%!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? 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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 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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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0000000000000000000000000000000000000000000000000000000000000000 0000000000000000000000000000000000000000000000000000000000000000 0000000000000000000000000000000000000000000000000000000000000000 0000000000000000000000000000000000000000000000000000000000000000 0000000000000000000000000000000000000000000000000000000000000000 0000000000000000000000000000000000000000000000000000000000000000 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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%%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 { end end } bd /setstrokeadjust isdefined? { true setstrokeadjust /m/moveto ld /l/lineto ld /c/curveto ld } { /pl { transform 0.25 sub round 0.25 add exch 0.25 sub round 0.25 add exch itransform } bd /m { pl moveto } bd /l { pl lineto } bd /c { pl curveto } bd } ifelse /v { currentpoint 6 2 roll c } bd /y { 2 copy c } bd /h/closepath ld /d/setdash ld /j/setlinejoin ld /J/setlinecap ld /M/setmiterlimit ld /w/setlinewidth ld /cf currentflat def /i { dup 0 eq { pop cf } if setflat } bd /ilp { /_lp /none dd } bd /sfc { _lp /fill ne { _sfcs _sfc /_lp /fill dd } if } bd /ssc { _lp /stroke ne { _sscs _ssc /_lp /stroke dd } if } bd /n { _doClip 1 ge { _doClip 1 eq { clip } { eoclip } ifelse /_doClip 0 dd } if newpath } bd /f { _doClip 1 ge { gsave sfc fill grestore _doClip 1 eq { clip } { eoclip } ifelse newpath ilp /_doClip 0 dd } { sfc fill } ifelse } bd /f* { _doClip 1 ge { gsave sfc eofill grestore _doClip 1 eq { clip } { eoclip } ifelse newpath ilp /_doClip 0 dd } { sfc eofill } ifelse } bd /S { _doClip 1 ge { gsave ssc stroke grestore _doClip 1 eq { clip } { eoclip } ifelse newpath ilp /_doClip 0 dd } { ssc stroke } ifelse } bd /s { h S } bd /B { _doClip dup 1 ge gsave f grestore { gsave S grestore 1 eq { clip } { eoclip } ifelse newpath ilp /_doClip 0 dd } { pop S } ifelse } bd /b { h B } bd /B* { _doClip dup 1 ge gsave f* grestore { gsave S grestore 1 eq { clip } { eoclip } ifelse newpath ilp /_doClip 0 dd } { pop S } ifelse } bd /b* { h B* } bd /W { /_doClip 1 dd } bd /W* { /_doClip 2 dd } bd /q/save ld /Q { restore ilp } bd Level2? not StartLoad { /cs { dup where { pop load } if /_sfcs { } dd dup type /arraytype eq { dup 0 get /Indexed eq { 1 } { 0 } ifelse get } if dup /DeviceCMYK eq { /_fc _f4 dd /_sfc { _fc aload pop setcmykcolor } dd } { dup /DeviceRGB eq { /_fc _f3 dd /_sfc { _fc aload pop setrgbcolor } dd } { /_fc _f1 dd /_sfc { _fc aload pop setgray } dd } ifelse } ifelse pop } bd /CS { dup where { pop load } if /_sscs { } dd dup type /arraytype eq { dup 0 get /Indexed eq { 1 } { 0 } ifelse get } if dup /DeviceCMYK eq { /_sc _s4 dd /_ssc { _sc aload pop setcmykcolor } dd } { dup /DeviceRGB eq { /_sc _s3 dd /_ssc { _sc aload pop setrgbcolor } dd } %%% /Pattern not impl'd { /_sc _s1 dd /_ssc { _sc aload pop setgray } dd } ifelse } ifelse pop } bd /ri { pop } bd } EndLoad Level2? StartLoad { /cs { dup where { pop load } if dup /_fcs xdd /_sfcs { _fcs setcolorspace } dd dup type /arraytype eq { dup 0 get /Indexed eq { 1 } { 0 } ifelse get } if dup /DeviceCMYK eq { /_fc _f4 dd } { dup /DeviceRGB eq dup /CIEBasedABC eq or { /_fc _f3 dd } { /_fc _f1 dd } ifelse } ifelse pop /_sfc { _fc aload pop setcolor } dd } bd /CS { dup where { pop load } if dup /_scs xdd /_sscs { _scs setcolorspace } dd dup type /arraytype eq { dup 0 get /Indexed eq { 1 } { 0 } ifelse get } if dup /DeviceCMYK eq { /_sc _s4 dd } { dup /DeviceRGB eq dup /CIEBasedABC eq or { /_sc _s3 dd } { /_sc _s1 dd } ifelse } ifelse pop /_ssc { _sc aload pop setcolor } dd } bd /ri { /findcolorrendering isdefined? { findcolorrendering pop dup /ColorRendering resourcestatus { pop pop /ColorRendering findresource setcolorrendering } { pop } ifelse } { pop } ifelse } bd } EndLoad /sc { _fc astore pop ilp } bd /SC { _sc astore pop ilp } bd /g { /DefaultGray cs sc } bd /rg { /DefaultRGB cs sc } bd /k { /DeviceCMYK cs sc } bd /pc { /DeviceGray cs pop 0.5 sc } bd /G { /DefaultGray CS SC } bd /RG { /DefaultRGB CS SC } bd /K { /DeviceCMYK CS SC } bd /PC { /DeviceGray CS pop 0.5 SC } bd /cm { _mtx astore concat } bd /re { 4 2 roll m 1 index 0 rlineto 0 exch rlineto neg 0 rlineto h } bd /RC/rectclip ld /EF/execform ld /PS { cvx exec } bd /initgs { /DefaultGray where { pop } { /DefaultGray /DeviceGray dd } ifelse /DefaultRGB where { pop } { /DefaultRGB /DeviceRGB dd } ifelse 0 g 0 G []0 d 0 j 0 J 10 M 1 w } bd %%EndFile %%BeginFile: pdftext.prc %%Copyright: Copyright 1987-1994 Adobe Systems Incorporated. All Rights Reserved. PDF /PDFText 51 dict dup begin put /initialize { /TZ isdefined? not { PDFText begin } if } bd /terminate { currentdict PDFText eq { end } if } bd /CopyFont { { 1 index /FID ne 2 index /UniqueID ne and { def } { pop pop } ifelse } forall } bd /modEnc { /_enc xdd /_icode 0 dd counttomark 1 sub -1 0 { index dup type /nametype eq { _enc _icode 3 -1 roll put _icode 1 add } if /_icode xdd } for cleartomark _enc } bd /trEnc { /_enc xdd 255 -1 0 { exch dup -1 eq { pop /.notdef } { Encoding exch get } ifelse _enc 3 1 roll put } for pop _enc } bd /TE { /_i xdd StandardEncoding 256 array copy modEnc _pdfEncodings exch _i exch put } bd /TZ { /_usePDFEncoding xdd findfont dup length 2 add dict begin { 1 index /FID ne { def } { pop pop } ifelse } forall /FontName exch def _usePDFEncoding 0 ge { /Encoding _pdfEncodings _usePDFEncoding get def pop } { _usePDFEncoding -1 eq { counttomark 0 eq { pop } { Encoding 256 array copy modEnc /Encoding exch def } ifelse } { 256 array trEnc /Encoding exch def } ifelse } ifelse FontName currentdict end definefont pop } bd /swj { dup 4 1 roll dup length exch stringwidth exch 5 -1 roll 3 index mul add 4 1 roll 3 1 roll mul add 6 2 roll /_cnt 0 dd {1 index eq {/_cnt _cnt 1 add dd} if} forall pop exch _cnt mul exch _cnt mul 2 index add 4 1 roll 2 index add 4 1 roll pop pop } bd /jss { 4 1 roll { 2 npop (0) exch 2 copy 0 exch put gsave 32 eq { exch 6 index 6 index 6 index 5 -1 roll widthshow currentpoint } { false charpath currentpoint 4 index setmatrix stroke } ifelse grestore moveto 2 copy rmoveto } exch cshow 6 npop } def /jsp { { 2 npop (0) exch 2 copy 0 exch put 32 eq { exch 5 index 5 index 5 index 5 -1 roll widthshow } { false charpath } ifelse 2 copy rmoveto } exch cshow 5 npop } bd /trj { _cx 0 32 _ax 0 6 5 roll } bd /pjsf { trj sfc awidthshow } bd /pjss { trj _ctm ssc jss } bd /pjsc { trj jsp } bd /_Tjdef [ /pjsf load /pjss load { dup currentpoint 3 2 roll pjsf newpath moveto pjss } bind { trj swj rmoveto } bind { dup currentpoint 4 2 roll gsave pjsf grestore 3 1 roll moveto pjsc } bind { dup currentpoint 4 2 roll currentpoint gsave newpath moveto pjss grestore 3 1 roll moveto pjsc } bind { dup currentpoint 4 2 roll gsave dup currentpoint 3 2 roll pjsf newpath moveto pjss grestore 3 1 roll moveto pjsc } bind /pjsc load ] def /BT { /_inT true dd _ctm currentmatrix pop matrix _tm copy pop 0 _rise translate _hs 1 scale 0 0 moveto } bd /ET { /_inT false dd _tr 3 gt {clip} if _ctm setmatrix newpath } bd /Tr { _inT { _tr 3 le {currentpoint newpath moveto} if } if dup /_tr xdd _Tjdef exch get /Tj xdd } bd /iTm { _ctm setmatrix _tm concat 0 _rise translate _hs 1 scale } bd /Tm { _tm astore pop iTm 0 0 moveto } bd /Td { _mtx translate _tm _tm concatmatrix pop iTm 0 0 moveto } bd /TD { dup /_ld xdd Td } bd /Tf { dup 1000 div /_fScl xdd exch findfont exch scalefont setfont } bd /TL { neg /_ld xdd } bd /Tw { /_cx xdd } bd /Tc { /_ax xdd } bd /Ts { /_rise xdd currentpoint iTm moveto } bd /Tz { 100 div /_hs xdd iTm } bd /Tk { exch pop _fScl mul neg 0 rmoveto } bd /T* { 0 _ld Td } bd /' { 0 0 3 -1 roll " } bd /" { exch Tc exch Tw T* Tj } bd /TJ { { dup type /stringtype eq { Tj } { 0 exch Tk } ifelse } forall } bd /T- { _hy Tj } bd /d0/setcharwidth ld /d1 { setcachedevice /sfc{}dd /ssc{}dd } bd /nND {{/.notdef} repeat} bd /T3Defs { /BuildChar { 1 index /Encoding get exch get 1 index /BuildGlyph get exec } def /BuildGlyph { exch begin GlyphProcs exch get exec end } def } bd /MakeBold { findfont dup dup length 2 add dict begin CopyFont /PaintType 2 def /StrokeWidth .03 0 FontMatrix idtransform pop def /dummybold currentdict end definefont 8 dict begin /_basefont exch def /_basefonto exch def /FontType 3 def /FontMatrix[1 0 0 1 0 0]def /FontBBox[0 0 1 1]def /Encoding StandardEncoding def /BuildChar { exch begin _basefont setfont ( )dup 0 4 -1 roll put dup stringwidth 1 index 0 ne { exch .03 add exch }if setcharwidth 0 0 moveto gsave dup show grestore _basefonto setfont show end }bd currentdict end definefont pop }bd 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. . . . . .\ . . . . . . . . . . . . . . . . . .)-482 (130)]TJ T* 0 Tc 0 Tw [(Conclusions)-526 ( . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .\ . . . . . . . . . . . . . . . . . . . . . . . .)-465 (130)]TJ -1 -2.818 TD [(Osteoporosis)-239 ( . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .\ . . . . . . . . . . . . . . . . . . . . . . . . . .)-475 (130)]TJ 1 -1.409 TD 0.001 Tc -0.001 Tw [(Biologic Plausibility)-501 ( . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .\ . . . . . . . . . . . . . . . . . .)-482 (131)]TJ T* 0.002 Tc [(Physical Activity and the Prevention of Fractures and Falling)-468 ( . . . . . . . . . . . . . . . . . . . . .)-484 (132)]TJ T* 0 Tc 0 Tw [(Conclusions)-526 ( . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .\ . . . . . . . . . . . . . . . . . . . . . . . .)-465 (132)]TJ -1 -2.818 TD [(Obesity)-449 ( . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .\ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .)-448 (133)]TJ 1 -1.409 TD 0.001 Tc -0.001 Tw [(Physical Activity and Obesity)-218 ( . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .\ . . . . . . . . . . .)-471 (133)]TJ T* [(Biologic Plausibility)-501 ( . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .\ . . . . . . . . . . . . . . . . . .)-482 (134)]TJ T* 0 Tc 0 Tw [(Conclusions)-526 ( . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .\ . . . . . . . . . . . . . . . . . . . . . . . .)-465 (135)]TJ -1 -2.818 TD [(Mental Health)-285 ( . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .\ . . . . . . . . . . . . . . . . . . . . . . . . .)-447 (135)]TJ 1 -1.409 TD 0.001 Tc -0.001 Tw [(Physical Activity and Mental Health)-554 ( . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .\ . . . . .)-488 (136)]TJ T* [(Biologic Plausibility)-501 ( . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .\ . . . . . . . . . . . . . . . . . .)-482 (141)]TJ T* 0 Tc 0 Tw [(Conclusions)-526 ( . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .\ . . . . . . . . . . . . . . . . . . . . . . . .)-465 (141)]TJ -1 -2.818 TD 0.001 Tc -0.001 Tw [(Health-Related Quality of Life)-440 ( . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .\ . . . . . . . . . . . .)-453 (141)]TJ 1 -1.409 TD 0 Tc 0 Tw [(Conclusions)-526 ( . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .\ . . . . . . . . . . . . . . . . . . . . . . . .)-465 (142)]TJ ET PDFVars/TermAll get exec restore gsave showpage grestore %%Page: 3 3 save PDFVars/InitAll get exec %PDF_BeginEncoding: F5 Optima-Bold [ 39/quotesingle 96/grave 127/.notdef/Adieresis/Aring/Ccedilla /Eacute/Ntilde/Odieresis/Udieresis/aacute/agrave /acircumflex/adieresis/atilde/aring/ccedilla/eacute /egrave/ecircumflex/edieresis/iacute/igrave/icircumflex 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/approxequal/Delta/guillemotleft/guillemotright/ellipsis/blank /Agrave/Atilde/Otilde/OE/oe/endash /emdash/quotedblleft/quotedblright/quoteleft/quoteright/divide /lozenge/ydieresis/Ydieresis/fraction/currency/guilsinglleft /guilsinglright/fi/fl/daggerdbl/periodcentered/quotesinglbase /quotedblbase/perthousand/Acircumflex/Ecircumflex/Aacute/Edieresis /Egrave/Iacute/Icircumflex/Idieresis/Igrave/Oacute /Ocircumflex/apple/Ograve/Uacute/Ucircumflex/Ugrave /dotlessi/circumflex/tilde/macron/breve/dotaccent /ring/cedilla/hungarumlaut/ogonek/caron /F9/Optima -1 TZ %PDF_EndEncoding 0 0 612 792 RC userdict /DefaultRGB /DeviceRGB put 0 G 1 i 0 J 0 j 0.5 w 10 M []0 d 65 655.25 m 508 655.25 l S BT /F5 1 Tf 12 0 0 12 65 661 Tm 0 Tr 0 g 0 Tc (Contents)Tj 14 0 0 14 111.5 661 Tm 0.008 Tc (, )Tj /F9 1 Tf 11 0 2.138 11 119.5 661 Tm 0.003 Tc (continued)Tj /F7 1 Tf 11 0 0 11 65 630 Tm 0.001 Tc -0.001 Tw [(Adverse Effects of Physical Activity)-286 ( . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .\ . . . . . . . . .)-416 (142)]TJ 1 -1.409 TD [(Types of Adverse Effects)-191 ( . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .\ . . . . . . . . . . . . . . . .)-381 (142)]TJ 1 -1.409 TD [(Musculoskeletal )-10 (Injuries)-146 ( . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .\ . . . . . . . . . . . . . .)-417 (142)]TJ T* [(Metabolic )-12 (Abnormalities)-128 ( . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .\ . . . . . . . . . . . . . .)-417 (143)]TJ T* 0 Tw [(Hematologic and Body Organ Abnormalities)-239 ( . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .)-387 (143)]TJ T* 0 Tc [(Hazards)-308 ( . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .\ . . . . . . . . . . . . . . . . . . . . . . . . . . .)-411 (143)]TJ T* 0.001 Tc [(I)15 (nfectious, Allergic, and Inflammatory Conditions)-396 ( . . . . . . . . . . . . . . . . . . . . . . . . . . . . .)-432 (143)]TJ T* 0 Tc [(Cardiac )-9 (Events)-534 ( . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .\ . . . . . . . . . . . . . . . . . . . . .)-383 (143)]TJ -1 -1.409 TD 0.001 Tc -0.001 Tw [(Occurrence of Adverse Effects)-373 ( . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .\ . . . . . . . . . . .)-426 (144)]TJ T* 0 Tc 0 Tw [(Conclusions)-526 ( . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .\ . . . . . . . . . . . . . . . . . . . . . . . . .)-402 (144)]TJ -1 -2.818 TD 0.001 Tc -0.001 Tw [(Nature of the Activity/Health Relationship)-494 ( . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .\ . . .)-388 (144)]TJ 1 -1.409 TD 0 Tc 0 Tw [(Causality)-285 ( . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .\ . . . . . . . . . . . . . . . . . . . . . . . . . . . .)-393 (144)]TJ T* 0.001 Tc -0.001 Tw [(Population Burden of Sedentary Living)-358 ( . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .\ . . . .)-415 (145)]TJ T* 0 Tc 0 Tw [(Dose)-568 ( . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .\ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .)-385 (146)]TJ T* [(Conclusions)-526 ( . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .\ . . . . . . . . . . . . . . . . . . . . . . . . .)-402 (148)]TJ -1 -2.818 TD [(Chapter Summary)-162 ( . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .\ . . . . . . . . . . . . . . . . . . . . . . .)-393 (149)]TJ T* [(Conclusions)-485 ( . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .\ . . . . . . . . . . . . . . . . . . . . . . . . . . .)-411 (149)]TJ 1 -1.409 TD [(Research Needs)-216 ( . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .\ . . . . . . . . . . . . . . . . . . . . . . .)-393 (150)]TJ -1 -2.818 TD [(References)-212 ( . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .\ . . . . . . . . . . . . . . . . . . . . . . . . . . . . .)-375 (151)]TJ ET PDFVars/TermAll get exec restore gsave showpage grestore %%Page: 4 4 save PDFVars/InitAll get exec 0 0 612 792 RC userdict /DefaultRGB /DeviceRGB put PDFVars/TermAll get exec restore gsave showpage grestore %%Page: 5 5 save PDFVars/InitAll get exec %PDF_BeginEncoding: F5 Optima-Bold [ 39/quotesingle 96/grave 127/.notdef/Adieresis/Aring/Ccedilla /Eacute/Ntilde/Odieresis/Udieresis/aacute/agrave /acircumflex/adieresis/atilde/aring/ccedilla/eacute /egrave/ecircumflex/edieresis/iacute/igrave/icircumflex /idieresis/ntilde/oacute/ograve/ocircumflex/odieresis /otilde/uacute/ugrave/ucircumflex/udieresis/dagger /degree/cent/sterling/section/bullet/paragraph /germandbls/registered/copyright/trademark/acute/dieresis /notequal/AE/Oslash/infinity/plusminus/lessequal /greaterequal/yen/mu/partialdiff/summation/product /pi/integral/ordfeminine/ordmasculine/Omega/ae /oslash/questiondown/exclamdown/logicalnot/radical/florin 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0 24 544.5 676 Tm -0.018 Tc 0 Tw ( 4)Tj -12.813 -1.187 TD (T)Tj 16.8 0 0 16.8 249.5 647.5 Tm -0.028 Tc (HE)Tj 24 0 0 24 270 647.5 Tm -0.02 Tc ( E)Tj 16.8 0 0 16.8 288 647.5 Tm -0.028 Tc (FFECTS)Tj 24 0 0 24 339 647.5 Tm ( )Tj 16.8 0 0 16.8 345.5 647.5 Tm (OF)Tj 24 0 0 24 366.5 647.5 Tm -0.02 Tc ( P)Tj 16.8 0 0 16.8 385.5 647.5 Tm -0.028 Tc (HYSICAL)Tj 24 0 0 24 450.5 647.5 Tm -0.02 Tc ( A)Tj 16.8 0 0 16.8 472 647.5 Tm -0.028 Tc (CTIVITY)Tj 24 0 0 24 531.5 647.5 Tm ( )Tj 16.8 0 0 16.8 537.5 647.5 Tm (ON)Tj 24 0 0 24 384 618.5 Tm (H)Tj 16.8 0 0 16.8 402 618.5 Tm -0.027 Tc [(EAL)34 (TH)]TJ 24 0 0 24 449.5 618.5 Tm ( )Tj 16.8 0 0 16.8 455.5 618.5 Tm -0.028 Tc (AND)Tj 24 0 0 24 491.5 618.5 Tm -0.018 Tc ( D)Tj 16.8 0 0 16.8 516 618.5 Tm -0.028 Tc (ISEASE)Tj ET 0 G 1 i 0 J 0 j 1 w 10 M []0 d 186 671.5 m 564 671.5 l S BT /F5 1 Tf 14 0 0 14 66 571 Tm -0.002 Tc (Introduction)Tj /F7 1 Tf 31.3 0 0 31.3 66 542 Tm (T)Tj 11 0 0 11 85.5 555 Tm 0.003 Tc -0.003 Tw (his chapter examines the relationship of physi-)Tj -0.046 -1.182 TD 0.189 Tw (cal activity and cardiorespiratory fitness to a)Tj -1.727 -1.227 TD -0.005 Tc 0.048 Tw (variety of health problems. The primary focus is on)Tj 0 -1.182 TD -0.09 Tw (diseases and conditions for which sufficient data exist)Tj T* 0.024 Tw (to evaluate an association with physical activity, the)Tj 0 -1.227 TD 0.188 Tw (strength of such relationships, and their potential)Tj 0 -1.182 TD -0.081 Tw (biologic mechanisms. Because most of the research to)Tj 0 -1.227 TD 0.085 Tw (date has addressed the health effects of endurance-)Tj 0 -1.182 TD 0.003 Tc 0.166 Tw (type physical activity \(involving repetitive use of)Tj T* -0.004 Tc 0.12 Tw [(large)-20 ( muscle groups, such as in walking and bicy-)]TJ 0 -1.227 TD -0.005 Tc 0.081 Tw (cling\), this chapter focuses on that type of activity.)Tj 0 -1.182 TD -0.044 Tw (Unless otherwise specified, the term physical activity)Tj 0 -1.227 TD -0.003 Tc 0.233 Tw [(should be understood to refer to endur)-11 (ance-type)]TJ 0 -1.182 TD 0.003 Tc 0.134 Tw (physical activity. Less well studied are the health)Tj T* 0.003 Tw (effects of resistance-type physical activity \(i.e., that)Tj 0 -1.227 TD -0.011 Tw (which develops muscular strength\); when this type)Tj 0 -1.182 TD 0.151 Tw (of physical activity is discussed, it is specified as)Tj 0 -1.227 TD -0.031 Tw (such. Much of the research summarized is based on)Tj 0 -1.182 TD 0.158 Tw (studies having only white men as participants; it)Tj T* 0.182 Tw (remains to be clarified whether the relationships)Tj 0 -1.227 TD 0.047 Tw (described here are the same for women, racial and)Tj 0 -1.182 TD -0.09 Tw (ethnic minority groups, and people with disabilities.)Tj 1.636 -1.227 TD -0.019 Tw (Physical activity is difficult to measure directly.)Tj -1.636 -1.182 TD -0.03 Tw (Three types of physical activity measures have been)Tj 0 -1.227 TD -0.011 Tw (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 0 -1.227 TD 0.201 Tw (a questionnaire or interview. A more objectively)Tj 0 -1.182 TD 0.04 Tw (measured characteristic is cardiorespiratory fitness)Tj 0 -1.227 TD 0.215 Tw (\(also referred to as cardiorespiratory endurance\))Tj 0 -1.182 TD -0.03 Tw (which is measured by aerobic power \(see Chapter 2)Tj T* -0.109 Tw (for more information on measurement issues\). Some)Tj 0 -1.227 TD -0.013 Tw (studies have relied on occupation to classify people)Tj 0 -1.182 TD 0.046 Tw (according to how likely they were to be physically)Tj 0 -1.227 TD 0.001 Tw (active at work.)Tj 25.591 42.455 TD 0.111 Tw (Epidemiologic studies of physical activity and)Tj -1.636 -1.182 TD 0.071 Tw (health have compared the activity levels of people)Tj T* -0.062 Tw (who have or develop diseases and those who do not.)Tj 0 -1.227 TD -0.117 Tw (Cohort studies follow populations forward in time to)Tj 0 -1.182 TD 0.092 Tw (observe how physical activity habits affect disease)Tj 0 -1.227 TD -0.061 Tw (occurrence or death. In case-control studies, groups)Tj 0 -1.182 TD -0.017 Tw (of persons who have disease and separate groups of)Tj T* 0.033 Tw (people who do not have disease are asked to recall)Tj 0 -1.227 TD 0 Tc -0.128 Tw (their previous physical activity. Cross-sectional stud-)Tj 0 -1.182 TD 0.003 Tc 0.048 Tw (ies assess the association between physical activity)Tj 0 -1.227 TD -0.056 Tw (and disease at the same point in time. Clinical trials,)Tj 0 -1.182 TD -0.018 Tw (on the other hand, attempt to alter physical activity)Tj T* -0.085 Tw (patterns and then assess whether disease occurrence)Tj 0 -1.227 TD 0 Tw (is modified as a result.)Tj 1.636 -1.182 TD -0.011 Tw (Results from epidemiologic studies can be used)Tj -1.636 -1.227 TD (to estimate the relative magnitude or strength of an)Tj 0 -1.182 TD 0.098 Tw (association between physical activity and a health)Tj 0 -1.227 TD 0.064 Tw (outcome. Two such measures used in this chapter)Tj 0 -1.182 TD 0.072 Tw (are risk ratio \(RR\) and odds ratio \(OR\). For these)Tj T* -0.127 Tw (measures, an estimate of 1.0 indicates no association,)Tj 0 -1.227 TD 0.14 Tw (when the risk of disease is equivalent in the two)Tj 0 -1.182 TD -0.04 Tw (groups being compared. RR or OR estimates greater)Tj 0 -1.227 TD -0.027 Tw (than 1.0 indicate an increase in risk; those less than)Tj 0 -1.182 TD 0.064 Tw (1.0 indicate a decreased risk. Confidence intervals)Tj T* -0.015 Tw (\(CI\) reported with estimates of association indicate)Tj 0 -1.227 TD -0.042 Tw (the precision of the estimate, as well as its statistical)Tj 0 -1.182 TD 0.103 Tw (significance. When the CI range includes 1.0, the)Tj 0 -1.227 TD 0 Tc -0.128 Tw (effect is considered likely to have occurred by chance;)Tj 0 -1.182 TD 0.003 Tc 0.048 Tw (therefore the estimate of association is not consid-)Tj T* -0.07 Tw (ered statistically significantly different from the null)Tj 0 -1.227 TD 0.001 Tw (value of 1.0.)Tj /F5 1 Tf 14 0 0 14 329.5 137.5 Tm -0.001 Tc -0.001 Tw (Overall Mortality)Tj /F7 1 Tf 11 0 0 11 329.5 121.5 Tm 0.003 Tc 0.164 Tw (Persons with moderate to high levels of physical)Tj 0 -1.182 TD 0.203 Tw (activity or cardiorespiratory fitness have a lower)Tj T* 0.092 Tw (mortality rate than those with sedentary habits or)Tj ET PDFVars/TermAll get exec restore gsave showpage grestore %%Page: 6 6 save PDFVars/InitAll get exec %PDF_BeginEncoding: F5 Optima-Bold [ 39/quotesingle 96/grave 127/.notdef/Adieresis/Aring/Ccedilla /Eacute/Ntilde/Odieresis/Udieresis/aacute/agrave /acircumflex/adieresis/atilde/aring/ccedilla/eacute /egrave/ecircumflex/edieresis/iacute/igrave/icircumflex /idieresis/ntilde/oacute/ograve/ocircumflex/odieresis /otilde/uacute/ugrave/ucircumflex/udieresis/dagger /degree/cent/sterling/section/bullet/paragraph /germandbls/registered/copyright/trademark/acute/dieresis /notequal/AE/Oslash/infinity/plusminus/lessequal /greaterequal/yen/mu/partialdiff/summation/product /pi/integral/ordfeminine/ordmasculine/Omega/ae /oslash/questiondown/exclamdown/logicalnot/radical/florin /approxequal/Delta/guillemotleft/guillemotright/ellipsis/blank /Agrave/Atilde/Otilde/OE/oe/endash /emdash/quotedblleft/quotedblright/quoteleft/quoteright/divide /lozenge/ydieresis/Ydieresis/fraction/currency/guilsinglleft /guilsinglright/fi/fl/daggerdbl/periodcentered/quotesinglbase /quotedblbase/perthousand/Acircumflex/Ecircumflex/Aacute/Edieresis /Egrave/Iacute/Icircumflex/Idieresis/Igrave/Oacute /Ocircumflex/apple/Ograve/Uacute/Ucircumflex/Ugrave /dotlessi/circumflex/tilde/macron/breve/dotaccent /ring/cedilla/hungarumlaut/ogonek/caron /F5/Optima-Bold -1 TZ %PDF_EndEncoding %PDF_BeginEncoding: F7 Berkeley-Medium [ 39/quotesingle 96/grave 127/.notdef/Adieresis/Aring/Ccedilla /Eacute/Ntilde/Odieresis/Udieresis/aacute/agrave /acircumflex/adieresis/atilde/aring/ccedilla/eacute /egrave/ecircumflex/edieresis/iacute/igrave/icircumflex /idieresis/ntilde/oacute/ograve/ocircumflex/odieresis /otilde/uacute/ugrave/ucircumflex/udieresis/dagger /degree/cent/sterling/section/bullet/paragraph /germandbls/registered/copyright/trademark/acute/dieresis /notequal/AE/Oslash/infinity/plusminus/lessequal /greaterequal/yen/mu/partialdiff/summation/product /pi/integral/ordfeminine/ordmasculine/Omega/ae /oslash/questiondown/exclamdown/logicalnot/radical/florin /approxequal/Delta/guillemotleft/guillemotright/ellipsis/blank /Agrave/Atilde/Otilde/OE/oe/endash /emdash/quotedblleft/quotedblright/quoteleft/quoteright/divide /lozenge/ydieresis/Ydieresis/fraction/currency/guilsinglleft /guilsinglright/fi/fl/daggerdbl/periodcentered/quotesinglbase /quotedblbase/perthousand/Acircumflex/Ecircumflex/Aacute/Edieresis /Egrave/Iacute/Icircumflex/Idieresis/Igrave/Oacute /Ocircumflex/apple/Ograve/Uacute/Ucircumflex/Ugrave /dotlessi/circumflex/tilde/macron/breve/dotaccent /ring/cedilla/hungarumlaut/ogonek/caron /F7/Berkeley-Medium -1 TZ %PDF_EndEncoding %PDF_BeginEncoding: F9 Optima [ 39/quotesingle 96/grave 127/.notdef/Adieresis/Aring/Ccedilla /Eacute/Ntilde/Odieresis/Udieresis/aacute/agrave /acircumflex/adieresis/atilde/aring/ccedilla/eacute /egrave/ecircumflex/edieresis/iacute/igrave/icircumflex /idieresis/ntilde/oacute/ograve/ocircumflex/odieresis /otilde/uacute/ugrave/ucircumflex/udieresis/dagger /degree/cent/sterling/section/bullet/paragraph /germandbls/registered/copyright/trademark/acute/dieresis /notequal/AE/Oslash/infinity/plusminus/lessequal /greaterequal/yen/mu/partialdiff/summation/product /pi/integral/ordfeminine/ordmasculine/Omega/ae /oslash/questiondown/exclamdown/logicalnot/radical/florin /approxequal/Delta/guillemotleft/guillemotright/ellipsis/blank /Agrave/Atilde/Otilde/OE/oe/endash /emdash/quotedblleft/quotedblright/quoteleft/quoteright/divide /lozenge/ydieresis/Ydieresis/fraction/currency/guilsinglleft /guilsinglright/fi/fl/daggerdbl/periodcentered/quotesinglbase /quotedblbase/perthousand/Acircumflex/Ecircumflex/Aacute/Edieresis /Egrave/Iacute/Icircumflex/Idieresis/Igrave/Oacute /Ocircumflex/apple/Ograve/Uacute/Ucircumflex/Ugrave /dotlessi/circumflex/tilde/macron/breve/dotaccent /ring/cedilla/hungarumlaut/ogonek/caron /F9/Optima -1 TZ %PDF_EndEncoding 0 0 612 792 RC userdict /DefaultRGB /DeviceRGB put BT /F9 1 Tf 11 0 0 11 292 41 Tm 0 Tr 0 g 0.008 Tc (86)Tj /F5 1 Tf -22.182 63.727 TD 0.003 Tc -0.001 Tw (Physical Activity and Health)Tj /F7 1 Tf 0 -2.818 TD 0.204 Tw (low cardiorespiratory fitness. For example, com-)Tj 0 -1.182 TD 0.096 Tw (pared with people who are most active, sedentary)Tj T* 0.175 Tw (people experience between a 1.2-fold to a 2-fold)Tj 0 -1.227 TD -0.079 Tw (increased risk of dying during the follow-up interval)Tj 0 -1.182 TD 0 Tc -0.128 Tw (\(Slattery and Jacobs 1988; Slattery, Jacobs, Nichaman)Tj 0 -1.227 TD 0.003 Tc 0.027 Tw (1989; Leon and Connett 1991; Stender et al. 1993;)Tj 0 -1.182 TD 0.159 Tw (Sandvik et al. 1993; Chang-Claude and Frentzel-)Tj T* -0.035 Tw (Beyme 1993; Kaplan et al. 1987; Arraiz, Wigle, Mao)Tj 0 -1.227 TD -0.001 Tw (1992; Paffenbarger et al. 1993\).)Tj 1.636 -1.182 TD -0.114 Tw (Associations are generally stronger for measured)Tj -1.636 -1.227 TD 0.02 Tw (cardiorespiratory fitness than for reported physical)Tj 0 -1.182 TD -0.11 Tw (activity \(Blair, Kohl, Paffenbarger 1989\). Blair, Kohl,)Tj 0 -1.227 TD -0.065 Tw (and Barlow \(1993\) showed that low levels of cardio-)Tj 0 -1.182 TD 0.252 Tw (respiratory fitness were strongly associated with)Tj T* 0.041 Tw (overall mortality for both women \(RR = 5.35; 95%)Tj 0 -1.227 TD -0.044 Tw (CI, 2.44\32011.73\) and men \(RR = 3.16; 95% CI, 1.92\320)Tj 0 -1.182 TD 0.045 Tw (5.20\). The association with physical inactivity was)Tj 0 -1.227 TD -0.077 Tw (weaker for men \(RR = 1.70; 95% CI, 1.06\3202.74\), and)Tj 0 -1.182 TD -0.079 Tw (there was no association for women \(RR = 0.95; 95%)Tj T* -0.001 Tw (CI, 0.54\3201.70\).)Tj 1.636 -1.227 TD 0.033 Tc -0.013 Tw (Though cardiorespiratory fitness may be the)Tj -1.636 -1.182 TD 0.003 Tc -0.07 Tw (better indicator of regular physical activity, the level)Tj 0 -1.227 TD -0.122 Tw (of reported physical activity has been associated with)Tj 0 -1.182 TD 0.029 Tw (reduced all-cause mortality. Paffenbarger, Lee, and)Tj 0 -1.227 TD 0.195 Tw (Leung \(1994\) evaluated several types of recalled)Tj 0 -1.182 TD -0.01 Tc -0.044 Tw [(activity \(walking, stair climbing, all sports, moderate)-6 (-)]TJ T* 0 Tc -0.096 Tw (level sports, and total energy expended in activity per)Tj 0 -1.227 TD 0.204 Tw (week\) as predictors of all-cause mortality among)Tj 0 -1.182 TD -0.076 Tw (male Harvard alumni. Among these men, the relative)Tj 0 -1.227 TD -0.12 Tw (risk of death within the follow-up period was reduced)Tj 0 -1.182 TD -0.076 Tw (to 0.67 with walking 15 or more kilometers per week)Tj T* -0.048 Tw [(\(reference group, < 5 kilometers/week\))25 (,)-14 ( to 0.75 with)]TJ 0 -1.227 TD -0.04 Tw (climbing 55 or more flights of stairs per week \(refer-)Tj 0 -1.182 TD -0.046 Tw [(ence group, < 20 flights/week\),)-14 ( to 0.63 with involve-)]TJ 0 -1.227 TD 0.02 Tc 0.259 Tw (ment in moderate sports \(reference group, no)Tj 0 -1.182 TD 0 Tc 0.048 Tw [(involvement\))-11 (,)31 ( and to 0.47 with 3 or more hours of)]TJ T* -0.103 Tw (moderate sports activities per week \(reference group,)Tj 0 -1.227 TD -0.126 Tw (< 1 hour/week\). Most importantly, there was a signifi-)Tj 0 -1.182 TD -0.04 Tw (cant trend of decreasing risk of death across increas-)Tj 0 -1.227 TD 0.16 Tw (ing categories of distance walked, flights of stairs)Tj 0 -1.182 TD 0 Tw (climbed, and degree of intensity of sports play.)Tj 1.636 -1.227 TD 0.003 Tc -0.023 Tw (Researchers have also examined age-specific ef-)Tj -1.636 -1.182 TD 0.109 Tw (fects of different levels of physical activity on all-)Tj T* -0.039 Tw (cause mortality. Kaplan and colleagues \(1987\) have)Tj 0 -1.227 TD 0.082 Tw (shown that physical activity level has an effect on)Tj 0 -1.182 TD -0.022 Tw (death rates among both older and younger persons.)Tj 0 -1.227 TD 0.056 Tw (Data from a study of 9,484 Seventh-Day Adventist)Tj 0 -1.182 TD 0.251 Tw (men aged 30 years or older in 1958 who were)Tj 23.955 56.409 TD -0.108 Tw (followed through 1985 indicated that both moderate)Tj 0 -1.182 TD -0.014 Tw (and intense levels of activity reduced overall risk of)Tj T* 0.103 Tw (death even late in life \(Lindsted, Tonstad, Kuzma)Tj 0 -1.227 TD -0.068 Tw (1991\). Both moderate and vigorous levels of activity)Tj 0 -1.182 TD -0.017 Tw (were equally protective at age 50 years. The protec-)Tj 0 -1.227 TD 0 Tw (tive effect of high levels of activity lasted only until)Tj 0 -1.182 TD -0.113 Tw (age 70 , but the protective effect for moderate activity)Tj T* 0 Tw (lasted beyond age 80.)Tj 1.636 -1.227 TD -0.09 Tw (The studies cited thus far in this section assessed)Tj -1.636 -1.182 TD 0.018 Tc 0.259 Tw (physical activity or cardiorespiratory fitness at)Tj 0 -1.227 TD 0.003 Tc -0.008 Tw (baseline only and then followed up for mortality. A)Tj 0 -1.182 TD 0.005 Tw (stronger test for a causal relationship is to examine)Tj 0 -1.227 TD -0.004 Tw (the effect that changing from lower to higher levels)Tj 0 -1.182 TD 0.05 Tw (of physical activity or cardiorespiratory fitness has)Tj T* -0.024 Tw (on subsequent mortality. Two large studies provide)Tj 0 -1.227 TD 0.114 Tw (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 (about 50 percent.)Tj ET PDFVars/TermAll get exec restore gsave showpage grestore %%Page: 7 7 save PDFVars/InitAll get exec %PDF_BeginEncoding: F5 Optima-Bold [ 39/quotesingle 96/grave 127/.notdef/Adieresis/Aring/Ccedilla /Eacute/Ntilde/Odieresis/Udieresis/aacute/agrave /acircumflex/adieresis/atilde/aring/ccedilla/eacute /egrave/ecircumflex/edieresis/iacute/igrave/icircumflex /idieresis/ntilde/oacute/ograve/ocircumflex/odieresis /otilde/uacute/ugrave/ucircumflex/udieresis/dagger /degree/cent/sterling/section/bullet/paragraph /germandbls/registered/copyright/trademark/acute/dieresis /notequal/AE/Oslash/infinity/plusminus/lessequal /greaterequal/yen/mu/partialdiff/summation/product /pi/integral/ordfeminine/ordmasculine/Omega/ae /oslash/questiondown/exclamdown/logicalnot/radical/florin /approxequal/Delta/guillemotleft/guillemotright/ellipsis/blank /Agrave/Atilde/Otilde/OE/oe/endash /emdash/quotedblleft/quotedblright/quoteleft/quoteright/divide /lozenge/ydieresis/Ydieresis/fraction/currency/guilsinglleft /guilsinglright/fi/fl/daggerdbl/periodcentered/quotesinglbase /quotedblbase/perthousand/Acircumflex/Ecircumflex/Aacute/Edieresis /Egrave/Iacute/Icircumflex/Idieresis/Igrave/Oacute /Ocircumflex/apple/Ograve/Uacute/Ucircumflex/Ugrave /dotlessi/circumflex/tilde/macron/breve/dotaccent /ring/cedilla/hungarumlaut/ogonek/caron /F5/Optima-Bold -1 TZ %PDF_EndEncoding %PDF_BeginEncoding: F7 Berkeley-Medium [ 39/quotesingle 96/grave 127/.notdef/Adieresis/Aring/Ccedilla /Eacute/Ntilde/Odieresis/Udieresis/aacute/agrave /acircumflex/adieresis/atilde/aring/ccedilla/eacute /egrave/ecircumflex/edieresis/iacute/igrave/icircumflex /idieresis/ntilde/oacute/ograve/ocircumflex/odieresis /otilde/uacute/ugrave/ucircumflex/udieresis/dagger /degree/cent/sterling/section/bullet/paragraph /germandbls/registered/copyright/trademark/acute/dieresis /notequal/AE/Oslash/infinity/plusminus/lessequal /greaterequal/yen/mu/partialdiff/summation/product /pi/integral/ordfeminine/ordmasculine/Omega/ae /oslash/questiondown/exclamdown/logicalnot/radical/florin /approxequal/Delta/guillemotleft/guillemotright/ellipsis/blank /Agrave/Atilde/Otilde/OE/oe/endash /emdash/quotedblleft/quotedblright/quoteleft/quoteright/divide /lozenge/ydieresis/Ydieresis/fraction/currency/guilsinglleft /guilsinglright/fi/fl/daggerdbl/periodcentered/quotesinglbase /quotedblbase/perthousand/Acircumflex/Ecircumflex/Aacute/Edieresis /Egrave/Iacute/Icircumflex/Idieresis/Igrave/Oacute /Ocircumflex/apple/Ograve/Uacute/Ucircumflex/Ugrave /dotlessi/circumflex/tilde/macron/breve/dotaccent /ring/cedilla/hungarumlaut/ogonek/caron /F7/Berkeley-Medium -1 TZ %PDF_EndEncoding %PDF_BeginEncoding: F9 Optima [ 39/quotesingle 96/grave 127/.notdef/Adieresis/Aring/Ccedilla /Eacute/Ntilde/Odieresis/Udieresis/aacute/agrave /acircumflex/adieresis/atilde/aring/ccedilla/eacute /egrave/ecircumflex/edieresis/iacute/igrave/icircumflex /idieresis/ntilde/oacute/ograve/ocircumflex/odieresis /otilde/uacute/ugrave/ucircumflex/udieresis/dagger /degree/cent/sterling/section/bullet/paragraph /germandbls/registered/copyright/trademark/acute/dieresis /notequal/AE/Oslash/infinity/plusminus/lessequal /greaterequal/yen/mu/partialdiff/summation/product /pi/integral/ordfeminine/ordmasculine/Omega/ae /oslash/questiondown/exclamdown/logicalnot/radical/florin /approxequal/Delta/guillemotleft/guillemotright/ellipsis/blank /Agrave/Atilde/Otilde/OE/oe/endash /emdash/quotedblleft/quotedblright/quoteleft/quoteright/divide /lozenge/ydieresis/Ydieresis/fraction/currency/guilsinglleft /guilsinglright/fi/fl/daggerdbl/periodcentered/quotesinglbase /quotedblbase/perthousand/Acircumflex/Ecircumflex/Aacute/Edieresis /Egrave/Iacute/Icircumflex/Idieresis/Igrave/Oacute /Ocircumflex/apple/Ograve/Uacute/Ucircumflex/Ugrave /dotlessi/circumflex/tilde/macron/breve/dotaccent /ring/cedilla/hungarumlaut/ogonek/caron /F9/Optima -1 TZ %PDF_EndEncoding 0 0 612 792 RC userdict /DefaultRGB /DeviceRGB put BT /F9 1 Tf 11 0 0 11 308 41 Tm 0 Tr 0 g 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 ET PDFVars/TermAll get exec restore gsave showpage grestore %%Page: 8 8 save PDFVars/InitAll get exec %PDF_BeginEncoding: F5 Optima-Bold [ 39/quotesingle 96/grave 127/.notdef/Adieresis/Aring/Ccedilla /Eacute/Ntilde/Odieresis/Udieresis/aacute/agrave /acircumflex/adieresis/atilde/aring/ccedilla/eacute /egrave/ecircumflex/edieresis/iacute/igrave/icircumflex /idieresis/ntilde/oacute/ograve/ocircumflex/odieresis /otilde/uacute/ugrave/ucircumflex/udieresis/dagger 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/Ocircumflex/apple/Ograve/Uacute/Ucircumflex/Ugrave /dotlessi/circumflex/tilde/macron/breve/dotaccent /ring/cedilla/hungarumlaut/ogonek/caron /F9/Optima -1 TZ %PDF_EndEncoding %PDF_BeginEncoding: F10 Symbol [/F10/Symbol -1 TZ %PDF_EndEncoding 0 0 612 792 RC userdict /DefaultRGB /DeviceRGB put BT /F9 1 Tf 11 0 0 11 292 41 Tm 0 Tr 0 g 0.008 Tc (88)Tj /F5 1 Tf -22.182 63.727 TD 0.003 Tc -0.001 Tw (Physical Activity and Health)Tj 10 0 0 10 48 712 Tm 0.005 Tc 0 Tw [(T)60 (able 4-1.)-970 (Population-based studies of association of physical activity or cardiore\ spiratory fitness with total)]TJ 5.4 -1.2 TD 0.001 Tw (cardiovascular diseases)Tj ET 0 G 1 i 0 J 0 j 0.5 w 10 M []0 d 48 695.75 m 1181 695.75 l S BT /F5 1 Tf 10 0 0 10 264 681 Tm 0 Tw [(Definition of physical activity)-3732 (Definition of)]TJ ET 48 665.25 m 1181 665.25 l S BT /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 9.6 0 TD (\263)Tj /F9 1 Tf 0.55 0 TD 0 Tw [( 30 years; 26-year)-20437 (\(n = 410\))]TJ -0.55 -1.2 TD (follow-up)Tj -9.6 -1.85 TD [(Arraiz, W)63 (igle,)-3591 (Stratified probability)-3162 (Physical activity index)-7068 (Death due to CVD)]TJ 0 -1.2 TD [(Mao \(1992\))-4549 (sample of Canadians)-2958 (summarizing frequency)68 (, intensity)74 (,)-2217 (\(n = 256\))]TJ 9.6 -1.25 TD [(aged 30\32069 years,)-4079 (and duration of leisure-time)]TJ T* -0.001 Tw [(conducted in 1978\320)-3238 (activity and household chores)]TJ 0 -1.2 TD (1979; 7-year follow-up)Tj -9.6 -1.85 TD 0 Tw [(Sherman et al.)-3364 (1,404 Framingham \(MA\))-1338 (Physical activity index based on)-2857 (CVD incidence \(n = 994\))]TJ 0 -1.2 TD [(\(1994\))-6789 (women aged 50\32074)-3359 (hours per day spent at activity-)-3412 (and mortality \(n = 303\))]TJ 9.6 -1.25 TD 0.001 Tw [(years; 16-year)-5874 (specific intensity)]TJ 0 -1.2 TD (follow-up)Tj -9.6 -1.85 TD 0 Tw [(LaCroix et al.)-3804 (1,645 HMO members)-2413 (Hours of walking per week)-5062 (CVD hospitalization)]TJ 0 -1.2 TD [(\(1996\))-6789 (age )]TJ /F10 1 Tf 11.4 0 TD (\263)Tj /F9 1 Tf 0.55 0 TD [( 65 years; 4.2-year)-18354 (\(ICD-9 390\320448\))]TJ -2.35 -1.25 TD 0.001 Tw [(average follow-up)-20933 (\(n = 359\))]TJ /F5 1 Tf -9.6 -3.05 TD -0.001 Tw (Cardiorespiratory fitness)Tj /F9 1 Tf 0 -1.8 TD 0 Tw [(Ekelund et al.)-3694 (3,106 North )18 (American)-2193 (Submaximal aerobic capacity)-3938 (Death due to CVD)]TJ 0 -1.25 TD [(\(1988\))-6789 (men aged 30\32069)-4704 (estimated from exer)45 (cise test)-4815 (\(ICD-8 390\320458\))]TJ 9.6 -1.25 TD 0.001 Tw [(years; 8.5-year)-22389 (\(n = 45\))]TJ 0 -1.2 TD 0.002 Tw (average follow-up)Tj -9.6 -1.85 TD 0 Tw [(Blair et al.)-5148 (10,244 men and 3,120)-2003 (Maximal aerobic capacity)-5513 (Death due to CVD)]TJ 0 -1.2 TD [(\(1989\))-6789 (women aged )]TJ /F10 1 Tf 15.5 0 TD (\263)Tj /F9 1 Tf 0.55 0 TD [( 20 years;)-1332 (estimated by exer)40 (cise test)-5766 (\(ICD-9 390\320448\))]TJ -6.45 -1.25 TD [(8.1-year average)-21554 (in men \(n = 66\))]TJ ET 48 71.25 m 1181 71.25 l S BT /F9 1 Tf 10 0 0 10 144 75.5 Tm [(follow-up)-24584 (and women \(n = 7\))]TJ ET 0 0 0 0 k 546 712.5 130 -672.5 re f PDFVars/TermAll get exec restore gsave showpage grestore %%Page: 9 9 save PDFVars/InitAll get exec %PDF_BeginEncoding: 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/Egrave/Iacute/Icircumflex/Idieresis/Igrave/Oacute /Ocircumflex/apple/Ograve/Uacute/Ucircumflex/Ugrave /dotlessi/circumflex/tilde/macron/breve/dotaccent /ring/cedilla/hungarumlaut/ogonek/caron /F9/Optima -1 TZ %PDF_EndEncoding 0 0 612 792 RC userdict /DefaultRGB /DeviceRGB put BT /F9 1 Tf 11 0 0 11 292 41 Tm 0 Tr 0 g 0.008 Tc (90)Tj /F5 1 Tf -22.182 63.727 TD 0.003 Tc -0.001 Tw (Physical Activity and Health)Tj 10 0 0 10 48 712 Tm 0.005 Tc 0.027 Tw [(T)60 (able 4-1.)]TJ /F9 1 Tf 8.5 0 1.652 8.5 102 712 Tm 0.006 Tc (Continued)Tj ET 0 G 1 i 0 J 0 j 0.5 w 10 M []0 d 48 707.75 m 1170 707.75 l S BT /F5 1 Tf 10 0 0 10 264 693 Tm 0.005 Tc 0 Tw [(Definition of physical activity)-3732 (Definition of)]TJ ET 48 677.25 m 1170 677.25 l S BT /F5 1 Tf 10 0 0 10 48 681 Tm -0.001 Tw [(Study)-7130 (Population)-7224 (or cardiorespiratory fitness)-4842 (cardiovascular disease)]TJ /F9 1 Tf 0 -1.8 TD 0 Tw [(Arraiz, W)63 (igle,)-3591 (Stratified probability)-3162 (Submaximal aerobic capacity)-3938 (Death due to CVD)]TJ 0 -1.25 TD [(Mao \(1992\))-4549 (sample of Canadians)-2958 (estimated from home step test)-3816 (\(n = 37\))]TJ 9.6 -1.2 TD (aged 30\32069 years,)Tj 0 -1.25 TD (conducted in 1978\320)Tj T* -0.001 Tw (1979; 7-year follow-up)Tj -9.6 -1.8 TD 0 Tw [(Sandvik et al.)-3749 (1,960 Norwegian men)-2178 (Maximal aerobic capacity)-5513 (Death due to CVD)]TJ 0 -1.25 TD [(\(1993\))-6789 (aged 40\32059 years;)-4079 (estimated by exer)40 (cise test)-5766 (\(n = 144\))]TJ 9.6 -1.2 TD 0.002 Tw (average 16-year)Tj 0 -1.25 TD (follow-up)Tj -9.6 -1.8 TD -0.001 Tw [(Blair et al.)-5148 (9,777 US men aged)-3358 (Maximal aerobic capacity)-5513 (Death due to CVD)]TJ 0 -1.25 TD 0 Tw [(\(1995\))-6789 (20\32082 years with 2)-3683 (estimated by exer)40 (cise test)-5766 (\(ICD-9 390\320449.9\))]TJ 9.6 -1.2 TD [(evaluations; 5.1-year)-19693 (\(n = 87\))]TJ ET 48 499.75 m 1170 499.75 l S BT /F9 1 Tf 10 0 0 10 144 503.5 Tm 0.002 Tw (average follow-up)Tj /F7 1 Tf 11 0 0 11 64.5 453 Tm 0.003 Tc -0.048 Tw (Thirty-six studies examining the relationship of)Tj -1.636 -1.182 TD 0.207 Tw (physical activity level to risk of CHD have been)Tj T* -0.051 Tw [(published since 1953 \()-9 (Table)37 ( 4-2\). Studies published)]TJ 0 -1.227 TD (before 1978 predominantly classified physical activ-)Tj 0 -1.182 TD -0.107 Tw (ity level by job title or occupational activities. Studies)Tj 0 -1.227 TD 0.055 Tw (thereafter usually defined activity level by recall of)Tj 0 -1.182 TD 0.133 Tw (leisure-time activity or by such activity combined)Tj T* 0.012 Tw (with occupational activity. These later studies were)Tj 0 -1.227 TD -0.032 Tw (also able to control statistically for many potentially)Tj 0 -1.182 TD 0.13 Tw (confounding variables in addition to age. Most of)Tj 0 -1.227 TD 0.24 Tw (these studies focused on men in the age ranges)Tj 0 -1.182 TD 0 Tc -0.127 Tw (associated with increasing risk of CHD \(30\32075 years\);)Tj T* 0.003 Tc -0.104 Tw (only four included women. Although in several stud-)Tj 0 -1.227 TD 0.083 Tw (ies, CHD mortality was the sole outcome variable,)Tj 0 -1.182 TD -0.104 Tw (most included both fatal and nonfatal disease. All but)Tj 0 -1.227 TD -0.066 Tw (one \(Morris et al. 1973\) were cohort studies; lengths)Tj 0 -1.182 TD -0.088 Tw (of follow-up from baseline assessment ranged from 4)Tj T* 0.227 Tw (to 25 years. All studies related a single baseline)Tj 0 -1.227 TD 0.16 Tw (estimate of physical activity level to risk of CHD)Tj 0 -1.182 TD -0.001 Tw (during the follow-up period.)Tj 1.636 -1.227 TD -0.081 Tw (Some study populations have had more than one)Tj -1.636 -1.182 TD 0.045 Tw (follow-up assessment for CHD. For example, three)Tj 0 -1.227 TD -0.063 Tw (follow-up assessments \(at 10, 12, and 23 years\) have)Tj 0 -1.182 TD 0.068 Tw (been reported for men in the Honolulu Heart Pro-)Tj T* -0.123 Tw (gram \(Yano, Reed, McGee 1984; Donahue et al. 1988;)Tj 0 -1.227 TD 0.022 Tw (Rodriguez et al. 1994\). Each represented follow-up)Tj 0 -1.182 TD -0.005 Tc 0.084 Tw [(f)-27 (urther removed from the original determination of)]TJ 0 -1.227 TD 0.132 Tw (physical activity. Thus, the diminishing effect seen)Tj 0 -1.182 TD -0.114 Tw [(over time might indicate changing patterns of physi)18 (c)-8 (a)-8 (l)]TJ 24.136 33.591 TD 0.003 Tc 0.032 Tw (activity\321and thereby a lessening of validity of the)Tj 0 -1.182 TD 0.006 Tw [(original physical activity classification \()-12 (Table)37 ( 4-2\).)]TJ T* 0.096 Tw (Oddly, in the 12-year follow-up, the reduction in)Tj 0 -1.227 TD -0.023 Tw (CHD risk observed among both active middle-aged)Tj 0 -1.182 TD 0.111 Tw (men \(RR = 0.7\) and active older men \(RR = 0.4\))Tj 0 -1.227 TD -0.043 Tw (when compared with their least active counterparts)Tj 0 -1.182 TD 0.246 Tw (was not diminished by bivariate adjustment for)Tj T* -0.086 Tw (serum cholesterol, body mass index \(BMI\), or blood)Tj 0 -1.227 TD 0.257 Tw (pressure \(Donahue et al. 1988\). In the 23-year)Tj 0 -1.182 TD 0.259 Tw (follow-up, however, the reduction in CHD risk)Tj 0 -1.227 TD -0.113 Tw (among active men \(RR = 0.8\) was greatly diminished)Tj 0 -1.182 TD -0.003 Tw (by simultaneous adjustment for serum cholesterol,)Tj T* 0.231 Tw (BMI, blood pressure, and diabetes \(RR = 0.95\),)Tj 0 -1.227 TD 0.029 Tw (leading the authors to conclude that the beneficial)Tj 0 -1.182 TD 0.219 Tw (effect of physical activity on CHD risk is likely)Tj 0 -1.227 TD -0.054 Tw (mediated by the beneficial effect of physical activity)Tj 0 -1.182 TD -0.095 Tw (on these other factors \(Rodriguez et al. 1994\). These)Tj T* -0.002 Tc -0.13 Tw (reports thus illustrate not only the problem of lengthy)Tj 0 -1.227 TD 0.003 Tc -0.053 Tw (follow-up without repeated assessments of physical)Tj 0 -1.182 TD -0.085 Tw (activity but also the problem of lack of uniformity in)Tj 0 -1.227 TD -0.005 Tc -0.068 Tw (adjustment for potential confounding factors, as well)Tj 0 -1.182 TD 0.003 Tc -0.09 Tw (as the underlying, thorny problem of adjustment for)Tj T* 0.019 Tw (multiple factors that may be in the causal pathway)Tj 0 -1.227 TD -0.006 Tw (between physical activity and disease. Studies have)Tj 0 -1.182 TD -0.11 Tw (in fact varied greatly in the extent to which they have)Tj 0 -1.227 TD 0.23 Tw (controlled for potential confounding and in the)Tj 0 -1.182 TD 0 Tw (factors selected for adjustment.)Tj 1.636 -1.227 TD -0.005 Tc -0.109 Tw (Although early studies were not designed to dem-)Tj -1.636 -1.182 TD 0.057 Tw (onstrate a dose-response gradient between physical)Tj ET 0 0 0 0 k 546 721 131.5 -243 re f PDFVars/TermAll get exec restore gsave showpage grestore %%Page: 11 11 save PDFVars/InitAll get exec %PDF_BeginEncoding: F5 Optima-Bold [ 39/quotesingle 96/grave 127/.notdef/Adieresis/Aring/Ccedilla /Eacute/Ntilde/Odieresis/Udieresis/aacute/agrave /acircumflex/adieresis/atilde/aring/ccedilla/eacute /egrave/ecircumflex/edieresis/iacute/igrave/icircumflex /idieresis/ntilde/oacute/ograve/ocircumflex/odieresis /otilde/uacute/ugrave/ucircumflex/udieresis/dagger /degree/cent/sterling/section/bullet/paragraph /germandbls/registered/copyright/trademark/acute/dieresis /notequal/AE/Oslash/infinity/plusminus/lessequal /greaterequal/yen/mu/partialdiff/summation/product /pi/integral/ordfeminine/ordmasculine/Omega/ae /oslash/questiondown/exclamdown/logicalnot/radical/florin /approxequal/Delta/guillemotleft/guillemotright/ellipsis/blank /Agrave/Atilde/Otilde/OE/oe/endash /emdash/quotedblleft/quotedblright/quoteleft/quoteright/divide /lozenge/ydieresis/Ydieresis/fraction/currency/guilsinglleft /guilsinglright/fi/fl/daggerdbl/periodcentered/quotesinglbase /quotedblbase/perthousand/Acircumflex/Ecircumflex/Aacute/Edieresis /Egrave/Iacute/Icircumflex/Idieresis/Igrave/Oacute /Ocircumflex/apple/Ograve/Uacute/Ucircumflex/Ugrave /dotlessi/circumflex/tilde/macron/breve/dotaccent /ring/cedilla/hungarumlaut/ogonek/caron /F5/Optima-Bold -1 TZ %PDF_EndEncoding %PDF_BeginEncoding: F7 Berkeley-Medium [ 39/quotesingle 96/grave 127/.notdef/Adieresis/Aring/Ccedilla /Eacute/Ntilde/Odieresis/Udieresis/aacute/agrave /acircumflex/adieresis/atilde/aring/ccedilla/eacute /egrave/ecircumflex/edieresis/iacute/igrave/icircumflex /idieresis/ntilde/oacute/ograve/ocircumflex/odieresis /otilde/uacute/ugrave/ucircumflex/udieresis/dagger /degree/cent/sterling/section/bullet/paragraph /germandbls/registered/copyright/trademark/acute/dieresis /notequal/AE/Oslash/infinity/plusminus/lessequal /greaterequal/yen/mu/partialdiff/summation/product /pi/integral/ordfeminine/ordmasculine/Omega/ae /oslash/questiondown/exclamdown/logicalnot/radical/florin /approxequal/Delta/guillemotleft/guillemotright/ellipsis/blank /Agrave/Atilde/Otilde/OE/oe/endash /emdash/quotedblleft/quotedblright/quoteleft/quoteright/divide /lozenge/ydieresis/Ydieresis/fraction/currency/guilsinglleft /guilsinglright/fi/fl/daggerdbl/periodcentered/quotesinglbase /quotedblbase/perthousand/Acircumflex/Ecircumflex/Aacute/Edieresis /Egrave/Iacute/Icircumflex/Idieresis/Igrave/Oacute /Ocircumflex/apple/Ograve/Uacute/Ucircumflex/Ugrave /dotlessi/circumflex/tilde/macron/breve/dotaccent /ring/cedilla/hungarumlaut/ogonek/caron /F7/Berkeley-Medium -1 TZ %PDF_EndEncoding %PDF_BeginEncoding: F9 Optima [ 39/quotesingle 96/grave 127/.notdef/Adieresis/Aring/Ccedilla /Eacute/Ntilde/Odieresis/Udieresis/aacute/agrave /acircumflex/adieresis/atilde/aring/ccedilla/eacute /egrave/ecircumflex/edieresis/iacute/igrave/icircumflex /idieresis/ntilde/oacute/ograve/ocircumflex/odieresis /otilde/uacute/ugrave/ucircumflex/udieresis/dagger /degree/cent/sterling/section/bullet/paragraph /germandbls/registered/copyright/trademark/acute/dieresis /notequal/AE/Oslash/infinity/plusminus/lessequal /greaterequal/yen/mu/partialdiff/summation/product /pi/integral/ordfeminine/ordmasculine/Omega/ae /oslash/questiondown/exclamdown/logicalnot/radical/florin /approxequal/Delta/guillemotleft/guillemotright/ellipsis/blank /Agrave/Atilde/Otilde/OE/oe/endash /emdash/quotedblleft/quotedblright/quoteleft/quoteright/divide /lozenge/ydieresis/Ydieresis/fraction/currency/guilsinglleft /guilsinglright/fi/fl/daggerdbl/periodcentered/quotesinglbase /quotedblbase/perthousand/Acircumflex/Ecircumflex/Aacute/Edieresis /Egrave/Iacute/Icircumflex/Idieresis/Igrave/Oacute /Ocircumflex/apple/Ograve/Uacute/Ucircumflex/Ugrave /dotlessi/circumflex/tilde/macron/breve/dotaccent /ring/cedilla/hungarumlaut/ogonek/caron /F9/Optima -1 TZ %PDF_EndEncoding 0 0 612 792 RC userdict /DefaultRGB /DeviceRGB put BT /F9 1 Tf 11 0 0 11 308 41 Tm 0 Tr 0 g 0.008 Tc (91)Tj /F5 1 Tf -0.409 63.727 TD 0.003 Tc 0 Tw (The Effects of Physical Activity on Health and Disease)Tj ET 0 G 1 i 0 J 0 j 0.5 w 10 M []0 d -564 707.75 m 558 707.75 l S BT /F5 1 Tf 10 0 0 10 282 693 Tm 0.005 Tc 0.001 Tw [(Dose)-4355 (Adjustment for confounders)]TJ ET -564 677.25 m 558 677.25 l S BT /F5 1 Tf 10 0 0 10 66 681 Tm 0.002 Tw [(Main findings)-15604 (response)]TJ /F9 1 Tf 7 0 0 7 321 684 Tm (*)Tj /F5 1 Tf 10 0 0 10 348 681 Tm 0 Tw [(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 0 -1.2 TD (categories had risks of 0.8 \(95% CI, 0.1\3207.6\))Tj 0 -1.25 TD (and 5.4 \(95% CI, 1.9\32015.9\), respectively)Tj 0 -3.05 TD [(Inverse association; relative to men in lowest)-2085 (Y)65 (e)0 (s)-5151 (Extensive control for confounding influences)]TJ 0 -1.25 TD (fitness quartile, multivariate adjusted RR in)Tj 0 -1.2 TD (quartiles 2, 3, and 4 were 0.59, 0.45, and)Tj 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 ET -564 499.75 m 558 499.75 l S BT /F9 1 Tf 10 0 0 10 66 503.5 Tm [(of 0.48 )-24 (\(95% CI, 0.31\3200.74\))]TJ 8 0 0 8 66 487 Tm 0.01 Tc (Abbreviations: BMI = body mass index \(wt [kg] /ht [m])Tj 4.7 0 0 4.7 257.5 489.5 Tm (2)Tj 8 0 0 8 260 487 Tm ( \); CVD = cardiovascular disease; CI = confidence interval; HMO = healt\ h)Tj -24.25 -1.187 TD [(maintenance or)-11 (ganization; ICD = International Classification of Diseases \(8 and 9 ref\ er to editions\); RR = relative risk.)]TJ 5.6 0 0 5.6 66 466.5 Tm (*)Tj 8 0 0 8 68.5 464 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 -0.312 -1.187 TD 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 /F7 1 Tf 11 0 0 11 67 398 Tm 0.003 Tc -0.042 Tw (activity level and CHD, most found an inverse asso-)Tj 0 -1.182 TD 0.146 Tw (ciation: more active persons were found to be at)Tj T* -0.021 Tw (lower risk of CHD than their more sedentary coun-)Tj 0 -1.227 TD 0.202 Tw (terparts. Of the 17 recent studies that found an)Tj 0 -1.182 TD -0.057 Tw (inverse relationship and were able to examine dose-)Tj 0 -1.227 TD -0.004 Tc -0.13 Tw (response relationships, 13 \(76 percent\) demonstrated)Tj 0 -1.182 TD 0.003 Tc 0.015 Tw (an inverse dose-response gradient between level of)Tj T* -0.096 Tw (physical activity and risk of CHD, whereas 2 showed)Tj 0 -1.227 TD 0 Tw (a dose-response gradient only for some subgroups.)Tj 1.636 -1.182 TD 0.03 Tw (The relationship between cardiorespiratory fit-)Tj -1.636 -1.227 TD -0.056 Tw (ness and risk of CHD was examined in seven cohort)Tj 0 -1.182 TD 0.057 Tw (studies \(follow-up range, 4\32020 years\). All but two)Tj 0 -1.227 TD 0.049 Tw (\(Lie, Mundal, Erikssen 1985; Erikssen 1986\) used)Tj 0 -1.182 TD 0.137 Tw (estimates of aerobic power based on submaximal)Tj T* 0.235 Tw (exercise testing. None of these studies included)Tj 0 -1.227 TD 0.1 Tw (women. Similar to the studies of physical activity)Tj 0 -1.182 TD 0.015 Tw (and CHD, these all related a single baseline assess-)Tj 0 -1.227 TD 0.175 Tw (ment of cardiorespiratory fitness to risk of CHD)Tj 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 (tically for possible confounding variables. All seven)Tj 0 -1.227 TD 0.021 Tc 0.201 Tw [(studies )25 (showed an inverse association between)]TJ 0 -1.182 TD 0.025 Tc 0.232 Tw (cardiorespiratory fitness and CHD. Of the six)Tj 0 -1.227 TD 0.014 Tc -0.126 Tw [(stud)-29 (ies that had more than two categories of cardio-)]TJ 0 -1.182 TD 0.013 Tc 0.257 Tw (respiratory fitness, all demonstrated an inverse)Tj T* 0 Tw (dose-response gradient.)Tj 25.5 28.773 TD -0.005 Tc -0.011 Tw [( Two recent meta-analyses of studies of physical)]TJ -1.636 -1.182 TD -0.084 Tw (activity and CHD have included independent scoring)Tj T* 0.13 Tw (for the quality of the methods used in each study)Tj 0 -1.227 TD 0.058 Tw (\(Powell et al. 1987; Berlin and Colditz 1990\). Both)Tj 0 -1.182 TD 0.21 Tw (concluded that studies with higher-quality scores)Tj 0 -1.227 TD 0.119 Tw (tended to show higher relative risk estimates than)Tj 0 -1.182 TD 0.149 Tw (those with lower-quality scores. In the Berlin and)Tj T* 0.071 Tw (Colditz quantitative meta-analysis, the pooled rela-)Tj 0 -1.227 TD -0.127 Tw (tive risk for CHD\321comparing risk for the lowest level)Tj 0 -1.182 TD 0.04 Tw (of physical activity with risk for the highest level\321)Tj 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 [(studies with low)-11 (-)9 (quality scores was in the null range.)]TJ /F5 1 Tf 12 0 0 12 329.5 211.5 Tm 0 Tc 0 Tw (CVD Risk Factors in Children)Tj /F7 1 Tf 11 0 0 11 329.5 196.5 Tm -0.005 Tc 0.024 Tw (Because CHD is rare in children, the cardiovascular)Tj 0 -1.227 TD 0.123 Tw (effects of physical activity in children are assessed)Tj 0 -1.182 TD 0.201 Tw (through the relationship of physical activity with)Tj T* 0.041 Tw (CHD risk factors such as elevated low-density lipo-)Tj 0 -1.227 TD 0.129 Tw (protein cholesterol \(LDL-C\), lowered high-density)Tj 0 -1.182 TD -0.055 Tw (lipoprotein cholesterol \(HDL-C\), and elevated blood)Tj 0 -1.227 TD 0.057 Tw (pressure. The presence of CHD risk factors in chil-)Tj 0 -1.182 TD 0.054 Tw (dren is of concern because of evidence that athero-)Tj T* 0.001 Tc 0.258 Tw (sclerosis begins in childhood \(Stary 1989\), that)Tj 0 -1.227 TD -0.005 Tc -0.085 Tw (presence of CHD in adults is related to elevated blood)Tj ET 0 0 0 0 k -66 721 131.5 -243 re f PDFVars/TermAll get exec restore gsave showpage grestore %%Page: 12 12 save PDFVars/InitAll get exec %PDF_BeginEncoding: F5 Optima-Bold [ 39/quotesingle 96/grave 127/.notdef/Adieresis/Aring/Ccedilla /Eacute/Ntilde/Odieresis/Udieresis/aacute/agrave /acircumflex/adieresis/atilde/aring/ccedilla/eacute /egrave/ecircumflex/edieresis/iacute/igrave/icircumflex /idieresis/ntilde/oacute/ograve/ocircumflex/odieresis /otilde/uacute/ugrave/ucircumflex/udieresis/dagger /degree/cent/sterling/section/bullet/paragraph /germandbls/registered/copyright/trademark/acute/dieresis /notequal/AE/Oslash/infinity/plusminus/lessequal /greaterequal/yen/mu/partialdiff/summation/product 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Tf 11 0 0 11 292 41 Tm 0 Tr 0 g 0.008 Tc (92)Tj /F5 1 Tf -22.182 63.727 TD 0.003 Tc -0.001 Tw (Physical Activity and Health)Tj 10 0 0 10 48 712 Tm 0.005 Tc 0 Tw [(T)60 (able 4-2.)