(culoskeletal injury, and fractures, as well as to)Tj
0 -1.227 TD
0.019 Tc
0.259 Tw
(concussions and chronic disability \(Kraus and)Tj
0 -1.182 TD
0.013 Tc
0.001 Tw
(Conroy 1984\).)Tj
/F5 1 Tf
11 0 2.138 11 329.5 484 Tm
0.003 Tc
0 Tw
(Infectious, Allergic, and)Tj
0.23 -1.182 TD
-0.002 Tw
(Inflammatory Conditions)Tj
/F7 1 Tf
11 0 0 11 329.5 456.5 Tm
0.026 Tc
0.259 Tw
(Swimming increases the risk of otitis externa)Tj
T*
0.003 Tc
-0.125 Tw
(\(\322swimmer\325s ear\323\). Overtrained athletes may have an)Tj
0 -1.227 TD
0.085 Tw
(increased risk of infections from immunosuppres-)Tj
0 -1.182 TD
0.138 Tw
(sion \(Newsholme and Parry-Billings 1994\). Exer-)Tj
0 -1.227 TD
-0.006 Tc
-0.129 Tw
(tion may provoke asthmatic attacks, usually occurring)Tj
0 -1.182 TD
0.003 Tc
-0.004 Tw
(after exercise in susceptible individuals \(Anderson,)Tj
T*
0 Tw
(Daviskas, Smith 1989\).)Tj
/F5 1 Tf
11 0 2.138 11 329.5 349.5 Tm
0.002 Tw
(Cardiac Events)Tj
/F7 1 Tf
11 0 0 11 329.5 335 Tm
0.214 Tw
(As was discussed earlier in this chapter, regular)Tj
T*
0.021 Tw
(physical activity improves cardiorespiratory fitness)Tj
0 -1.227 TD
-0.042 Tw
(and reduces the risk of CVD mortality over the long)Tj
0 -1.182 TD
0.078 Tw
[(term, although it can acutely increase risk for un)-8 (-)]TJ
T*
-0.121 Tw
[(toward cardiac events in the short)-15 ( )49 (term. Persons with)]TJ
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(compromised coronary circulation may develop an-)Tj
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(gina or acute myocardial infarction during vigorous)Tj
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(activity \(Mittleman et al. 1993; Willich et al. 1993\).)Tj
0 -1.182 TD
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(Arrythmias may be precipitated by a combination of)Tj
T*
-0.086 Tw
(exertion and underlying heart disease, and some can)Tj
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(lead to sudden death \(Kohl et al. 1992; Koplan 1979;)Tj
0 -1.182 TD
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(Siscovick et al. 1984; Thompson, Funk, et al. 1982\).)Tj
0 -1.227 TD
0.013 Tc
0.189 Tw
(Compared with sedentary people who suddenly)Tj
0 -1.182 TD
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(begin exercising vigorously, persons who exercise)Tj
T*
0.017 Tc
[(regul)16 (arly)-23 ( )]TJ
4.115 0 TD
0.008 Tc
-0.014 Tw
[(have a lower risk of )11 (exercise-related )-8 (sud-)]TJ
-4.115 -1.227 TD
0.012 Tc
-0.068 Tw
[(den death,)-2 ( )20 (although even this group has a transient)]TJ
0 -1.182 TD
0.013 Tc
-0.023 Tw
(elevation of risk during and immediately after vig-)Tj
0 -1.227 TD
0.109 Tw
[(orous exercise \(Kohl et al. 1992)-17 (;)44 ( Siscovick et al.)]TJ
0 -1.182 TD
-0.057 Tw
(1984\). Nonetheless, the net effect of regular physi-)Tj
T*
-0.013 Tw
(cal activity is to decrease the risk of cardiac death.)Tj
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(144)Tj
/F5 1 Tf
-21.864 63.727 TD
0.003 Tc
-0.001 Tw
(Physical Activity and Health)Tj
12 0 0 12 48 710.5 Tm
0 Tc
0 Tw
(Occurrence of Adverse Effects)Tj
/F7 1 Tf
11 0 0 11 48 695.5 Tm
0.003 Tc
-0.026 Tw
(Determining the incidence or prevalence of adverse)Tj
0 -1.182 TD
0.008 Tw
(effects of physical activity, or factors that influence)Tj
0 -1.227 TD
0.055 Tw
(the likelihood of their occurrence, is hampered by)Tj
0 -1.182 TD
-0.099 Tw
(not knowing how many people have similar physical)Tj
0 -1.227 TD
0.007 Tw
(activity patterns and are thus similarly at risk of an)Tj
0 -1.182 TD
-0.02 Tw
(adverse event, or how many inactive people sustain)Tj
T*
0.178 Tw
(similar injuries. Nevertheless, a few studies have)Tj
0 -1.227 TD
-0.121 Tw
(provided some insight into the occurrence of adverse)Tj
0 -1.182 TD
0.188 Tw
(events. Of the activities that are common in the)Tj
0 -1.227 TD
0.045 Tw
(United States, including jogging/running, walking,)Tj
0 -1.182 TD
-0.073 Tw
(gardening, bicycling, swimming, aerobic dance, and)Tj
T*
-0.029 Tw
(softball, running has received the most attention by)Tj
0 -1.227 TD
(researchers.)Tj
1.636 -1.182 TD
0.013 Tc
0.05 Tw
(Injuries among runners are common, ranging)Tj
-1.636 -1.227 TD
-0.102 Tw
(from 25 through 65 percent \(Jones, Cowan, Knapik)Tj
0 -1.182 TD
0.12 Tw
(1994\). Most running-related injuries involve the)Tj
0 -1.227 TD
0.152 Tw
[(leg and foot and are usually self)12 (-)-18 (correcting in a)]TJ
0 -1.182 TD
-0.008 Tw
(relatively short time. Studies of such injuries have)Tj
T*
0.068 Tw
(generally shown that occurrence of musculoskel-)Tj
0 -1.227 TD
-0.017 Tw
(etal injury is directly related to mileage run \(Blair,)Tj
0 -1.182 TD
0.046 Tw
(Kohl, Goodyear 1987; Hoeberigs 1992; Koplan et)Tj
0 -1.227 TD
0.043 Tw
[(al. 1982; Macera 1992; )18 ( Macera et al. 1989; Marti)]TJ
0 -1.182 TD
0.069 Tw
(1988; Marti et al. 1988; Walter et al. 1989\) or to)Tj
T*
0.128 Tw
(frequency or duration of running \(Pollock et al.)Tj
0 -1.227 TD
-0.118 Tw
(1977\). Previous injury appears to be a risk factor for)Tj
0 -1.182 TD
0.141 Tw
(subsequent injury. In one small study of people)Tj
0 -1.227 TD
0.163 Tw
(aged 70\32079 years, the injury rate was lower for)Tj
0 -1.182 TD
0.141 Tw
(walking than jogging \(5 percent vs. 57 percent\))Tj
T*
0.012 Tw
(\(Pollock et al. 1991\). Whether this finding is true)Tj
0 -1.227 TD
-0.03 Tw
(only among the elderly or is characteristic of these)Tj
0 -1.182 TD
0 Tw
(activities at all ages remains to be determined.)Tj
1.636 -1.227 TD
0.003 Tc
-0.096 Tw
(Although few studies of aerobic dance have been)Tj
-1.636 -1.182 TD
0.244 Tw
(conducted, the injury rate appears to be higher)Tj
0 -1.227 TD
0.082 Tw
(among those taking more than 4 classes per week)Tj
0 -1.182 TD
0 Tw
(\(Richie, Kelso, Bellucci 1985\).)Tj
/F5 1 Tf
12 0 0 12 48 218 Tm
0 Tc
(Conclusions)Tj
/F7 1 Tf
11 0 0 11 48 203 Tm
0.003 Tc
0.051 Tw
(A wide spectrum of adverse events can occur with)Tj
T*
-0.007 Tw
(physical activity, ranging from those that cause mi-)Tj
0 -1.227 TD
-0.068 Tw
(nor inconvenience to those that are life-threatening.)Tj
0 -1.182 TD
0.164 Tw
(At least some of the musculoskeletal injuries are)Tj
T*
-0.031 Tw
[(likely to be preven)21 (table)-30 ( if people gradually work up)]TJ
0 -1.227 TD
-0.005 Tc
-0.129 Tw
(to a physical activity goal and avoid excessive amounts)Tj
0 -1.182 TD
0.003 Tc
0.232 Tw
(of physical activity or excessively high levels of)Tj
0 -1.227 TD
-0.042 Tw
(intensity. Although adverse cardiac events are more)Tj
0 -1.182 TD
-0.025 Tw
(likely to occur with physical exertion, the net effect)Tj
23.955 55.773 TD
-0.048 Tw
(of regular physical activity is a lower CVD mortality)Tj
0 -1.182 TD
0.058 Tw
(rate among active than inactive people \(see earlier)Tj
T*
0.001 Tw
(sections of this chapter\).)Tj
1.636 -1.227 TD
0.002 Tc
-0.127 Tw
(People should be advised not to undertake physi-)Tj
-1.636 -1.182 TD
0.003 Tc
-0.037 Tw
(cal activities well beyond their normal level of exer-)Tj
0 -1.227 TD
-0.117 Tw
(tion. Inactive people wishing to begin a new program)Tj
0 -1.182 TD
0.036 Tw
(of moderate activity should begin with short dura-)Tj
0 -1.227 TD
0.257 Tw
(tions and gradually lengthen them toward their)Tj
0 -1.182 TD
-0.07 Tw
(target. Men over age 40 and women over age 50 who)Tj
T*
0.111 Tw
(wish to begin a new program involving vigorous-)Tj
0 -1.227 TD
0 Tc
-0.128 Tw
(intensity activity, people who have preexisting health)Tj
0 -1.182 TD
0.003 Tc
0.035 Tw
(problems, and people who are at high risk of CVD)Tj
0 -1.227 TD
0.013 Tc
0.007 Tw
(should consult a physician before embarking on a)Tj
0 -1.182 TD
0.241 Tw
(program of physical activity to which they are)Tj
T*
0.001 Tw
(unaccustomed \(ACSM 1991\).)Tj
/F5 1 Tf
14 0 0 14 311.5 486.5 Tm
-0.001 Tc
(Nature of the)Tj
0 -1.179 TD
-0.001 Tw
(Activity/Health Relationship)Tj
12 0 0 12 311.5 448.5 Tm
0 Tc
(Causality)Tj
/F7 1 Tf
11 0 0 11 311.5 433.5 Tm
0.003 Tc
0.102 Tw
(The studies reviewed in this chapter indicate that)Tj
0 -1.182 TD
-0.119 Tw
(physical activity is associated with a reduction in risk)Tj
0 -1.227 TD
0.161 Tw
(of all-cause mortality, all CVDs combined, CHD,)Tj
0 -1.182 TD
-0.022 Tw
(hypertension, colon cancer, and NIDDM. To evalu-)Tj
0 -1.227 TD
-0.127 Tw
(ate whether the information presented is sufficient to)Tj
0 -1.182 TD
-0.077 Tw
(infer that these associations are causal in nature, it is)Tj
T*
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0 -1.227 TD
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/F16 1 Tf
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(Strength of Association. )Tj
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T*
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0 -1.227 TD
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0 -1.227 TD
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0.198 Tw
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0 -1.227 TD
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(which in turn would bias studies toward finding less)Tj
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T*
0.157 Tw
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0.003 Tc
0 Tw
(The Effects of Physical Activity on Health and Disease)Tj
/F7 1 Tf
-21.591 -2.818 TD
-0.043 Tw
(measurement have found that the methodologically)Tj
0 -1.182 TD
-0.05 Tw
(better studies showed larger associations than those)Tj
T*
-0.032 Tw
(with lower quality scores \(Powell et al. 1987; Berlin)Tj
0 -1.227 TD
0.17 Tw
(and Colditz 1990\). In addition, cardiorespiratory)Tj
0 -1.182 TD
-0.092 Tw
(fitness, which is more objectively and precisely mea-)Tj
0 -1.227 TD
0.129 Tw
(sured than the reported level of physical activity,)Tj
0 -1.182 TD
0.239 Tw
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T*
-0.005 Tc
0.033 Tw
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0 -1.227 TD
-0.098 Tw
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0 -1.182 TD
0 Tw
(physical activity measurements were more accurate.)Tj
/F16 1 Tf
1.636 -1.227 TD
0.003 Tc
-0.052 Tw
(Consistency of Findings.)Tj
/F7 1 Tf
9.591 0 TD
-0.054 Tw
[( Although the epidemio-)]TJ
-11.227 -1.182 TD
-0.013 Tw
(logic studies of physical activity have varied greatly)Tj
0 -1.227 TD
-0.127 Tw
(in methodology, in ways of classifying physical activ-)Tj
0 -1.182 TD
0.115 Tw
(ity, and in populations studied, the findings have)Tj
T*
0.043 Tw
(been remarkably consistent in supporting a reduc-)Tj
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0.21 Tw
(tion in risk as a function of greater amounts of)Tj
0 -1.182 TD
-0.095 Tw
(physical activity, or conversely, an increase in risk as)Tj
0 -1.227 TD
0 Tw
(a function of inactivity.)Tj
/F16 1 Tf
1.636 -1.182 TD
(Temporality)Tj
/F7 1 Tf
4.909 0 TD
0.039 Tw
(. For most of the health conditions)Tj
-6.545 -1.227 TD
0.023 Tw
(included in this chapter \(all-cause mortality, CVD,)Tj
0 -1.182 TD
-0.002 Tc
-0.129 Tw
(CHD, hypertension, NIDDM\), longitudinal data from)Tj
T*
0.003 Tc
0.133 Tw
(cohort studies have been available and have con-)Tj
0 -1.227 TD
-0.06 Tw
(firmed a temporal sequence in which physical activ-)Tj
0 -1.182 TD
-0.023 Tw
(ity patterns are determined prior to development of)Tj
0 -1.227 TD
-0.026 Tw
(disease. For obesity and mental health, fewer longi-)Tj
0 -1.182 TD
0.058 Tw
(tudinal studies have been conducted, and findings)Tj
T*
0.164 Tw
(have been more equivocal. Perhaps the strongest)Tj
0 -1.227 TD
-0.017 Tw
(evidence for temporality comes from two studies of)Tj
0 -1.182 TD
-0.033 Tw
(the effect of changes in activity or fitness level. Men)Tj
0 -1.227 TD
0.129 Tw
(who became more active or more fit had a lower)Tj
0 -1.182 TD
0.077 Tw
(mortality rate during follow-up than men who re-)Tj
T*
0.068 Tw
(mained inactive or unfit \(Paffenbarger et al. 1993;)Tj
0 -1.227 TD
-0.001 Tw
(Blair et al. 1995\).)Tj
/F16 1 Tf
1.636 -1.182 TD
0.004 Tw
(Biological Gradient. )Tj
/F7 1 Tf
8.318 0 TD
(Studies of all-cause mortal-)Tj
-9.955 -1.227 TD
-0.034 Tw
(ity, CVD, CHD, and NIDDM have shown a gradient)Tj
0 -1.182 TD
-0.047 Tw
(of greater benefit associated with higher amounts of)Tj
0 -1.227 TD
0.088 Tw
(physical activity. Most studies that included more)Tj
0 -1.182 TD
0.076 Tw
(than two categories of amount of physical activity)Tj
T*
-0.02 Tw
(and were therefore able to evaluate a dose-response)Tj
0 -1.227 TD
0.068 Tw
(relationship found a gradient of decreasing risk of)Tj
0 -1.182 TD
-0.043 Tw
(disease with increasing amounts of physical activity)Tj
0 -1.227 TD
0 Tw
[(\(see )-15 (Table)-7 (s 4-1 through 4-8\).)]TJ
/F16 1 Tf
1.636 -1.182 TD
0.013 Tc
-0.018 Tw
(Biologic Plausibility. )Tj
/F7 1 Tf
8.727 0 TD
-0.019 Tw
(Evidence that physiologic)Tj
-10.364 -1.227 TD
0.107 Tw
(effects of physical activity have beneficial conse-)Tj
0 -1.182 TD
-0.093 Tw
(quences for CHD, NIDDM, and obesity is abundant)Tj
T*
0.018 Tw
(\(see Chapter 3, as well as the biologic plausibility)Tj
0 -1.227 TD
0.093 Tw
(sections of this chapter\). Such evidence includes)Tj