-1321 (Population-based studies of association of physical activity or cardiore\ spiratory fitness with coronary)]TJ 5.7 -1.2 TD -0.002 Tw (heart disease)Tj ET 0 G 1 i 0 J 0 j 0.5 w 10 M []0 d 48 695.75 m 1176 695.75 l S BT /F5 1 Tf 10 0 0 10 264 681 Tm 0 Tw [(Definition of physical activity)-3732 (Definition of coronary)]TJ ET 48 665.25 m 1176 665.25 l S BT /F5 1 Tf 10 0 0 10 48 669 Tm -0.001 Tw [(Study)-7130 (Population)-7224 (or cardiorespiratory fitness)-4842 (heart disease)]TJ 0 -1.8 TD 0 Tw (Physical activity)Tj /F9 1 Tf 0 -1.85 TD [(Morris et al.)-4368 (31,000 male employees)-1558 (Occupational classification of job)-2121 (First clinical episode of)]TJ 0 -1.2 TD [(\(1953\))-6789 (of London T)131 (ransport)-3309 (duties: sedentary drivers and)-4372 (CHD)]TJ 9.6 -1.25 TD [(Executive aged 35\32064)-2454 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(Physical activity at work defined)-2687 (Death due to CHD)]TJ 9.6 -1.2 TD [(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 T* (Office between 1906)Tj 0 -1.2 TD (and 1940; followed)Tj 0 -1.25 TD (through December 1961)Tj -9.6 -1.8 TD 0 Tw [(Morris et al.)-4368 (667 London bus)-4924 (Occupational classification of job)-2121 (Incidence of CHD)]TJ 0 -1.25 TD [(\(1966\))-6789 (conductors and drivers)-2053 (duties as sedentary drivers)-5382 (\(n = 47\))]TJ 9.6 -1.2 TD [(aged 30\32069 years;)-4079 (and active conductors)]TJ 0 -1.25 TD -0.002 Tw (5-year follow-up)Tj -9.6 -1.8 TD 0 Tw [(Cassel et al.)-4424 (3,009 male residents)-2953 (Occupational classification of job)-2121 (Incidence of CHD)]TJ 0 -1.25 TD [(\(1971\))-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 0 -1.2 TD -0.001 Tw (years in 1960\3201962;)Tj 0 -1.25 TD -0.002 Tw 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myocardial)]TJ 9.6 -1.2 TD 0 Tw [(employees aged)-4984 (test; age-specific median split used)-1671 (infar)19 (ction \(n = 36\))]TJ 0 -1.25 TD [(< 55 years; 4.8-year)-3293 (to determine low/high fitness)]TJ T* 0.002 Tw (average follow-up)Tj -9.6 -1.8 TD -0.001 Tw [(Lie, Mundal,)-4094 (2,014 Norwegian)-4368 (Near maximal cycle er)30 (gometer)-3415 (Incident cases of fatal)]TJ 0 -1.25 TD 0 Tw [(Erikssen)-6114 (employed men aged)-3134 (exercise test; total work in)-5437 (and nonfatal CHD)]TJ 0 -1.2 TD [(\(1985\))-6789 (40\32059 years; 7-year)-3403 (quartiles)]TJ 9.6 -1.25 TD (follow-up)Tj -9.6 -1.8 TD -0.001 Tw [(Erikssen \(1986\))-3023 (1,832 Norwegian)-4368 (Near maximal cycle er)30 (gometer)-3415 (Incident cases of fatal)]TJ 9.6 -1.25 TD 0 Tw [(men aged 40\32059 years;)-1893 (exercise test; total work in)-5437 (and nonfatal myocardial)]TJ 0 -1.2 TD -0.001 Tw [(7-year average)-5599 (quartiles)-13089 (infar)19 (ction and CHD death)]TJ 0 -1.25 TD (follow-up)Tj -9.6 -1.8 TD 0 Tw [(Sobolski et al.)-3523 (2,109 Belgian men)-3743 (Submaximal aerobic capacity)-3938 (Incident cases of fatal)]TJ 0 -1.25 TD [(\(1987\))-6789 (aged 40\32055 years in)-3233 (estimated from cycle er)20 (gometry)-3115 (and nonfatal myocardial)]TJ 9.6 -1.25 TD [(1976\3201978; 5-year)-3688 (test)-15335 (infar)19 (ction and sudden)]TJ 0 -1.2 TD -0.001 Tw [(follow-up)-24584 (death \(n = 36\))]TJ -9.6 -1.85 TD 0.001 Tw [(Ekelund et al.)-3694 (3,106 North )19 (American)-2193 (Submaximal aerobic capacity)-3938 (Death due to CHD)]TJ 0 -1.2 TD 0 Tw [(\(1988\))-6789 (men aged 30\32069 years;)-1893 (estimated from exer)45 (cise test)-4815 (\(ICD-8 410\320414\))]TJ 9.6 -1.25 TD -0.001 Tw (8.5-year average)Tj 0 -1.2 TD (follow-up)Tj -9.6 -1.85 TD 0 Tw [(Slattery et al.)-3968 (2,431 US male railroad)-1832 (Submaximal exer)19 (cise heart rate on)-1819 (Death due to CHD)]TJ 0 -1.2 TD [(\(1988\))-6789 (employees; 17- through)-1663 (standard \(3 min\) treadmill test)-3806 (\(ICD-8 410\320414\))]TJ 9.6 -1.25 TD 0.002 Tw [(20-year follow-up)-4188 (evaluation)]TJ -9.6 -1.8 TD 0.002 Tc 0.003 Tw [(Hein,)-7187 (4,999 Copenhagen)-3697 (Submaximal aerobic capacity)-3941 (Fatal )8 (myocardial )8 (infar)39 (ction)]TJ 0 -1.25 TD 0.005 Tc 0 Tw [(Suadicani,)-5049 (men aged 40\32059 years;)-1893 (estimated from cycle er)20 (gometer)-3115 (\(ICD-8 410\320414\))]TJ T* 0.001 Tw [(Gyntelber)23 (g)-4795 (17-year follow-up)-4188 (exercise test)-11514 (\(n = 266\))]TJ ET 48 163.75 m 1176 163.75 l S BT /F9 1 Tf 10 0 0 10 48 168 Tm -0.002 Tw [(\(1992\))-6789 (from 1970/1971)]TJ ET 0 0 0 0 k 546 727.9 132 -58.9 re f 558 211.9 102 -51 re f 547.5 189 128.5 -58 re f PDFVars/TermAll get exec restore gsave showpage grestore %%Page: 21 21 save PDFVars/InitAll get exec %PDF_BeginEncoding: F5 Optima-Bold [ 39/quotesingle 96/grave 127/.notdef/Adieresis/Aring/Ccedilla /Eacute/Ntilde/Odieresis/Udieresis/aacute/agrave /acircumflex/adieresis/atilde/aring/ccedilla/eacute /egrave/ecircumflex/edieresis/iacute/igrave/icircumflex 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/quotedblbase/perthousand/Acircumflex/Ecircumflex/Aacute/Edieresis /Egrave/Iacute/Icircumflex/Idieresis/Igrave/Oacute /Ocircumflex/apple/Ograve/Uacute/Ucircumflex/Ugrave /dotlessi/circumflex/tilde/macron/breve/dotaccent /ring/cedilla/hungarumlaut/ogonek/caron /F9/Optima -1 TZ %PDF_EndEncoding 0 0 612 792 RC userdict /DefaultRGB /DeviceRGB put BT /F9 1 Tf 11 0 0 11 305 41 Tm 0 Tr 0 g 0.006 Tc (101)Tj /F5 1 Tf -0.136 63.727 TD 0.003 Tc 0 Tw (The Effects of Physical Activity on Health and Disease)Tj ET 0 G 1 i 0 J 0 j 0.5 w 10 M []0 d -564 708.75 m 564 708.75 l S BT /F5 1 Tf 10 0 0 10 285 694 Tm 0.005 Tc 0.001 Tw [(Dose)-4355 (Adjustment for confounders)]TJ ET -564 678.25 m 564 678.25 l S BT /F5 1 Tf 10 0 0 10 66 682 Tm 0.002 Tw [(Main findings)-15904 (response)]TJ /F9 1 Tf 7 0 0 7 324 684.5 Tm (*)Tj /F5 1 Tf 10 0 0 10 351 682 Tm 0 Tw [(and o)20 (t)-62 (her comments)]TJ /F9 1 Tf -28.5 -1.8 TD [(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 S BT /F9 1 Tf 8 0 0 8 66 151.5 Tm 0.01 Tc (Abbreviations: BMI = Body mass index \(wt [kg] /ht [m])Tj 4.7 0 0 4.7 258 154 Tm (2)Tj 8 0 0 8 260.5 151.5 Tm ( \); CHD = coronary heart disease; CI = confidence interval; ICD = Inter\ national)Tj -24.312 -1.187 TD (Classification of Diseases \(8 and 9 refer to editions\); IMF = ischemic\ myocardial fibrosis; RR = relative risk.)Tj 5.6 0 0 5.6 66 131 Tm (*)Tj 8 0 0 8 68.5 128.5 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)Tj -0.312 -1.187 TD 0 Tw [(2 levels of comparison; \322No\323 means that there were more than 2 le\ vels but no dose-response gradient was found; \322Y)55 (es\323 means)]TJ T* (that there were more than 2 levels and a dose-response gradient was foun\ d.)Tj ET 0 0 0 0 k -66 727.9 132 -58.9 re f -54 211.9 102 -51 re f -64.5 189 128.5 -58 re f PDFVars/TermAll get exec restore gsave showpage grestore %%Page: 22 22 save PDFVars/InitAll get exec %PDF_BeginEncoding: F5 Optima-Bold [ 39/quotesingle 96/grave 127/.notdef/Adieresis/Aring/Ccedilla /Eacute/Ntilde/Odieresis/Udieresis/aacute/agrave /acircumflex/adieresis/atilde/aring/ccedilla/eacute /egrave/ecircumflex/edieresis/iacute/igrave/icircumflex /idieresis/ntilde/oacute/ograve/ocircumflex/odieresis /otilde/uacute/ugrave/ucircumflex/udieresis/dagger /degree/cent/sterling/section/bullet/paragraph /germandbls/registered/copyright/trademark/acute/dieresis /notequal/AE/Oslash/infinity/plusminus/lessequal 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/quotedblbase/perthousand/Acircumflex/Ecircumflex/Aacute/Edieresis /Egrave/Iacute/Icircumflex/Idieresis/Igrave/Oacute /Ocircumflex/apple/Ograve/Uacute/Ucircumflex/Ugrave /dotlessi/circumflex/tilde/macron/breve/dotaccent /ring/cedilla/hungarumlaut/ogonek/caron /F9/Optima -1 TZ %PDF_EndEncoding 0 0 612 792 RC userdict /DefaultRGB /DeviceRGB put BT /F9 1 Tf 11 0 0 11 288.5 41 Tm 0 Tr 0 g 0.006 Tc (102)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 -0.015 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 0 Tc -0.129 Tw (Recently, Armstrong and Simons-Morton \(1994\))Tj -1.636 -1.182 TD 0.003 Tc -0.041 Tw (reviewed the research literature on physical activity)Tj 0 -1.227 TD -0.102 Tw (and blood lipids in children and adolescents, includ-)Tj 0 -1.182 TD -0.098 Tw (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 /F5 1 Tf 12 0 0 12 311.5 432 Tm 0 Tc (Stroke)Tj /F7 1 Tf 11 0 0 11 311.5 417 Tm 0.003 Tc -0.063 Tw (A major cardiovascular problem in developed coun-)Tj 0 -1.227 TD -0.007 Tc -0.129 Tw (tries, stroke \(ischemic stroke and hemorrhagic stroke\))Tj 0 -1.182 TD 0.003 Tc -0.122 Tw (is the third leading cause of death in the United States)Tj T* 0.152 Tw (\(NCHS 1994\). Atherosclerosis of the extracranial)Tj 0 -1.227 TD -0.071 Tw (and intracranial arteries, which triggers thrombosis,)Tj 0 -1.182 TD 0.035 Tw (is thought to be the underlying pathologic basis of)Tj 0 -1.227 TD 0.002 Tw (ischemic stroke. Cigarette smoking and high blood)Tj 0 -1.182 TD 0.023 Tw (pressure are major risk factors for ischemic stroke,)Tj T* 0.045 Tw (whereas high blood pressure is the major determi-)Tj 0 -1.227 TD -0.074 Tw (nant of hemorrhagic stroke. The studies cited in this)Tj 0 -1.182 TD 0.007 Tw (section examined the association between reported)Tj 0 -1.227 TD 0.065 Tw (level of physical activity and stroke. No published)Tj 0 -1.182 TD -0.027 Tw (studies have examined the association between car-)Tj T* 0 Tw (diorespiratory fitness and stroke.)Tj 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 (designs and populations previously cited for CVD)Tj 0 -1.227 TD -0.037 Tw (and CHD \(Table 4-3\). Thirteen of the studies were)Tj 0 -1.182 TD -0.059 Tw (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 -0.078 Tw (earlier studies on CHD, the earlier studies of stroke)Tj 0 -1.182 TD -0.039 Tw (did not permit a dose-response evaluation. Among)Tj 0 -1.227 TD 0.05 Tw (later studies that could do so by virtue of design,)Tj 0 -1.182 TD -0.064 Tw (half did not find a gradient. This outcome, coupled)Tj T* 0.014 Tw (with some suggestion of a \322U-shaped\323 association)Tj ET PDFVars/TermAll get exec restore gsave showpage grestore %%Page: 23 23 save PDFVars/InitAll get exec %PDF_BeginEncoding: F5 Optima-Bold [ 39/quotesingle 96/grave 127/.notdef/Adieresis/Aring/Ccedilla /Eacute/Ntilde/Odieresis/Udieresis/aacute/agrave /acircumflex/adieresis/atilde/aring/ccedilla/eacute /egrave/ecircumflex/edieresis/iacute/igrave/icircumflex /idieresis/ntilde/oacute/ograve/ocircumflex/odieresis /otilde/uacute/ugrave/ucircumflex/udieresis/dagger /degree/cent/sterling/section/bullet/paragraph /germandbls/registered/copyright/trademark/acute/dieresis /notequal/AE/Oslash/infinity/plusminus/lessequal /greaterequal/yen/mu/partialdiff/summation/product /pi/integral/ordfeminine/ordmasculine/Omega/ae /oslash/questiondown/exclamdown/logicalnot/radical/florin /approxequal/Delta/guillemotleft/guillemotright/ellipsis/blank /Agrave/Atilde/Otilde/OE/oe/endash /emdash/quotedblleft/quotedblright/quoteleft/quoteright/divide /lozenge/ydieresis/Ydieresis/fraction/currency/guilsinglleft /guilsinglright/fi/fl/daggerdbl/periodcentered/quotesinglbase /quotedblbase/perthousand/Acircumflex/Ecircumflex/Aacute/Edieresis /Egrave/Iacute/Icircumflex/Idieresis/Igrave/Oacute /Ocircumflex/apple/Ograve/Uacute/Ucircumflex/Ugrave /dotlessi/circumflex/tilde/macron/breve/dotaccent /ring/cedilla/hungarumlaut/ogonek/caron /F5/Optima-Bold -1 TZ %PDF_EndEncoding %PDF_BeginEncoding: F7 Berkeley-Medium [ 39/quotesingle 96/grave 127/.notdef/Adieresis/Aring/Ccedilla /Eacute/Ntilde/Odieresis/Udieresis/aacute/agrave /acircumflex/adieresis/atilde/aring/ccedilla/eacute /egrave/ecircumflex/edieresis/iacute/igrave/icircumflex /idieresis/ntilde/oacute/ograve/ocircumflex/odieresis /otilde/uacute/ugrave/ucircumflex/udieresis/dagger /degree/cent/sterling/section/bullet/paragraph /germandbls/registered/copyright/trademark/acute/dieresis /notequal/AE/Oslash/infinity/plusminus/lessequal /greaterequal/yen/mu/partialdiff/summation/product /pi/integral/ordfeminine/ordmasculine/Omega/ae /oslash/questiondown/exclamdown/logicalnot/radical/florin /approxequal/Delta/guillemotleft/guillemotright/ellipsis/blank /Agrave/Atilde/Otilde/OE/oe/endash /emdash/quotedblleft/quotedblright/quoteleft/quoteright/divide /lozenge/ydieresis/Ydieresis/fraction/currency/guilsinglleft /guilsinglright/fi/fl/daggerdbl/periodcentered/quotesinglbase /quotedblbase/perthousand/Acircumflex/Ecircumflex/Aacute/Edieresis /Egrave/Iacute/Icircumflex/Idieresis/Igrave/Oacute /Ocircumflex/apple/Ograve/Uacute/Ucircumflex/Ugrave /dotlessi/circumflex/tilde/macron/breve/dotaccent /ring/cedilla/hungarumlaut/ogonek/caron /F7/Berkeley-Medium -1 TZ %PDF_EndEncoding %PDF_BeginEncoding: F9 Optima [ 39/quotesingle 96/grave 127/.notdef/Adieresis/Aring/Ccedilla /Eacute/Ntilde/Odieresis/Udieresis/aacute/agrave /acircumflex/adieresis/atilde/aring/ccedilla/eacute /egrave/ecircumflex/edieresis/iacute/igrave/icircumflex /idieresis/ntilde/oacute/ograve/ocircumflex/odieresis /otilde/uacute/ugrave/ucircumflex/udieresis/dagger /degree/cent/sterling/section/bullet/paragraph /germandbls/registered/copyright/trademark/acute/dieresis /notequal/AE/Oslash/infinity/plusminus/lessequal /greaterequal/yen/mu/partialdiff/summation/product /pi/integral/ordfeminine/ordmasculine/Omega/ae /oslash/questiondown/exclamdown/logicalnot/radical/florin /approxequal/Delta/guillemotleft/guillemotright/ellipsis/blank /Agrave/Atilde/Otilde/OE/oe/endash /emdash/quotedblleft/quotedblright/quoteleft/quoteright/divide /lozenge/ydieresis/Ydieresis/fraction/currency/guilsinglleft /guilsinglright/fi/fl/daggerdbl/periodcentered/quotesinglbase /quotedblbase/perthousand/Acircumflex/Ecircumflex/Aacute/Edieresis /Egrave/Iacute/Icircumflex/Idieresis/Igrave/Oacute /Ocircumflex/apple/Ograve/Uacute/Ucircumflex/Ugrave /dotlessi/circumflex/tilde/macron/breve/dotaccent /ring/cedilla/hungarumlaut/ogonek/caron /F9/Optima -1 TZ %PDF_EndEncoding 0 0 612 792 RC userdict /DefaultRGB /DeviceRGB put BT /F9 1 Tf 11 0 0 11 305 41 Tm 0 Tr 0 g 0.006 Tc (103)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 0.015 Tc 0.257 Tw [(in )-10 (two )-10 (stud)-28 (ies \(Menotti and Seccareccia 1985;)]TJ 0 -1.182 TD 0.003 Tc -0.084 Tw (Lindsted, Tonstad, Kuzma 1991\), casts doubt on the)Tj T* 0.057 Tw (nature of the association between physical activity)Tj 0 -1.227 TD 0 Tw (and risk of both types of strokes combined.)Tj 1.636 -1.182 TD 0.006 Tc 0.259 Tw (Because of their different pathophysiologies,)Tj -1.636 -1.227 TD 0.003 Tc -0.094 Tw (physical activity may not affect ischemic and hemor-)Tj 0 -1.182 TD 0.106 Tw (rhagic stroke in the same way; this issue requires)Tj 0 -1.227 TD 0.17 Tw (more research. Only one study distinguished be-)Tj 0 -1.182 TD 0.022 Tw (tween ischemic and hemorrhagic stroke \(Abbott et)Tj T* -0.005 Tc -0.086 Tw (al. 1994\). In this study, inactive men were more likely)Tj 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 (risk of stroke.)Tj /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 (group lost more weight than those in the control)Tj 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 (and each demonstrated a dose-response gradient)Tj T* -0.07 Tw (between amount of activity and degree of protection)Tj 0 -1.227 TD 0.095 Tw (from hypertension. Point estimates for quantifica-)Tj 0 -1.182 TD -0.038 Tw (tion of risk suggest that those least physically active)Tj 0 -1.227 TD 0.007 Tw (have a 30 percent greater risk of developing hyper-)Tj 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 (which high blood pressure is a risk factor with a)Tj 0 -1.182 TD 0.208 Tw (dose-response relationship \(NIH 1992\). Thirteen)Tj ET PDFVars/TermAll get exec restore gsave showpage grestore %%Page: 24 24 save PDFVars/InitAll get exec %PDF_BeginEncoding: F5 Optima-Bold [ 39/quotesingle 96/grave 127/.notdef/Adieresis/Aring/Ccedilla /Eacute/Ntilde/Odieresis/Udieresis/aacute/agrave /acircumflex/adieresis/atilde/aring/ccedilla/eacute /egrave/ecircumflex/edieresis/iacute/igrave/icircumflex /idieresis/ntilde/oacute/ograve/ocircumflex/odieresis /otilde/uacute/ugrave/ucircumflex/udieresis/dagger /degree/cent/sterling/section/bullet/paragraph /germandbls/registered/copyright/trademark/acute/dieresis /notequal/AE/Oslash/infinity/plusminus/lessequal /greaterequal/yen/mu/partialdiff/summation/product /pi/integral/ordfeminine/ordmasculine/Omega/ae /oslash/questiondown/exclamdown/logicalnot/radical/florin /approxequal/Delta/guillemotleft/guillemotright/ellipsis/blank /Agrave/Atilde/Otilde/OE/oe/endash /emdash/quotedblleft/quotedblright/quoteleft/quoteright/divide /lozenge/ydieresis/Ydieresis/fraction/currency/guilsinglleft /guilsinglright/fi/fl/daggerdbl/periodcentered/quotesinglbase /quotedblbase/perthousand/Acircumflex/Ecircumflex/Aacute/Edieresis /Egrave/Iacute/Icircumflex/Idieresis/Igrave/Oacute /Ocircumflex/apple/Ograve/Uacute/Ucircumflex/Ugrave /dotlessi/circumflex/tilde/macron/breve/dotaccent /ring/cedilla/hungarumlaut/ogonek/caron /F5/Optima-Bold -1 TZ %PDF_EndEncoding %PDF_BeginEncoding: F9 Optima [ 39/quotesingle 96/grave 127/.notdef/Adieresis/Aring/Ccedilla /Eacute/Ntilde/Odieresis/Udieresis/aacute/agrave /acircumflex/adieresis/atilde/aring/ccedilla/eacute /egrave/ecircumflex/edieresis/iacute/igrave/icircumflex /idieresis/ntilde/oacute/ograve/ocircumflex/odieresis /otilde/uacute/ugrave/ucircumflex/udieresis/dagger /degree/cent/sterling/section/bullet/paragraph /germandbls/registered/copyright/trademark/acute/dieresis /notequal/AE/Oslash/infinity/plusminus/lessequal /greaterequal/yen/mu/partialdiff/summation/product /pi/integral/ordfeminine/ordmasculine/Omega/ae /oslash/questiondown/exclamdown/logicalnot/radical/florin /approxequal/Delta/guillemotleft/guillemotright/ellipsis/blank /Agrave/Atilde/Otilde/OE/oe/endash /emdash/quotedblleft/quotedblright/quoteleft/quoteright/divide /lozenge/ydieresis/Ydieresis/fraction/currency/guilsinglleft /guilsinglright/fi/fl/daggerdbl/periodcentered/quotesinglbase /quotedblbase/perthousand/Acircumflex/Ecircumflex/Aacute/Edieresis /Egrave/Iacute/Icircumflex/Idieresis/Igrave/Oacute /Ocircumflex/apple/Ograve/Uacute/Ucircumflex/Ugrave /dotlessi/circumflex/tilde/macron/breve/dotaccent /ring/cedilla/hungarumlaut/ogonek/caron /F9/Optima -1 TZ %PDF_EndEncoding 0 0 612 792 RC userdict /DefaultRGB /DeviceRGB put BT /F9 1 Tf 11 0 0 11 288.5 41 Tm 0 Tr 0 g 0.006 Tc (104)Tj /F5 1 Tf -21.864 63.727 TD 0.003 Tc -0.001 Tw (Physical Activity and Health)Tj 10 0 0 10 48 712 Tm 0.005 Tc 0 Tw [(T)60 (able 4-3.)-1321 (Population-based studies of association of physical activity with stroke\ \(CV)76 (A\))]TJ ET 0 G 1 i 0 J 0 j 0.5 w 10 M []0 d 48 707.75 m 1176 707.75 l S BT /F5 1 Tf 10 0 0 10 264 693 Tm [(Definition of)-11158 (Definition of)]TJ ET 48 677.25 m 1176 677.25 l S BT /F5 1 Tf 10 0 0 10 48 681 Tm [(Study)-7130 (Population)-7224 (physical activity)-9658 (stroke)]TJ /F9 1 Tf 0 -1.8 TD [(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 (Countries Study;)Tj ET 48 70.75 m 1176 70.75 l S BT /F9 1 Tf 10 0 0 10 144 74.5 Tm 0.002 Tw (20-year follow-up)Tj ET 0 0 0 0 k 545 720 131 -61 re f 548 87 131 -61 re f PDFVars/TermAll get exec restore gsave showpage grestore %%Page: 25 25 save PDFVars/InitAll get exec %PDF_BeginEncoding: F5 Optima-Bold [ 39/quotesingle 96/grave 127/.notdef/Adieresis/Aring/Ccedilla /Eacute/Ntilde/Odieresis/Udieresis/aacute/agrave /acircumflex/adieresis/atilde/aring/ccedilla/eacute /egrave/ecircumflex/edieresis/iacute/igrave/icircumflex /idieresis/ntilde/oacute/ograve/ocircumflex/odieresis /otilde/uacute/ugrave/ucircumflex/udieresis/dagger /degree/cent/sterling/section/bullet/paragraph /germandbls/registered/copyright/trademark/acute/dieresis /notequal/AE/Oslash/infinity/plusminus/lessequal /greaterequal/yen/mu/partialdiff/summation/product 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Tf 11 0 0 11 305 41 Tm 0 Tr 0 g 0.006 Tc (105)Tj /F5 1 Tf -0.136 63.727 TD 0.003 Tc 0 Tw (The Effects of Physical Activity on Health and Disease)Tj ET 0 G 1 i 0 J 0 j 0.5 w 10 M []0 d -564 707.75 m 564 707.75 l S BT /F5 1 Tf 10 0 0 10 282 693 Tm 0.005 Tc 0.001 Tw [(Dose)-4655 (Adjustment for confounders)]TJ ET -564 677.25 m 564 677.25 l S BT /F5 1 Tf 10 0 0 10 66 681 Tm 0.002 Tw [(Main findings)-15604 (response)]TJ /F9 1 Tf 7 0 0 7 321 684 Tm (*)Tj /F5 1 Tf 10 0 0 10 351 681 Tm 0 Tw (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 (sports than were decedents; hemorrhagic)Tj 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 (heavy occupational activity categories had)Tj 0 -1.25 TD (risks of 0.65 and 1.0, respectively)Tj 0 -1.8 TD [(Inverse association; women with low physical)-1595 (NA)-5445 (Age-adjusted only)]TJ 0 -1.25 TD (activity at work were 7.8 times as likely as)Tj 0 -1.2 TD (others to have stroke \(95% CI, 2.7\32023.0\);)Tj 0 -1.25 TD (womenwith low physical activity leisure were)Tj T* (10.1 times as likely as others to have stroke)Tj 0 -1.2 TD (\(95% CI, 3.8\32027.1\))Tj 0 -1.85 TD [(Null association)-14573 (No)-5555 (No association after statistical adjustment)]TJ 28.5 -1.2 TD (for risk factors)Tj ET -564 70.75 m 564 70.75 l S 0 0 0 0 k -67 720 131 -61 re f -64 87 131 -61 re f PDFVars/TermAll get exec restore gsave showpage grestore %%Page: 26 26 save PDFVars/InitAll get exec %PDF_BeginEncoding: F5 Optima-Bold [ 39/quotesingle 96/grave 127/.notdef/Adieresis/Aring/Ccedilla /Eacute/Ntilde/Odieresis/Udieresis/aacute/agrave /acircumflex/adieresis/atilde/aring/ccedilla/eacute /egrave/ecircumflex/edieresis/iacute/igrave/icircumflex /idieresis/ntilde/oacute/ograve/ocircumflex/odieresis /otilde/uacute/ugrave/ucircumflex/udieresis/dagger /degree/cent/sterling/section/bullet/paragraph /germandbls/registered/copyright/trademark/acute/dieresis /notequal/AE/Oslash/infinity/plusminus/lessequal /greaterequal/yen/mu/partialdiff/summation/product /pi/integral/ordfeminine/ordmasculine/Omega/ae 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/DeviceRGB put BT /F9 1 Tf 11 0 0 11 288.5 41 Tm 0 Tr 0 g 0.006 Tc (106)Tj /F5 1 Tf -21.864 63.727 TD 0.003 Tc -0.001 Tw (Physical Activity and Health)Tj 10 0 0 10 48 712 Tm 0.005 Tc 0.027 Tw [(T)60 (able 4-3.)]TJ /F9 1 Tf 8.5 0 1.652 8.5 102 712 Tm 0.006 Tc (Continued)Tj ET 0 G 1 i 0 J 0 j 0.5 w 10 M []0 d 48 707.75 m 1176 707.75 l S BT /F5 1 Tf 10 0 0 10 264 693 Tm 0.005 Tc 0 Tw [(Definition of)-11158 (Definition of)]TJ ET 48 677.25 m 1176 677.25 l S BT /F5 1 Tf 10 0 0 10 48 681 Tm [(Study)-7130 (Population)-7224 (physical activity)-9658 (stroke)]TJ /F9 1 Tf 0 -1.8 TD [(Harmsen et al.)-3253 (7,495 Swedish men)-3413 (Physical activity at work and)-4317 (Fatal stroke)]TJ 0 -1.25 TD [(\(1990\))-6789 (aged 47\32055 years at)-3289 (leisure hours \(low)58 (, high\))-6342 (\(all and subtypes\))]TJ 9.6 -1.2 TD [(baseline examination;)-19248 (\(n = 230\))]TJ 0 -1.25 TD 0.002 Tw [(1)60 (1.8-year average)]TJ T* (follow-up)Tj -9.6 -1.8 TD 0 Tw [(Lindsted,)-5664 (9,484 male Seventh-)-3013 (Self-report of physical activity)-3857 (Fatal stroke \(n = 410\))]TJ 0 -1.25 TD [(T)110 (onstad,)-6004 (Day )25 (Adventists aged)-3151 (level in 1960 \(highly active,)]TJ 0 -1.2 TD (Kuzma,)Tj /F10 1 Tf 9.6 0 TD (\263)Tj /F9 1 Tf 0.55 0 TD [( 30 years; 26-year)-3637 (moderately active, low activity\))]TJ -10.15 -1.25 TD [(\(1991\))-6789 (follow-up)]TJ 0 -1.8 TD [(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 (of activity)Tj -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 0 -1.25 TD -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 0 -1.2 TD 0.001 Tw [(follow-up)-24584 (occurrence and remaining)]TJ 28.8 -1.25 TD 0 Tw (present for at least 2 weeks)Tj 0 -1.2 TD (or until death \(subtypes\))Tj 0 -1.25 TD (\(n = 537\))Tj -38.4 -1.8 TD [(Kiely et al.)-4984 (Four cohorts of)-5423 (Self-report of daily activity level;)-2671 (Fatal and nonfatal)]TJ 0 -1.25 TD [(\(1994\))-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 0 -1.2 TD 0.001 Tw [(1,897 men aged 35\32069)-1893 (medium, and low physical activity)-1796 (infar)19 (ction, cerebral)]TJ 0 -1.25 TD 0 Tw [(years; cohort II\3212,299)-18798 (embolism, or other stroke)]TJ 0 -1.2 TD [(women aged 35\32068)-20159 (\(cohort I, n = 195;)]TJ 0 -1.25 TD [(years; cohort III\321men)-19138 (cohort II, n = 232;)]TJ T* [(aged 49\32083 years;)-20879 (cohort III, n = 1)56 (13;)]TJ 0 -1.2 TD 0.001 Tw [(cohort IV\321women)-20498 (cohort IV)96 (,)]TJ 10 0 1.944 10 474 295 Tm ( )Tj 10 0 0 10 477 295 Tm 0 Tw (n = 140\))Tj -33.3 -1.25 TD (aged 49\32083 years;)Tj 0 -1.2 TD 0.001 Tw (follow-up for cohorts I)Tj 0 -1.25 TD 0 Tw (and II up to 32 years,)Tj T* (for cohorts III and IV)Tj ET 48 229.25 m 1176 229.25 l S BT /F9 1 Tf 10 0 0 10 144 233.5 Tm 0.001 Tw (up to 18 years)Tj ET 0 0 0 0 k 548 720 130 -67 re f 548 261.65 127 -66.65 re f PDFVars/TermAll get exec restore gsave showpage grestore %%Page: 27 27 save PDFVars/InitAll get exec %PDF_BeginEncoding: F5 Optima-Bold [ 39/quotesingle 96/grave 127/.notdef/Adieresis/Aring/Ccedilla /Eacute/Ntilde/Odieresis/Udieresis/aacute/agrave /acircumflex/adieresis/atilde/aring/ccedilla/eacute /egrave/ecircumflex/edieresis/iacute/igrave/icircumflex /idieresis/ntilde/oacute/ograve/ocircumflex/odieresis /otilde/uacute/ugrave/ucircumflex/udieresis/dagger 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/Ocircumflex/apple/Ograve/Uacute/Ucircumflex/Ugrave /dotlessi/circumflex/tilde/macron/breve/dotaccent /ring/cedilla/hungarumlaut/ogonek/caron /F9/Optima -1 TZ %PDF_EndEncoding 0 0 612 792 RC userdict /DefaultRGB /DeviceRGB put BT /F9 1 Tf 11 0 0 11 305 41 Tm 0 Tr 0 g 0.006 Tc (107)Tj /F5 1 Tf -0.136 63.727 TD 0.003 Tc 0 Tw (The Effects of Physical Activity on Health and Disease)Tj ET 0 G 1 i 0 J 0 j 0.5 w 10 M []0 d -564 707.75 m 564 707.75 l S BT /F5 1 Tf 10 0 0 10 291 693 Tm 0.005 Tc 0.001 Tw [(Dose)-4355 (Adjustment for confounders)]TJ ET -564 677.25 m 564 677.25 l S BT /F5 1 Tf 10 0 0 10 66 681 Tm 0.002 Tw [(Main findings)-16504 (response)]TJ /F9 1 Tf 7 0 0 7 330 684 Tm (*)Tj /F5 1 Tf 10 0 0 10 357 681 Tm 0 Tw (and other comments)Tj /F9 1 Tf -29.1 -1.8 TD [(Null association; relative to low physical)-4780 (No)-5255 (No association after statistical adjustment)]TJ 0 -1.25 TD [(activity category)91 (, slightly elevated estimates)-10179 (for risk factors)]TJ 0 -1.2 TD (were observed for all strokes and subtypes)Tj 0 -1.25 TD -0.001 Tw (for high activity group)Tj 0 -3.05 TD 0 Tw [(Nonlinear \322U\323 shape association; relative to)-3330 (No)-5255 (Adjusted for sociodemographic factors, BMI,)]TJ 0 -1.25 TD [(low activity level, risk estimates were 0.78)-10650 (and dietary pattern)]TJ 0 -1.2 TD -0.001 Tw (\(95% CI, 0.61\3201.00\) for moderate activity)Tj 0 -1.25 TD 0 Tw (and 1.08 \(95% CI, 0.58\3202.01\) for high activity)Tj 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 (physical activity scale)Tj 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 T* [(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 [(and for high group = 0.84 \(0.59\3201.18\);)-5696 (Y)65 (es, C I)]TJ 0 -1.2 TD -0.003 Tc (cohort II\321nonsignificant nonlinear association)Tj 0 -1.25 TD 0.005 Tc [(for medium group = 1.21 \(0.89\3201.63\))-6211 (No, C II)]TJ T* [(and for high group = 0.89 \(0.60\3201.31\);)-5696 (No, C II)]TJ 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 (and for high group = 0.53 \(0.34\3200.84\);)Tj 0 -1.25 TD -0.002 Tc -0.001 Tw [(cohort IV\321nonsignificant nonlinear association)-2217 (No, )-8 (C )-8 (IV)]TJ T* 0.005 Tc 0 Tw (for medium group = 0.97 \(0.64\3201.47\))Tj ET -564 229.25 m 564 229.25 l S BT /F9 1 Tf 10 0 0 10 66 233.5 Tm (and for high group = 1.21)Tj 8 0 0 8 66 217 Tm 0.01 Tc (Abbreviations: BMI = body mass index \(wt [kg] /ht [m])Tj 4.7 0 0 4.7 257.5 219.5 Tm (2)Tj 8 0 0 8 260 217 Tm [( \); CV)68 (A)51 ( = cerebrovascular accident; CI = confidence interval; ICD = Internation\ al)]TJ -24.25 -1.187 TD (Classification of Diseases \(8 and 9 refer to editions\); RR = relative \ risk.)Tj 5.6 0 0 5.6 66 196 Tm (*)Tj 8 0 0 8 68.5 194 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 -0.312 -1.187 TD 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 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-0.001 Tw (Physical Activity and Health)Tj 10 0 0 10 48 712 Tm 0.005 Tc 0 Tw [(T)60 (able 4-4.)-1321 (Population-based cohort studies of association of physical activity with\ hypertension)]TJ ET 0 G 1 i 0 J 0 j 0.5 w 10 M []0 d 48 707.75 m 1176 707.75 l S BT /F5 1 Tf 10 0 0 10 264 693 Tm [(Definition of)-11158 (Definition of)]TJ ET 48 677.25 m 1176 677.25 l S BT /F5 1 Tf 10 0 0 10 48 681 Tm [(Study)-7130 (Population)-7224 (physical activity)-9658 (hypertension)]TJ /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 (\()]TJ /F10 1 Tf 12.3 0 TD (\263)Tj /F9 1 Tf 0.55 0 TD 0.001 Tw [( 85th per)36 (centile\) and \322low\323)]TJ -12.85 -1.25 TD [(20\32065 years at baseline)-1768 (fitness)]TJ -9.6 -1.8 TD 0 Tw [(Stamler et al.)-3918 (201 US men and women)-1118 (Self-report of moderate physical)-2916 (Initiation of hypertensive)]TJ 0 -1.25 TD 0.001 Tw [(\(1989\))-6789 (with diastolic blood)-3338 (activity)-13649 (therapy or sustained)]TJ 9.6 -1.2 TD 0 Tw [(pressure 85\32089 mm Hg)-18643 (elevation of diastolic)]TJ 0 -1.25 TD [(or 80\32084 mm Hg \(if)-20207 (blood pressure)]TJ T* 0.001 Tw (overweight\) were)Tj /F10 1 Tf 28.8 0 TD (\263)Tj /F9 1 Tf 0.55 0 TD -0.001 Tw ( 90 mm Hg)Tj -29.35 -1.2 TD 0.001 Tw (randomly assigned to)Tj 0 -1.25 TD (control or nutritional/)Tj 0 -1.2 TD 0.002 Tw (hygienic intervention)Tj 0 -1.25 TD -0.002 Tw [(\(including exer)19 (cise\))]TJ -9.6 -1.8 TD -0.001 Tw [(Folsom et al.)-4033 (41,837 Iowa women)-2968 (Self-reported frequency of)-5502 (Self-reported incidence of)]TJ 0 -1.25 TD 0 Tw [(\(1990\))-6789 (aged 55\32069 years;)-4079 (leisure-time physical activity from)-2066 (physician-diagnosed)]TJ 9.6 -1.25 TD -0.002 Tw [(2-year follow-up)-4753 (mail-back survey)-9389 (hypertension)]TJ -9.6 -6.7 TD 0 Tw [(Paffenbarger et al.)-1727 (5,463 male college)-3628 (Self-report of physical activity from)-1556 (Self-reported incidence of)]TJ 0 -1.25 TD 0.001 Tw [(\(1991\))-6789 (alumni from the)-5033 (mail-back questionnaire in 1962)-2637 (physician-diagnosed)]TJ 9.6 -1.25 TD 0 Tw [(University of)-23233 (hypertension from mail-)]TJ 0 -1.2 TD 0.001 Tw [(Pennsylvania)-23069 (back questionnaire)]TJ ET 48 155.75 m 1176 155.75 l S BT /F9 1 Tf 10 0 0 10 432 159.5 Tm 0 Tw (in 1976 \(n = 739\))Tj ET 0 0 0 0 k 548 738 130 -82 re f 545 177 132 -86 re f PDFVars/TermAll get exec restore gsave showpage grestore %%Page: 29 29 save 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66 681 Tm 0.002 Tw [(Main findings)-15304 (response)]TJ /F9 1 Tf 7 0 0 7 318 684 Tm (*)Tj /F5 1 Tf 10 0 0 10 351 681 Tm 0 Tw (and other comments)Tj /F9 1 Tf -28.5 -1.8 TD [(Inverse association; respondents who)-5111 (NA)-5745 (Adjustments for age and follow-up)]TJ 0 -1.25 TD [(reported participation in sports or exercise)-10113 (had little effect)]TJ 0 -1.2 TD (fewer than 5 hours per week had a)Tj 0 -1.25 TD (significantly increased age- and interval-)Tj T* (adjusted risk of physician-diagnosed)Tj 0 -1.2 TD (hypertension \(RR = 1.30, p < 0.01\))Tj 0 -3.05 TD [(Inverse association; alumni with)-7301 (Y)65 (es,)-5467 (Increased risk observed for less active alumni)]TJ 0 -1.25 TD [(< 2,000 kcal/week of energy expenditure)-3439 (especially)-2869 (with stratification of student blood pressure,)]TJ 0 -1.2 TD [(had RR of 1.30 \(95% CI, 1.09\3201.55\))-5676 (in)-6355 (alumnus BMI, increase in BMI since college,)]TJ 0 -1.25 TD [(of developing hypertension relative)-5952 (heavier)-4000 (and family history of hypertension)]TJ T* 0.002 Tw [(to others)-17529 (men)]TJ 0 -3.65 TD 0 Tw [(Patients in low fitness category were 1.52)-3250 (NA)-5745 (Extensive control for confounding variables;)]TJ 0 -1.25 TD [(times as likely \(95% CI, 1.08\3202.15\) to)-12136 (no sex-specific analyses)]TJ T* -0.001 Tw (develop hypertension as those in high)Tj 0 -1.2 TD -0.002 Tw (fitness category)Tj 0 -3.05 TD 0 Tw [(Control group RR = 2.4 \(90% CI, 1.2\3204.8\))-3150 (NA)-5745 (Intervention was combined nutritional,)]TJ 0 -1.25 TD [(of developing hypertension when compared)-9291 (weight loss, and physical activity)]TJ 0 -1.2 TD (with the intervention group)Tj 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 [(at low levels of physical activity)98 (, women)-10886 (cigarette smoking, and age eliminated)]TJ T* [(at high and moderate levels had 30% and)-10351 (the association with physical activity)]TJ 0 -1.2 TD (10% lower age-adjusted risks of developing)Tj 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 [(with a 30% reduced risk of developing)-11641 (since college, and parental history of)]TJ T* [(hypertension)-22884 (hypertension)]TJ ET -564 155.75 m 564 155.75 l S BT /F9 1 Tf 8 0 0 8 66 143 Tm 0.01 Tc (Abbreviations: BMI = body mass index \(wt [kg] /ht [m])Tj 4.7 0 0 4.7 257.5 146 Tm (2)Tj 8 0 0 8 260 143 Tm ( \); CI = confidence interval; RR = relative risk.)Tj 5.6 0 0 5.6 66 132 Tm (*)Tj 8 0 0 8 68.5 129.5 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)Tj -0.312 -1.187 TD 0 Tw [(2 levels of comparison; \322No\323 means that there were more than 2 lev\ els but no dose-response gradient was found; \322Y)80 (es\323 means)]TJ T* (that there were more than 2 levels and a dose-response gradient was foun\ d.)Tj ET 0 0 0 0 k -64 738 130 -82 re f -67 177 132 -86 re f PDFVars/TermAll get exec restore gsave showpage grestore %%Page: 30 30 save PDFVars/InitAll get exec %PDF_BeginEncoding: F5 Optima-Bold [ 39/quotesingle 96/grave 127/.notdef/Adieresis/Aring/Ccedilla /Eacute/Ntilde/Odieresis/Udieresis/aacute/agrave /acircumflex/adieresis/atilde/aring/ccedilla/eacute /egrave/ecircumflex/edieresis/iacute/igrave/icircumflex /idieresis/ntilde/oacute/ograve/ocircumflex/odieresis /otilde/uacute/ugrave/ucircumflex/udieresis/dagger /degree/cent/sterling/section/bullet/paragraph /germandbls/registered/copyright/trademark/acute/dieresis /notequal/AE/Oslash/infinity/plusminus/lessequal /greaterequal/yen/mu/partialdiff/summation/product /pi/integral/ordfeminine/ordmasculine/Omega/ae /oslash/questiondown/exclamdown/logicalnot/radical/florin 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/lozenge/ydieresis/Ydieresis/fraction/currency/guilsinglleft /guilsinglright/fi/fl/daggerdbl/periodcentered/quotesinglbase /quotedblbase/perthousand/Acircumflex/Ecircumflex/Aacute/Edieresis /Egrave/Iacute/Icircumflex/Idieresis/Igrave/Oacute /Ocircumflex/apple/Ograve/Uacute/Ucircumflex/Ugrave /dotlessi/circumflex/tilde/macron/breve/dotaccent /ring/cedilla/hungarumlaut/ogonek/caron /F12/INHJAA+Berkeley-Bold -1 TZ %PDF_EndEncoding 0 0 612 792 RC userdict /DefaultRGB /DeviceRGB put BT /F9 1 Tf 11 0 0 11 288.5 41 Tm 0 Tr 0 g 0.006 Tc (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 (controlled trials of habitual activity and blood pres-)Tj 0 -1.182 TD -0.017 Tw (sure were analyzed in a meta-analysis by Arroll and)Tj 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 (dently concluded that aerobic exercise decreases)Tj 0 -1.227 TD 0.166 Tw (both systolic and diastolic blood pressure by ap-)Tj 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 (of different intensities of exercise on blood pressure.)Tj 0 -1.182 TD 0.005 Tw (Hagberg et al. \(1989\) randomly assigned 33 hyper-)Tj T* -0.127 Tw (tensive participants to a nonexercising control group)Tj 0 -1.227 TD -0.029 Tw (and to two groups participating in different intensi-)Tj 0 -1.182 TD 0.054 Tw (ties of exercise \(53 percent and 73 percent of)Tj /F12 1 Tf 19.5 0.182 TD 0.05 Tc 0 Tw ( \372)Tj /F7 1 Tf 0.136 -0.182 TD 0.003 Tc (VO)Tj 6.4 0 0 6.4 279 430.5 Tm (2)Tj 11 0 0 11 48 420.5 Tm -0.11 Tw [(m)9 (a)9 (x)-6 (\) 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 (pressure in the higher-intensity group. Matsusaki)Tj 0 -1.182 TD -0.042 Tw (and colleagues \(1992\) randomly assigned 26 mildly)Tj 0 -1.227 TD -0.056 Tw (hypertensive participants to two exercise intensities)Tj 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 -0.001 Tw (and diastolic blood pressure in the lower-workload)Tj 0 -1.182 TD 0.119 Tw (group were significant \(9 mm Hg/6 mm Hg\), but)Tj 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 (a randomized crossover design to compare intensi-)Tj 0 -1.227 TD -0.126 Tw (ties of 50 percent and 70 percent)Tj /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 ET PDFVars/TermAll get exec restore gsave showpage grestore %%Page: 31 31 save PDFVars/InitAll get exec %PDF_BeginEncoding: F5 Optima-Bold [ 39/quotesingle 96/grave 127/.notdef/Adieresis/Aring/Ccedilla /Eacute/Ntilde/Odieresis/Udieresis/aacute/agrave /acircumflex/adieresis/atilde/aring/ccedilla/eacute /egrave/ecircumflex/edieresis/iacute/igrave/icircumflex /idieresis/ntilde/oacute/ograve/ocircumflex/odieresis /otilde/uacute/ugrave/ucircumflex/udieresis/dagger /degree/cent/sterling/section/bullet/paragraph /germandbls/registered/copyright/trademark/acute/dieresis /notequal/AE/Oslash/infinity/plusminus/lessequal /greaterequal/yen/mu/partialdiff/summation/product /pi/integral/ordfeminine/ordmasculine/Omega/ae /oslash/questiondown/exclamdown/logicalnot/radical/florin /approxequal/Delta/guillemotleft/guillemotright/ellipsis/blank /Agrave/Atilde/Otilde/OE/oe/endash /emdash/quotedblleft/quotedblright/quoteleft/quoteright/divide /lozenge/ydieresis/Ydieresis/fraction/currency/guilsinglleft /guilsinglright/fi/fl/daggerdbl/periodcentered/quotesinglbase /quotedblbase/perthousand/Acircumflex/Ecircumflex/Aacute/Edieresis /Egrave/Iacute/Icircumflex/Idieresis/Igrave/Oacute /Ocircumflex/apple/Ograve/Uacute/Ucircumflex/Ugrave /dotlessi/circumflex/tilde/macron/breve/dotaccent /ring/cedilla/hungarumlaut/ogonek/caron /F5/Optima-Bold -1 TZ %PDF_EndEncoding %PDF_BeginEncoding: F7 Berkeley-Medium [ 39/quotesingle 96/grave 127/.notdef/Adieresis/Aring/Ccedilla /Eacute/Ntilde/Odieresis/Udieresis/aacute/agrave /acircumflex/adieresis/atilde/aring/ccedilla/eacute /egrave/ecircumflex/edieresis/iacute/igrave/icircumflex /idieresis/ntilde/oacute/ograve/ocircumflex/odieresis /otilde/uacute/ugrave/ucircumflex/udieresis/dagger /degree/cent/sterling/section/bullet/paragraph /germandbls/registered/copyright/trademark/acute/dieresis /notequal/AE/Oslash/infinity/plusminus/lessequal /greaterequal/yen/mu/partialdiff/summation/product /pi/integral/ordfeminine/ordmasculine/Omega/ae /oslash/questiondown/exclamdown/logicalnot/radical/florin /approxequal/Delta/guillemotleft/guillemotright/ellipsis/blank /Agrave/Atilde/Otilde/OE/oe/endash /emdash/quotedblleft/quotedblright/quoteleft/quoteright/divide /lozenge/ydieresis/Ydieresis/fraction/currency/guilsinglleft /guilsinglright/fi/fl/daggerdbl/periodcentered/quotesinglbase /quotedblbase/perthousand/Acircumflex/Ecircumflex/Aacute/Edieresis /Egrave/Iacute/Icircumflex/Idieresis/Igrave/Oacute /Ocircumflex/apple/Ograve/Uacute/Ucircumflex/Ugrave /dotlessi/circumflex/tilde/macron/breve/dotaccent /ring/cedilla/hungarumlaut/ogonek/caron /F7/Berkeley-Medium -1 TZ %PDF_EndEncoding %PDF_BeginEncoding: F9 Optima [ 39/quotesingle 96/grave 127/.notdef/Adieresis/Aring/Ccedilla /Eacute/Ntilde/Odieresis/Udieresis/aacute/agrave /acircumflex/adieresis/atilde/aring/ccedilla/eacute /egrave/ecircumflex/edieresis/iacute/igrave/icircumflex /idieresis/ntilde/oacute/ograve/ocircumflex/odieresis /otilde/uacute/ugrave/ucircumflex/udieresis/dagger /degree/cent/sterling/section/bullet/paragraph /germandbls/registered/copyright/trademark/acute/dieresis /notequal/AE/Oslash/infinity/plusminus/lessequal /greaterequal/yen/mu/partialdiff/summation/product /pi/integral/ordfeminine/ordmasculine/Omega/ae /oslash/questiondown/exclamdown/logicalnot/radical/florin /approxequal/Delta/guillemotleft/guillemotright/ellipsis/blank /Agrave/Atilde/Otilde/OE/oe/endash /emdash/quotedblleft/quotedblright/quoteleft/quoteright/divide /lozenge/ydieresis/Ydieresis/fraction/currency/guilsinglleft /guilsinglright/fi/fl/daggerdbl/periodcentered/quotesinglbase /quotedblbase/perthousand/Acircumflex/Ecircumflex/Aacute/Edieresis /Egrave/Iacute/Icircumflex/Idieresis/Igrave/Oacute /Ocircumflex/apple/Ograve/Uacute/Ucircumflex/Ugrave /dotlessi/circumflex/tilde/macron/breve/dotaccent /ring/cedilla/hungarumlaut/ogonek/caron /F9/Optima -1 TZ %PDF_EndEncoding 0 0 612 792 RC userdict /DefaultRGB /DeviceRGB put BT /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 0 -1.182 TD 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 ET PDFVars/TermAll get exec restore gsave showpage grestore %%Page: 32 32 save PDFVars/InitAll get exec %PDF_BeginEncoding: F5 Optima-Bold [ 39/quotesingle 96/grave 127/.notdef/Adieresis/Aring/Ccedilla /Eacute/Ntilde/Odieresis/Udieresis/aacute/agrave /acircumflex/adieresis/atilde/aring/ccedilla/eacute /egrave/ecircumflex/edieresis/iacute/igrave/icircumflex /idieresis/ntilde/oacute/ograve/ocircumflex/odieresis /otilde/uacute/ugrave/ucircumflex/udieresis/dagger /degree/cent/sterling/section/bullet/paragraph /germandbls/registered/copyright/trademark/acute/dieresis /notequal/AE/Oslash/infinity/plusminus/lessequal /greaterequal/yen/mu/partialdiff/summation/product /pi/integral/ordfeminine/ordmasculine/Omega/ae /oslash/questiondown/exclamdown/logicalnot/radical/florin /approxequal/Delta/guillemotleft/guillemotright/ellipsis/blank /Agrave/Atilde/Otilde/OE/oe/endash 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/guilsinglright/fi/fl/daggerdbl/periodcentered/quotesinglbase /quotedblbase/perthousand/Acircumflex/Ecircumflex/Aacute/Edieresis /Egrave/Iacute/Icircumflex/Idieresis/Igrave/Oacute /Ocircumflex/apple/Ograve/Uacute/Ucircumflex/Ugrave /dotlessi/circumflex/tilde/macron/breve/dotaccent /ring/cedilla/hungarumlaut/ogonek/caron /F12/INHJAA+Berkeley-Bold -1 TZ %PDF_EndEncoding %PDF_BeginEncoding: F14 INIJFA+Berkeley-BoldItalic [ 39/quotesingle 96/grave 127/.notdef/Adieresis/Aring/Ccedilla /Eacute/Ntilde/Odieresis/Udieresis/aacute/agrave /acircumflex/adieresis/atilde/aring/ccedilla/eacute /egrave/ecircumflex/edieresis/iacute/igrave/icircumflex /idieresis/ntilde/oacute/ograve/ocircumflex/odieresis /otilde/uacute/ugrave/ucircumflex/udieresis/dagger /degree/cent/sterling/section/bullet/paragraph /germandbls/registered/copyright/trademark/acute/dieresis /notequal/AE/Oslash/infinity/plusminus/lessequal /greaterequal/yen/mu/partialdiff/summation/product /pi/integral/ordfeminine/ordmasculine/Omega/ae /oslash/questiondown/exclamdown/logicalnot/radical/florin /approxequal/Delta/guillemotleft/guillemotright/ellipsis/blank /Agrave/Atilde/Otilde/OE/oe/endash /emdash/quotedblleft/quotedblright/quoteleft/quoteright/divide /lozenge/ydieresis/Ydieresis/fraction/currency/guilsinglleft /guilsinglright/fi/fl/daggerdbl/periodcentered/quotesinglbase /quotedblbase/perthousand/Acircumflex/Ecircumflex/Aacute/Edieresis /Egrave/Iacute/Icircumflex/Idieresis/Igrave/Oacute /Ocircumflex/apple/Ograve/Uacute/Ucircumflex/Ugrave /dotlessi/circumflex/tilde/macron/breve/dotaccent /ring/cedilla/hungarumlaut/ogonek/caron /F14/INIJFA+Berkeley-BoldItalic -1 TZ %PDF_EndEncoding 0 0 612 792 RC userdict /DefaultRGB /DeviceRGB put BT /F9 1 Tf 11 0 0 11 288.5 41 Tm 0 Tr 0 g 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 (clot formation \(thrombosis\), which further reduces)Tj 0 -1.182 TD 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 0 -1.227 TD -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 0 Tc (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 14 0 0 14 311.5 150.5 Tm -0.002 Tc (Cancer)Tj /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 ET PDFVars/TermAll get exec restore gsave showpage grestore %%Page: 33 33 save PDFVars/InitAll get exec %PDF_BeginEncoding: F5 Optima-Bold [ 39/quotesingle 96/grave 127/.notdef/Adieresis/Aring/Ccedilla /Eacute/Ntilde/Odieresis/Udieresis/aacute/agrave /acircumflex/adieresis/atilde/aring/ccedilla/eacute /egrave/ecircumflex/edieresis/iacute/igrave/icircumflex /idieresis/ntilde/oacute/ograve/ocircumflex/odieresis /otilde/uacute/ugrave/ucircumflex/udieresis/dagger /degree/cent/sterling/section/bullet/paragraph /germandbls/registered/copyright/trademark/acute/dieresis /notequal/AE/Oslash/infinity/plusminus/lessequal /greaterequal/yen/mu/partialdiff/summation/product /pi/integral/ordfeminine/ordmasculine/Omega/ae /oslash/questiondown/exclamdown/logicalnot/radical/florin /approxequal/Delta/guillemotleft/guillemotright/ellipsis/blank /Agrave/Atilde/Otilde/OE/oe/endash /emdash/quotedblleft/quotedblright/quoteleft/quoteright/divide /lozenge/ydieresis/Ydieresis/fraction/currency/guilsinglleft /guilsinglright/fi/fl/daggerdbl/periodcentered/quotesinglbase /quotedblbase/perthousand/Acircumflex/Ecircumflex/Aacute/Edieresis /Egrave/Iacute/Icircumflex/Idieresis/Igrave/Oacute /Ocircumflex/apple/Ograve/Uacute/Ucircumflex/Ugrave /dotlessi/circumflex/tilde/macron/breve/dotaccent /ring/cedilla/hungarumlaut/ogonek/caron /F5/Optima-Bold -1 TZ %PDF_EndEncoding %PDF_BeginEncoding: F7 Berkeley-Medium [ 39/quotesingle 96/grave 127/.notdef/Adieresis/Aring/Ccedilla /Eacute/Ntilde/Odieresis/Udieresis/aacute/agrave /acircumflex/adieresis/atilde/aring/ccedilla/eacute /egrave/ecircumflex/edieresis/iacute/igrave/icircumflex /idieresis/ntilde/oacute/ograve/ocircumflex/odieresis /otilde/uacute/ugrave/ucircumflex/udieresis/dagger /degree/cent/sterling/section/bullet/paragraph /germandbls/registered/copyright/trademark/acute/dieresis /notequal/AE/Oslash/infinity/plusminus/lessequal /greaterequal/yen/mu/partialdiff/summation/product /pi/integral/ordfeminine/ordmasculine/Omega/ae /oslash/questiondown/exclamdown/logicalnot/radical/florin /approxequal/Delta/guillemotleft/guillemotright/ellipsis/blank /Agrave/Atilde/Otilde/OE/oe/endash /emdash/quotedblleft/quotedblright/quoteleft/quoteright/divide /lozenge/ydieresis/Ydieresis/fraction/currency/guilsinglleft /guilsinglright/fi/fl/daggerdbl/periodcentered/quotesinglbase /quotedblbase/perthousand/Acircumflex/Ecircumflex/Aacute/Edieresis /Egrave/Iacute/Icircumflex/Idieresis/Igrave/Oacute /Ocircumflex/apple/Ograve/Uacute/Ucircumflex/Ugrave /dotlessi/circumflex/tilde/macron/breve/dotaccent /ring/cedilla/hungarumlaut/ogonek/caron /F7/Berkeley-Medium -1 TZ %PDF_EndEncoding %PDF_BeginEncoding: F9 Optima [ 39/quotesingle 96/grave 127/.notdef/Adieresis/Aring/Ccedilla /Eacute/Ntilde/Odieresis/Udieresis/aacute/agrave /acircumflex/adieresis/atilde/aring/ccedilla/eacute /egrave/ecircumflex/edieresis/iacute/igrave/icircumflex /idieresis/ntilde/oacute/ograve/ocircumflex/odieresis /otilde/uacute/ugrave/ucircumflex/udieresis/dagger /degree/cent/sterling/section/bullet/paragraph /germandbls/registered/copyright/trademark/acute/dieresis /notequal/AE/Oslash/infinity/plusminus/lessequal /greaterequal/yen/mu/partialdiff/summation/product /pi/integral/ordfeminine/ordmasculine/Omega/ae /oslash/questiondown/exclamdown/logicalnot/radical/florin /approxequal/Delta/guillemotleft/guillemotright/ellipsis/blank /Agrave/Atilde/Otilde/OE/oe/endash /emdash/quotedblleft/quotedblright/quoteleft/quoteright/divide /lozenge/ydieresis/Ydieresis/fraction/currency/guilsinglleft /guilsinglright/fi/fl/daggerdbl/periodcentered/quotesinglbase /quotedblbase/perthousand/Acircumflex/Ecircumflex/Aacute/Edieresis /Egrave/Iacute/Icircumflex/Idieresis/Igrave/Oacute /Ocircumflex/apple/Ograve/Uacute/Ucircumflex/Ugrave /dotlessi/circumflex/tilde/macron/breve/dotaccent /ring/cedilla/hungarumlaut/ogonek/caron /F9/Optima -1 TZ %PDF_EndEncoding 0 0 612 792 RC userdict /DefaultRGB /DeviceRGB put BT /F9 1 Tf 11 0 0 11 305 41 Tm 0 Tr 0 g 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 PDFVars/TermAll get exec restore gsave showpage grestore %%Page: 34 34 save PDFVars/InitAll get exec %PDF_BeginEncoding: F5 Optima-Bold [ 39/quotesingle 96/grave 127/.notdef/Adieresis/Aring/Ccedilla /Eacute/Ntilde/Odieresis/Udieresis/aacute/agrave 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10 0 0 10 264 681 Tm 0 Tw [(Definition of)-11158 (Definition of)]TJ ET 48 665.25 m 1176 665.25 l S BT /F5 1 Tf 10 0 0 10 48 669 Tm [(Study)-7130 (Population)-7224 (physical activity)-9658 (cancer)]TJ /F9 1 Tf 0 -1.8 TD [(Polednak)-5559 (Cohort of 8,393 former)-1942 (College athletic status; major)98 (,)-4017 (Colon cancer mortality)]TJ 0 -1.25 TD 0.001 Tw [(\(1976\))-6789 (US college men)-5094 (minor)80 (, and nonathlete)-7215 (\(n = 107\))]TJ 0 -1.8 TD 0 Tw [(Paffenbarger)97 (,)-3967 (Cohort of 51,977 male,)-1827 (Sports play in college)-7463 (Colon cancer incidence)]TJ 0 -1.25 TD [(Hyde, W)23 (ing)-4351 (4,706 female former US)-18352 (\(n = 201\))]TJ 0 -1.2 TD -0.001 Tw [(\(1987\))-6789 (college students)]TJ 9.6 -1.85 TD 0 Tw [(Cohort of 16,936 male)-2113 (Physical activity index \(kcal/week\))-1842 (Colon cancer mortality)]TJ 0 -1.2 TD [(US college alumni)-20768 (\(n = 44\))]TJ 0 -1.25 TD -0.001 Tw (aged 35\32074 years)Tj -9.6 -1.8 TD [(Gerhardsson,)-3814 (Cohort of 16,477)-4528 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or)]TJ T* [(controls\) and women)-2788 (moderate activity)80 (, and in)]TJ 0 -1.2 TD [(\(78 cases and 618)-4134 (vigorous activity)]TJ 0 -1.25 TD -0.002 Tw (controls\) aged)Tj 0 -1.2 TD 0.002 Tw (20\32079 years)Tj -9.6 -1.85 TD 0 Tw [(Lee,)-7800 (Cohort of 7,148 male)-2673 (Index of ener)34 (gy expenditure based)-1829 (Colon cancer incidence)]TJ 0 -1.2 TD [(Paffenbarger)97 (,)-3967 (male US college alumni)-1553 (on stair climbing, walking, and)]TJ 0 -1.25 TD -0.001 Tw [(Hsieh)-7074 (aged 30\32079 years)-4364 (sports/recreation, assessed 2 times)]TJ ET 48 77.25 m 1176 77.25 l S BT /F9 1 Tf 10 0 0 10 48 81 Tm 0 Tw [(\(1991\))-18789 (> 1)54 (1)0 ( years apart)]TJ ET 0 0 0 0 k 548 705 128 -50 re f 546 92 130 -50 re f PDFVars/TermAll get exec restore gsave showpage grestore %%Page: 35 35 save PDFVars/InitAll get exec %PDF_BeginEncoding: F5 Optima-Bold [ 39/quotesingle 96/grave 127/.notdef/Adieresis/Aring/Ccedilla /Eacute/Ntilde/Odieresis/Udieresis/aacute/agrave 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Of 13 studies that investigated occupa-)Tj 0 -1.182 TD -0.024 Tw (tional physical activity alone, 10 reported no statis-)Tj 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 \(Kato, Tominaga, Ikari 1990; Fraser)Tj 0 -1.182 TD 0.003 Tc 0.138 Tw (and Pearce 1993\), 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 0 -1.227 TD 0.013 Tc 0.091 Tw (\(1990\) observed a statistically significant inverse)Tj 0 -1.182 TD -0.103 Tw (association in one study population and no effect in)Tj 0 -1.227 TD 0.136 Tw (the other. Paffenbarger, Hyde, and Wing \(1987\))Tj 0 -1.182 TD 0.023 Tw (found an inverse relationship in one cohort and a)Tj 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 0 -1.182 TD -0.001 Tw (physical activity.)Tj /F5 1 Tf 12 0 0 12 311.5 202 Tm 0 Tc 0 Tw (Hormone-Dependent Cancers in Women)Tj /F7 1 Tf 11 0 0 11 311.5 187 Tm 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 0 -1.227 TD 0.003 Tc 0.016 Tw (dependent cancers in women, 13 have investigated)Tj 0 -1.182 TD 0.22 Tw (the risk associated with breast cancer, two with)Tj 0 -1.227 TD 0.248 Tw (ovarian cancer, four with uterine corpus cancer)Tj 0 -1.182 TD -0.127 Tw (\(mostly endometrial\), and one with a combination of)Tj T* 0.022 Tw (cancers. It should be noted that studies of physical)Tj 0 -1.227 TD 0.183 Tw (activity in women have been especially prone to)Tj 0 -1.182 TD 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 0.006 Tc (Continued)Tj ET 0 G 1 i 0 J 0 j 0.5 w 10 M []0 d 48 706.75 m 1170 706.75 l S BT /F5 1 Tf 10 0 0 10 264 692 Tm 0.005 Tc 0 Tw [(Definition of)-11158 (Definition of)]TJ ET 48 676.25 m 1170 676.25 l S BT /F5 1 Tf 10 0 0 10 48 680 Tm 0.02 Tw [(Study)-7130 (Population)-7224 (physical a)54 (ctivity)-9693 (cancer)]TJ /F9 1 Tf 0 -1.8 TD 0 Tw [(Mar)35 (cus,)-6158 (W)54 (isconsin women)-3977 (T)110 (otal strenuous physical activity)-2962 (Colon cancer incidence)]TJ 0 -1.25 TD [(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 -0.001 Tw [(Giovannucci et al.)-1563 (47,723 US male health)-1948 (W)54 (eekly recreational physical)-4213 (Colon cancer incidence)]TJ 0 -1.25 TD 0 Tw [(\(1995\))-6789 (professionals aged)-4018 (activity index based on 8)-5893 (\(n = 201\))]TJ 9.6 -1.25 TD [(40\32075 years)-6719 (categories of moderate and)]TJ 12 -1.2 TD 0.002 Tw (vigorous activities)Tj -21.6 -1.85 TD 0 Tw [(Longnecker et al.)-2124 (US men aged > 30)-3869 (Leisure-time vigorous physical)-3592 (Right-sided colon cancer)]TJ 0 -1.2 TD [(\(1995\))-6789 (years, 163 cases)-4919 (activity)-13649 (incidence)]TJ ET 48 523.25 m 1170 523.25 l S BT /F9 1 Tf 10 0 0 10 144 527 Tm -0.001 Tw (703 controls)Tj ET 0 0 0 0 k 558 737 102 -105 re f 558 572 102 -32 re f 558 685.5 102 -32 re f 548 724 130 -218 re f PDFVars/TermAll get exec restore gsave showpage grestore %%Page: 37 37 save PDFVars/InitAll get exec %PDF_BeginEncoding: F5 Optima-Bold [ 39/quotesingle 96/grave 127/.notdef/Adieresis/Aring/Ccedilla /Eacute/Ntilde/Odieresis/Udieresis/aacute/agrave /acircumflex/adieresis/atilde/aring/ccedilla/eacute /egrave/ecircumflex/edieresis/iacute/igrave/icircumflex /idieresis/ntilde/oacute/ograve/ocircumflex/odieresis /otilde/uacute/ugrave/ucircumflex/udieresis/dagger /degree/cent/sterling/section/bullet/paragraph /germandbls/registered/copyright/trademark/acute/dieresis /notequal/AE/Oslash/infinity/plusminus/lessequal /greaterequal/yen/mu/partialdiff/summation/product /pi/integral/ordfeminine/ordmasculine/Omega/ae /oslash/questiondown/exclamdown/logicalnot/radical/florin /approxequal/Delta/guillemotleft/guillemotright/ellipsis/blank /Agrave/Atilde/Otilde/OE/oe/endash /emdash/quotedblleft/quotedblright/quoteleft/quoteright/divide /lozenge/ydieresis/Ydieresis/fraction/currency/guilsinglleft /guilsinglright/fi/fl/daggerdbl/periodcentered/quotesinglbase /quotedblbase/perthousand/Acircumflex/Ecircumflex/Aacute/Edieresis /Egrave/Iacute/Icircumflex/Idieresis/Igrave/Oacute /Ocircumflex/apple/Ograve/Uacute/Ucircumflex/Ugrave 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/lozenge/ydieresis/Ydieresis/fraction/currency/guilsinglleft /guilsinglright/fi/fl/daggerdbl/periodcentered/quotesinglbase /quotedblbase/perthousand/Acircumflex/Ecircumflex/Aacute/Edieresis /Egrave/Iacute/Icircumflex/Idieresis/Igrave/Oacute /Ocircumflex/apple/Ograve/Uacute/Ucircumflex/Ugrave /dotlessi/circumflex/tilde/macron/breve/dotaccent /ring/cedilla/hungarumlaut/ogonek/caron /F7/Berkeley-Medium -1 TZ %PDF_EndEncoding %PDF_BeginEncoding: F9 Optima [ 39/quotesingle 96/grave 127/.notdef/Adieresis/Aring/Ccedilla /Eacute/Ntilde/Odieresis/Udieresis/aacute/agrave /acircumflex/adieresis/atilde/aring/ccedilla/eacute /egrave/ecircumflex/edieresis/iacute/igrave/icircumflex /idieresis/ntilde/oacute/ograve/ocircumflex/odieresis /otilde/uacute/ugrave/ucircumflex/udieresis/dagger /degree/cent/sterling/section/bullet/paragraph /germandbls/registered/copyright/trademark/acute/dieresis /notequal/AE/Oslash/infinity/plusminus/lessequal /greaterequal/yen/mu/partialdiff/summation/product /pi/integral/ordfeminine/ordmasculine/Omega/ae /oslash/questiondown/exclamdown/logicalnot/radical/florin /approxequal/Delta/guillemotleft/guillemotright/ellipsis/blank /Agrave/Atilde/Otilde/OE/oe/endash /emdash/quotedblleft/quotedblright/quoteleft/quoteright/divide /lozenge/ydieresis/Ydieresis/fraction/currency/guilsinglleft /guilsinglright/fi/fl/daggerdbl/periodcentered/quotesinglbase /quotedblbase/perthousand/Acircumflex/Ecircumflex/Aacute/Edieresis /Egrave/Iacute/Icircumflex/Idieresis/Igrave/Oacute /Ocircumflex/apple/Ograve/Uacute/Ucircumflex/Ugrave /dotlessi/circumflex/tilde/macron/breve/dotaccent /ring/cedilla/hungarumlaut/ogonek/caron /F9/Optima -1 TZ %PDF_EndEncoding %PDF_BeginEncoding: F10 Symbol [/F10/Symbol -1 TZ %PDF_EndEncoding 0 0 612 792 RC userdict /DefaultRGB /DeviceRGB put BT /F9 1 Tf 11 0 0 11 305 41 Tm 0 Tr 0 g 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 (assessment. Studies of leisure-time or total physical)Tj 0 -1.182 TD -0.027 Tw (activity and hormone-dependent cancers in women)Tj 0 -1.227 TD 0.001 Tw [(are summarized in )17 (Table)-7 ( 4-6.)]TJ /F5 1 Tf 11 0 2.138 11 66.5 359 Tm -0.002 Tw (Breast Cancer)Tj /F7 1 Tf 11 0 0 11 66.5 344.5 Tm -0.064 Tw (Four of the 13 breast cancer studies considered only)Tj 0 -1.182 TD -0.034 Tw (occupational physical activity. Two of those studies)Tj 0 -1.227 TD 0.087 Tw (described significant inverse associations \(Vena et)Tj 0 -1.182 TD -0.086 Tw (al. 1987; Zheng et al. 1993\), and two others reported)Tj 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 (yielded inconsistent results \(Table 4-6\). Of these 10)Tj T* 0.066 Tw (studies, two reported a significant inverse associa-)Tj 0 -1.227 TD 0.015 Tw (tion \(Bernstein et al. 1994; Mittendorf et al. 1995\),)Tj 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 0 G 1 i 0 J 0 j 0.5 w 10 M []0 d -564 706.75 m 558 706.75 l S BT /F5 1 Tf 10 0 0 10 291 692 Tm 0.005 Tc 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 0 -1.25 TD [(RR = 1.0 \(95% CI, 0.8\3201.3\))-16702 (sigmoidoscopy)61 (, BMI; population based)]TJ 0 -4.25 TD [(Most active quintile compared with least)-4791 (Y)65 (e)0 (s)-4551 (Adjusted for age, BMI, parental history of)]TJ 0 -1.25 TD [(active quintile, RR = 0.53 \(95% CI,)-13266 (colorectal cancer)80 (, history of endoscopic)]TJ T* [(0.32\3200.88\) p for trend = 0.03)-15796 (screening or polyp diagnosis, smoking,)]TJ 28.5 -1.2 TD (aspirin use, and diet)Tj -28.5 -1.85 TD [(V)71 (igorous activity )]TJ /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 [(to none: RR = 0.6 \(95% CI, 0.4\3201.0\))-12821 (race, smoking, and intakes of alcohol, ener)22 (gy)59 (,)]TJ ET -564 523.25 m 558 523.25 l S BT /F9 1 Tf 10 0 0 10 351 527 Tm [(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\ 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 ET 0 0 0 0 k -54 737 102 -105 re f -54 572 102 -32 re f -54 685.5 102 -32 re f -64 724 130 -218 re f PDFVars/TermAll get 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/oslash/questiondown/exclamdown/logicalnot/radical/florin /approxequal/Delta/guillemotleft/guillemotright/ellipsis/blank /Agrave/Atilde/Otilde/OE/oe/endash /emdash/quotedblleft/quotedblright/quoteleft/quoteright/divide /lozenge/ydieresis/Ydieresis/fraction/currency/guilsinglleft /guilsinglright/fi/fl/daggerdbl/periodcentered/quotesinglbase /quotedblbase/perthousand/Acircumflex/Ecircumflex/Aacute/Edieresis /Egrave/Iacute/Icircumflex/Idieresis/Igrave/Oacute /Ocircumflex/apple/Ograve/Uacute/Ucircumflex/Ugrave /dotlessi/circumflex/tilde/macron/breve/dotaccent /ring/cedilla/hungarumlaut/ogonek/caron /F9/Optima -1 TZ %PDF_EndEncoding %PDF_BeginEncoding: F10 Symbol [/F10/Symbol -1 TZ %PDF_EndEncoding 0 0 612 792 RC userdict /DefaultRGB /DeviceRGB put BT /F9 1 Tf 11 0 0 11 288.5 41 Tm 0 Tr 0 g 0.006 Tc (118)Tj /F5 1 Tf -21.864 63.727 TD 0.003 Tc -0.001 Tw (Physical Activity and Health)Tj 10 0 0 10 48 712 Tm 0.005 Tc 0 Tw [(T)60 (able 4-6.)-1321 (Epidemiologic studies of leisure-time or leisure-time plus occupational \ physical activity)]TJ /F9 1 Tf 7 0 0 7 490 715 Tm (*)Tj /F5 1 Tf 10 0 0 10 105 700 Tm (and hormone-dependent cancers in women)Tj ET 0 G 1 i 0 J 0 j 0.5 w 10 M []0 d 48 695.75 m 1176 695.75 l S BT /F5 1 Tf 10 0 0 10 264 681 Tm [(Definition of)-11158 (Definition of)]TJ ET 48 665.25 m 1176 665.25 l S BT /F5 1 Tf 10 0 0 10 48 669 Tm [(Study)-7130 (Population)-7224 (physical activity)-9658 (cancer)]TJ 0 -1.8 TD 0.001 Tw (Breast cancer)Tj /F9 1 Tf 0 -1.85 TD -0.001 Tw [(Frisch et al.)-4589 (Cohort of former US)-3182 (Athletic status during college)-4202 (Breast cancer prevalence)]TJ 0 -1.2 TD 0 Tw [(\(1985 and 1987\))-2353 (college athletes and)-20143 (\(n = 69\))]TJ 9.6 -1.25 TD 0.002 Tw (nonathletes; 5,398)Tj 0 -1.2 TD 0.001 Tw (women aged 21\32080)Tj 0 -1.25 TD (years)Tj -9.6 -1.8 TD 0 Tw [(Paffenbarger)97 (,)-3967 (Cohort of former US)-3182 (Sports play during college)-5497 (Breast cancer incidence)]TJ 0 -1.25 TD -0.001 Tw [(Hyde, W)23 (ing)-4351 (college students,)-21543 (and mortality)]TJ T* -0.002 Tw [(\(1987\))-6789 (4,706 women)]TJ 0 -1.8 TD 0.001 Tw [(Albanes, Blair)72 (,)-3317 (NHANES cohort: 7,413)-1783 (One question on nonrecreational)-2362 (Breast cancer incidence)]TJ 0 -1.25 TD [(T)110 (aylor \(1989\))-3863 (women aged 25\32074)-3359 (activity)101 (, one on recreational)-4695 (\(n = 122\))]TJ 9.6 -1.2 TD -0.001 Tw [(years, in US)-6774 (activity)]TJ -9.6 -1.85 TD 0 Tw [(Sternfeld et al.)-3353 (254 cases and 201)-3854 (Age-specific recreational activity)-2572 (Breast cancer incidence)]TJ 0 -1.2 TD 0.001 Tw [(\(1993\))-6789 (controls in an HMO)-3238 (levels)]TJ 0 -4.3 TD 0 Tw [(Bernstein et al.)-3128 (W)54 (omen )]TJ /F10 1 Tf 13.3 0 TD (\263)Tj /F9 1 Tf 0.55 0 TD 0.001 Tw [( 40 years; 545)-1565 (Participation in several leisure-)-3351 (Breast cancer incidence)]TJ -13.85 -1.2 TD 0 Tw [(\(1994\))-6789 (cases and 545 controls)-2053 (time activities after menarche)-3979 (in situ and invasive)]TJ 9.6 -1.25 TD 0.001 Tw (in California, US)Tj -9.6 -4.3 TD [(Dor)31 (gan et al.)-3953 (Framingham Study)-3863 (Physical activity index)-7068 (Breast cancer incidence)]TJ 0 -1.2 TD 0 Tw [(\(1994\))-6789 (cohort: 2,307 women)-19368 (\(n = 1)79 (17\))]TJ 9.6 -1.25 TD (aged 35\32068 years,)Tj 0 -1.2 TD -0.001 Tw (Massachusetts, US)Tj -9.6 -1.85 TD 0 Tw [(Friedenreich and)-2239 (Australian women)-4083 (Recreational physical activity)-4037 (Breast cancer incidence)]TJ 0 -1.2 TD [(Rohan \(1995\))-3704 (aged 20\32074 years;)-4079 (index)]TJ 9.6 -1.25 TD (451 cases and 451)Tj T* 0.001 Tw ( controls \(matched\))Tj -9.6 -1.8 TD 0 Tw [(Mittendorf et al.)-2623 (US women aged)-4824 (Strenuous physical activity at)-4147 (Breast cancer incidence)]TJ 0 -1.25 TD [(\(1995\))-6789 (17\32074 years; 6,888)-3628 (ages 14\32022 years)]TJ 9.6 -1.2 TD -0.001 Tw (cases and 9,539)Tj 0 -1.25 TD (controls)Tj -9.6 -1.8 TD 0 Tw [(T)110 (aioli, Barone,)-3302 (All ages in US; 617)-3623 (Leisure-time physical activity at)-3077 (Breast cancer incidence)]TJ 0 -1.25 TD [(W)54 (ynder \(1995\))-3089 (cases; 531 controls)-3678 (ages 15\32022 years)]TJ /F5 1 Tf 0 -3.05 TD -0.002 Tw (Ovarian cancers)Tj /F9 1 Tf 0 -1.8 TD 0 Tw [(Mink et al. \(1996\))-1838 (Iowa W)68 (omen\325)47 (s)-5556 (Categories of physical activity)-3807 (Ovarian cancer incidence)]TJ 9.6 -1.25 TD [(Health Study; cohort)-19808 (\(n = 97\))]TJ 0 -1.2 TD 0.001 Tw (of 31,396 postmeno-)Tj ET 48 90.25 m 1176 90.25 l S BT /F9 1 Tf 10 0 0 10 144 94 Tm (pausal women)Tj ET 0 0 0 0 k 548 706 131 -54 re f 546 98 131 -54 re f PDFVars/TermAll get exec restore gsave showpage grestore %%Page: 39 39 save PDFVars/InitAll get exec %PDF_BeginEncoding: F5 Optima-Bold [ 39/quotesingle 96/grave 127/.notdef/Adieresis/Aring/Ccedilla /Eacute/Ntilde/Odieresis/Udieresis/aacute/agrave /acircumflex/adieresis/atilde/aring/ccedilla/eacute /egrave/ecircumflex/edieresis/iacute/igrave/icircumflex /idieresis/ntilde/oacute/ograve/ocircumflex/odieresis 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(che, number of pregnancies,)]TJ 28.2 -1.25 TD (oral contraceptive use, smoking,)Tj 0 -1.2 TD (use of estrogen, leanness)Tj -28.2 -3.05 TD (Sports play of )Tj ET 0.38 w 134 564.09 m 128 564.09 l S BT /F9 1 Tf 10 0 0 10 128 565.5 Tm [(>)10 ( 5 relative to < 5 hours/week)-2621 (NA)-4845 (Adjusted for age)]TJ -6.2 -1.25 TD (RR = 0.96 \(p value = 0.92\))Tj 0 -3.05 TD [(Sedentary relative to most active: RR = 1.1)-3405 (No)-4955 (Adjusted for age; adjustment for confounders)]TJ 0 -1.25 TD [(\(95% CI, 0.6\3202.0\) for nonrecreational;)-11611 (had little effect on results; suggestive of variable)]TJ 0 -1.2 TD [(RR = 1.0 \(95% CI, 0.6\3201.6\) for recreational)-9480 (effects by menopausal status)]TJ 0 -1.85 TD [(For activity from age 30\32039, high activity)-4016 (Y)65 (e)0 (s)-4851 (Adjusted for age, menopausal status, and)]TJ 0 -1.2 TD [(quartile vs. low activity quartile, postmeno-)-3000 (\(opposite)-2309 (potential confounders)]TJ 0 -1.25 TD [(pausal OR = 2.3 \(95% CI, 1.03\3205.04\); pre-)-3360 (direction\))]TJ 0 -1.2 TD (menopausal OR = 2.8 \(95% CI, 0.98\3205.18\))Tj ET 72 423.09 m 66 423.09 l S BT /F9 1 Tf 10 0 0 10 66 424.5 Tm [(>)10 ( 3.8 hours/week relative to 0 hours)-6177 (Y)65 (e)0 (s)-4851 (Adjusted for age, race, neighborhood, age at)]TJ T* [(of leisure-time activity)77 (, RR = 0.42)-13659 (menarche, age at first full-term pregnancy)111 (,)]TJ 0 -1.25 TD [(\(95% CI, 0.27\3200.64\))-19378 (number of full-term pregnancies, oral)]TJ 28.2 -1.25 TD (contraceptive use, lactation, family history of)Tj 0 -1.2 TD [(breast cancer)87 (, Quetelet index; population-based)]TJ -28.2 -1.85 TD [(High activity quartile relative to low activity)-2770 (Y)65 (e)0 (s)-4851 (Adjusted for age, menopausal status, age at)]TJ 0 -1.2 TD [(quartile: RR = 1.6 \(95% CI, 0.9\3202.9\))-6216 (\(opposite)-2309 (first pregnancy)59 (, parity)90 (, education, occupation,)]TJ 21.9 -1.25 TD 0.002 Tw [(direction\))-2139 (and alcohol)]TJ -21.9 -3.05 TD 0 Tw [(> 4,000 kcal/week in physical activity)-5377 (Y)65 (e)0 (s)-4851 (Adjusted for BMI and ener)12 (gy intake;)]TJ 0 -1.2 TD [(relative to none: RR = 0.73)-16452 (effects observed for premenopausal and)]TJ 0 -1.25 TD [(\(95% CI, 0.51\3201.05\))-19378 (postmenopausal cancer and for light and)]TJ 28.2 -1.25 TD (vigorous activity; population-based)Tj ET 72 245.59 m 66 245.59 l S BT /F9 1 Tf 10 0 0 10 66 247 Tm [(>)10 ( daily strenuous activity relative)-7513 (Y)65 (e)0 (s)-4851 (Adjusted for age, parity)72 (, age at first birth, family)]TJ T* [(to none: RR = 0.5 \(95% CI, 0.4\3200.7\))-12521 (history)74 (, BMI, prior breast disease, age at)]TJ 28.2 -1.2 TD (menopause, menopausal status, alcohol use,)Tj 0 -1.25 TD (and menopausal status x BMI; population-based)Tj -28.2 -1.8 TD [(> 1,750 kcal/week relative to none:)-6447 (No)-4955 (Adjusted for age, education, BMI, age at)]TJ 0 -1.25 TD [(RR = 1.1 \(95% CI, 0.5\3202.6\))-16402 (menarche, and prior pregnancy; hospital-based)]TJ 0 -4.85 TD [(Most active relative to least active:)-6876 (Y)65 (e)0 (s)-4851 (Adjusted for age, smoking, education, live births,)]TJ 0 -1.25 TD -0.001 Tw [(RR = 1.97 \(95% CI, 1.22\3203.19\))-8422 (\(opposite)-2309 (hysterectomy)82 (, and family history)]TJ 21.9 -1.2 TD (direction\))Tj ET 0.5 w -564 90.25 m 564 90.25 l S 0 0 0 0 k -64 706 131 -54 re f -66 98 131 -54 re f PDFVars/TermAll get exec restore gsave showpage grestore %%Page: 40 40 save PDFVars/InitAll get exec %PDF_BeginEncoding: F5 Optima-Bold [ 39/quotesingle 96/grave 127/.notdef/Adieresis/Aring/Ccedilla /Eacute/Ntilde/Odieresis/Udieresis/aacute/agrave /acircumflex/adieresis/atilde/aring/ccedilla/eacute /egrave/ecircumflex/edieresis/iacute/igrave/icircumflex /idieresis/ntilde/oacute/ograve/ocircumflex/odieresis /otilde/uacute/ugrave/ucircumflex/udieresis/dagger /degree/cent/sterling/section/bullet/paragraph /germandbls/registered/copyright/trademark/acute/dieresis /notequal/AE/Oslash/infinity/plusminus/lessequal /greaterequal/yen/mu/partialdiff/summation/product 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/Egrave/Iacute/Icircumflex/Idieresis/Igrave/Oacute /Ocircumflex/apple/Ograve/Uacute/Ucircumflex/Ugrave /dotlessi/circumflex/tilde/macron/breve/dotaccent /ring/cedilla/hungarumlaut/ogonek/caron /F9/Optima -1 TZ %PDF_EndEncoding 0 0 612 792 RC userdict /DefaultRGB /DeviceRGB put BT /F9 1 Tf 11 0 0 11 288.5 41 Tm 0 Tr 0 g 0.006 Tc (120)Tj /F5 1 Tf -21.864 63.727 TD 0.003 Tc -0.001 Tw (Physical Activity and Health)Tj /F7 1 Tf -0.273 -36.636 TD -0.07 Tw (and young adulthood may be protective against later)Tj 0 -1.182 TD -0.001 Tw (development of breast cancer.)Tj /F5 1 Tf 11 0 2.138 11 45 298.5 Tm (Other Hormone-Dependent Cancers in Women)Tj /F7 1 Tf 11 0 0 11 45 284 Tm 0.166 Tw (Too little information is available to evaluate the)Tj 0 -1.227 TD -0.02 Tw (possible effect of physical activity on risk of ovarian)Tj 0 -1.182 TD 0.032 Tw (cancer. Zheng and colleagues \(1993\) found no sig-)Tj 0 -1.227 TD -0.008 Tw (nificant associations between occupational physical)Tj 0 -1.182 TD 0.177 Tw (activity and risk of ovarian cancer. On the other)Tj T* 0.156 Tw (hand, data from the Iowa Women\325s Health Study)Tj 0 -1.227 TD 0.095 Tw (showed that risk of ovarian cancer among women)Tj 0 -1.182 TD 0.197 Tw (who were most active was twice the risk among)Tj 0 -1.227 TD 0 Tw (sedentary women \(Mink et al. 1996\).)Tj 1.636 -1.182 TD -0.123 Tw (Findings are limited for uterine corpus cancers as)Tj -1.636 -1.227 TD 0.257 Tw (well. Zheng et al. \(1993\) found no relationship)Tj 0 -1.182 TD 0.074 Tw (between physical activity and risk of cancer of the)Tj T* -0.072 Tw (uterine corpus. Among the endometrial cancer stud-)Tj 0 -1.227 TD 0.134 Tw (ies, one \(Levi et al. 1993\) found a decreased risk)Tj 0 -1.182 TD 0.126 Tw (associated with nonoccupational activity, and one)Tj 0 -1.227 TD -0.004 Tw (\(Sturgeon et al. 1993\) found combined recreational)Tj 24.227 22.773 TD 0.114 Tw (and nonrecreational activity to be protective. An-)Tj 0 -1.182 TD 0.083 Tw (other study \(Shu et al. 1993\) found no protective)Tj T* 0.01 Tw (effect of nonoccupational activity in any age group)Tj 0 -1.227 TD -0.127 Tw (and a possible protective effect of occupational activ-)Tj 0 -1.182 TD 0.171 Tw (ity among younger women but not among older)Tj 0 -1.227 TD (women.)Tj 1.636 -1.182 TD 0.127 Tw (In Frisch and colleagues\325 \(1985\) study of the)Tj -1.636 -1.227 TD -0.107 Tw (combined prevalence of cancers of the ovary, uterus,)Tj 0 -1.182 TD -0.067 Tw (cervix, and vagina, nonathletes were 2.5 times more)Tj T* 0.188 Tw (likely than former college athletes to have these)Tj 0 -1.227 TD -0.027 Tw (forms of cancer at follow-up. Because these cancers)Tj 0 -1.182 TD -0.098 Tw (have different etiologies, however, the import of this)Tj 0 -1.227 TD 0 Tw (finding is difficult to determine.)Tj 1.636 -1.182 TD 0.253 Tw (Thus the data are either too limited or too)Tj -1.636 -1.227 TD 0.228 Tw (inconsistent to firmly establish relationships be-)Tj 0 -1.182 TD -0.001 Tc -0.129 Tw (tween physical activity and hormone-dependent can-)Tj T* 0.003 Tc -0.057 Tw (cers in women. The suggestive finding that physical)Tj 0 -1.227 TD 0.196 Tw (activity in adolescence and early adulthood may)Tj 0 -1.182 TD 0.077 Tw (protect against later development of breast cancer)Tj 0 -1.227 TD 0 Tw (deserves further study.)Tj /F5 1 Tf 10 0 0 10 48 712 Tm 0.005 Tc 0.027 Tw [(T)60 (able 4-6.)]TJ /F9 1 Tf 8.5 0 1.652 8.5 102 712 Tm 0.006 Tc (Continued)Tj ET 0 G 1 i 0 J 0 j 0.5 w 10 M []0 d 48 707.75 m 1176 707.75 l S BT /F5 1 Tf 10 0 0 10 264 693 Tm 0.005 Tc 0 Tw [(Definition of)-11158 (Definition of)]TJ ET 48 677.25 m 1176 677.25 l S BT /F5 1 Tf 10 0 0 10 48 681 Tm [(Study)-7130 (Population)-7224 (physical activity)-9658 (cancer)]TJ 0 -1.8 TD 0.001 Tw (Endometrial cancers)Tj /F9 1 Tf 0 -1.85 TD 0 Tw [(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 [(Stur)36 (geon et al.)-3393 (US women aged)-4824 (Recreational and nonrecreational)-2302 (Endometrial cancer)]TJ 0 -1.2 TD -0.001 Tw [(\(1993\))-6789 (20\32074 years;)-6439 (activity categories)-8983 (incidence)]TJ 9.6 -1.25 TD 0.002 Tw (405 cases)Tj 0 -1.2 TD 0 Tw (and 297 controls)Tj /F5 1 Tf -9.6 -3.05 TD -0.001 Tw (Combined set)Tj /F9 1 Tf 0 -1.85 TD 0 Tw [(Frisch et al.)-4589 (Cohort of former US)-3182 (Athletic status during college)-4202 (Cervix, uterus, ovary)97 (,)]TJ 0 -1.2 TD [(\(1985 and 1987\))-2353 (college athletes and)-20143 (vagina cancer prevalence)]TJ 9.6 -1.25 TD 0.001 Tw [(nonathletes; 5,398)-20703 (\(n = 37\))]TJ T* (women aged 21\32080)Tj ET 48 383.25 m 1176 383.25 l S BT /F9 1 Tf 10 0 0 10 144 387.5 Tm (years)Tj ET 0 0 0 0 k 548 736 129 -76 re f 548 390 128.5 -76 re f PDFVars/TermAll get exec restore gsave showpage grestore %%Page: 41 41 save PDFVars/InitAll get exec %PDF_BeginEncoding: F5 Optima-Bold [ 39/quotesingle 96/grave 127/.notdef/Adieresis/Aring/Ccedilla /Eacute/Ntilde/Odieresis/Udieresis/aacute/agrave /acircumflex/adieresis/atilde/aring/ccedilla/eacute /egrave/ecircumflex/edieresis/iacute/igrave/icircumflex /idieresis/ntilde/oacute/ograve/ocircumflex/odieresis /otilde/uacute/ugrave/ucircumflex/udieresis/dagger /degree/cent/sterling/section/bullet/paragraph /germandbls/registered/copyright/trademark/acute/dieresis /notequal/AE/Oslash/infinity/plusminus/lessequal /greaterequal/yen/mu/partialdiff/summation/product /pi/integral/ordfeminine/ordmasculine/Omega/ae /oslash/questiondown/exclamdown/logicalnot/radical/florin /approxequal/Delta/guillemotleft/guillemotright/ellipsis/blank /Agrave/Atilde/Otilde/OE/oe/endash /emdash/quotedblleft/quotedblright/quoteleft/quoteright/divide /lozenge/ydieresis/Ydieresis/fraction/currency/guilsinglleft /guilsinglright/fi/fl/daggerdbl/periodcentered/quotesinglbase /quotedblbase/perthousand/Acircumflex/Ecircumflex/Aacute/Edieresis /Egrave/Iacute/Icircumflex/Idieresis/Igrave/Oacute /Ocircumflex/apple/Ograve/Uacute/Ucircumflex/Ugrave /dotlessi/circumflex/tilde/macron/breve/dotaccent /ring/cedilla/hungarumlaut/ogonek/caron /F5/Optima-Bold -1 TZ %PDF_EndEncoding %PDF_BeginEncoding: F7 Berkeley-Medium [ 39/quotesingle 96/grave 127/.notdef/Adieresis/Aring/Ccedilla /Eacute/Ntilde/Odieresis/Udieresis/aacute/agrave /acircumflex/adieresis/atilde/aring/ccedilla/eacute /egrave/ecircumflex/edieresis/iacute/igrave/icircumflex /idieresis/ntilde/oacute/ograve/ocircumflex/odieresis /otilde/uacute/ugrave/ucircumflex/udieresis/dagger /degree/cent/sterling/section/bullet/paragraph /germandbls/registered/copyright/trademark/acute/dieresis /notequal/AE/Oslash/infinity/plusminus/lessequal /greaterequal/yen/mu/partialdiff/summation/product /pi/integral/ordfeminine/ordmasculine/Omega/ae /oslash/questiondown/exclamdown/logicalnot/radical/florin /approxequal/Delta/guillemotleft/guillemotright/ellipsis/blank /Agrave/Atilde/Otilde/OE/oe/endash /emdash/quotedblleft/quotedblright/quoteleft/quoteright/divide /lozenge/ydieresis/Ydieresis/fraction/currency/guilsinglleft /guilsinglright/fi/fl/daggerdbl/periodcentered/quotesinglbase /quotedblbase/perthousand/Acircumflex/Ecircumflex/Aacute/Edieresis /Egrave/Iacute/Icircumflex/Idieresis/Igrave/Oacute /Ocircumflex/apple/Ograve/Uacute/Ucircumflex/Ugrave /dotlessi/circumflex/tilde/macron/breve/dotaccent /ring/cedilla/hungarumlaut/ogonek/caron /F7/Berkeley-Medium -1 TZ %PDF_EndEncoding %PDF_BeginEncoding: F9 Optima [ 39/quotesingle 96/grave 127/.notdef/Adieresis/Aring/Ccedilla /Eacute/Ntilde/Odieresis/Udieresis/aacute/agrave /acircumflex/adieresis/atilde/aring/ccedilla/eacute /egrave/ecircumflex/edieresis/iacute/igrave/icircumflex /idieresis/ntilde/oacute/ograve/ocircumflex/odieresis /otilde/uacute/ugrave/ucircumflex/udieresis/dagger /degree/cent/sterling/section/bullet/paragraph /germandbls/registered/copyright/trademark/acute/dieresis /notequal/AE/Oslash/infinity/plusminus/lessequal /greaterequal/yen/mu/partialdiff/summation/product /pi/integral/ordfeminine/ordmasculine/Omega/ae /oslash/questiondown/exclamdown/logicalnot/radical/florin /approxequal/Delta/guillemotleft/guillemotright/ellipsis/blank /Agrave/Atilde/Otilde/OE/oe/endash /emdash/quotedblleft/quotedblright/quoteleft/quoteright/divide /lozenge/ydieresis/Ydieresis/fraction/currency/guilsinglleft /guilsinglright/fi/fl/daggerdbl/periodcentered/quotesinglbase /quotedblbase/perthousand/Acircumflex/Ecircumflex/Aacute/Edieresis /Egrave/Iacute/Icircumflex/Idieresis/Igrave/Oacute /Ocircumflex/apple/Ograve/Uacute/Ucircumflex/Ugrave /dotlessi/circumflex/tilde/macron/breve/dotaccent /ring/cedilla/hungarumlaut/ogonek/caron /F9/Optima -1 TZ %PDF_EndEncoding %PDF_BeginEncoding: F10 Symbol [/F10/Symbol -1 TZ %PDF_EndEncoding 0 0 612 792 RC userdict /DefaultRGB /DeviceRGB put BT /F9 1 Tf 11 0 0 11 305 41 Tm 0 Tr 0 g 0.006 Tc (121)Tj /F5 1 Tf -0.136 63.727 TD 0.003 Tc 0 Tw (The Effects of Physical Activity on Health and Disease)Tj 12 0 0 12 66 277.5 Tm 0 Tc (Cancers in Men)Tj 11 0 2.138 11 66 257.5 Tm 0.003 Tc -0.001 Tw (Prostate Cancer)Tj /F7 1 Tf 11 0 0 11 66 243 Tm 0.161 Tw (Among epidemiologic studies of physical activity)Tj 0 -1.182 TD -0.06 Tw (and cancer, prostate cancer is the second most com-)Tj 0 -1.227 TD 0.163 Tw (monly studied, after colorectal cancer. Results of)Tj 0 -1.182 TD 0.129 Tw (these studies are inconsistent. Seven studies have)Tj T* (investigated the association between occupational)Tj 0 -1.227 TD -0.026 Tw (physical activity and prostate cancer risk or mortal-)Tj 0 -1.182 TD -0.111 Tw [(ity. Two described significant inverse dose-response)]TJ 0 -1.227 TD 0.22 Tw (relationships \(Vena et al. 1987; Brownson et al.)Tj 0 -1.182 TD -0.028 Tw (1991\). Two showed a nonsignificant decreased risk)Tj T* 0.128 Tw (with heavy occupational activity \(Dosemeci et al.)Tj 0 -1.227 TD 0.097 Tw (1993; Thune and Lund 1994\). In one publication)Tj 0 -1.182 TD -0.003 Tw (that presented data from two cohorts, there was no)Tj 0 -1.227 TD 0.131 Tw (effect in either \(Paffenbarger, Hyde, Wing 1987\).)Tj 23.955 17.409 TD 0.031 Tc 0.258 Tw (The remaining study \(Le Marchand, Kolonel,)Tj 0 -1.182 TD 0.003 Tc 0.03 Tw (Yoshizawa 1991\) reported inconsistent findings by)Tj T* 0.036 Tw (age: increasing risk with increasing activity among)Tj 0 -1.227 TD 0.202 Tw (men aged 70 years or older and no relationship)Tj 0 -1.182 TD 0 Tw (among men younger than age 70.)Tj 1.636 -1.227 TD 0.013 Tc -0.081 Tw [(T)-12 (he 10 studies of leisure-time physical activity)42 (,)]TJ -1.636 -1.182 TD 0.003 Tc -0.088 Tw [(o)-10 (r)-4 ( total physical activity, or cardiorespiratory fitness)]TJ 0 -1.227 TD 0.013 Tc 0.21 Tw (and risk of prostate cancer have also produced)Tj 0 -1.182 TD 0.004 Tc -0.008 Tw (inconsistent results \(Table 4-7\). Two of the studies)Tj T* 0.012 Tc 0.259 Tw (described significant inverse relationships \(Lee,)Tj 0 -1.227 TD 0.013 Tc 0.197 Tw (Paffenbarger, Hsieh 1992; Oliveria et al. 1996\),)Tj 0 -1.182 TD 0.003 Tc 0.244 Tw [(a)-10 (l)10 (though one of these \(Lee, Paffenbarger, Hsieh)]TJ 0 -1.227 TD 0.075 Tw (1992\) observed this relationship only among men)Tj 0 -1.182 TD 0.042 Tw (aged 70 years or older. Four studies found inverse)Tj T* -0.067 Tw (relationships \(Albanes, Blair, Taylor 1989; Severson)Tj 0 -1.227 TD 0.103 Tw (et al. 1989; Yu, Harris, Wynder 1988; Thune and)Tj ET 0 G 1 i 0 J 0 j 0.5 w 10 M []0 d -564 707.75 m 564 707.75 l S BT /F5 1 Tf 10 0 0 10 291 693 Tm 0.005 Tc 0.001 Tw [(Dose)-3755 (Adjustment for confounders)]TJ ET -564 677.25 m 564 677.25 l S BT /F5 1 Tf 10 0 0 10 66 681 Tm 0.024 Tw [(Main f)-80 (indings)-16402 (response)]TJ /F9 1 Tf 7 0 0 7 330 687 Tm (\240)Tj /F5 1 Tf 10 0 0 10 351 681 Tm 0 Tw (and other comments)Tj /F9 1 Tf -28.5 -3.65 TD [(Sedentary relative to active for total activity:)-3365 (Y)65 (e)0 (s)-4551 (Adjusted for age, education, parity)64 (,)]TJ 0 -1.2 TD [(RR = 2.4 \(95% CI, 1.0\3205.8\) to RR = 8.6)-11480 (menopausal status, oral contraceptive use,)]TJ 0 -1.25 TD [(\(95% CI, 3.0\32025.3\) for different ages)-12696 (estrogen replacement, BMI, and caloric intake;)]TJ 28.5 -1.2 TD (hospital-based)Tj -28.5 -1.85 TD [(Low average adult activity quartile relative)-3996 (No)-4655 (Adjusted for age, number of pregnancies,)]TJ 0 -1.2 TD (to high quartile: occupational age )Tj /F10 1 Tf 14.95 0 TD (\243)Tj /F9 1 Tf 0.55 0 TD [( 55 years)-9065 (BMI, and caloric intake; possible modification)]TJ -15.5 -1.25 TD [(RR = 2.5 \(95% CI, 0.9\3206.3\), age > 55 years)-9790 (of occupational activity by age;)]TJ T* [(RR = 0.6 \(no CI given\); nonoccupational)-10911 (population-based)]TJ 0 -1.2 TD (RR = 0.8 \(95% CI, 0.5\3201.3\))Tj 0 -1.85 TD [(Sustained \(lifetime\) activity)55 (, inactive)-6853 (No)-4655 (Adjusted for age, study area, education, parity)70 (,)]TJ 0 -1.2 TD [(relative to active: recreational RR = 1.5)-11461 (oral contraceptive use, hormone replacement)]TJ 0 -1.25 TD [(\(95% CI, 0.7\3203.2\) nonrecreational RR = 1.6)-9565 (use, cigarette smoking, BMI, and other type of)]TJ 0 -1.2 TD -0.001 Tw [(\(95% CI, 0.7\3203.3\))-20798 (activity; recent activity also protective;)]TJ 28.5 -1.25 TD (population-based)Tj -28.5 -3.65 TD 0 Tw [(Nonathletes vs. athletes:)-11928 (N/A)-4260 (Adjusted for age, family history of cancer)80 (,)]TJ 0 -1.2 TD [(RR = 2.53 \(95% CI, 1.17\3205.47\))-15022 (age at menar)14 (che, number of pregnancies,)]TJ 28.5 -1.25 TD (oral contraceptive use, smoking, use of)Tj T* (estrogen, leanness)Tj ET -564 383.25 m 564 383.25 l S BT /F9 1 Tf 8 0 0 8 66 371 Tm 0.01 Tc (Abbreviations: BMI = body mass index \(wt [kg]/ht [m])Tj 4.7 0 0 4.7 255 373.5 Tm (2)Tj 8 0 0 8 257.5 371 Tm [( \); CI = confidence interval; HMO = health maintenance or)21 (ganization;)]TJ -23.937 -1.187 TD (NHANES = National Health and Examination Survey; OR = odds ratio; RR = r\ elative risk.)Tj 5.6 0 0 5.6 66 349 Tm (*)Tj 8 0 0 8 68.5 347 Tm (Excludes studies where only occupational physical activity was measured.\ )Tj 5.6 0 0 5.6 66 338 Tm (\240)Tj 8 0 0 8 69 336 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 )44 (2 levels of)]TJ -0.375 -1.25 TD 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 0 -1.187 TD (more than 2 levels and a dose-response gradient was found.)Tj ET 0 0 0 0 k -64 736 129 -76 re f -64 390 128.5 -76 re f PDFVars/TermAll get exec restore gsave showpage grestore %%Page: 42 42 save PDFVars/InitAll get exec %PDF_BeginEncoding: F5 Optima-Bold [ 39/quotesingle 96/grave 127/.notdef/Adieresis/Aring/Ccedilla /Eacute/Ntilde/Odieresis/Udieresis/aacute/agrave /acircumflex/adieresis/atilde/aring/ccedilla/eacute /egrave/ecircumflex/edieresis/iacute/igrave/icircumflex /idieresis/ntilde/oacute/ograve/ocircumflex/odieresis /otilde/uacute/ugrave/ucircumflex/udieresis/dagger /degree/cent/sterling/section/bullet/paragraph /germandbls/registered/copyright/trademark/acute/dieresis /notequal/AE/Oslash/infinity/plusminus/lessequal /greaterequal/yen/mu/partialdiff/summation/product /pi/integral/ordfeminine/ordmasculine/Omega/ae /oslash/questiondown/exclamdown/logicalnot/radical/florin /approxequal/Delta/guillemotleft/guillemotright/ellipsis/blank /Agrave/Atilde/Otilde/OE/oe/endash /emdash/quotedblleft/quotedblright/quoteleft/quoteright/divide /lozenge/ydieresis/Ydieresis/fraction/currency/guilsinglleft /guilsinglright/fi/fl/daggerdbl/periodcentered/quotesinglbase /quotedblbase/perthousand/Acircumflex/Ecircumflex/Aacute/Edieresis /Egrave/Iacute/Icircumflex/Idieresis/Igrave/Oacute /Ocircumflex/apple/Ograve/Uacute/Ucircumflex/Ugrave /dotlessi/circumflex/tilde/macron/breve/dotaccent /ring/cedilla/hungarumlaut/ogonek/caron /F5/Optima-Bold -1 TZ %PDF_EndEncoding %PDF_BeginEncoding: F9 Optima [ 39/quotesingle 96/grave 127/.notdef/Adieresis/Aring/Ccedilla /Eacute/Ntilde/Odieresis/Udieresis/aacute/agrave /acircumflex/adieresis/atilde/aring/ccedilla/eacute /egrave/ecircumflex/edieresis/iacute/igrave/icircumflex /idieresis/ntilde/oacute/ograve/ocircumflex/odieresis 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Tf 11 0 0 11 288.5 41 Tm 0 Tr 0 g 0.006 Tc (122)Tj /F5 1 Tf -21.864 63.727 TD 0.003 Tc -0.001 Tw (Physical Activity and Health)Tj 10 0 0 10 48 712 Tm 0.005 Tc 0 Tw [(T)60 (able 4-7.)-970 (Epidemiologic studies of leisure-time or total physical activity or card\ iorespiratory fitness and)]TJ 5.4 -1.2 TD 0.002 Tw (prostate cancer)Tj ET 0 G 1 i 0 J 0 j 0.5 w 10 M []0 d 48 695.75 m 1179 695.75 l S BT /F5 1 Tf 10 0 0 10 264 681 Tm 0 Tw [(Definition of physical activity)-3732 (Definition of)]TJ ET 48 665.25 m 1179 665.25 l S BT /F5 1 Tf 10 0 0 10 48 669 Tm -0.001 Tw [(Study)-7130 (Population)-7224 (or cardiorespiratory fitness)-4842 (cancer)]TJ 0 -1.8 TD 0 Tw (Physical activity)Tj /F9 1 Tf 0 -1.5 TD [(Polednak \(1976\))-2464 (Cohort of 8,393 former)-1942 (College athletic status, major)98 (,)-4017 (Prostate cancer incidence)]TJ 9.6 -1.15 TD 0.001 Tw [(US college men)-5094 (minor)80 (, and nonathletes)-6820 (\(n = 124\))]TJ -9.6 -1.75 TD 0 Tw [(Paffenbarger)97 (,)-3967 (Cohort of 51,977)-4528 (Sports play)-12019 (Prostate cancer incidence)]TJ 0 -1.15 TD [(Hyde, W)23 (ing)-4351 (US male former)-21953 (and mortality \(n = 154 \))]TJ T* -0.001 Tw [(\(1987\))-6789 (college students)]TJ 9.6 -1.5 TD 0 Tw [(16,936 US male alumni)-1613 (Physical activity index)-7068 (Prostate cancer mortality)]TJ 0 -1.15 TD [(aged 35\32074 years)-21164 (\(n = 36\))]TJ -9.6 -1.75 TD [(Y)115 (u, Harris,)-5048 (US men, all ages,)-4413 (Categories of leisure-time)-5722 (Prostate cancer incidence)]TJ 0 -1.15 TD -0.001 Tw [(W)54 (ynder)-6180 (1,162 cases and)-4979 (aerobic exer)41 (cise)]TJ T* 0.001 Tw [(\(1988\))-6789 (3,124 controls)]TJ 0 -2.9 TD 0 Tw [(Albanes, Blair)72 (,)-3317 (NHANES cohort of)-3748 (Categories of recreational and)-3757 (Prostate cancer incidence)]TJ 0 -1.2 TD [(T)110 (aylor \(1989\))-3863 (5,141 US men aged)-3358 (nonrecreational activity)]TJ 9.6 -1.15 TD 0.002 Tw (25\32074 years)Tj -9.6 -6.4 TD 0 Tw [(Severson et al.)-3299 (Cohort of 7,925)-5088 (Physical activity index from)-4767 (Prostate cancer incidence)]TJ 0 -1.15 TD [(\(1989\))-6789 (Japanese men)-5994 (Framingham study and heart rate)]TJ 9.6 -1.15 TD -0.001 Tw (in Hawaii aged)Tj T* 0.002 Tw (46\32065 years)Tj -9.6 -4.1 TD 0 Tw [(W)54 (est et al. \(1991\))-1948 (Utah men aged 45\32074)-2288 (Categories of ener)18 (gy expended)-3394 (Prostate cancer incidence)]TJ 9.6 -1.15 TD (years, 358 cases)Tj T* (and 679 controls)Tj -9.6 -1.75 TD -0.001 Tw [(Lee, Paffenbar)31 (ger)47 (,)-1867 (Cohort of US college)-2898 (Physical activity index based on)-2857 (Prostate cancer incidence)]TJ 0 -1.15 TD 0 Tw [(Hsieh \(1992\))-3979 (alumni, 17,719 men)-3128 (stair climbing, walking, playing)-3136 (\(n = 221\))]TJ 9.6 -1.2 TD -0.001 Tw [(aged 30\32079 years)-4364 (sports)]TJ -9.6 -2.9 TD 0 Tw [(Thune and Lund)-2469 (Cohort of Norwegian)-2788 (Recreational and occupational)-3482 (Prostate cancer incidence)]TJ 0 -1.15 TD [(\(1994\))-6789 (43,685 men)-6724 (activity based on questionnaire;)-2967 (\(n = 220\))]TJ 21.6 -1.15 TD (categories of occupational and)Tj T* 0.001 Tw (leisure-time activity)Tj /F5 1 Tf -21.6 -1.75 TD -0.001 Tw (Cardiorespiratory Fitness)Tj /F9 1 Tf T* 0 Tw [(Oliveria et al.)-3633 (Cohort of 12,975)-4528 (Maximal exercise test)-7415 (Prostate cancer incidence)]TJ 0 -1.2 TD -0.001 Tw [(\(1996\))-6789 (T)110 (exas men)-24254 (or mortality \(n = 94\))]TJ 9.6 -1.15 TD (aged 20\32080 years)Tj 0 -2.3 TD [(Cohort of 7,570)-5088 (Categories of weekly ener)39 (gy)-4590 (Prostate cancer incidence)]TJ ET 48 99.75 m 1179 99.75 l S BT /F9 1 Tf 10 0 0 10 144 104 Tm [(T)110 (exas men)-7454 (expenditure in leisure time)-5162 (or mortality \(n = 44\))]TJ ET 0 0 0 0 k 546 704 130 -50 re f 544.5 107.5 131.5 -57.5 re f PDFVars/TermAll get exec restore gsave showpage grestore %%Page: 43 43 save PDFVars/InitAll get exec %PDF_BeginEncoding: F5 Optima-Bold [ 39/quotesingle 96/grave 127/.notdef/Adieresis/Aring/Ccedilla /Eacute/Ntilde/Odieresis/Udieresis/aacute/agrave 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/lozenge/ydieresis/Ydieresis/fraction/currency/guilsinglleft /guilsinglright/fi/fl/daggerdbl/periodcentered/quotesinglbase /quotedblbase/perthousand/Acircumflex/Ecircumflex/Aacute/Edieresis /Egrave/Iacute/Icircumflex/Idieresis/Igrave/Oacute /Ocircumflex/apple/Ograve/Uacute/Ucircumflex/Ugrave /dotlessi/circumflex/tilde/macron/breve/dotaccent /ring/cedilla/hungarumlaut/ogonek/caron /F9/Optima -1 TZ %PDF_EndEncoding %PDF_BeginEncoding: F10 Symbol [/F10/Symbol -1 TZ %PDF_EndEncoding 0 0 612 792 RC userdict /DefaultRGB /DeviceRGB put BT /F9 1 Tf 11 0 0 11 305 41 Tm 0 Tr 0 g 0.006 Tc (123)Tj /F5 1 Tf -0.136 63.727 TD 0.003 Tc 0 Tw (The Effects of Physical Activity on Health and Disease)Tj ET 0 G 1 i 0 J 0 j 0.5 w 10 M []0 d -564 695.75 m 567 695.75 l S BT /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 S BT /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* 0 Tc 0 Tw (than 2 levels and a dose-response gradient was found.)Tj ET 0 0 0 0 k -66 704 130 -50 re f -67.5 107.5 131.5 -57.5 re f PDFVars/TermAll get exec restore gsave showpage 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/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 0 -1.227 TD 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 ET PDFVars/TermAll get exec restore gsave showpage grestore %%Page: 45 45 save PDFVars/InitAll get exec %PDF_BeginEncoding: F5 Optima-Bold [ 39/quotesingle 96/grave 127/.notdef/Adieresis/Aring/Ccedilla /Eacute/Ntilde/Odieresis/Udieresis/aacute/agrave /acircumflex/adieresis/atilde/aring/ccedilla/eacute /egrave/ecircumflex/edieresis/iacute/igrave/icircumflex /idieresis/ntilde/oacute/ograve/ocircumflex/odieresis /otilde/uacute/ugrave/ucircumflex/udieresis/dagger /degree/cent/sterling/section/bullet/paragraph /germandbls/registered/copyright/trademark/acute/dieresis /notequal/AE/Oslash/infinity/plusminus/lessequal /greaterequal/yen/mu/partialdiff/summation/product /pi/integral/ordfeminine/ordmasculine/Omega/ae 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/Agrave/Atilde/Otilde/OE/oe/endash /emdash/quotedblleft/quotedblright/quoteleft/quoteright/divide /lozenge/ydieresis/Ydieresis/fraction/currency/guilsinglleft /guilsinglright/fi/fl/daggerdbl/periodcentered/quotesinglbase /quotedblbase/perthousand/Acircumflex/Ecircumflex/Aacute/Edieresis /Egrave/Iacute/Icircumflex/Idieresis/Igrave/Oacute /Ocircumflex/apple/Ograve/Uacute/Ucircumflex/Ugrave /dotlessi/circumflex/tilde/macron/breve/dotaccent /ring/cedilla/hungarumlaut/ogonek/caron /F12/INHJAA+Berkeley-Bold -1 TZ %PDF_EndEncoding 0 0 612 792 RC userdict /DefaultRGB /DeviceRGB put BT /F9 1 Tf 11 0 0 11 305 41 Tm 0 Tr 0 g 0.006 Tc (125)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 0.007 Tc [(Non)-18 (\320)42 (Insulin-Dependent)]TJ 0 -1.214 TD -0.002 Tw (Diabetes Mellitus)Tj /F7 1 Tf 11 0 0 11 66 676.5 Tm -0.005 Tc -0.084 Tw (An estimated 8 million Americans \(about 3 percent of)Tj 0 -1.227 TD -0.082 Tw (the U.S. population\) have been diagnosed with diabe-)Tj 0 -1.182 TD 0.006 Tw (tes mellitus, and it is estimated that twice that many)Tj 0 -1.227 TD -0.083 Tw [(have diabetes but do not know it \(Harris 1995\). More)]TJ 0 -1.182 TD -0.118 Tw (than 169,000 deaths per year are attributed to diabetes)Tj T* -0.102 Tw (as the underlying cause, making it the seventh leading)Tj 0 -1.227 TD -0.05 Tw (cause of mortality in the United States \(NCHS 1994\).)Tj 0 -1.182 TD -0.094 Tw (This figure, however, underestimates the actual death)Tj 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 (occurred among persons for whom diabetes was listed)Tj 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 (of diabetes, particularly CVDs, including CHD, stroke,)Tj 0 -1.227 TD -0.005 Tc -0.057 Tw (peripheral vascular disease, and congestive heart fail-)Tj 0 -1.182 TD 0.081 Tw (ure. Diabetes accounts for at least 10 percent of all)Tj T* 0.163 Tw (acute hospital days and in 1992 accounted for an)Tj 0 -1.227 TD 0.056 Tw (estimated $92 billion in direct and indirect medical)Tj 0 -1.182 TD -0.071 Tw [(costs \(Rubin et al. 1993\). In addition, by age 65 years)23 (,)]TJ 0 -1.227 TD 0.072 Tw (about 40 percent of the general population has im-)Tj 0 -1.182 TD 0.007 Tw (paired glucose tolerance, which increases the risk of)Tj T* 0 Tw [(CVD \(Harris et al. 1987\))-17 (.)]TJ 1.636 -1.227 TD 0.07 Tw (Diabetes is a heterogeneous group of metabolic)Tj -1.636 -1.182 TD -0.127 Tw (disorders that have in common elevated blood glucose)Tj 0 -1.227 TD 0.004 Tc 0.247 Tw [(and associated metabolic derangements. Insu)22 (lin-)]TJ 0 -1.182 TD 0.003 Tc 0.14 Tw (dependent diabetes mellitus \(IDDM, or type I\) is)Tj 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 (immune process. Non\320insulin-dependent diabetes)Tj 0 -1.182 TD -0.042 Tw (mellitus \(NIDDM, or type II\) is characterized either)Tj 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 (resistance \(decreased sensitivity to insulin\), largely)Tj 0 -1.227 TD -0.04 Tw (in skeletal muscle, or by impaired insulin secretion.)Tj 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 (\(which presumably)Tj /F12 1 Tf 8 0 TD ( )Tj /F7 1 Tf 0.227 0 TD (included large amounts of regu-)Tj -8.227 -1.227 TD -0.055 Tw (lar physical activity\) 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 (vanced environment had higher prevalences of)Tj 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 (in their native land \(Hara et al. 1983; Kawate et al.)Tj 0 -1.182 TD 0.027 Tw (1979; Ravussin et al. 1994\) 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 (studies that have examined the relationship between)Tj 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 \(Lindg\212rde)Tj T* 0.022 Tw (and Saltin 1981; Wang et al. 1989; McKeigue et al.)Tj 0 -1.227 TD -0.005 Tc -0.129 Tw (1992; Feskens, Loeber, Kromhout 1994; Regensteiner)Tj 0 -1.182 TD 0.003 Tc 0.052 Tw (et al. 1995\) were significantly higher in less active)Tj 0 -1.227 TD 0.011 Tw (than in more active persons. However, some cross-)Tj 0 -1.182 TD -0.075 Tw (sectional studies did not find that physical inactivity)Tj T* 0.077 Tw (was consistently associated with NIDDM in either)Tj 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 0 -1.227 TD -0.032 Tw (example, the Second National Health and Nutrition)Tj 0 -1.182 TD 0.119 Tw (Examination Survey and the Hispanic Health and)Tj 0 -1.227 TD 0.212 Tw (Nutrition Examination Survey found that higher)Tj ET PDFVars/TermAll get exec restore gsave showpage grestore %%Page: 46 46 save PDFVars/InitAll get exec %PDF_BeginEncoding: F5 Optima-Bold [ 39/quotesingle 96/grave 127/.notdef/Adieresis/Aring/Ccedilla /Eacute/Ntilde/Odieresis/Udieresis/aacute/agrave /acircumflex/adieresis/atilde/aring/ccedilla/eacute /egrave/ecircumflex/edieresis/iacute/igrave/icircumflex /idieresis/ntilde/oacute/ograve/ocircumflex/odieresis /otilde/uacute/ugrave/ucircumflex/udieresis/dagger /degree/cent/sterling/section/bullet/paragraph /germandbls/registered/copyright/trademark/acute/dieresis /notequal/AE/Oslash/infinity/plusminus/lessequal /greaterequal/yen/mu/partialdiff/summation/product /pi/integral/ordfeminine/ordmasculine/Omega/ae /oslash/questiondown/exclamdown/logicalnot/radical/florin /approxequal/Delta/guillemotleft/guillemotright/ellipsis/blank /Agrave/Atilde/Otilde/OE/oe/endash /emdash/quotedblleft/quotedblright/quoteleft/quoteright/divide /lozenge/ydieresis/Ydieresis/fraction/currency/guilsinglleft /guilsinglright/fi/fl/daggerdbl/periodcentered/quotesinglbase /quotedblbase/perthousand/Acircumflex/Ecircumflex/Aacute/Edieresis /Egrave/Iacute/Icircumflex/Idieresis/Igrave/Oacute /Ocircumflex/apple/Ograve/Uacute/Ucircumflex/Ugrave /dotlessi/circumflex/tilde/macron/breve/dotaccent /ring/cedilla/hungarumlaut/ogonek/caron /F5/Optima-Bold -1 TZ %PDF_EndEncoding %PDF_BeginEncoding: F7 Berkeley-Medium [ 39/quotesingle 96/grave 127/.notdef/Adieresis/Aring/Ccedilla /Eacute/Ntilde/Odieresis/Udieresis/aacute/agrave /acircumflex/adieresis/atilde/aring/ccedilla/eacute /egrave/ecircumflex/edieresis/iacute/igrave/icircumflex /idieresis/ntilde/oacute/ograve/ocircumflex/odieresis /otilde/uacute/ugrave/ucircumflex/udieresis/dagger /degree/cent/sterling/section/bullet/paragraph /germandbls/registered/copyright/trademark/acute/dieresis /notequal/AE/Oslash/infinity/plusminus/lessequal /greaterequal/yen/mu/partialdiff/summation/product /pi/integral/ordfeminine/ordmasculine/Omega/ae /oslash/questiondown/exclamdown/logicalnot/radical/florin /approxequal/Delta/guillemotleft/guillemotright/ellipsis/blank /Agrave/Atilde/Otilde/OE/oe/endash /emdash/quotedblleft/quotedblright/quoteleft/quoteright/divide /lozenge/ydieresis/Ydieresis/fraction/currency/guilsinglleft /guilsinglright/fi/fl/daggerdbl/periodcentered/quotesinglbase /quotedblbase/perthousand/Acircumflex/Ecircumflex/Aacute/Edieresis /Egrave/Iacute/Icircumflex/Idieresis/Igrave/Oacute /Ocircumflex/apple/Ograve/Uacute/Ucircumflex/Ugrave /dotlessi/circumflex/tilde/macron/breve/dotaccent /ring/cedilla/hungarumlaut/ogonek/caron /F7/Berkeley-Medium -1 TZ %PDF_EndEncoding %PDF_BeginEncoding: F9 Optima [ 39/quotesingle 96/grave 127/.notdef/Adieresis/Aring/Ccedilla /Eacute/Ntilde/Odieresis/Udieresis/aacute/agrave /acircumflex/adieresis/atilde/aring/ccedilla/eacute /egrave/ecircumflex/edieresis/iacute/igrave/icircumflex /idieresis/ntilde/oacute/ograve/ocircumflex/odieresis /otilde/uacute/ugrave/ucircumflex/udieresis/dagger /degree/cent/sterling/section/bullet/paragraph /germandbls/registered/copyright/trademark/acute/dieresis /notequal/AE/Oslash/infinity/plusminus/lessequal /greaterequal/yen/mu/partialdiff/summation/product /pi/integral/ordfeminine/ordmasculine/Omega/ae /oslash/questiondown/exclamdown/logicalnot/radical/florin /approxequal/Delta/guillemotleft/guillemotright/ellipsis/blank /Agrave/Atilde/Otilde/OE/oe/endash /emdash/quotedblleft/quotedblright/quoteleft/quoteright/divide /lozenge/ydieresis/Ydieresis/fraction/currency/guilsinglleft /guilsinglright/fi/fl/daggerdbl/periodcentered/quotesinglbase /quotedblbase/perthousand/Acircumflex/Ecircumflex/Aacute/Edieresis /Egrave/Iacute/Icircumflex/Idieresis/Igrave/Oacute /Ocircumflex/apple/Ograve/Uacute/Ucircumflex/Ugrave /dotlessi/circumflex/tilde/macron/breve/dotaccent /ring/cedilla/hungarumlaut/ogonek/caron /F9/Optima -1 TZ %PDF_EndEncoding %PDF_BeginEncoding: F10 Symbol [/F10/Symbol -1 TZ %PDF_EndEncoding 0 0 612 792 RC userdict /DefaultRGB /DeviceRGB put BT /F9 1 Tf 11 0 0 11 288.5 41 Tm 0 Tr 0 g 0.006 Tc (126)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 0.023 Tc 0.255 Tw (levels of occupational physical activity among)Tj 0 -1.182 TD 0.013 Tc (Mexi)Tj 2.136 0 TD -0.005 Tc -0.13 Tw [(can )131 (Americans were associated with less NIDDM)]TJ -2.136 -1.182 TD 0.003 Tc -0.095 Tw (\(Harris 1991\). However, in contrast to findings from)Tj 0 -1.227 TD -0.121 Tw (the First National Health and Nutrition Examination)Tj 0 -1.182 TD 0.074 Tw (Survey \(Chen and Lewenstein 1986\), this associa-)Tj 0 -1.227 TD -0.109 Tw (tion was not found for either occupational or leisure-)Tj 0 -1.182 TD 0 Tw (time physical activity among blacks or whites.)Tj 1.636 -1.227 TD 0.131 Tw (Two case-control studies have found physical)Tj -1.636 -1.182 TD -0.087 Tw (inactivity to be significantly associated with NIDDM)Tj 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 (population-based nested case-control study, in which)Tj 0 -1.182 TD 0.003 Tc 0.14 Tw (women aged 55\32069 years who had high levels of)Tj 0 -1.227 TD 0.069 Tw (physical activity were found to be half as likely to)Tj 0 -1.182 TD -0.111 Tw (develop NIDDM as were same-aged women with low)Tj T* 0.11 Tw (levels of physical activity \(age-adjusted OR = 0.5;)Tj 0 -1.227 TD 0.178 Tw (95% CI, 0.4\3200.7\) \(Kaye et al. 1991\). Moderately)Tj 0 -1.182 TD 0.06 Tw (active women had an intermediate risk \(OR = 0.7;)Tj 0 -1.227 TD -0.001 Tw (95% CI, 0.5\3200.9\).)Tj 1.636 -1.182 TD 0.193 Tw (Prospective cohort studies of college alumni,)Tj -1.636 -1.227 TD 0.012 Tw (female registered nurses, and male physicians have)Tj 0 -1.182 TD -0.022 Tw (demonstrated that physical activity protects against)Tj T* -0.019 Tw [(the development of NIDDM \()25 (Table)-7 ( 4-8\). A study of)]TJ 23.909 25.182 TD -0.05 Tw (male university alumni \(Helmrich et al. 1991\) dem-)Tj 0 -1.182 TD -0.082 Tw (onstrated that physical activity was inversely related)Tj T* -0.007 Tw (to the incidence of NIDDM, a relationship that was)Tj 0 -1.227 TD -0.049 Tw (particularly evident in men at high risk for develop-)Tj 0 -1.182 TD 0.107 Tw (ing diabetes \(defined as those with a high BMI, a)Tj 0 -1.227 TD -0.036 Tw (history of high blood pressure, or a parental history)Tj 0 -1.182 TD 0.229 Tw (of diabetes\). Each 500 kilocalories of additional)Tj T* 0.057 Tw (leisure-time physical activity per week was associ-)Tj 0 -1.227 TD 0.013 Tw (ated with a 6 percent decrease in risk \(adjusted for)Tj 0 -1.182 TD -0.062 Tw (age, BMI, history of high blood pressure, and paren-)Tj 0 -1.227 TD 0.001 Tw (tal history of diabetes\) of developing NIDDM. This)Tj 0 -1.182 TD -0.023 Tw (study showed a more pronounced benefit from vig-)Tj T* -0.056 Tw (orous sports than from stair climbing or walking. In)Tj 0 -1.227 TD -0.104 Tw (a study of female registered nurses aged 34\32059 years,)Tj 0 -1.182 TD -0.058 Tw (women who reported engaging in vigorous physical)Tj 0 -1.227 TD -0.012 Tw (activity at least once a week had a 16 percent lower)Tj 0 -1.182 TD -0.124 Tw (adjusted relative risk of self-reported NIDDM during)Tj T* -0.001 Tw (the 8 years of follow-up than women who reported)Tj 0 -1.227 TD 0.005 Tw (no vigorous physical activity \(Manson et al. 1991\).)Tj 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 10 0 0 10 48 384 Tm 0.005 Tc 0 Tw [(T)60 (able 4-8.)