0 -1.182 TD
0.192 Tw
(beneficial effects on physiologic risk factors for)Tj
23.955 56.409 TD
0.188 Tw
(disease, such as high blood pressure and blood)Tj
0 -1.182 TD
-0.096 Tw
(lipoproteins, as well as beneficial effects on circula-)Tj
T*
0.016 Tc
0.259 Tw
(tory system functioning, blood-clotting mecha-)Tj
0 -1.227 TD
0.013 Tc
0.126 Tw
(nisms, insulin production and glucose handling,)Tj
0 -1.182 TD
0 Tw
(and caloric balance.)Tj
/F16 1 Tf
1.636 -1.227 TD
0.003 Tc
-0.025 Tw
(Experimental Evidence)Tj
/F7 1 Tf
9.091 0 TD
(. Controlled clinical trials)Tj
-10.727 -1.182 TD
0.013 Tc
-0.037 Tw
[(h)10 (a)10 (ve not been conducted for the outcomes of mor-)]TJ
0 -1.227 TD
-0.017 Tw
(tality, CVD, cancer, obesity, or NIDDM. However,)Tj
0 -1.182 TD
0.224 Tw
(randomized clinical trials have determined that)Tj
T*
0.016 Tw
(physical activity improves these diseases\325 risk fac-)Tj
0 -1.227 TD
0.127 Tw
(tors, such as blood pressure, lipoprotein profile,)Tj
0 -1.182 TD
0 Tw
(insulin sensitivity, and body fat.)Tj
1.636 -1.227 TD
0.003 Tc
-0.054 Tw
(The information reviewed in this chapter shows)Tj
-1.636 -1.182 TD
-0.124 Tw
(that the inverse association between physical activity)Tj
0 -1.227 TD
-0.036 Tw
(and several diseases is moderate in magnitude, con-)Tj
0 -1.182 TD
0.093 Tw
(sistent across studies that differed substantially in)Tj
T*
0.222 Tw
(methods and populations, and biologically plau-)Tj
0 -1.227 TD
-0.089 Tw
(sible. A dose-response gradient has been observed in)Tj
0 -1.182 TD
-0.024 Tw
(most studies that examined more than two levels of)Tj
0 -1.227 TD
0.131 Tw
(activity. For most of the diseases found to be in-)Tj
0 -1.182 TD
0.222 Tw
(versely related to physical activity, the temporal)Tj
T*
0.146 Tw
(sequence of exposure preceding disease has been)Tj
0 -1.227 TD
0.239 Tw
(demonstrated. Although controlled clinical trials)Tj
0 -1.182 TD
0.061 Tw
(have not been conducted \(and are not likely to be)Tj
0 -1.227 TD
0.095 Tw
(conducted\) for morbidity and mortality related to)Tj
0 -1.182 TD
-0.064 Tw
(the diseases of interest, controlled trials have shown)Tj
T*
-0.069 Tw
(that activity can improve physiologic risk factors for)Tj
0 -1.227 TD
0.105 Tw
(these diseases. From this large body of consistent)Tj
0 -1.182 TD
-0.045 Tw
(information, it is reasonable to conclude that physi-)Tj
0 -1.227 TD
-0.081 Tw
(cal activity is causally related to the health outcomes)Tj
0 -1.182 TD
-0.001 Tw
(reported here.)Tj
/F5 1 Tf
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0 Tc
0 Tw
(Population Burden of Sedentary Living)Tj
/F7 1 Tf
11 0 0 11 329.5 271.5 Tm
0.003 Tc
0.204 Tw
(Given that the relationship between activity and)Tj
T*
-0.013 Tw
(several diseases is likely to be causal, it follows that)Tj
0 -1.227 TD
-0.016 Tw
(a large number of Americans unnecessarily become)Tj
0 -1.182 TD
-0.053 Tw
(ill or die each year because of an inactive way of life.)Tj
T*
0.005 Tw
(Published estimates of the number of lives lost in a)Tj
0 -1.227 TD
-0.06 Tw
(year because of inactivity have ranged from 200,000)Tj
0 -1.182 TD
-0.117 Tw
(for inactivity alone to 300,000 for inactivity and poor)Tj
0 -1.227 TD
0.054 Tw
(diet combined \(Hahn et al. 1990; Powell and Blair)Tj
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(1994; McGinnis and Foege 1993\). Such estimates are)Tj
T*
0.048 Tw
(generally derived by calculating the population at-)Tj
0 -1.227 TD
0.099 Tw
[(tribut)6 (able)-30 ( risk \(PAR\), which is based on both the)]TJ
0 -1.182 TD
-0.05 Tw
(relative mortality rate associated with inactivity and)Tj
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/F7 1 Tf
0 -2.818 TD
0.069 Tw
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0 -1.182 TD
-0.093 Tw
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0.097 Tw
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0.014 Tw
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T*
0.056 Tw
(eliminating one modifiable risk factor, in this case)Tj
0 -1.227 TD
0.156 Tw
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0 -1.182 TD
0.09 Tw
(mates of avoidable mortality do not address other)Tj
0 -1.227 TD
0.012 Tw
(important aspects of the population burden of sed-)Tj
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0.119 Tw
(entary living. The benefits of reducing the occur-)Tj
T*
0.133 Tw
(rence of CHD, colon cancer, and diabetes greatly)Tj
0 -1.227 TD
0.024 Tw
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T*
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/F16 1 Tf
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T*
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(freestyle swimmers. )Tj
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/F16 1 Tf
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17.4 0 TD
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-18.7 -1.2 TD
(2543\3202549.)Tj
-1.2 -1.75 TD
0.164 Tw
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0.046 Tw
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0.045 Tw
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0.243 Tw
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T*
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T*
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0.037 Tw
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T*
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T*
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0.088 Tw
[( Arthritis and Rheumatism)]TJ
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0.233 Tw
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T*
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[( Journal)]TJ
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0.175 Tw
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T*
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T*
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0.07 Tw
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T*
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(Bernstein L, Henderson BE, Hanisch R, Sullivan-Halley J,)Tj
1.2 -1.2 TD
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T*
0.015 Tc
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/F16 1 Tf
10.45 0 TD
-0.031 Tw
[( )33 (Journal of the National Can-)]TJ
-10.45 -1.2 TD
0.005 Tc
0.001 Tw
[(c)-10 (e)-10 (r)-12 ( Institute)]TJ
/F7 1 Tf
4.8 0 TD
( 1994;86:1403\3201408.)Tj
-6 -1.75 TD
-0.071 Tw
(Bj\232rntorp P, Krotkiewski M. Exercise treatment in diabe-)Tj
1.2 -1.2 TD
-0.022 Tw
(tes mellitus. )Tj
/F16 1 Tf
5.3 0 TD
-0.021 Tw
[( Acta Medica Scandinavica)]TJ
/F7 1 Tf
10.7 0 TD
-0.022 Tw
[( 1985;217:3\3207.)]TJ
-17.2 -1.75 TD
-0.008 Tw
(Bj\232rntorp P, Sj\232str\232m L, Sullivan L. The role of physical)Tj
1.2 -1.2 TD
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(exercise in the management of obesity. In: Munro JF,)Tj
T*
(editor. )Tj
/F16 1 Tf
3.05 0 TD
0.016 Tw
(The treatment of obesity)Tj
/F7 1 Tf
9.7 0 TD
0.017 Tw
(. Baltimore: University)Tj
-12.75 -1.2 TD
0 Tw
(Park Press, 1979:123\320138.)Tj
-1.2 -1.7 TD
0.023 Tw
(Blackburn H, Prineas R. Diet and hypertension: anthro-)Tj
1.2 -1.2 TD
-0.073 Tw
(pology, epidemiology, and public health implications.)Tj
/F16 1 Tf
T*
-0.031 Tw
(Progress in Biochemical Pharmacology)Tj
/F7 1 Tf
15.5 0 TD
-0.033 Tw
[( 1983;19:31\32079.)]TJ
-16.7 -1.75 TD
0.137 Tw
(Blair SN. Physical activity, fitness, and coronary heart)Tj
1.2 -1.2 TD
0.177 Tw
(disease. In: Bouchard C, Shephard RJ, Stephens T,)Tj
T*
(editors. )Tj
/F16 1 Tf
3.55 0 TD
0.117 Tw
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(tional proceedings and consensus statement.)Tj
/F7 1 Tf
17 0 TD
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[( Champaign,)]TJ
-17 -1.2 TD
0.005 Tc
0 Tw
(IL: Human Kinetics, 1994:579\320590.)Tj
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1.2 -1.2 TD
0.096 Tw
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T*
-0.001 Tw
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/F16 1 Tf
13.5 0 TD
( Journal of the Ameri-)Tj
-13.5 -1.2 TD
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(can Medical Association)Tj
/F7 1 Tf
9.65 0 TD
( 1984;252:487\320490.)Tj
-10.85 -1.75 TD
-0.098 Tw
(Blair SN, Kohl HW, Barlow CE. Physical activity, physical)Tj
1.2 -1.2 TD
0.006 Tw
(fitness, and all-cause mortality in women: do women)Tj
T*
0.081 Tw
(need to be active? )Tj
/F16 1 Tf
8.1 0 TD
0.078 Tw
(Journal of the American College of)Tj
-8.1 -1.2 TD
(Nutrition)Tj
/F7 1 Tf
5.8 0 0 5.8 97.5 376 Tm
( )Tj
10 0 0 10 99 379.5 Tm
(1993;12:368\320371.)Tj
-5.1 -1.75 TD
0.094 Tw
(Blair SN, Kohl HW, Goodyear NN. Rates and risks for)Tj
1.2 -1.2 TD
-0.074 Tw
(running and exercise injuries: studies in three popula-)Tj
T*
0.032 Tc
(tions. )Tj
/F16 1 Tf
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0.031 Tc
0.25 Tw
(Research Quarterly for Exercise and Sport)Tj
/F7 1 Tf
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0.005 Tc
(1987;58:221\320228.)Tj
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0.091 Tw
(Blair SN, Kohl HW III, Barlow CE, Paffenbarger RS Jr,)Tj
1.2 -1.2 TD
-0.017 Tw
(Gibbons LW, Macera CA. Changes in physical fitness)Tj
T*
-0.057 Tw
(and all-cause mortality: a prospective study of healthy)Tj
T*
0.045 Tw
(and unhealthy men. )Tj
/F16 1 Tf
8.8 0 TD
0.043 Tw
[( Journal of the American Medical)]TJ
-8.8 -1.2 TD
(Association)Tj
/F7 1 Tf
4.55 0 TD
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( 1995;273:1093\3201098.)Tj
-5.75 -1.75 TD
0.138 Tw
(Blair SN, Kohl HW III, Paffenbarger RS Jr, Clark DG,)Tj
1.2 -1.2 TD
0.178 Tw
(Cooper KH, Gibbons LW. Physical fitness and all-)Tj
T*
0.094 Tw
(cause mortality: a prospective study of healthy men)Tj
T*
-0.002 Tw
(and women. )Tj
/F16 1 Tf
5.4 0 TD
( Journal of the American Medical Associa-)Tj
-5.4 -1.2 TD
(tion)Tj
/F7 1 Tf
1.55 0 TD
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( 1989;262:2395\3202401.)Tj
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0.01 Tc
0.259 Tw
(Blumenthal JA, Emery CF, Madden DJ, George LK,)Tj
1.2 -1.2 TD
0.005 Tc
0.104 Tw
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T*
0.001 Tc
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T*
0.043 Tc
0.259 Tw
(older men and women. )Tj
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0.042 Tc
0.25 Tw
(Journal of Gerontology)Tj
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0.005 Tc
(1989;44:147\320157.)Tj
-1.2 -1.75 TD
-0.03 Tw
(Bouchard C, Despr\216s J-P, Tremblay A. Exercise and obe-)Tj
1.2 -1.2 TD
(sity. )Tj
/F16 1 Tf
2 0 TD
0.001 Tw
(Obesity Research )Tj
/F7 1 Tf
7.1 0 TD
(1993;1:133\320147.)Tj
16.05 61.15 TD
-0.019 Tw
(Bradfield RB, Paulos J, Grossman L. Energy expenditure)Tj
1.2 -1.2 TD
0.128 Tw
(and heart rate of obese high school girls. )Tj
/F16 1 Tf
18.3 0 TD
(American)Tj
-18.3 -1.2 TD
0 Tw
(Journal of Clinical Nutrition)Tj
/F7 1 Tf
11.4 0 TD
( 1971;24:1482\3201488.)Tj
-12.6 -1.75 TD
0.159 Tw
(Bray GA. Complications of obesity. )Tj
/F16 1 Tf
15.8 0 TD
0.154 Tw
(Annals of Internal)Tj
-14.6 -1.2 TD
(Medicine)Tj
/F7 1 Tf
3.6 0 TD
0.001 Tw
( 1985;103\(Suppl 6, Pt 2\):1052\3201062.)Tj
-4.8 -1.75 TD
-0.021 Tw
(Bray GA. The energetics of obesity. )Tj
/F16 1 Tf
14.85 0 TD
-0.02 Tw
(Medicine and Science)Tj
-13.65 -1.2 TD
0 Tw
(in Sports and Exercise)Tj
/F7 1 Tf
8.9 0 TD
( 1983;15:32\32040.)Tj
-10.1 -1.7 TD
0.008 Tc
0.259 Tw
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1.2 -1.2 TD
0.005 Tc
0.22 Tw
(Bouchard C, Shephard RJ, Stephens T, Sutton JR,)Tj
T*
-0.018 Tw
(McPherson BD, editors.)Tj
/F16 1 Tf
9.9 0 TD
[( Exercise, fitness, and health: a)]TJ
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0.103 Tw
(consensus of current knowledge. )Tj
/F7 1 Tf
13.5 0 TD
0.107 Tw
(Champaign, IL: Hu-)Tj
-13.5 -1.2 TD
-0.001 Tw
(man Kinetics, 1990:607\320626.)Tj
-1.2 -1.75 TD
0.089 Tw
(Brown DR, Wang Y. The relationships among exercise)Tj
1.2 -1.2 TD
0.234 Tw
(training, aerobic capacity, and psychological well-)Tj
T*
0.125 Tw
(being in the general population. )Tj
/F16 1 Tf
14.3 0 TD
0.121 Tw
(Medicine, Exercise,)Tj
-14.3 -1.2 TD
0 Tw
(Nutrition, and Health )Tj
/F7 1 Tf
8.9 0 TD
(1992;3:125\320142.)Tj
-10.1 -1.75 TD
0.066 Tw
(Brown DR, Wang Y, Ward A, Ebbeling CB, Fortlage L,)Tj
1.2 -1.2 TD
-0.119 Tw
(Puleo E, et al. Chronic psychological effects of exercise)Tj
T*
0.129 Tw
(and exercise plus cognitive strategies. )Tj
/F16 1 Tf
16.7 0 TD
0.124 Tw
(Medicine and)Tj
-16.7 -1.2 TD
0 Tw
(Science in Sports and Exercise)Tj
/F7 1 Tf
12.1 0 TD
-0.001 Tw
( 1995;27:765\320775.)Tj
-13.3 -1.75 TD
-0.061 Tw
(Brownell KD, Stunkard AJ. Physical activity in the devel-)Tj
1.2 -1.2 TD
-0.102 Tw
(opment and control of obesity. In: Stunkard AJ, editor.)Tj
/F16 1 Tf
T*
(Obesity)Tj
/F7 1 Tf
3 0 TD
-0.019 Tw
(. Philadelphia: W.B. Saunders, 1980:300\320324.)Tj
-4.2 -1.75 TD
0.043 Tw
(Brownson RC, Chang JC, Davis JR, Smith CA. Physical)Tj
1.2 -1.2 TD
0.04 Tw