-1321 (Cohort studies of association of physical activity with non\320insulin-d\ ependent diabetes mellitus)]TJ 5.7 -1.2 TD (\(NIDDM\))Tj ET 0 G 1 i 0 J 0 j 0.5 w 10 M []0 d 48 368.25 m 1176 368.25 l S BT /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 BT /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 (\(walking, stair climbing, and)-4427 (diagnosed diabetes)]TJ 21.6 -1.25 TD (sports\))Tj -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 16.8 -1.2 TD 0.001 Tw (fasting plasma glucose)Tj /F10 1 Tf 0 -1.25 TD (\263)Tj /F9 1 Tf 0.55 0 TD 0 Tw ( 140 mg/dl; two elevated)Tj -0.55 -1.2 TD (plasma glucose levels on)Tj 0 -1.25 TD (two different occasions;)Tj T* 0.002 Tw (hypoglycemic medication)Tj 0 -1.2 TD (use)Tj -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 21.6 -1.25 TD (activity)Tj ET 48 122.75 m 1176 122.75 l S 0 0 0 0 k 558 377.25 102 -100 re f 548 392.25 130 -83 re f 548 170.25 128 -100 re f PDFVars/TermAll get exec restore gsave showpage grestore %%Page: 47 47 save PDFVars/InitAll get exec %PDF_BeginEncoding: F5 Optima-Bold [ 39/quotesingle 96/grave 127/.notdef/Adieresis/Aring/Ccedilla /Eacute/Ntilde/Odieresis/Udieresis/aacute/agrave /acircumflex/adieresis/atilde/aring/ccedilla/eacute /egrave/ecircumflex/edieresis/iacute/igrave/icircumflex /idieresis/ntilde/oacute/ograve/ocircumflex/odieresis /otilde/uacute/ugrave/ucircumflex/udieresis/dagger /degree/cent/sterling/section/bullet/paragraph /germandbls/registered/copyright/trademark/acute/dieresis /notequal/AE/Oslash/infinity/plusminus/lessequal /greaterequal/yen/mu/partialdiff/summation/product /pi/integral/ordfeminine/ordmasculine/Omega/ae /oslash/questiondown/exclamdown/logicalnot/radical/florin /approxequal/Delta/guillemotleft/guillemotright/ellipsis/blank /Agrave/Atilde/Otilde/OE/oe/endash /emdash/quotedblleft/quotedblright/quoteleft/quoteright/divide /lozenge/ydieresis/Ydieresis/fraction/currency/guilsinglleft /guilsinglright/fi/fl/daggerdbl/periodcentered/quotesinglbase /quotedblbase/perthousand/Acircumflex/Ecircumflex/Aacute/Edieresis /Egrave/Iacute/Icircumflex/Idieresis/Igrave/Oacute /Ocircumflex/apple/Ograve/Uacute/Ucircumflex/Ugrave /dotlessi/circumflex/tilde/macron/breve/dotaccent /ring/cedilla/hungarumlaut/ogonek/caron /F5/Optima-Bold -1 TZ %PDF_EndEncoding %PDF_BeginEncoding: F7 Berkeley-Medium [ 39/quotesingle 96/grave 127/.notdef/Adieresis/Aring/Ccedilla /Eacute/Ntilde/Odieresis/Udieresis/aacute/agrave /acircumflex/adieresis/atilde/aring/ccedilla/eacute /egrave/ecircumflex/edieresis/iacute/igrave/icircumflex /idieresis/ntilde/oacute/ograve/ocircumflex/odieresis /otilde/uacute/ugrave/ucircumflex/udieresis/dagger /degree/cent/sterling/section/bullet/paragraph /germandbls/registered/copyright/trademark/acute/dieresis /notequal/AE/Oslash/infinity/plusminus/lessequal /greaterequal/yen/mu/partialdiff/summation/product /pi/integral/ordfeminine/ordmasculine/Omega/ae /oslash/questiondown/exclamdown/logicalnot/radical/florin /approxequal/Delta/guillemotleft/guillemotright/ellipsis/blank /Agrave/Atilde/Otilde/OE/oe/endash /emdash/quotedblleft/quotedblright/quoteleft/quoteright/divide /lozenge/ydieresis/Ydieresis/fraction/currency/guilsinglleft /guilsinglright/fi/fl/daggerdbl/periodcentered/quotesinglbase /quotedblbase/perthousand/Acircumflex/Ecircumflex/Aacute/Edieresis /Egrave/Iacute/Icircumflex/Idieresis/Igrave/Oacute /Ocircumflex/apple/Ograve/Uacute/Ucircumflex/Ugrave /dotlessi/circumflex/tilde/macron/breve/dotaccent /ring/cedilla/hungarumlaut/ogonek/caron /F7/Berkeley-Medium -1 TZ %PDF_EndEncoding %PDF_BeginEncoding: F9 Optima [ 39/quotesingle 96/grave 127/.notdef/Adieresis/Aring/Ccedilla /Eacute/Ntilde/Odieresis/Udieresis/aacute/agrave /acircumflex/adieresis/atilde/aring/ccedilla/eacute /egrave/ecircumflex/edieresis/iacute/igrave/icircumflex /idieresis/ntilde/oacute/ograve/ocircumflex/odieresis /otilde/uacute/ugrave/ucircumflex/udieresis/dagger /degree/cent/sterling/section/bullet/paragraph /germandbls/registered/copyright/trademark/acute/dieresis /notequal/AE/Oslash/infinity/plusminus/lessequal /greaterequal/yen/mu/partialdiff/summation/product /pi/integral/ordfeminine/ordmasculine/Omega/ae /oslash/questiondown/exclamdown/logicalnot/radical/florin /approxequal/Delta/guillemotleft/guillemotright/ellipsis/blank /Agrave/Atilde/Otilde/OE/oe/endash /emdash/quotedblleft/quotedblright/quoteleft/quoteright/divide /lozenge/ydieresis/Ydieresis/fraction/currency/guilsinglleft /guilsinglright/fi/fl/daggerdbl/periodcentered/quotesinglbase /quotedblbase/perthousand/Acircumflex/Ecircumflex/Aacute/Edieresis /Egrave/Iacute/Icircumflex/Idieresis/Igrave/Oacute /Ocircumflex/apple/Ograve/Uacute/Ucircumflex/Ugrave /dotlessi/circumflex/tilde/macron/breve/dotaccent /ring/cedilla/hungarumlaut/ogonek/caron /F9/Optima -1 TZ %PDF_EndEncoding %PDF_BeginEncoding: F10 Symbol [/F10/Symbol -1 TZ %PDF_EndEncoding 0 0 612 792 RC userdict /DefaultRGB /DeviceRGB put BT /F9 1 Tf 11 0 0 11 305 41 Tm 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 0 -1.182 TD 0.002 Tc -0.128 Tw (college-educated persons. In these three cohort stud-)Tj 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 0 -1.227 TD -0.023 Tw (duce certain cardiovascular risk factors among per-)Tj 0 -1.182 TD -0.001 Tw (sons with diabetes \(American Diabetes Association)Tj 0 -1.227 TD -0.083 Tw (1990\). 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 \(particularly those who take insulin for)Tj 0 -1.182 TD 0 Tc 0.2 Tw [(blood glucose control\) 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 0 -1.227 TD 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 (among older people with NIDDM and advanced, but)Tj 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 0 -1.187 TD 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 ET 0 0 0 0 k -54 377.25 102 -100 re f -64 392.25 130 -83 re f -64 170.25 128 -100 re f PDFVars/TermAll get exec restore gsave showpage grestore %%Page: 48 48 save PDFVars/InitAll get exec %PDF_BeginEncoding: F5 Optima-Bold [ 39/quotesingle 96/grave 127/.notdef/Adieresis/Aring/Ccedilla /Eacute/Ntilde/Odieresis/Udieresis/aacute/agrave /acircumflex/adieresis/atilde/aring/ccedilla/eacute /egrave/ecircumflex/edieresis/iacute/igrave/icircumflex /idieresis/ntilde/oacute/ograve/ocircumflex/odieresis /otilde/uacute/ugrave/ucircumflex/udieresis/dagger /degree/cent/sterling/section/bullet/paragraph /germandbls/registered/copyright/trademark/acute/dieresis /notequal/AE/Oslash/infinity/plusminus/lessequal /greaterequal/yen/mu/partialdiff/summation/product /pi/integral/ordfeminine/ordmasculine/Omega/ae /oslash/questiondown/exclamdown/logicalnot/radical/florin /approxequal/Delta/guillemotleft/guillemotright/ellipsis/blank /Agrave/Atilde/Otilde/OE/oe/endash /emdash/quotedblleft/quotedblright/quoteleft/quoteright/divide /lozenge/ydieresis/Ydieresis/fraction/currency/guilsinglleft /guilsinglright/fi/fl/daggerdbl/periodcentered/quotesinglbase /quotedblbase/perthousand/Acircumflex/Ecircumflex/Aacute/Edieresis /Egrave/Iacute/Icircumflex/Idieresis/Igrave/Oacute /Ocircumflex/apple/Ograve/Uacute/Ucircumflex/Ugrave /dotlessi/circumflex/tilde/macron/breve/dotaccent /ring/cedilla/hungarumlaut/ogonek/caron /F5/Optima-Bold -1 TZ %PDF_EndEncoding %PDF_BeginEncoding: F7 Berkeley-Medium [ 39/quotesingle 96/grave 127/.notdef/Adieresis/Aring/Ccedilla /Eacute/Ntilde/Odieresis/Udieresis/aacute/agrave /acircumflex/adieresis/atilde/aring/ccedilla/eacute /egrave/ecircumflex/edieresis/iacute/igrave/icircumflex /idieresis/ntilde/oacute/ograve/ocircumflex/odieresis /otilde/uacute/ugrave/ucircumflex/udieresis/dagger /degree/cent/sterling/section/bullet/paragraph /germandbls/registered/copyright/trademark/acute/dieresis /notequal/AE/Oslash/infinity/plusminus/lessequal /greaterequal/yen/mu/partialdiff/summation/product /pi/integral/ordfeminine/ordmasculine/Omega/ae /oslash/questiondown/exclamdown/logicalnot/radical/florin /approxequal/Delta/guillemotleft/guillemotright/ellipsis/blank /Agrave/Atilde/Otilde/OE/oe/endash /emdash/quotedblleft/quotedblright/quoteleft/quoteright/divide /lozenge/ydieresis/Ydieresis/fraction/currency/guilsinglleft /guilsinglright/fi/fl/daggerdbl/periodcentered/quotesinglbase /quotedblbase/perthousand/Acircumflex/Ecircumflex/Aacute/Edieresis /Egrave/Iacute/Icircumflex/Idieresis/Igrave/Oacute /Ocircumflex/apple/Ograve/Uacute/Ucircumflex/Ugrave /dotlessi/circumflex/tilde/macron/breve/dotaccent /ring/cedilla/hungarumlaut/ogonek/caron /F7/Berkeley-Medium -1 TZ %PDF_EndEncoding %PDF_BeginEncoding: F9 Optima [ 39/quotesingle 96/grave 127/.notdef/Adieresis/Aring/Ccedilla /Eacute/Ntilde/Odieresis/Udieresis/aacute/agrave /acircumflex/adieresis/atilde/aring/ccedilla/eacute /egrave/ecircumflex/edieresis/iacute/igrave/icircumflex /idieresis/ntilde/oacute/ograve/ocircumflex/odieresis /otilde/uacute/ugrave/ucircumflex/udieresis/dagger /degree/cent/sterling/section/bullet/paragraph /germandbls/registered/copyright/trademark/acute/dieresis /notequal/AE/Oslash/infinity/plusminus/lessequal /greaterequal/yen/mu/partialdiff/summation/product /pi/integral/ordfeminine/ordmasculine/Omega/ae /oslash/questiondown/exclamdown/logicalnot/radical/florin /approxequal/Delta/guillemotleft/guillemotright/ellipsis/blank /Agrave/Atilde/Otilde/OE/oe/endash /emdash/quotedblleft/quotedblright/quoteleft/quoteright/divide /lozenge/ydieresis/Ydieresis/fraction/currency/guilsinglleft /guilsinglright/fi/fl/daggerdbl/periodcentered/quotesinglbase /quotedblbase/perthousand/Acircumflex/Ecircumflex/Aacute/Edieresis /Egrave/Iacute/Icircumflex/Idieresis/Igrave/Oacute /Ocircumflex/apple/Ograve/Uacute/Ucircumflex/Ugrave /dotlessi/circumflex/tilde/macron/breve/dotaccent /ring/cedilla/hungarumlaut/ogonek/caron /F9/Optima -1 TZ %PDF_EndEncoding 0 0 612 792 RC userdict /DefaultRGB /DeviceRGB put BT /F9 1 Tf 11 0 0 11 288.5 41 Tm 0 Tr 0 g 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 ET PDFVars/TermAll get exec restore gsave showpage grestore %%Page: 49 49 save PDFVars/InitAll get exec %PDF_BeginEncoding: F5 Optima-Bold [ 39/quotesingle 96/grave 127/.notdef/Adieresis/Aring/Ccedilla /Eacute/Ntilde/Odieresis/Udieresis/aacute/agrave /acircumflex/adieresis/atilde/aring/ccedilla/eacute /egrave/ecircumflex/edieresis/iacute/igrave/icircumflex /idieresis/ntilde/oacute/ograve/ocircumflex/odieresis /otilde/uacute/ugrave/ucircumflex/udieresis/dagger /degree/cent/sterling/section/bullet/paragraph /germandbls/registered/copyright/trademark/acute/dieresis /notequal/AE/Oslash/infinity/plusminus/lessequal /greaterequal/yen/mu/partialdiff/summation/product /pi/integral/ordfeminine/ordmasculine/Omega/ae /oslash/questiondown/exclamdown/logicalnot/radical/florin /approxequal/Delta/guillemotleft/guillemotright/ellipsis/blank /Agrave/Atilde/Otilde/OE/oe/endash /emdash/quotedblleft/quotedblright/quoteleft/quoteright/divide /lozenge/ydieresis/Ydieresis/fraction/currency/guilsinglleft /guilsinglright/fi/fl/daggerdbl/periodcentered/quotesinglbase /quotedblbase/perthousand/Acircumflex/Ecircumflex/Aacute/Edieresis /Egrave/Iacute/Icircumflex/Idieresis/Igrave/Oacute /Ocircumflex/apple/Ograve/Uacute/Ucircumflex/Ugrave /dotlessi/circumflex/tilde/macron/breve/dotaccent /ring/cedilla/hungarumlaut/ogonek/caron /F5/Optima-Bold -1 TZ %PDF_EndEncoding %PDF_BeginEncoding: F7 Berkeley-Medium [ 39/quotesingle 96/grave 127/.notdef/Adieresis/Aring/Ccedilla /Eacute/Ntilde/Odieresis/Udieresis/aacute/agrave /acircumflex/adieresis/atilde/aring/ccedilla/eacute /egrave/ecircumflex/edieresis/iacute/igrave/icircumflex /idieresis/ntilde/oacute/ograve/ocircumflex/odieresis /otilde/uacute/ugrave/ucircumflex/udieresis/dagger /degree/cent/sterling/section/bullet/paragraph /germandbls/registered/copyright/trademark/acute/dieresis /notequal/AE/Oslash/infinity/plusminus/lessequal /greaterequal/yen/mu/partialdiff/summation/product /pi/integral/ordfeminine/ordmasculine/Omega/ae /oslash/questiondown/exclamdown/logicalnot/radical/florin /approxequal/Delta/guillemotleft/guillemotright/ellipsis/blank /Agrave/Atilde/Otilde/OE/oe/endash /emdash/quotedblleft/quotedblright/quoteleft/quoteright/divide /lozenge/ydieresis/Ydieresis/fraction/currency/guilsinglleft /guilsinglright/fi/fl/daggerdbl/periodcentered/quotesinglbase /quotedblbase/perthousand/Acircumflex/Ecircumflex/Aacute/Edieresis /Egrave/Iacute/Icircumflex/Idieresis/Igrave/Oacute /Ocircumflex/apple/Ograve/Uacute/Ucircumflex/Ugrave /dotlessi/circumflex/tilde/macron/breve/dotaccent /ring/cedilla/hungarumlaut/ogonek/caron /F7/Berkeley-Medium -1 TZ %PDF_EndEncoding %PDF_BeginEncoding: F9 Optima [ 39/quotesingle 96/grave 127/.notdef/Adieresis/Aring/Ccedilla /Eacute/Ntilde/Odieresis/Udieresis/aacute/agrave /acircumflex/adieresis/atilde/aring/ccedilla/eacute /egrave/ecircumflex/edieresis/iacute/igrave/icircumflex /idieresis/ntilde/oacute/ograve/ocircumflex/odieresis /otilde/uacute/ugrave/ucircumflex/udieresis/dagger /degree/cent/sterling/section/bullet/paragraph /germandbls/registered/copyright/trademark/acute/dieresis /notequal/AE/Oslash/infinity/plusminus/lessequal /greaterequal/yen/mu/partialdiff/summation/product /pi/integral/ordfeminine/ordmasculine/Omega/ae /oslash/questiondown/exclamdown/logicalnot/radical/florin /approxequal/Delta/guillemotleft/guillemotright/ellipsis/blank /Agrave/Atilde/Otilde/OE/oe/endash /emdash/quotedblleft/quotedblright/quoteleft/quoteright/divide /lozenge/ydieresis/Ydieresis/fraction/currency/guilsinglleft /guilsinglright/fi/fl/daggerdbl/periodcentered/quotesinglbase /quotedblbase/perthousand/Acircumflex/Ecircumflex/Aacute/Edieresis /Egrave/Iacute/Icircumflex/Idieresis/Igrave/Oacute /Ocircumflex/apple/Ograve/Uacute/Ucircumflex/Ugrave /dotlessi/circumflex/tilde/macron/breve/dotaccent /ring/cedilla/hungarumlaut/ogonek/caron /F9/Optima -1 TZ %PDF_EndEncoding 0 0 612 792 RC userdict /DefaultRGB /DeviceRGB put BT /F9 1 Tf 11 0 0 11 305 41 Tm 0 Tr 0 g 0.006 Tc (129)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 0.004 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 0 Tw (topic needs further study.)Tj /F5 1 Tf 14 0 0 14 66 618.5 Tm -0.002 Tc (Osteoarthritis)Tj /F7 1 Tf 11 0 0 11 66 603 Tm 0.003 Tc -0.098 Tw (Osteoarthritis, the most common form of arthritis, is)Tj 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 12 0 0 12 329.5 484.5 Tm 0 Tc (Physical Activity in Persons with Arthritis)Tj /F7 1 Tf 11 0 0 11 329.5 470 Tm 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 0 -1.182 TD -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 -0.045 Tw (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 0 -1.227 TD 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 ET PDFVars/TermAll get exec restore gsave showpage grestore %%Page: 50 50 save PDFVars/InitAll get exec %PDF_BeginEncoding: F5 Optima-Bold [ 39/quotesingle 96/grave 127/.notdef/Adieresis/Aring/Ccedilla /Eacute/Ntilde/Odieresis/Udieresis/aacute/agrave /acircumflex/adieresis/atilde/aring/ccedilla/eacute /egrave/ecircumflex/edieresis/iacute/igrave/icircumflex /idieresis/ntilde/oacute/ograve/ocircumflex/odieresis /otilde/uacute/ugrave/ucircumflex/udieresis/dagger /degree/cent/sterling/section/bullet/paragraph /germandbls/registered/copyright/trademark/acute/dieresis /notequal/AE/Oslash/infinity/plusminus/lessequal /greaterequal/yen/mu/partialdiff/summation/product /pi/integral/ordfeminine/ordmasculine/Omega/ae /oslash/questiondown/exclamdown/logicalnot/radical/florin /approxequal/Delta/guillemotleft/guillemotright/ellipsis/blank /Agrave/Atilde/Otilde/OE/oe/endash /emdash/quotedblleft/quotedblright/quoteleft/quoteright/divide /lozenge/ydieresis/Ydieresis/fraction/currency/guilsinglleft /guilsinglright/fi/fl/daggerdbl/periodcentered/quotesinglbase /quotedblbase/perthousand/Acircumflex/Ecircumflex/Aacute/Edieresis /Egrave/Iacute/Icircumflex/Idieresis/Igrave/Oacute /Ocircumflex/apple/Ograve/Uacute/Ucircumflex/Ugrave /dotlessi/circumflex/tilde/macron/breve/dotaccent /ring/cedilla/hungarumlaut/ogonek/caron /F5/Optima-Bold -1 TZ %PDF_EndEncoding %PDF_BeginEncoding: F7 Berkeley-Medium [ 39/quotesingle 96/grave 127/.notdef/Adieresis/Aring/Ccedilla /Eacute/Ntilde/Odieresis/Udieresis/aacute/agrave /acircumflex/adieresis/atilde/aring/ccedilla/eacute /egrave/ecircumflex/edieresis/iacute/igrave/icircumflex /idieresis/ntilde/oacute/ograve/ocircumflex/odieresis /otilde/uacute/ugrave/ucircumflex/udieresis/dagger /degree/cent/sterling/section/bullet/paragraph /germandbls/registered/copyright/trademark/acute/dieresis /notequal/AE/Oslash/infinity/plusminus/lessequal /greaterequal/yen/mu/partialdiff/summation/product /pi/integral/ordfeminine/ordmasculine/Omega/ae /oslash/questiondown/exclamdown/logicalnot/radical/florin /approxequal/Delta/guillemotleft/guillemotright/ellipsis/blank /Agrave/Atilde/Otilde/OE/oe/endash /emdash/quotedblleft/quotedblright/quoteleft/quoteright/divide /lozenge/ydieresis/Ydieresis/fraction/currency/guilsinglleft /guilsinglright/fi/fl/daggerdbl/periodcentered/quotesinglbase /quotedblbase/perthousand/Acircumflex/Ecircumflex/Aacute/Edieresis /Egrave/Iacute/Icircumflex/Idieresis/Igrave/Oacute /Ocircumflex/apple/Ograve/Uacute/Ucircumflex/Ugrave /dotlessi/circumflex/tilde/macron/breve/dotaccent /ring/cedilla/hungarumlaut/ogonek/caron /F7/Berkeley-Medium -1 TZ %PDF_EndEncoding %PDF_BeginEncoding: F9 Optima [ 39/quotesingle 96/grave 127/.notdef/Adieresis/Aring/Ccedilla /Eacute/Ntilde/Odieresis/Udieresis/aacute/agrave /acircumflex/adieresis/atilde/aring/ccedilla/eacute /egrave/ecircumflex/edieresis/iacute/igrave/icircumflex /idieresis/ntilde/oacute/ograve/ocircumflex/odieresis /otilde/uacute/ugrave/ucircumflex/udieresis/dagger /degree/cent/sterling/section/bullet/paragraph /germandbls/registered/copyright/trademark/acute/dieresis /notequal/AE/Oslash/infinity/plusminus/lessequal /greaterequal/yen/mu/partialdiff/summation/product /pi/integral/ordfeminine/ordmasculine/Omega/ae /oslash/questiondown/exclamdown/logicalnot/radical/florin /approxequal/Delta/guillemotleft/guillemotright/ellipsis/blank /Agrave/Atilde/Otilde/OE/oe/endash /emdash/quotedblleft/quotedblright/quoteleft/quoteright/divide /lozenge/ydieresis/Ydieresis/fraction/currency/guilsinglleft /guilsinglright/fi/fl/daggerdbl/periodcentered/quotesinglbase /quotedblbase/perthousand/Acircumflex/Ecircumflex/Aacute/Edieresis /Egrave/Iacute/Icircumflex/Idieresis/Igrave/Oacute /Ocircumflex/apple/Ograve/Uacute/Ucircumflex/Ugrave /dotlessi/circumflex/tilde/macron/breve/dotaccent /ring/cedilla/hungarumlaut/ogonek/caron /F9/Optima -1 TZ %PDF_EndEncoding 0 0 612 792 RC userdict /DefaultRGB /DeviceRGB put BT /F9 1 Tf 11 0 0 11 288.5 41 Tm 0 Tr 0 g 0.006 Tc (130)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 (Biologic Plausibility)Tj /F7 1 Tf 11 0 0 11 48 695.5 Tm 0.013 Tc 0.243 Tw (The biologic effects of physical activity on the)Tj 0 -1.182 TD -0.009 Tw (health and function of joints have not been exten-)Tj 0 -1.227 TD -0.105 Tw (sively investigated, but some level of physical activ-)Tj 0 -1.182 TD -0.021 Tw (ity is necessary to preserve joint function. Because)Tj 0 -1.227 TD 0.124 Tw (hyaline cartilage has no blood vessels or nerves,)Tj 0 -1.182 TD -0.095 Tw (mature cartilage cells \(chondrocytes\) receive nour-)Tj T* 0.017 Tc 0.259 Tw (ishment only from the diffusion of substances)Tj 0 -1.227 TD 0.013 Tc -0.114 Tw (through the cartilage matrix from joint fluid. Physi-)Tj 0 -1.182 TD -0.115 Tw (cal activity enhances this process. In the laboratory,)Tj 0 -1.227 TD 0.12 Tw (putting pressure on cartilage deforms the tissue,)Tj 0 -1.182 TD -0.04 Tw (creating pressure gradients that cause fluid to flow)Tj T* 0.181 Tw (and alter osmotic pressures within the cartilage)Tj 0 -1.227 TD -0.085 Tw (matrix \(Hall, Urban, Gehl 1991\). The effect of such)Tj 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 14 0 0 14 311.5 709 Tm -0.002 Tc (Osteoporosis)Tj /F7 1 Tf 11 0 0 11 311.5 693 Tm 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 -0.105 Tw (the development of bone mass during childhood and)Tj 0 -1.182 TD -0.076 Tw (adolescence and in the maintenance of skeletal mass)Tj ET PDFVars/TermAll get exec restore gsave showpage grestore %%Page: 51 51 save PDFVars/InitAll get exec %PDF_BeginEncoding: F5 Optima-Bold [ 39/quotesingle 96/grave 127/.notdef/Adieresis/Aring/Ccedilla /Eacute/Ntilde/Odieresis/Udieresis/aacute/agrave /acircumflex/adieresis/atilde/aring/ccedilla/eacute /egrave/ecircumflex/edieresis/iacute/igrave/icircumflex /idieresis/ntilde/oacute/ograve/ocircumflex/odieresis /otilde/uacute/ugrave/ucircumflex/udieresis/dagger /degree/cent/sterling/section/bullet/paragraph /germandbls/registered/copyright/trademark/acute/dieresis /notequal/AE/Oslash/infinity/plusminus/lessequal /greaterequal/yen/mu/partialdiff/summation/product /pi/integral/ordfeminine/ordmasculine/Omega/ae /oslash/questiondown/exclamdown/logicalnot/radical/florin /approxequal/Delta/guillemotleft/guillemotright/ellipsis/blank /Agrave/Atilde/Otilde/OE/oe/endash /emdash/quotedblleft/quotedblright/quoteleft/quoteright/divide /lozenge/ydieresis/Ydieresis/fraction/currency/guilsinglleft /guilsinglright/fi/fl/daggerdbl/periodcentered/quotesinglbase /quotedblbase/perthousand/Acircumflex/Ecircumflex/Aacute/Edieresis /Egrave/Iacute/Icircumflex/Idieresis/Igrave/Oacute /Ocircumflex/apple/Ograve/Uacute/Ucircumflex/Ugrave /dotlessi/circumflex/tilde/macron/breve/dotaccent /ring/cedilla/hungarumlaut/ogonek/caron /F5/Optima-Bold -1 TZ %PDF_EndEncoding %PDF_BeginEncoding: F7 Berkeley-Medium [ 39/quotesingle 96/grave 127/.notdef/Adieresis/Aring/Ccedilla /Eacute/Ntilde/Odieresis/Udieresis/aacute/agrave /acircumflex/adieresis/atilde/aring/ccedilla/eacute /egrave/ecircumflex/edieresis/iacute/igrave/icircumflex /idieresis/ntilde/oacute/ograve/ocircumflex/odieresis /otilde/uacute/ugrave/ucircumflex/udieresis/dagger /degree/cent/sterling/section/bullet/paragraph /germandbls/registered/copyright/trademark/acute/dieresis /notequal/AE/Oslash/infinity/plusminus/lessequal /greaterequal/yen/mu/partialdiff/summation/product /pi/integral/ordfeminine/ordmasculine/Omega/ae /oslash/questiondown/exclamdown/logicalnot/radical/florin /approxequal/Delta/guillemotleft/guillemotright/ellipsis/blank /Agrave/Atilde/Otilde/OE/oe/endash /emdash/quotedblleft/quotedblright/quoteleft/quoteright/divide /lozenge/ydieresis/Ydieresis/fraction/currency/guilsinglleft /guilsinglright/fi/fl/daggerdbl/periodcentered/quotesinglbase /quotedblbase/perthousand/Acircumflex/Ecircumflex/Aacute/Edieresis /Egrave/Iacute/Icircumflex/Idieresis/Igrave/Oacute /Ocircumflex/apple/Ograve/Uacute/Ucircumflex/Ugrave /dotlessi/circumflex/tilde/macron/breve/dotaccent /ring/cedilla/hungarumlaut/ogonek/caron /F7/Berkeley-Medium -1 TZ %PDF_EndEncoding %PDF_BeginEncoding: F9 Optima [ 39/quotesingle 96/grave 127/.notdef/Adieresis/Aring/Ccedilla /Eacute/Ntilde/Odieresis/Udieresis/aacute/agrave /acircumflex/adieresis/atilde/aring/ccedilla/eacute /egrave/ecircumflex/edieresis/iacute/igrave/icircumflex /idieresis/ntilde/oacute/ograve/ocircumflex/odieresis /otilde/uacute/ugrave/ucircumflex/udieresis/dagger /degree/cent/sterling/section/bullet/paragraph /germandbls/registered/copyright/trademark/acute/dieresis /notequal/AE/Oslash/infinity/plusminus/lessequal /greaterequal/yen/mu/partialdiff/summation/product /pi/integral/ordfeminine/ordmasculine/Omega/ae /oslash/questiondown/exclamdown/logicalnot/radical/florin /approxequal/Delta/guillemotleft/guillemotright/ellipsis/blank /Agrave/Atilde/Otilde/OE/oe/endash /emdash/quotedblleft/quotedblright/quoteleft/quoteright/divide /lozenge/ydieresis/Ydieresis/fraction/currency/guilsinglleft /guilsinglright/fi/fl/daggerdbl/periodcentered/quotesinglbase /quotedblbase/perthousand/Acircumflex/Ecircumflex/Aacute/Edieresis /Egrave/Iacute/Icircumflex/Idieresis/Igrave/Oacute /Ocircumflex/apple/Ograve/Uacute/Ucircumflex/Ugrave /dotlessi/circumflex/tilde/macron/breve/dotaccent /ring/cedilla/hungarumlaut/ogonek/caron /F9/Optima -1 TZ %PDF_EndEncoding 0 0 612 792 RC userdict /DefaultRGB /DeviceRGB put BT /F9 1 Tf 11 0 0 11 305 41 Tm 0 Tr 0 g 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 0 -1.182 TD 0.236 Tw (determine definitively the longitudinal effects of)Tj T* 0.023 Tc -0.023 Tw (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 0 -1.182 TD (density.)Tj /F5 1 Tf 12 0 0 12 329.5 273.5 Tm 0 Tc 0 Tw (Biologic Plausibility)Tj /F7 1 Tf 11 0 0 11 329.5 258.5 Tm 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 -0.078 Tw (Physical activity, through its load-bearing effect on)Tj 0 -1.182 TD 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 -0.051 Tw (bone resorption, which in turn builds greater bone)Tj 0 -1.182 TD -0.116 Tw (mass \(Lanyon 1987, 1993\). The higher the load, the)Tj 0 -1.227 TD 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 (declines. Glucose-6-phosphate, prostaglandins, and)Tj 0 -1.227 TD 0.013 Tc -0.091 Tw (nitric oxide play a role in mediating the mechanical)Tj ET PDFVars/TermAll get exec restore gsave showpage grestore %%Page: 52 52 save PDFVars/InitAll get exec %PDF_BeginEncoding: F5 Optima-Bold [ 39/quotesingle 96/grave 127/.notdef/Adieresis/Aring/Ccedilla /Eacute/Ntilde/Odieresis/Udieresis/aacute/agrave /acircumflex/adieresis/atilde/aring/ccedilla/eacute /egrave/ecircumflex/edieresis/iacute/igrave/icircumflex /idieresis/ntilde/oacute/ograve/ocircumflex/odieresis /otilde/uacute/ugrave/ucircumflex/udieresis/dagger /degree/cent/sterling/section/bullet/paragraph /germandbls/registered/copyright/trademark/acute/dieresis /notequal/AE/Oslash/infinity/plusminus/lessequal /greaterequal/yen/mu/partialdiff/summation/product /pi/integral/ordfeminine/ordmasculine/Omega/ae /oslash/questiondown/exclamdown/logicalnot/radical/florin /approxequal/Delta/guillemotleft/guillemotright/ellipsis/blank /Agrave/Atilde/Otilde/OE/oe/endash /emdash/quotedblleft/quotedblright/quoteleft/quoteright/divide /lozenge/ydieresis/Ydieresis/fraction/currency/guilsinglleft /guilsinglright/fi/fl/daggerdbl/periodcentered/quotesinglbase /quotedblbase/perthousand/Acircumflex/Ecircumflex/Aacute/Edieresis /Egrave/Iacute/Icircumflex/Idieresis/Igrave/Oacute /Ocircumflex/apple/Ograve/Uacute/Ucircumflex/Ugrave /dotlessi/circumflex/tilde/macron/breve/dotaccent /ring/cedilla/hungarumlaut/ogonek/caron /F5/Optima-Bold -1 TZ %PDF_EndEncoding %PDF_BeginEncoding: F7 Berkeley-Medium [ 39/quotesingle 96/grave 127/.notdef/Adieresis/Aring/Ccedilla /Eacute/Ntilde/Odieresis/Udieresis/aacute/agrave /acircumflex/adieresis/atilde/aring/ccedilla/eacute /egrave/ecircumflex/edieresis/iacute/igrave/icircumflex /idieresis/ntilde/oacute/ograve/ocircumflex/odieresis /otilde/uacute/ugrave/ucircumflex/udieresis/dagger /degree/cent/sterling/section/bullet/paragraph /germandbls/registered/copyright/trademark/acute/dieresis /notequal/AE/Oslash/infinity/plusminus/lessequal /greaterequal/yen/mu/partialdiff/summation/product /pi/integral/ordfeminine/ordmasculine/Omega/ae /oslash/questiondown/exclamdown/logicalnot/radical/florin /approxequal/Delta/guillemotleft/guillemotright/ellipsis/blank /Agrave/Atilde/Otilde/OE/oe/endash /emdash/quotedblleft/quotedblright/quoteleft/quoteright/divide /lozenge/ydieresis/Ydieresis/fraction/currency/guilsinglleft /guilsinglright/fi/fl/daggerdbl/periodcentered/quotesinglbase /quotedblbase/perthousand/Acircumflex/Ecircumflex/Aacute/Edieresis /Egrave/Iacute/Icircumflex/Idieresis/Igrave/Oacute /Ocircumflex/apple/Ograve/Uacute/Ucircumflex/Ugrave /dotlessi/circumflex/tilde/macron/breve/dotaccent /ring/cedilla/hungarumlaut/ogonek/caron /F7/Berkeley-Medium -1 TZ %PDF_EndEncoding %PDF_BeginEncoding: F9 Optima [ 39/quotesingle 96/grave 127/.notdef/Adieresis/Aring/Ccedilla /Eacute/Ntilde/Odieresis/Udieresis/aacute/agrave /acircumflex/adieresis/atilde/aring/ccedilla/eacute /egrave/ecircumflex/edieresis/iacute/igrave/icircumflex /idieresis/ntilde/oacute/ograve/ocircumflex/odieresis /otilde/uacute/ugrave/ucircumflex/udieresis/dagger /degree/cent/sterling/section/bullet/paragraph /germandbls/registered/copyright/trademark/acute/dieresis /notequal/AE/Oslash/infinity/plusminus/lessequal /greaterequal/yen/mu/partialdiff/summation/product /pi/integral/ordfeminine/ordmasculine/Omega/ae /oslash/questiondown/exclamdown/logicalnot/radical/florin /approxequal/Delta/guillemotleft/guillemotright/ellipsis/blank /Agrave/Atilde/Otilde/OE/oe/endash /emdash/quotedblleft/quotedblright/quoteleft/quoteright/divide /lozenge/ydieresis/Ydieresis/fraction/currency/guilsinglleft /guilsinglright/fi/fl/daggerdbl/periodcentered/quotesinglbase /quotedblbase/perthousand/Acircumflex/Ecircumflex/Aacute/Edieresis /Egrave/Iacute/Icircumflex/Idieresis/Igrave/Oacute /Ocircumflex/apple/Ograve/Uacute/Ucircumflex/Ugrave /dotlessi/circumflex/tilde/macron/breve/dotaccent /ring/cedilla/hungarumlaut/ogonek/caron /F9/Optima -1 TZ %PDF_EndEncoding 0 0 612 792 RC userdict /DefaultRGB /DeviceRGB put BT /F9 1 Tf 11 0 0 11 288.5 41 Tm 0 Tr 0 g 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 (against falling and fractures among the elderly, prob-)Tj T* 0 Tw (ably by increasing muscle strength and balance.)Tj ET PDFVars/TermAll get exec restore gsave showpage grestore %%Page: 53 53 save PDFVars/InitAll get exec %PDF_BeginEncoding: F5 Optima-Bold [ 39/quotesingle 96/grave 127/.notdef/Adieresis/Aring/Ccedilla /Eacute/Ntilde/Odieresis/Udieresis/aacute/agrave /acircumflex/adieresis/atilde/aring/ccedilla/eacute /egrave/ecircumflex/edieresis/iacute/igrave/icircumflex /idieresis/ntilde/oacute/ograve/ocircumflex/odieresis /otilde/uacute/ugrave/ucircumflex/udieresis/dagger 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/Eacute/Ntilde/Odieresis/Udieresis/aacute/agrave /acircumflex/adieresis/atilde/aring/ccedilla/eacute /egrave/ecircumflex/edieresis/iacute/igrave/icircumflex /idieresis/ntilde/oacute/ograve/ocircumflex/odieresis /otilde/uacute/ugrave/ucircumflex/udieresis/dagger /degree/cent/sterling/section/bullet/paragraph /germandbls/registered/copyright/trademark/acute/dieresis /notequal/AE/Oslash/infinity/plusminus/lessequal /greaterequal/yen/mu/partialdiff/summation/product /pi/integral/ordfeminine/ordmasculine/Omega/ae /oslash/questiondown/exclamdown/logicalnot/radical/florin /approxequal/Delta/guillemotleft/guillemotright/ellipsis/blank /Agrave/Atilde/Otilde/OE/oe/endash /emdash/quotedblleft/quotedblright/quoteleft/quoteright/divide /lozenge/ydieresis/Ydieresis/fraction/currency/guilsinglleft /guilsinglright/fi/fl/daggerdbl/periodcentered/quotesinglbase /quotedblbase/perthousand/Acircumflex/Ecircumflex/Aacute/Edieresis /Egrave/Iacute/Icircumflex/Idieresis/Igrave/Oacute /Ocircumflex/apple/Ograve/Uacute/Ucircumflex/Ugrave /dotlessi/circumflex/tilde/macron/breve/dotaccent /ring/cedilla/hungarumlaut/ogonek/caron /F7/Berkeley-Medium -1 TZ %PDF_EndEncoding %PDF_BeginEncoding: F9 Optima [ 39/quotesingle 96/grave 127/.notdef/Adieresis/Aring/Ccedilla /Eacute/Ntilde/Odieresis/Udieresis/aacute/agrave /acircumflex/adieresis/atilde/aring/ccedilla/eacute /egrave/ecircumflex/edieresis/iacute/igrave/icircumflex /idieresis/ntilde/oacute/ograve/ocircumflex/odieresis /otilde/uacute/ugrave/ucircumflex/udieresis/dagger /degree/cent/sterling/section/bullet/paragraph /germandbls/registered/copyright/trademark/acute/dieresis /notequal/AE/Oslash/infinity/plusminus/lessequal /greaterequal/yen/mu/partialdiff/summation/product /pi/integral/ordfeminine/ordmasculine/Omega/ae /oslash/questiondown/exclamdown/logicalnot/radical/florin /approxequal/Delta/guillemotleft/guillemotright/ellipsis/blank /Agrave/Atilde/Otilde/OE/oe/endash /emdash/quotedblleft/quotedblright/quoteleft/quoteright/divide /lozenge/ydieresis/Ydieresis/fraction/currency/guilsinglleft /guilsinglright/fi/fl/daggerdbl/periodcentered/quotesinglbase /quotedblbase/perthousand/Acircumflex/Ecircumflex/Aacute/Edieresis /Egrave/Iacute/Icircumflex/Idieresis/Igrave/Oacute /Ocircumflex/apple/Ograve/Uacute/Ucircumflex/Ugrave /dotlessi/circumflex/tilde/macron/breve/dotaccent /ring/cedilla/hungarumlaut/ogonek/caron /F9/Optima -1 TZ %PDF_EndEncoding %PDF_BeginEncoding: F10 Symbol [/F10/Symbol -1 TZ %PDF_EndEncoding 0 0 612 792 RC userdict /DefaultRGB /DeviceRGB put BT /F9 1 Tf 11 0 0 11 305 41 Tm 0 Tr 0 g 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 \(Shear et)Tj 0 -1.182 TD 0 Tw (al. 1988; Troiano et al. 1995\).)Tj /F5 1 Tf 12 0 0 12 329.5 379 Tm 0 Tc (Physical Activity and Obesity)Tj /F7 1 Tf 11 0 0 11 329.5 364 Tm 0.003 Tc -0.108 Tw (It is commonly believed that physically active people)Tj T* -0.048 Tw (are less likely to gain weight over the course of their)Tj 0 -1.227 TD -0.047 Tw (lives and are thus more likely to have a lower preva-)Tj 0 -1.182 TD -0.053 Tw (lence of obesity than inactive people; accordingly, it)Tj T* -0.09 Tw (is also commonly believed that low levels of physical)Tj 0 -1.227 TD 0.067 Tw (activity are a cause of obesity. Few data, however,)Tj 0 -1.182 TD 0 Tw (exist to evaluate the truth of these suppositions.)Tj 1.636 -1.227 TD 0.018 Tc 0.259 Tw (Several cross-sectional studies report lower)Tj -1.636 -1.182 TD 0.003 Tc 0.147 Tw (weight, BMI, or skinfold measures among people)Tj 0 -1.227 TD 0.035 Tw (with higher levels of self-reported physical activity)Tj 0 -1.182 TD 0.03 Tc 0.259 Tw (or fitness \(DiPietro 1995; Ching et al. 1996;)Tj T* 0.003 Tc -0.099 Tw (Williamson et al. 1993; French et al. 1994; Folsom et)Tj 0 -1.227 TD -0.09 Tw (al. 1985; Dannenberg et al. 1989; Slattery et al. 1992;)Tj 0 -1.182 TD 0.013 Tc -0.103 Tw [(Gibbons et al. 1983; Voorrips et al. 1992\). Prospec-)]TJ 0 -1.227 TD 0.227 Tw (tive studies have shown less consistent results.)Tj 0 -1.182 TD 0.008 Tw (French and colleagues \(1994\) reported an inverse)Tj T* 0.061 Tw (association between leisure-time physical activity)Tj 0 -1.227 TD -0.088 Tw (\(either walking or engaging in high-intensity activ-)Tj 0 -1.182 TD -0.121 Tw (ity\) and later weight gain, and Ching and colleagues)Tj 0 -1.227 TD 0.08 Tw (\(1996\) found that physical activity was inversely)Tj 0 -1.182 TD -0.073 Tw (related to the risk of becoming overweight. Klesges)Tj T* 0.004 Tc -0.092 Tw [(and )-9 (col)-20 (leagues \(1992\) reported that weight gain was)]TJ ET PDFVars/TermAll get exec restore gsave showpage grestore %%Page: 54 54 save PDFVars/InitAll get exec %PDF_BeginEncoding: F5 Optima-Bold [ 39/quotesingle 96/grave 127/.notdef/Adieresis/Aring/Ccedilla /Eacute/Ntilde/Odieresis/Udieresis/aacute/agrave /acircumflex/adieresis/atilde/aring/ccedilla/eacute /egrave/ecircumflex/edieresis/iacute/igrave/icircumflex /idieresis/ntilde/oacute/ograve/ocircumflex/odieresis /otilde/uacute/ugrave/ucircumflex/udieresis/dagger /degree/cent/sterling/section/bullet/paragraph /germandbls/registered/copyright/trademark/acute/dieresis /notequal/AE/Oslash/infinity/plusminus/lessequal /greaterequal/yen/mu/partialdiff/summation/product /pi/integral/ordfeminine/ordmasculine/Omega/ae /oslash/questiondown/exclamdown/logicalnot/radical/florin /approxequal/Delta/guillemotleft/guillemotright/ellipsis/blank /Agrave/Atilde/Otilde/OE/oe/endash /emdash/quotedblleft/quotedblright/quoteleft/quoteright/divide /lozenge/ydieresis/Ydieresis/fraction/currency/guilsinglleft /guilsinglright/fi/fl/daggerdbl/periodcentered/quotesinglbase /quotedblbase/perthousand/Acircumflex/Ecircumflex/Aacute/Edieresis /Egrave/Iacute/Icircumflex/Idieresis/Igrave/Oacute /Ocircumflex/apple/Ograve/Uacute/Ucircumflex/Ugrave /dotlessi/circumflex/tilde/macron/breve/dotaccent /ring/cedilla/hungarumlaut/ogonek/caron /F5/Optima-Bold -1 TZ %PDF_EndEncoding %PDF_BeginEncoding: F7 Berkeley-Medium [ 39/quotesingle 96/grave 127/.notdef/Adieresis/Aring/Ccedilla /Eacute/Ntilde/Odieresis/Udieresis/aacute/agrave /acircumflex/adieresis/atilde/aring/ccedilla/eacute /egrave/ecircumflex/edieresis/iacute/igrave/icircumflex /idieresis/ntilde/oacute/ograve/ocircumflex/odieresis /otilde/uacute/ugrave/ucircumflex/udieresis/dagger /degree/cent/sterling/section/bullet/paragraph /germandbls/registered/copyright/trademark/acute/dieresis /notequal/AE/Oslash/infinity/plusminus/lessequal /greaterequal/yen/mu/partialdiff/summation/product /pi/integral/ordfeminine/ordmasculine/Omega/ae /oslash/questiondown/exclamdown/logicalnot/radical/florin /approxequal/Delta/guillemotleft/guillemotright/ellipsis/blank /Agrave/Atilde/Otilde/OE/oe/endash /emdash/quotedblleft/quotedblright/quoteleft/quoteright/divide /lozenge/ydieresis/Ydieresis/fraction/currency/guilsinglleft /guilsinglright/fi/fl/daggerdbl/periodcentered/quotesinglbase /quotedblbase/perthousand/Acircumflex/Ecircumflex/Aacute/Edieresis /Egrave/Iacute/Icircumflex/Idieresis/Igrave/Oacute /Ocircumflex/apple/Ograve/Uacute/Ucircumflex/Ugrave /dotlessi/circumflex/tilde/macron/breve/dotaccent /ring/cedilla/hungarumlaut/ogonek/caron /F7/Berkeley-Medium -1 TZ %PDF_EndEncoding %PDF_BeginEncoding: F9 Optima [ 39/quotesingle 96/grave 127/.notdef/Adieresis/Aring/Ccedilla /Eacute/Ntilde/Odieresis/Udieresis/aacute/agrave /acircumflex/adieresis/atilde/aring/ccedilla/eacute /egrave/ecircumflex/edieresis/iacute/igrave/icircumflex /idieresis/ntilde/oacute/ograve/ocircumflex/odieresis /otilde/uacute/ugrave/ucircumflex/udieresis/dagger /degree/cent/sterling/section/bullet/paragraph /germandbls/registered/copyright/trademark/acute/dieresis /notequal/AE/Oslash/infinity/plusminus/lessequal /greaterequal/yen/mu/partialdiff/summation/product /pi/integral/ordfeminine/ordmasculine/Omega/ae /oslash/questiondown/exclamdown/logicalnot/radical/florin /approxequal/Delta/guillemotleft/guillemotright/ellipsis/blank /Agrave/Atilde/Otilde/OE/oe/endash /emdash/quotedblleft/quotedblright/quoteleft/quoteright/divide /lozenge/ydieresis/Ydieresis/fraction/currency/guilsinglleft /guilsinglright/fi/fl/daggerdbl/periodcentered/quotesinglbase /quotedblbase/perthousand/Acircumflex/Ecircumflex/Aacute/Edieresis /Egrave/Iacute/Icircumflex/Idieresis/Igrave/Oacute /Ocircumflex/apple/Ograve/Uacute/Ucircumflex/Ugrave /dotlessi/circumflex/tilde/macron/breve/dotaccent /ring/cedilla/hungarumlaut/ogonek/caron /F9/Optima -1 TZ %PDF_EndEncoding 0 0 612 792 RC userdict /DefaultRGB /DeviceRGB put BT /F9 1 Tf 11 0 0 11 288.5 41 Tm 0 Tr 0 g 0.006 Tc (134)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 -0.112 Tw (inversely associated with leisure-time physical activ-)Tj 0 -1.182 TD -0.003 Tw (ity among women but not among men. Williamson)Tj T* 0.021 Tw (and colleagues \(1993\), however, found no associa-)Tj 0 -1.227 TD 0 Tc -0.128 Tw (tion between physical activity and subsequent weight)Tj 0 -1.182 TD 0.013 Tc 0.259 Tw (change. Williamson and colleagues \(1993\) and)Tj 0 -1.227 TD 0.003 Tc 0.089 Tw (Voorrips and colleagues \(1992\) proposed that de-)Tj 0 -1.182 TD -0.024 Tw (creases in physical activity may be both a cause and)Tj T* -0.094 Tw (a consequence of weight gain over a lifetime and that)Tj 0 -1.227 TD -0.029 Tw (multiple measurements over time may be necessary)Tj 0 -1.182 TD 0.218 Tw (to characterize the interrelationship. One cohort)Tj 0 -1.227 TD 0.013 Tc 0.206 Tw (study that assessed changes in physical activity)Tj 0 -1.182 TD 0.14 Tw (reported that among women, decreased physical)Tj T* 0.076 Tw (activity performed as work was related to weight)Tj 0 -1.227 TD 0.026 Tc 0.259 Tw (gain; no associations were found among men)Tj 0 -1.182 TD 0.01 Tc 0.003 Tw [(\(Klesges et al. )23 (1992\).)]TJ 1.636 -1.227 TD 0.003 Tc 0.052 Tw (The relationship between physical activity and)Tj -1.636 -1.182 TD -0.056 Tw (obesity in children is still under investigation. Some)Tj 0 -1.227 TD 0.257 Tw (studies comparing obese and nonobese children)Tj 0 -1.182 TD 0.029 Tc 0.259 Tw (have shown higher physical activity levels in)Tj T* 0.008 Tc 0.103 Tw [(nonobese )-10 (children )-10 (\(John)16 (son, Burke, Mayer 1956;)]TJ 0 -1.227 TD 0.003 Tc -0.046 Tw (Bullen, Reed, Mayer 1964\); others have shown little)Tj 0 -1.182 TD 0.183 Tw (or no relationship \(Stefanik, Heald, Mayer 1959;)Tj 0 -1.227 TD 0.042 Tw [(Bradfield, Paulos, Grossman 1971\). Somewhat in-)]TJ 0 -1.182 TD 0.257 Tw (consistent results have also been seen in cross-)Tj T* -0.073 Tw (sectional studies, with several finding lower BMIs or)Tj 0 -1.227 TD -0.126 Tw (skinfold measures among children with higher levels)Tj 0 -1.182 TD 0.222 Tw (of physical activity or fitness \(Wolf et al. 1993;)Tj 0 -1.227 TD -0.119 Tw (Obarzanek et al. 1994; Strazzullo et al. 1988; Tell and)Tj 0 -1.182 TD 0.108 Tw (Vellar 1988\) and some smaller studies finding no)Tj T* 0.03 Tw (association \(Sallis et al. 1988; LaPorte et al. 1982\).)Tj 0 -1.227 TD 0.207 Tw (More recently, two longitudinal studies have re-)Tj 0 -1.182 TD -0.059 Tw (ported inverse relationships between physical activ-)Tj 0 -1.227 TD -0.102 Tw (ity and triceps skinfold measures \(Moore et al. 1995\))Tj 0 -1.182 TD 0.01 Tw (and BMI \(Klesges et al. 1995\) in young children. A)Tj T* 0.122 Tw (third longitudinal study \(Ku et al. 1981\) found a)Tj 0 -1.227 TD 0.007 Tc 0.186 Tw [(significant negative associa)14 (tion )-10 (between )-10 (physical)]TJ 0 -1.182 TD 0.013 Tc -0.015 Tw (activity and percentage of body fat in boys but not)Tj 0 -1.227 TD -0.118 Tw (in girls. Additional longitudinal studies of children,)Tj 0 -1.182 TD 0.002 Tw (including measurement of changes in physical ac-)Tj T* 0.15 Tw (tivity, will help clarify whether physical activity)Tj 0 -1.227 TD 0 Tw (prevents the development of obesity.)Tj 1.636 -1.182 TD 0.003 Tc 0.007 Tw (Over the past two decades, several comprehen-)Tj -1.636 -1.227 TD 0.198 Tw (sive review articles \(Oscai 1973; Stefanick 1993;)Tj 0 -1.182 TD 0.1 Tw (Thompson, Jarvie, et al. 1982; Wilmore 1983\), as)Tj 0 -1.227 TD -0.011 Tw (well as two meta-analyses \(Ballor and Keesey 1991;)Tj 0 -1.182 TD -0.054 Tw (Epstein and Wing 1980\), have examined the impact)Tj T* 0.183 Tw (of exercise training on body weight and obesity.)Tj 0 -1.227 TD 0.216 Tw (These reviews conclude that 1\) physical activity)Tj 23.955 56.409 TD 0.083 Tw (generally affects body composition and weight fa-)Tj 0 -1.182 TD 0.093 Tw (vorably by promoting fat loss while preserving or)Tj T* 0.094 Tw (increasing lean mass; 2\) the rate of weight loss is)Tj 0 -1.227 TD -0.079 Tw (positively related, in a dose-response manner, to the)Tj 0 -1.182 TD -0.01 Tw (frequency and duration of the physical activity ses-)Tj 0 -1.227 TD -0.041 Tw (sion, as well as to the duration \(e.g., months, years\))Tj 0 -1.182 TD -0.101 Tw (of the physical activity program; and 3\) although the)Tj T* -0.066 Tw (rate of weight loss resulting from increased physical)Tj 0 -1.227 TD -0.079 Tw (activity without caloric restriction is relatively slow,)Tj 0 -1.182 TD 0.046 Tw (the combination of increased physical activity and)Tj 0 -1.227 TD 0.077 Tw (dieting appears to be more effective for long-term)Tj 0 -1.182 TD 0.121 Tw (weight regulation than is dieting alone \(Brownell)Tj T* -0.036 Tw (and Stunkard 1980; Kayman, Bruvold, Stern 1990\).)Tj 1.636 -1.227 TD 0.013 Tc 0.067 Tw (Independent of its effect on body weight and)Tj -1.636 -1.182 TD 0.004 Tw (total adiposity, physical activity may favorably af-)Tj 0 -1.227 TD 0.097 Tw (fect fat distribution. Several large cross-sectional)Tj 0 -1.182 TD 0.195 Tw (studies in Europe \(Seidell et al. 1991\), Canada)Tj 0 -1.227 TD -0.098 Tw (\(Tremblay et al. 1990\), and the United States \(Kaye)Tj 0 -1.182 TD 0.016 Tw (et al. 1990; Slattery et al. 1992; Troisi et al. 1991;)Tj T* 0.178 Tw (Wing et al. 1991\) report an inverse association)Tj 0 -1.227 TD -0.068 Tw (between energy expenditure from physical activity)Tj 0 -1.182 TD -0.014 Tw (and several indicators of central body fat distribu-)Tj 0 -1.227 TD -0.039 Tw (tion, such as the waist-to-hip ratio or the waist-to-)Tj 0 -1.182 TD 0.001 Tw (thigh-circumference ratio.)Tj /F5 1 Tf 12 0 0 12 311.5 379 Tm 0 Tc 0 Tw (Biologic Plausibility)Tj /F7 1 Tf 11 0 0 11 311.5 364 Tm 0.003 Tc -0.038 Tw (Increase in fat mass and the development of obesity)Tj T* -0.08 Tw (occur when energy intake exceeds total daily energy)Tj 0 -1.227 TD 0.237 Tw (expenditure for a prolonged period \(Bray 1983;)Tj 0 -1.182 TD -0.011 Tw (Leibel, Rosenbaum, Hirsch 1995\). Total energy ex-)Tj T* 0.082 Tw (penditure represents the sum of 1\) resting energy)Tj 0 -1.227 TD 0.115 Tw (expenditure for maintaining basic body functions)Tj 0 -1.182 TD 0.04 Tw (\(approximately 60 percent of total energy require-)Tj 0 -1.227 TD -0.051 Tw (ments\); 2\) the thermic effect of eating for digestion,)Tj 0 -1.182 TD 0.102 Tw (absorption, transport, and deposition of nutrients)Tj T* -0.11 Tw (\(about 10 percent\); and 3\) nonresting energy expen-)Tj 0 -1.227 TD 0.18 Tw (diture, primarily in the form of physical activity)Tj 0 -1.182 TD 0.013 Tc 0.21 Tw (\(about 30 percent\) \(Leibel, Rosenbaum, Hirsch)Tj 0 -1.227 TD 0.004 Tc 0.184 Tw [(1995\).)-25 ( This third component, nonresting energy)]TJ 0 -1.182 TD 0.003 Tc 0.114 Tw (expenditure, is the most variable. Energy balance)Tj T* 0.077 Tw (tilts to weight gain when disproportionately more)Tj 0 -1.227 TD 0.063 Tw (energy is taken in; theoretically, about one pound)Tj 0 -1.182 TD 0.07 Tw (\(or 0.45 kg\) of fat energy is stored for each 3,500)Tj 0 -1.227 TD 0.072 Tw (kilocalories of excess energy intake. By increasing)Tj 0 -1.182 TD -0.054 Tw (nonresting energy expenditure, regular physical ac-)Tj T* -0.095 Tw (tivity contributes to weight maintenance and weight)Tj 0 -1.227 TD 0.246 Tw (reduction. Evidence supports the metabolic and)Tj ET PDFVars/TermAll get exec restore gsave showpage grestore %%Page: 55 55 save PDFVars/InitAll get exec %PDF_BeginEncoding: F5 Optima-Bold [ 39/quotesingle 96/grave 127/.notdef/Adieresis/Aring/Ccedilla /Eacute/Ntilde/Odieresis/Udieresis/aacute/agrave /acircumflex/adieresis/atilde/aring/ccedilla/eacute /egrave/ecircumflex/edieresis/iacute/igrave/icircumflex /idieresis/ntilde/oacute/ograve/ocircumflex/odieresis /otilde/uacute/ugrave/ucircumflex/udieresis/dagger /degree/cent/sterling/section/bullet/paragraph /germandbls/registered/copyright/trademark/acute/dieresis /notequal/AE/Oslash/infinity/plusminus/lessequal /greaterequal/yen/mu/partialdiff/summation/product /pi/integral/ordfeminine/ordmasculine/Omega/ae /oslash/questiondown/exclamdown/logicalnot/radical/florin /approxequal/Delta/guillemotleft/guillemotright/ellipsis/blank /Agrave/Atilde/Otilde/OE/oe/endash /emdash/quotedblleft/quotedblright/quoteleft/quoteright/divide /lozenge/ydieresis/Ydieresis/fraction/currency/guilsinglleft /guilsinglright/fi/fl/daggerdbl/periodcentered/quotesinglbase /quotedblbase/perthousand/Acircumflex/Ecircumflex/Aacute/Edieresis /Egrave/Iacute/Icircumflex/Idieresis/Igrave/Oacute /Ocircumflex/apple/Ograve/Uacute/Ucircumflex/Ugrave /dotlessi/circumflex/tilde/macron/breve/dotaccent /ring/cedilla/hungarumlaut/ogonek/caron /F5/Optima-Bold -1 TZ %PDF_EndEncoding %PDF_BeginEncoding: F7 Berkeley-Medium [ 39/quotesingle 96/grave 127/.notdef/Adieresis/Aring/Ccedilla /Eacute/Ntilde/Odieresis/Udieresis/aacute/agrave /acircumflex/adieresis/atilde/aring/ccedilla/eacute /egrave/ecircumflex/edieresis/iacute/igrave/icircumflex /idieresis/ntilde/oacute/ograve/ocircumflex/odieresis /otilde/uacute/ugrave/ucircumflex/udieresis/dagger /degree/cent/sterling/section/bullet/paragraph /germandbls/registered/copyright/trademark/acute/dieresis /notequal/AE/Oslash/infinity/plusminus/lessequal /greaterequal/yen/mu/partialdiff/summation/product /pi/integral/ordfeminine/ordmasculine/Omega/ae /oslash/questiondown/exclamdown/logicalnot/radical/florin /approxequal/Delta/guillemotleft/guillemotright/ellipsis/blank /Agrave/Atilde/Otilde/OE/oe/endash /emdash/quotedblleft/quotedblright/quoteleft/quoteright/divide /lozenge/ydieresis/Ydieresis/fraction/currency/guilsinglleft /guilsinglright/fi/fl/daggerdbl/periodcentered/quotesinglbase /quotedblbase/perthousand/Acircumflex/Ecircumflex/Aacute/Edieresis /Egrave/Iacute/Icircumflex/Idieresis/Igrave/Oacute /Ocircumflex/apple/Ograve/Uacute/Ucircumflex/Ugrave /dotlessi/circumflex/tilde/macron/breve/dotaccent /ring/cedilla/hungarumlaut/ogonek/caron /F7/Berkeley-Medium -1 TZ %PDF_EndEncoding %PDF_BeginEncoding: F9 Optima [ 39/quotesingle 96/grave 127/.notdef/Adieresis/Aring/Ccedilla /Eacute/Ntilde/Odieresis/Udieresis/aacute/agrave /acircumflex/adieresis/atilde/aring/ccedilla/eacute /egrave/ecircumflex/edieresis/iacute/igrave/icircumflex /idieresis/ntilde/oacute/ograve/ocircumflex/odieresis /otilde/uacute/ugrave/ucircumflex/udieresis/dagger /degree/cent/sterling/section/bullet/paragraph /germandbls/registered/copyright/trademark/acute/dieresis /notequal/AE/Oslash/infinity/plusminus/lessequal /greaterequal/yen/mu/partialdiff/summation/product /pi/integral/ordfeminine/ordmasculine/Omega/ae /oslash/questiondown/exclamdown/logicalnot/radical/florin /approxequal/Delta/guillemotleft/guillemotright/ellipsis/blank /Agrave/Atilde/Otilde/OE/oe/endash /emdash/quotedblleft/quotedblright/quoteleft/quoteright/divide /lozenge/ydieresis/Ydieresis/fraction/currency/guilsinglleft /guilsinglright/fi/fl/daggerdbl/periodcentered/quotesinglbase /quotedblbase/perthousand/Acircumflex/Ecircumflex/Aacute/Edieresis /Egrave/Iacute/Icircumflex/Idieresis/Igrave/Oacute /Ocircumflex/apple/Ograve/Uacute/Ucircumflex/Ugrave /dotlessi/circumflex/tilde/macron/breve/dotaccent /ring/cedilla/hungarumlaut/ogonek/caron /F9/Optima -1 TZ %PDF_EndEncoding 0 0 612 792 RC userdict /DefaultRGB /DeviceRGB put BT /F9 1 Tf 11 0 0 11 305 41 Tm 0 Tr 0 g 0.006 Tc (135)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 0.009 Tw (physiological benefits of incorporating physical ac-)Tj 0 -1.182 TD -0.023 Tw (tivity into programs that prevent or manage obesity)Tj T* 0.188 Tw (\(Pi-Sunyer 1988; Leon 1989; Bouchard, Despr\216s,)Tj 0 -1.227 TD 0.013 Tc 0.209 Tw (Tremblay 1993; DiPietro 1995; Ewbank, Darga,)Tj 0 -1.182 TD 0 Tw (Lucas 1995\).)Tj 1.636 -1.227 TD 0.003 Tc -0.024 Tw (Controversy exists over whether physical activ-)Tj -1.636 -1.182 TD 0.041 Tw (ity following a meal increases the thermic effect of)Tj 0 -1.227 TD -0.006 Tw (food ingestion and whether physical activity before)Tj 0 -1.182 TD -0.047 Tw [(a meal reduces appetite. The evidence suggests that)]TJ T* 0.089 Tw (physical activity programs do not necessarily pro-)Tj 0 -1.227 TD -0.117 Tw (duce a compensatory increase in food intake in obese)Tj 0 -1.182 TD 0 Tc -0.129 Tw (individuals \(Woo, Garrow, Pi-Sunyer 1982a, 1982b\).)Tj 0 -1.227 TD 0.003 Tc 0.008 Tw (Moreover, daily physical activity may further assist)Tj 0 -1.182 TD 0.085 Tw (in weight loss by partially reducing the decline in)Tj T* -0.003 Tw (resting energy expenditure that occurs during diet-)Tj 0 -1.227 TD -0.044 Tw (ing and associated weight loss \(Lennon et al. 1985\).)Tj 0 -1.182 TD 0.039 Tw (This effect is plausible because endurance exercise)Tj 0 -1.227 TD 0.119 Tw (and strength training may help preserve, to some)Tj 0 -1.182 TD 0 Tc -0.129 Tw (degree, metabolically active, lean body mass, whereas)Tj T* 0.003 Tc 0.141 Tw (caloric restriction does not \(Hill, Drougas, Peters)Tj 0 -1.227 TD 0 Tw (1994; Ballor and Keesy 1991\).)Tj 1.636 -1.182 TD 0.013 Tc -0.039 Tw (Because abdominal fat is more responsive than)Tj -1.636 -1.227 TD 0.074 Tw (gluteal or lower-body fat to epinephrine stimula-)Tj 0 -1.182 TD -0.071 Tw (tion \(Wahrenberg, Bolinder, Arner 1991\), physical)Tj 0 -1.227 TD -0.011 Tw (activity may result in a more beneficial redistribu-)Tj 0 -1.182 TD -0.008 Tw (tion of body fat in both sexes \(Bouchard, Despr\216s,)Tj T* 0.032 Tw [(Tremblay 1993\). Further investigation, however,)]TJ 0 -1.227 TD 0.111 Tw (is needed to clarify the associations between go-)Tj 0 -1.182 TD 0.039 Tw (nadal hormone levels, baseline regional fat distri-)Tj 0 -1.227 TD -0.062 Tw (bution, and exercise-related changes in weight and)Tj 0 -1.182 TD 0 Tw (body fat distribution.)Tj /F5 1 Tf 12 0 0 12 66 286.5 Tm 0 Tc (Conclusions)Tj /F7 1 Tf 11 0 0 11 66 271.5 Tm 0.003 Tc -0.026 Tw (Physical activity is important for weight control. By)Tj T* -0.095 Tw (using energy and maintaining muscle mass, physical)Tj 0 -1.227 TD 0.077 Tw (activity is a useful and effective adjunct to dietary)Tj 0 -1.182 TD 0.005 Tc 0.258 Tw (management for avoiding weight gain or losing)Tj T* 0.003 Tc 0.005 Tw (weight. Physical activity appears to favorably affect)Tj 0 -1.227 TD 0 Tw (distribution of body fat.)Tj /F5 1 Tf 14 0 0 14 66 166 Tm -0.001 Tc 0.001 Tw (Mental Health)Tj /F7 1 Tf 11 0 0 11 66 150 Tm 0.003 Tc 0.175 Tw (Mental disorders pose a significant public health)Tj 0 -1.182 TD -0.077 Tw (burden in the United States. Some disorders, such as)Tj T* 0.194 Tw (depression, are associated with suicide, which is)Tj 0 -1.227 TD 0.108 Tw (currently the ninth leading cause of death among)Tj 0 -1.182 TD -0.08 Tw (Americans \(NCHS 1996\). A major cause of hospital-)Tj 0 -1.227 TD 0.128 Tw (ization and disability, mental disorders cost $148)Tj 23.955 57 TD -0.037 Tw (billion per year, about half of which is due to severe)Tj 0 -1.182 TD 0.222 Tw (mental illness \(National Advisory Mental Health)Tj T* 0.001 Tw (Council 1993\).)Tj 1.636 -1.227 TD -0.113 Tw (The annual prevalence of mental disorders in the)Tj -1.636 -1.182 TD -0.067 Tw (United States population is high. Nearly three out of)Tj 0 -1.227 TD -0.125 Tw (10 persons 15\32054 years of age who live in households)Tj 0 -1.182 TD 0.236 Tw (report having had a mental disorder during the)Tj 0 -1.227 TD -0.111 Tw (previous year \(Regier et al. 1993; Kessler et al. 1994\).)Tj 0 -1.182 TD -0.058 Tw (The most frequently reported disorders are affective)Tj T* -0.061 Tw (\(mood\) and anxiety disorders. More than one out of)Tj 0 -1.227 TD 0.036 Tw (10 adults suffers from a depressive disorder in any)Tj 0 -1.182 TD -0.1 Tw (given year; between 13 and 17 percent suffer from an)Tj 0 -1.227 TD -0.088 Tw (anxiety disorder. Women report a higher prevalence)Tj 0 -1.182 TD -0.078 Tw (of affective and anxiety disorders than do men. Most)Tj T* 0.215 Tw (people with mental disorders do not obtain any)Tj 0 -1.227 TD -0.034 Tw (professional treatment; only one in five people with)Tj 0 -1.182 TD -0.103 Tw (a disorder during the previous year has received help)Tj 0 -1.227 TD 0 Tw (from a health service provider.)Tj 1.636 -1.182 TD 0.03 Tc 0.259 Tw (Mental disorders, mental illnesses, mental)Tj -1.636 -1.227 TD 0.013 Tc -0.052 Tw (health, and psychological well-being relate to such)Tj 0 -1.182 TD 0.112 Tw (factors as mood or affect, personality, cognition,)Tj T* 0.015 Tc 0.259 Tw (and perception. Psychological constructs about)Tj 0 -1.227 TD 0.013 Tc -0.058 Tw (these factors are interrelated with a person\325s physi-)Tj 0 -1.182 TD -0.083 Tw (cal health status and quality of life. In studies of the)Tj 0 -1.227 TD 0.128 Tw (effects of physical activity on mental health, the)Tj 0 -1.182 TD 0.124 Tw (most frequently studied outcomes include mood)Tj T* -0.091 Tw (\(anxiety, depression, negative affect, and to a lesser)Tj 0 -1.227 TD 0.164 Tw (extent, positive affect\), self-esteem, self-efficacy,)Tj 0 -1.182 TD -0.021 Tw (and cognitive functioning. The general hypothesis)Tj 0 -1.227 TD 0.143 Tw (is that people who are physically active or have)Tj 0 -1.182 TD 0.046 Tw (higher levels of cardiorespiratory fitness have en-)Tj T* 0.137 Tw (hanced mood \(less negative and greater positive)Tj 0 -1.227 TD 0.15 Tw (affect\), higher self-esteem, greater confidence in)Tj 0 -1.182 TD 0.179 Tw (their ability to perform tasks requiring physical)Tj 0 -1.227 TD 0.007 Tw (activity \(i.e., greater self-efficacy\), and better cog-)Tj 0 -1.182 TD -0.035 Tw (nitive functioning than sedentary persons or those)Tj T* -0.03 Tw (who are less physically fit. One National Institutes)Tj 0 -1.227 TD -0.066 Tw (of Mental Health workshop \(Morgan and Goldston)Tj 0 -1.182 TD 0.238 Tw (1987\) and numerous recent reviews have been)Tj 0 -1.227 TD -0.102 Tw [(devoted to this literature \(Brown 1990; LaFontaine)]TJ 0 -1.182 TD 0.006 Tc -0.127 Tw (et al. 1992; Landers and Petruzzello 1994; Martinsen)Tj T* 0.013 Tc -0.048 Tw (and Stephens 1994; McAuley 1994; McDonald and)Tj 0 -1.227 TD -0.005 Tc 0.193 Tw (Hodgdon 1991; Morgan 1994; North, McCullagh,)Tj 0 -1.182 TD -0.084 Tw (Tran 1990; Plante and Rodin 1990; Raglin 1990; Sime)Tj 0 -1.227 TD -0.07 Tw (1990\). The effects of physical activity on most mental)Tj 0 -1.182 TD 0.005 Tc 0.259 Tw (disorders\321including sleep and eating disorders,)Tj T* -0.005 Tc -0.004 Tw (schizophrenia, dementia, personality disorders, and)Tj 0 -1.227 TD -0.031 Tw (substance-related disorders\321are not as )Tj 16.182 0 TD 0.013 Tc -0.029 Tw (well studied)Tj ET PDFVars/TermAll get exec restore gsave showpage grestore %%Page: 56 56 save PDFVars/InitAll get exec %PDF_BeginEncoding: F5 Optima-Bold [ 39/quotesingle 96/grave 127/.notdef/Adieresis/Aring/Ccedilla /Eacute/Ntilde/Odieresis/Udieresis/aacute/agrave /acircumflex/adieresis/atilde/aring/ccedilla/eacute /egrave/ecircumflex/edieresis/iacute/igrave/icircumflex /idieresis/ntilde/oacute/ograve/ocircumflex/odieresis /otilde/uacute/ugrave/ucircumflex/udieresis/dagger /degree/cent/sterling/section/bullet/paragraph /germandbls/registered/copyright/trademark/acute/dieresis /notequal/AE/Oslash/infinity/plusminus/lessequal /greaterequal/yen/mu/partialdiff/summation/product /pi/integral/ordfeminine/ordmasculine/Omega/ae /oslash/questiondown/exclamdown/logicalnot/radical/florin /approxequal/Delta/guillemotleft/guillemotright/ellipsis/blank /Agrave/Atilde/Otilde/OE/oe/endash /emdash/quotedblleft/quotedblright/quoteleft/quoteright/divide /lozenge/ydieresis/Ydieresis/fraction/currency/guilsinglleft /guilsinglright/fi/fl/daggerdbl/periodcentered/quotesinglbase /quotedblbase/perthousand/Acircumflex/Ecircumflex/Aacute/Edieresis /Egrave/Iacute/Icircumflex/Idieresis/Igrave/Oacute /Ocircumflex/apple/Ograve/Uacute/Ucircumflex/Ugrave /dotlessi/circumflex/tilde/macron/breve/dotaccent /ring/cedilla/hungarumlaut/ogonek/caron /F5/Optima-Bold -1 TZ %PDF_EndEncoding %PDF_BeginEncoding: F7 Berkeley-Medium [ 39/quotesingle 96/grave 127/.notdef/Adieresis/Aring/Ccedilla /Eacute/Ntilde/Odieresis/Udieresis/aacute/agrave /acircumflex/adieresis/atilde/aring/ccedilla/eacute /egrave/ecircumflex/edieresis/iacute/igrave/icircumflex /idieresis/ntilde/oacute/ograve/ocircumflex/odieresis /otilde/uacute/ugrave/ucircumflex/udieresis/dagger /degree/cent/sterling/section/bullet/paragraph /germandbls/registered/copyright/trademark/acute/dieresis /notequal/AE/Oslash/infinity/plusminus/lessequal /greaterequal/yen/mu/partialdiff/summation/product /pi/integral/ordfeminine/ordmasculine/Omega/ae /oslash/questiondown/exclamdown/logicalnot/radical/florin /approxequal/Delta/guillemotleft/guillemotright/ellipsis/blank /Agrave/Atilde/Otilde/OE/oe/endash /emdash/quotedblleft/quotedblright/quoteleft/quoteright/divide /lozenge/ydieresis/Ydieresis/fraction/currency/guilsinglleft /guilsinglright/fi/fl/daggerdbl/periodcentered/quotesinglbase /quotedblbase/perthousand/Acircumflex/Ecircumflex/Aacute/Edieresis /Egrave/Iacute/Icircumflex/Idieresis/Igrave/Oacute /Ocircumflex/apple/Ograve/Uacute/Ucircumflex/Ugrave /dotlessi/circumflex/tilde/macron/breve/dotaccent /ring/cedilla/hungarumlaut/ogonek/caron /F7/Berkeley-Medium -1 TZ %PDF_EndEncoding %PDF_BeginEncoding: F9 Optima [ 39/quotesingle 96/grave 127/.notdef/Adieresis/Aring/Ccedilla /Eacute/Ntilde/Odieresis/Udieresis/aacute/agrave /acircumflex/adieresis/atilde/aring/ccedilla/eacute /egrave/ecircumflex/edieresis/iacute/igrave/icircumflex /idieresis/ntilde/oacute/ograve/ocircumflex/odieresis /otilde/uacute/ugrave/ucircumflex/udieresis/dagger /degree/cent/sterling/section/bullet/paragraph /germandbls/registered/copyright/trademark/acute/dieresis /notequal/AE/Oslash/infinity/plusminus/lessequal /greaterequal/yen/mu/partialdiff/summation/product /pi/integral/ordfeminine/ordmasculine/Omega/ae /oslash/questiondown/exclamdown/logicalnot/radical/florin /approxequal/Delta/guillemotleft/guillemotright/ellipsis/blank /Agrave/Atilde/Otilde/OE/oe/endash /emdash/quotedblleft/quotedblright/quoteleft/quoteright/divide /lozenge/ydieresis/Ydieresis/fraction/currency/guilsinglleft /guilsinglright/fi/fl/daggerdbl/periodcentered/quotesinglbase /quotedblbase/perthousand/Acircumflex/Ecircumflex/Aacute/Edieresis /Egrave/Iacute/Icircumflex/Idieresis/Igrave/Oacute /Ocircumflex/apple/Ograve/Uacute/Ucircumflex/Ugrave /dotlessi/circumflex/tilde/macron/breve/dotaccent /ring/cedilla/hungarumlaut/ogonek/caron /F9/Optima -1 TZ %PDF_EndEncoding 0 0 612 792 RC userdict /DefaultRGB /DeviceRGB put BT /F9 1 Tf 11 0 0 11 288.5 41 Tm 0 Tr 0 g 0.006 Tc (136)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 0.04 Tc 0.259 Tw (\(Dishman 1986; Taylor, Sallis, Needle 1985;)Tj 0 -1.182 TD 0.013 Tc 0.001 Tw (Martinsen and Stephens 1994\).)Tj 1.636 -1.227 TD 0.003 Tc -0.105 Tw (This section focuses primarily on the association)Tj -1.636 -1.182 TD 0.2 Tw (of physical activity with anxiety and depression.)Tj T* -0.108 Tw (Evidence related to other psychological factors, such)Tj 0 -1.227 TD -0.041 Tw (as positive affect, self-esteem, self-efficacy, and cog-)Tj 0 -1.182 TD -0.006 Tw (nitive functioning, is discussed later in this chapter)Tj 0 -1.227 TD 0 Tw (in the \322Health-Related Quality of Life\323 section.)Tj /F5 1 Tf 12 0 0 12 48 590 Tm 0 Tc (Physical Activity and Mental Health)Tj /F7 1 Tf 11 0 0 11 48 575.5 Tm 0.003 Tc 0.244 Tw (Epidemiologic research among men and women)Tj T* 0.2 Tw (suggests that physical activity may be associated)Tj 0 -1.182 TD 0.177 Tw (with reduced symptoms of depression \(Ross and)Tj 0 -1.227 TD 0.209 Tw (Hayes 1988; Stephens 1988; Stephens and Craig)Tj 0 -1.182 TD 0.165 Tw (1990; Farmer et al. 1988; Camacho et al. 1991\),)Tj T* 0.145 Tw (clinical depression \(Weyerer 1992\), symptoms of)Tj 0 -1.227 TD -0.041 Tw (anxiety \(Ross and Hayes 1988; Stephens 1988\), and)Tj 0 -1.182 TD 0.234 Tw (improvements in positive affect \(Stephens 1988;)Tj 0 -1.227 TD 0.128 Tw (Stephens and Craig 1990\) and general well-being)Tj 0 -1.182 TD -0.005 Tc -0.088 Tw (\(Stephens 1988\). In general, persons who are inactive)Tj T* 0.003 Tc 0.027 Tw (are twice as likely to have symptoms of depression)Tj 0 -1.227 TD 0 Tw (than are more active persons.)Tj 1.636 -1.182 TD -0.058 Tw (Most epidemiologic and intervention studies on)Tj -1.636 -1.227 TD 0 Tc -0.129 Tw (the relationship of physical activity and mental health)Tj 0 -1.182 TD 0.003 Tc -0.068 Tw (have used self-report questionnaires to assess symp-)Tj 0 -1.227 TD -0.075 Tw (toms of anxiety and depression among persons from)Tj 0 -1.182 TD -0.033 Tw (the general population, although some studies have)Tj T* -0.001 Tw (focused on patients diagnosed by clinicians. These)Tj 0 -1.227 TD 0.232 Tw (questionnaires are useful for identifying persons)Tj 0 -1.182 TD 0.013 Tc 0.231 Tw (experiencing mental distress \(i.e., symptoms of)Tj 0 -1.227 TD 0.004 Tc 0.037 Tw [(anxi)-24 (ety or depression\), but such identifications do)]TJ 0 -1.182 TD 0.003 Tc -0.119 Tw (not necessarily correspond to diagnoses of anxiety or)Tj T* 0.147 Tw (depression by clinicians using standard interview)Tj 0 -1.227 TD 0 Tw (criteria \(Fechner-Bates, Coyne, Schwenk 1994\).)Tj 1.636 -1.182 TD -0.003 Tc -0.129 Tw (The literature suggests that physical activity helps)Tj -1.636 -1.227 TD 0.005 Tc 0.259 Tw (improve the mental health of both clinical and)Tj 0 -1.182 TD 0.003 Tc 0.02 Tw (nonclinical populations. Physical activity interven-)Tj 0 -1.227 TD -0.065 Tw (tions have benefited persons from the general popu-)Tj 0 -1.182 TD 0.115 Tw (lation who report mood disturbance \(Simons and)Tj T* -0.041 Tw (Birkimer 1988; Wilfley and Kunce 1986\), including)Tj 0 -1.227 TD 0.063 Tw (symptoms of anxiety \(Steptoe et al. 1989\) and de-)Tj 0 -1.182 TD 0.11 Tw (pression \(Morgan et al. 1970\), as well as patients)Tj 0 -1.227 TD 0.055 Tc 0.259 Tw (who have been diagnosed with nonbipolar,)Tj 0 -1.182 TD 0.003 Tc -0.119 Tw (nonpsychotic depression \(Doyne et al. 1987; Klein et)Tj T* -0.035 Tw (al. 1985; Martinsen, Medhus, Sandvik 1985\). These)Tj 0 -1.227 TD -0.06 Tw (findings are supported by a limited number of inter-)Tj 0 -1.182 TD -0.003 Tw (vention studies conducted in community and labo-)Tj 0 -1.227 TD 0 Tc -0.128 Tw (ratory settings \(Brown 1990; Landers and Petruzzello)Tj 23.955 56.773 TD 0.003 Tc -0.088 Tw (1994; Martinsen and Stephens 1994; McAuley 1994;)Tj 0 -1.182 TD 0.016 Tw (Morgan 1994; Plante and Rodin 1990; Sime 1990\).)Tj T* 0.155 Tw (Intervention studies have primarily evaluated the)Tj 0 -1.227 TD 0.099 Tw (effects of aerobic physical activities, such as brisk)Tj 0 -1.182 TD 0.021 Tw (walking and running, on mental health; how other)Tj 0 -1.227 TD -0.04 Tw (forms of physical activity, such as strength training,)Tj 0 -1.182 TD 0 Tw (affect mental health requires further study.)Tj 1.636 -1.227 TD 0.013 Tc 0.029 Tw (The psychological benefits of regular physical)Tj -1.636 -1.182 TD -0.104 Tw (activity for persons who have relatively good physi-)Tj T* -0.071 Tw (cal and mental health are less clear. Some interven-)Tj 0 -1.227 TD 0.026 Tc 0.259 Tw (tion studies have found that physical activity)Tj 0 -1.182 TD 0.01 Tc -0.127 Tw (provides mental health benefits to persons recruited)Tj 0 -1.227 TD 0.013 Tc -0.024 Tw (from the community who are without serious psy-)Tj 0 -1.182 TD 0.113 Tw (chological problems. These benefits included in-)Tj T* -0.12 Tw (creases in general well-being \(Cramer, Nieman, Lee)Tj 0 -1.227 TD -0.083 Tw (1991\) and reductions in tension, confusion \(Moses)Tj 0 -1.182 TD -0.111 Tw (et al. 1989\), and perceived stress and anxiety \(King,)Tj 0 -1.227 TD 0.006 Tc -0.128 Tw (Taylor, Haskell 1993\). Other researchers have found)Tj 0 -1.182 TD 0.013 Tc -0.088 Tw (that few \(Brown et al. 1995; Blumenthal et al. 1989;)Tj T* 0.106 Tw (King, Taylor, Haskell 1989\) or no mental health)Tj 0 -1.227 TD 0.008 Tc -0.127 Tw (benefits \(Hughes, Casal, Leon 1986; Lennox, Bedell,)Tj 0 -1.182 TD 0.013 Tc -0.041 Tw (Stone 1990\) occurred among people without men-)Tj 0 -1.227 TD 0.039 Tw (tal disorders who participated in physical activity)Tj 0 -1.182 TD (interventions.)Tj 1.636 -1.227 TD 0.003 Tc 0.076 Tw (Most of these studies involved relatively small)Tj -1.636 -1.182 TD -0.124 Tw (sample sizes. Furthermore, the participants had little)Tj T* -0.045 Tw (opportunity to show improvement on objective and)Tj 0 -1.227 TD 0.193 Tw (standardized mental health measures, since their)Tj 0 -1.182 TD -0.01 Tw (baseline scores were already in the normal range or)Tj 0 -1.227 TD -0.063 Tw (lower on measures of negative affect and were in the)Tj 0 -1.182 TD -0.127 Tw (normal range or higher for positive affect. Even when)Tj T* 0.053 Tw (no change was observed on objective measures, in)Tj 0 -1.227 TD -0.085 Tw (some of these studies, participants reported feeling a)Tj 0 -1.182 TD 0.025 Tw (subjective sensation of improved physical, psycho-)Tj 0 -1.227 TD 0.181 Tw (logical, or social well-being after participating in)Tj 0 -1.182 TD 0.164 Tw (regular physical activity \(Blumenthal et al. 1989;)Tj T* 0 Tw (King, Taylor, Haskell 1993\).)Tj 1.636 -1.227 TD 0.037 Tw (Psychological assessments that have been used)Tj -1.636 -1.182 TD -0.052 Tw (in physical activity research have included state and)Tj 0 -1.227 TD 0.005 Tw (trait measures. State measures, which reflect how a)Tj 0 -1.182 TD 0.054 Tw (person feels \322right now,\323 are particularly useful in)Tj 0 -1.227 TD 0.141 Tw (assessing changes in mood that occur before and)Tj 0 -1.182 TD 0.157 Tw (after an intervention, such as a single episode of)Tj T* 0.219 Tw (physical activity. Trait measures, which evaluate)Tj 0 -1.227 TD -0.044 Tw (how a person \322generally\323 feels, focus on personality)Tj 0 -1.182 TD 0.139 Tw [(characteristics that tend to be stable)14 ( or sustained)]TJ 0 -1.227 TD -0.091 Tw (across the life span. Although physical activity train-)Tj 0 -1.182 TD 0.033 Tw (ing programs can result in sustained psychological)Tj ET PDFVars/TermAll get exec restore gsave showpage grestore %%Page: 57 57 save PDFVars/InitAll get exec %PDF_BeginEncoding: F5 Optima-Bold [ 39/quotesingle 96/grave 127/.notdef/Adieresis/Aring/Ccedilla /Eacute/Ntilde/Odieresis/Udieresis/aacute/agrave /acircumflex/adieresis/atilde/aring/ccedilla/eacute /egrave/ecircumflex/edieresis/iacute/igrave/icircumflex /idieresis/ntilde/oacute/ograve/ocircumflex/odieresis /otilde/uacute/ugrave/ucircumflex/udieresis/dagger /degree/cent/sterling/section/bullet/paragraph /germandbls/registered/copyright/trademark/acute/dieresis /notequal/AE/Oslash/infinity/plusminus/lessequal /greaterequal/yen/mu/partialdiff/summation/product /pi/integral/ordfeminine/ordmasculine/Omega/ae /oslash/questiondown/exclamdown/logicalnot/radical/florin /approxequal/Delta/guillemotleft/guillemotright/ellipsis/blank /Agrave/Atilde/Otilde/OE/oe/endash /emdash/quotedblleft/quotedblright/quoteleft/quoteright/divide /lozenge/ydieresis/Ydieresis/fraction/currency/guilsinglleft /guilsinglright/fi/fl/daggerdbl/periodcentered/quotesinglbase /quotedblbase/perthousand/Acircumflex/Ecircumflex/Aacute/Edieresis /Egrave/Iacute/Icircumflex/Idieresis/Igrave/Oacute /Ocircumflex/apple/Ograve/Uacute/Ucircumflex/Ugrave /dotlessi/circumflex/tilde/macron/breve/dotaccent /ring/cedilla/hungarumlaut/ogonek/caron /F5/Optima-Bold -1 TZ %PDF_EndEncoding %PDF_BeginEncoding: F7 Berkeley-Medium [ 39/quotesingle 96/grave 127/.notdef/Adieresis/Aring/Ccedilla /Eacute/Ntilde/Odieresis/Udieresis/aacute/agrave /acircumflex/adieresis/atilde/aring/ccedilla/eacute /egrave/ecircumflex/edieresis/iacute/igrave/icircumflex /idieresis/ntilde/oacute/ograve/ocircumflex/odieresis /otilde/uacute/ugrave/ucircumflex/udieresis/dagger /degree/cent/sterling/section/bullet/paragraph /germandbls/registered/copyright/trademark/acute/dieresis /notequal/AE/Oslash/infinity/plusminus/lessequal /greaterequal/yen/mu/partialdiff/summation/product /pi/integral/ordfeminine/ordmasculine/Omega/ae /oslash/questiondown/exclamdown/logicalnot/radical/florin /approxequal/Delta/guillemotleft/guillemotright/ellipsis/blank /Agrave/Atilde/Otilde/OE/oe/endash /emdash/quotedblleft/quotedblright/quoteleft/quoteright/divide /lozenge/ydieresis/Ydieresis/fraction/currency/guilsinglleft /guilsinglright/fi/fl/daggerdbl/periodcentered/quotesinglbase /quotedblbase/perthousand/Acircumflex/Ecircumflex/Aacute/Edieresis /Egrave/Iacute/Icircumflex/Idieresis/Igrave/Oacute /Ocircumflex/apple/Ograve/Uacute/Ucircumflex/Ugrave /dotlessi/circumflex/tilde/macron/breve/dotaccent /ring/cedilla/hungarumlaut/ogonek/caron /F7/Berkeley-Medium -1 TZ %PDF_EndEncoding %PDF_BeginEncoding: F9 Optima [ 39/quotesingle 96/grave 127/.notdef/Adieresis/Aring/Ccedilla /Eacute/Ntilde/Odieresis/Udieresis/aacute/agrave /acircumflex/adieresis/atilde/aring/ccedilla/eacute /egrave/ecircumflex/edieresis/iacute/igrave/icircumflex /idieresis/ntilde/oacute/ograve/ocircumflex/odieresis /otilde/uacute/ugrave/ucircumflex/udieresis/dagger /degree/cent/sterling/section/bullet/paragraph /germandbls/registered/copyright/trademark/acute/dieresis /notequal/AE/Oslash/infinity/plusminus/lessequal /greaterequal/yen/mu/partialdiff/summation/product /pi/integral/ordfeminine/ordmasculine/Omega/ae /oslash/questiondown/exclamdown/logicalnot/radical/florin /approxequal/Delta/guillemotleft/guillemotright/ellipsis/blank /Agrave/Atilde/Otilde/OE/oe/endash /emdash/quotedblleft/quotedblright/quoteleft/quoteright/divide /lozenge/ydieresis/Ydieresis/fraction/currency/guilsinglleft /guilsinglright/fi/fl/daggerdbl/periodcentered/quotesinglbase /quotedblbase/perthousand/Acircumflex/Ecircumflex/Aacute/Edieresis /Egrave/Iacute/Icircumflex/Idieresis/Igrave/Oacute /Ocircumflex/apple/Ograve/Uacute/Ucircumflex/Ugrave /dotlessi/circumflex/tilde/macron/breve/dotaccent /ring/cedilla/hungarumlaut/ogonek/caron /F9/Optima -1 TZ %PDF_EndEncoding 0 0 612 792 RC userdict /DefaultRGB /DeviceRGB put BT /F9 1 Tf 11 0 0 11 305 41 Tm 0 Tr 0 g 0.006 Tc (137)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 -0.061 Tw (benefits, many people after a single session of physi-)Tj 0 -1.182 TD -0.097 Tw (cal activity report improvements in transient moods,)Tj T* -0.12 Tw (such as reduced anxiety \(Morgan 1979a; Roth 1989\),)Tj 0 -1.227 TD -0.037 Tw (and have temporary reductions in muscular tension)Tj 0 -1.182 TD 0.035 Tw (\(DeVries 1981; DeVries and Adams 1972\). The re-)Tj 0 -1.227 TD 0.208 Tw (duction in anxiety may persist for 2 to 6 hours)Tj 0 -1.182 TD -0.064 Tw (following a session of physical activity \(Landers and)Tj T* -0.11 Tw (Petruzzello 1994; Raglin and Morgan 1987\). Regular)Tj 0 -1.227 TD -0.019 Tw (daily physical activity is required to experience this)Tj 0 -1.182 TD -0.118 Tw (calming effect on an ongoing basis. Some researchers)Tj 0 -1.227 TD -0.004 Tw (have thus proposed that the episodic mental health)Tj 0 -1.182 TD -0.023 Tw (benefits associated with physical activity may act as)Tj T* -0.005 Tw (an important preventive measure that could lead to)Tj 0 -1.227 TD -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 -1.636 -1.182 TD -0.086 Tw (tutionalized populations have evaluated the associa-)Tj 0 -1.227 TD -0.121 Tw (tions between self-reported levels of physical activity)Tj 0 -1.182 TD 0.011 Tw (and mental health. These studies typically assessed)Tj T* 0.235 Tw (retrospective self-reports of leisure-time physical)Tj 0 -1.227 TD -0.003 Tw (activity during the previous several weeks or more.)Tj 0 -1.182 TD 0.013 Tw (How these assessments relate to changes in cardio-)Tj 0 -1.227 TD 0.126 Tw (respiratory fitness is unknown. The available evi-)Tj 0 -1.182 TD 0.057 Tc 0.259 Tw (dence indicates, however, that increases in)Tj T* 0.003 Tc 0.051 Tw (cardiorespiratory fitness are not necessary for psy-)Tj 0 -1.227 TD -0.099 Tw (chological benefits to occur \(Brown and Wang 1992;)Tj 0 -1.182 TD -0.08 Tw (King, Taylor, Haskell 1989; Landers and Petruzzello)Tj 0 -1.227 TD 0 Tw (1994; Martinsen and Stephens 1994\).)Tj 1.636 -1.182 TD 0.006 Tc 0.259 Tw (Cross-sectional epidemiologic or community)Tj -1.636 -1.227 TD 0.003 Tc 0.048 Tw (population studies support an association between)Tj 0 -1.182 TD 0.013 Tc 0.131 Tw (physical activity and psychological well-being in)Tj T* -0.028 Tw (the general population. For example, in one cross-)Tj 0 -1.227 TD 0.003 Tc 0.15 Tw [(s)-10 (e)-10 (c)-12 (tional study using data generated from a state)]TJ 0 -1.182 TD 0.002 Tc -0.128 Tw (telephone survey, researchers determined that adults)Tj 0 -1.227 TD 0.003 Tc 0.2 Tw (\(n = 401\) who spent more time participating in)Tj 0 -1.182 TD 0.03 Tw (regular exercise, sports, or other physical activities)Tj T* -0.053 Tw (had fewer symptoms of depression and anxiety than)Tj 0 -1.227 TD -0.127 Tw (persons reporting no physical activity or low levels of)Tj 0 -1.182 TD -0.067 Tw (participation \(Ross and Hayes 1988\). These associa-)Tj 0 -1.227 TD -0.054 Tw (tions were similar for men and women and for older)Tj 0 -1.182 TD 0.059 Tw (and younger adults. The cause-and-effect relation-)Tj T* -0.081 Tw (ship, however, cannot be determined because physi-)Tj 0 -1.227 TD 0.111 Tw (cal activity and mood were measured at the same)Tj 0 -1.182 TD (time.)Tj 1.636 -1.227 TD -0.003 Tc -0.129 Tw [(I)11 (n)1 ( another cross-sectional study \(Stephens 1988\),)]TJ -1.636 -1.182 TD 0.003 Tc 0.132 Tw (secondary analyses of two Canadian surveys \(n =)Tj 0 -1.227 TD -0.005 Tc -0.062 Tw (23,791 and 22,250 young people and adults\) and two)Tj 0 -1.182 TD -0.011 Tw (U.S. surveys \(n = 3,025 and 6,913 adults\) conducted)Tj 23.955 56.409 TD 0.054 Tw (between 1971 and 1981 associated physical activity)Tj 0 -1.182 TD 0.005 Tw (with fewer symptoms of anxiety and depression and)Tj T* 0.127 Tw (with higher positive mood and general well-being.)Tj 0 -1.227 TD -0.023 Tw (These associations were observed in all four surveys,)Tj 0 -1.182 TD -0.053 Tw (even though they used different measures of physical)Tj 0 -1.227 TD -0.074 Tw (activity and mental health, and were strongest among)Tj 0 -1.182 TD 0.072 Tw (women and among persons aged 40 years or older.)Tj T* 0.003 Tc 0.088 Tw (However, one of the Canadian surveys found that)Tj 0 -1.227 TD -0.057 Tw (women manifested higher positive affect when their)Tj 0 -1.182 TD 0.252 Tw (energy expenditure scores were based on recre-)Tj 0 -1.227 TD -0.051 Tw (ational activities only, rather than on a combination)Tj 0 -1.182 TD 0.007 Tc 0.259 Tw (of recreational and household activities. Hence,)Tj T* 0.003 Tc -0.012 Tw (mental health outcomes may depend on the type of)Tj 0 -1.227 TD 0.009 Tw (physical activities being performed and perhaps on)Tj 0 -1.182 TD 0.22 Tw (the setting in which they occur. This finding is)Tj 0 -1.227 TD -0.04 Tw (important in that investigators have typically evalu-)Tj 0 -1.182 TD -0.071 Tw (ated the mental health effects of recreational aerobic)Tj T* -0.065 Tw (activities, such as running, rather than occupational)Tj 0 -1.227 TD 0.001 Tw (and household activities.)Tj 1.636 -1.182 TD 0.025 Tc 0.259 Tw (A subsequent nationwide Canadian survey)Tj -1.636 -1.227 TD 0.003 Tc 0.022 Tw (\(Stephens and Craig 1990\) of approximately 4,000)Tj 0 -1.182 TD 0.21 Tw (respondents aged 10 years and older found that)Tj 0 -1.227 TD 0.161 Tw (persons who reported higher levels of total daily)Tj 0 -1.182 TD -0.076 Tw (leisure-time energy expenditure had a more positive)Tj T* -0.036 Tw (mood than persons reporting lower levels of expen-)Tj 0 -1.227 TD 0.205 Tw (diture. Persons aged 25 years and older demon-)Tj 0 -1.182 TD 0.259 Tw (strated an inverse relationship between physical)Tj 0 -1.227 TD -0.001 Tw (activity and symptoms of depression.)Tj 1.636 -1.182 TD -0.092 Tw (Although many cross-sectional studies suggest a)Tj -1.636 -1.227 TD 0.129 Tw (positive association between physical activity and)Tj 0 -1.182 TD 0.166 Tw (mental health, they do not necessarily indicate a)Tj T* -0.003 Tc -0.13 Tw (cause-and-effect relationship. Persons who have good)Tj 0 -1.227 TD 0.003 Tc -0.108 Tw (mental health may simply be more likely to be active.)Tj 0 -1.182 TD -0.104 Tw (Another possibility is that physical activity and men-)Tj 0 -1.227 TD 0.024 Tw (tal health vary together, in which case a third vari-)Tj 0 -1.182 TD 0.011 Tc 0.258 Tw (able, such as chronic health conditions, would)Tj T* 0.003 Tc 0 Tw (mediate this relationship.)Tj 1.636 -1.227 TD 0.024 Tw (Cohort studies provide additional insights into)Tj -1.636 -1.182 TD -0.062 Tw (whether physical activity contributes to the primary)Tj 0 -1.227 TD 0.013 Tc -0.029 Tw (prevention of mental health problems \(Table 4-9\).)Tj 0 -1.182 TD 0.048 Tw (In one cohort study of 1,900 U.S. adults, a cross-)Tj 0 -1.227 TD 0.003 Tc 0.106 Tw [(s)-10 (e)-10 (c)-12 (tional analysis of the baseline data revealed an)]TJ 0 -1.182 TD -0.029 Tw (association between depressive symptoms and little)Tj T* -0.055 Tw (or no involvement in physical activity \(Farmer et al.)Tj 0 -1.227 TD 0.001 Tw (1988\). At 8-year follow-up, little or no recreational)Tj 0 -1.182 TD -0.107 Tw (physical activity was found to be a significant predic-)Tj 0 -1.227 TD 0 Tw (tor of increased depressive symptoms among white)Tj 0 -1.182 TD -0.052 Tw (women who had reported few depressive symptoms)Tj ET PDFVars/TermAll get exec restore gsave showpage grestore %%Page: 58 58 save PDFVars/InitAll get exec %PDF_BeginEncoding: F5 Optima-Bold [ 39/quotesingle 96/grave 127/.notdef/Adieresis/Aring/Ccedilla /Eacute/Ntilde/Odieresis/Udieresis/aacute/agrave /acircumflex/adieresis/atilde/aring/ccedilla/eacute /egrave/ecircumflex/edieresis/iacute/igrave/icircumflex /idieresis/ntilde/oacute/ograve/ocircumflex/odieresis /otilde/uacute/ugrave/ucircumflex/udieresis/dagger /degree/cent/sterling/section/bullet/paragraph /germandbls/registered/copyright/trademark/acute/dieresis /notequal/AE/Oslash/infinity/plusminus/lessequal /greaterequal/yen/mu/partialdiff/summation/product /pi/integral/ordfeminine/ordmasculine/Omega/ae /oslash/questiondown/exclamdown/logicalnot/radical/florin /approxequal/Delta/guillemotleft/guillemotright/ellipsis/blank /Agrave/Atilde/Otilde/OE/oe/endash /emdash/quotedblleft/quotedblright/quoteleft/quoteright/divide /lozenge/ydieresis/Ydieresis/fraction/currency/guilsinglleft /guilsinglright/fi/fl/daggerdbl/periodcentered/quotesinglbase /quotedblbase/perthousand/Acircumflex/Ecircumflex/Aacute/Edieresis /Egrave/Iacute/Icircumflex/Idieresis/Igrave/Oacute /Ocircumflex/apple/Ograve/Uacute/Ucircumflex/Ugrave /dotlessi/circumflex/tilde/macron/breve/dotaccent /ring/cedilla/hungarumlaut/ogonek/caron /F5/Optima-Bold -1 TZ %PDF_EndEncoding %PDF_BeginEncoding: F9 Optima [ 39/quotesingle 96/grave 127/.notdef/Adieresis/Aring/Ccedilla /Eacute/Ntilde/Odieresis/Udieresis/aacute/agrave /acircumflex/adieresis/atilde/aring/ccedilla/eacute /egrave/ecircumflex/edieresis/iacute/igrave/icircumflex /idieresis/ntilde/oacute/ograve/ocircumflex/odieresis /otilde/uacute/ugrave/ucircumflex/udieresis/dagger /degree/cent/sterling/section/bullet/paragraph /germandbls/registered/copyright/trademark/acute/dieresis /notequal/AE/Oslash/infinity/plusminus/lessequal /greaterequal/yen/mu/partialdiff/summation/product /pi/integral/ordfeminine/ordmasculine/Omega/ae /oslash/questiondown/exclamdown/logicalnot/radical/florin /approxequal/Delta/guillemotleft/guillemotright/ellipsis/blank /Agrave/Atilde/Otilde/OE/oe/endash /emdash/quotedblleft/quotedblright/quoteleft/quoteright/divide /lozenge/ydieresis/Ydieresis/fraction/currency/guilsinglleft /guilsinglright/fi/fl/daggerdbl/periodcentered/quotesinglbase /quotedblbase/perthousand/Acircumflex/Ecircumflex/Aacute/Edieresis /Egrave/Iacute/Icircumflex/Idieresis/Igrave/Oacute /Ocircumflex/apple/Ograve/Uacute/Ucircumflex/Ugrave /dotlessi/circumflex/tilde/macron/breve/dotaccent /ring/cedilla/hungarumlaut/ogonek/caron /F9/Optima -1 TZ %PDF_EndEncoding %PDF_BeginEncoding: F10 Symbol [/F10/Symbol -1 TZ %PDF_EndEncoding 0 0 612 792 RC userdict /DefaultRGB /DeviceRGB put BT /F9 1 Tf 11 0 0 11 288.5 41 Tm 0 Tr 0 g 0.006 Tc (138)Tj /F5 1 Tf -21.864 63.727 TD 0.003 Tc -0.001 Tw (Physical Activity and Health)Tj 10 0 0 10 48 712 Tm 0.005 Tc 0 Tw [(T)60 (able 4-9. Longitudinal population-based studies of physical activity as\ related to depressive symptoms)]TJ ET 0 G 1 i 0 J 0 j 0.5 w 10 M []0 d 48 707.75 m 1176 707.75 l S BT /F5 1 Tf 10 0 0 10 264 693 Tm [(Definition of)-11158 (Definition of)]TJ ET 48 677.25 m 1176 677.25 l S BT /F5 1 Tf 10 0 0 10 48 681 Tm [(Study)-7130 (Population)-7224 (physical activity)-9658 (cancer)]TJ /F9 1 Tf 0 -1.8 TD [(Farmer et al.)-4148 (NHANES I)-7404 (Little or no exer)13 (cise done for)-4328 (Depressive symptoms)]TJ 0 -1.25 TD [(\(1988\))-6789 (Follow-up Study)-4868 (recreation at baseline)-7463 (scores of \(a\) < 16 and)]TJ 9.6 -1.2 TD [(participants,)-23454 (\(b\) )]TJ /F10 1 Tf 30.2 0 TD (\263)Tj /F9 1 Tf 0.55 0 TD 0.001 Tw ( 16 at baseline)Tj -30.75 -1.25 TD -0.002 Tw (white adults,)Tj T* 0 Tw (aged 25\32077 years,)Tj 0 -1.2 TD 0.002 Tw (1975 baseline)Tj -9.6 -4.3 TD 0 Tw [(Camacho et al.)-3029 (Alameda )16 (County)77 (, )16 (CA)-2907 (Self-reported frequency of)-5502 (Depressive symptoms at)]TJ 0 -1.2 TD [(\(1991\))-6789 (population study)-4693 (involvement in active sports,)-4317 (1974 follow-up)]TJ 9.6 -1.25 TD (participants aged )Tj /F10 1 Tf 7.7 0 TD (\263)Tj /F9 1 Tf 0.55 0 TD [( 20)-2345 (swimming or walking, daily)]TJ -8.25 -1.25 TD [(years; or ever)-6154 (exercise, and gardening;)]TJ -9.6 -1.2 TD [(married, 1965 baseline)-11543 (\(low = 0\3204, moderate = 5\3208,)]TJ 21.6 -1.25 TD -0.001 Tw (high = 9\32014\))Tj -21.6 -5.5 TD 0 Tw [(W)54 (eyerer \(1992\))-2859 (German population)-3468 (Regular)62 (, occasional, or no)-5451 (Psychiatric interview)]TJ 9.6 -1.25 TD -0.001 Tw [(study participants)-4353 (exercise at baseline based on)-4098 (assessed depression at)]TJ 0 -1.2 TD (aged )Tj /F10 1 Tf 2.35 0 TD (\263)Tj /F9 1 Tf 0.55 0 TD 0 Tw [( 16 years at)-4096 (single question: How often do you)-1791 (follow-up \(1980\3201984\))]TJ -2.9 -1.25 TD [(1975\3201979 baseline)-3128 (currently exer)14 (cise for sports?)]TJ -9.6 -12.9 TD -0.002 Tw [(Paffenbarger)97 (,)-3967 (Harvard alumni)-5153 (\(a\) )]TJ /F10 1 Tf 22.95 0 TD (\243)Tj /F9 1 Tf 0.55 0 TD 0 Tw [( 1hour)64 (, 1\3202 hours, 3+)-5471 (Physician-diagnosed)]TJ -23.5 -1.2 TD -0.001 Tw [(Lee, Leung)-4884 (study participants,)]TJ 1 g 21.6 0 TD (\(a\) )Tj 0 g 1.35 0 TD 0 Tw [(hours of sports play/week at)-3305 (depression at 1988)]TJ -22.95 -1.25 TD [(\(1994\))-6789 (men aged 35\32074 years,)]TJ 1 g 21.6 0 TD (\(a\) )Tj 0 g 1.35 0 TD [(baseline)-11853 (follow-up)]TJ -13.35 -1.2 TD (1962 or 1966 baseline)Tj 12 -1.25 TD -0.001 Tw (\(b\) < 1,000 kcal, 1,000\3202,499 kcal,)Tj 1 g T* (\(a\) )Tj 0 g 1.35 0 TD 0 Tw (or 2,500+ kcal/week at baseline)Tj ET 48 198.25 m 1176 198.25 l S 1 g 545 720 133 -56 re f 545 209.5 133 -56 re f PDFVars/TermAll get exec restore gsave showpage grestore %%Page: 59 59 save PDFVars/InitAll get exec %PDF_BeginEncoding: F5 Optima-Bold [ 39/quotesingle 96/grave 127/.notdef/Adieresis/Aring/Ccedilla /Eacute/Ntilde/Odieresis/Udieresis/aacute/agrave 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/lozenge/ydieresis/Ydieresis/fraction/currency/guilsinglleft /guilsinglright/fi/fl/daggerdbl/periodcentered/quotesinglbase /quotedblbase/perthousand/Acircumflex/Ecircumflex/Aacute/Edieresis /Egrave/Iacute/Icircumflex/Idieresis/Igrave/Oacute /Ocircumflex/apple/Ograve/Uacute/Ucircumflex/Ugrave /dotlessi/circumflex/tilde/macron/breve/dotaccent /ring/cedilla/hungarumlaut/ogonek/caron /F9/Optima -1 TZ %PDF_EndEncoding %PDF_BeginEncoding: F10 Symbol [/F10/Symbol -1 TZ %PDF_EndEncoding 0 0 612 792 RC userdict /DefaultRGB /DeviceRGB put BT /F9 1 Tf 11 0 0 11 305 41 Tm 0 Tr 0 g 0.006 Tc (139)Tj /F5 1 Tf -0.136 63.727 TD 0.003 Tc 0 Tw (The Effects of Physical Activity on Health and Disease)Tj ET 0 G 1 i 0 J 0 j 0.5 w 10 M []0 d -564 707.75 m 564 707.75 l S BT /F5 1 Tf 10 0 0 10 282 693 Tm 0.005 Tc 0.001 Tw [(Dose)-4055 (Adjustment for confounders)]TJ ET -564 677.25 m 564 677.25 l S BT /F5 1 Tf 10 0 0 10 66 681 Tm 0.002 Tw [(Main findings)-15604 (response)]TJ /F9 1 Tf 7 0 0 7 321 684 Tm (*)Tj /F5 1 Tf 10 0 0 10 345 681 Tm 0 Tw (and other comments)Tj /F9 1 Tf -27.9 -1.8 TD [(\(a\))-430 (Men: 1.3 \(95% CI, 0.5\3203.1\))-8187 (NA)-4845 (Odds ratio adjusted for age, education,)]TJ 1.5 -1.25 TD [(W)54 (omen: 1.9 \(95% CI, 1.1\3203.2\))-13032 (chronic conditions, employment status,)]TJ -1.5 -1.2 TD [(\(b\))-375 (Men: 12.9 \(95% CI, 1.7\32098.9\))-13362 (household income, physical activity apart)]TJ 1.5 -1.25 TD [(W)54 (omen: 2.0 \(95% CI, 0.8\32014.5\))-12467 (from recreation at baseline, length of follow-up)]TJ -1.5 -6.75 TD [(Relative to high active,)-17943 (Odds ratio adjusted for age, income, race,)]TJ 0 -1.2 TD [(low active men:)-20933 (smoking status, alcohol consumption,)]TJ 0 -1.25 TD [(1.76 \(95% CI, 1.06\3202.92\))-10527 (Y)65 (e)0 (s)-4851 (relative weight for height, education, chronic)]TJ T* [(moderate active men:)-18463 (conditions, physical symptoms/disability)95 (,)]TJ 0 -1.2 TD [(1.46 \(95% CI, 0.91\3202.34\))-10527 (No)-4955 (stress events, isolation, feelings of anomie)]TJ 0 -1.25 TD 0.001 Tw (low active women:)Tj 0 -1.2 TD 0 Tw [(1.70 \(95% CI, 1.06\3202.70\))-10527 (NA)]TJ 0 -1.25 TD -0.001 Tw (moderate active women:)Tj T* 0 Tw [(1.00 \(95% CI, 0.63\3201.59\))-10527 (NA)]TJ 0 -1.8 TD [(Relative to regular exer)15 (cise,)-15880 (Odds ratio adjusted for age, social class,)]TJ 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 -0.312 -1.187 TD 0 Tw [(2 levels of comparison; \322No\323 means that there were more than 2 lev\ els but no dose-response gradient was found; \322Y)80 (es\323 means)]TJ T* (that there were more than 2 levels and a dose-response gradient was foun\ d.)Tj ET 1 g -67 720 133 -56 re f -67 209.5 133 -56 re f PDFVars/TermAll get exec restore gsave showpage grestore %%Page: 60 60 save PDFVars/InitAll get exec %PDF_BeginEncoding: F5 Optima-Bold [ 39/quotesingle 96/grave 127/.notdef/Adieresis/Aring/Ccedilla /Eacute/Ntilde/Odieresis/Udieresis/aacute/agrave /acircumflex/adieresis/atilde/aring/ccedilla/eacute /egrave/ecircumflex/edieresis/iacute/igrave/icircumflex /idieresis/ntilde/oacute/ograve/ocircumflex/odieresis /otilde/uacute/ugrave/ucircumflex/udieresis/dagger /degree/cent/sterling/section/bullet/paragraph /germandbls/registered/copyright/trademark/acute/dieresis /notequal/AE/Oslash/infinity/plusminus/lessequal /greaterequal/yen/mu/partialdiff/summation/product /pi/integral/ordfeminine/ordmasculine/Omega/ae /oslash/questiondown/exclamdown/logicalnot/radical/florin 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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 ET PDFVars/TermAll get exec restore gsave showpage grestore %%Page: 61 61 save PDFVars/InitAll get exec %PDF_BeginEncoding: F5 Optima-Bold [ 39/quotesingle 96/grave 127/.notdef/Adieresis/Aring/Ccedilla /Eacute/Ntilde/Odieresis/Udieresis/aacute/agrave /acircumflex/adieresis/atilde/aring/ccedilla/eacute /egrave/ecircumflex/edieresis/iacute/igrave/icircumflex /idieresis/ntilde/oacute/ograve/ocircumflex/odieresis /otilde/uacute/ugrave/ucircumflex/udieresis/dagger /degree/cent/sterling/section/bullet/paragraph /germandbls/registered/copyright/trademark/acute/dieresis /notequal/AE/Oslash/infinity/plusminus/lessequal /greaterequal/yen/mu/partialdiff/summation/product /pi/integral/ordfeminine/ordmasculine/Omega/ae /oslash/questiondown/exclamdown/logicalnot/radical/florin /approxequal/Delta/guillemotleft/guillemotright/ellipsis/blank /Agrave/Atilde/Otilde/OE/oe/endash /emdash/quotedblleft/quotedblright/quoteleft/quoteright/divide /lozenge/ydieresis/Ydieresis/fraction/currency/guilsinglleft /guilsinglright/fi/fl/daggerdbl/periodcentered/quotesinglbase /quotedblbase/perthousand/Acircumflex/Ecircumflex/Aacute/Edieresis /Egrave/Iacute/Icircumflex/Idieresis/Igrave/Oacute /Ocircumflex/apple/Ograve/Uacute/Ucircumflex/Ugrave /dotlessi/circumflex/tilde/macron/breve/dotaccent /ring/cedilla/hungarumlaut/ogonek/caron /F5/Optima-Bold -1 TZ %PDF_EndEncoding %PDF_BeginEncoding: F7 Berkeley-Medium [ 39/quotesingle 96/grave 127/.notdef/Adieresis/Aring/Ccedilla /Eacute/Ntilde/Odieresis/Udieresis/aacute/agrave /acircumflex/adieresis/atilde/aring/ccedilla/eacute /egrave/ecircumflex/edieresis/iacute/igrave/icircumflex /idieresis/ntilde/oacute/ograve/ocircumflex/odieresis /otilde/uacute/ugrave/ucircumflex/udieresis/dagger /degree/cent/sterling/section/bullet/paragraph /germandbls/registered/copyright/trademark/acute/dieresis /notequal/AE/Oslash/infinity/plusminus/lessequal /greaterequal/yen/mu/partialdiff/summation/product /pi/integral/ordfeminine/ordmasculine/Omega/ae /oslash/questiondown/exclamdown/logicalnot/radical/florin /approxequal/Delta/guillemotleft/guillemotright/ellipsis/blank /Agrave/Atilde/Otilde/OE/oe/endash /emdash/quotedblleft/quotedblright/quoteleft/quoteright/divide /lozenge/ydieresis/Ydieresis/fraction/currency/guilsinglleft /guilsinglright/fi/fl/daggerdbl/periodcentered/quotesinglbase /quotedblbase/perthousand/Acircumflex/Ecircumflex/Aacute/Edieresis /Egrave/Iacute/Icircumflex/Idieresis/Igrave/Oacute /Ocircumflex/apple/Ograve/Uacute/Ucircumflex/Ugrave /dotlessi/circumflex/tilde/macron/breve/dotaccent /ring/cedilla/hungarumlaut/ogonek/caron /F7/Berkeley-Medium -1 TZ %PDF_EndEncoding %PDF_BeginEncoding: F9 Optima [ 39/quotesingle 96/grave 127/.notdef/Adieresis/Aring/Ccedilla /Eacute/Ntilde/Odieresis/Udieresis/aacute/agrave /acircumflex/adieresis/atilde/aring/ccedilla/eacute /egrave/ecircumflex/edieresis/iacute/igrave/icircumflex /idieresis/ntilde/oacute/ograve/ocircumflex/odieresis /otilde/uacute/ugrave/ucircumflex/udieresis/dagger /degree/cent/sterling/section/bullet/paragraph /germandbls/registered/copyright/trademark/acute/dieresis /notequal/AE/Oslash/infinity/plusminus/lessequal /greaterequal/yen/mu/partialdiff/summation/product /pi/integral/ordfeminine/ordmasculine/Omega/ae /oslash/questiondown/exclamdown/logicalnot/radical/florin /approxequal/Delta/guillemotleft/guillemotright/ellipsis/blank /Agrave/Atilde/Otilde/OE/oe/endash /emdash/quotedblleft/quotedblright/quoteleft/quoteright/divide /lozenge/ydieresis/Ydieresis/fraction/currency/guilsinglleft /guilsinglright/fi/fl/daggerdbl/periodcentered/quotesinglbase /quotedblbase/perthousand/Acircumflex/Ecircumflex/Aacute/Edieresis /Egrave/Iacute/Icircumflex/Idieresis/Igrave/Oacute /Ocircumflex/apple/Ograve/Uacute/Ucircumflex/Ugrave /dotlessi/circumflex/tilde/macron/breve/dotaccent /ring/cedilla/hungarumlaut/ogonek/caron /F9/Optima -1 TZ %PDF_EndEncoding 0 0 612 792 RC userdict /DefaultRGB /DeviceRGB put BT /F9 1 Tf 11 0 0 11 305 41 Tm 0 Tr 0 g 0.006 Tc (141)Tj /F5 1 Tf -0.136 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 (Biologic Plausibility)Tj /F7 1 Tf 11 0 0 11 66 695.5 Tm 0.023 Tc 0.205 Tw (Some researchers have proposed that exercise-)Tj 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 /F7 1 Tf 11 0 0 11 66 414.5 Tm 0.003 Tc 0.135 Tw (The literature reported here supports a beneficial)Tj 0 -1.227 TD 0.015 Tw (effect of physical activity on relieving symptoms of)Tj 0 -1.182 TD 0.171 Tw (depression and anxiety and on improving mood.)Tj T* 0.095 Tw (There is some evidence that physical activity may)Tj 0 -1.227 TD 0.083 Tw (protect against the development of depression, al-)Tj 0 -1.182 TD 0.018 Tw (though further research is needed to confirm these)Tj 0 -1.227 TD (findings.)Tj /F5 1 Tf 14 0 0 14 66 295.5 Tm -0.001 Tc 0 Tw (Health-Related Quality of Life)Tj /F7 1 Tf 11 0 0 11 66 280 Tm 0.003 Tc 0.21 Tw (For several decades, it has been recognized that)Tj T* -0.111 Tw (health should not be defined simply as the absence of)Tj 0 -1.182 TD -0.034 Tw (disease and disability; rather, health is now concep-)Tj 0 -1.227 TD 0.234 Tw (tualized by the World Health Organization as a)Tj 0 -1.182 TD 0.096 Tw (positive state of physical, mental, and social well-)Tj T* -0.005 Tw (being \(World Health Organization 1947\). This rec-)Tj 0 -1.227 TD 0.014 Tc 0.259 Tw (ognition has resulted in an increasing clinical,)Tj 0 -1.182 TD 0.003 Tc -0.019 Tw (scientific, and public interest in the assessment and)Tj 0 -1.227 TD -0.003 Tw (promotion of health-related quality of life \(HRQL\).)Tj 1.636 -1.182 TD 0.138 Tw (Kaplan and Bush \(1982\) introduced the term)Tj -1.636 -1.227 TD -0.099 Tw (HRQL to capture the influence that health status and)Tj 0 -1.182 TD 0.104 Tw (health care have on the quality of day-to-day life.)Tj T* -0.014 Tw (Viewed as a multidimensional construct that repre-)Tj 0 -1.227 TD -0.013 Tw (sents a person\325s overall satisfaction with life, HRQL)Tj 0 -1.182 TD 0.013 Tc 0.073 Tw (includes the following dimensions: cognitive, so-)Tj 0 -1.227 TD -0.063 Tw (cial, physical, and emotional functioning; personal)Tj 23.955 57.227 TD 0.003 Tc 0.119 Tw [(p)-10 (r)-10 (oductivity; and intimacy \(Shumaker, Anderson,)]TJ 0 -1.182 TD -0.036 Tw (Czajkowski 1990\). Rejeski, Brawley, and Shumaker)Tj T* -0.072 Tw (\(1996\) have shown that physical activity has signifi-)Tj 0 -1.227 TD 0.044 Tw (cant potential to influence HRQL. The most direct)Tj 0 -1.182 TD 0.019 Tw (effects are likely in the areas of psychological well-)Tj 0 -1.227 TD 0.245 Tw (being \(e.g., self-concept, self-esteem, mood, and)Tj 0 -1.182 TD 0.002 Tw (affect\), perceived physical function \(e.g., perceived)Tj T* -0.046 Tw (ability to perform activities of daily living\), physical)Tj 0 -1.227 TD -0.057 Tw (well-being \(e.g., perceived symptoms and perceived)Tj 0 -1.182 TD 0.041 Tw (physical states, such as dyspnea, pain, fatigue, and)Tj 0 -1.227 TD -0.072 Tw (energy\), and, to a limited extent, cognitive function.)Tj 1.636 -1.182 TD 0.038 Tw (In a recent review, McAuley \(1994\) concluded)Tj -1.636 -1.227 TD 0.091 Tw (that a positive association exists between physical)Tj 0 -1.182 TD -0.021 Tw (activity habits and self-esteem in both young adults)Tj T* 0.083 Tw (and children. The strength of this relationship in-)Tj 0 -1.227 TD 0.045 Tw (creases when physical activity is personally valued)Tj 0 -1.182 TD -0.014 Tw (and when measures of psychological well-being are)Tj 0 -1.227 TD -0.052 Tw (specific rather than general. Among nonclinical and)Tj 0 -1.182 TD -0.074 Tw (clinical samples of men and women, this association)Tj T* -0.003 Tw (is observed both with the long-term effects of exer-)Tj 0 -1.227 TD 0.17 Tw (cise training and with the immediate, short-term)Tj 0 -1.182 TD 0 Tw (effects of a single episode of activity.)Tj 1.636 -1.227 TD -0.005 Tc -0.061 Tw (In a review of studies of middle-aged participants)Tj -1.636 -1.182 TD -0.1 Tw (\(mean age, 56.7 years\), McAuley and Rudolph \(1995\))Tj 0 -1.227 TD 0.024 Tw (found correlations between involvement in physical)Tj 0 -1.182 TD -0.02 Tw (activity and psychological well-being that were simi-)Tj T* 0.101 Tw (lar to those patterns observed among younger per-)Tj 0 -1.227 TD -0.041 Tw (sons. Further, the strength of these relationships was)Tj 0 -1.182 TD 0.001 Tw (directly related to the length of time that the partici-)Tj 0 -1.227 TD -0.128 Tw (pants had been involved in physical activity programs.)Tj 0 -1.182 TD 0.054 Tw (This moderating effect requires cautious interpreta-)Tj T* -0.034 Tw (tion because of the possibility of selective adherence.)Tj 0 -1.227 TD 0.161 Tw (There was little evidence that the relationship be-)Tj 0 -1.182 TD -0.011 Tw (tween physical activity and psychological well-being)Tj 0 -1.227 TD 0.002 Tw (was affected by either sex or age. Finally, although a)Tj 0 -1.182 TD 0.065 Tw (number of studies noted improvements in both the)Tj T* 0.011 Tw (cardiorespiratory fitness and the psychological well-)Tj 0 -1.227 TD 0.049 Tw (being of older adults, these improvements were not)Tj 0 -1.182 TD -0.051 Tw (necessarily correlated \(McAuley and Rudolph 1995\).)Tj 0 -1.227 TD -0.122 Tw (Involvement in physical activity may thus increase the)Tj 0 -1.182 TD 0.242 Tw (psychological well-being of older adults indepen-)Tj T* -0.028 Tw (dently of cardiorespiratory fitness \(Brown and Wang)Tj 0 -1.227 TD 0.01 Tc 0.258 Tw (1992; King, Taylor, Haskell 1989; Landers and)Tj 0 -1.182 TD 0 Tc [(Petruzz)-11 (ello 1994; Martinsen and Stephens 1994;)]TJ 0 -1.227 TD -0.005 Tc 0 Tw (McAuley and Rudolph 1995\).)Tj 1.636 -1.182 TD 0.003 Tc 0.089 Tw (Other data suggest that physical activity is re-)Tj -1.636 -1.227 TD -0.089 Tw (lated to perceived improvement in physical function)Tj 0 -1.182 TD -0.029 Tw (in activities of daily living. However, there is a limit)Tj ET PDFVars/TermAll get exec restore gsave showpage grestore %%Page: 62 62 save PDFVars/InitAll get exec %PDF_BeginEncoding: F5 Optima-Bold [ 39/quotesingle 96/grave 127/.notdef/Adieresis/Aring/Ccedilla /Eacute/Ntilde/Odieresis/Udieresis/aacute/agrave /acircumflex/adieresis/atilde/aring/ccedilla/eacute /egrave/ecircumflex/edieresis/iacute/igrave/icircumflex /idieresis/ntilde/oacute/ograve/ocircumflex/odieresis /otilde/uacute/ugrave/ucircumflex/udieresis/dagger /degree/cent/sterling/section/bullet/paragraph /germandbls/registered/copyright/trademark/acute/dieresis /notequal/AE/Oslash/infinity/plusminus/lessequal /greaterequal/yen/mu/partialdiff/summation/product /pi/integral/ordfeminine/ordmasculine/Omega/ae /oslash/questiondown/exclamdown/logicalnot/radical/florin /approxequal/Delta/guillemotleft/guillemotright/ellipsis/blank /Agrave/Atilde/Otilde/OE/oe/endash /emdash/quotedblleft/quotedblright/quoteleft/quoteright/divide /lozenge/ydieresis/Ydieresis/fraction/currency/guilsinglleft /guilsinglright/fi/fl/daggerdbl/periodcentered/quotesinglbase /quotedblbase/perthousand/Acircumflex/Ecircumflex/Aacute/Edieresis /Egrave/Iacute/Icircumflex/Idieresis/Igrave/Oacute /Ocircumflex/apple/Ograve/Uacute/Ucircumflex/Ugrave /dotlessi/circumflex/tilde/macron/breve/dotaccent /ring/cedilla/hungarumlaut/ogonek/caron /F5/Optima-Bold -1 TZ %PDF_EndEncoding %PDF_BeginEncoding: F7 Berkeley-Medium [ 39/quotesingle 96/grave 127/.notdef/Adieresis/Aring/Ccedilla /Eacute/Ntilde/Odieresis/Udieresis/aacute/agrave /acircumflex/adieresis/atilde/aring/ccedilla/eacute /egrave/ecircumflex/edieresis/iacute/igrave/icircumflex /idieresis/ntilde/oacute/ograve/ocircumflex/odieresis /otilde/uacute/ugrave/ucircumflex/udieresis/dagger /degree/cent/sterling/section/bullet/paragraph /germandbls/registered/copyright/trademark/acute/dieresis /notequal/AE/Oslash/infinity/plusminus/lessequal /greaterequal/yen/mu/partialdiff/summation/product /pi/integral/ordfeminine/ordmasculine/Omega/ae /oslash/questiondown/exclamdown/logicalnot/radical/florin /approxequal/Delta/guillemotleft/guillemotright/ellipsis/blank /Agrave/Atilde/Otilde/OE/oe/endash /emdash/quotedblleft/quotedblright/quoteleft/quoteright/divide /lozenge/ydieresis/Ydieresis/fraction/currency/guilsinglleft /guilsinglright/fi/fl/daggerdbl/periodcentered/quotesinglbase /quotedblbase/perthousand/Acircumflex/Ecircumflex/Aacute/Edieresis /Egrave/Iacute/Icircumflex/Idieresis/Igrave/Oacute /Ocircumflex/apple/Ograve/Uacute/Ucircumflex/Ugrave /dotlessi/circumflex/tilde/macron/breve/dotaccent /ring/cedilla/hungarumlaut/ogonek/caron /F7/Berkeley-Medium -1 TZ %PDF_EndEncoding %PDF_BeginEncoding: F9 Optima [ 39/quotesingle 96/grave 127/.notdef/Adieresis/Aring/Ccedilla /Eacute/Ntilde/Odieresis/Udieresis/aacute/agrave /acircumflex/adieresis/atilde/aring/ccedilla/eacute /egrave/ecircumflex/edieresis/iacute/igrave/icircumflex /idieresis/ntilde/oacute/ograve/ocircumflex/odieresis /otilde/uacute/ugrave/ucircumflex/udieresis/dagger /degree/cent/sterling/section/bullet/paragraph /germandbls/registered/copyright/trademark/acute/dieresis /notequal/AE/Oslash/infinity/plusminus/lessequal /greaterequal/yen/mu/partialdiff/summation/product /pi/integral/ordfeminine/ordmasculine/Omega/ae /oslash/questiondown/exclamdown/logicalnot/radical/florin /approxequal/Delta/guillemotleft/guillemotright/ellipsis/blank /Agrave/Atilde/Otilde/OE/oe/endash /emdash/quotedblleft/quotedblright/quoteleft/quoteright/divide /lozenge/ydieresis/Ydieresis/fraction/currency/guilsinglleft /guilsinglright/fi/fl/daggerdbl/periodcentered/quotesinglbase /quotedblbase/perthousand/Acircumflex/Ecircumflex/Aacute/Edieresis /Egrave/Iacute/Icircumflex/Idieresis/Igrave/Oacute /Ocircumflex/apple/Ograve/Uacute/Ucircumflex/Ugrave /dotlessi/circumflex/tilde/macron/breve/dotaccent /ring/cedilla/hungarumlaut/ogonek/caron /F9/Optima -1 TZ %PDF_EndEncoding 0 0 612 792 RC userdict /DefaultRGB /DeviceRGB put BT /F9 1 Tf 11 0 0 11 288.5 41 Tm 0 Tr 0 g 0.006 Tc (142)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 -0.011 Tw (to this effect, since sedentary people can usually do)Tj 0 -1.182 TD 0.157 Tw (their daily tasks. Most research on this aspect of)Tj T* -0.127 Tw (HRQL is thus confined to populations of people who,)Tj 0 -1.227 TD -0.114 Tw (because of health problems, have restrictions in their)Tj 0 -1.182 TD -0.044 Tw (activities of daily living. The growing body of litera-)Tj 