(activity on the job and cancer in Missouri.)Tj
/F16 1 Tf
18 0 TD
0.039 Tw
[( American)]TJ
-18 -1.2 TD
0 Tw
(Journal of Public Health)Tj
/F7 1 Tf
9.65 0 TD
( 1991;81:639\320642.)Tj
-10.85 -1.7 TD
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(Brownson RC, Zahm SH, Chang JC, Blair A. Occupational)Tj
1.2 -1.2 TD
-0.007 Tw
(risk of colon cancer: an analysis by anatomic subsite.)Tj
/F16 1 Tf
T*
0 Tw
(American Journal of Epidemiology)Tj
/F7 1 Tf
13.75 0 TD
( 1989;130:675\320687.)Tj
-14.95 -1.75 TD
0.246 Tw
(Brunner D, Manelis G, Modan M, Levin S. Physical)Tj
1.2 -1.2 TD
0.02 Tw
(activity at work and the incidence of myocardial inf-)Tj
T*
0.106 Tw
(arction, angina pectoris, and death due to ischemic)Tj
T*
-0.005 Tw
(heart disease: an epidemiological study in Israeli col-)Tj
T*
0.224 Tw
(lective settlements \(kibbutzim\).)Tj
/F16 1 Tf
13.8 0 TD
0.217 Tw
[( Journal of Chronic)]TJ
-13.8 -1.2 TD
(Diseases)Tj
/F7 1 Tf
3.4 0 TD
-0.003 Tw
( 1974;27:217\320233.)Tj
-4.6 -1.75 TD
0.046 Tw
(Bullen BA, Reed RB, Mayer J. Physical activity of obese)Tj
1.2 -1.2 TD
0.122 Tw
(and nonobese adolescent girls appraised by motion)Tj
T*
0.046 Tw
(picture sampling. )Tj
/F16 1 Tf
7.7 0 TD
0.044 Tw
(American Journal of Clinical Nutri-)Tj
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(tion)Tj
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1.55 0 TD
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( 1964;14:211\320223.)Tj
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-18.4 -1.2 TD
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0.248 Tw
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17.9 0 TD
0.239 Tw
[( American)]TJ
-17.9 -1.2 TD
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-10.85 -1.75 TD
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/F16 1 Tf
T*
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T*
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1.2 -1.2 TD
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1.2 -1.2 TD
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T*
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T*
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1.2 -1.2 TD
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T*
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20.8 0 TD
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T*
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T*
0.249 Tw
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/F16 1 Tf
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0.241 Tw
[( American Journal of Epidemiology)]TJ
/F7 1 Tf
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0.121 Tw
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1.2 -1.2 TD
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T*
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0.116 Tw
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8.5 0 TD
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0.136 Tw
[( 1985;53:)]TJ
-18.2 -1.2 TD
(363\320373.)Tj
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1.2 -1.2 TD
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T*
(ventricle. )Tj
/F16 1 Tf
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(1979;60:798\320804.)Tj
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0.217 Tw
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T*
0.182 Tw
(in healthy subjects. )Tj
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T*
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0.197 Tw
[(D)8 (eVries HA. Tranquilizer effect of exercise: a critical)]TJ
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T*
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T*
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T*
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T*
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[( 1988;128:1340\320)]TJ
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T*
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11.7 0 TD
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( 1994;62:550\320559.)Tj
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(Federation of American Societies for Experimental Biol-)Tj
1.2 -1.2 TD
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(ogy, Life Sciences Research Office. )Tj
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T*
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T*
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[( American Journal of Epidemiol-)]TJ
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(ogy)Tj
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( 1994;140:350\320360.)Tj
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T*
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T*
(people. )Tj
/F16 1 Tf
3.5 0 TD
0.167 Tw
(New England Journal of Medicine)Tj
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14.15 0 TD
0.173 Tw
[( 1994;330:)]TJ
-17.65 -1.2 TD
(1769\3201775.)Tj
-1.2 -1.75 TD
0.209 Tw
(Fisch A, Pichard E, Prazuck T, Leblanc H, Sidibe Y,)Tj
1.2 -1.2 TD
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T*
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(mellitus in the rural region of Mali \(West Africa\): a)Tj
T*
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T*
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T*
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0.001 Tc
-0.127 Tw
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T*
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T*
0.142 Tw
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T*
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/F16 1 Tf
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0.131 Tw
[( American Journal of Epidemiology)]TJ
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0.136 Tw
[( 1985;121:)]TJ
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(570\320579.)Tj
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T*
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T*
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T*
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T*
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T*
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(Frisch RE, Wyshak G, Albright NL, Albright TE, Schiff I,)Tj
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T*
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T*
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T*
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[(Frizzell RT, Lang GH, Lowance DC, Lathan SR. Hy)23 (-)]TJ
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0.184 Tw
[( American Journal of)]TJ
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1.2 -1.2 TD
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T*
0.05 Tw
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/F16 1 Tf
18.4 0 TD
(American)Tj
-18.4 -1.2 TD
0 Tw
(Journal of Cardiology)Tj
/F7 1 Tf
8.7 0 TD
( 1982;50:749\320755.)Tj
-9.9 -1.75 TD
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1.2 -1.2 TD
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/F16 1 Tf
3.9 0 TD
(Cancer)Tj
/F7 1 Tf
2.85 0 TD
0.001 Tw
( 1988;62:1844\3201850.)Tj
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-0.119 Tw
(Garn SM, Leonard WR, Hawthorne VM. Three limitations)Tj
1.2 -1.2 TD
0.065 Tw
(of the body mass index. )Tj
/F16 1 Tf
10.55 0 TD
0.062 Tw
(American Journal of Clinical)Tj
-10.55 -1.2 TD
(Nutrition)Tj
/F7 1 Tf
3.75 0 TD
0.001 Tw
( 1986;44:996\320997.)Tj
-4.95 -1.75 TD
-0.042 Tw
(Gerhardsson M, Steineck G, Hagman U, Rieger \201, Norell)Tj
1.2 -1.2 TD
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(SE. Physical activity and colon cancer: a case-referent)Tj
T*
0.163 Tw
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/F16 1 Tf
9.2 0 TD
0.158 Tw
(International Journal of Cancer)Tj
/F7 1 Tf
-9.2 -1.2 TD
(1990;46:985\320989.)Tj
-1.2 -1.75 TD
0.01 Tw
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1.2 -1.2 TD
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9.2 0 TD
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(ology)Tj
/F7 1 Tf
2.15 0 TD
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( 1988;17:743\320746.)Tj
-3.35 -1.75 TD
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1.2 -1.2 TD
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(Ahlbom A. Sedentary jobs and colon cancer.)Tj
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18.2 0 TD
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[( American)]TJ
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9.65 0 TD
( 1986;123:775\320780.)Tj
-10.85 -1.75 TD
0.012 Tw
(Getz GS. The involvement of lipoproteins in atherogen-)Tj
1.2 -1.2 TD
(esis: evolving concepts.)Tj
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9.85 0 TD
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[( Annals of the New York Acad-)]TJ
-9.85 -1.2 TD
-0.001 Tw
(emy of Sciences)Tj
/F7 1 Tf
6.2 0 TD
( 1990;598:17\32028.)Tj
-7.4 -1.7 TD
-0.074 Tw
(Gibbons LW, Blair SN, Cooper KH, Smith M. Association)Tj
1.2 -1.2 TD
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(between coronary heart disease risk factors and physi-)Tj
T*
0.032 Tc
0.258 Tw
(cal fitness in healthy adult women. )Tj
/F16 1 Tf
17.4 0 TD
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0.005 Tc
(1983;67:977\320983.)Tj
-1.2 -1.75 TD
0.013 Tw
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1.2 -1.2 TD
-0.122 Tw
(Skinner JS, editor. )Tj
/F16 1 Tf
7.5 0 TD
-0.117 Tw
(Exercise testing and exercise prescrip-)Tj
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(tion for special cases: theoretical basis and clinical appli-)Tj
T*
(cation. )Tj
/F7 1 Tf
3.05 0 TD
0.078 Tw
(2nd ed. Philadelphia: Lea and Febiger, 1993:)Tj
-3.05 -1.2 TD
(127\320137.)Tj
-1.2 -1.75 TD
0.124 Tw
(Gillum RF. Trends in acute myocardial infarction and)Tj
1.2 -1.2 TD
0.217 Tw
(coronary heart disease death in the United States.)Tj
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T*
-0.026 Tw
(Journal of the American College of Cardiology)Tj
/F7 1 Tf
18.35 0 TD
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[( 1994;23:)]TJ
-18.35 -1.2 TD
(1273\3201277.)Tj
-1.2 -1.75 TD
0.012 Tc
0.259 Tw
(Giovannucci E, Ascherio A, Rimm EB, Colditz GA,)Tj
1.2 -1.2 TD
0.005 Tc
-0.123 Tw
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T*
0.025 Tw
(risk for colon cancer and adenoma in men. )Tj
/F16 1 Tf
18.45 0 TD
0.024 Tw
(Annals of)Tj
-18.45 -1.2 TD
0.001 Tw
(Internal Medicine)Tj
/F7 1 Tf
7.05 0 TD
( 1995;122:327\320334.)Tj
-8.25 -1.75 TD
0.009 Tw
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1.2 -1.2 TD
-0.104 Tw
(factors for coronary heart disease. )Tj
/F16 1 Tf
13.9 0 TD
-0.1 Tw
(Medicine and Science)Tj
-13.9 -1.2 TD
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(in Sports and Exercise)Tj
/F7 1 Tf
8.9 0 TD
( 1989;21:669\320674.)Tj
16.25 59.3 TD
-0.066 Tw
(Gordon NF, Scott CB. The role of exercise in the primary)Tj
1.2 -1.2 TD
0 Tw
(and secondary prevention of coronary artery disease.)Tj
/F16 1 Tf
T*
-0.001 Tw
(Clinics in Sports Medicine)Tj
/F7 1 Tf
10.5 0 TD
( 1991;10:87\320103.)Tj
-11.7 -1.75 TD
-0.083 Tw
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1.2 -1.2 TD
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T*
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[(E)8 (ffect of exercise training in 60- to 69-year-old per-)]TJ
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T*
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[( Journal of the American Medical Association)]TJ
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T*
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T*
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T*
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1.2 -1.2 TD
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T*
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( 1991;14\(Suppl 3\):639\320648.)Tj
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T*
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T*
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( 1987;36:523\320534.)Tj
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0.134 Tw
[(Harrison GG. Height-weight )-11 (Table)20 (s. )]TJ
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15.95 0 TD
0.129 Tw
(Annals of Internal)Tj
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(Medicine)Tj
/F7 1 Tf
3.6 0 TD
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( 1985;103\(Suppl 6, Pt 2\):989\320994.)Tj
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(Haskell WL. Physical activity in the prevention and man-)Tj
1.2 -1.2 TD
0.118 Tw
(agement of coronary heart disease. )Tj
/F16 1 Tf
15.4 0 TD
0.114 Tw
(Physical Activity)Tj
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0.001 Tw
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/F7 1 Tf
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( 1995;Series 2:1\3207.)Tj
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0.053 Tw
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1.2 -1.2 TD
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T*
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T*
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T*
0.07 Tw
(artery disease: the Stanford Coronary Risk Interven-)Tj
T*
0 Tw
(tion Project \(SCRIP\). )Tj
/F16 1 Tf
9.2 0 TD
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/F7 1 Tf
4.8 0 TD
(1994;89:975\320990.)Tj
-15.2 -1.75 TD
0.017 Tw
(Hein HO, Suadicani P, Gyntelberg F. Physical fitness or)Tj
1.2 -1.2 TD
0.232 Tw
(physical activity as a predictor of ischaemic heart)Tj
T*
0.004 Tw
(disease: a 17-year follow-up in the Copenhagen Male)Tj
T*
(Study.)Tj
/F16 1 Tf
2.65 0 TD
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[( Journal of Internal Medicine)]TJ
/F7 1 Tf
11.3 0 TD
-0.064 Tw
[( 1992;232:471\320479.)]TJ
-15.15 -1.75 TD
-0.025 Tw
(Heinonen A, Oja P, Kannus P, Sievanen H, Haapasalo H,)Tj
1.2 -1.2 TD
0.085 Tw
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T*
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T*
0.005 Tc
0 Tw
(acteristics of the skeleton. )Tj
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0.015 Tc
0.216 Tw
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T*
0.001 Tc
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[(insu)5 (lin-dependent diabetes mellitus. )]TJ
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(New England Jour-)Tj
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0.005 Tc
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6.15 0 TD
( 1991;325:147\320152.)Tj
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0.157 Tw
(Herman B, Schmitz PIM, Leyten ACM, Van Luijk JH,)Tj
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T*
0.07 Tw
(logistic analysis of risk factors for stroke in Tilburg,)Tj
T*
0.194 Tw
(The Netherlands.)Tj
/F16 1 Tf
7.5 0 TD
0.187 Tw
[( American Journal of Epidemiology)]TJ
/F7 1 Tf
-7.5 -1.2 TD
(1983;118:514\320525.)Tj
-1.2 -1.75 TD
0.178 Tw
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(causation? )Tj
/F16 1 Tf
4.65 0 TD
-0.031 Tw
(Proceedings of the Royal Society of Medicine)Tj
/F7 1 Tf
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(1965;58:295\320300.)Tj
25.15 58.2 TD
-0.001 Tw
(Hill JO, Drougas HJ, Peters JC. Physical activity, fitness,)Tj
1.2 -1.2 TD
0.054 Tw
(and moderate obesity. In: Bouchard C, Shephard RJ,)Tj
T*
0.003 Tc
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0.25 Tw
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T*
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1.2 -1.2 TD
0 Tw
(injuries: a review. )Tj
/F16 1 Tf
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(Sports Medicine )Tj
/F7 1 Tf
6.65 0 TD
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T*
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0.046 Tw
(International Journal of Obesity)Tj
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12.9 0 TD
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[( 1989;13:)]TJ
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(723\320729.)Tj
-1.2 -1.7 TD
0.117 Tw
(Hollenbeck CB, Haskell W, Rosenthal M, Reaven GM.)Tj
1.2 -1.2 TD
0.145 Tw
(Effect of habitual physical activity on regulation of)Tj
T*
0.205 Tw
(insulin-stimulated glucose disposal in older males.)Tj
/F16 1 Tf
T*
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(Journal of the American Geriatrics Society)Tj
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16.35 0 TD
-0.123 Tw
[( 1984;33:273\320)]TJ
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(277.)Tj
-1.2 -1.75 TD
0.122 Tw
(Holloszy JO, Schultz J, Kusnierkiewicz J, Hagberg JM,)Tj
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(Ehsani AA. Effects of exercise on glucose tolerance and)Tj
T*
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(insulin resistance: brief review and some preliminary)Tj
T*
0.035 Tc
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3.3 0 TD
0.034 Tc
0.25 Tw
[( Acta Medica Scandinavica Supplementum)]TJ
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-3.3 -1.2 TD
0.005 Tc
(1986;711:55\32065.)Tj
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0.07 Tw
(Holman H, Mazonson P, Lorig K. Health education for)Tj
1.2 -1.2 TD
0.098 Tw
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T*
0.025 Tw
(benefits in chronic arthritis.)Tj
/F16 1 Tf
11.8 0 TD
0.024 Tw
[( Transactions of the Asso-)]TJ
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0.001 Tw
(ciation of American Physicians)Tj
/F7 1 Tf
12.35 0 TD
( 1989;102:204\320208.)Tj
-13.55 -1.75 TD
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(Horton ES. Exercise and decreased risk of NIDDM. )Tj
/F16 1 Tf
21.65 0 TD
(New)Tj
-20.45 -1.2 TD
0 Tw
(England Journal of Medicine)Tj
/F7 1 Tf
11.4 0 TD
( 1991;325:196\320198.)Tj
-12.6 -1.75 TD
0.164 Tw
(Howell DW. Musculoskeletal profile and incidence of)Tj
1.2 -1.2 TD
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-0.056 Tw
(musculoskeletal injuries in lightweight women rowers.)Tj
/F16 1 Tf
T*
0.005 Tc
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(American Journal of Sports Medicine)Tj
/F7 1 Tf
14.5 0 TD
-0.063 Tw
[( 1984;12:278\320282.)]TJ
-15.7 -1.7 TD
0.194 Tw
(Hubert HB, Feinleib M, McNamara PM, Castelli WP.)Tj
1.2 -1.2 TD
-0.057 Tw
(Obesity as an independent risk factor for cardiovascu-)Tj
T*
0.022 Tw
(lar disease: a 26-year follow-up of participants in the)Tj
T*
0.134 Tw
(Framingham Heart Study. )Tj
/F16 1 Tf
11.55 0 TD
(Circulation )Tj
/F7 1 Tf
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(1983;67:968\320)Tj
-16.5 -1.2 TD
(977.)Tj
-1.2 -1.75 TD
0.039 Tw
(Hughes JR, Casal DC, Leon AS. Psychological effects of)Tj
1.2 -1.2 TD
-0.053 Tw
(exercise: a randomized cross-over trial. )Tj
/F16 1 Tf
16.4 0 TD
-0.051 Tw
(Journal of Psy-)Tj
-16.4 -1.2 TD
0 Tw
(chosomatic Research)Tj
/F7 1 Tf
8.3 0 TD
( 1986;30:355\320360.)Tj
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(Jacobson PC, Beaver W, Grubb SA, Taft TN, Talmage RV.)Tj
1.2 -1.2 TD
0.176 Tw
(Bone density in women: college athletes and older)Tj
T*
0.028 Tc
0.259 Tw
(athletic women. )Tj
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7.85 0 TD
0.027 Tc
0.25 Tw
(Journal of Orthopaedic Research)Tj
/F7 1 Tf
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0.005 Tc
(1984;2:328\320332.)Tj
-1.2 -1.75 TD
-0.068 Tw
(Jaglal SB, Kreiger N, Darlington G. Past and recent physi-)Tj
1.2 -1.2 TD
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(cal activity and risk of hip fracture.)Tj
/F16 1 Tf
14.2 0 TD
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[( American Journal of)]TJ
-14.2 -1.2 TD
(Epidemiology)Tj
/F7 1 Tf
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( 1993;138:107\320118.)Tj
ET
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T*
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T*
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T*
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(Republic of Kiribati.)Tj
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[( American Journal)]TJ
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( 1984;119:396\320409.)Tj
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(sion. )Tj
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0.131 Tw
[( 1985;13:)]TJ
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( 1995;95:126\320130.)Tj
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1.2 -1.2 TD
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(American)Tj
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[( Journal of Bone and)]TJ
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( 1995;10:1303\3201311.)Tj
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0.102 Tw
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/F16 1 Tf
T*
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( 1979;64:1011\3201015.)Tj
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0.221 Tw
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T*
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17.1 0 TD
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[( 1988;20:50\320)]TJ
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(54.)Tj
25.35 62.9 TD
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( 1991;44:1255\3201261.)Tj
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[( Journal of)]TJ
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[( 1979;242:2578\3202579.)]TJ
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0.252 Tw
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0.256 Tw
(atherogenic diet. )Tj
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( 1992;8:355\320372.)Tj
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[( 1994;)]TJ
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T*
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[( Diabetologia )]TJ
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5.55 0 TD
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T*
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[( 1988;723:213\320223.)]TJ
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( 1992;55:495S\320502S.)Tj
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T*
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0.066 Tw
(veys, 1960 to 1991. )Tj
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[( Journal of the American Medical)]TJ
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20.15 0 TD
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(tional Journal of Sports Medicine)Tj
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13.2 0 TD
( 1994;15:132\320135.)Tj
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0.06 Tw
(Kujala UM, Kaprio J, Sarna S. Osteoarthritis of weight-)Tj
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T*
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T*
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T*
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[( Journal of the American Medical Associa-)]TJ
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T*
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( 1992;135:169\320179.)Tj
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T*
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1.2 -1.2 TD
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16.05 0 TD
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( 1991a;11:46\32057.)Tj
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1.2 -1.2 TD
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(Gordon S, Timmis GC, editors. )Tj
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1.2 -1.2 TD
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T*
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[( New York: Marcel)]TJ
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0.232 Tw
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0.258 Tw
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T*
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[(81\320)-17 (9)10 (2)10 (.)]TJ
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T*
0.045 Tc
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0.25 Tw
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0.014 Tw
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T*
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0.143 Tw
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T*
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T*
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T*
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0.059 Tw
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1.2 -1.2 TD
0.16 Tw
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T*
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T*
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5.45 0 TD
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/F7 1 Tf
9.75 0 TD
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0.145 Tw
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1.2 -1.2 TD
0.015 Tc
0.256 Tw
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18.45 0 TD
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0.005 Tc
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[(M)-10 (e)-8 (tabolism Reviews)]TJ
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0.036 Tw
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0.258 Tw
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1.2 -1.2 TD
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T*
0.161 Tw
(and mild type-2 diabetes. )Tj
/F16 1 Tf
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-21.864 63.727 TD
0.003 Tc
-0.001 Tw
(Physical Activity and Health)Tj
/F7 1 Tf
10 0 0 10 48 712 Tm
0.005 Tc
-0.016 Tw
(Longnecker MP, De Verdier MG, Frumkin H, Carpenter)Tj