0 -1.227 TD 0.251 Tw (ture on this topic indicates that patients whose)Tj 0 -1.182 TD 0.052 Tw (physical function is compromised by heart disease)Tj T* 0.013 Tc -0.047 Tw (\(Ewart 1989\) or arthritis \(Fisher et al. 1993\) expe-)Tj 0 -1.227 TD 0.085 Tw (rience improved daily function from increases in)Tj 0 -1.182 TD 0.002 Tw (physical activity.)Tj 1.636 -1.227 TD 0.023 Tc -0.02 Tw [(H)18 (RQL requires a number of different types of)]TJ -1.636 -1.182 TD 0.021 Tw (measurements; however, few studies on physical)Tj 0 -1.227 TD 0.106 Tw (activity have used a multidimensional measure-)Tj 0 -1.182 TD 0.097 Tw (ment scheme. Exceptions include a randomized)Tj T* 0.249 Tw (clinical trial involving healthy elderly persons)Tj 0 -1.227 TD -0.037 Tw (\(Stewart, King, Haskell 1993\) and a 2-year obser-)Tj 0 -1.182 TD 0.017 Tc 0.236 Tw [(vational )-10 (study )-10 (of)17 ( persons with chronic disease)]TJ 0 -1.227 TD 0.013 Tc -0.013 Tw [(\(Stewart et al. 1994\). In the clinical trial, healthy)]TJ 0 -1.182 TD 0.026 Tw (persons who were assigned to endurance exercise)Tj T* 0.149 Tw (had better self-reported ratings of their physical)Tj 0 -1.227 TD 0.012 Tc -0.127 Tw (functioning and health \(e.g., physical and role func-)Tj 0 -1.182 TD 0.013 Tc 0.19 Tw (tion, experiencing of pain, perception of health)Tj 0 -1.227 TD 0.198 Tw (status\) than control participants, yet endurance)Tj 0 -1.182 TD 0.122 Tw (training brought no changes in self-reported en-)Tj T* -0.054 Tw (ergy/fatigue, psychological distress, or psychologi-)Tj 0 -1.227 TD 0.147 Tw (cal well-being. By contrast, among persons with)Tj 0 -1.182 TD 0.09 Tw (chronic diseases, physical activity was associated)Tj 0 -1.227 TD 0.049 Tw (with improvement in both psychological well-be-)Tj 0 -1.182 TD -0.069 Tw (ing and physical function; however, the magnitude)Tj T* -0.041 Tw (of these effects was highly dependent on the status)Tj 0 -1.227 TD 0.078 Tw (of the patient\325s chronic disease. Participants who)Tj 0 -1.182 TD -0.03 Tw (have lower levels of mental or physical health may)Tj 0 -1.227 TD 0.003 Tc -0.127 Tw (have the most to gain from physical activity \(Lennox,)Tj 0 -1.182 TD 0.013 Tc -0.084 Tw (Bedell, Stone 1990; Morgan et al. 1970; Simons and)Tj T* -0.081 Tw (Birkimer 1988; Rejeski et al. 1995\), since they have)Tj 0 -1.227 TD 0.208 Tw (more room to improve their health status than)Tj 0 -1.182 TD -0.001 Tw (people already possessing good health.)Tj 1.636 -1.227 TD -0.005 Tc -0.084 Tw (A relatively small number of cross-sectional stud-)Tj -1.636 -1.182 TD 0.013 Tc 0.142 Tw [(i)19 (e)19 (s)18 ( have shown a strong positive association be-)]TJ 0 -1.227 TD 0.068 Tw (tween regular physical activity and cognitive and)Tj 0 -1.182 TD 0.034 Tw (neuropsychological performance on tasks such as)Tj T* 0.06 Tc 0.258 Tw (math, acuity, and reaction time \(Dustman,)Tj 0 -1.227 TD 0.013 Tc 0.202 Tw (Emmerson, Shearer 1994; Thomas et al. 1994\).)Tj 0 -1.182 TD 0.024 Tw (However, longer-term training studies \(2 or more)Tj 0 -1.227 TD 0.226 Tw (years\) are required to confirm whether aerobic)Tj 0 -1.182 TD -0.089 Tw (exercise has a pronounced effect on cognitive func-)Tj T* 0.061 Tw (tion. Also unclear are whether the effects of low-)Tj 0 -1.227 TD 0.01 Tc 0.141 Tw [(intensity physical activity are simi)-11 (lar )10 (to )10 (those )10 (of)]TJ 23.955 56.409 TD 0.003 Tc -0.008 Tw (aerobic exercise and whether objective measures of)Tj 0 -1.182 TD 0.008 Tw (cognitive function can elucidate the perceived cog-)Tj T* 0 Tc -0.129 Tw (nitive function of participants \(Dustman, Emmerson,)Tj 0 -1.227 TD 0.003 Tc 0.001 Tw (Shearer 1994\).)Tj /F5 1 Tf 12 0 0 12 311.5 643 Tm 0 Tc (Conclusions)Tj /F7 1 Tf 11 0 0 11 311.5 628 Tm 0.003 Tc 0.066 Tw (Physical activity appears to improve psychological)Tj 0 -1.182 TD -0.002 Tc -0.129 Tw [(well-being. Among people compromised by ill health,)]TJ T* 0.003 Tc 0.011 Tw (physical activity appears to improve their ability to)Tj 0 -1.227 TD 0 Tw (perform activities of daily living.)Tj /F5 1 Tf 14 0 0 14 311.5 549 Tm -0.001 Tc [(Adverse Ef)30 (fects of Physical Activity)]TJ /F7 1 Tf 11 0 0 11 311.5 533 Tm 0.003 Tc -0.126 Tw (Although physical activity has numerous health ben-)Tj 0 -1.182 TD (efits, its potential adverse effects must also be consid-)Tj T* 0.006 Tc 0.258 Tw (ered. Listing the potential risks associated with)Tj 0 -1.227 TD 0.003 Tc 0.16 Tw (physical activity is a straightforward matter. It is)Tj 0 -1.182 TD 0.097 Tw (much more difficult to determine how commonly)Tj 0 -1.227 TD -0.03 Tw (they occur among people who are physically active.)Tj /F5 1 Tf 12 0 0 12 311.5 438.5 Tm 0 Tc 0 Tw (Types of Adverse Effects)Tj 11 0 2.138 11 311.5 419 Tm 0.003 Tc 0.001 Tw (Musculoskeletal Injuries)Tj /F7 1 Tf 11 0 0 11 311.5 404.5 Tm 0.146 Tw (Acute stress from sudden forceful movement can)Tj T* -0.098 Tw (cause strains, tears, and even fractures. For example,)Tj 0 -1.182 TD 0.185 Tw (a vigorous swing of a baseball bat can lead to a)Tj T* 0.12 Tw (dislocated shoulder. An attempt to accelerate for-)Tj 0 -1.227 TD -0.031 Tw (ward in tennis can tear an Achilles tendon. Bending)Tj 0 -1.182 TD 0.092 Tw (to retrieve an object can rupture an intervertebral)Tj 0 -1.227 TD -0.033 Tw (disc. Injuries like these can result from any activity,)Tj 0 -1.182 TD 0.012 Tw (exercise, or sport that features sudden movements,)Tj T* 0.246 Tw (such as those that can occur in professional or)Tj 0 -1.227 TD 0.033 Tw (amateur track and field, racquet sports, basketball,)Tj 0 -1.182 TD 0.056 Tw (baseball, football, soccer, and golf. Collisions with)Tj 0 -1.227 TD -0.068 Tw (equipment, other participants, and surfaces can also)Tj 0 -1.182 TD 0.227 Tw (produce severe injury. Children and adolescents)Tj T* -0.02 Tw (with developing bodies are at special risk of perma-)Tj 0 -1.227 TD -0.031 Tw (nent physical damage if injury occurs to the growth)Tj 0 -1.182 TD 0.003 Tw (plates of long bones or to other bone or connective)Tj 0 -1.227 TD 0 Tw (tissue structures.)Tj 1.636 -1.182 TD 0.009 Tc -0.127 Tw (Activities that involve repetitive motions, some-)Tj -1.636 -1.227 TD 0.013 Tc -0.074 Tw (times with traumatic contact with a ground surface)Tj 0 -1.182 TD 0.041 Tw (or ball, are associated with other musculoskeletal)Tj T* 0.022 Tw (injuries. An extensive literature describes injuries)Tj 0 -1.227 TD 0.109 Tw (related to jogging and running \(Hoeberigs 1992;)Tj 0 -1.182 TD -0.028 Tw [(Rolf 1995; Van Mechelen 1992\). Lower-extremity)]TJ 0 -1.227 TD 0.052 Tw (injuries appear to be the most common; of these,)Tj ET PDFVars/TermAll get exec restore gsave showpage grestore %%Page: 63 63 save PDFVars/InitAll get exec %PDF_BeginEncoding: F5 Optima-Bold [ 39/quotesingle 96/grave 127/.notdef/Adieresis/Aring/Ccedilla /Eacute/Ntilde/Odieresis/Udieresis/aacute/agrave /acircumflex/adieresis/atilde/aring/ccedilla/eacute /egrave/ecircumflex/edieresis/iacute/igrave/icircumflex /idieresis/ntilde/oacute/ograve/ocircumflex/odieresis /otilde/uacute/ugrave/ucircumflex/udieresis/dagger /degree/cent/sterling/section/bullet/paragraph /germandbls/registered/copyright/trademark/acute/dieresis /notequal/AE/Oslash/infinity/plusminus/lessequal /greaterequal/yen/mu/partialdiff/summation/product /pi/integral/ordfeminine/ordmasculine/Omega/ae /oslash/questiondown/exclamdown/logicalnot/radical/florin /approxequal/Delta/guillemotleft/guillemotright/ellipsis/blank /Agrave/Atilde/Otilde/OE/oe/endash /emdash/quotedblleft/quotedblright/quoteleft/quoteright/divide /lozenge/ydieresis/Ydieresis/fraction/currency/guilsinglleft /guilsinglright/fi/fl/daggerdbl/periodcentered/quotesinglbase /quotedblbase/perthousand/Acircumflex/Ecircumflex/Aacute/Edieresis /Egrave/Iacute/Icircumflex/Idieresis/Igrave/Oacute /Ocircumflex/apple/Ograve/Uacute/Ucircumflex/Ugrave /dotlessi/circumflex/tilde/macron/breve/dotaccent /ring/cedilla/hungarumlaut/ogonek/caron /F5/Optima-Bold -1 TZ %PDF_EndEncoding %PDF_BeginEncoding: F7 Berkeley-Medium [ 39/quotesingle 96/grave 127/.notdef/Adieresis/Aring/Ccedilla /Eacute/Ntilde/Odieresis/Udieresis/aacute/agrave /acircumflex/adieresis/atilde/aring/ccedilla/eacute /egrave/ecircumflex/edieresis/iacute/igrave/icircumflex /idieresis/ntilde/oacute/ograve/ocircumflex/odieresis /otilde/uacute/ugrave/ucircumflex/udieresis/dagger /degree/cent/sterling/section/bullet/paragraph /germandbls/registered/copyright/trademark/acute/dieresis /notequal/AE/Oslash/infinity/plusminus/lessequal /greaterequal/yen/mu/partialdiff/summation/product /pi/integral/ordfeminine/ordmasculine/Omega/ae /oslash/questiondown/exclamdown/logicalnot/radical/florin /approxequal/Delta/guillemotleft/guillemotright/ellipsis/blank /Agrave/Atilde/Otilde/OE/oe/endash /emdash/quotedblleft/quotedblright/quoteleft/quoteright/divide /lozenge/ydieresis/Ydieresis/fraction/currency/guilsinglleft /guilsinglright/fi/fl/daggerdbl/periodcentered/quotesinglbase /quotedblbase/perthousand/Acircumflex/Ecircumflex/Aacute/Edieresis /Egrave/Iacute/Icircumflex/Idieresis/Igrave/Oacute /Ocircumflex/apple/Ograve/Uacute/Ucircumflex/Ugrave /dotlessi/circumflex/tilde/macron/breve/dotaccent /ring/cedilla/hungarumlaut/ogonek/caron /F7/Berkeley-Medium -1 TZ %PDF_EndEncoding %PDF_BeginEncoding: F9 Optima [ 39/quotesingle 96/grave 127/.notdef/Adieresis/Aring/Ccedilla /Eacute/Ntilde/Odieresis/Udieresis/aacute/agrave /acircumflex/adieresis/atilde/aring/ccedilla/eacute /egrave/ecircumflex/edieresis/iacute/igrave/icircumflex /idieresis/ntilde/oacute/ograve/ocircumflex/odieresis /otilde/uacute/ugrave/ucircumflex/udieresis/dagger /degree/cent/sterling/section/bullet/paragraph /germandbls/registered/copyright/trademark/acute/dieresis /notequal/AE/Oslash/infinity/plusminus/lessequal /greaterequal/yen/mu/partialdiff/summation/product /pi/integral/ordfeminine/ordmasculine/Omega/ae /oslash/questiondown/exclamdown/logicalnot/radical/florin /approxequal/Delta/guillemotleft/guillemotright/ellipsis/blank /Agrave/Atilde/Otilde/OE/oe/endash /emdash/quotedblleft/quotedblright/quoteleft/quoteright/divide /lozenge/ydieresis/Ydieresis/fraction/currency/guilsinglleft /guilsinglright/fi/fl/daggerdbl/periodcentered/quotesinglbase /quotedblbase/perthousand/Acircumflex/Ecircumflex/Aacute/Edieresis /Egrave/Iacute/Icircumflex/Idieresis/Igrave/Oacute /Ocircumflex/apple/Ograve/Uacute/Ucircumflex/Ugrave /dotlessi/circumflex/tilde/macron/breve/dotaccent /ring/cedilla/hungarumlaut/ogonek/caron /F9/Optima -1 TZ %PDF_EndEncoding 0 0 612 792 RC userdict /DefaultRGB /DeviceRGB put BT /F9 1 Tf 11 0 0 11 305 41 Tm 0 Tr 0 g 0.006 Tc (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 11 0 2.138 11 66 245.5 Tm 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 11 0 2.138 11 329.5 711 Tm (Hazards)Tj /F7 1 Tf 11 0 0 11 329.5 696.5 Tm -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 0 -1.227 TD -0.053 Tw (compromised coronary circulation may develop an-)Tj 0 -1.182 TD -0.043 Tw (gina or acute myocardial infarction during vigorous)Tj 0 -1.227 TD -0.028 Tw (activity \(Mittleman et al. 1993; Willich et al. 1993\).)Tj 0 -1.182 TD -0.062 Tw (Arrythmias may be precipitated by a combination of)Tj T* -0.086 Tw (exertion and underlying heart disease, and some can)Tj 0 -1.227 TD -0.09 Tw (lead to sudden death \(Kohl et al. 1992; Koplan 1979;)Tj 0 -1.182 TD -0.064 Tw (Siscovick et al. 1984; Thompson, Funk, et al. 1982\).)Tj 0 -1.227 TD 0.013 Tc 0.189 Tw (Compared with sedentary people who suddenly)Tj 0 -1.182 TD -0.004 Tw (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 ET PDFVars/TermAll get exec restore gsave showpage grestore %%Page: 64 64 save PDFVars/InitAll get exec %PDF_BeginEncoding: F5 Optima-Bold [ 39/quotesingle 96/grave 127/.notdef/Adieresis/Aring/Ccedilla /Eacute/Ntilde/Odieresis/Udieresis/aacute/agrave /acircumflex/adieresis/atilde/aring/ccedilla/eacute /egrave/ecircumflex/edieresis/iacute/igrave/icircumflex /idieresis/ntilde/oacute/ograve/ocircumflex/odieresis /otilde/uacute/ugrave/ucircumflex/udieresis/dagger /degree/cent/sterling/section/bullet/paragraph /germandbls/registered/copyright/trademark/acute/dieresis /notequal/AE/Oslash/infinity/plusminus/lessequal /greaterequal/yen/mu/partialdiff/summation/product /pi/integral/ordfeminine/ordmasculine/Omega/ae /oslash/questiondown/exclamdown/logicalnot/radical/florin /approxequal/Delta/guillemotleft/guillemotright/ellipsis/blank /Agrave/Atilde/Otilde/OE/oe/endash /emdash/quotedblleft/quotedblright/quoteleft/quoteright/divide /lozenge/ydieresis/Ydieresis/fraction/currency/guilsinglleft /guilsinglright/fi/fl/daggerdbl/periodcentered/quotesinglbase /quotedblbase/perthousand/Acircumflex/Ecircumflex/Aacute/Edieresis /Egrave/Iacute/Icircumflex/Idieresis/Igrave/Oacute /Ocircumflex/apple/Ograve/Uacute/Ucircumflex/Ugrave /dotlessi/circumflex/tilde/macron/breve/dotaccent /ring/cedilla/hungarumlaut/ogonek/caron /F5/Optima-Bold -1 TZ %PDF_EndEncoding %PDF_BeginEncoding: F7 Berkeley-Medium [ 39/quotesingle 96/grave 127/.notdef/Adieresis/Aring/Ccedilla /Eacute/Ntilde/Odieresis/Udieresis/aacute/agrave /acircumflex/adieresis/atilde/aring/ccedilla/eacute /egrave/ecircumflex/edieresis/iacute/igrave/icircumflex /idieresis/ntilde/oacute/ograve/ocircumflex/odieresis /otilde/uacute/ugrave/ucircumflex/udieresis/dagger /degree/cent/sterling/section/bullet/paragraph /germandbls/registered/copyright/trademark/acute/dieresis /notequal/AE/Oslash/infinity/plusminus/lessequal /greaterequal/yen/mu/partialdiff/summation/product /pi/integral/ordfeminine/ordmasculine/Omega/ae /oslash/questiondown/exclamdown/logicalnot/radical/florin /approxequal/Delta/guillemotleft/guillemotright/ellipsis/blank /Agrave/Atilde/Otilde/OE/oe/endash /emdash/quotedblleft/quotedblright/quoteleft/quoteright/divide /lozenge/ydieresis/Ydieresis/fraction/currency/guilsinglleft /guilsinglright/fi/fl/daggerdbl/periodcentered/quotesinglbase /quotedblbase/perthousand/Acircumflex/Ecircumflex/Aacute/Edieresis /Egrave/Iacute/Icircumflex/Idieresis/Igrave/Oacute /Ocircumflex/apple/Ograve/Uacute/Ucircumflex/Ugrave /dotlessi/circumflex/tilde/macron/breve/dotaccent /ring/cedilla/hungarumlaut/ogonek/caron /F7/Berkeley-Medium -1 TZ %PDF_EndEncoding %PDF_BeginEncoding: F9 Optima [ 39/quotesingle 96/grave 127/.notdef/Adieresis/Aring/Ccedilla /Eacute/Ntilde/Odieresis/Udieresis/aacute/agrave /acircumflex/adieresis/atilde/aring/ccedilla/eacute /egrave/ecircumflex/edieresis/iacute/igrave/icircumflex /idieresis/ntilde/oacute/ograve/ocircumflex/odieresis /otilde/uacute/ugrave/ucircumflex/udieresis/dagger /degree/cent/sterling/section/bullet/paragraph /germandbls/registered/copyright/trademark/acute/dieresis /notequal/AE/Oslash/infinity/plusminus/lessequal /greaterequal/yen/mu/partialdiff/summation/product /pi/integral/ordfeminine/ordmasculine/Omega/ae /oslash/questiondown/exclamdown/logicalnot/radical/florin /approxequal/Delta/guillemotleft/guillemotright/ellipsis/blank /Agrave/Atilde/Otilde/OE/oe/endash /emdash/quotedblleft/quotedblright/quoteleft/quoteright/divide /lozenge/ydieresis/Ydieresis/fraction/currency/guilsinglleft /guilsinglright/fi/fl/daggerdbl/periodcentered/quotesinglbase /quotedblbase/perthousand/Acircumflex/Ecircumflex/Aacute/Edieresis /Egrave/Iacute/Icircumflex/Idieresis/Igrave/Oacute /Ocircumflex/apple/Ograve/Uacute/Ucircumflex/Ugrave /dotlessi/circumflex/tilde/macron/breve/dotaccent /ring/cedilla/hungarumlaut/ogonek/caron /F9/Optima -1 TZ %PDF_EndEncoding %PDF_BeginEncoding: F16 Berkeley-Italic [ 39/quotesingle 96/grave 127/.notdef/Adieresis/Aring/Ccedilla /Eacute/Ntilde/Odieresis/Udieresis/aacute/agrave /acircumflex/adieresis/atilde/aring/ccedilla/eacute /egrave/ecircumflex/edieresis/iacute/igrave/icircumflex /idieresis/ntilde/oacute/ograve/ocircumflex/odieresis /otilde/uacute/ugrave/ucircumflex/udieresis/dagger /degree/cent/sterling/section/bullet/paragraph /germandbls/registered/copyright/trademark/acute/dieresis /notequal/AE/Oslash/infinity/plusminus/lessequal /greaterequal/yen/mu/partialdiff/summation/product /pi/integral/ordfeminine/ordmasculine/Omega/ae /oslash/questiondown/exclamdown/logicalnot/radical/florin /approxequal/Delta/guillemotleft/guillemotright/ellipsis/blank /Agrave/Atilde/Otilde/OE/oe/endash /emdash/quotedblleft/quotedblright/quoteleft/quoteright/divide /lozenge/ydieresis/Ydieresis/fraction/currency/guilsinglleft /guilsinglright/fi/fl/daggerdbl/periodcentered/quotesinglbase /quotedblbase/perthousand/Acircumflex/Ecircumflex/Aacute/Edieresis /Egrave/Iacute/Icircumflex/Idieresis/Igrave/Oacute /Ocircumflex/apple/Ograve/Uacute/Ucircumflex/Ugrave /dotlessi/circumflex/tilde/macron/breve/dotaccent /ring/cedilla/hungarumlaut/ogonek/caron /F16/Berkeley-Italic -1 TZ %PDF_EndEncoding 0 0 612 792 RC userdict /DefaultRGB /DeviceRGB put BT /F9 1 Tf 11 0 0 11 288.5 41 Tm 0 Tr 0 g 0.006 Tc (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* 0.185 Tw (useful to review the evidence according to Hill\325s)Tj 0 -1.227 TD -0.05 Tw (classic criteria for causality \(Hill 1965; Paffenbarger)Tj 0 -1.182 TD (1988\).)Tj /F16 1 Tf 1.636 -1.227 TD -0.072 Tw (Strength of Association. )Tj /F7 1 Tf 9.455 0 TD -0.075 Tw (The numerous estimated)Tj -11.091 -1.182 TD -0.107 Tw (measures of association for cardiovascular outcomes)Tj 0 -1.227 TD 0.107 Tw (presented in this chapter generally fall within the)Tj 0 -1.182 TD -0.038 Tw (range of a 1.5- to 2.0-fold increase in risk of adverse)Tj T* 0.251 Tw (health outcomes associated with inactivity. This)Tj 0 -1.227 TD 0.155 Tw (range represents a moderately strong association,)Tj 0 -1.182 TD 0.16 Tw (similar in magnitude to the relationship between)Tj 0 -1.227 TD 0.053 Tw (CHD and smoking, hypertension, or elevated cho-)Tj 0 -1.182 TD 0.104 Tw (lesterol. The associations with NIDDM, hyperten-)Tj T* -0.041 Tw (sion, and colon cancer have been somewhat smaller)Tj 0 -1.227 TD 0.027 Tw (in magnitude. The difficulty in measuring physical)Tj 0 -1.182 TD 0.198 Tw (activity may lead to substantial misclassification,)Tj 0 -1.227 TD -0.076 Tw (which in turn would bias studies toward finding less)Tj 0 -1.182 TD -0.098 Tw (of an effect of activity than may actually exist. On the)Tj T* 0.157 Tw (other hand, not controlling for all potential con-)Tj 0 -1.227 TD -0.003 Tw (founders could bias studies toward finding more of)Tj 0 -1.182 TD 0.037 Tw (an effect than may actually exist. Efforts to stratify)Tj 0 -1.227 TD -0.107 Tw (studies of physical activity and CHD by the quality of)Tj ET PDFVars/TermAll get exec restore gsave showpage grestore %%Page: 65 65 save PDFVars/InitAll get exec %PDF_BeginEncoding: F5 Optima-Bold [ 39/quotesingle 96/grave 127/.notdef/Adieresis/Aring/Ccedilla /Eacute/Ntilde/Odieresis/Udieresis/aacute/agrave /acircumflex/adieresis/atilde/aring/ccedilla/eacute /egrave/ecircumflex/edieresis/iacute/igrave/icircumflex /idieresis/ntilde/oacute/ograve/ocircumflex/odieresis /otilde/uacute/ugrave/ucircumflex/udieresis/dagger /degree/cent/sterling/section/bullet/paragraph /germandbls/registered/copyright/trademark/acute/dieresis /notequal/AE/Oslash/infinity/plusminus/lessequal /greaterequal/yen/mu/partialdiff/summation/product /pi/integral/ordfeminine/ordmasculine/Omega/ae /oslash/questiondown/exclamdown/logicalnot/radical/florin /approxequal/Delta/guillemotleft/guillemotright/ellipsis/blank /Agrave/Atilde/Otilde/OE/oe/endash /emdash/quotedblleft/quotedblright/quoteleft/quoteright/divide /lozenge/ydieresis/Ydieresis/fraction/currency/guilsinglleft /guilsinglright/fi/fl/daggerdbl/periodcentered/quotesinglbase /quotedblbase/perthousand/Acircumflex/Ecircumflex/Aacute/Edieresis /Egrave/Iacute/Icircumflex/Idieresis/Igrave/Oacute /Ocircumflex/apple/Ograve/Uacute/Ucircumflex/Ugrave /dotlessi/circumflex/tilde/macron/breve/dotaccent /ring/cedilla/hungarumlaut/ogonek/caron /F5/Optima-Bold -1 TZ %PDF_EndEncoding %PDF_BeginEncoding: F7 Berkeley-Medium [ 39/quotesingle 96/grave 127/.notdef/Adieresis/Aring/Ccedilla /Eacute/Ntilde/Odieresis/Udieresis/aacute/agrave /acircumflex/adieresis/atilde/aring/ccedilla/eacute /egrave/ecircumflex/edieresis/iacute/igrave/icircumflex /idieresis/ntilde/oacute/ograve/ocircumflex/odieresis /otilde/uacute/ugrave/ucircumflex/udieresis/dagger /degree/cent/sterling/section/bullet/paragraph /germandbls/registered/copyright/trademark/acute/dieresis /notequal/AE/Oslash/infinity/plusminus/lessequal /greaterequal/yen/mu/partialdiff/summation/product /pi/integral/ordfeminine/ordmasculine/Omega/ae /oslash/questiondown/exclamdown/logicalnot/radical/florin /approxequal/Delta/guillemotleft/guillemotright/ellipsis/blank /Agrave/Atilde/Otilde/OE/oe/endash /emdash/quotedblleft/quotedblright/quoteleft/quoteright/divide /lozenge/ydieresis/Ydieresis/fraction/currency/guilsinglleft /guilsinglright/fi/fl/daggerdbl/periodcentered/quotesinglbase /quotedblbase/perthousand/Acircumflex/Ecircumflex/Aacute/Edieresis /Egrave/Iacute/Icircumflex/Idieresis/Igrave/Oacute /Ocircumflex/apple/Ograve/Uacute/Ucircumflex/Ugrave /dotlessi/circumflex/tilde/macron/breve/dotaccent /ring/cedilla/hungarumlaut/ogonek/caron /F7/Berkeley-Medium -1 TZ %PDF_EndEncoding %PDF_BeginEncoding: F9 Optima [ 39/quotesingle 96/grave 127/.notdef/Adieresis/Aring/Ccedilla /Eacute/Ntilde/Odieresis/Udieresis/aacute/agrave /acircumflex/adieresis/atilde/aring/ccedilla/eacute /egrave/ecircumflex/edieresis/iacute/igrave/icircumflex /idieresis/ntilde/oacute/ograve/ocircumflex/odieresis /otilde/uacute/ugrave/ucircumflex/udieresis/dagger /degree/cent/sterling/section/bullet/paragraph /germandbls/registered/copyright/trademark/acute/dieresis /notequal/AE/Oslash/infinity/plusminus/lessequal /greaterequal/yen/mu/partialdiff/summation/product /pi/integral/ordfeminine/ordmasculine/Omega/ae /oslash/questiondown/exclamdown/logicalnot/radical/florin /approxequal/Delta/guillemotleft/guillemotright/ellipsis/blank /Agrave/Atilde/Otilde/OE/oe/endash /emdash/quotedblleft/quotedblright/quoteleft/quoteright/divide /lozenge/ydieresis/Ydieresis/fraction/currency/guilsinglleft /guilsinglright/fi/fl/daggerdbl/periodcentered/quotesinglbase /quotedblbase/perthousand/Acircumflex/Ecircumflex/Aacute/Edieresis /Egrave/Iacute/Icircumflex/Idieresis/Igrave/Oacute /Ocircumflex/apple/Ograve/Uacute/Ucircumflex/Ugrave /dotlessi/circumflex/tilde/macron/breve/dotaccent /ring/cedilla/hungarumlaut/ogonek/caron /F9/Optima -1 TZ %PDF_EndEncoding %PDF_BeginEncoding: F16 Berkeley-Italic [ 39/quotesingle 96/grave 127/.notdef/Adieresis/Aring/Ccedilla /Eacute/Ntilde/Odieresis/Udieresis/aacute/agrave /acircumflex/adieresis/atilde/aring/ccedilla/eacute /egrave/ecircumflex/edieresis/iacute/igrave/icircumflex /idieresis/ntilde/oacute/ograve/ocircumflex/odieresis /otilde/uacute/ugrave/ucircumflex/udieresis/dagger /degree/cent/sterling/section/bullet/paragraph /germandbls/registered/copyright/trademark/acute/dieresis /notequal/AE/Oslash/infinity/plusminus/lessequal /greaterequal/yen/mu/partialdiff/summation/product /pi/integral/ordfeminine/ordmasculine/Omega/ae /oslash/questiondown/exclamdown/logicalnot/radical/florin /approxequal/Delta/guillemotleft/guillemotright/ellipsis/blank /Agrave/Atilde/Otilde/OE/oe/endash /emdash/quotedblleft/quotedblright/quoteleft/quoteright/divide /lozenge/ydieresis/Ydieresis/fraction/currency/guilsinglleft /guilsinglright/fi/fl/daggerdbl/periodcentered/quotesinglbase /quotedblbase/perthousand/Acircumflex/Ecircumflex/Aacute/Edieresis /Egrave/Iacute/Icircumflex/Idieresis/Igrave/Oacute /Ocircumflex/apple/Ograve/Uacute/Ucircumflex/Ugrave /dotlessi/circumflex/tilde/macron/breve/dotaccent /ring/cedilla/hungarumlaut/ogonek/caron /F16/Berkeley-Italic -1 TZ %PDF_EndEncoding 0 0 612 792 RC userdict /DefaultRGB /DeviceRGB put BT /F9 1 Tf 11 0 0 11 305 41 Tm 0 Tr 0 g 0.006 Tc (145)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 -0.043 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 (often is also more strongly related to CVD and)Tj T* -0.005 Tc 0.033 Tw (mortality. Measures of association between physical)Tj 0 -1.227 TD -0.098 Tw (activity and health outcomes thus might be stronger if)Tj 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 0 -1.227 TD 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 12 0 0 12 329.5 286.5 Tm 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 \(Hahn et al. 1990; Powell and Blair)Tj 0 -1.182 TD -0.126 Tw (1994; McGinnis and Foege 1993\). 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 0 -1.227 TD -0.007 Tw (the prevalence of inactivity in the population. Such)Tj 0 -1.182 TD 0.033 Tw (estimates are inherently uncertain because they do)Tj ET PDFVars/TermAll get exec restore gsave showpage grestore %%Page: 66 66 save PDFVars/InitAll get exec %PDF_BeginEncoding: F5 Optima-Bold [ 39/quotesingle 96/grave 127/.notdef/Adieresis/Aring/Ccedilla /Eacute/Ntilde/Odieresis/Udieresis/aacute/agrave /acircumflex/adieresis/atilde/aring/ccedilla/eacute /egrave/ecircumflex/edieresis/iacute/igrave/icircumflex /idieresis/ntilde/oacute/ograve/ocircumflex/odieresis /otilde/uacute/ugrave/ucircumflex/udieresis/dagger /degree/cent/sterling/section/bullet/paragraph /germandbls/registered/copyright/trademark/acute/dieresis /notequal/AE/Oslash/infinity/plusminus/lessequal /greaterequal/yen/mu/partialdiff/summation/product /pi/integral/ordfeminine/ordmasculine/Omega/ae /oslash/questiondown/exclamdown/logicalnot/radical/florin /approxequal/Delta/guillemotleft/guillemotright/ellipsis/blank /Agrave/Atilde/Otilde/OE/oe/endash /emdash/quotedblleft/quotedblright/quoteleft/quoteright/divide /lozenge/ydieresis/Ydieresis/fraction/currency/guilsinglleft /guilsinglright/fi/fl/daggerdbl/periodcentered/quotesinglbase /quotedblbase/perthousand/Acircumflex/Ecircumflex/Aacute/Edieresis /Egrave/Iacute/Icircumflex/Idieresis/Igrave/Oacute /Ocircumflex/apple/Ograve/Uacute/Ucircumflex/Ugrave /dotlessi/circumflex/tilde/macron/breve/dotaccent /ring/cedilla/hungarumlaut/ogonek/caron /F5/Optima-Bold -1 TZ %PDF_EndEncoding %PDF_BeginEncoding: F7 Berkeley-Medium [ 39/quotesingle 96/grave 127/.notdef/Adieresis/Aring/Ccedilla /Eacute/Ntilde/Odieresis/Udieresis/aacute/agrave /acircumflex/adieresis/atilde/aring/ccedilla/eacute /egrave/ecircumflex/edieresis/iacute/igrave/icircumflex /idieresis/ntilde/oacute/ograve/ocircumflex/odieresis /otilde/uacute/ugrave/ucircumflex/udieresis/dagger /degree/cent/sterling/section/bullet/paragraph /germandbls/registered/copyright/trademark/acute/dieresis /notequal/AE/Oslash/infinity/plusminus/lessequal /greaterequal/yen/mu/partialdiff/summation/product /pi/integral/ordfeminine/ordmasculine/Omega/ae /oslash/questiondown/exclamdown/logicalnot/radical/florin /approxequal/Delta/guillemotleft/guillemotright/ellipsis/blank /Agrave/Atilde/Otilde/OE/oe/endash /emdash/quotedblleft/quotedblright/quoteleft/quoteright/divide /lozenge/ydieresis/Ydieresis/fraction/currency/guilsinglleft /guilsinglright/fi/fl/daggerdbl/periodcentered/quotesinglbase /quotedblbase/perthousand/Acircumflex/Ecircumflex/Aacute/Edieresis /Egrave/Iacute/Icircumflex/Idieresis/Igrave/Oacute /Ocircumflex/apple/Ograve/Uacute/Ucircumflex/Ugrave /dotlessi/circumflex/tilde/macron/breve/dotaccent /ring/cedilla/hungarumlaut/ogonek/caron /F7/Berkeley-Medium -1 TZ %PDF_EndEncoding %PDF_BeginEncoding: F9 Optima [ 39/quotesingle 96/grave 127/.notdef/Adieresis/Aring/Ccedilla /Eacute/Ntilde/Odieresis/Udieresis/aacute/agrave /acircumflex/adieresis/atilde/aring/ccedilla/eacute /egrave/ecircumflex/edieresis/iacute/igrave/icircumflex /idieresis/ntilde/oacute/ograve/ocircumflex/odieresis /otilde/uacute/ugrave/ucircumflex/udieresis/dagger /degree/cent/sterling/section/bullet/paragraph /germandbls/registered/copyright/trademark/acute/dieresis /notequal/AE/Oslash/infinity/plusminus/lessequal /greaterequal/yen/mu/partialdiff/summation/product /pi/integral/ordfeminine/ordmasculine/Omega/ae /oslash/questiondown/exclamdown/logicalnot/radical/florin /approxequal/Delta/guillemotleft/guillemotright/ellipsis/blank /Agrave/Atilde/Otilde/OE/oe/endash /emdash/quotedblleft/quotedblright/quoteleft/quoteright/divide /lozenge/ydieresis/Ydieresis/fraction/currency/guilsinglleft /guilsinglright/fi/fl/daggerdbl/periodcentered/quotesinglbase /quotedblbase/perthousand/Acircumflex/Ecircumflex/Aacute/Edieresis /Egrave/Iacute/Icircumflex/Idieresis/Igrave/Oacute /Ocircumflex/apple/Ograve/Uacute/Ucircumflex/Ugrave /dotlessi/circumflex/tilde/macron/breve/dotaccent /ring/cedilla/hungarumlaut/ogonek/caron /F9/Optima -1 TZ %PDF_EndEncoding 0 0 612 792 RC userdict /DefaultRGB /DeviceRGB put BT /F9 1 Tf 11 0 0 11 288.5 41 Tm 0 Tr 0 g 0.006 Tc (146)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 0.069 Tw (not take into account the reality that some people)Tj 0 -1.182 TD -0.098 Tw (have more than one risk factor for a disease; for these)Tj T* -0.11 Tw (people, the elimination of a single risk factor \(e.g., by)Tj 0 -1.227 TD -0.063 Tw (becoming physically active\) may not reduce mortal-)Tj 0 -1.182 TD -0.093 Tw (ity risk to the level attainable for people who initially)Tj 0 -1.227 TD 0.097 Tw (have only that one risk factor. PAR methods thus)Tj 0 -1.182 TD 0.014 Tw (overestimate the proportion of deaths avoidable by)Tj T* 0.056 Tw (eliminating one modifiable risk factor, in this case)Tj 0 -1.227 TD 0.156 Tw (physical inactivity. On the other hand, PAR esti-)Tj 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 0 -1.182 TD 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 (surpass the benefits of reducing premature mortal-)Tj 0 -1.182 TD 0.006 Tw (ity, yet the reductions in avoidable disease, disabil-)Tj 0 -1.227 TD 0.085 Tw (ity, suffering, and health care costs have not been)Tj 0 -1.182 TD -0.12 Tw (calculated. Similarly, the health benefits of improved)Tj T* 0.054 Tw (mood, quality of life, and functional capacity have)Tj 0 -1.227 TD 0.026 Tw (not been quantified. Although the total population)Tj 0 -1.182 TD -0.09 Tw (burden of physical inactivity in the United States has)Tj 0 -1.227 TD 0.035 Tw (not been quantified, sedentary living habits clearly)Tj 0 -1.182 TD 0 Tw (constitute a major public health problem.)Tj /F5 1 Tf 12 0 0 12 48 405.5 Tm 0 Tc (Dose)Tj /F7 1 Tf 11 0 0 11 48 390.5 Tm 0.003 Tc -0.011 Tw (Using the epidemiologic literature to derive recom-)Tj T* -0.098 Tw (mendations for how much and what kind of physical)Tj 0 -1.227 TD 0.126 Tw (activity a person should obtain is problematic, in)Tj 0 -1.182 TD -0.004 Tw (part because the methods for measuring and classi-)Tj T* 0.038 Tw (fying physical activity in epidemiologic studies are)Tj 0 -1.227 TD 0.01 Tw (not standardized. Measurement of physical activity)Tj 0 -1.182 TD 0.06 Tw (generally relies on self-reported information in re-)Tj 0 -1.227 TD -0.087 Tw (sponse to questionnaires, although some studies use)Tj 0 -1.182 TD 0.024 Tw (occupation to categorize a person\325s presumed level)Tj T* -0.018 Tw (of physical activity at work. Responses to questions)Tj 0 -1.227 TD -0.068 Tw (or occupational activity categories are usually trans-)Tj 0 -1.182 TD -0.076 Tw (formed, using a variety of methods, into estimates of)Tj 0 -1.227 TD -0.017 Tw (calories expended per week, minutes of activity per)Tj 0 -1.182 TD 0.064 Tw (week, categories of total activity, or other types of)Tj T* -0.001 Tw (composite scores.)Tj 1.636 -1.227 TD 0.016 Tw (Numerous studies have used this type of infor-)Tj -1.636 -1.182 TD 0.206 Tw (mation to estimate total amount of activity, and)Tj 0 -1.227 TD -0.025 Tw (many have been able to explore dose-response rela-)Tj 0 -1.182 TD 0.057 Tw (tionships across categories of activity amount. For)Tj 0 -1.227 TD 0.002 Tc -0.127 Tw (the most part, these studies demonstrate that amount)Tj 0 -1.182 TD 0.003 Tc 0.066 Tw (of benefit is directly related to amount of physical)Tj T* 0.124 Tw [(activity \(see )10 (Table)-7 (s 4-1 through 4-8\), rather than)]TJ 0 -1.227 TD -0.124 Tw (showing a threshold level of activity necessary before)Tj 0 -1.182 TD -0.047 Tw (health benefits accrue. Such studies are less helpful,)Tj 23.955 56.727 TD 0.259 Tw (however, in assessing the relationship of health)Tj 0 -1.182 TD 0.104 Tw (benefits to intensity of physical activity \(i.e., how)Tj T* 0.08 Tw (hard one must work during the activity itself\) be-)Tj 0 -1.227 TD -0.003 Tw (cause few studies have separately measured or ana-)Tj 0 -1.182 TD -0.121 Tw (lyzed levels of intensity while taking into account the)Tj 0 -1.227 TD 0.017 Tw (other dimensions of activity \(e.g., frequency, dura-)Tj 0 -1.182 TD -0.081 Tw (tion, total caloric expenditure\). As described earlier,)Tj T* -0.02 Tw (however, for some health benefits \(e.g., blood pres-)Tj 0 -1.227 TD 0.121 Tw (sure lowering\), clinical trials of exercise intensity)Tj 0 -1.182 TD -0.005 Tc -0.063 Tw (suggest similar, if not greater, benefit from moderate-)Tj 0 -1.227 TD 0.003 Tc 0 Tw (as from vigorous-intensity exercise.)Tj 1.636 -1.182 TD 0.013 Tc 0.077 Tw (It is often asked how little physical activity a)Tj -1.636 -1.227 TD 0.093 Tw (person can obtain and still derive health benefit.)Tj 0 -1.182 TD 0.117 Tw (Although the dose-response relationship appears)Tj T* 0.063 Tw (not to have a lower threshold, thereby indicating)Tj 0 -1.227 TD 0.05 Tc 0.259 Tw (that any activity is better than none, some)Tj 0 -1.182 TD 0.013 Tc -0.043 Tw (quantitation of a target \322dose\323 of activity is helpful)Tj 0 -1.227 TD 0.242 Tw (for many people. It has been shown that total)Tj 0 -1.182 TD 0.052 Tw (amount of physical activity \(a combination of in-)Tj T* 0.011 Tc -0.127 Tw (tensity, frequency, and duration\) is related to health)Tj 0 -1.227 TD 0.013 Tc -0.067 Tw (outcomes in a dose-response fashion, but the abso-)Tj 0 -1.182 TD 0.151 Tw (lute difference in amount of physical activity in)Tj 0 -1.227 TD -0.036 Tw (kilocalories of energy expended between exposure)Tj 0 -1.182 TD -0.121 Tw (categories has not been estimated routinely. Several)Tj T* 0.133 Tw (studies, however, have estimated average caloric)Tj 0 -1.227 TD -0.021 Tw (expenditure for the activity categories studied and)Tj 0 -1.182 TD -0.118 Tw (thus allow quantitation of amount of physical activ-)Tj 0 -1.227 TD 0.017 Tc 0.259 Tw (ity associated with improved health outcomes.)Tj 0 -1.182 TD 0.009 Tc -0.127 Tw (Paffenbarger and colleagues \(1986\) found that com-)Tj T* 0.013 Tc -0.092 Tw (pared with the least active group in the study, those)Tj 0 -1.227 TD 0.093 Tw (who expended 71\320143 kilocalories of energy per)Tj 0 -1.182 TD -0.091 Tw (day had a 22 percent reduction in overall mortality,)Tj 0 -1.227 TD -0.022 Tw (and those who expended 143\320214 kilocalories per)Tj 0 -1.182 TD 0.206 Tw [(day had a 27 percent reduction. )23 (Leon and col-)]TJ T* -0.103 Tw (leagues \(1987\) showed that a difference of about 30)Tj 0 -1.227 TD 0.09 Tw (minutes per day of activity \(light, moderate, and)Tj 0 -1.182 TD -0.079 Tw (vigorous activity combined\), equivalent to an aver-)Tj 0 -1.227 TD 0.043 Tw (age difference of about 150 kilocalories of energy)Tj 0 -1.182 TD -0.085 Tw (expended per day, was associated with a 36 percent)Tj T* -0.082 Tw (lower risk of CHD mortality and a 27 percent lower)Tj 0 -1.227 TD 0.05 Tw (risk of all-cause death, after the analysis adjusted)Tj 0 -1.182 TD 0.207 Tw (for other factors that can effect CHD and total)Tj 0 -1.227 TD 0.222 Tw [(mortality. Slattery and colleagues \(1989\))6 ( )-6 (found)]TJ 0 -1.182 TD -0.036 Tw (that a daily average of 73 more kilocalories of total)Tj T* 0.003 Tc 0.008 Tw (activity than were expended among the least active)Tj 0 -1.227 TD -0.005 Tc 0.006 Tw (group was associated with a 16 percent reduction in)Tj 0 -1.182 TD -0.113 Tw (CHD mortality and a 14 percent reduction in all-cause)Tj 0 -1.227 TD -0.072 Tw [(mortality. Furthermore, in the majority \(62 )]TJ 17.727 0 TD 0.013 Tc (percent\))Tj ET PDFVars/TermAll get exec restore gsave showpage grestore %%Page: 67 67 save PDFVars/InitAll get exec %PDF_BeginEncoding: F5 Optima-Bold [ 39/quotesingle 96/grave 127/.notdef/Adieresis/Aring/Ccedilla /Eacute/Ntilde/Odieresis/Udieresis/aacute/agrave /acircumflex/adieresis/atilde/aring/ccedilla/eacute /egrave/ecircumflex/edieresis/iacute/igrave/icircumflex /idieresis/ntilde/oacute/ograve/ocircumflex/odieresis /otilde/uacute/ugrave/ucircumflex/udieresis/dagger /degree/cent/sterling/section/bullet/paragraph /germandbls/registered/copyright/trademark/acute/dieresis /notequal/AE/Oslash/infinity/plusminus/lessequal /greaterequal/yen/mu/partialdiff/summation/product /pi/integral/ordfeminine/ordmasculine/Omega/ae /oslash/questiondown/exclamdown/logicalnot/radical/florin /approxequal/Delta/guillemotleft/guillemotright/ellipsis/blank /Agrave/Atilde/Otilde/OE/oe/endash /emdash/quotedblleft/quotedblright/quoteleft/quoteright/divide /lozenge/ydieresis/Ydieresis/fraction/currency/guilsinglleft /guilsinglright/fi/fl/daggerdbl/periodcentered/quotesinglbase /quotedblbase/perthousand/Acircumflex/Ecircumflex/Aacute/Edieresis /Egrave/Iacute/Icircumflex/Idieresis/Igrave/Oacute /Ocircumflex/apple/Ograve/Uacute/Ucircumflex/Ugrave /dotlessi/circumflex/tilde/macron/breve/dotaccent /ring/cedilla/hungarumlaut/ogonek/caron /F5/Optima-Bold -1 TZ %PDF_EndEncoding %PDF_BeginEncoding: F7 Berkeley-Medium [ 39/quotesingle 96/grave 127/.notdef/Adieresis/Aring/Ccedilla /Eacute/Ntilde/Odieresis/Udieresis/aacute/agrave /acircumflex/adieresis/atilde/aring/ccedilla/eacute /egrave/ecircumflex/edieresis/iacute/igrave/icircumflex /idieresis/ntilde/oacute/ograve/ocircumflex/odieresis /otilde/uacute/ugrave/ucircumflex/udieresis/dagger /degree/cent/sterling/section/bullet/paragraph /germandbls/registered/copyright/trademark/acute/dieresis /notequal/AE/Oslash/infinity/plusminus/lessequal /greaterequal/yen/mu/partialdiff/summation/product /pi/integral/ordfeminine/ordmasculine/Omega/ae /oslash/questiondown/exclamdown/logicalnot/radical/florin /approxequal/Delta/guillemotleft/guillemotright/ellipsis/blank /Agrave/Atilde/Otilde/OE/oe/endash /emdash/quotedblleft/quotedblright/quoteleft/quoteright/divide /lozenge/ydieresis/Ydieresis/fraction/currency/guilsinglleft /guilsinglright/fi/fl/daggerdbl/periodcentered/quotesinglbase /quotedblbase/perthousand/Acircumflex/Ecircumflex/Aacute/Edieresis /Egrave/Iacute/Icircumflex/Idieresis/Igrave/Oacute /Ocircumflex/apple/Ograve/Uacute/Ucircumflex/Ugrave /dotlessi/circumflex/tilde/macron/breve/dotaccent /ring/cedilla/hungarumlaut/ogonek/caron /F7/Berkeley-Medium -1 TZ %PDF_EndEncoding %PDF_BeginEncoding: F9 Optima [ 39/quotesingle 96/grave 127/.notdef/Adieresis/Aring/Ccedilla /Eacute/Ntilde/Odieresis/Udieresis/aacute/agrave /acircumflex/adieresis/atilde/aring/ccedilla/eacute /egrave/ecircumflex/edieresis/iacute/igrave/icircumflex /idieresis/ntilde/oacute/ograve/ocircumflex/odieresis /otilde/uacute/ugrave/ucircumflex/udieresis/dagger /degree/cent/sterling/section/bullet/paragraph /germandbls/registered/copyright/trademark/acute/dieresis /notequal/AE/Oslash/infinity/plusminus/lessequal /greaterequal/yen/mu/partialdiff/summation/product /pi/integral/ordfeminine/ordmasculine/Omega/ae /oslash/questiondown/exclamdown/logicalnot/radical/florin /approxequal/Delta/guillemotleft/guillemotright/ellipsis/blank /Agrave/Atilde/Otilde/OE/oe/endash /emdash/quotedblleft/quotedblright/quoteleft/quoteright/divide /lozenge/ydieresis/Ydieresis/fraction/currency/guilsinglleft /guilsinglright/fi/fl/daggerdbl/periodcentered/quotesinglbase /quotedblbase/perthousand/Acircumflex/Ecircumflex/Aacute/Edieresis /Egrave/Iacute/Icircumflex/Idieresis/Igrave/Oacute /Ocircumflex/apple/Ograve/Uacute/Ucircumflex/Ugrave /dotlessi/circumflex/tilde/macron/breve/dotaccent /ring/cedilla/hungarumlaut/ogonek/caron /F9/Optima -1 TZ %PDF_EndEncoding 0 0 612 792 RC userdict /DefaultRGB /DeviceRGB put BT /F9 1 Tf 11 0 0 11 305 41 Tm 0 Tr 0 g 0.006 Tc (147)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 0.014 Tw (of that study population, no vigorous activity was)Tj 0 -1.182 TD 0.211 Tw [(reported. )28 (In that group, a daily average of 150)]TJ T* -0.005 Tc -0.031 Tw (kilocalories greater expenditure in light-to-moderate)Tj 0 -1.227 TD 0.013 Tc 0.189 Tw (activity was associated with a 27 percent lower)Tj 0 -1.182 TD -0.088 Tw (CHD mortality and a 19 percent lower total mortal-)Tj 0 -1.227 TD 0.225 Tw (ity. The effects of light-to-moderate activity on)Tj 0 -1.182 TD 0.016 Tw (CHD death remained significant after the analysis)Tj T* 0.02 Tc -0.045 Tw [(adjusted )11 (for )10 (potential confounders. Similarly, in a)]TJ 0 -1.227 TD 0.012 Tc -0.128 Tw (study of NIDDM \(Helmrich et al. 1991\) that showed)Tj 0 -1.182 TD 0.023 Tc 0.157 Tw (a significant inverse trend between kilocalories)Tj 0 -1.227 TD -0.076 Tw (expended in activity and development of NIDDM,)Tj 0 -1.182 TD -0.014 Tw (total activity of 140\320215 kilocalories per day was)Tj T* -0.055 Tw (associated with a 21 percent reduction in NIDDM)Tj 0 -1.227 TD 0.191 Tw (onset. In the group that obtained this level of)Tj 0 -1.182 TD 0.073 Tw (energy expenditure without any vigorous sports)Tj 0 -1.227 TD -0.023 Tw (participation, the reduction in NIDDM onset was)Tj 0 -1.182 TD 0.001 Tw (13 percent.)Tj 1.636 -1.227 TD 0.003 Tc 0.046 Tw (Based on these studies, it is reasonable to con-)Tj -1.636 -1.182 TD 0.138 Tw (clude that activity leading to an increase in daily)Tj T* 0.069 Tw (expenditure of approximately 150 kilocalories/day)Tj 0 -1.227 TD -0.003 Tw (\(equivalent to about 1,000 kilocalories/week\) is as-)Tj 0 -1.182 TD -0.096 Tw (sociated with substantial health benefits and that the)Tj 0 -1.227 TD 0.188 Tw (activity does not need to be vigorous to achieve)Tj 0 -1.182 TD 0.229 Tw (benefit. It should be emphasized that this is an)Tj T* 0.05 Tw (estimate based on few studies, and that further re-)Tj 0 -1.227 TD -0.063 Tw (search will be required to refine it. For example, it is)Tj 0 -1.182 TD 0.092 Tw (not clear whether it is the total amount of caloric)Tj 0 -1.227 TD 0.105 Tw (expenditure or the amount of caloric expenditure)Tj 0 -1.182 TD -0.027 Tw (per unit of body weight that is important. Nonethe-)Tj T* -0.084 Tw (less, this amount of physical activity can be obtained)Tj 0 -1.227 TD -0.017 Tw (in a variety of ways and can vary from day to day to)Tj 0 -1.182 TD 0.069 Tw (meet the needs and interests of the individual. An)Tj 0 -1.227 TD 0 Tc -0.129 Tw (average expenditure of 150 kilocalories/day \(or 1,000)Tj 0 -1.182 TD 0.003 Tc 0.216 Tw (kilocalories/week\) could be achieved by walking)Tj T* 0.229 Tw (briskly for 30 minutes per day, or by a shorter)Tj 0 -1.227 TD -0.039 Tw (duration of more vigorous activity \(e.g., 15 minutes)Tj 0 -1.182 TD 0.048 Tw (of running at 10 minutes per mile\), or by a longer)Tj 0 -1.227 TD 0.116 Tw (duration of more vigorous activity less frequently)Tj 0 -1.182 TD 0.057 Tw (\(e.g., running at 10 minutes per mile for about 35)Tj T* 0.015 Tw (minutes 3 times per week\). Other sample activities)Tj 0 -1.227 TD 0 Tw [(are provided in )-16 (Table)37 ( 4-10.)]TJ 1.636 -1.182 TD -0.007 Tw (In addition to the health effects associated with)Tj -1.636 -1.227 TD 0.111 Tw (a moderate amount of physical activity, the dose-)Tj 0 -1.182 TD -0.115 Tw (response relationships show that further increases in)Tj 0 -1.227 TD -0.003 Tc -0.129 Tw (activity confer additional health benefits. Thus people)Tj 0 -1.182 TD 0.003 Tc 0.021 Tw (who are already meeting the moderate activity rec-)Tj T* -0.123 Tw (ommendation can expect to derive additional benefit)Tj 0 -1.227 TD 0 Tc -0.019 Tw (by increasing their activity. Since amount of activity)Tj 23.955 56.409 TD 0.078 Tw (is a function of intensity, frequency, and duration,)Tj 0 -1.182 TD 0.225 Tw (increasing the amount of activity can be accom-)Tj T* -0.105 Tw (plished by increasing any, or all, of those dimensions.)Tj 1.636 -1.227 TD 0.003 Tc -0.048 Tw (There is evidence that increasing physical activ-)Tj -1.636 -1.182 TD 0.067 Tw (ity, even after years of inactivity, improves health.)Tj 0 -1.227 TD 0.078 Tw (Studies of the health effects of increasing physical)Tj 0 -1.182 TD -0.122 Tw (activity or fitness \(Paffenbarger et al. 1993; Blair et al.)Tj 0 -1.227 TD 0.021 Tw (1995\) have shown a reduced mortality rate in men)Tj 0 -1.182 TD -0.039 Tw (who become more active or more fit compared with)Tj T* -0.099 Tw (those who remain sedentary. This benefit was appar-)Tj 0 -1.227 TD -0.059 Tw (ent even for men who became physically active after)Tj 0 -1.182 TD 0 Tw (the age of 60.)Tj 1.636 -1.227 TD 0.027 Tw (Most importantly, a regular pattern of physical)Tj -1.636 -1.182 TD 0.139 Tw (activity must be maintained to sustain the physi-)Tj 0 -1.227 TD -0.02 Tw (ologic changes that are assumed responsible for the)Tj 0 -1.182 TD -0.06 Tw (health benefits \(see Chapter 3\). Thus it is crucial for)Tj T* 0.222 Tw (each person to select physical activities that are)Tj 0 -1.227 TD 0.118 Tw (sustainable over the course of his or her life. For)Tj 0 -1.182 TD -0.018 Tw (some people, a vigorous workout at a health club is)Tj 0 -1.227 TD 0.168 Tw (the most sustainable choice; for others, activities)Tj 0 -1.182 TD 0.224 Tw (integrated into daily life \(e.g., walking to work,)Tj T* -0.042 Tw (gardening and household chores, walking after din-)Tj 0 -1.227 TD 0.186 Tw (ner\) may be a more sustainable option. Periodic)Tj 0 -1.182 TD 0.199 Tw (reevaluation may be necessary to meet changing)Tj 0 -1.227 TD 0 Tw (needs across the life span.)Tj 1.636 -1.182 TD -0.005 Tc 0.228 Tw (A related issue of pattern of physical activity)Tj -1.636 -1.227 TD 0.038 Tw (\(frequency and duration in the course of a day\) has)Tj 0 -1.182 TD -0.032 Tw (recently come under review. Three studies have held)Tj T* -0.088 Tw (constant both total amount of activity and intensity of)Tj 0 -1.227 TD 0.239 Tw (activity while daily pattern was varied \(one long)Tj 0 -1.182 TD -0.031 Tw (session versus shorter, more frequent sessions\). Two)Tj 0 -1.227 TD -0.069 Tw (studies showed equivalent increases in cardiorespira-)Tj 0 -1.182 TD 0.152 Tw (tory fitness \(Jakicic et al. 1995; Ebisu 1985\). One)Tj T* 0.12 Tw (study showed gains in cardiorespiratory fitness for)Tj 0 -1.227 TD 0.143 Tw (both the \322short bout\323 and \322long bout\323 groups, al-)Tj 0 -1.182 TD 0.067 Tw (though on one of three measures \(maximal oxygen)Tj 0 -1.227 TD -0.078 Tw (uptake versus treadmill test duration and heart rate at)Tj 0 -1.182 TD -0.025 Tw (submaximal exercise\), the gain in fitness was signifi-)Tj T* 0.032 Tw (cantly greater in the long bout group \(DeBusk et al.)Tj 0 -1.227 TD -0.057 Tw (1990\). These observations give rise to the notion that)Tj 0 -1.182 TD 0.05 Tw (intermittent episodes of activity accumulated in the)Tj 0 -1.227 TD 0.137 Tw (course of a day may have cardiorespiratory fitness)Tj 0 -1.182 TD 0.127 Tw (benefits comparable to one longer continuous epi-)Tj T* 0.176 Tw (sode. Whether this assumption holds true for the)Tj 0 -1.227 TD -0.062 Tw (outcomes of disease occurrence and death remains to)Tj 0 -1.182 TD -0.075 Tw (be determined. Nevertheless, some previous observa-)Tj 0 -1.227 TD -0.018 Tw (tional studies have shown lower rates of CHD, CVD,)Tj 0 -1.182 TD 0.005 Tw (and all-cause mortality among people with an active)Tj ET PDFVars/TermAll get exec restore gsave showpage grestore %%Page: 68 68 save PDFVars/InitAll get exec %PDF_BeginEncoding: F5 Optima-Bold [ 39/quotesingle 96/grave 127/.notdef/Adieresis/Aring/Ccedilla /Eacute/Ntilde/Odieresis/Udieresis/aacute/agrave /acircumflex/adieresis/atilde/aring/ccedilla/eacute /egrave/ecircumflex/edieresis/iacute/igrave/icircumflex /idieresis/ntilde/oacute/ograve/ocircumflex/odieresis /otilde/uacute/ugrave/ucircumflex/udieresis/dagger /degree/cent/sterling/section/bullet/paragraph /germandbls/registered/copyright/trademark/acute/dieresis /notequal/AE/Oslash/infinity/plusminus/lessequal /greaterequal/yen/mu/partialdiff/summation/product /pi/integral/ordfeminine/ordmasculine/Omega/ae /oslash/questiondown/exclamdown/logicalnot/radical/florin /approxequal/Delta/guillemotleft/guillemotright/ellipsis/blank /Agrave/Atilde/Otilde/OE/oe/endash /emdash/quotedblleft/quotedblright/quoteleft/quoteright/divide /lozenge/ydieresis/Ydieresis/fraction/currency/guilsinglleft /guilsinglright/fi/fl/daggerdbl/periodcentered/quotesinglbase /quotedblbase/perthousand/Acircumflex/Ecircumflex/Aacute/Edieresis /Egrave/Iacute/Icircumflex/Idieresis/Igrave/Oacute /Ocircumflex/apple/Ograve/Uacute/Ucircumflex/Ugrave /dotlessi/circumflex/tilde/macron/breve/dotaccent /ring/cedilla/hungarumlaut/ogonek/caron /F5/Optima-Bold -1 TZ %PDF_EndEncoding %PDF_BeginEncoding: F7 Berkeley-Medium [ 39/quotesingle 96/grave 127/.notdef/Adieresis/Aring/Ccedilla /Eacute/Ntilde/Odieresis/Udieresis/aacute/agrave /acircumflex/adieresis/atilde/aring/ccedilla/eacute /egrave/ecircumflex/edieresis/iacute/igrave/icircumflex /idieresis/ntilde/oacute/ograve/ocircumflex/odieresis /otilde/uacute/ugrave/ucircumflex/udieresis/dagger /degree/cent/sterling/section/bullet/paragraph /germandbls/registered/copyright/trademark/acute/dieresis /notequal/AE/Oslash/infinity/plusminus/lessequal /greaterequal/yen/mu/partialdiff/summation/product /pi/integral/ordfeminine/ordmasculine/Omega/ae /oslash/questiondown/exclamdown/logicalnot/radical/florin /approxequal/Delta/guillemotleft/guillemotright/ellipsis/blank /Agrave/Atilde/Otilde/OE/oe/endash /emdash/quotedblleft/quotedblright/quoteleft/quoteright/divide /lozenge/ydieresis/Ydieresis/fraction/currency/guilsinglleft /guilsinglright/fi/fl/daggerdbl/periodcentered/quotesinglbase /quotedblbase/perthousand/Acircumflex/Ecircumflex/Aacute/Edieresis /Egrave/Iacute/Icircumflex/Idieresis/Igrave/Oacute /Ocircumflex/apple/Ograve/Uacute/Ucircumflex/Ugrave /dotlessi/circumflex/tilde/macron/breve/dotaccent /ring/cedilla/hungarumlaut/ogonek/caron /F7/Berkeley-Medium -1 TZ %PDF_EndEncoding %PDF_BeginEncoding: F9 Optima [ 39/quotesingle 96/grave 127/.notdef/Adieresis/Aring/Ccedilla /Eacute/Ntilde/Odieresis/Udieresis/aacute/agrave /acircumflex/adieresis/atilde/aring/ccedilla/eacute /egrave/ecircumflex/edieresis/iacute/igrave/icircumflex /idieresis/ntilde/oacute/ograve/ocircumflex/odieresis /otilde/uacute/ugrave/ucircumflex/udieresis/dagger /degree/cent/sterling/section/bullet/paragraph /germandbls/registered/copyright/trademark/acute/dieresis /notequal/AE/Oslash/infinity/plusminus/lessequal /greaterequal/yen/mu/partialdiff/summation/product /pi/integral/ordfeminine/ordmasculine/Omega/ae /oslash/questiondown/exclamdown/logicalnot/radical/florin /approxequal/Delta/guillemotleft/guillemotright/ellipsis/blank /Agrave/Atilde/Otilde/OE/oe/endash /emdash/quotedblleft/quotedblright/quoteleft/quoteright/divide /lozenge/ydieresis/Ydieresis/fraction/currency/guilsinglleft /guilsinglright/fi/fl/daggerdbl/periodcentered/quotesinglbase /quotedblbase/perthousand/Acircumflex/Ecircumflex/Aacute/Edieresis /Egrave/Iacute/Icircumflex/Idieresis/Igrave/Oacute /Ocircumflex/apple/Ograve/Uacute/Ucircumflex/Ugrave /dotlessi/circumflex/tilde/macron/breve/dotaccent /ring/cedilla/hungarumlaut/ogonek/caron /F9/Optima -1 TZ %PDF_EndEncoding 0 0 612 792 RC userdict /DefaultRGB /DeviceRGB put BT /F9 1 Tf 11 0 0 11 288.5 41 Tm 0 Tr 0 g 0.006 Tc (148)Tj /F5 1 Tf -21.864 63.727 TD 0.003 Tc -0.001 Tw (Physical Activity and Health)Tj /F7 1 Tf 0.091 -33.091 TD -0.005 Tc -0.083 Tw (lifestyle that included activities such as walking, stair)Tj 0 -1.182 TD -0.034 Tw (climbing, household or yard work, and gardening\321)Tj T* -0.015 Tc -0.129 Tw (activities that are often performed intermittently \(Leon)Tj 0 -1.227 TD -0.005 Tc 0.021 Tw (et al. 1987; Paffenbarger et al. 1986\). This informa-)Tj 0 -1.182 TD 0.063 Tw (tion, together with evidence that some people may)Tj 0 -1.227 TD 0.134 Tw (adhere better to an exercise recommendation that)Tj 0 -1.182 TD -0.021 Tw (allows for accumulating short episodes of activity as)Tj T* -0.011 Tw (an alternative to one longer episode per day \(Jakicic)Tj 0 -1.227 TD -0.104 Tw (et al. 1995\), supports the notion that accumulation of)Tj 0 -1.182 TD 0.021 Tw (physical activity throughout the day is a reasonable)Tj 0 -1.227 TD -0.106 Tw (alternative to setting aside an uninterrupted period of)Tj 0 -1.182 TD 0.067 Tw (time for physical activity each day. Although more)Tj T* -0.011 Tw (research is clearly needed to better define the differ-)Tj 0 -1.227 TD 0.051 Tw (ential effects of various patterns of activity, experts)Tj 0 -1.182 TD -0.038 Tw (have agreed that intermittent episodes of activity are)Tj 0 -1.227 TD -0.042 Tw (more beneficial than remaining sedentary. This con-)Tj 0 -1.182 TD -0.012 Tw (sensus is reflected in recent physical activity recom-)Tj T* -0.06 Tw (mendations from the CDC and the ACSM \(Pate et al.)Tj 0 -1.227 TD 0.117 Tw (1995\) and from the NIH Consensus Development)Tj 0 -1.182 TD 0.063 Tw (Panel on Physical Activity and Cardiovascular Dis-)Tj 0 -1.227 TD -0.004 Tc -0.001 Tw [(ease \()11 (see )-5 (Chapter 2, Appendix B\).)]TJ /F5 1 Tf 12 0 0 12 310 378.5 Tm 0 Tc (Conclusions)Tj /F7 1 Tf 11 0 0 11 310 363.5 Tm 0.013 Tc -0.097 Tw (The findings reviewed in this chapter form the basis)Tj 0 -1.182 TD 0.083 Tw (for concluding that moderate amounts of activity)Tj 0 -1.227 TD 0.064 Tw (can protect against several diseases. A greater de-)Tj 0 -1.182 TD -0.087 Tw (gree of protection can be achieved by increasing the)Tj 0 -1.227 TD 0.011 Tw (amount of activity, which can be accomplished by)Tj 0 -1.182 TD -0.054 Tw (increasing intensity, frequency, or duration. None-)Tj T* 0.147 Tw (theless, modest increases in physical activity are)Tj 0 -1.227 TD 0.162 Tw (likely to be more achievable and sustainable for)Tj 0 -1.182 TD -0.127 Tw (sedentary people than are more drastic changes, and)Tj 0 -1.227 TD 0.079 Tw (it is sedentary people who are at greatest risk for)Tj 0 -1.182 TD 0.091 Tw (poor health related to inactivity. Thus the public)Tj T* 0.109 Tw (health emphasis should be on encouraging those)Tj 0 -1.227 TD 0.01 Tc -0.128 Tw (who are inactive to become moderately active. These)Tj 0 -1.182 TD 0.013 Tc 0.125 Tw (conclusions are consistent with the recent CDC-)Tj 0 -1.227 TD -0.064 Tw (ACSM recommendations for physical activity \(Pate)Tj 0 -1.182 TD 0.027 Tw (et al. 1995\) and the NIH Consensus Development)Tj T* -0.119 Tw (Conference Statement on Physical Activity and Car-)Tj 0 -1.227 TD 0.012 Tc 0.135 Tw [(diovascular Health \()22 (see )10 (Chapter 2, Appendix B\),)]TJ 0 -1.182 TD 0.008 Tc -0.127 Tw (which emphasize the importance of obtaining physi-)Tj 0 -1.227 TD 0.013 Tc -0.081 Tw (cal activity of at least moderate amount on a regular)Tj 0 -1.182 TD 0.025 Tw (basis. The recommendations also encourage those)Tj /F5 1 Tf 10 0 0 10 48 712 Tm 0.005 Tc 0 Tw [(T)60 (able 4-10.)