1.2 -1.2 TD
-0.043 Tw
(C. A case-control study of physical activity in relation)Tj
T*
-0.054 Tw
(to risk of cancer of the right colon and rectum in men.)Tj
/F16 1 Tf
T*
(International)Tj
/F7 1 Tf
5.25 0 TD
( )Tj
/F16 1 Tf
0.25 0 TD
0 Tw
(Journal of Epidemiology )Tj
/F7 1 Tf
9.95 0 TD
(1995;24:42\32050.)Tj
-16.65 -1.75 TD
0.151 Tw
(Lynge E, Thygesen L. Use of surveillance systems for)Tj
1.2 -1.2 TD
0.101 Tw
(occupational cancer: data from the Danish National)Tj
T*
0.068 Tc
(system. )Tj
/F16 1 Tf
4.15 0 TD
0.066 Tc
0.25 Tw
(International Journal of Epidemiology)Tj
/F7 1 Tf
-4.15 -1.2 TD
0.005 Tc
(1988;17:493\320500.)Tj
-1.2 -1.75 TD
0.195 Tw
(Macera CA. Lower extremity injuries in runners: ad-)Tj
1.2 -1.2 TD
0 Tw
(vances in prediction. )Tj
/F16 1 Tf
9 0 TD
(Sports Medicine )Tj
/F7 1 Tf
6.65 0 TD
(1992;13:50\32057.)Tj
-16.85 -1.7 TD
0.015 Tc
-0.012 Tw
(Macera CA, Pate RR, Powell KE, Jackson KL, Kendrick)Tj
1.2 -1.2 TD
0.017 Tc
0.094 Tw
[(JS, )-15 (Craven )-10 (TE.)-10 ( )20 (P)-27 (redicting lower extremity injuries)]TJ
T*
0.015 Tc
-0.063 Tw
(among habitual runners. )Tj
/F16 1 Tf
10.65 0 TD
-0.061 Tw
(Archives of Inernal Medicine)Tj
/F7 1 Tf
-10.65 -1.2 TD
(1989;149:2565\3202568.)Tj
-1.2 -1.75 TD
0.005 Tc
0.257 Tw
(Mahoney LT, Lauer RM, Lee J, Clarke WR. Factors)Tj
1.2 -1.2 TD
-0.112 Tw
(affecting tracking of coronary heart disease risk factors)Tj
T*
0.083 Tw
(in children: the Muscatine Study. )Tj
/F16 1 Tf
14.65 0 TD
0.08 Tw
(Annals of the New)Tj
-14.65 -1.2 TD
0 Tw
(York Academy of Sciences )Tj
/F7 1 Tf
10.65 0 TD
(1991;623:120\320132.)Tj
-11.85 -1.75 TD
0.179 Tw
(Manson JE, Nathan DM, Krolewski AS, Stampfer MJ,)Tj
1.2 -1.2 TD
0.081 Tw
(Willett WC, Hennekens CH. A prospective study of)Tj
T*
0.095 Tw
(exercise and incidence of diabetes among U.S. male)Tj
T*
(physicians. )Tj
/F16 1 Tf
4.8 0 TD
-0.103 Tw
[( Journal of the American Medical Association)]TJ
/F7 1 Tf
-4.8 -1.2 TD
(1992;268:63\32067.)Tj
-1.2 -1.75 TD
0.001 Tw
(Manson JE, Rimm EB, Stampfer MJ, Colditz GA, Willett)Tj
1.2 -1.2 TD
0.101 Tw
(WC, Krolewski AS, et al. Physical activity and inci-)Tj
T*
0.071 Tw
(dence of non-insulin-dependent diabetes mellitus in)Tj
T*
(women. )Tj
/F16 1 Tf
3.6 0 TD
(Lancet)Tj
/F7 1 Tf
2.65 0 TD
0 Tw
( 1991;338:774778.)Tj
-7.45 -1.75 TD
-0.123 Tw
(Manson JE, Willett WC, Stampfer MJ, Colditz GA, Hunter)Tj
1.2 -1.2 TD
0.092 Tw
(DJ, Hankinson SE, et al. Body weight and mortality)Tj
T*
0.018 Tc
0.259 Tw
(among women. )Tj
/F16 1 Tf
7.4 0 TD
0.25 Tw
(New England Journal of Medicine)Tj
/F7 1 Tf
-7.4 -1.2 TD
0.005 Tc
(1995;333:677\320685.)Tj
-1.2 -1.7 TD
-0.058 Tw
(Marceau M, Kouame N, Lacourciere Y, Cleroux J. Effects)Tj
1.2 -1.2 TD
0.256 Tw
(of different training intensities on 24 hour blood)Tj
T*
0.119 Tw
(pressure in hypertensive subjects. )Tj
/F16 1 Tf
14.9 0 TD
(Circulation )Tj
/F7 1 Tf
4.95 0 TD
(1993;)Tj
-19.85 -1.2 TD
(88:2803\3202811.)Tj
-1.2 -1.75 TD
0.099 Tw
(Marcus PM, Newcomb PA, Storer BE. Early adulthood)Tj
1.2 -1.2 TD
-0.096 Tw
(physical activity and colon cancer risk among Wiscon-)Tj
T*
-0.039 Tw
(sin women. )Tj
/F16 1 Tf
5 0 TD
-0.038 Tw
(Cancer Epidemiology, Biomarkers and Pre-)Tj
-5 -1.2 TD
(vention)Tj
/F7 1 Tf
2.9 0 TD
-0.004 Tw
( 1994;3:641\320644.)Tj
-4.1 -1.75 TD
-0.003 Tc
-0.085 Tw
(Marcus R, Cann C, Madvig P, Minkoff J, Goddard M, Bayer)Tj
1.2 -1.2 TD
0.153 Tw
(M, et al. Menstrual function and bone mass in elite)Tj
T*
-0.044 Tw
(women distance runners: endocrine and metabolic fea-)Tj
T*
-0.004 Tc
(tures. )Tj
/F16 1 Tf
2.55 0 TD
-0.003 Tc
-0.001 Tw
(Annals of Internal Medicine)Tj
/F7 1 Tf
10.85 0 TD
( 1985;102:158\320163.)Tj
-14.6 -1.75 TD
0.005 Tc
-0.104 Tw
(Markowitz S, Morabia A, Garibaldi K, Wynder E. Effect of)Tj
1.2 -1.2 TD
0.077 Tw
(occupational and recreational activity on the risk of)Tj
T*
0.035 Tw
(colorectal cancer among males: a case-control study.)Tj
/F16 1 Tf
T*
0.139 Tw
(International Journal of Epidemiology )Tj
/F7 1 Tf
16 0 TD
(1992;21:1057\320)Tj
-16 -1.2 TD
(1062.)Tj
25.15 62.35 TD
-0.029 Tw
(Marti B. Benefits and risks of running among women: an)Tj
1.2 -1.2 TD
0.203 Tw
(epidemiologic study. )Tj
/F16 1 Tf
9.4 0 TD
0.196 Tw
(International Journal of Sports)Tj
-9.4 -1.2 TD
(Medicine )Tj
/F7 1 Tf
3.85 0 TD
(1988;9:92\32098.)Tj
-5.05 -1.75 TD
0.021 Tc
0.258 Tw
(Marti B, Minder CE. Physische berufsaktivit\212t und)Tj
1.2 -1.2 TD
0.024 Tc
0.259 Tw
(kolonkarzinommortalit\212t bei Schweizer m\212nnern)Tj
T*
0.005 Tc
0.21 Tw
(1979\3201982 [Physical occupational activity and co-)Tj
T*
-0.034 Tw
(lonic carcinoma mortality in Swiss men, 1979\3201982].)Tj
/F16 1 Tf
T*
0.001 Tw
(Sozial- und Pr\212ventivmedizin)Tj
/F7 1 Tf
11.85 0 TD
( 1989;34:30\32037.)Tj
-13.05 -1.75 TD
-0.048 Tw
(Marti B, Vader JP, Minder CE, Abelin T. On the epidemi-)Tj
1.2 -1.2 TD
0.049 Tw
(ology of running injuries: the 1984 Bern Grand-Prix)Tj
T*
0.015 Tc
(study. )Tj
/F16 1 Tf
2.95 0 TD
0.044 Tw
(American Journal of Sports Medicine)Tj
/F7 1 Tf
15.25 0 TD
0.045 Tw
[( 1988;16:)]TJ
-18.2 -1.2 TD
0.01 Tc
[(285\320)10 (294.)]TJ
-1.2 -1.7 TD
0.005 Tc
0.016 Tw
(Martinsen EW, Medhus A, Sandvik L. Effects of aerobic)Tj
1.2 -1.2 TD
0.227 Tw
(exercise on depression: a controlled study.)Tj
/F16 1 Tf
19 0 TD
0.22 Tw
[( British)]TJ
-19 -1.2 TD
-0.001 Tw
(Medical Journal )Tj
/F7 1 Tf
6.65 0 TD
(1985;291:109\320110.)Tj
-7.85 -1.75 TD
-0.097 Tw
(Martinsen EW, Stephens T. Exercise and mental health in)Tj
1.2 -1.2 TD
0.009 Tw
(clinical and free-living populations. In: Dishman RK,)Tj
T*
(editor. )Tj
/F16 1 Tf
2.95 0 TD
-0.048 Tw
(Advances in exercise adherence)Tj
/F7 1 Tf
12.35 0 TD
-0.05 Tw
(. Champaign, IL:)Tj
-15.3 -1.2 TD
-0.001 Tw
(Human Kinetics, 1994:55\32072.)Tj
-1.2 -1.75 TD
0.188 Tw
(Matsusaki M, Ikeda M, Tashiro E, Koga M, Miura S,)Tj
1.2 -1.2 TD
-0.001 Tw
(Ideishi M, et al. Influence of workload on the antihy-)Tj
T*
-0.059 Tw
(pertensive effect of exercise. )Tj
/F16 1 Tf
11.85 0 TD
-0.057 Tw
(Clinical and Experimental)Tj
-11.85 -1.2 TD
0 Tw
(Pharmacology and Physiology)Tj
/F7 1 Tf
12.1 0 TD
( 1992;19:471\320479.)Tj
-13.3 -1.75 TD
-0.074 Tw
(McAuley E. Physical activity and psychosocial outcomes.)Tj
1.2 -1.2 TD
0.188 Tw
(In: Bouchard C, Shephard RJ, Stephens T, editors.)Tj
/F16 1 Tf
T*
0.032 Tw
(Physical activity, fitness, and health: international pro-)Tj
T*
-0.005 Tw
(ceedings and consensus statement. )Tj
/F7 1 Tf
13.85 0 TD
(Champaign, IL: Hu-)Tj
-13.85 -1.2 TD
-0.001 Tw
(man Kinetics, 1994:551\320568.)Tj
-1.2 -1.75 TD
0.218 Tw
(McAuley E, Rudolph D. Physical activity, aging, and)Tj
1.2 -1.2 TD
-0.092 Tw
(psychological well-being. )Tj
/F16 1 Tf
10.7 0 TD
-0.088 Tw
(Journal of Aging and Physical)Tj
-10.7 -1.2 TD
(Activity)Tj
/F7 1 Tf
3.15 0 TD
0 Tw
( 1995;3:67\32096.)Tj
-4.35 -1.7 TD
0.037 Tw
(McDonald DG, Hodgdon JA.)Tj
/F16 1 Tf
12.15 0 TD
0.036 Tw
[( The psychological effects of)]TJ
-10.95 -1.2 TD
-0.051 Tw
(aerobic fitness training: research and theory.)Tj
/F7 1 Tf
17.65 0 TD
-0.053 Tw
[( New York:)]TJ
-17.65 -1.2 TD
-0.002 Tw
(Springer-Verlag, 1991.)Tj
-1.2 -1.75 TD
0.037 Tw
(McGinnis JM, Foege WH. Actual causes of death in the)Tj
1.2 -1.2 TD
-0.083 Tw
(United States. )Tj
/F16 1 Tf
5.9 0 TD
-0.08 Tw
[( Journal of the American Medical Associa-)]TJ
-5.9 -1.2 TD
(tion)Tj
/F7 1 Tf
1.55 0 TD
-0.004 Tw
( 1993;270:2207\3202212.)Tj
-2.75 -1.75 TD
-0.042 Tw
(McKeigue PM, Pierpoint T, Ferrie JE, Marmot MG. Rela-)Tj
1.2 -1.2 TD
-0.106 Tw
(tionship of glucose intolerance and hyperinsulinaemia)Tj
T*
0.117 Tw
(to body fat pattern in south Asians and Europeans.)Tj
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T*
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T*
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T*
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T*
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T*
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[( 1993;150:1447\3201465)-24 (.)]TJ
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T*
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(44, No. 4, Suppl\).)Tj
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0.007 Tw
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T*
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/F16 1 Tf
T*
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[( 1991;53:1304\320)]TJ
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(1311.)Tj
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0.032 Tw
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1.2 -1.2 TD
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T*
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1.2 -1.2 TD
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T*
0.076 Tw
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/F7 1 Tf
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( 1994;26:1220\3201225.)Tj
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/F16 1 Tf
18.15 0 TD
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[( American)]TJ
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( 1992;136:201\320213.)Tj
-10.85 -1.75 TD
0.037 Tw
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1.2 -1.2 TD
0.038 Tc
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0.036 Tc
0.25 Tw
(Exercise and Sport Sciences Reviews)Tj
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(1990;18:379\320415.)Tj
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0.012 Tw
(Obarzanek E, Schreiber GB, Crawford PB, Goldman SR,)Tj
1.2 -1.2 TD
0.089 Tw
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T*
-0.035 Tw
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T*
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T*
0.13 Tw
(Health Study. )Tj
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/F7 1 Tf
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T*
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T*
0 Tw
(dial infarction. )Tj
/F16 1 Tf
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( 1989;80:234\320244.)Tj
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(Oliveria SA, Kohl HW III, Trichopoulos D, Blair SN. The)Tj
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0.002 Tc
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T*
0.005 Tc
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T*
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/F16 1 Tf
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[(Lan)13 (c)10 (e)10 (t)]TJ
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2.7 0 TD
0.005 Tc
0.003 Tw
( 1990;336:129\320133.)Tj
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/F7 1 Tf
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/F16 1 Tf
T*
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[( 1994;)]TJ
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( 1987;45:312\320317.)Tj
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(Paffenbarger RS Jr, Hyde RT, Wing AL, Hsieh C-C. Physi-)Tj
1.2 -1.2 TD
0.038 Tw
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T*
0.049 Tc
0.259 Tw
(lege alumni. )Tj
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0.048 Tc
0.25 Tw
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0.005 Tc
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-1.2 -1.75 TD
-0.072 Tw
[(P)10 (affenbarger RS Jr, Hyde RT, Wing AL, Lee I-M, Jung DL,)]TJ
1.2 -1.2 TD
0.13 Tw
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T*
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T*
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(Paffenbarger RS Jr, Hyde RT, Wing AL, Lee I-M, Kampert)Tj
1.2 -1.2 TD
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T*
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(cal fitness, health, and longevity. In: Bouchard C,)Tj
T*
0.182 Tw
(Shephard RJ, Stephens T, editors. )Tj
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T*
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(sus statement.)Tj
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[( Champaign, IL: Human Kinetics,)]TJ
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0.005 Tc
(1994:119\320133.)Tj
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0.025 Tc
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[(P)30 (affenbarger RS Jr, Hyde RT, Wing AL, Steinmetz CH.)]TJ
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0.173 Tw
[(A)-20 ( )-40 (natural history of athleticism and cardiovascular)]TJ
T*
(health. )Tj
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0.223 Tw
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T*
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0.243 Tw
(personal characteristics associated with depression)Tj
T*
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( )Tj
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0.04 Tw
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0.003 Tc
-0.128 Tw
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T*
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0.003 Tc
-0.127 Tw
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/F16 1 Tf
19.4 0 TD
-0.123 Tw
[( Ameri-)]TJ
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0.001 Tw
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(Paffenbarger RS Jr, Wing AL, Hyde RT. Physical activity as)Tj
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0.259 Tw
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/F16 1 Tf
T*
0.005 Tc
0 Tw
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(Paffenbarger RS Jr, Wing AL, Hyde RT, Jung DL. Physical)Tj
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-0.005 Tc
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/F16 1 Tf
T*
0.005 Tc
0 Tw
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/F7 1 Tf
13.8 0 TD
( 1983;117:245\320257.)Tj
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0.172 Tw
(Pan X, Li G, Hu Y. [Effect of dietary and/or exercise)Tj
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0.015 Tw
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T*
0.196 Tw
(with impaired glucose tolerance from 1986\3201992].)Tj
/F16 1 Tf
T*
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14.5 0 TD
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[( 1995;34:108\320112.)]TJ
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0.013 Tw
(Panush RS, Hanson CS, Caldwell JR, Longley S, Stork J,)Tj
1.2 -1.2 TD
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T*
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(An eight-year follow-up study. )Tj
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( 1995;1:35\32039.)Tj
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1.2 -1.2 TD
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0.128 Tw
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[( 1994;8:79\320)]TJ
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(102.)Tj
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T*
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/F16 1 Tf
8.2 0 TD
0.161 Tw
[( Journal of the American Medical)]TJ
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0.186 Tw
(Pate RR, Pratt M, Blair SN, Haskell WL, Macera CA,)Tj
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T*
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T*
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T*
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/F16 1 Tf
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[( Journal of the American Medical Association)]TJ
/F7 1 Tf
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(1995;273:402\320407.)Tj
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(Pekkanen J, Marti B, Nissinen A, Tuomilehto J, Punsar S,)Tj
1.2 -1.2 TD
0.134 Tw
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T*
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(high physical activity: a 20-year follow-up of middle-)Tj
T*
0 Tw
(aged Finnish men. )Tj
/F16 1 Tf
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T*
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0.077 Tw
[( Journal of the American Medical)]TJ
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( 1983;249:3052\3203056.)Tj
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T*
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1.2 -1.2 TD
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( 1995;19:311\320325.)Tj
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0.096 Tw
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/F16 1 Tf
1.2 -1.2 TD
0.233 Tw
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T*
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(. Rockville, MD:)Tj
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(Aspen Publishers, 1988:241\320255.)Tj
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10 0 0 10 48 712 Tm
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1.2 -1.2 TD
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T*
0.055 Tw
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T*
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[( 1995;9:1614\3201622.)]TJ
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0.005 Tc
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0.141 Tw
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6.45 0 TD
0.136 Tw
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1.2 -1.2 TD
0.063 Tw
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T*
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18.4 0 TD
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/F7 1 Tf
8.6 0 TD
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( 1986;78:618\320621.)Tj
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0.203 Tw
(Polednak AP. College athletes, body size, and cancer)Tj
1.2 -1.2 TD
(mortality.)Tj
/F16 1 Tf
4.1 0 TD
0 Tw
( Cancer)Tj
/F7 1 Tf
3.15 0 TD
( 1976;38:382\320387.)Tj
-8.45 -1.75 TD
-0.074 Tw
(Polivy J. Physical activity, fitness, and compulsive behav-)Tj
1.2 -1.2 TD
-0.089 Tw
(iors. In: Bouchard C, Shephard RJ, Stephens T, editors)Tj
/F16 1 Tf
22.05 0 TD
(.)Tj
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T*
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/F7 1 Tf
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(. Champaign, IL:)Tj
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0.005 Tc
0 Tw
[(H)-20 (u)-42 (man Kinetics, 1994:883\320897.)]TJ
-1.2 -1.75 TD
-0.096 Tw
(Pollock ML, Carroll JF, Graves JE, Leggett SH, Braith RW,)Tj
1.2 -1.2 TD
-0.021 Tw
(Limacher M, et al. Injuries and adherence to walk/jog)Tj
T*
-0.025 Tw
(and resistance training programs in the elderly. )Tj
/F16 1 Tf
19.9 0 TD
(Medi-)Tj
-19.9 -1.2 TD
0.005 Tw
(cine and Science in Sports and Exercise)Tj
/F7 1 Tf
15.7 0 TD
( 1991;23:1194\320)Tj
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(1200.)Tj
-1.2 -1.75 TD
-0.021 Tw
(Pollock ML, Gettman LR, Milesis CA, Bah MD, Durstine)Tj
1.2 -1.2 TD
0.081 Tw
(L, Johnson RB. Effects of frequency and duration of)Tj
T*
-0.033 Tw
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/F16 1 Tf
18.4 0 TD
-0.032 Tw
[( Medicine)]TJ
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0 Tw
(and Science in Sports)Tj
/F7 1 Tf
8.5 0 TD
( 1977;9:31\32036.)Tj
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-0.037 Tw
(Pomrehn PR, Wallace RB, Burmeister LF. Ischemic heart)Tj
1.2 -1.2 TD
-0.077 Tw
(disease mortality in Iowa farmers: the influence of life-)Tj
T*
(style. )Tj
/F16 1 Tf
2.7 0 TD
0.246 Tw
[( Journal of the American Medical Association)]TJ
/F7 1 Tf
-2.7 -1.2 TD
(1982;248:1073\3201076.)Tj
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-0.055 Tw
(Powell KE, Blair SN. The public health burdens of seden-)Tj
1.2 -1.2 TD
0.105 Tw
(tary living habits: theoretical but realistic estimates.)Tj
/F16 1 Tf
T*
0.097 Tw
(Medicine and Science in Sports and Exercise)Tj
/F7 1 Tf
18.25 0 TD
0.101 Tw
[( 1994;26:)]TJ
-18.25 -1.2 TD
(851\320856.)Tj
-1.2 -1.75 TD
-0.003 Tc
0.164 Tw
(Powell KE, Thompson PD, Caspersen CJ, Kendrick JS.)Tj
1.2 -1.2 TD
0.114 Tw
(Physical activity and the incidence of coronary heart)Tj
T*
-0.004 Tc
(disease. )Tj
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3.3 0 TD
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(Annual Review of Public Health)Tj
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11.95 0 TD
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[( 1987;8:253\320287.)]TJ
-16.45 -1.75 TD
0.012 Tc
0.258 Tw
(Prince RL, Smith M, Dick IM, Price RI, Webb PG,)Tj
1.2 -1.2 TD
0.005 Tc
0.074 Tw
(Henderson NK, et al. Prevention of postmenopausal)Tj
T*
-0.079 Tw
(osteoporosis: a comparative study of exercise, calcium)Tj
T*
-0.048 Tw
(supplementation, and hormone-replacement therapy.)Tj
/F16 1 Tf
T*
-0.123 Tw
(New England Journal of Medicine)Tj
/F7 1 Tf
12.95 0 TD
-0.127 Tw
[( 1991:325:1189\3201195.)]TJ
-14.15 -1.75 TD
0.131 Tw
(Province MA, Hadley EC, Hornbrook MC, Lipsitz LA,)Tj
1.2 -1.2 TD
-0.033 Tw
(Miller JP, Mulrow CD, et al. The effects of exercise on)Tj
T*
-0.032 Tw
(falls in elderly patients: a preplanned meta-analysis of)Tj
T*
0.196 Tw
(the FICSIT trials. )Tj
/F16 1 Tf
8.1 0 TD
0.189 Tw
[( Journal of the American Medical)]TJ
-8.1 -1.2 TD
(Association)Tj
/F7 1 Tf
4.55 0 TD
-0.003 Tw
( 1995;273:1341\3201347.)Tj
20.6 62.35 TD
-0.067 Tw
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T*
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[( 1994;121:133\320140.)]TJ
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T*
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T*
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T*
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T*
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T*
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T*
0.005 Tc
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T*
0.02 Tc
0.259 Tw
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-1.2 -1.75 TD
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1.2 -1.2 TD
0.119 Tw
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/F16 1 Tf
14.6 0 TD
0.115 Tw
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1.2 -1.2 TD
0.099 Tw
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T*
0.016 Tw
(activity on exercise-induced feeling states in women.)Tj
/F16 1 Tf
T*
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/F7 1 Tf
7.45 0 TD
( 1995;14:350\320359.)Tj
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1.2 -1.2 TD
0.066 Tw
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/F16 1 Tf
T*
0 Tw
(Physician and Sportsmedicine)Tj
/F7 1 Tf
11.95 0 TD
( 1985;13:130\320140.)Tj
-13.15 -1.75 TD
0.051 Tw
(Richter EA, Ruderman NB, Schneider SH. Diabetes and)Tj
1.2 -1.2 TD
(exercise. )Tj
/F16 1 Tf
4 0 TD
0.08 Tw
(American Journal of Medicine)Tj
/F7 1 Tf
12.15 0 TD
0.082 Tw
[( 1981;70:201\320)]TJ
-16.15 -1.2 TD
(209.)Tj
-1.2 -1.75 TD
-0.084 Tw
(Robinson TL, Snow-Harter C, Taaffe DR, Gillis D, Shaw J,)Tj
1.2 -1.2 TD
0.097 Tw
(Marcus R. Gymnasts exhibit higher bone mass than)Tj
T*
-0.056 Tw
(runners despite similar prevalence of amenorrhea and)Tj
T*
(oligomenorrhea.)Tj
/F16 1 Tf
6.95 0 TD
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[( Journal of Bone and Mineral Research)]TJ
/F7 1 Tf
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(1995;10:26\32035.)Tj
-1.2 -1.75 TD
0.018 Tc
0.259 Tw
(Rodriguez BL, Curb JD, Burchfiel CM, Abbott RD,)Tj
1.2 -1.2 TD
0.005 Tc
-0.063 Tw
(Petrovitch H, Masaki K, et al. Physical activity and 23-)Tj
T*
-0.107 Tw
(year incidence of coronary heart disease morbidity and)Tj
T*
0.001 Tc
-0.127 Tw
(mortality among middle-aged men: the Honolulu Heart)Tj
T*
0.005 Tc
(Program.)Tj
/F16 1 Tf
3.85 0 TD
0.001 Tw
( Circulation)Tj
/F7 1 Tf
4.85 0 TD
( 1994;89:2540\3202544.)Tj
-9.9 -1.75 TD
-0.122 Tw
(Rolf C. Overuse injuries of the lower extremity in runners.)Tj
/F16 1 Tf
1.2 -1.2 TD
0.01 Tw
(Scandinavian Journal of Medicine and Science in Sports)Tj
/F7 1 Tf
T*
(1995;5:181\320190.)Tj
-1.2 -1.7 TD
0.116 Tw
(R\232nnemaa T, Mattila K, Lehtonen A, Kallio V. A con-)Tj
1.2 -1.2 TD
0.097 Tw
(trolled randomized study on the effect of long-term)Tj
T*
0.077 Tw
(physical exercise on the metabolic control in type 2)Tj
T*
0.014 Tc
0.259 Tw
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/F16 1 Tf
7.55 0 TD
0.25 Tw
[( Acta Medica Scandinavica)]TJ
/F7 1 Tf
11.8 0 TD
0.259 Tw
[( 1986;)]TJ
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0.005 Tc
(220:219\320224.)Tj
-1.2 -1.75 TD
0.039 Tc
(Roos H, Lindberg H, Gardsell P, Lohmander LS,)Tj
1.2 -1.2 TD
0.005 Tc
-0.034 Tw
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T*
0.169 Tw
(relation to meniscectomy in former soccer players.)Tj
/F16 1 Tf
T*
-0.061 Tw
(American Journal of Sports Medicine)Tj
/F7 1 Tf
14.5 0 TD
-0.063 Tw
[( 1994;22:219\320222.)]TJ
-15.7 -1.75 TD
0.04 Tw
(Rosenman RH, Bawol RD, Oscherwitz M. A 4-year pro-)Tj
1.2 -1.2 TD
-0.037 Tw
(spective study of the relationship of different habitual)Tj
T*
0.103 Tw
(vocational physical activity to risk and incidence of)Tj
T*
0.043 Tw
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T*
(ployees. )Tj
/F16 1 Tf
3.75 0 TD
0.078 Tw
(Annals of the New York Academy of Sciences)Tj
/F7 1 Tf
-3.75 -1.2 TD
(1977;301:627\320641.)Tj
25.15 60.6 TD
-0.109 Tw
(Ross CE, Hayes D. Exercise and psychologic well-being in)Tj
1.2 -1.2 TD
0.011 Tc
0.259 Tw
(the community.)Tj
/F16 1 Tf
7.05 0 TD
0.25 Tw
[( American Journal of Epidemiology)]TJ
/F7 1 Tf
-7.05 -1.2 TD
0.005 Tc
(1988;127:762\320771.)Tj
-1.2 -1.75 TD
0.089 Tw
(Roth DL. Acute emotional and psychophysiological ef-)Tj
1.2 -1.2 TD
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0.25 Tw
(fects of aerobic exercise. )Tj
/F16 1 Tf
11.2 0 TD
-0.004 Tc
(Psychophysiology)Tj
/F7 1 Tf
6.95 0 TD
-0.003 Tc
[( 1989;26:)]TJ
-18.15 -1.2 TD
0.005 Tc
(593\320602.)Tj
-1.2 -1.75 TD
-0.079 Tw
(Rubin K, Schirduan V, Gendreau P, Sarfarazi M, Mendola)Tj
1.2 -1.2 TD
0.052 Tw
(R, Dalsky G. Predictors of axial and peripheral bone)Tj
T*
0.056 Tw
(mineral density in healthy children and adolescents,)Tj
T*
-0.053 Tw
(with special attention to the role of puberty. )Tj
/F16 1 Tf
18.35 0 TD
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(Journal of)Tj
-18.35 -1.2 TD
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/F7 1 Tf
4 0 TD
0.002 Tw
( 1993;123:863\320870.)Tj
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0.017 Tw
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1.2 -1.2 TD
0.033 Tw
(variables and physical activity in preschool children.)Tj
/F16 1 Tf
T*
0 Tc
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(Journal of Developmental and Behavioral Pediatrics)Tj
/F7 1 Tf
19.8 0 TD
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[( 1988;)]TJ
-19.8 -1.2 TD
0.005 Tc
(9:57\32061.)Tj
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(Salonen JT, Puska P, Tuomilehto J. Physical activity and)Tj
1.2 -1.2 TD
0.243 Tw
(risk of myocardial infarction, cerebral stroke, and)Tj
T*
-0.048 Tw
(death: a longitudinal study in Eastern Finland.)Tj
/F16 1 Tf
19.25 0 TD
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[( Ameri-)]TJ
-19.25 -1.2 TD
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(can Journal of Epidemiology)Tj
/F7 1 Tf
11.35 0 TD
( 1982;115:526\320537.)Tj
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1.2 -1.2 TD
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(time and occupational physical activity: risk of death)Tj
T*
-0.113 Tw
(from ischemic heart disease.)Tj
/F16 1 Tf
11.55 0 TD
-0.109 Tw
[( American Journal of Epide-)]TJ
-11.55 -1.2 TD
(miology)Tj
/F7 1 Tf
3.2 0 TD
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( 1988;127:87\32094.)Tj
-4.4 -1.75 TD
0.004 Tw
(Saltin B, Lindg\212rde F, Houston M, Horlin R, Nygaard E,)Tj
1.2 -1.2 TD
0.241 Tw
(Gad P. Physical training and glucose tolerance in)Tj
T*
0.239 Tw
(middle-aged men with chemical diabetes. )Tj
/F16 1 Tf
18.85 0 TD
(Diabetes)Tj
/F7 1 Tf
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(1979;28:30\32032.)Tj
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0.071 Tw
(Sandler RB, Cauley JA, Sashin D, Scialabba MA, Kriska)Tj
1.2 -1.2 TD
0.214 Tw
(AM. The effect of grip strength on radial bone in)Tj
T*
0.176 Tw
(postmenopausal women.)Tj
/F16 1 Tf
10.6 0 TD
0.17 Tw
[( Journal of Orthopaedic Re-)]TJ
-10.6 -1.2 TD
(search)Tj
/F7 1 Tf
2.6 0 TD
-0.001 Tw
( 1989;7:440\320444.)Tj
-3.8 -1.7 TD
-0.126 Tw
(Sandler RS, Pritchard ML, Bangdiwala SI. Physical activity)Tj
1.2 -1.2 TD
0.229 Tw
(and the risk of colorectal adenomas. )Tj
/F16 1 Tf
16.8 0 TD
(Epidemiology)Tj
/F7 1 Tf
-16.8 -1.2 TD
(1995;6:602\320606.)Tj
-1.2 -1.75 TD
-0.063 Tw
(Sandvik L, Erikssen J, Thaulow E, Erikssen G, Mundal R,)Tj
1.2 -1.2 TD
0.029 Tw
(Rodahl K. Physical fitness as a predictor of mortality)Tj
T*
0.208 Tw
(among healthy, middle-aged Norwegian men. )Tj
/F16 1 Tf
20.45 0 TD
(New)Tj
-20.45 -1.2 TD
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(England Journal of Medicine)Tj
/F7 1 Tf
11.4 0 TD
( 1993;328:533\320537.)Tj
-12.6 -1.75 TD
0.22 Tw
(Scheuer J. Effects of physical training on myocardial)Tj
1.2 -1.2 TD
0.139 Tw
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T*
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T*
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/F16 1 Tf
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T*
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T*
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T*
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[( American Journal of Public)]TJ
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0.005 Tc
-0.087 Tw
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1.2 -1.2 TD
0.093 Tw
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T*
0.012 Tc
0.258 Tw
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/F16 1 Tf
7 0 TD
0.011 Tc
0.25 Tw
[( American Journal of Epidemiology)]TJ
/F7 1 Tf
-7 -1.2 TD
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(1988;128:989\320999.)Tj
-1.2 -1.75 TD
-0.021 Tw
(Smith TW, Leon AS. )Tj
/F16 1 Tf
8.75 0 TD
-0.02 Tw
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/F7 1 Tf
4.4 0 TD
0.084 Tw
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(20.)Tj
-1.2 -1.75 TD
0.023 Tc
0.259 Tw
(Sobolski J, Kornitzer M, DeBacker G, Dramaix M,)Tj
1.2 -1.2 TD
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0.25 Tw
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-0.008 Tw
(ischemic heart disease in the Belgian Physical Fitness)Tj
T*
0.08 Tw
(Study: physical fitness rather than physical activity?)Tj
/F16 1 Tf
T*
0 Tw
(American Journal of Epidemiology)Tj
/F7 1 Tf
13.8 0 TD
( 1987;125:601\320610.)Tj
-15 -1.7 TD
0.067 Tw
(Stamler R, Stamler J, Gosch FC, Civinelli J, Fishman J,)Tj
1.2 -1.2 TD
-0.082 Tw
(McKeever P, et al. Primary prevention of hypertension)Tj
T*
0.085 Tw
(by nutritional-hygienic means: final report of a ran-)Tj
T*
0.22 Tw
(domized, controlled trial. )Tj
/F16 1 Tf
11.6 0 TD
0.212 Tw
[( Journal of the American)]TJ
-11.6 -1.2 TD
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(Medical Association)Tj
/F7 1 Tf
8 0 TD
( 1989;262:1801\3201807.)Tj
-9.2 -1.75 TD
0.076 Tw
(Stary HC. Evolution and progression of atherosclerotic)Tj
1.2 -1.2 TD
0.192 Tw
[(lesions in coronary arteries of children )-15 (and young)]TJ
T*
(adults.)Tj
/F16 1 Tf
2.8 0 TD
0.001 Tw
( Arteriosclerosis)Tj
/F7 1 Tf
6.5 0 TD
( 1989;9\(Suppl 1\):119\320132.)Tj
-10.5 -1.75 TD
0.015 Tw
(Stefanick ML. Exercise and weight control.)Tj
/F16 1 Tf
18.1 0 TD
0.014 Tw
[( Exercise and)]TJ
-16.9 -1.2 TD
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(Sport Sciences Reviews )Tj
/F7 1 Tf
9.45 0 TD
(1993;21:363\320396.)Tj
-10.65 -1.75 TD
0.245 Tw
(Stefanick ML, Wood PD. Physical activity, lipid and)Tj
1.2 -1.2 TD
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(lipoprotein metabolism, and lipid transport. In:)Tj
T*
0.005 Tc
-0.126 Tw
(Bouchard C, Shephard RJ, Stephens T, editors. )Tj
/F16 1 Tf
18.9 0 TD
(Physical)Tj
-18.9 -1.2 TD
0.16 Tw
(activity, fitness, and health: international proceedings)Tj
T*
0.083 Tw
(and consensus statement.)Tj
/F7 1 Tf
10.2 0 TD
0.086 Tw
[( Champaign, IL: Human Ki-)]TJ
-10.2 -1.2 TD
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(netics, 1994:417\320431.)Tj
-1.2 -1.75 TD
-0.013 Tc
-0.05 Tw
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1.2 -1.2 TD
0.067 Tw
(energy output of obese and nonobese adolescent boys.)Tj
/F16 1 Tf
T*
-0.003 Tc
0 Tw
(American Journal of Clinical Nutrition)Tj
/F7 1 Tf
15.15 0 TD
( 1959;7:55\32062.)Tj
-16.35 -1.7 TD
0.005 Tc
-0.088 Tw
(Stender M, Hense HW, D\232ring A, Keil U. Physical activity)Tj
1.2 -1.2 TD
0.035 Tw
(at work and cardiovascular disease risk: results from)Tj
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-0.052 Tw
(the MONICA Augsburg Study. )Tj
/F16 1 Tf
12.9 0 TD
-0.051 Tw
(International Journal of)Tj
-12.9 -1.2 TD
(Epidemiology)Tj
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5.45 0 TD
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( 1993;22:644\320650.)Tj
-6.65 -1.75 TD
0.117 Tw
(Stephens T. Physical activity and mental health in the)Tj
1.2 -1.2 TD
-0.071 Tw
(United States and Canada: evidence from four popula-)Tj
T*
0.001 Tw
(tion surveys. )Tj
/F16 1 Tf
5.65 0 TD
(Preventive Medicine)Tj
/F7 1 Tf
8 0 TD
( 1988;17:35\32047.)Tj
-14.85 -1.75 TD
-0.008 Tw
(Stephens T, Craig CL. )Tj
/F16 1 Tf
9.45 0 TD
(The well-being of Canadians: high-)Tj
-8.25 -1.2 TD
-0.055 Tw
(lights of the 1988 Campbell\325s Survey)Tj
/F7 1 Tf
14.35 0 TD
-0.057 Tw
(. Ottawa: Canadian)Tj
-14.35 -1.2 TD
0 Tw
(Fitness and Lifestyle Research Institute, 1990.)Tj
-1.2 -1.75 TD
-0.054 Tw
(Steptoe A, Edwards S, Moses J, Mathews A. The effects of)Tj
1.2 -1.2 TD
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(exercise training on mood and perceived coping ability)Tj
T*
-0.068 Tw
(in anxious adults from the general population. )Tj
/F16 1 Tf
19.3 0 TD
(Journal)Tj
-19.3 -1.2 TD
0 Tw
(of Psychosomatic Research)Tj
/F7 1 Tf
10.7 0 TD
( 1989;33:537\320547.)Tj
14.45 58.75 TD
-0.116 Tw
(Sternfeld B, Williams CS, Quesenberry CP, Satariano WA,)Tj
1.2 -1.2 TD
0.067 Tw
(Sidney S. Lifetime physical activity and incidence of)Tj
T*
-0.039 Tw
(breast cancer. )Tj
/F16 1 Tf
5.95 0 TD
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(cise)Tj
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( 1993;25\(5 Suppl\):S147.)Tj
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-0.065 Tw
(Stewart AL, Hays RD, Wells KB, Rogers WH, Spritzer KL,)Tj
1.2 -1.2 TD
0.103 Tw
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T*
0.047 Tw
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T*
-0.074 Tw
(cise in patients with chronic conditions in the Medical)Tj
T*
0.002 Tc
-0.127 Tw
(Outcomes Study. )Tj
/F16 1 Tf
7.15 0 TD
-0.123 Tw
(Journal of Clinical Epidemiology)Tj
/F7 1 Tf
12.65 0 TD
-0.127 Tw
[( 1994;)]TJ
-19.8 -1.2 TD
0.005 Tc
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-1.2 -1.75 TD
0.081 Tw
(Stewart AL, King AC, Haskell WL. Endurance exercise)Tj
1.2 -1.2 TD
0.17 Tw
(and health-related quality of life in 50\32065-year-old)Tj
T*
(adults. )Tj
/F16 1 Tf
3.1 0 TD
(Gerontologist)Tj
/F7 1 Tf
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( 1993:33:782\3209.)Tj
-9.7 -1.7 TD
-0.083 Tw
(Strazzullo P, Cappuccio FP, Trevisan M, De Leo A, Krogh)Tj
1.2 -1.2 TD
0.101 Tw
(V, Giorgione N, et al. Leisure-time physical activity)Tj
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0.015 Tc
-0.087 Tw
(and blood pressure in schoolchildren.)Tj
/F16 1 Tf
15.9 0 TD
-0.084 Tw
[( American Jour)18 (-)]TJ
-15.9 -1.2 TD
0.005 Tc
0 Tw
(nal of Epidemiology)Tj
/F7 1 Tf
8 0 TD
( 1988;127:726\320733.)Tj
-9.2 -1.75 TD
(Sturgeon SR, Brinton LA, Berman ML, Mortel R, Twiggs)Tj
1.2 -1.2 TD
-0.021 Tw
(LB, Barrett RJ, et al. Past and present physical activity)Tj
T*
-0.005 Tw
(and endometrial cancer risk.)Tj
/F16 1 Tf
11.95 0 TD
( British Journal of Cancer)Tj
/F7 1 Tf
-11.95 -1.2 TD
(1993;68:584\320589.)Tj
-1.2 -1.75 TD
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(Superko HR. Exercise training, serum lipids, and lipopro-)Tj
1.2 -1.2 TD
0.098 Tw
(tein particles: is there a change threshold? )Tj
/F16 1 Tf
18.65 0 TD
(Medicine)Tj
-18.65 -1.2 TD
0 Tw
(and Science in Sports and Exercise)Tj
/F7 1 Tf
13.8 0 TD
( 1991;23:677\320685.)Tj
-15 -1.75 TD
0.142 Tw
(Surgenor S, Uphold RE. Acute hyponatremia in ultra-)Tj
1.2 -1.2 TD
0.225 Tw
(endurance athletes. )Tj
/F16 1 Tf
8.85 0 TD
0.217 Tw
(American Journal of Emergency)Tj
-8.85 -1.2 TD
(Medicine)Tj
/F7 1 Tf
3.6 0 TD
0.002 Tw
( 1994;12:441\320444.)Tj
-4.8 -1.75 TD
0.035 Tw
(Taioli E, Barone J, Wynder EL. A case-control study on)Tj
1.2 -1.2 TD
0.152 Tw
(breast cancer and body mass: the American Health)Tj
T*
-0.1 Tw
(Foundation, Division of Epidemiology.)Tj
/F16 1 Tf
16.1 0 TD
-0.096 Tw
[( European Jour-)]TJ
-16.1 -1.2 TD
0 Tw
(nal of Cancer)Tj
/F7 1 Tf
5.4 0 TD
( 1995;31A:723\320728.)Tj
-6.6 -1.7 TD
0.104 Tw
(Tall AR. Plasma high density lipoproteins: metabolism)Tj
1.2 -1.2 TD
0.072 Tw
(and relationship to atherogenesis.)Tj
/F16 1 Tf
14.4 0 TD
0.07 Tw
[( Journal of Clinical)]TJ
-14.4 -1.2 TD
(Investigation)Tj
/F7 1 Tf
5.15 0 TD
-0.001 Tw
( 1990;86:379\320384.)Tj
-6.35 -1.75 TD
0.229 Tw
(Talmage RV, Stinnett SS, Landwehr JT, Vincent LM,)Tj
1.2 -1.2 TD
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(McCartney WH. Age-related loss of bone mineral den-)Tj
T*
0.222 Tw
(sity in non-athletic and athletic women. )Tj
/F16 1 Tf
18.35 0 TD
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-18.35 -1.2 TD
(Mineral)Tj
/F7 1 Tf
3.2 0 TD
-0.005 Tw
( 1986;1:115\320125.)Tj
-4.4 -1.75 TD
-0.052 Tw
(Tang LY, Raab-Cullen DM, Yee JA, Jee WSS, Kimmel DB.)Tj
1.2 -1.2 TD
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(Prostaglandin E)Tj
7 0 0 7 407 187 Tm
(2)Tj
10 0 0 10 410.5 190 Tm
[( increases skeletal response.)]TJ
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[( Journal of)]TJ
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(Bone and Mineral Research)Tj
/F7 1 Tf
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( 1995;10:S246.)Tj
-12.15 -1.75 TD
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1.2 -1.2 TD
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T*
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(Control in Children\3211987. )Tj
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/F7 1 Tf
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( 1987;79:1\32025.)Tj
-17.2 -1.75 TD
0.061 Tw
(Taylor CB, Sallis JF, Needle R. The relation of physical)Tj
1.2 -1.2 TD
0.094 Tw
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/F16 1 Tf
16.4 0 TD
0.09 Tw
[( Public Health)]TJ
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T*
0.043 Tw
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19.15 0 TD
0.041 Tw
[( Ameri-)]TJ
-19.15 -1.2 TD
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(Taylor RJ, Bennett PH, LeGonidec G, Lacoste J, Combe D,)Tj
1.2 -1.2 TD
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T*
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T*
0.013 Tc
0.259 Tw
(Island survey. )Tj
/F16 1 Tf
6.75 0 TD
0.25 Tw
[( American Journal of Public Health)]TJ
/F7 1 Tf
-6.75 -1.2 TD
0.005 Tc
(1983;6:334\320340.)Tj
-1.2 -1.7 TD
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1.2 -1.2 TD
-0.001 Tw
(cardiovascular disease risk factors in adolescents: the)Tj
T*
-0.1 Tw
(Oslo Youth Study. )Tj
/F16 1 Tf
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-0.097 Tw
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/F7 1 Tf
7.9 0 TD
-0.1 Tw
[( 1988;17:12\32024.)]TJ
-16.75 -1.75 TD
-0.119 Tw
(Thomas JR, Landers DM, Salazar W, Etnier J. Exercise and)Tj
1.2 -1.2 TD
0.008 Tc
0.259 Tw
(cognitive function. In: Bouchard C, Shephard RJ,)Tj
T*
0.003 Tc
-0.127 Tw
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0.25 Tw
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(.)Tj
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(Champaign, IL: Human Kinetics, 1994:521\320529.)Tj
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-0.039 Tw
(Thompson JK, Jarvie GJ, Lahey BB, Cureton KJ. Exercise)Tj
1.2 -1.2 TD
0.141 Tw
(and obesity: etiology, physiology, and intervention.)Tj
/F16 1 Tf
T*
0.001 Tw
(Psychological Bulletin)Tj
/F7 1 Tf
8.85 0 TD
( 1982;91:55\32079.)Tj
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0.258 Tw
(Thompson PD, Funk EJ, Carleton RA, Sturner WQ.)Tj
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0.167 Tw
(Incidence of death during jogging in Rhode Island)Tj
T*
0.195 Tw
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11.7 0 TD
0.189 Tw
[( Journal of the American)]TJ
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-0.002 Tw
(Medical Association)Tj
/F7 1 Tf
8 0 TD
( 1982;247:2535\3202538.)Tj
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-0.054 Tw
(Thompson PD, Mitchell JH. Exercise and sudden cardiac)Tj
1.2 -1.2 TD
-0.117 Tw
(death: protection or provocation? )Tj
/F16 1 Tf
13.9 0 TD
-0.113 Tw
(New England Journal)Tj
-13.9 -1.2 TD
0.001 Tw
(of Medicine)Tj
/F7 1 Tf
4.6 0 TD
( 1984;311:914\320915.)Tj
-5.8 -1.7 TD
-0.06 Tw
(Thor P, Konturek JW, Konturek SJ, Anderson JH. Role of)Tj
1.2 -1.2 TD
-0.075 Tw
(prostaglandins in control of intestinal motility. )Tj
/F16 1 Tf
19.45 0 TD
(Ameri-)Tj
-19.45 -1.2 TD
0 Tw
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/F7 1 Tf
10.25 0 TD
( 1985;248:G353\320G359.)Tj
-11.45 -1.75 TD
-0.081 Tw
(Thune I, Lund E. Physical activity and the risk of prostate)Tj
1.2 -1.2 TD
-0.08 Tw
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T*
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(gian men. )Tj
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10.75 0 TD
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[( 1994;5:549\320556.)]TJ
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0.095 Tw
(Tinetti ME, Baker DI, McAvay G, Claus EB, Garrett P,)Tj
1.2 -1.2 TD
0.084 Tw
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T*
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T*
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0.259 Tw
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(1994;331:821\320827.)Tj
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1.2 -1.2 TD
0.002 Tw
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20.45 0 TD
(New)Tj
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11.4 0 TD
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0.236 Tw
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1.2 -1.2 TD
0.013 Tw
(Eckert HM, Montoye HJ, editors.)Tj
/F16 1 Tf
13.9 0 TD
[( Exercise and health)]TJ
/F7 1 Tf
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(.)Tj
-22 -1.2 TD
0 Tw
(Champaign, IL: Human Kinetics, 1984:32\32041.)Tj
-1.2 -1.75 TD
-0.009 Tw
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1.2 -1.2 TD
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3.5 0 TD
0.181 Tw
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-3.5 -1.2 TD
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0.006 Tw
(Tremblay A, Despr\216s J-P, Leblanc C, Craig CL, Ferris B,)Tj
1.2 -1.2 TD
-0.083 Tw
(Stephens T, et al. Effect of intensity of physical activity)Tj
T*
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/F16 1 Tf
15.2 0 TD
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(American Journal)Tj
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( 1990;51:153\320157.)Tj
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0.095 Tw
(Troiano RP, Flegal KM, Kuczmarski RJ, Campbell SM,)Tj
1.2 -1.2 TD
0.155 Tw
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T*
0.21 Tw
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T*
0.2 Tw
(Nutrition Examination Surveys, 1963 to 1991.)Tj
/F16 1 Tf
20.45 0 TD
0.194 Tw
[( Ar-)]TJ
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0.012 Tc
0.25 Tw
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19.35 0 TD
0.259 Tw
[( 1995;)]TJ
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0.005 Tc
(149:1085\3201091.)Tj
-1.2 -1.75 TD
0.012 Tw
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1.2 -1.2 TD
0.005 Tw
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T*
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/F16 1 Tf
T*
0.04 Tw
(American Journal of Clinical Nutrition)Tj
/F7 1 Tf
15.7 0 TD
0.041 Tw
[( 1991;53:1104\320)]TJ
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(1111.)Tj
-1.2 -1.75 TD
0.245 Tw
(Trovati M, Carta Q, Cavalot F, Vitali S, Banaudi C,)Tj
1.2 -1.2 TD
0.042 Tw
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T*
0.077 Tw
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T*
0.029 Tw
(cretion, and insulin action in noninsulin-dependent-)Tj
T*
0 Tw
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/F16 1 Tf
7.5 0 TD
(Diabetes Care)Tj
/F7 1 Tf
5.65 0 TD
( 1984;7:416\320420.)Tj
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0.231 Tw
(Tsopanakis AD, Sgouraki EP, Pavlou KN, Nadel ER,)Tj
1.2 -1.2 TD
0.103 Tw
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T*
0.006 Tw
(hour endurance test on a recumbent cycloergometer.)Tj
/F16 1 Tf
T*
0.144 Tw
(American Journal of Clinical Nutrition)Tj
/F7 1 Tf
16.1 0 TD
0.149 Tw
[( 1989;49:980\320)]TJ
-16.1 -1.2 TD
(984.)Tj
-1.2 -1.75 TD
0.107 Tw
(Turner CH, Owan I, Takano Y, Madali S, Murrell GA.)Tj
1.2 -1.2 TD
-0.049 Tw
(Nitric oxide plays a role in bone mechanotrasduction.)Tj
/F16 1 Tf
T*
0 Tw
(Journal of Bone and Mineral Research)Tj
/F7 1 Tf
15.2 0 TD
( 1995;10:S235.)Tj
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-0.111 Tw
(Turner CH, Takano Y, Owan I. Aging changes mechanical)Tj
1.2 -1.2 TD
-0.017 Tw
(loading thresholds for bone formation in rats.)Tj
/F16 1 Tf
19.05 0 TD
-0.016 Tw
[( Journal)]TJ
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0 Tw
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/F7 1 Tf
11.95 0 TD
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1.2 -1.2 TD
0.12 Tw
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T*
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/F16 1 Tf
3.25 0 TD
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( British Journal of Cancer )Tj
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10.55 0 TD
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(Underwood FB, Laughlin MH, Sturek M. Altered control)Tj
1.2 -1.2 TD
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(of calcium in coronary smooth muscle cells by exercise)Tj
T*
(training. )Tj
/F16 1 Tf
3.95 0 TD
0.103 Tw
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/F7 1 Tf
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(1994;26:1230\3201238.)Tj
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(United Kingdom Testicular Cancer Study Group. Aetiol-)Tj
1.2 -1.2 TD
0.099 Tw
(ogy of testicular cancer: association with congenital)Tj
T*
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(abnormalities, age at puberty, infertility, and exercise.)Tj
/F16 1 Tf
T*
0 Tw
(British Medical Journal )Tj
/F7 1 Tf
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(1994;308:1393\3201399.)Tj
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/F7 1 Tf
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[( Hyattsville, MD: U.S. Department)]TJ
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(of Health and Human Services, Public Health Service,)Tj
T*
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T*
0.014 Tw
(Center for Health Statistics, 1995. DHHS Publication)Tj
T*
0 Tw
(No. \(PHS\)95-1232.)Tj
-1.2 -1.75 TD
0.161 Tw
(Uusitupa M, Siitonen O, Py\232r\212l\212 K, Aro A, Hersio K,)Tj
1.2 -1.2 TD
0.052 Tw
(Penttil\212 I, Voutilainen E. The relationship of cardio-)Tj
T*
0.19 Tw
(vascular risk factors to the prevalence of coronary)Tj
T*
-0.033 Tw
(heart disease in newly diagnosed type 2 \(non-insulin-)Tj
T*
0 Tw
(dependent\) diabetes. )Tj
/F16 1 Tf
9 0 TD
(Diabetologia )Tj
/F7 1 Tf
5.35 0 TD
(1985;28:653\320659.)Tj
-15.55 -1.75 TD
0.243 Tw
(Van Mechelen W. Running injuries: a review of the)Tj
1.2 -1.2 TD
0.024 Tc
0.259 Tw
(epidemiological literature. )Tj
/F16 1 Tf
12.35 0 TD
0.023 Tc
0.251 Tw
(Sports Medicine)Tj
/F7 1 Tf
6.95 0 TD
0.024 Tc
0.259 Tw
[( 1992;)]TJ
-19.3 -1.2 TD
0.005 Tc
(14:320\320335.)Tj
-1.2 -1.7 TD
-0.029 Tw
(Vena JE, Graham S, Zielezny M, Brasure J, Swanson MK.)Tj
1.2 -1.2 TD
0.145 Tw
(Occupational exercise and risk of cancer. )Tj
/F16 1 Tf
18.4 0 TD
(American)Tj
-18.4 -1.2 TD
-0.001 Tw
(Journal of Clinical Nutrition)Tj
/F7 1 Tf
11.4 0 TD
( 1987;45:318\320327.)Tj
-12.6 -1.75 TD
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(Vena JE, Graham S, Zielezny M, Swanson MK, Barnes RE,)Tj
1.2 -1.2 TD
0.24 Tw
(Nolan J. Lifetime occupational exercise and colon)Tj
T*
-0.006 Tc
(cancer.)Tj
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2.9 0 TD
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[( American Journal of Epidemiology)]TJ
/F7 1 Tf
13.15 0 TD
-0.129 Tw
[( 1985;122:357\320)]TJ
-16.05 -1.2 TD
0.005 Tc
(365.)Tj
-1.2 -1.75 TD
0.085 Tw
(Vetter R, Dosemeci M, Blair A, Wacholder S, Unsal M,)Tj
1.2 -1.2 TD
0.219 Tw
(Engin K, et al. Occupational physical activity and)Tj
T*
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(colon cancer risk in Turkey. )Tj
/F16 1 Tf
11.65 0 TD
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(European Journal of Epide-)Tj
-11.65 -1.2 TD
(miology)Tj
/F7 1 Tf
3.2 0 TD
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( 1992;8:845\320850.)Tj
-4.4 -1.75 TD
0.073 Tw
(Vincelette P, Laurin CA, L\216vesque HP. The footballer\325s)Tj
1.2 -1.2 TD
0.056 Tw
(ankle and foot. )Tj
/F16 1 Tf
6.75 0 TD
0.054 Tw
(Canadian Medical Association Journal)Tj
/F7 1 Tf
-6.75 -1.2 TD
(1972;107:872\320877.)Tj
-1.2 -1.75 TD
0.2 Tw
(Vineis P, Ciccone G, Magnino A. Asbestos exposure,)Tj
1.2 -1.2 TD
0.216 Tw
(physical activity, and colon cancer: a case control)Tj
T*
(study. )Tj
/F16 1 Tf
2.85 0 TD
(Tumori)Tj
/F7 1 Tf
2.95 0 TD
-0.002 Tw
( 1993;79:301\320303.)Tj
-7 -1.7 TD
-0.048 Tw
(Vlajinac H, Jarebinski M, Adanja B. Relationship of some)Tj
1.2 -1.2 TD
-0.065 Tw
(biosocial factors to colon cancer in Belgrade \(Yugosla-)Tj
T*
(via\). )Tj
/F16 1 Tf
2.15 0 TD
(Neoplasma )Tj
/F7 1 Tf
4.7 0 TD
(1987;34:503\320507.)Tj
-8.05 -1.75 TD
-0.037 Tw
(Voorrips LE, Meijers JHH, Sol P, Seidell JC, van Staveren)Tj
1.2 -1.2 TD
0.072 Tw
(WA. History of body weight and physical activity of)Tj
T*
0.08 Tw
(elderly women differing in current physical activity.)Tj
/F16 1 Tf
T*
0 Tw
(International Journal of Obesity)Tj
/F7 1 Tf
12.75 0 TD
( 1992;16:199\320205.)Tj
-13.95 -1.75 TD
0.015 Tc
-0.002 Tw
(Wahrenberg H, Bolinder J, Arner P. Adrenergic regula-)Tj
1.2 -1.2 TD
0.066 Tw
(tion of lipolysis in human fat cells during exercise.)Tj
/F16 1 Tf
T*
0.181 Tw
(European Journal of Clinical Investigation)Tj
/F7 1 Tf
18.05 0 TD
0.188 Tw
[( 1991;21:)]TJ
-18.05 -1.2 TD
(534\320541.)Tj
-1.2 -1.75 TD
0.005 Tc
0.009 Tw
(Wallberg-Henriksson H. Exercise and diabetes mellitus.)Tj
/F16 1 Tf
1.2 -1.2 TD
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(Exercise and Sport Sciences Reviews )Tj
/F7 1 Tf
14.7 0 TD
(1992;20:339\320368.)Tj
10.45 57.55 TD
-0.091 Tw
(Walter SD, Hart LE, McIntosh JM, Sutton JR. The Ontario)Tj
1.2 -1.2 TD
0.096 Tw
(cohort study of running-related injuries.)Tj
/F16 1 Tf
17.35 0 TD
0.093 Tw
[( Archives of)]TJ
-17.35 -1.2 TD
0 Tw
(Internal Medicine)Tj
/F7 1 Tf
7.1 0 TD
( 1989;149:2561\3202564.)Tj
-8.3 -1.75 TD
-0.084 Tw
(Wang JT, Ho LT, Tang KT, Wang LM, Chen Y-DI, Reaven)Tj
1.2 -1.2 TD
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T*
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