-959 (Duration of various activities to expend 150 kilocalories for an average\ 70 kg adult)]TJ ET 0 G 1 i 0 J 0 j 0.5 w 10 M []0 d 48 707.75 m 546 707.75 l S BT /F5 1 Tf 10 0 0 10 356 693 Tm [(Metabolic)-6314 (Approximate)]TJ -0.3 -1.25 TD [(equivalents)-6999 (duration)]TJ ET 48 664.25 m 546 664.25 l S BT /F5 1 Tf 10 0 0 10 48 668.5 Tm [(Intensity)-6379 (Activity)-18069 (MET)59 (s)]TJ /F9 1 Tf 7 0 0 7 388 671 Tm (*)Tj /F5 1 Tf 10 0 0 10 467 668.5 Tm -0.001 Tw (in minutes)Tj /F9 1 Tf 7 0 0 7 513 671 Tm (\240)Tj 10 0 0 10 48 644 Tm [(Moderate)-6049 (V)71 (olleyball, noncompetitive)-10520 (3.0)-9995 (43)]TJ 0 -1.8 TD 0 Tw [(Moderate)-6049 (W)54 (alking, moderate pace \(3 mph,)]TJ 10.2 -1.25 TD [(20 min/mile\))-16688 (3.5)-9995 (37)]TJ -10.2 -1.8 TD [(Moderate)-6049 (W)54 (alking, brisk pace \(4 mph, 15 min/mile\))-4155 (4.0)-9995 (32)]TJ 0 -1.85 TD -0.002 Tw [(Moderate)-6049 (T)110 (able tennis)-17078 (4.0)-9995 (32)]TJ 0 -1.8 TD 0.001 Tw [(Moderate)-6049 (Raking leaves)-16294 (4.5)-9995 (32)]TJ T* 0 Tw [(Moderate)-6049 (Social dancing)-15844 (4.5)-9995 (29)]TJ 0 -1.85 TD [(Moderate)-6049 (Lawn mowing \(powered push mower\))-5751 (4.5)-9995 (29)]TJ 0 -1.8 TD -0.001 Tw [(Hard)-8015 (Jogging \(5 mph, 12 min/mile\))-9551 (7.0)-9995 (18)]TJ 0 -1.85 TD [(Hard)-8015 (Field hockey)-16689 (8.0)-9995 (16)]TJ ET 48 464.25 m 546 464.25 l S BT /F9 1 Tf 10 0 0 10 48 468 Tm 0 Tw [(V)71 (ery hard)-6002 (Running \(6 mph, 10 min/mile\))-8556 (10.0)-9985 (13)]TJ 6 0 0 6 48 453 Tm (*)Tj 8.5 0 0 8.5 50.5 450.5 Tm 0.009 Tc [(Based on average MET)76 (s in )58 (Ainsworth et al. 1993.)]TJ 6 0 0 6 48 439.5 Tm (\240)Tj 8.5 0 0 8.5 51 437 Tm -0.001 Tw [(Formula:)-1861 (150 kcal x 60 min/hour)]TJ 17.176 -0.471 TD [(=)-797 (minutes)]TJ -11 -0.588 TD 0 Tw [(MET)89 (s \(kcal/kg/hr\) x kg)]TJ ET 98 435.25 m 188.5 435.25 l S PDFVars/TermAll get exec restore gsave showpage grestore %%Page: 69 69 save PDFVars/InitAll get exec %PDF_BeginEncoding: F5 Optima-Bold [ 39/quotesingle 96/grave 127/.notdef/Adieresis/Aring/Ccedilla /Eacute/Ntilde/Odieresis/Udieresis/aacute/agrave /acircumflex/adieresis/atilde/aring/ccedilla/eacute /egrave/ecircumflex/edieresis/iacute/igrave/icircumflex /idieresis/ntilde/oacute/ograve/ocircumflex/odieresis /otilde/uacute/ugrave/ucircumflex/udieresis/dagger /degree/cent/sterling/section/bullet/paragraph /germandbls/registered/copyright/trademark/acute/dieresis /notequal/AE/Oslash/infinity/plusminus/lessequal /greaterequal/yen/mu/partialdiff/summation/product /pi/integral/ordfeminine/ordmasculine/Omega/ae /oslash/questiondown/exclamdown/logicalnot/radical/florin /approxequal/Delta/guillemotleft/guillemotright/ellipsis/blank /Agrave/Atilde/Otilde/OE/oe/endash /emdash/quotedblleft/quotedblright/quoteleft/quoteright/divide /lozenge/ydieresis/Ydieresis/fraction/currency/guilsinglleft /guilsinglright/fi/fl/daggerdbl/periodcentered/quotesinglbase 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Effects of Physical Activity on Health and Disease)Tj /F7 1 Tf -21.591 -2.818 TD 0.013 Tc -0.051 Tw (who are already moderately active to become more)Tj 0 -1.182 TD 0.258 Tw (active to achieve additional health benefits, by)Tj T* 0.008 Tw (increasing the intensity, duration, or frequency of)Tj 0 -1.227 TD -0.03 Tw (physical activity. Further study is needed to deter-)Tj 0 -1.182 TD -0.068 Tw (mine which combinations of these interrelated fac-)Tj 0 -1.227 TD -0.082 Tw (tors are most important for specific health benefits.)Tj 0 -1.182 TD 0.085 Tw (Most important, however, is the recognition that)Tj T* 0.073 Tw (physical activity recommendations should be tai-)Tj 0 -1.227 TD 0.248 Tw (lored to an individual\325s needs and preferences.)Tj 0 -1.182 TD 0.081 Tw (Encouraging sedentary people to become moder-)Tj 0 -1.227 TD -0.069 Tw (ately active is likely to reduce the burden of unnec-)Tj 0 -1.182 TD -0.095 Tw (essary suffering and death only if the activity can be)Tj T* 0 Tw (sustained on a daily basis for many years.)Tj /F5 1 Tf 14 0 0 14 66 513 Tm -0.001 Tc (Chapter Summary)Tj /F7 1 Tf 11 0 0 11 66 497.5 Tm 0.023 Tc 0.089 Tw (Despite the variety of methods used to measure)Tj 0 -1.227 TD 0.061 Tw (and classify physical activity, the imprecision of)Tj 0 -1.182 TD -0.029 Tw (these measures, and the considerable variation in)Tj T* -0.028 Tw (study designs and analytic sophistication, several)Tj 0 -1.227 TD 0.028 Tw (findings consistently emerge from the epidemio-)Tj 0 -1.182 TD 0.158 Tw (logic literature on physical activity and health.)Tj 0 -1.227 TD -0.054 Tw (Physical activity of the type that improves cardio-)Tj 0 -1.182 TD -0.112 Tw (respiratory endurance reduces the risk of develop-)Tj T* 0.027 Tc 0.259 Tw (ing or dying from CVD \(CHD in particular\),)Tj 0 -1.227 TD 0.023 Tc -0.009 Tw (hypertension, colon cancer, and NIDDM and im-)Tj 0 -1.182 TD -0.063 Tw (proves mental health. Findings are highly sugges-)Tj 0 -1.227 TD 0.24 Tw (tive that endurance-type physical activity may)Tj 0 -1.182 TD -0.009 Tw (reduce the risk of developing obesity, osteoporo-)Tj T* -0.023 Tw (sis, and depression and may improve psychologi-)Tj 0 -1.227 TD 0.011 Tc -0.125 Tw [(cal well-being and quality of life. )9 (There )11 (is )11 (promising)]TJ 0 -1.182 TD 0.019 Tc 0.157 Tw [(evidence that muscle)21 ( )-10 (strengthening )-10 (\(resistance\))]TJ 0 -1.227 TD 0.023 Tc 0.056 Tw (exercise reduces the risk of falling and fractures)Tj 0 -1.182 TD -0.04 Tw (among the elderly. Furthermore, there appears to)Tj T* -0.027 Tw (be a dose-response relationship between physical)Tj 0 -1.227 TD 0.099 Tw (activity and disease prevention: higher levels of)Tj 0 -1.182 TD -0.08 Tw (activity appear to have the most benefit, but lower)Tj 0 -1.227 TD 0.119 Tw (levels have demonstrable benefits for some dis-)Tj 0 -1.182 TD -0.118 Tw (eases as well. For the U.S. population, in which the)Tj T* -0.123 Tw (majority of people are sedentary or only minimally)Tj 0 -1.227 TD -0.039 Tw (active, achievable increases in physical activity of)Tj 0 -1.182 TD 0.208 Tw (a moderate amount, including some resistance)Tj 0 -1.227 TD 0.064 Tw (exercise to strengthen muscle, are likely to sub-)Tj 0 -1.182 TD -0.041 Tw [(stantially improve the health and quality of life)16 ( )21 (o)20 (f)]TJ T* -0.002 Tw (many people.)Tj /F5 1 Tf 14 0 0 14 329.5 709 Tm -0.002 Tc (Conclusions)Tj 11 0 2.138 11 329.5 688 Tm 0.003 Tc 0.001 Tw (Overall Mortality)Tj /F7 1 Tf 11 0 0 11 329.5 674 Tm -0.098 Tw [(1.)-578 (Higher levels of regular physical activity are asso-)]TJ 1.364 -1.227 TD 0.046 Tw [(ciated with lower mortality rates for both )-17 (older)]TJ 0 -1.182 TD 0 Tw (and younger adults.)Tj -1.364 -1.773 TD -0.043 Tw [(2.)-578 (Even those who are moderately active on a regu-)]TJ 1.364 -1.182 TD 0.11 Tw (lar basis have lower mortality rates than those)Tj T* 0 Tw (who are least active.)Tj /F5 1 Tf 11 0 2.138 11 329.5 568 Tm -0.001 Tw (Cardiovascular Diseases)Tj /F7 1 Tf 11 0 0 11 329.5 554 Tm -0.064 Tw [(1.)-578 (Regular physical activity or cardiorespiratory fit-)]TJ 1.364 -1.227 TD -0.006 Tw (ness decreases the risk of cardiovascular disease)Tj 0 -1.182 TD -0.109 Tw (mortality in general and of coronary heart disease)Tj 0 -1.227 TD 0.004 Tw (\(CHD\) mortality in particular. Existing data are)Tj 0 -1.182 TD -0.011 Tw (not conclusive regarding a relationship between)Tj T* -0.001 Tw (physical activity and stroke.)Tj -1.364 -1.773 TD 0.013 Tc -0.02 Tw [(2.)-559 (The level of decreased risk of CHD attributable)]TJ 1.364 -1.182 TD 0.029 Tw (to regular physical activity is similar to that of)Tj 0 -1.227 TD -0.075 Tw (other lifestyle factors, such as keeping free from)Tj 0 -1.182 TD 0.001 Tw [(cigarette)15 ( smoking.)]TJ -1.364 -1.727 TD 0.023 Tc -0.1 Tw [(3)10 (.)-549 (Regular physical activity prevents or delays the)]TJ 1.364 -1.227 TD -0.071 Tw (development of high blood pressure, and exer-)Tj 0 -1.182 TD 0.232 Tw (cise reduces blood pressure in people with)Tj 0 -1.227 TD (hypertension.)Tj /F5 1 Tf 11 0 2.138 11 329.5 336.5 Tm 0.003 Tc (Cancer)Tj /F7 1 Tf 11 0 0 11 329.5 322 Tm 0.243 Tw [(1.)-578 (Regular physical activity is associated with a)]TJ 1.364 -1.182 TD 0 Tw (decreased risk of colon cancer.)Tj -1.364 -1.727 TD -0.059 Tw [(2.)-578 (There is no association between physical activity)]TJ 1.364 -1.227 TD 0.12 Tw [(and rectal cancer. Data are too sparse to )15 (draw)]TJ 0 -1.182 TD 0.259 Tw (conclusions regarding a relationship between)Tj 0 -1.227 TD 0.21 Tw (physical activity and endometrial, ovarian, or)Tj 0 -1.182 TD 0.002 Tw (testicular cancers.)Tj -1.364 -1.727 TD 0.029 Tw [(3.)-578 (Despite numerous studies on the subject, exist-)]TJ 1.364 -1.227 TD -0.103 Tw [(ing data are inconsistent regarding an )-7 (association)]TJ 0 -1.182 TD 0.023 Tw (between physical activity and breast or prostate)Tj 0 -1.227 TD (cancers.)Tj /F5 1 Tf 11 0 2.138 11 329.5 144.5 Tm 0 Tw (Non\320Insulin-Dependent Diabetes Mellitus)Tj /F7 1 Tf 11 0 0 11 329.5 130 Tm 0.033 Tc 0.156 Tw [(1.)-521 (Regular physical activity lowers the risk of)]TJ 1.364 -1.182 TD 0.236 Tw (developing non\320insulin-dependent diabetes)Tj T* (mellitus.)Tj ET PDFVars/TermAll get exec restore gsave showpage grestore %%Page: 70 70 save PDFVars/InitAll get exec %PDF_BeginEncoding: F5 Optima-Bold [ 39/quotesingle 96/grave 127/.notdef/Adieresis/Aring/Ccedilla 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0.067 Tw [(1.)-578 (Regular physical activity is necessary for main-)]TJ 1.364 -1.227 TD 0.012 Tw (taining normal muscle strength, joint structure,)Tj 0 -1.182 TD -0.121 Tw (and joint function. In the range recommended for)Tj 0 -1.227 TD 0.14 Tw (health, physical activity is not associated with)Tj 0 -1.182 TD 0.169 Tw (joint damage or development of osteoarthritis)Tj T* 0.242 Tw (and may be beneficial for many people with)Tj 0 -1.227 TD (arthritis.)Tj -1.364 -1.727 TD -0.065 Tw [(2.)-578 (Competitive athletics may be associated with the)]TJ 1.364 -1.227 TD 0.158 Tw (development of osteoarthritis later in life, but)Tj 0 -1.182 TD 0 Tw (sports-related injuries are the likely cause.)Tj /F5 1 Tf 11 0 2.138 11 48 538.5 Tm (Osteoporosis)Tj /F7 1 Tf 11 0 0 11 48 524 Tm 0.013 Tc -0.048 Tw [(1.)-559 (Weight-bearing physical activity is essential for)]TJ 1.364 -1.182 TD -0.027 Tw (normal skeletal development during childhood)Tj 0 -1.227 TD 0.122 Tw (and adolescence and for achieving and main-)Tj 0 -1.182 TD 0 Tw (taining peak bone mass in young adults.)Tj -1.364 -1.773 TD 0.003 Tw [(2)-13 (.)-546 (It is unclear whether resistance- or endurance-)]TJ 1.364 -1.182 TD -0.098 Tw (type physical activity can reduce the accelerated)Tj T* 0.017 Tw (rate of bone loss in postmenopausal women in)Tj 0 -1.227 TD 0 Tw (the absence of estrogen replacement therapy.)Tj /F5 1 Tf 11 0 2.138 11 48 392 Tm 0.003 Tc (Falling)Tj /F7 1 Tf 11 0 0 11 48 377.5 Tm -0.003 Tw [(1.)-578 (There is promising evidence that strength train-)]TJ 1.364 -1.182 TD 0.082 Tw (ing and other forms of exercise in older adults)Tj 0 -1.227 TD -0.034 Tw (preserve the ability to maintain independent liv-)Tj 0 -1.182 TD 0 Tw (ing status and reduce the risk of falling.)Tj /F5 1 Tf 11 0 2.138 11 48 304.5 Tm (Obesity)Tj /F7 1 Tf 11 0 0 11 48 290 Tm -0.088 Tw [(1.)-578 (Low levels of activity, resulting in fewer kilocalo-)]TJ 1.364 -1.182 TD -0.016 Tw [(ries used than consumed, contribute to the )-10 (high)]TJ 0 -1.227 TD 0 Tw (prevalence of obesity in the United States.)Tj -1.364 -1.727 TD 0.147 Tw [(2.)-578 (Physical activity may favorably affect body fat)]TJ 1.364 -1.227 TD (distribution.)Tj /F5 1 Tf 11 0 2.138 11 48 197.5 Tm 0 Tw (Mental Health)Tj /F7 1 Tf 11 0 0 11 48 183 Tm -0.002 Tw [(1.)-578 (Physical activity appears to relieve symptoms of)]TJ 1.364 -1.182 TD 0 Tw (depression and anxiety and improve mood.)Tj -1.364 -1.727 TD 0.02 Tw [(2.)-578 (Regular physical activity may reduce the risk of)]TJ 1.364 -1.227 TD 0.002 Tc -0.127 Tw (developing depression, although further research)Tj 0 -1.182 TD 0.013 Tc 0 Tw (is required on this topic.)Tj /F5 1 Tf 11 0 2.138 11 311.5 711 Tm 0.003 Tc -0.001 Tw (Health-Related Quality of Life)Tj /F7 1 Tf 11 0 0 11 311.5 697 Tm 0.013 Tc 0.237 Tw [(1)9 (.)-568 (Physical activity appears to improve health-)]TJ 1.364 -1.227 TD 0.003 Tc -0.103 Tw [(r)-10 (e)11 (lated quality of life by enhancing psychological)]TJ 0 -1.182 TD -0.001 Tw (well-being and by improving physical function-)Tj 0 -1.227 TD 0 Tw (ing in persons compromised by poor health.)Tj /F5 1 Tf 11 0 2.138 11 311.5 623.5 Tm (Adverse Effects)Tj /F7 1 Tf 11 0 0 11 311.5 609 Tm 0.023 Tc -0.121 Tw [(1.)-540 (Most)-15 ( )24 (musculoskeletal injuries related to physi-)]TJ 1.364 -1.182 TD 0.071 Tw [(cal activity are believed to be prevent)-26 (able by)]TJ T* 0.239 Tw (gradually working up to a desired level of)Tj 0 -1.227 TD -0.014 Tw (activity and by avoiding excessive amounts of)Tj 0 -1.182 TD (activity.)Tj -1.364 -1.773 TD 0.003 Tc 0.227 Tw [(2.)-578 (Serious cardiovascular events can occur with)]TJ 1.364 -1.182 TD 0.113 Tw (physical exertion, but the net effect of regular)Tj T* -0.053 Tw (physical activity is a lower risk of mortality from)Tj 0 -1.227 TD 0.001 Tw (cardiovascular disease.)Tj /F5 1 Tf 12 0 0 12 311.5 463 Tm 0 Tc (Research Needs)Tj /F7 1 Tf 11 0 0 11 311.5 448.5 Tm 0.013 Tc -0.119 Tw [(1)9 (.)-568 (Delineat)21 (e)10 ( )8 (the most important features or combi-)]TJ 1.364 -1.227 TD 0.178 Tw (nations of features of physical activity \(total)Tj 0 -1.182 TD 0.012 Tc -0.127 Tw (amount, intensity, duration, frequency, pattern,)Tj T* 0.013 Tc 0 Tw (or type\) that confer specific health benefits.)Tj -1.364 -1.773 TD 0.003 Tc 0.181 Tw [(2.)-578 (Determine specific health benefits of physical)]TJ 1.364 -1.182 TD 0.107 Tw (activity for women, racial and ethnic minority)Tj 0 -1.227 TD 0 Tw (groups, and people with disabilities.)Tj -1.364 -1.727 TD -0.012 Tw [(3.)-578 (Examine the protective effects of physical activ-)]TJ 1.364 -1.182 TD -0.032 Tw (ity in conjunction with other lifestyle character-)Tj 0 -1.227 TD 0 Tw (istics and disease prevention behaviors.)Tj -1.364 -1.727 TD 0.031 Tw [(4.)-578 (Examine the types of physical activity that pre-)]TJ 1.364 -1.227 TD -0.049 Tw (serve muscle strength and functional capacity in)Tj 0 -1.182 TD -0.001 Tw (the elderly.)Tj -1.364 -1.727 TD -0.029 Tw [(5.)-578 (Further study the relationship between physical)]TJ 1.364 -1.227 TD 0.002 Tw (activity in adolescence and early adulthood and)Tj 0 -1.182 TD 0 Tw (the later development of breast cancer.)Tj -1.364 -1.773 TD -0.025 Tc -0.023 Tw [(6.)-638 (Clarif)8 (y)-44 ( the role of physical activity in pre)]TJ 17.045 0 TD -0.005 Tc (venting or)Tj -15.682 -1.182 TD 0 Tw (reducing bone loss after menopause.)Tj ET PDFVars/TermAll get exec restore gsave showpage grestore %%Page: 71 71 save PDFVars/InitAll get exec %PDF_BeginEncoding: F5 Optima-Bold [ 39/quotesingle 96/grave 127/.notdef/Adieresis/Aring/Ccedilla /Eacute/Ntilde/Odieresis/Udieresis/aacute/agrave /acircumflex/adieresis/atilde/aring/ccedilla/eacute /egrave/ecircumflex/edieresis/iacute/igrave/icircumflex /idieresis/ntilde/oacute/ograve/ocircumflex/odieresis /otilde/uacute/ugrave/ucircumflex/udieresis/dagger /degree/cent/sterling/section/bullet/paragraph /germandbls/registered/copyright/trademark/acute/dieresis /notequal/AE/Oslash/infinity/plusminus/lessequal /greaterequal/yen/mu/partialdiff/summation/product /pi/integral/ordfeminine/ordmasculine/Omega/ae /oslash/questiondown/exclamdown/logicalnot/radical/florin /approxequal/Delta/guillemotleft/guillemotright/ellipsis/blank 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/guilsinglright/fi/fl/daggerdbl/periodcentered/quotesinglbase /quotedblbase/perthousand/Acircumflex/Ecircumflex/Aacute/Edieresis /Egrave/Iacute/Icircumflex/Idieresis/Igrave/Oacute /Ocircumflex/apple/Ograve/Uacute/Ucircumflex/Ugrave /dotlessi/circumflex/tilde/macron/breve/dotaccent /ring/cedilla/hungarumlaut/ogonek/caron /F16/Berkeley-Italic -1 TZ %PDF_EndEncoding 0 0 612 792 RC userdict /DefaultRGB /DeviceRGB put BT /F9 1 Tf 11 0 0 11 305 41 Tm 0 Tr 0 g 0.006 Tc (151)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 (References)Tj /F7 1 Tf 10 0 0 10 66 694 Tm 0.005 Tc -0.058 Tw (Abbott RD, Rodriguez BL, Burchfiel CM, Curb JD. Physi-)Tj 1.2 -1.2 TD -0.079 Tw (cal activity in older middle-aged men and reduced risk)Tj T* -0.095 Tw (of stroke: the Honolulu Heart Program.)Tj /F16 1 Tf 16.05 0 TD -0.091 Tw [( American Jour-)]TJ -16.05 -1.2 TD 0 Tw (nal of Epidemiology)Tj /F7 1 Tf 8 0 TD ( 1994;139:881\320893.)Tj -9.2 -1.75 TD 0.025 Tc 0.076 Tw (Abraham S, Collins G, Nordsieck M. Relationship of)Tj 1.2 -1.2 TD 0.014 Tc -0.127 Tw (childhood weight status to morbidity in adults. )Tj /F16 1 Tf 19.6 0 TD 0.015 Tc (Health)Tj -19.6 -1.2 TD 0.025 Tc 0.236 Tw (Services and Mental Health Administration Health)Tj T* (Reports)Tj /F7 1 Tf 3.15 0 TD 0 Tw ( 1971;86:273\320284.)Tj -4.35 -1.75 TD 0.005 Tc 0.067 Tw (Adams JE. Injury to the throwing arm: a study of trau-)Tj 1.2 -1.2 TD 0.221 Tw (matic changes in the elbow joints of boy baseball)Tj T* (players. )Tj /F16 1 Tf 3.5 0 TD 0 Tw (California Medicine)Tj /F7 1 Tf 8 0 TD ( 1965;102:127\320132.)Tj -12.7 -1.7 TD 0.129 Tw (Albanes D. 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Clinical implica-)Tj 1.2 -1.2 TD 0.152 Tw (tions of secondary impingement of the shoulder in)Tj T* 0.015 Tw (freestyle swimmers. )Tj /F16 1 Tf 8.6 0 TD (Journal of Orthopaedic and Sports)Tj -8.6 -1.2 TD 0 Tw (Physical Therapy )Tj /F7 1 Tf 7.25 0 TD (1994;20:307\320318.)Tj -8.45 -1.75 TD 0.17 Tw (Allen SH. Exercise considerations for postmenopausal)Tj 1.2 -1.2 TD -0.028 Tw (women with osteoporosis. )Tj /F16 1 Tf 11.2 0 TD -0.027 Tw (Arthritis Care and Research)Tj /F7 1 Tf -11.2 -1.2 TD (1994;7:205\320214.)Tj -1.2 -1.7 TD -0.028 Tw (Aloia JF, Vaswani AN, Yeh JK, Cohn SH. Premenopausal)Tj 1.2 -1.2 TD 0.092 Tw (bone mass is related to physical activity.)Tj /F16 1 Tf 17.4 0 TD 0.089 Tw [( Archives of)]TJ -17.4 -1.2 TD 0.001 Tw (Internal Medicine)Tj /F7 1 Tf 7.1 0 TD ( 1988;148:121\320123.)Tj -8.3 -1.75 TD -0.016 Tw (Alpert BS, Wilmore JH. Physical activity and blood pres-)Tj 1.2 -1.2 TD 0.053 Tc 0.259 Tw (sure in adolescents.)Tj /F16 1 Tf 9.7 0 TD 0.052 Tc 0.25 Tw [( Pediatric Exercise Science)]TJ /F7 1 Tf -9.7 -1.2 TD 0.005 Tc (1994;6:361\320380.)Tj -1.2 -1.75 TD -0.015 Tw (American Cancer Society. )Tj /F16 1 Tf 11 0 TD (Cancer facts and figures)Tj /F7 1 Tf 9.65 0 TD (, 1996.)Tj -19.45 -1.2 TD 0.053 Tw (Atlanta: American Cancer Society, 1996. Publication)Tj T* 0.002 Tw (No. 5008.96.)Tj -1.2 -1.75 TD 0 Tc -0.049 Tw (American College of Sports Medicine. )Tj /F16 1 Tf 15.7 0 TD 0.005 Tc -0.048 Tw (Guidelines for exer-)Tj -14.5 -1.2 TD 0.02 Tw (cise testing and prescription)Tj /F7 1 Tf 11.25 0 TD 0.021 Tw (. 4th ed. Philadelphia: Lea)Tj -11.25 -1.2 TD -0.001 Tw (and Febiger, 1991.)Tj -1.2 -1.75 TD 0 Tc 0.225 Tw (American College of Sports Medicine. Position stand:)Tj 1.2 -1.2 TD 0.137 Tw (physical activity, physical fitness, and hypertension.)Tj /F16 1 Tf T* -0.085 Tw (Medicine and Science in Sports and Exercise )Tj /F7 1 Tf 17.1 0 TD (1993;25:i\320x.)Tj -18.3 -1.7 TD 0.005 Tc 0.042 Tw [(American Diabetes Association. Technical re)12 (view: exer-)]TJ 1.2 -1.2 TD -0.001 Tw (cise and NIDDM.)Tj /F16 1 Tf 7.3 0 TD ( Diabetes Care)Tj /F7 1 Tf 5.85 0 TD ( 1990;13:785\320789.)Tj 12 60.4 TD 0.062 Tw (Anderson SD, Daviskas E, Smith CM. Exercise-induced)Tj 1.2 -1.2 TD -0.096 Tw (asthma: a difference in opinion regarding the stimulus.)Tj /F16 1 Tf T* -0.002 Tw (Allergy Proceedings)Tj /F7 1 Tf 7.95 0 TD ( 1989;10:215\320226.)Tj -9.15 -1.75 TD -0.077 Tw (Arbman G, Axelson O, Fredriksson M, Nilsson E, Sj\232dahl)Tj 1.2 -1.2 TD -0.005 Tw (R. Do occupational factors influence the risk of colon)Tj T* 0.065 Tw (and rectal cancer in different ways? )Tj /F16 1 Tf 15.5 0 TD (Cancer )Tj /F7 1 Tf 3.2 0 TD (1993;72:)Tj -18.7 -1.2 TD (2543\3202549.)Tj -1.2 -1.75 TD 0.164 Tw (Armstrong N, Simons-Morton B. Physical activity and)Tj 1.2 -1.2 TD 0.046 Tw (blood lipids in adolescents. )Tj /F16 1 Tf 11.9 0 TD 0.045 Tw (Pediatric Exercise Science)Tj /F7 1 Tf -11.9 -1.2 TD (1994;6:381\320405.)Tj -1.2 -1.7 TD -0.014 Tw (Armstrong SJ, Read RA, Ghosh P, Wilson DM. Moderate)Tj 1.2 -1.2 TD 0.243 Tw (exercise exacerbates the osteoarthritic lesions pro-)Tj T* 0.003 Tw (duced in cartilage by meniscectomy: a morphological)Tj T* (study. )Tj /F16 1 Tf 2.85 0 TD -0.001 Tw (Osteoarthritis and Cartilage)Tj /F7 1 Tf 11.3 0 TD ( 1993;1:89\32096.)Tj -15.35 -1.75 TD 0.044 Tw (Arokoski J, Kiviranta I, Jurvelin J, Tammi M, Helminen)Tj 1.2 -1.2 TD 0.037 Tw (HJ. Long-distance running causes site-dependent de-)Tj T* 0.086 Tw (crease of cartilage glycosaminoglycan content in the)Tj T* 0.092 Tw (knee joints of beagle dogs.)Tj /F16 1 Tf 11.45 0 TD 0.088 Tw [( Arthritis and Rheumatism)]TJ /F7 1 Tf -11.45 -1.2 TD (1993;36:1451\3201459.)Tj -1.2 -1.75 TD -0.054 Tw (Arraiz GA, Wigle DT, Mao Y. Risk assessment of physical)Tj 1.2 -1.2 TD 0.233 Tw (activity and physical fitness in the Canada Health)Tj T* 0.025 Tw (Survey Mortality Follow-up Study.)Tj /F16 1 Tf 14.6 0 TD [( Journal of Clinical)]TJ -14.6 -1.2 TD (Epidemiology )Tj /F7 1 Tf 5.7 0 TD (1992;45:419\320428.)Tj -6.9 -1.75 TD -0.071 Tw (Arroll B, Beaglehole R. Does physical activity lower blood)Tj 1.2 -1.2 TD -0.069 Tw (pressure? A critical review of the clinical trials.)Tj /F16 1 Tf 19.2 0 TD -0.067 Tw [( Journal)]TJ -19.2 -1.2 TD 0 Tw (of Clinical Epidemiology)Tj /F7 1 Tf 9.9 0 TD ( 1992;45:439\320447.)Tj -11.1 -1.75 TD 0.181 Tw (Bahrke MS, Morgan WP. Anxiety reduction following)Tj 1.2 -1.2 TD (exercise and meditation. )Tj /F16 1 Tf 11.05 0 TD 0.175 Tw (Cognitive Therapy and Re-)Tj -11.05 -1.2 TD (search )Tj /F7 1 Tf 2.85 0 TD (1978;2:323\320333.)Tj -4.05 -1.7 TD 0.169 Tw (Ballard-Barbash R, Schatzkin A, Albanes D, Schiffman)Tj 1.2 -1.2 TD -0.076 Tw (MH, Kreger BE, Kannel WB, et al. Physical activity and)Tj T* 0.053 Tw (risk of large bowel cancer in the Framingham study.)Tj /F16 1 Tf T* -0.001 Tw (Cancer Research )Tj /F7 1 Tf 6.95 0 TD (1990;50:3610\3203613.)Tj -8.15 -1.75 TD 0.222 Tw (Ballor DL, Keesey RE. A meta-analysis of the factors)Tj 1.2 -1.2 TD 0.07 Tw (affecting exercise-induced changes in body mass, fat)Tj T* -0.013 Tw (mass, and fat-free mass in males and females. )Tj /F16 1 Tf 19.1 0 TD (Interna-)Tj -19.1 -1.2 TD 0 Tw (tional Journal of Obesity)Tj /F7 1 Tf 9.8 0 TD ( 1991;15:717\320726.)Tj -11 -1.75 TD 0.04 Tw (Barnard RJ, Jung T, Inkeles SB. Diet and exercise in the)Tj 1.2 -1.2 TD 0.182 Tw (treatment of NIDDM: the need for early emphasis.)Tj /F16 1 Tf T* 0 Tw (Diabetes Care)Tj /F7 1 Tf 5.65 0 TD ( 1994;17:1469\3201472.)Tj -6.85 -1.75 TD 0.106 Tw (Bennett GE. Shoulder and elbow lesions of the profes-)Tj 1.2 -1.2 TD -0.096 Tw (sional baseball pitcher. )Tj /F16 1 Tf 9.6 0 TD -0.092 Tw [( Journal of the American Medical)]TJ -9.6 -1.2 TD (Association)Tj /F7 1 Tf 4.55 0 TD -0.001 Tw ( 1941;117:510\320514.)Tj -5.75 -1.75 TD -0.088 Tw (Berlin JA, Colditz GA. A meta-analysis of physical activity)Tj 1.2 -1.2 TD 0 Tw (in the prevention of coronary heart disease.)Tj /F16 1 Tf 18.25 0 TD ( American)Tj -18.25 -1.2 TD 0.001 Tw (Journal of Epidemiology)Tj /F7 1 Tf 9.65 0 TD ( 1990;132:612\320628.)Tj ET PDFVars/TermAll get exec restore gsave showpage grestore %%Page: 72 72 save PDFVars/InitAll get exec %PDF_BeginEncoding: F5 Optima-Bold [ 39/quotesingle 96/grave 127/.notdef/Adieresis/Aring/Ccedilla /Eacute/Ntilde/Odieresis/Udieresis/aacute/agrave /acircumflex/adieresis/atilde/aring/ccedilla/eacute /egrave/ecircumflex/edieresis/iacute/igrave/icircumflex /idieresis/ntilde/oacute/ograve/ocircumflex/odieresis /otilde/uacute/ugrave/ucircumflex/udieresis/dagger /degree/cent/sterling/section/bullet/paragraph /germandbls/registered/copyright/trademark/acute/dieresis /notequal/AE/Oslash/infinity/plusminus/lessequal /greaterequal/yen/mu/partialdiff/summation/product /pi/integral/ordfeminine/ordmasculine/Omega/ae 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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 3.05 0 TD 0.031 Tc 0.25 Tw (Research Quarterly for Exercise and Sport)Tj /F7 1 Tf -3.05 -1.2 TD 0.005 Tc (1987;58:221\320228.)Tj -1.2 -1.7 TD 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 -0.003 Tw ( 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 -0.004 Tw ( 1989;262:2395\3202401.)Tj -2.75 -1.75 TD 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 (Coleman RE, Riddle MW, et al. Cardiovascular and)Tj T* 0.001 Tc -0.128 Tw (behavioral effects of aerobic exercise training in healthy)Tj T* 0.043 Tc 0.259 Tw (older men and women. )Tj /F16 1 Tf 11.8 0 TD 0.042 Tc 0.25 Tw (Journal of Gerontology)Tj /F7 1 Tf -11.8 -1.2 TD 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 (Brown DR. Exercise, fitness, and mental health. In:)Tj 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 -9.9 -1.2 TD 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 -0.118 Tw (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 -7.7 -1.2 TD (tion)Tj /F7 1 Tf 1.55 0 TD -0.002 Tw ( 1964;14:211\320223.)Tj -2.75 -1.75 TD 0.003 Tc -0.127 Tw (Camacho TC, Roberts RE, Lazarus NB, Kaplan GA, Cohen)Tj 1.2 -1.2 TD 0.005 Tc 0.072 Tw (RD. Physical activity and depression: evidence from)Tj T* -0.082 Tw (the Alameda County Study.)Tj /F16 1 Tf 11.3 0 TD -0.079 Tw [( American Journal of Epide-)]TJ -11.3 -1.2 TD (miology)Tj /F7 1 Tf 3.2 0 TD -0.001 Tw ( 1991;134:220\320231.)Tj -4.4 -1.75 TD 0.049 Tw (Cassel J, Heyden S, Bartel AG, Kaplan BH, Tyroler HA,)Tj 1.2 -1.2 TD -0.127 Tw (Cornoni JC, et al. Occupation and physical activity and)Tj T* 0.081 Tw (coronary heart disease.)Tj /F16 1 Tf 9.8 0 TD 0.078 Tw [( Archives of Internal Medicine)]TJ /F7 1 Tf -9.8 -1.2 TD (1971;128:920\320928.)Tj ET PDFVars/TermAll get exec restore gsave showpage grestore %%Page: 73 73 save PDFVars/InitAll get exec %PDF_BeginEncoding: F5 Optima-Bold [ 39/quotesingle 96/grave 127/.notdef/Adieresis/Aring/Ccedilla /Eacute/Ntilde/Odieresis/Udieresis/aacute/agrave /acircumflex/adieresis/atilde/aring/ccedilla/eacute /egrave/ecircumflex/edieresis/iacute/igrave/icircumflex /idieresis/ntilde/oacute/ograve/ocircumflex/odieresis /otilde/uacute/ugrave/ucircumflex/udieresis/dagger /degree/cent/sterling/section/bullet/paragraph /germandbls/registered/copyright/trademark/acute/dieresis /notequal/AE/Oslash/infinity/plusminus/lessequal /greaterequal/yen/mu/partialdiff/summation/product /pi/integral/ordfeminine/ordmasculine/Omega/ae /oslash/questiondown/exclamdown/logicalnot/radical/florin 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Brisk walking does not stop)Tj 1.2 -1.2 TD -0.001 Tc -0.129 Tw (bone loss in postmenopausal women. )Tj /F16 1 Tf 15.05 0 TD (Bone )Tj /F7 1 Tf 2.05 0 TD -0.002 Tc (1988;9:201\320)Tj -17.1 -1.2 TD 0.005 Tc (204.)Tj -1.2 -1.75 TD 0.066 Tw (Cederholm J, Wibell L. Glucose tolerance and physical)Tj 1.2 -1.2 TD 0.146 Tw (activity in a health survey of middle-aged subjects.)Tj /F16 1 Tf T* 0 Tw (Acta Medica Scandinavica)Tj /F7 1 Tf 10.5 0 TD ( 1985;217:373\320378.)Tj -11.7 -1.75 TD -0.014 Tw (Chang-Claude J, Frentzel-Beyme R. Dietary and lifestyle)Tj 1.2 -1.2 TD -0.089 Tw (determinants of mortality among German vegetarians.)Tj /F16 1 Tf T* 0 Tc -0.123 Tw (International Journal of Epidemiology)Tj /F7 1 Tf 14.6 0 TD -0.127 Tw [( 1993;22:228\320236.)]TJ -15.8 -1.7 TD 0.015 Tc -0.003 Tw (Chave SPW, Morris JN, Moss S, Semmence AM. Vigor-)Tj 1.2 -1.2 TD -0.108 Tw (ous exercise in leisure time and the death rate: a study)Tj T* 0.145 Tw (of male civil servants. )Tj /F16 1 Tf 10.2 0 TD 0.14 Tw (Journal of Epidemiology and)Tj -10.2 -1.2 TD 0 Tw (Community Health)Tj /F7 1 Tf 7.8 0 TD ( 1978;32:239\320243.)Tj -9 -1.75 TD 0.005 Tc 0.043 Tw (Chen MK, Lowenstein FW. Epidemiology of factors re-)Tj 1.2 -1.2 TD -0.076 Tw (lated to self-reported diabetes among adults. )Tj /F16 1 Tf 18.4 0 TD (American)Tj -18.4 -1.2 TD 0 Tw (Journal of Preventive Medicine)Tj /F7 1 Tf 12.25 0 TD ( 1986;2:14\32019.)Tj -13.45 -1.75 TD -0.126 Tw (Chesnut CH III. Bone mass and exercise. )Tj /F16 1 Tf 16.5 0 TD -0.122 Tw (American Journal)Tj -15.3 -1.2 TD 0 Tw (of Medicine)Tj /F7 1 Tf 4.6 0 TD ( 1993;95\(5A Suppl\):34S\32036S.)Tj -5.8 -1.75 TD 0.029 Tc 0.258 Tw (Ching PLYH, Willett WC, Rimm EB, Colditz GA,)Tj 1.2 -1.2 TD 0.005 Tc -0.015 Tw (Gortmaker SL, Stampfer MJ. Activity level and risk of)Tj T* 0.248 Tw (overweight in male health professionals.)Tj /F16 1 Tf 17.9 0 TD 0.239 Tw [( American)]TJ -17.9 -1.2 TD 0 Tw (Journal of Public Health)Tj /F7 1 Tf 9.65 0 TD ( 1996;86:25\32030.)Tj -10.85 -1.75 TD 0.163 Tw (Chow RK, Harrison JE, Brown CF, Hajek V. Physical)Tj 1.2 -1.2 TD -0.106 Tw (fitness effect on bone mass in postmenopausal women.)Tj /F16 1 Tf T* 0.035 Tc 0.25 Tw (Archives of Physical Medicine and Rehabilitation)Tj /F7 1 Tf T* 0.005 Tc (1986;67:231\320234.)Tj -1.2 -1.7 TD -0.127 Tw (Chow W-H, Dosemeci M, Zheng W, Vetter R, McLaughlin)Tj 1.2 -1.2 TD 0.016 Tw (JK, Gao Y-T, et al. Physical activity and occupational)Tj T* -0.009 Tw (risk of colon cancer in Shanghai, China. )Tj /F16 1 Tf 17 0 TD (International)Tj -17 -1.2 TD 0.001 Tw (Journal of Epidemiology )Tj /F7 1 Tf 9.95 0 TD (1993;22:23\32029.)Tj -11.15 -1.75 TD 0.021 Tw (Cohen GC. Cycling injuries. )Tj /F16 1 Tf 12.3 0 TD 0.02 Tw (Canadian Family Physician)Tj /F7 1 Tf -11.1 -1.2 TD (1993;39:628\320632.)Tj -1.2 -1.75 TD -0.092 Tw (Cohen MV. )Tj /F16 1 Tf 4.9 0 TD -0.089 Tw (Coronary collaterals: clinical and experimental)Tj -3.7 -1.2 TD 0.006 Tc (observations.)Tj /F7 1 Tf 5.25 0 TD 0.259 Tw [( Mount Kisco, NY: Futura Publishing)]TJ -5.25 -1.2 TD 0.005 Tc 0.002 Tw (Company, 1985.)Tj -1.2 -1.75 TD -0.118 Tw (Conroy BP, Kraemer WJ, Maresh CM, Fleck SJ, Stone MH,)Tj 1.2 -1.2 TD 0.168 Tw (Fry AC, et al. Bone mineral density in elite junior)Tj T* 0.044 Tw (Olympic weightlifters. )Tj /F16 1 Tf 9.7 0 TD 0.043 Tw (Medicine and Science in Sports)Tj -9.7 -1.2 TD 0.001 Tw (and Exercise)Tj /F7 1 Tf 5.05 0 TD ( 1993;25:1103\3201109.)Tj -6.25 -1.75 TD 0.015 Tc -0.122 Tw (Cordain L, Latin RW, Behnke JJ. The effects of an aerobic)Tj 1.2 -1.2 TD 0.121 Tw (running program on bowel transit time. )Tj /F16 1 Tf 18.1 0 TD 0.117 Tw (Journal of)Tj -18.1 -1.2 TD 0.187 Tw (Sports Medicine and Physical Fitness)Tj /F7 1 Tf 15.95 0 TD 0.194 Tw [( 1986;26:101\320)]TJ -15.95 -1.2 TD (104.)Tj -1.2 -1.7 TD 0.005 Tc -0.051 Tw (Cramer SR, Nieman DC, Lee JW. The effects of moderate)Tj 1.2 -1.2 TD 0 Tc -0.13 Tw (exercise training on psychological well-being and mood)Tj T* 0.005 Tc 0.243 Tw (state in women. )Tj /F16 1 Tf 7.65 0 TD 0.235 Tw (Journal of Psychosomatic Research)Tj /F7 1 Tf -7.65 -1.2 TD (1991;35:437\320449.)Tj 25.15 62.2 TD -0.123 Tw (Cruz-Vidal M, Costas R Jr, Garc\222a-Palmieri MR, Sorlie PD,)Tj 1.2 -1.2 TD 0.085 Tw (Hertzmark E. Factors related to diabetes mellitus in)Tj T* 0 Tw (Puerto Rican men. )Tj /F16 1 Tf 8.05 0 TD (Diabetes )Tj /F7 1 Tf 3.65 0 TD (1979;28:300\320307.)Tj -12.9 -1.75 TD 0.058 Tw (Cumming RG, Klineberg RJ. Case-control study of risk)Tj 1.2 -1.2 TD -0.127 Tw (factors for hip fractures in the elderly.)Tj /F16 1 Tf 15.2 0 TD -0.123 Tw [( American Journal)]TJ -15.2 -1.2 TD 0.001 Tw (of Epidemiology)Tj /F7 1 Tf 6.45 0 TD ( 1994;139:493\320503.)Tj -7.65 -1.75 TD -0.048 Tw (Cummings SR, Kelsey JL, Nevitt MC, O\325Dowd KJ. Epide-)Tj 1.2 -1.2 TD 0.149 Tw (miology of osteoporosis and osteoporotic fractures.)Tj /F16 1 Tf T* -0.001 Tw (Epidemiological Reviews)Tj /F7 1 Tf 9.9 0 TD ( 1985;7:178\320208.)Tj -11.1 -1.7 TD 0.097 Tw (Cummings SR, Nevitt MC, Browner WS, Stone K, Fox)Tj 1.2 -1.2 TD 0.014 Tw (KM, Ensrud KE, et al. Risk factors for hip fracture in)Tj T* 0.03 Tc 0.259 Tw (white women. )Tj /F16 1 Tf 7.05 0 TD 0.029 Tc 0.25 Tw (New England Journal of Medicine)Tj /F7 1 Tf -7.05 -1.2 TD 0.005 Tc (1995;332:767\320773.)Tj -1.2 -1.75 TD -0.109 Tw (Dalsky GP, Stocke KS, Ehsani AA, Slatopolsky E, Lee WC,)Tj 1.2 -1.2 TD -0.055 Tw (Birge SJ. Weight-bearing exercise training and lumbar)Tj T* -0.039 Tw (bone mineral content in postmenopausal women. )Tj /F16 1 Tf 20.8 0 TD (An-)Tj -20.8 -1.2 TD -0.001 Tw (nals of Internal Medicine)Tj /F7 1 Tf 10 0 TD ( 1988;108:824\320828.)Tj -11.2 -1.75 TD 0.145 Tw (Dannenberg AL, Keller JB, Wilson PWF, Castelli WP.)Tj 1.2 -1.2 TD -0.06 Tw (Leisure-time physical activity in the Framingham Off-)Tj T* -0.039 Tw (spring Study: description, seasonal variation, and risk)Tj T* 0.249 Tw (factor correlates.)Tj /F16 1 Tf 7.25 0 TD 0.241 Tw [( American Journal of Epidemiology)]TJ /F7 1 Tf -7.25 -1.2 TD (1989;129:76\32088.)Tj -1.2 -1.75 TD 0.121 Tw (Davies MJ, Thomas AC. Plaque fissuring: the cause of)Tj 1.2 -1.2 TD -0.015 Tw (acute myocardial infarction, sudden ischaemic death,)Tj T* -0.003 Tc 0.116 Tw (and crescendo angina. )Tj /F16 1 Tf 9.7 0 TD 0.112 Tw (British Heart Journal)Tj /F7 1 Tf 8.5 0 TD 0.005 Tc 0.136 Tw [( 1985;53:)]TJ -18.2 -1.2 TD (363\320373.)Tj -1.2 -1.75 TD 0.033 Tw (Dawson AK, Leon AS, Taylor HL. Effect of submaximal)Tj 1.2 -1.2 TD 0.054 Tw (exercise on vulnerability to fibrillation in the canine)Tj T* (ventricle. )Tj /F16 1 Tf 4.2 0 TD (Circulation )Tj /F7 1 Tf 4.8 0 TD (1979;60:798\320804.)Tj -10.2 -1.7 TD 0.217 Tw (DeBusk RF, Stenestrand U, Sheehan M, Haskell WL.)Tj 1.2 -1.2 TD -0.018 Tw (Training effects of long versus short bouts of exercise)Tj T* 0.182 Tw (in healthy subjects. )Tj /F16 1 Tf 8.95 0 TD 0.175 Tw (American Journal of Cardiology)Tj /F7 1 Tf -8.95 -1.2 TD (1990;65:1010\3201013.)Tj -1.2 -1.75 TD -0.114 Tw (Despr\216s J-P, Tremblay A, Nadeau A, Bouchard C. Physical)Tj 1.2 -1.2 TD -0.023 Tw (training and changes in regional adipose tissue distri-)Tj T* 0.035 Tc (bution. )Tj /F16 1 Tf 3.8 0 TD 0.034 Tc 0.25 Tw (Acta Medica Scandinavica Supplementum)Tj /F7 1 Tf -3.8 -1.2 TD 0.005 Tc (1988;723:205\320212.)Tj -1.2 -1.75 TD 0.197 Tw [(D)8 (eVries HA. Tranquilizer effect of exercise: a critical)]TJ 1.2 -1.2 TD (review. )Tj /F16 1 Tf 3.3 0 TD 0 Tw (Physician and Sportsmedicine)Tj /F7 1 Tf 11.95 0 TD ( 1981;9:47\32055.)Tj -16.45 -1.75 TD -0.081 Tw [(D)8 (eVries HA, Adams GM. Electromyographic comparison)]TJ 1.2 -1.2 TD 0.176 Tw (of single doses of exercise and meprobamate as to)Tj T* 0.17 Tw (effects on muscular relaxation. )Tj /F16 1 Tf 13.85 0 TD 0.164 Tw (American Journal of)Tj -13.85 -1.2 TD 0 Tw (Physical Medicine)Tj /F7 1 Tf 7.25 0 TD ( 1972;51:130\320141.)Tj -8.45 -1.75 TD -0.044 Tw (DiPietro L. 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Occupational physical activity, socio-)Tj T* -0.109 Tw (economic status, and risks of 15 cancer sites in Turkey.)Tj /F16 1 Tf T* -0.001 Tw (Cancer Causes and Control)Tj /F7 1 Tf 11 0 TD ( 1993;4:313\320321.)Tj -12.2 -1.75 TD 0.166 Tw (Dowse GK, Zimmet PZ, Gareeboo H, Alberti KGMM,)Tj 1.2 -1.2 TD -0.035 Tw (Tuomilehto J, Finch CF, et al. Abdominal obesity and)Tj T* 0.241 Tw (physical inactivity as risk factors for NIDDM and)Tj T* 0.25 Tw (impaired glucose tolerance in Indian, Creole, and)Tj T* 0 Tw (Chinese Mauritians.)Tj /F16 1 Tf 8.45 0 TD ( Diabetes Care)Tj /F7 1 Tf 5.85 0 TD ( 1991;14:271\320282.)Tj -15.5 -1.75 TD 0.187 Tw (Doyne EJ, Ossip-Klein DJ, Bowman ED, Osborn KM,)Tj 1.2 -1.2 TD -0.007 Tw (McDougall-Wilson IB, Neimeyer RA. 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Lower prevalence of breast cancer and)Tj T* 0.249 Tw (cancers of the reproductive system among former)Tj T* -0.054 Tw (college athletes compared to nonathletes. )Tj /F16 1 Tf 17.3 0 TD -0.052 Tw (British Jour-)Tj -17.3 -1.2 TD -0.001 Tw (nal of Cancer)Tj /F7 1 Tf 5.4 0 TD ( 1985;52:885\320891.)Tj -6.6 -1.7 TD -0.045 Tw (Frisch RE, Wyshak G, Albright NL, Albright TE, Schiff I,)Tj 1.2 -1.2 TD 0.091 Tw (Witschi J, et al. Lower lifetime occurrence of breast)Tj T* -0.028 Tw (cancer and cancers of the reproductive system among)Tj T* 0.118 Tw (former college athletes. )Tj /F16 1 Tf 10.4 0 TD 0.114 Tw (American Journal of Clinical)Tj -10.4 -1.2 TD (Nutrition)Tj /F7 1 Tf 3.75 0 TD 0.001 Tw ( 1987;45:328\320335.)Tj -4.95 -1.75 TD -0.045 Tw (Frisch RE, Wyshak G, Albright TE, Albright NL, Schiff I.)Tj 1.2 -1.2 TD -0.042 Tw (Lower prevalence of diabetes in female former college)Tj T* 0.06 Tc 0.259 Tw (athletes compared with nonathletes. )Tj /F16 1 Tf 18.45 0 TD 0.058 Tc (Diabetes)Tj /F7 1 Tf -18.45 -1.2 TD 0.005 Tc (1986;35:1101\3201105.)Tj -1.2 -1.75 TD 0.015 Tc 0.158 Tw [(Frizzell RT, Lang GH, Lowance DC, Lathan SR. Hy)23 (-)]TJ 1.2 -1.2 TD 0.005 Tc -0.099 Tw (ponatremia and ultra-marathon running. )Tj /F16 1 Tf 17 0 TD -0.095 Tw (Journal of the)Tj -17 -1.2 TD 0 Tw (American Medical Association)Tj /F7 1 Tf 12.1 0 TD ( 1986;255:772\320774.)Tj ET PDFVars/TermAll get exec restore gsave showpage grestore %%Page: 76 76 save PDFVars/InitAll get exec %PDF_BeginEncoding: F5 Optima-Bold [ 39/quotesingle 96/grave 127/.notdef/Adieresis/Aring/Ccedilla /Eacute/Ntilde/Odieresis/Udieresis/aacute/agrave /acircumflex/adieresis/atilde/aring/ccedilla/eacute /egrave/ecircumflex/edieresis/iacute/igrave/icircumflex /idieresis/ntilde/oacute/ograve/ocircumflex/odieresis /otilde/uacute/ugrave/ucircumflex/udieresis/dagger /degree/cent/sterling/section/bullet/paragraph /germandbls/registered/copyright/trademark/acute/dieresis /notequal/AE/Oslash/infinity/plusminus/lessequal /greaterequal/yen/mu/partialdiff/summation/product /pi/integral/ordfeminine/ordmasculine/Omega/ae 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In:)Tj 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 -7.5 -1.2 TD -0.069 Tw (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 /F16 1 Tf T* -0.026 Tw (Journal of the American College of Cardiology)Tj /F7 1 Tf 18.35 0 TD -0.027 Tw [( 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 (Stampfer M, Willett WC. Physical activity, obesity, and)Tj 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 (Goldberg AP. Aerobic and resistive exercise modify risk)Tj 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 0 Tw (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 (Grimston SK, Willows ND, Hanley DA. Mechanical load-)Tj 1.2 -1.2 TD -0.107 Tw (ing regime and its relationship to bone mineral density)Tj T* -0.084 Tw (in children. )Tj /F16 1 Tf 4.95 0 TD -0.081 Tw (Medicine and Science in Sports and Exercise)Tj /F7 1 Tf -4.95 -1.2 TD (1993;25:1203\3201210.)Tj -1.2 -1.75 TD -0.098 Tw (Grodzinsky AJ. Age-related changes in cartilage: physical)Tj 1.2 -1.2 TD 0.026 Tc 0.259 Tw (properties and cellular response to loading. In:)Tj T* 0.005 Tc -0.058 Tw (Buckwalter JA, Goldberg VM, Woo SLY, editors.)Tj /F16 1 Tf 19.9 0 TD -0.056 Tw [( Mus-)]TJ -19.9 -1.2 TD 0.028 Tc 0.25 Tw (culoskeletal soft-tissue aging: impact on mobility)Tj /F7 1 Tf 21.9 0 TD (.)Tj -21.9 -1.2 TD 0.005 Tc -0.051 Tw (Rosemont, IL: American Academy of Orthopedic Sur-)Tj T* -0.002 Tw (geons, 1993:137\320149.)Tj -1.2 -1.7 TD -0.08 Tw (Gudat U, Berger M, Lef\217bvre PJ. Physical activity, fitness,)Tj 1.2 -1.2 TD 0.1 Tw (and non-insulin-dependent \(type II\) diabetes melli-)Tj T* -0.072 Tw (tus. In: Bouchard C, Shephard RJ, Stephens T, editors.)Tj /F16 1 Tf T* 0.015 Tw (Physical activity, fitness, and health: international pro-)Tj T* -0.022 Tw (ceedings and consensus statement.)Tj /F7 1 Tf 13.55 0 TD -0.023 Tw [( Champaign, IL: Hu-)]TJ -13.55 -1.2 TD -0.001 Tw (man Kinetics, 1994:669\320683.)Tj -1.2 -1.75 TD 0.178 Tw (Hagberg JM, Montain SJ, Martin WH III, Ehsani AA.)Tj 1.2 -1.2 TD 0.015 Tc -0.001 Tw [(E)8 (ffect of exercise training in 60- to 69-year-old per-)]TJ T* 0.006 Tc -0.02 Tw [(sons)4 ( with essential hypertension. )]TJ /F16 1 Tf 14.1 0 TD 0.005 Tc -0.019 Tw (American Journal of)Tj -14.1 -1.2 TD (Cardiology)Tj /F7 1 Tf 4.45 0 TD 0 Tw ( 1989;64:348\320353.)Tj -5.65 -1.75 TD -0.041 Tw (Hahn RA, Teutsch SM, Rothenberg RB, Marks JS. Excess)Tj 1.2 -1.2 TD -0.099 Tw (deaths from nine chronic diseases in the United States,)Tj T* (1986. )Tj /F16 1 Tf 2.85 0 TD 0.209 Tw [( Journal of the American Medical Association)]TJ /F7 1 Tf -2.85 -1.2 TD (1990;264:2654\3202659.)Tj -1.2 -1.75 TD -0.031 Tw (Hall AC, Urban JPG, Gehl KA. The effects of hydrostatic)Tj 1.2 -1.2 TD 0.191 Tw (pressure on matrix synthesis in articular cartilage.)Tj /F16 1 Tf T* 0 Tw (Journal of Orthopaedic Research )Tj /F7 1 Tf 13.25 0 TD (1991;9:1\32010.)Tj -14.45 -1.75 TD 0.006 Tc 0.259 Tw (Hambrecht R, Niebauer J, Marburger C, Grunze M,)Tj 1.2 -1.2 TD 0.005 Tc 0.254 Tw (K\212lberer B, Hauer K, et al. Various intensities of)Tj T* -0.122 Tw (leisure-time physical activity in patients with coronary)Tj T* -0.047 Tw (artery disease: effects on cardiorespiratory fitness and)Tj T* -0.003 Tw (progression of coronary atherosclerotic lesions. )Tj /F16 1 Tf 20.15 0 TD (Jour-)Tj -20.15 -1.2 TD -0.095 Tw (nal of the American College of Cardiology )Tj /F7 1 Tf 16.4 0 TD (1993;22:468\320)Tj -16.4 -1.2 TD (477.)Tj -1.2 -1.7 TD -0.067 Tw (Hara H, Kawase T, Yamakido M, Nishimoto Y. Compara-)Tj 1.2 -1.2 TD 0.037 Tw (tive observation of micro- and macroangiopathies in)Tj T* 0.197 Tw (Japanese diabetics in Japan and U.S.A. In: Abe H,)Tj T* 0.006 Tc 0.259 Tw (Hoshi M, editors. )Tj /F16 1 Tf 8.35 0 TD 0.25 Tw (Diabetic microangiopathy)Tj /F7 1 Tf 10.6 0 TD 0.259 Tw (. Basel:)Tj -18.95 -1.2 TD 0.005 Tc -0.002 Tw (Karger, 1983.)Tj -1.2 -1.75 TD -0.026 Tw (Harmsen P, Rosengren A, Tsipogianni A, Wilhelmsen L.)Tj 1.2 -1.2 TD 0 Tc -0.127 Tw (Risk factors for stroke in middle-aged men in G\232teborg,)Tj T* 0.005 Tc (Sweden. )Tj /F16 1 Tf 3.75 0 TD (Stroke )Tj /F7 1 Tf 2.85 0 TD (1990;21:223\320229.)Tj ET PDFVars/TermAll get exec restore gsave showpage grestore %%Page: 77 77 save PDFVars/InitAll get exec %PDF_BeginEncoding: F5 Optima-Bold [ 39/quotesingle 96/grave 127/.notdef/Adieresis/Aring/Ccedilla /Eacute/Ntilde/Odieresis/Udieresis/aacute/agrave /acircumflex/adieresis/atilde/aring/ccedilla/eacute /egrave/ecircumflex/edieresis/iacute/igrave/icircumflex /idieresis/ntilde/oacute/ograve/ocircumflex/odieresis /otilde/uacute/ugrave/ucircumflex/udieresis/dagger /degree/cent/sterling/section/bullet/paragraph /germandbls/registered/copyright/trademark/acute/dieresis /notequal/AE/Oslash/infinity/plusminus/lessequal 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Classification, diagnostic criteria, and screen-)Tj 1.2 -1.2 TD 0.03 Tw (ing for diabetes. In: Harris MI, Cowie CC, Stern MP,)Tj T* -0.008 Tw (Boyko EJ, Reiber GE, Bennett PH, editors.)Tj /F16 1 Tf 17.55 0 TD [( Diabetes in)]TJ -17.55 -1.2 TD (America.)Tj /F7 1 Tf 3.6 0 TD -0.027 Tw [( Bethesda, MD: National Institutes of Health,)]TJ -3.6 -1.2 TD 0.008 Tw (National Institute of Diabetes and Digestive and Kid-)Tj T* 0.107 Tw (ney Diseases, 1995:15\32036. NIH Publication No. 95-)Tj T* (1468.)Tj -1.2 -1.75 TD -0.01 Tw (Harris MI. Epidemiological correlates of NIDDM in His-)Tj 1.2 -1.2 TD 0.219 Tw (panics, whites, and blacks in the U.S. population.)Tj /F16 1 Tf T* -0.001 Tw (Diabetes Care)Tj /F7 1 Tf 5.65 0 TD ( 1991;14\(Suppl 3\):639\320648.)Tj -6.85 -1.75 TD -0.103 Tw (Harris MI, Hadden WC, Knowler WC, Bennett PH. Preva-)Tj 1.2 -1.2 TD 0.019 Tw (lence of diabetes and impaired glucose tolerance and)Tj T* 0.044 Tw (plasma glucose levels in U.S. population aged 20\32074)Tj T* (yr. )Tj /F16 1 Tf 1.4 0 TD (Diabetes)Tj /F7 1 Tf 3.4 0 TD 0 Tw ( 1987;36:523\320534.)Tj -6 -1.7 TD 0.134 Tw [(Harrison GG. Height-weight )-11 (Table)20 (s. )]TJ /F16 1 Tf 15.95 0 TD 0.129 Tw (Annals of Internal)Tj -14.75 -1.2 TD (Medicine)Tj /F7 1 Tf 3.6 0 TD 0 Tw ( 1985;103\(Suppl 6, Pt 2\):989\320994.)Tj -4.8 -1.75 TD -0.067 Tw (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 -15.4 -1.2 TD 0.001 Tw (and Fitness Research)Tj /F7 1 Tf 8.4 0 TD ( 1995;Series 2:1\3207.)Tj -9.6 -1.75 TD 0.053 Tw (Haskell WL, Alderman EL, Fair JM, Maron DJ, Mackey)Tj 1.2 -1.2 TD -0.092 Tw (SF, Superko HR, et al. Effects of intensive multiple risk)Tj T* -0.099 Tw (factor reduction on coronary atherosclerosis and clini-)Tj T* 0.047 Tw (cal cardiac events in men and women with coronary)Tj 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 (Circulation )Tj /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 -0.061 Tw [( 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 (Manttari A, Vuori I. Bone mineral density in female)Tj T* 0 Tc -0.128 Tw (athletes representing sports with different loading char-)Tj T* 0.005 Tc 0 Tw (acteristics of the skeleton. )Tj /F16 1 Tf 11.15 0 TD (Bone )Tj /F7 1 Tf 2.25 0 TD (1995;17:197\320203.)Tj -14.6 -1.7 TD -0.086 Tw (Helmrich SP, Ragland DR, Leung RW, Paffenbarger RS Jr.)Tj 1.2 -1.2 TD 0.015 Tc 0.216 Tw (Physical activity and reduced occurrence of non-)Tj T* 0.001 Tc -0.13 Tw [(insu)5 (lin-dependent diabetes mellitus. )]TJ /F16 1 Tf 14.95 0 TD 0 Tc -0.124 Tw (New England Jour-)Tj -14.95 -1.2 TD 0.005 Tc -0.001 Tw (nal of Medicine)Tj /F7 1 Tf 6.15 0 TD ( 1991;325:147\320152.)Tj -7.35 -1.75 TD 0.157 Tw (Herman B, Schmitz PIM, Leyten ACM, Van Luijk JH,)Tj 1.2 -1.2 TD -0.076 Tw (Frenken CWGM, Op de Coul AAW, et al. Multivariate)Tj 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 (Hill AB. The environment and disease: association or)Tj 1.2 -1.2 TD (causation? )Tj /F16 1 Tf 4.65 0 TD -0.031 Tw (Proceedings of the Royal Society of Medicine)Tj /F7 1 Tf -4.65 -1.2 TD (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 -0.127 Tw (Stephens T, editors. )Tj /F16 1 Tf 8.15 0 TD -0.123 Tw (Physical activity, fitness, and health:)Tj -8.15 -1.2 TD 0.022 Tc 0.25 Tw (international proceedings and consensus statement.)Tj /F7 1 Tf T* 0.005 Tc 0 Tw (Champaign, IL: Human Kinetics, 1994:684\320695.)Tj -1.2 -1.75 TD -0.068 Tw (Hoeberigs JH. Factors related to the incidence of running)Tj 1.2 -1.2 TD 0 Tw (injuries: a review. )Tj /F16 1 Tf 7.75 0 TD (Sports Medicine )Tj /F7 1 Tf 6.65 0 TD (1992;13:408\320422.)Tj -15.6 -1.75 TD -0.005 Tw (Holbrook TL, Barrett-Connor E, Wingard DL. The asso-)Tj 1.2 -1.2 TD -0.015 Tw (ciation of lifetime weight and weight control patterns)Tj T* 0.192 Tw (with diabetes among men and women in an adult)Tj T* (community. )Tj /F16 1 Tf 5.4 0 TD 0.046 Tw (International Journal of Obesity)Tj /F7 1 Tf 12.9 0 TD 0.047 Tw [( 1989;13:)]TJ -18.3 -1.2 TD (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* -0.119 Tw (Journal of the American Geriatrics Society)Tj /F7 1 Tf 16.35 0 TD -0.123 Tw [( 1984;33:273\320)]TJ -16.35 -1.2 TD (277.)Tj -1.2 -1.75 TD 0.122 Tw (Holloszy JO, Schultz J, Kusnierkiewicz J, Hagberg JM,)Tj 1.2 -1.2 TD -0.113 Tw (Ehsani AA. Effects of exercise on glucose tolerance and)Tj T* 0.003 Tw (insulin resistance: brief review and some preliminary)Tj T* 0.035 Tc (results.)Tj /F16 1 Tf 3.3 0 TD 0.034 Tc 0.25 Tw [( Acta Medica Scandinavica Supplementum)]TJ /F7 1 Tf -3.3 -1.2 TD 0.005 Tc (1986;711:55\32065.)Tj -1.2 -1.75 TD 0.07 Tw (Holman H, Mazonson P, Lorig K. Health education for)Tj 1.2 -1.2 TD 0.098 Tw (self-management has significant early and sustained)Tj T* 0.025 Tw (benefits in chronic arthritis.)Tj /F16 1 Tf 11.8 0 TD 0.024 Tw [( Transactions of the Asso-)]TJ -11.8 -1.2 TD 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 -0.005 Tw (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 -0.003 Tc -0.056 Tw (musculoskeletal injuries in lightweight women rowers.)Tj /F16 1 Tf T* 0.005 Tc -0.061 Tw (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 4.95 0 TD (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 -9.5 -1.75 TD -0.075 Tw (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 /F16 1 Tf 7.85 0 TD 0.027 Tc 0.25 Tw (Journal of Orthopaedic Research)Tj /F7 1 Tf -7.85 -1.2 TD 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 -0.089 Tw (cal activity and risk of hip fracture.)Tj /F16 1 Tf 14.2 0 TD -0.086 Tw [( American Journal of)]TJ -14.2 -1.2 TD (Epidemiology)Tj /F7 1 Tf 5.45 0 TD -0.002 Tw ( 1993;138:107\320118.)Tj ET PDFVars/TermAll get exec restore gsave showpage grestore %%Page: 78 78 save PDFVars/InitAll get exec %PDF_BeginEncoding: F5 Optima-Bold [ 39/quotesingle 96/grave 127/.notdef/Adieresis/Aring/Ccedilla /Eacute/Ntilde/Odieresis/Udieresis/aacute/agrave /acircumflex/adieresis/atilde/aring/ccedilla/eacute /egrave/ecircumflex/edieresis/iacute/igrave/icircumflex /idieresis/ntilde/oacute/ograve/ocircumflex/odieresis /otilde/uacute/ugrave/ucircumflex/udieresis/dagger /degree/cent/sterling/section/bullet/paragraph /germandbls/registered/copyright/trademark/acute/dieresis /notequal/AE/Oslash/infinity/plusminus/lessequal /greaterequal/yen/mu/partialdiff/summation/product /pi/integral/ordfeminine/ordmasculine/Omega/ae 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Effects of differing)Tj 1.2 -1.2 TD -0.055 Tw (intensities and formats of 12 months of exercise train-)Tj T* -0.035 Tw (ing on psychological outcomes in older adults. )Tj /F16 1 Tf 19.6 0 TD (Health)Tj -19.6 -1.2 TD (Psychology)Tj /F7 1 Tf 4.5 0 TD -0.003 Tw ( 1993;12:292\320300.)Tj ET PDFVars/TermAll get exec restore gsave showpage grestore %%Page: 79 79 save PDFVars/InitAll get exec %PDF_BeginEncoding: F5 Optima-Bold [ 39/quotesingle 96/grave 127/.notdef/Adieresis/Aring/Ccedilla /Eacute/Ntilde/Odieresis/Udieresis/aacute/agrave /acircumflex/adieresis/atilde/aring/ccedilla/eacute /egrave/ecircumflex/edieresis/iacute/igrave/icircumflex /idieresis/ntilde/oacute/ograve/ocircumflex/odieresis /otilde/uacute/ugrave/ucircumflex/udieresis/dagger /degree/cent/sterling/section/bullet/paragraph /germandbls/registered/copyright/trademark/acute/dieresis /notequal/AE/Oslash/infinity/plusminus/lessequal /greaterequal/yen/mu/partialdiff/summation/product /pi/integral/ordfeminine/ordmasculine/Omega/ae 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Risk factors for)Tj 1.2 -1.2 TD -0.057 Tw (diabetes in three Pacific populations.)Tj /F16 1 Tf 15.25 0 TD -0.055 Tw [( American Journal)]TJ -15.25 -1.2 TD 0.001 Tw (of Epidemiology)Tj /F7 1 Tf 6.45 0 TD ( 1984;119:396\320409.)Tj -7.65 -1.75 TD 0.228 Tw (Kirchner EM, Lewis RD, O\325Connor PJ. Effect of past)Tj 1.2 -1.2 TD -0.103 Tw (gymnastics participation on adult bone mass. )Tj /F16 1 Tf 18.6 0 TD -0.099 Tw (Journal of)Tj -18.6 -1.2 TD 0 Tw (Applied Physiology)Tj /F7 1 Tf 7.65 0 TD ( 1996;80:225\320232.)Tj -8.85 -1.75 TD 0.059 Tw (Klein MH, Greist JH, Gurman AS, Neimeyer RA, Lesser)Tj 1.2 -1.2 TD -0.085 Tw (DP, Bushnell NJ, et al. A comparative outcome study of)Tj T* -0.122 Tw (group psychotherapy vs exercise treatments for depres-)Tj T* (sion. )Tj /F16 1 Tf 2.4 0 TD 0.127 Tw (International Journal of Mental Health)Tj /F7 1 Tf 16 0 TD 0.131 Tw [( 1985;13:)]TJ -18.4 -1.2 TD (148\320177.)Tj -1.2 -1.75 TD -0.024 Tw (Klesges RC, Klesges LM, Eck LH, Shelton ML. A longitu-)Tj 1.2 -1.2 TD 0.023 Tw (dinal analysis of accelerated weight gain in preschool)Tj T* (children. )Tj /F16 1 Tf 4.05 0 TD (Pediatrics)Tj /F7 1 Tf 3.95 0 TD -0.002 Tw ( 1995;95:126\320130.)Tj -9.2 -1.75 TD -0.084 Tw (Klesges RC, Klesges LM, Haddock CK, Eck LH. A longitu-)Tj 1.2 -1.2 TD 0.254 Tw (dinal analysis of the impact of dietary intake and)Tj T* -0.039 Tw (physical activity on weight change in adults. )Tj /F16 1 Tf 18.6 0 TD (American)Tj -18.6 -1.2 TD -0.001 Tw (Journal of Clinical Nutrition)Tj /F7 1 Tf 11.4 0 TD ( 1992;55:818\320822.)Tj -12.6 -1.7 TD -0.002 Tc -0.129 Tw (Kohl HW III, Powell KE, Gordon NF, Blair SN, Paffenbarger)Tj 1.2 -1.2 TD 0.005 Tc 0.103 Tw (RS Jr. Physical activity, physical fitness, and sudden)Tj T* 0.001 Tw (cardiac death. )Tj /F16 1 Tf 6.1 0 TD (Epidemiologic Reviews )Tj /F7 1 Tf 9.4 0 TD (1992;14:37\32058.)Tj -16.7 -1.75 TD -0.049 Tw (Kohrt WM, Snead DB, Slatopolsky E, Birge SJ Jr. Additive)Tj 1.2 -1.2 TD -0.111 Tw (effects of weight-bearing exercise and estrogen on bone)Tj T* 0.078 Tw (mineral density in older women.)Tj /F16 1 Tf 14 0 TD 0.075 Tw [( Journal of Bone and)]TJ -14 -1.2 TD 0 Tw (Mineral Research)Tj /F7 1 Tf 7 0 TD ( 1995;10:1303\3201311.)Tj -8.2 -1.75 TD 0.102 Tw (Koivisto VA, Soman V, Conrad P, Hendler R, Nadel E,)Tj 1.2 -1.2 TD 0.045 Tw (Felig P. Insulin binding to monocytes in trained ath-)Tj T* 0.098 Tw (letes: changes in the resting state and after exercise.)Tj /F16 1 Tf T* 0.001 Tw (Journal of Clinical Investigation)Tj /F7 1 Tf 12.8 0 TD ( 1979;64:1011\3201015.)Tj -14 -1.75 TD 0.004 Tc -0.128 Tw (Koivisto VA, Yki-J\212rvinen H, DeFronzo RA. Physical train-)Tj 1.2 -1.2 TD 0.005 Tc 0.229 Tw (ing and insulin sensitivity. )Tj /F16 1 Tf 12.3 0 TD 0.221 Tw (Diabetes/Metabolism Re-)Tj -12.3 -1.2 TD (views )Tj /F7 1 Tf 2.45 0 TD (1986;1:445\320481.)Tj -3.65 -1.75 TD 0.004 Tc -0.127 Tw (Kokkinos PF, Hurley BF, Vaccaro P, Patterson JC, Gardner)Tj 1.2 -1.2 TD 0.005 Tc 0 Tw (LB, Ostrove SM, et al. Effects of low- and high-repeti-)Tj T* 0.249 Tw (tion resistive training on lipoprotein-lipid profiles.)Tj /F16 1 Tf T* -0.1 Tw (Medicine and Science in Sports and Exercise)Tj /F7 1 Tf 17.1 0 TD -0.104 Tw [( 1988;20:50\320)]TJ -17.1 -1.2 TD 0.004 Tc (54.)Tj 25.35 62.9 TD 0.005 Tc -0.089 Tw (Kono S, Shinchi K, Ikeda N, Yanai F, Imanishi K. Physical)Tj 1.2 -1.2 TD -0.097 Tw (activity, dietary habits, and adenomatous polyps of the)Tj T* -0.121 Tw (sigmoid colon: a study of self-defense officials in Japan.)Tj /F16 1 Tf T* 0 Tw (Journal of Clinical Epidemiology)Tj /F7 1 Tf 13.1 0 TD ( 1991;44:1255\3201261.)Tj -14.3 -1.75 TD -0.003 Tc -0.118 Tw (Koplan JP. Cardiovascular deaths while running. )Tj /F16 1 Tf 19.55 0 TD -0.114 Tw [( Journal of)]TJ -18.35 -1.2 TD -0.06 Tw (the American Medical Association)Tj /F7 1 Tf 13.1 0 TD -0.062 Tw [( 1979;242:2578\3202579.)]TJ -14.3 -1.75 TD 0.005 Tc 0.036 Tw (Koplan JP, Powell KE, Sikes RK, Shirley RW, Campbell)Tj 1.2 -1.2 TD -0.108 Tw (CC. An epidemiologic study of the benefits and risks of)Tj T* (running. )Tj /F16 1 Tf 3.95 0 TD 0.039 Tw [( Journal of the American Medical Association)]TJ /F7 1 Tf -3.95 -1.2 TD (1982;248:3118\3203121.)Tj -1.2 -1.7 TD 0.252 Tw (Krall LP, Beaser RS. )Tj /F16 1 Tf 9.55 0 TD 0.243 Tw (Joslin diabetes manual. )Tj /F7 1 Tf 10.2 0 TD 0.252 Tw (12th ed.)Tj -18.55 -1.2 TD 0 Tw (Philadelphia: Lea and Febiger, 1989.)Tj -1.2 -1.75 TD 0.038 Tw (Kramsch DM, Aspen AJ, Abramowitz BM, Kreimendahl)Tj 1.2 -1.2 TD -0.052 Tw (T, Hood WB Jr. Reduction of coronary atherosclerosis)Tj T* 0.002 Tw (by moderate conditioning exercise in monkeys on an)Tj T* 0.256 Tw (atherogenic diet. )Tj /F16 1 Tf 7.8 0 TD 0.247 Tw (New England Journal of Medicine)Tj /F7 1 Tf -7.8 -1.2 TD (1981;305:1483\3201489.)Tj -1.2 -1.75 TD -0.005 Tw (Kraus JF, Conroy C. Mortality and morbidity from inju-)Tj 1.2 -1.2 TD 0.033 Tw (ries in sports and recreation. )Tj /F16 1 Tf 12.45 0 TD 0.032 Tw (Annual Review of Public)Tj -12.45 -1.2 TD (Health )Tj /F7 1 Tf 2.95 0 TD (1984;5:163\320192.)Tj -4.15 -1.75 TD 0.004 Tw (Kriska AM, Bennett PH. An epidemiological perspective)Tj 1.2 -1.2 TD 0.013 Tc 0.259 Tw (of the relationship between physical activity and)Tj T* 0.015 Tc 0.17 Tw (NIDDM: from activity assessment to intervention.)Tj /F16 1 Tf T* 0.005 Tc -0.001 Tw [(D)-10 (i)-10 (a)-21 (betes/Metabolism Reviews)]TJ /F7 1 Tf 11.85 0 TD ( 1992;8:355\320372.)Tj -13.05 -1.75 TD 0.07 Tw (Kriska AM, Blair SN, Pereira MA. The potential role of)Tj 1.2 -1.2 TD 0.015 Tc 0.201 Tw (physical activity in the prevention of noninsulin-)Tj T* 0.005 Tc -0.017 Tw [(d)-10 (e)1 (pendent diabetes mellitus: the epidemiological evi-)]TJ T* 0.018 Tc (dence. )Tj /F16 1 Tf 3.35 0 TD 0.017 Tc 0.25 Tw (Exercise and Sport Sciences Reviews)Tj /F7 1 Tf 15.9 0 TD 0.028 Tc 0.259 Tw [( 1994;)]TJ -19.25 -1.2 TD 0.005 Tc (22:121\320143.)Tj -1.2 -1.7 TD -0.036 Tw (Kriska AM, Gregg EW, Utter AC, Knowler WC, Narayan)Tj 1.2 -1.2 TD 0.142 Tw (V, Bennett PH. Association of physical activity and)Tj T* 0.038 Tw (plasma insulin levels in a population at high risk for)Tj T* (NIDDM. )Tj /F16 1 Tf 4 0 TD 0.097 Tw (Medicine and Science in Sports and Exercise)Tj /F7 1 Tf -4 -1.2 TD 0.001 Tw (1993;26\(5 Suppl\):S121.)Tj -1.2 -1.75 TD 0.041 Tw (Kriska AM, LaPorte RE, Pettitt DJ, Charles MA, Nelson)Tj 1.2 -1.2 TD -0.055 Tw (RG, Kuller LH, et al. The association of physical activ-)Tj T* 0.008 Tw (ity with obesity, fat distribution, and glucose intoler-)Tj T* -0.039 Tw (ance in Pima Indians. )Tj /F16 1 Tf 9.15 0 TD -0.037 Tw [( Diabetologia )]TJ /F7 1 Tf 5.55 0 TD (1993;36:863\320869.)Tj -15.9 -1.75 TD -0.017 Tw (Kr\277lner B, Toft B, Pors Nielsen S, T\277ndevold E. Physical)Tj 1.2 -1.2 TD -0.001 Tw (exercise as prophylaxis against involutional vertebral)Tj T* 0.184 Tw (bone loss: a controlled trial. )Tj /F16 1 Tf 12.9 0 TD 0.178 Tw (Clinical Science)Tj /F7 1 Tf 6.55 0 TD 0.184 Tw [( 1983;)]TJ -19.45 -1.2 TD (64:541\320546.)Tj -1.2 -1.75 TD -0.099 Tw (Krotkiewski M. Can body fat patterning be changed? )Tj /F16 1 Tf 21.65 0 TD (Acta)Tj -20.45 -1.2 TD 0 Tc -0.125 Tw (Medica Scandinavica Supplementum)Tj /F7 1 Tf 14.15 0 TD -0.129 Tw [( 1988;723:213\320223.)]TJ -15.35 -1.75 TD 0.005 Tc -0.011 Tw (Krotkiewski M. Physical training in the prophylaxis and)Tj 1.2 -1.2 TD -0.114 Tw (treatment of obesity, hypertension, and diabetes. )Tj /F16 1 Tf 20 0 TD (Scan-)Tj -20 -1.2 TD (dinavian)Tj /F7 1 Tf 3.5 0 TD ( )Tj /F16 1 Tf 0.2 0 TD -0.021 Tw (Journal of Rehabilitation Medicine Supplement)Tj /F7 1 Tf -3.7 -1.2 TD (1983;9:55\32070.)Tj ET PDFVars/TermAll get exec restore gsave showpage grestore %%Page: 80 80 save PDFVars/InitAll get exec %PDF_BeginEncoding: F5 Optima-Bold [ 39/quotesingle 96/grave 127/.notdef/Adieresis/Aring/Ccedilla /Eacute/Ntilde/Odieresis/Udieresis/aacute/agrave /acircumflex/adieresis/atilde/aring/ccedilla/eacute /egrave/ecircumflex/edieresis/iacute/igrave/icircumflex /idieresis/ntilde/oacute/ograve/ocircumflex/odieresis /otilde/uacute/ugrave/ucircumflex/udieresis/dagger /degree/cent/sterling/section/bullet/paragraph /germandbls/registered/copyright/trademark/acute/dieresis /notequal/AE/Oslash/infinity/plusminus/lessequal /greaterequal/yen/mu/partialdiff/summation/product 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Medicine)Tj /F7 1 Tf 8.65 0 TD ( 1993;204:123\320137.)Tj -9.85 -1.75 TD -0.017 Tw (Ku LC, Shapiro LR, Crawford PB, Huenemann RL. Body)Tj 1.2 -1.2 TD 0.035 Tc 0.212 Tw (composition and physical activity in 8-year-old)Tj T* (chil)Tj 1.7 0 TD -0.004 Tc (dren. )Tj /F16 1 Tf 2.45 0 TD -0.003 Tc 0.056 Tw (American Journal of Clinical Nutrition)Tj /F7 1 Tf 15.35 0 TD 0.005 Tc 0.06 Tw [( 1981;)]TJ -19.5 -1.2 TD (34:2770\3202775.)Tj -1.2 -1.75 TD -0.105 Tw (Kuczmarski RJ. Prevalence of overweight and weight gain)Tj 1.2 -1.2 TD -0.102 Tw (in the United States. )Tj /F16 1 Tf 8.35 0 TD -0.098 Tw (American Journal of Clinical Nutri-)Tj -8.35 -1.2 TD (tion)Tj /F7 1 Tf 1.55 0 TD -0.003 Tw ( 1992;55:495S\320502S.)Tj -2.75 -1.7 TD 0.065 Tw (Kuczmarski RJ, Flegal KM, Campbell SM, Johnson CL.)Tj 1.2 -1.2 TD -0.08 Tw (Increasing prevalence of overweight among US adults:)Tj T* 0.048 Tw (the National Health and Nutrition Examination Sur-)Tj T* 0.066 Tw (veys, 1960 to 1991. )Tj /F16 1 Tf 8.7 0 TD 0.064 Tw [( Journal of the American Medical)]TJ -8.7 -1.2 TD (Association)Tj /F7 1 Tf 4.55 0 TD -0.001 Tw ( 1994;272:205\320211.)Tj -5.75 -1.75 TD 0.181 Tw (Kuipers H. Exercise-induced muscle damage. )Tj /F16 1 Tf 20.15 0 TD (Interna-)Tj -18.95 -1.2 TD 0 Tw (tional Journal of Sports Medicine)Tj /F7 1 Tf 13.2 0 TD ( 1994;15:132\320135.)Tj -14.4 -1.75 TD 0.06 Tw (Kujala UM, Kaprio J, Sarna S. Osteoarthritis of weight-)Tj 1.2 -1.2 TD 0.212 Tw (bearing joints of lower limbs in former elite male)Tj T* (athletes.)Tj /F16 1 Tf 3.5 0 TD 0 Tw ( British Medical Journal )Tj /F7 1 Tf 9.85 0 TD (1994;308:231\320234.)Tj -14.55 -1.75 TD -0.033 Tw (Kujala UM, Kettunen J, Paananen H, Aalto T, Batti\216 MC,)Tj 1.2 -1.2 TD 0.015 Tc 0.218 Tw (Impivaara O, et al. Knee osteoarthritis in former)Tj T* -0.027 Tw (runners, soccer players, weight lifters, and shooters.)Tj /F16 1 Tf T* 0.005 Tc -0.001 Tw [(A)-10 (r)-30 (thritis and Rheumatism )]TJ /F7 1 Tf 10.65 0 TD (1995;38:539\320546.)Tj -11.85 -1.75 TD -0.042 Tw (Kune GA, Kune S, Watson LF. Body weight and physical)Tj 1.2 -1.2 TD 0.02 Tw (activity as predictors of colorectal cancer risk. )Tj /F16 1 Tf 19.65 0 TD (Nutri-)Tj -19.65 -1.2 TD 0 Tw (tion and Cancer)Tj /F7 1 Tf 6.4 0 TD ( 1990;13:9\32017.)Tj -7.6 -1.7 TD -0.003 Tc -0.035 Tw (LaCroix AZ, Leveille SG, Hecht JA, Grothaus LC, Wagner)Tj 1.2 -1.2 TD 0.07 Tw (EH. Does walking decrease the risk of cardiovascular)Tj T* -0.081 Tw (disease hospitalizations and death in older adults? )Tj /F16 1 Tf 20.2 0 TD -0.004 Tc (Jour-)Tj -20.2 -1.2 TD -0.003 Tc -0.064 Tw (nal of the American Geriatrics Society)Tj /F7 1 Tf 14.6 0 TD -0.066 Tw [( 1996;44:113\320120.)]TJ -15.8 -1.75 TD 0.005 Tc -0.126 Tw (LaFontaine TP, DiLorenzo TM, Frensch PA, Stucky-Ropp)Tj 1.2 -1.2 TD -0.073 Tw (RC, Bargman EP, McDonald DG. Aerobic exercise and)Tj T* 0.251 Tw (mood: a brief review, 1985\3201990. )Tj /F16 1 Tf 15.6 0 TD 0.242 Tw (Sports Medicine)Tj /F7 1 Tf -15.6 -1.2 TD (1992;13:160\320170.)Tj -1.2 -1.75 TD -0.044 Tw (Lai J-S, Lan C, Wong M-K, Teng S-H. Two-year trends in)Tj 1.2 -1.2 TD -0.128 Tw (cardiorespiratory function among older Tai Chi Chuan)Tj T* 0.207 Tw (practitioners and sedentary subjects. )Tj /F16 1 Tf 16.4 0 TD 0.2 Tw (Journal of the)Tj -16.4 -1.2 TD 0.001 Tw (American Geriatrics Society )Tj /F7 1 Tf 11.55 0 TD (1995;43:1222\3201227.)Tj -12.75 -1.75 TD 0.005 Tw (Lammi M. )Tj /F16 1 Tf 4.6 0 TD (Influences of in vivo and in vitro loading on the)Tj -3.4 -1.2 TD -0.004 Tc -0.125 Tw (proteoglycan syntheses of articular cartilage chondrocytes.)Tj /F7 1 Tf T* 0.005 Tc 0 Tw (Kuopio, Finland: Kuopio University, 1993.)Tj -1.2 -1.75 TD -0.002 Tw (Lampman RM, Schteingart DE. Effects of exercise train-)Tj 1.2 -1.2 TD -0.005 Tw (ing on glucose control, lipid metabolism, and insulin)Tj T* 0.139 Tw (sensitivity in hypertriglyceridemia and non-insulin-)Tj T* 0.068 Tw (dependent diabetes mellitus. )Tj /F16 1 Tf 12.45 0 TD 0.066 Tw (Medicine and Science in)Tj -12.45 -1.2 TD 0 Tw (Sports and Exercise)Tj /F7 1 Tf 7.85 0 TD ( 1991;23:703\320712.)Tj 17.3 62.9 TD -0.092 Tw (Landers DM, Petruzzello SJ. Physical activity, fitness, and)Tj 1.2 -1.2 TD 0.161 Tw (anxiety. In: Bouchard C, Shephard RJ, Stephens T,)Tj T* (editors. )Tj /F16 1 Tf 3.55 0 TD 0.117 Tw (Physical activity, fitness, and health: interna-)Tj -3.55 -1.2 TD 0.004 Tc -0.123 Tw (tional proceedings and consensus statement.)Tj /F7 1 Tf 17 0 TD -0.127 Tw [( Champaign,)]TJ -17 -1.2 TD 0.005 Tc 0 Tw (IL: Human Kinetics, 1994:868\320882.)Tj -1.2 -1.75 TD 0.103 Tw (Lane NE. Exercise: a cause of osteoarthritis. )Tj /F16 1 Tf 19.4 0 TD 0.1 Tw (Journal of)Tj -18.2 -1.2 TD (Rheumatology)Tj /F7 1 Tf 5.7 0 TD 0 Tw ( 1995;22 \(Suppl 43\):3\3206.)Tj -6.9 -1.75 TD -0.023 Tw (Lane NE, Bloch DA, Jones HH, Marshall WH, Wood PD,)Tj 1.2 -1.2 TD 0.156 Tw (Fries JF. Long-distance running, bone density, and)Tj T* (osteoarthritis. )Tj /F16 1 Tf 6 0 TD -0.096 Tw [( Journal of the American Medical Associa-)]TJ -6 -1.2 TD (tion)Tj /F7 1 Tf 1.55 0 TD -0.004 Tw ( 1986;255:1147\3201151.)Tj -2.75 -1.7 TD -0.103 Tw (Lane NE, Michel B, Bjorkengren A, Oehlert J, Shi H, Bloch)Tj 1.2 -1.2 TD 0.005 Tw (DA, et al. The risk of osteoarthritis with running and)Tj T* -0.02 Tw (aging: a 5-year longitudinal study. )Tj /F16 1 Tf 14.5 0 TD -0.019 Tw (Journal of Rheuma-)Tj -14.5 -1.2 TD (tology)Tj /F7 1 Tf 2.45 0 TD 0.001 Tw ( 1993;20:461\320468.)Tj -3.65 -1.75 TD -0.015 Tw (Lanyon LE. Functional strain in bone tissue as an objec-)Tj 1.2 -1.2 TD 0.122 Tw (tive, and controlling stimulus for adaptive bone re-)Tj T* -0.005 Tc (modelling. )Tj /F16 1 Tf 4.5 0 TD -0.004 Tc -0.125 Tw (Journal of Biomechanics)Tj /F7 1 Tf 9.2 0 TD -0.13 Tw [( 1987;20:1083\3201093.)]TJ -14.9 -1.75 TD 0.005 Tc -0.005 Tw (Lanyon LE. Osteocytes, strain detection, bone modeling)Tj 1.2 -1.2 TD -0.082 Tw (and remodeling. )Tj /F16 1 Tf 6.95 0 TD -0.079 Tw (Calcified Tissue International)Tj /F7 1 Tf 11.7 0 TD -0.082 Tw [( 1993;53)]TJ -18.65 -1.2 TD -0.002 Tw (\(1 Suppl\):S102\320S107.)Tj -1.2 -1.75 TD 0.057 Tw (Lanyon LE. Using functional loading to influence bone)Tj 1.2 -1.2 TD 0.122 Tw (mass and architecture: objectives, mechanisms, and)Tj T* 0.035 Tw (relationship with estrogen of the mechanically adap-)Tj T* -0.055 Tw (tive process in bone. )Tj /F16 1 Tf 8.65 0 TD (Bone)Tj /F7 1 Tf 1.95 0 TD [( 1996;18\(1 Suppl\):37S\32043S.)]TJ -11.8 -1.75 TD 0.003 Tc -0.128 Tw (Lapidus L, Bengtsson C. Socioeconomic factors and physi-)Tj 1.2 -1.2 TD 0.005 Tc 0.092 Tw (cal activity in relation to cardiovascular disease and)Tj T* -0.052 Tw (death: a 12-year follow-up of participants in a popula-)Tj T* 0.018 Tw (tion study of women in Gothenburg, Sweden. )Tj /F16 1 Tf 19.55 0 TD (British)Tj -19.55 -1.2 TD 0.001 Tw (Heart Journal)Tj /F7 1 Tf 5.5 0 TD ( 1986;55:295\320301.)Tj -6.7 -1.7 TD -0.113 Tw (LaPorte RE, Cauley JA, Kinsey CM, Corbett W, Robertson)Tj 1.2 -1.2 TD -0.085 Tw (R, Black-Sandler R, et al. The epidemiology of physical)Tj T* 0.001 Tc -0.128 Tw (activity in children, college students, middle-aged men,)Tj T* 0.005 Tc -0.042 Tw (menopausal females, and monkeys.)Tj /F16 1 Tf 14.7 0 TD -0.041 Tw [( Journal of Chronic)]TJ -14.7 -1.2 TD (Diseases)Tj /F7 1 Tf 3.4 0 TD -0.003 Tw ( 1982;35:787\320795.)Tj -4.6 -1.75 TD 0.124 Tw (Laughlin MH. Effects of exercise training on coronary)Tj 1.2 -1.2 TD 0.001 Tc -0.128 Tw (circulation: introduction. )Tj /F16 1 Tf 10.5 0 TD -0.123 Tw (Medicine and Science in Sports)Tj -10.5 -1.2 TD 0.005 Tc 0.001 Tw (and Exercise)Tj /F7 1 Tf 5.05 0 TD ( 1994;26:1226\3201229.)Tj -6.25 -1.75 TD 0.155 Tw (Le Marchand L, Kolonel LN, Yoshizawa CN. Lifetime)Tj 1.2 -1.2 TD -0.124 Tw (occupational physical activity and prostate cancer risk.)Tj /F16 1 Tf T* 0 Tw (American Journal of Epidemiology)Tj /F7 1 Tf 13.75 0 TD ( 1991;133:103\320111.)Tj -14.95 -1.75 TD 0 Tc -0.129 Tw (Lee I-M. Physical activity, fitness, and cancer. In: Bouchard)Tj 1.2 -1.2 TD 0.005 Tc -0.017 Tw (C, Shephard RJ, Stephens T, editors. )Tj /F16 1 Tf 15.4 0 TD -0.016 Tw (Physical activity,)Tj -15.4 -1.2 TD -0.113 Tw (fitness, and health: international proceedings and consen-)Tj T* 0.033 Tc 0.25 Tw (sus statement.)Tj /F7 1 Tf 6.25 0 TD 0.034 Tc 0.259 Tw [( Champaign, IL: Human Kinetics,)]TJ -6.25 -1.2 TD 0.005 Tc (1994:814\320831.)Tj ET PDFVars/TermAll get exec restore gsave showpage grestore %%Page: 81 81 save PDFVars/InitAll get exec %PDF_BeginEncoding: F5 Optima-Bold [ 39/quotesingle 96/grave 127/.notdef/Adieresis/Aring/Ccedilla /Eacute/Ntilde/Odieresis/Udieresis/aacute/agrave /acircumflex/adieresis/atilde/aring/ccedilla/eacute /egrave/ecircumflex/edieresis/iacute/igrave/icircumflex /idieresis/ntilde/oacute/ograve/ocircumflex/odieresis /otilde/uacute/ugrave/ucircumflex/udieresis/dagger /degree/cent/sterling/section/bullet/paragraph /germandbls/registered/copyright/trademark/acute/dieresis 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mortality: a 27-year follow-up of)Tj T* 0.178 Tw (middle-aged men. )Tj /F16 1 Tf 8.15 0 TD 0.172 Tw [( Journal of the American Medical)]TJ -8.15 -1.2 TD (Association)Tj /F7 1 Tf 4.55 0 TD -0.003 Tw ( 1993;270:2823\3202828.)Tj -5.75 -1.75 TD -0.023 Tw (Lee I-M, Paffenbarger RS Jr, Hsieh C-C. Physical activity)Tj 1.2 -1.2 TD -0.107 Tw (and risk of developing colorectal cancer among college)Tj T* 0.035 Tc (alumni.)Tj /F16 1 Tf 3.45 0 TD 0.034 Tc 0.25 Tw [( Journal of the National Cancer Institute)]TJ /F7 1 Tf -3.45 -1.2 TD 0.005 Tc (1991;83:1324\3201329.)Tj -1.2 -1.75 TD -0.023 Tw (Lee I-M, Paffenbarger RS Jr, Hsieh C-C. Physical activity)Tj 1.2 -1.2 TD 0.153 Tw (and risk of prostatic cancer among college alumni.)Tj /F16 1 Tf T* 0 Tw (American Journal of Epidemiology)Tj /F7 1 Tf 13.8 0 TD ( 1992;135:169\320179.)Tj -15 -1.7 TD -0.075 Tw (Lee J, Lauer RM, Clarke WR. Lipoproteins in the progeny)Tj 1.2 -1.2 TD 0.047 Tw [(of young men with coronary artery )25 (disease: children)]TJ T* -0.001 Tw (with increased risk. )Tj /F16 1 Tf 8.5 0 TD (Pediatrics)Tj /F7 1 Tf 3.95 0 TD ( 1986;78:330\320337.)Tj -13.65 -1.75 TD 0.089 Tw (Leibel RL, Rosenbaum M, Hirsch J. Changes in energy)Tj 1.2 -1.2 TD 0.008 Tw (expenditure resulting from altered body weight. )Tj /F16 1 Tf 20.45 0 TD (New)Tj -20.45 -1.2 TD 0 Tw (England Journal of Medicine)Tj /F7 1 Tf 11.4 0 TD ( 1995;332:621\320628.)Tj -12.6 -1.75 TD -0.043 Tw (Lennon D, Nagle F, Stratman F, Shrago E, Dennis S. Diet)Tj 1.2 -1.2 TD -0.055 Tw (and exercise training effects on resting metabolic rate.)Tj /F16 1 Tf T* 0 Tw (International Journal of Obesity)Tj /F7 1 Tf 12.75 0 TD ( 1985;9:39\32047.)Tj -13.95 -1.75 TD -0.043 Tw (Lennox SS, Bedell JR, Stone AA. The effect of exercise on)Tj 1.2 -1.2 TD 0.025 Tc 0.259 Tw (normal mood. )Tj /F16 1 Tf 7 0 TD 0.024 Tc 0.25 Tw (Journal of Psychosomatic Research)Tj /F7 1 Tf -7 -1.2 TD 0.005 Tc (1990;34:629\320636.)Tj -1.2 -1.75 TD -0.022 Tw (Leon AS. Effects of exercise conditioning on physiologic)Tj 1.2 -1.2 TD 0.067 Tw (precursors of coronary heart disease. )Tj /F16 1 Tf 16.05 0 TD 0.065 Tw (Journal of Car-)Tj -16.05 -1.2 TD -0.002 Tw (diopulmonary Rehabilitation)Tj /F7 1 Tf 11.5 0 TD ( 1991a;11:46\32057.)Tj -12.7 -1.7 TD -0.086 Tw (Leon AS. Patients with diabetes mellitus. In: Franklin BA,)Tj 1.2 -1.2 TD 0.18 Tw (Gordon S, Timmis GC, editors. )Tj /F16 1 Tf 14.25 0 TD 0.174 Tw (Exercise in modern)Tj -14.25 -1.2 TD (medicine)Tj /F7 1 Tf 3.55 0 TD -0.1 Tw (. Baltimore: Williams and Wilkins, 1989:118\320)Tj -3.55 -1.2 TD (145.)Tj -1.2 -1.75 TD 0.188 Tw (Leon AS. Physical activity and risk of ischemic heart)Tj 1.2 -1.2 TD -0.042 Tw (disease: an update, 1990. In: Oja P, Telama R, editors.)Tj /F16 1 Tf T* 0 Tw (Sport for all)Tj /F7 1 Tf 4.85 0 TD (. New York: Elsevier, 1991b:251\32064.)Tj -6.05 -1.75 TD 0.015 Tw (Leon AS. Recent advances in the management of hyper-)Tj 1.2 -1.2 TD 0.013 Tc (tension. )Tj /F16 1 Tf 3.95 0 TD 0.25 Tw (Journal of Cardiopulmonary Rehabilitation)Tj /F7 1 Tf -3.95 -1.2 TD 0.005 Tc (1991c;11:182\320191.)Tj -1.2 -1.75 TD 0.207 Tw (Leon AS. The role of exercise in the prevention and)Tj 1.2 -1.2 TD -0.002 Tw (management of diabetes mellitus and blood lipid dis-)Tj T* -0.037 Tw (orders. In: Shephard RJ, Miller HS Jr, editors. )Tj /F16 1 Tf 18.9 0 TD (Exercise)Tj -18.9 -1.2 TD 0.026 Tw (and the heart in health and disease.)Tj /F7 1 Tf 14.3 0 TD 0.027 Tw [( New York: Marcel)]TJ -14.3 -1.2 TD 0.002 Tw (Dekker, 1992:299\320368.)Tj -1.2 -1.75 TD -0.119 Tw (Leon AS, Bloor CM. Effects of exercise and its cessation on)Tj 1.2 -1.2 TD 0.24 Tw (the heart and its blood supply. )Tj /F16 1 Tf 14.5 0 TD 0.232 Tw (Journal of Applied)Tj -14.5 -1.2 TD (Physiology)Tj /F7 1 Tf 4.35 0 TD 0.001 Tw ( 1968;24:485\320490.)Tj 20.8 58.1 TD 0.079 Tw (Leon AS, Bloor CM. The effect of complete and partial)Tj 1.2 -1.2 TD 0.007 Tc 0.258 Tw (deconditioning on exercise-induced cardiovascular)Tj T* 0.015 Tc 0.048 Tw (changes in the rat. )Tj /F16 1 Tf 8.4 0 TD 0.047 Tw (Advances in Cardiology )Tj /F7 1 Tf 10.1 0 TD (1976;18:)Tj -18.5 -1.2 TD [(81\320)-17 (9)10 (2)10 (.)]TJ -1.2 -1.75 TD 0.005 Tc -0.018 Tw (Leon AS, Connett J. Physical activity and 10.5 year mor-)Tj 1.2 -1.2 TD 0.108 Tw (tality in the Multiple Risk Factor Intervention Trial)Tj T* 0.045 Tc (\(MRFIT\). )Tj /F16 1 Tf 4.95 0 TD 0.044 Tc 0.25 Tw (International Journal of Epidemiology)Tj /F7 1 Tf -4.95 -1.2 TD 0.005 Tc (1991;20:690\320697.)Tj -1.2 -1.75 TD 0.014 Tw (Leon AS, Connett J, Jacobs DR Jr, Rauramaa R. Leisure-)Tj 1.2 -1.2 TD -0.055 Tw (time physical activity levels and risk of coronary heart)Tj T* 0 Tw (disease and death: the Multiple Risk Factor Interven-)Tj T* -0.036 Tw (tion Trial. )Tj /F16 1 Tf 4.4 0 TD -0.034 Tw [( Journal of the American Medical Association)]TJ /F7 1 Tf -4.4 -1.2 TD (1987;258:2388\3202395.)Tj -1.2 -1.7 TD 0.143 Tw (Levi F, La Vecchia C, Negri E, Franceschi S. Selected)Tj 1.2 -1.2 TD -0.012 Tw (physical activities and the risk of endometrial cancer.)Tj /F16 1 Tf T* -0.001 Tw (British Journal of Cancer)Tj /F7 1 Tf 10.05 0 TD ( 1993;67:846\320851.)Tj -11.25 -1.75 TD 0.055 Tw (Levitt NS, Katzenellenbogen JM, Bradshaw D, Hoffman)Tj 1.2 -1.2 TD (MN, Bonnici F. The prevalence and identification of)Tj T* 0.179 Tw (risk factors for NIDDM in urban Africans in Cape)Tj T* 0 Tw (Town, South Africa.)Tj /F16 1 Tf 8.45 0 TD ( Diabetes Care)Tj /F7 1 Tf 5.85 0 TD ( 1993;16:601\320607.)Tj -15.5 -1.75 TD 0.059 Tw (Lie H, Mundal R, Erikssen J. Coronary risk factors and)Tj 1.2 -1.2 TD 0.16 Tw (incidence of coronary death in relation to physical)Tj T* -0.11 Tw (fitness: seven-year follow-up study of middle-aged and)Tj T* -0.025 Tw (elderly men. )Tj /F16 1 Tf 5.45 0 TD -0.024 Tw (European Heart Journal )Tj /F7 1 Tf 9.75 0 TD (1985;6:147\320157.)Tj -16.4 -1.75 TD 0.145 Tw (Lillioja S, Bogardus C. Obesity and insulin resistance:)Tj 1.2 -1.2 TD 0.015 Tc 0.256 Tw (lessons learned from the Pima Indians. )Tj /F16 1 Tf 18.45 0 TD (Diabetes/)Tj -18.45 -1.2 TD 0.005 Tc -0.001 Tw [(M)-10 (e)-8 (tabolism Reviews)]TJ /F7 1 Tf 8.1 0 TD ( 1988;4:517\320540.)Tj -9.3 -1.75 TD 0 Tc -0.127 Tw (Lindberg H, Roos H, G\212rdsell P. Prevalence of coxarthrosis)Tj 1.2 -1.2 TD 0.005 Tc 0.036 Tw (in former soccer players: 286 players compared with)Tj T* 0.014 Tc 0.258 Tw (matched controls. )Tj /F16 1 Tf 8.5 0 TD 0.013 Tc 0.25 Tw (Acta Orthopaedica Scandinavica)Tj /F7 1 Tf -8.5 -1.2 TD 0.005 Tc (1993;64:165\320167.)Tj -1.2 -1.7 TD -0.06 Tw (Lindg\212rde F, Malmquist J, Balke B. Physical fitness, insu-)Tj 1.2 -1.2 TD 0.045 Tw (lin secretion, and glucose tolerance in healthy males)Tj T* 0.161 Tw (and mild type-2 diabetes. )Tj /F16 1 Tf 11.5 0 TD 0.156 Tw (Acta Diabetologica Latina)Tj /F7 1 Tf -11.5 -1.2 TD (1983;20:33\32040.)Tj -1.2 -1.75 TD -0.095 Tw (Lindg\212rde F, Saltin B. Daily physical activity, work capac-)Tj 1.2 -1.2 TD 0.056 Tc 0.259 Tw (ity, and glucose tolerance in lean and obese)Tj T* 0.037 Tc (normoglycaemic middle-aged men. )Tj /F16 1 Tf 16.8 0 TD 0.036 Tc (Diabetologia)Tj /F7 1 Tf -16.8 -1.2 TD 0.005 Tc (1981;20:134\320138.)Tj -1.2 -1.75 TD -0.059 Tw (Lindsted KD, Tonstad S, Kuzma JW. Self-report of physi-)Tj 1.2 -1.2 TD 0.077 Tw (cal activity and patterns of mortality in Seventh-day)Tj T* 0.033 Tc 0.259 Tw (Adventist men.)Tj /F16 1 Tf 7 0 TD 0.032 Tc 0.25 Tw [( Journal of Clinical Epidemiology)]TJ /F7 1 Tf -7 -1.2 TD 0.005 Tc (1991;44:355\320364.)Tj -1.2 -1.75 TD -0.113 Tw (Little J, Logan RFA, Hawtin PG, Hardcastle JD, Turner ID.)Tj 1.2 -1.2 TD -0.114 Tw (Colorectal adenomas and energy intake, body size, and)Tj T* -0.018 Tw (physical activity: a case-control study of subjects par-)Tj T* 0 Tc -0.127 Tw (ticipating in the Nottingham faecal occult blood screen-)Tj T* 0.03 Tc 0.258 Tw (ing programme. )Tj /F16 1 Tf 7.85 0 TD 0.029 Tc 0.25 Tw (British Journal of Cancer)Tj /F7 1 Tf 11.4 0 TD 0.03 Tc 0.258 Tw [( 1993;)]TJ -19.25 -1.2 TD 0.005 Tc (67:172\320176.)Tj ET PDFVars/TermAll get exec restore gsave showpage grestore %%Page: 82 82 save PDFVars/InitAll get exec %PDF_BeginEncoding: F5 Optima-Bold [ 39/quotesingle 96/grave 127/.notdef/Adieresis/Aring/Ccedilla 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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. 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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 /F16 1 Tf T* (Diabetologia )Tj /F7 1 Tf 5.35 0 TD [(1992;35:)21 (785\320791.)]TJ -6.55 -1.75 TD -0.055 Tw (Mellion MB. Common cycling injuries: management and)Tj 1.2 -1.2 TD (prevention. )Tj /F16 1 Tf 5.05 0 TD 0.001 Tw (Sports Medicine )Tj /F7 1 Tf 6.7 0 TD (1991;11:52\32070.)Tj -12.95 -1.75 TD 0.019 Tw (Menotti A, Keys A, Blackburn H, Aravanis C, Dontas A,)Tj 1.2 -1.2 TD 0.175 Tw (Fidanza F, et al. Twenty-year stroke mortality and)Tj T* 0.092 Tw (prediction in twelve cohorts of the Seven Countries)Tj T* (Study. )Tj /F16 1 Tf 2.95 0 TD 0.045 Tw (International Journal of Epidemiology)Tj /F7 1 Tf 15.3 0 TD 0.047 Tw [( 1990;19:)]TJ -18.25 -1.2 TD (309\320315.)Tj ET PDFVars/TermAll get exec restore gsave showpage grestore %%Page: 83 83 save PDFVars/InitAll get exec %PDF_BeginEncoding: F5 Optima-Bold [ 39/quotesingle 96/grave 127/.notdef/Adieresis/Aring/Ccedilla /Eacute/Ntilde/Odieresis/Udieresis/aacute/agrave /acircumflex/adieresis/atilde/aring/ccedilla/eacute /egrave/ecircumflex/edieresis/iacute/igrave/icircumflex /idieresis/ntilde/oacute/ograve/ocircumflex/odieresis /otilde/uacute/ugrave/ucircumflex/udieresis/dagger /degree/cent/sterling/section/bullet/paragraph /germandbls/registered/copyright/trademark/acute/dieresis /notequal/AE/Oslash/infinity/plusminus/lessequal /greaterequal/yen/mu/partialdiff/summation/product /pi/integral/ordfeminine/ordmasculine/Omega/ae 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Weight-bearing exercise,)Tj 1.2 -1.2 TD 0.146 Tw (overexercise, and lumbar bone density over age 50)Tj T* (years.)Tj /F16 1 Tf 2.4 0 TD 0.148 Tw [( Archives of Internal Medicine)]TJ /F7 1 Tf 12.65 0 TD 0.153 Tw [( 1989;149:2325\320)]TJ -15.05 -1.2 TD (2329.)Tj -1.2 -1.75 TD 0.194 Tw (Mink PJ, Folsom AR, Sellers TA, Kushi LH. Physical)Tj 1.2 -1.2 TD 0.056 Tw (activity, waist-to-hip ratio, and other risk factors for)Tj T* 0.159 Tw (ovarian cancer: a follow-up study of older women.)Tj /F16 1 Tf T* (Epidemiology )Tj /F7 1 Tf 5.7 0 TD (1996;7:38\32045.)Tj -6.9 -1.75 TD -0.093 Tw (Minor MA. Physical activity and management of arthritis.)Tj /F16 1 Tf 1.2 -1.2 TD -0.001 Tw (Annals of Behavioral Medicine )Tj /F7 1 Tf 12.5 0 TD (1991;13:117\320124.)Tj -13.7 -1.75 TD 0.036 Tw (Minor MA, Brown JD. Exercise maintenance of persons)Tj 1.2 -1.2 TD -0.022 Tw (with arthritis after participation in a class experience.)Tj /F16 1 Tf T* 0.001 Tw (Health Education Quarterly )Tj /F7 1 Tf 11.4 0 TD (1993;20:83\32095.)Tj -12.6 -1.75 TD -0.034 Tw (Minor MA, Hewett JE, Webel RR, Anderson SK, Kay DR.)Tj 1.2 -1.2 TD 0.03 Tw (Efficacy of physical conditioning exercise in patients)Tj T* -0.005 Tw (with rheumatoid arthritis and osteoarthritis. )Tj /F16 1 Tf 18.8 0 TD (Arthritis)Tj -18.8 -1.2 TD 0 Tw (and Rheumatism )Tj /F7 1 Tf 6.95 0 TD (1989;32:1396\3201405.)Tj -8.15 -1.7 TD -0.074 Tw (Minor MA, Hewett JE, Webel RR, Dreisinger TE, Kay DR.)Tj 1.2 -1.2 TD 0.222 Tw (Exercise tolerance and disease-related measures in)Tj T* 0.02 Tw (patients with rheumatoid arthritis and osteoarthritis.)Tj /F16 1 Tf T* -0.002 Tw (Journal of Rheumatology )Tj /F7 1 Tf 10.2 0 TD (1988;15:905\320911.)Tj -11.4 -1.75 TD 0.015 Tw (Mittendorf R, Longnecker MP, Newcomb PA, Dietz AT,)Tj 1.2 -1.2 TD 0.059 Tw (Greenberg ER, Bogdan GF, et al. Strenuous physical)Tj T* 0.012 Tw (activity in young adulthood and risk of breast cancer)Tj T* 0 Tc -0.128 Tw (\(United States\). )Tj /F16 1 Tf 6.5 0 TD -0.124 Tw (Cancer Causes and Control)Tj /F7 1 Tf 10.45 0 TD -0.128 Tw [( 1995;6:347\320)]TJ -16.95 -1.2 TD 0.005 Tc (353.)Tj -1.2 -1.75 TD 0.192 Tw (Mittleman MA, Maclure M, Tofler GH, Sherwood JB,)Tj 1.2 -1.2 TD -0.117 Tw (Goldberg RJ, Muller JE. Triggering of acute myocardial)Tj T* -0.003 Tc -0.13 Tw (infarction by heavy physical exertion: protection against)Tj T* 0.005 Tc -0.032 Tw (triggering by regular exertion. )Tj /F16 1 Tf 12.75 0 TD -0.031 Tw (New England Journal of)Tj -12.75 -1.2 TD (Medicine)Tj /F7 1 Tf 3.6 0 TD 0 Tw ( 1993;329:1677\3201683.)Tj -4.8 -1.75 TD 0.037 Tw (Montoye HJ, Block WD, Metzner H, Keller JB. Habitual)Tj 1.2 -1.2 TD -0.003 Tc -0.108 Tw (physical activity and glucose tolerance: males age 16\32064)Tj T* 0.005 Tc 0 Tw (in a total community. )Tj /F16 1 Tf 9.35 0 TD (Diabetes)Tj /F7 1 Tf 3.4 0 TD ( 1977;26:172\320176.)Tj -13.95 -1.75 TD -0.001 Tw (Moore M. Endorphins and exercise: a puzzling relation-)Tj 1.2 -1.2 TD (ship. )Tj /F16 1 Tf 2.3 0 TD 0 Tw (Physician and Sportsmedicine)Tj /F7 1 Tf 11.95 0 TD ( 1982;10:111\320114.)Tj 10.9 60.5 TD -0.06 Tw (Moore LL, Nguyen US, Rothman KJ, Cupples LA, Ellison)Tj 1.2 -1.2 TD 0.129 Tw (RC. Preschool physical activity level and change in)Tj T* 0.01 Tc 0.259 Tw (body fatness in young children: the Framingham)Tj T* 0.005 Tc 0.201 Tw (Children\325s Study.)Tj /F16 1 Tf 7.45 0 TD 0.194 Tw [( American Journal of Epidemiology)]TJ /F7 1 Tf -7.45 -1.2 TD (1995;142:982\320988.)Tj -1.2 -1.75 TD -0.024 Tw (Morgan WP. Anxiety reduction following acute physical)Tj 1.2 -1.2 TD (activity. )Tj /F16 1 Tf 3.6 0 TD 0 Tw (Psychiatric Annals)Tj /F7 1 Tf 7.5 0 TD ( 1979a;9:36\32045.)Tj -12.3 -1.75 TD -0.11 Tw (Morgan WP. Negative addiction in runners. )Tj /F16 1 Tf 17.95 0 TD -0.106 Tw (Physician and)Tj -16.75 -1.2 TD (Sportsmedicine)Tj /F7 1 Tf 6.05 0 TD 0 Tw ( 1979b;7:57\32070.)Tj -7.25 -1.7 TD -0.097 Tw (Morgan WP. Physical activity, fitness, and depression. In:)Tj 1.2 -1.2 TD -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* 0.025 Tc 0.233 Tw (and consensus statement.)Tj /F7 1 Tf 10.95 0 TD 0.241 Tw [( Champaign, IL: Human)]TJ -10.95 -1.2 TD 0.015 Tc 0.002 Tw (Kinetics, 1994:851\320867.)Tj -1.2 -1.75 TD 0.005 Tc 0.035 Tw (Morgan WP. Psychological benefits of physical activity.)Tj 1.2 -1.2 TD -0.126 Tw (In: Nagle FJ, Montoye HJ, editors. )Tj /F16 1 Tf 13.75 0 TD -0.121 Tw (Exercise in health and)Tj -13.75 -1.2 TD (disease)Tj /F7 1 Tf 2.85 0 TD -0.106 Tw (. Springfield, IL: Charles C. Thomas, 1981:299\320)Tj -2.85 -1.2 TD (314.)Tj -1.2 -1.75 TD -0.127 Tw (Morgan WP, Brown DR, Raglin JS, O\325Connor PJ, Ellickson)Tj 1.2 -1.2 TD 0 Tc -0.129 Tw (KA. Psychological monitoring of overtraining and stale-)Tj T* 0.005 Tc (ness. )Tj /F16 1 Tf 2.4 0 TD 0.054 Tw (British Journal of Sports Medicine)Tj /F7 1 Tf 13.8 0 TD 0.056 Tw [( 1987;21:107\320)]TJ -16.2 -1.2 TD (114.)Tj -1.2 -1.75 TD 0.097 Tw (Morgan WP, Goldston SE, editors. )Tj /F16 1 Tf 15.2 0 TD 0.094 Tw (Exercise and mental)Tj -14 -1.2 TD -0.001 Tc (health)Tj /F7 1 Tf 2.45 0 TD 0 Tc -0.13 Tw (. Washington, DC: Hemisphere Publishing, 1987.)Tj -3.65 -1.75 TD 0.005 Tc -0.119 Tw (Morgan WP, Horstman DH, Cymerman A, Stokes J. Use of)Tj 1.2 -1.2 TD -0.069 Tw (exercise as a relaxation technique. )Tj /F16 1 Tf 14.25 0 TD -0.066 Tw (Primary Cardiology)Tj /F7 1 Tf -14.25 -1.2 TD (1980;6:48\32057.)Tj -1.2 -1.7 TD -0.003 Tw (Morgan WP, Roberts JA, Brand FR, Feinerman AD. Psy-)Tj 1.2 -1.2 TD -0.049 Tw (chological effect of chronic physical activity. )Tj /F16 1 Tf 18.65 0 TD (Medicine)Tj -18.65 -1.2 TD 0.001 Tw (and Science in Sports )Tj /F7 1 Tf 8.75 0 TD (1970;2:213\320217.)Tj -9.95 -1.75 TD 0.178 Tw (Morris JN, Chave SPW, Adam C, Sirey C, Epstein L,)Tj 1.2 -1.2 TD -0.042 Tw (Sheehan DJ. Vigorous exercise in leisure-time and the)Tj T* 0 Tc -0.13 Tw (incidence of coronary heart disease. )Tj /F16 1 Tf 14.35 0 TD -0.001 Tc (Lancet)Tj /F7 1 Tf 2.65 0 TD 0 Tc [( 1973;1:333\320)]TJ -17 -1.2 TD 0.005 Tc (339.)Tj -1.2 -1.75 TD -0.003 Tc -0.009 Tw (Morris JN, Clayton DG, Everitt MG, Semmence AM, Bur-)Tj 1.2 -1.2 TD 0.029 Tw (gess EH. Exercise in leisure time: coronary attack and)Tj T* 0 Tw (death rates. )Tj /F16 1 Tf 4.95 0 TD (British Heart Journal)Tj /F7 1 Tf 8.3 0 TD ( 1990;63:325\320334.)Tj -14.45 -1.75 TD 0.005 Tc 0.142 Tw (Morris JN, Crawford MD. Coronary heart disease and)Tj 1.2 -1.2 TD -0.006 Tc -0.129 Tw (physical activity of work: evidence of a national necropsy)Tj T* 0.005 Tc (survey.)Tj /F16 1 Tf 3 0 TD 0 Tw ( British Medical Journal )Tj /F7 1 Tf 9.9 0 TD (1958;2:1485\3201496.)Tj -14.1 -1.75 TD -0.095 Tw (Morris JN, Everitt MG, Pollard R, Chave SPW, Semmence)Tj 1.2 -1.2 TD -0.005 Tc -0.13 Tw (AM. Vigorous exercise in leisure time: protection against)Tj T* 0.005 Tc 0 Tw (coronary heart disease. )Tj /F16 1 Tf 9.9 0 TD (Lancet)Tj /F7 1 Tf 2.65 0 TD ( 1980;2:1207\3201210.)Tj -13.75 -1.7 TD -0.018 Tw (Morris JN, Heady JA, Raffle PAB, Roberts CG, Parks JW.)Tj 1.2 -1.2 TD -0.003 Tw (Coronary heart disease and physical activity of work.)Tj /F16 1 Tf T* (Lancet)Tj /F7 1 Tf 2.65 0 TD 0.003 Tw ( 1953;2:1111\3201120.)Tj ET PDFVars/TermAll get exec restore gsave showpage grestore %%Page: 84 84 save PDFVars/InitAll get exec %PDF_BeginEncoding: F5 Optima-Bold [ 39/quotesingle 96/grave 127/.notdef/Adieresis/Aring/Ccedilla /Eacute/Ntilde/Odieresis/Udieresis/aacute/agrave /acircumflex/adieresis/atilde/aring/ccedilla/eacute /egrave/ecircumflex/edieresis/iacute/igrave/icircumflex /idieresis/ntilde/oacute/ograve/ocircumflex/odieresis /otilde/uacute/ugrave/ucircumflex/udieresis/dagger /degree/cent/sterling/section/bullet/paragraph /germandbls/registered/copyright/trademark/acute/dieresis 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The effects of)Tj 1.2 -1.2 TD 0.02 Tw (exercise training on mental well-being in the normal)Tj T* -0.076 Tw (population: a controlled trial. )Tj /F16 1 Tf 12.3 0 TD -0.073 Tw (Journal of Psychosomatic)Tj -12.3 -1.2 TD (Research)Tj /F7 1 Tf 3.55 0 TD 0.002 Tw ( 1989;33:47\32061.)Tj -4.75 -1.75 TD 0.107 Tw (Must A, Jacques PF, Dallal GE, Bajema CJ, Dietz WH.)Tj 1.2 -1.2 TD -0.117 Tw (Long-term morbidity and mortality of overweight ado-)Tj T* 0.006 Tw (lescents: a follow-up of the Harvard Growth Study of)Tj T* 0.026 Tc 0.259 Tw (1922 to 1935. )Tj /F16 1 Tf 7.15 0 TD 0.25 Tw (New England Journal of Medicine)Tj /F7 1 Tf -7.15 -1.2 TD 0.005 Tc (1992;327:1350\3201355.)Tj -1.2 -1.7 TD -0.003 Tc -0.129 Tw (Nagulesparan M, Savage PJ, Bennion LJ, Unger RH, Bennett)Tj 1.2 -1.2 TD 0.005 Tc -0.053 Tw (PH. Diminished effect of caloric restriction on control)Tj T* 0.033 Tw (of hyperglycemia with increasing known duration of)Tj T* -0.102 Tw (type II diabetes mellitus. )Tj /F16 1 Tf 10.15 0 TD -0.099 Tw (Journal of Clinical Endocrinol-)Tj -10.15 -1.2 TD 0 Tw (ogy and Metabolism)Tj /F7 1 Tf 8.05 0 TD ( 1981;53:560\320568.)Tj -9.25 -1.75 TD 0.106 Tw (National Advisory Mental Health Council. Health care)Tj 1.2 -1.2 TD 0.17 Tw (reform for Americans with severe mental illnesses:)Tj T* -0.015 Tw (report of the National Advisory Mental Health Coun-)Tj T* -0.007 Tc (cil. )Tj /F16 1 Tf 1.35 0 TD -0.006 Tc -0.125 Tw (American Journal of Psychiatry)Tj /F7 1 Tf 11.8 0 TD -0.13 Tw [( 1993;150:1447\3201465)-24 (.)]TJ -14.35 -1.75 TD 0.005 Tc -0.079 Tw (National Center for Health Statistics. )Tj /F16 1 Tf 15.3 0 TD -0.076 Tw (Vital Statistics of the)Tj -14.1 -1.2 TD 0.002 Tc -0.123 Tw (United States, 1990, Vol. 2, Mortality, Part A.)Tj /F7 1 Tf 17.4 0 TD -0.128 Tw [( Hyattsville,)]TJ -17.4 -1.2 TD 0.005 Tc -0.005 Tw (MD: U.S. Department of Health and Human Services,)Tj T* -0.093 Tw (Public Health Service, Centers for Disease Control and)Tj T* 0.001 Tc -0.127 Tw (Prevention, National Center for Health Statistics, 1994.)Tj T* 0.005 Tc 0 Tw (DHHS Publication No. \(PHS\) 95-1102.)Tj -1.2 -1.75 TD -0.063 Tw (National Center for Health Statistics, Gardner P, Hudson)Tj 1.2 -1.2 TD (BL. )Tj /F16 1 Tf 1.75 0 TD 0.127 Tw (Advance report of final mortality statistics, 1993)Tj /F7 1 Tf 20.25 0 TD (.)Tj -22 -1.2 TD 0.048 Tw (Hyattsville, MD: U.S. Department of Health and Hu-)Tj T* 0.015 Tw (man Services, Public Health Service, Centers for Dis-)Tj T* -0.003 Tc -0.129 Tw (ease Control and Prevention, National Center for Health)Tj T* 0.005 Tc 0.062 Tw (Statistics, 1996. \(Monthly vital statistics report; Vol.)Tj T* -0.001 Tw (44, No. 4, Suppl\).)Tj -1.2 -1.75 TD 0.222 Tw (National Institutes of Health. Consensus Conference:)Tj 1.2 -1.2 TD (Osteoporosis. )Tj /F16 1 Tf 5.95 0 TD -0.061 Tw (Journal of the American Medical Associa-)Tj -5.95 -1.2 TD (tion)Tj /F7 1 Tf 1.55 0 TD -0.001 Tw ( 1984;252:799\320802.)Tj -2.75 -1.7 TD -0.071 Tw (National Institutes of Health. Health implications of obe-)Tj 1.2 -1.2 TD -0.089 Tw (sity: National Institutes of Health Consensus Develop-)Tj T* 0 Tc -0.128 Tw (ment Conference Statement. )Tj /F16 1 Tf 11.65 0 TD -0.123 Tw (Annals of Internal Medicine)Tj /F7 1 Tf -11.65 -1.2 TD 0.005 Tc 0 Tw (1985;103\(Suppl 6, Pt 2\):1073\3201077.)Tj -1.2 -1.75 TD -0.031 Tw (National Institutes of Health. )Tj /F16 1 Tf 12.35 0 TD -0.029 Tw (The Fifth Report of the Joint)Tj -11.15 -1.2 TD -0.12 Tw (National Committee on Detection, Evaluation, and Treat-)Tj T* 0.058 Tw (ment of High Blood Pressure.)Tj /F7 1 Tf 11.85 0 TD 0.06 Tw [( Bethesda, MD: National)]TJ -11.85 -1.2 TD -0.002 Tw (Institutes of Health, National Heart, Lung, and Blood)Tj T* 0 Tw (Institute, 1992:1\32048. NIH Publication No. 93-1088.)Tj 25.15 58.85 TD 0.007 Tw (Nelson ME, Fisher EC, Dilmanian FA, Dallal GE, Evans)Tj 1.2 -1.2 TD -0.105 Tw (WJ. A one-year walking program and increased dietary)Tj T* 0.052 Tw (calcium in postmenopausal women: effects on bone.)Tj /F16 1 Tf T* 0.04 Tw (American Journal of Clinical Nutrition)Tj /F7 1 Tf 15.7 0 TD 0.041 Tw [( 1991;53:1304\320)]TJ -15.7 -1.2 TD (1311.)Tj -1.2 -1.75 TD 0.032 Tw (Newsholme EA, Parry-Billings M. Effects of exercise on)Tj 1.2 -1.2 TD 0.164 Tw (the immune system. In: Bouchard C, Shephard RJ,)Tj T* 0.003 Tc -0.127 Tw (Stephens T, editors. )Tj /F16 1 Tf 8.15 0 TD -0.123 Tw (Physical activity, fitness, and health:)Tj -8.15 -1.2 TD 0.022 Tc 0.25 Tw (international proceedings and consensus statement.)Tj /F7 1 Tf T* 0.005 Tc 0 Tw (Champaign, IL: Human Kinetics, 1994:451\320455.)Tj -1.2 -1.75 TD -0.08 Tw (Nichols DL, Sanborn CF, Bonnick SL, Ben-Ezra V, Gench)Tj 1.2 -1.2 TD -0.04 Tw (B, DiMarco NM. The effects of gymnastics training on)Tj T* 0.076 Tw (bone mineral density. )Tj /F16 1 Tf 9.6 0 TD 0.074 Tw (Medicine and Science in Sports)Tj -9.6 -1.2 TD 0.001 Tw (and Exercise)Tj /F7 1 Tf 5.05 0 TD ( 1994;26:1220\3201225.)Tj -6.25 -1.7 TD -0.081 Tw (Nieto FJ, Szklo M, Comstock GW. Childhood weight and)Tj 1.2 -1.2 TD -0.029 Tw (growth rate as predictors of adult mortality.)Tj /F16 1 Tf 18.15 0 TD -0.028 Tw [( American)]TJ -18.15 -1.2 TD 0.001 Tw (Journal of Epidemiology)Tj /F7 1 Tf 9.65 0 TD ( 1992;136:201\320213.)Tj -10.85 -1.75 TD 0.037 Tw (North TC, McCullagh P, Tran ZV. Effect of exercise on)Tj 1.2 -1.2 TD 0.038 Tc (depression. )Tj /F16 1 Tf 5.7 0 TD 0.036 Tc 0.25 Tw (Exercise and Sport Sciences Reviews)Tj /F7 1 Tf -5.7 -1.2 TD 0.005 Tc (1990;18:379\320415.)Tj -1.2 -1.75 TD 0.012 Tw (Obarzanek E, Schreiber GB, Crawford PB, Goldman SR,)Tj 1.2 -1.2 TD 0.089 Tw (Barrier PM, Frederick MM, et al. Energy intake and)Tj T* -0.035 Tw (physical activity in relation to indexes of body fat: the)Tj T* -0.074 Tw (National Heart, Lung, and Blood Institute Growth and)Tj T* 0.13 Tw (Health Study. )Tj /F16 1 Tf 6.25 0 TD 0.126 Tw (American Journal of Clinical Nutrition)Tj /F7 1 Tf -6.25 -1.2 TD (1994;60:15\32022.)Tj -1.2 -1.75 TD 0 Tc -0.129 Tw (O\325Connor GT, Buring JE, Yusuf S, Goldhaber SZ, Olmstead)Tj 1.2 -1.2 TD 0.005 Tc -0.04 Tw (EM, Paffenbarger RS Jr, et al. An overview of random-)Tj T* -0.069 Tw (ized trials of rehabilitation with exercise after myocar-)Tj T* 0 Tw (dial infarction. )Tj /F16 1 Tf 6.45 0 TD (Circulation)Tj /F7 1 Tf 4.55 0 TD ( 1989;80:234\320244.)Tj -12.2 -1.75 TD -0.037 Tw (Oliveria SA, Kohl HW III, Trichopoulos D, Blair SN. The)Tj 1.2 -1.2 TD 0.002 Tc -0.127 Tw (association between cardiorespiratory fitness and pros-)Tj T* 0.005 Tc -0.061 Tw (tate cancer. )Tj /F16 1 Tf 4.95 0 TD -0.059 Tw (Medicine and Science in Sports and Exercise)Tj /F7 1 Tf -4.95 -1.2 TD (1996;28:97\320104.)Tj -1.2 -1.7 TD -0.001 Tc -0.13 Tw (Ornish D, Brown SE, Scherwitz LW, Billings JH, Armstrong)Tj 1.2 -1.2 TD 0.015 Tc 0.133 Tw (WT, Ports TA, et al. Can lifestyle changes reverse)Tj T* 0.19 Tw (coronary heart disease? The Lifestyle Heart Trial.)Tj /F16 1 Tf T* [(Lan)13 (c)10 (e)10 (t)]TJ /F7 1 Tf 2.7 0 TD 0.005 Tc 0.003 Tw ( 1990;336:129\320133.)Tj -3.9 -1.75 TD -0.039 Tw (Oscai LB. The role of exercise in weight control. )Tj /F16 1 Tf 20.1 0 TD (Exercise)Tj -18.9 -1.2 TD -0.001 Tw (and Sport Sciences Reviews)Tj /F7 1 Tf 10.9 0 TD ( 1973;1:103\320123.)Tj -12.1 -1.75 TD -0.022 Tw (Overholser KA, Laughlin MH, Bhatte MJ. Exercise train-)Tj 1.2 -1.2 TD 0.068 Tw (ing-induced increase in coronary transport capacity.)Tj /F16 1 Tf T* 0.009 Tc 0.25 Tw (Medicine and Science in Sports and Exercise)Tj /F7 1 Tf 19.35 0 TD 0.259 Tw [( 1994;)]TJ -19.35 -1.2 TD 0.005 Tc (26:1239\3201244.)Tj -1.2 -1.75 TD 0.21 Tw (Paffenbarger RS Jr. Contributions of epidemiology to)Tj 1.2 -1.2 TD 0.083 Tw (exercise science and cardiovascular health. )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 ( 1988;20:426\320438.)Tj ET PDFVars/TermAll get exec restore gsave showpage grestore %%Page: 85 85 save PDFVars/InitAll get exec %PDF_BeginEncoding: F5 Optima-Bold [ 39/quotesingle 96/grave 127/.notdef/Adieresis/Aring/Ccedilla /Eacute/Ntilde/Odieresis/Udieresis/aacute/agrave /acircumflex/adieresis/atilde/aring/ccedilla/eacute /egrave/ecircumflex/edieresis/iacute/igrave/icircumflex /idieresis/ntilde/oacute/ograve/ocircumflex/odieresis 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In: Bouchard C,)Tj T* 0.182 Tw (Shephard RJ, Stephens T, editors. )Tj /F16 1 Tf 15.2 0 TD 0.176 Tw (Physical activity,)Tj -15.2 -1.2 TD -0.113 Tw (fitness, and health: international proceedings and consen-)Tj T* 0.033 Tc 0.25 Tw (sus statement.)Tj /F7 1 Tf 6.25 0 TD 0.034 Tc 0.259 Tw [( Champaign, IL: Human Kinetics,)]TJ -6.25 -1.2 TD 0.005 Tc (1994:119\320133.)Tj -1.2 -1.75 TD 0.025 Tc -0.026 Tw [(P)30 (affenbarger RS Jr, Hyde RT, Wing AL, Steinmetz CH.)]TJ 1.2 -1.2 TD 0.005 Tc 0.173 Tw [(A)-20 ( )-40 (natural history of athleticism and cardiovascular)]TJ T* (health. )Tj /F16 1 Tf 3.4 0 TD 0.223 Tw (Journal of the American Medical Association)Tj /F7 1 Tf -3.4 -1.2 TD 0 Tw (1984; 252:491\320495.)Tj -1.2 -1.7 TD -0.052 Tw (Paffenbarger RS Jr, Jung DL, Leung RW, Hyde RT. Physi-)Tj 1.2 -1.2 TD -0.126 Tw (cal activity and hypertension: an epidemiological view.)Tj /F16 1 Tf T* 0 Tw (Annals of Medicine)Tj /F7 1 Tf 7.65 0 TD ( 1991;23:319\320327.)Tj -8.85 -1.75 TD -0.122 Tw (Paffenbarger RS Jr, Lee I-M, Leung R. Physical activity and)Tj 1.2 -1.2 TD 0.243 Tw (personal characteristics associated with depression)Tj T* -0.109 Tw (and suicide in American college men. )Tj /F16 1 Tf 15.35 0 TD -0.105 Tw (Acta Psychiatrica)Tj -15.35 -1.2 TD (Scandinavica)Tj /F7 1 Tf 5.3 0 TD ( )Tj /F16 1 Tf 0.25 0 TD (Supplementum)Tj /F7 1 Tf 5.9 0 TD -0.002 Tw ( 1994;377:16\32022.)Tj -12.65 -1.75 TD 0.04 Tw (Paffenbarger RS Jr, Thorne MC, Wing AL. Chronic dis-)Tj 1.2 -1.2 TD 0.003 Tc -0.128 Tw (ease in former college students: characteristics in youth)Tj T* 0.005 Tc -0.005 Tw (predisposing to hypertension in later years.)Tj /F16 1 Tf 18.15 0 TD 0.004 Tc -0.004 Tw ( American)Tj -18.15 -1.2 TD 0.005 Tc 0.001 Tw (Journal of Epidemiology)Tj /F7 1 Tf 9.65 0 TD ( 1968;88:25\32032.)Tj -10.85 -1.75 TD -0.119 Tw (Paffenbarger RS Jr, Williams JL. Chronic disease in former)Tj 1.2 -1.2 TD 0.003 Tc -0.127 Tw (college students: early precursors of fatal stroke.)Tj /F16 1 Tf 19.4 0 TD -0.123 Tw [( Ameri-)]TJ -19.4 -1.2 TD 0.005 Tc 0.001 Tw (can Journal of Public Health)Tj /F7 1 Tf 11.3 0 TD ( 1967;57:1290\3201299.)Tj 13.85 61.15 TD -0.118 Tw (Paffenbarger RS Jr, Wing AL, Hyde RT. 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Is running associated with osteoarthritis?)Tj T* -0.123 Tw (An eight-year follow-up study. )Tj /F16 1 Tf 12.6 0 TD -0.118 Tw (Journal of Clinical Rheu-)Tj -12.6 -1.2 TD (matology)Tj /F7 1 Tf 3.7 0 TD 0 Tw ( 1995;1:35\32039.)Tj -4.9 -1.75 TD 0.053 Tw (Panush RS, Lane NE. Exercise and the musculoskeletal)Tj 1.2 -1.2 TD (system. )Tj /F16 1 Tf 3.5 0 TD 0.128 Tw (Bailliere\325s Clinical Rheumatology)Tj /F7 1 Tf 13.65 0 TD 0.132 Tw [( 1994;8:79\320)]TJ -17.15 -1.2 TD (102.)Tj -1.2 -1.75 TD -0.121 Tw (Panush RS, Schmidt C, Caldwell JR, Edwards NL, Longley)Tj 1.2 -1.2 TD -0.098 Tw (S, Yonker R, et al. Is running associated with degenera-)Tj T* 0.167 Tw (tive joint disease? )Tj /F16 1 Tf 8.2 0 TD 0.161 Tw [( Journal of the American Medical)]TJ -8.2 -1.2 TD (Association)Tj /F7 1 Tf 4.55 0 TD -0.003 Tw ( 1986;255:1152\3201154.)Tj -5.75 -1.75 TD 0.186 Tw (Pate RR, Pratt M, Blair SN, Haskell WL, Macera CA,)Tj 1.2 -1.2 TD -0.024 Tw (Bouchard C, et al. Physical activity and public health:)Tj T* -0.025 Tw (a recommendation from the Centers for Disease Con-)Tj T* -0.126 Tw (trol and Prevention and the American College of Sports)Tj T* (Medicine. )Tj /F16 1 Tf 4.35 0 TD -0.028 Tw [( Journal of the American Medical Association)]TJ /F7 1 Tf -4.35 -1.2 TD (1995;273:402\320407.)Tj -1.2 -1.75 TD -0.055 Tw (Pekkanen J, Marti B, Nissinen A, Tuomilehto J, Punsar S,)Tj 1.2 -1.2 TD 0.134 Tw (Karvonen MJ. Reduction of premature mortality by)Tj T* -0.003 Tw (high physical activity: a 20-year follow-up of middle-)Tj T* 0 Tw (aged Finnish men. )Tj /F16 1 Tf 8.05 0 TD (Lancet)Tj /F7 1 Tf 2.65 0 TD ( 1987;1:1473\3201477.)Tj -11.9 -1.7 TD -0.099 Tw (Peters RK, Cady LD Jr, Bischoff DP, Bernstein L, Pike MC.)Tj 1.2 -1.2 TD -0.054 Tw (Physical fitness and subsequent myocardial infarction)Tj T* 0.08 Tw (in healthy workers. )Tj /F16 1 Tf 8.65 0 TD 0.077 Tw [( Journal of the American Medical)]TJ -8.65 -1.2 TD (Association)Tj /F7 1 Tf 4.55 0 TD -0.003 Tw ( 1983;249:3052\3203056.)Tj -5.75 -1.75 TD 0.149 Tw (Peters RK, Garabrant DH, Yu MC, Mack TM. A case-)Tj 1.2 -1.2 TD 0.106 Tw (control study of occupational and dietary factors in)Tj T* 0.175 Tw (colorectal cancer in young men by subsite. )Tj /F16 1 Tf 19.4 0 TD (Cancer)Tj -19.4 -1.2 TD (Research)Tj /F7 1 Tf 3.6 0 TD 0.002 Tw ( 1989;49:5459\3205468.)Tj -4.8 -1.75 TD 0.123 Tw (Pfeiffer RP, Kronisch RL. Off-road cycling injuries: an)Tj 1.2 -1.2 TD (overview. )Tj /F16 1 Tf 4.3 0 TD -0.001 Tw (Sports Medicine)Tj /F7 1 Tf 6.4 0 TD ( 1995;19:311\320325.)Tj -11.9 -1.75 TD 0.096 Tw (Pi-Sunyer FX. Exercise in the treatment of obesity. In:)Tj /F16 1 Tf 1.2 -1.2 TD 0.233 Tw (Obesity and weight control: the health professional\325s)Tj T* 0.077 Tw (guide to understanding and treatment)Tj /F7 1 Tf 15.3 0 TD 0.08 Tw (. 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Effects of)Tj 1.2 -1.2 TD 0.099 Tw (baseline responses, in-task feelings, and duration of)Tj T* 0.016 Tw (activity on exercise-induced feeling states in women.)Tj /F16 1 Tf T* 0 Tw (Health Psychology)Tj /F7 1 Tf 7.45 0 TD ( 1995;14:350\320359.)Tj -8.65 -1.7 TD -0.065 Tw (Richie DH, Kelso SF, Bellucci PA. Aerobic dance injuries:)Tj 1.2 -1.2 TD 0.066 Tw (a retrospective study of instructors and participants.)Tj /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 -0.016 Tw [( Journal of Bone and Mineral Research)]TJ /F7 1 Tf -6.95 -1.2 TD (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 (diabetic patients.)Tj /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 -19.35 -1.2 TD 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 (Wingstrand H. The prevalence of gonarthrosis and its)Tj 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 (ischemic heart disease in volunteer male federal em-)Tj 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 -0.003 Tc 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 -0.051 Tw (Journal of)Tj -18.35 -1.2 TD (Pediatrics)Tj /F7 1 Tf 4 0 TD 0.002 Tw ( 1993;123:863\320870.)Tj -5.2 -1.7 TD 0.017 Tw (Sallis JF, Patterson TL, McKenzie TL, Nader PR. Family)Tj 1.2 -1.2 TD 0.033 Tw (variables and physical activity in preschool children.)Tj /F16 1 Tf T* 0 Tc -0.124 Tw (Journal of Developmental and Behavioral Pediatrics)Tj /F7 1 Tf 19.8 0 TD -0.129 Tw [( 1988;)]TJ -19.8 -1.2 TD 0.005 Tc (9:57\32061.)Tj -1.2 -1.75 TD -0.016 Tw (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 -0.047 Tw [( Ameri-)]TJ -19.25 -1.2 TD 0 Tw (can Journal of Epidemiology)Tj /F7 1 Tf 11.35 0 TD ( 1982;115:526\320537.)Tj -12.55 -1.75 TD -0.033 Tw (Salonen JT, Slater JS, Tuomilehto J, Rauramaa R. Leisure)Tj 1.2 -1.2 TD 0.01 Tw (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 -0.003 Tw ( 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 -18.85 -1.2 TD (1979;28:30\32032.)Tj -1.2 -1.75 TD 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 0 Tw (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 (vascularity and perfusion. )Tj /F16 1 Tf 11.55 0 TD (Circulation )Tj /F7 1 Tf 4.95 0 TD (1982;66:491\320)Tj -16.5 -1.2 TD (495.)Tj -1.2 -1.75 TD -0.127 Tw (Schneider SH, Amorosa LF, Khachadurian AK, Ruderman)Tj 1.2 -1.2 TD 0.025 Tc -0.043 Tw (NB. Studies on the mechanism of improved glucose)Tj T* 0.251 Tw (control during regular exercise in type 2 \(non-)Tj T* -0.067 Tw (insulin-dependent\) diabetes. )Tj /F16 1 Tf 12.7 0 TD -0.065 Tw [( Diabetologia )]TJ /F7 1 Tf 5.75 0 TD 0.024 Tc [(1984;26)19 (:)]TJ -18.45 -1.2 TD 0.025 Tc (355\320360.)Tj ET PDFVars/TermAll get exec restore gsave showpage grestore %%Page: 88 88 save PDFVars/InitAll get exec %PDF_BeginEncoding: F5 Optima-Bold [ 39/quotesingle 96/grave 127/.notdef/Adieresis/Aring/Ccedilla /Eacute/Ntilde/Odieresis/Udieresis/aacute/agrave /acircumflex/adieresis/atilde/aring/ccedilla/eacute /egrave/ecircumflex/edieresis/iacute/igrave/icircumflex /idieresis/ntilde/oacute/ograve/ocircumflex/odieresis /otilde/uacute/ugrave/ucircumflex/udieresis/dagger /degree/cent/sterling/section/bullet/paragraph /germandbls/registered/copyright/trademark/acute/dieresis /notequal/AE/Oslash/infinity/plusminus/lessequal /greaterequal/yen/mu/partialdiff/summation/product 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/emdash/quotedblleft/quotedblright/quoteleft/quoteright/divide /lozenge/ydieresis/Ydieresis/fraction/currency/guilsinglleft /guilsinglright/fi/fl/daggerdbl/periodcentered/quotesinglbase /quotedblbase/perthousand/Acircumflex/Ecircumflex/Aacute/Edieresis /Egrave/Iacute/Icircumflex/Idieresis/Igrave/Oacute /Ocircumflex/apple/Ograve/Uacute/Ucircumflex/Ugrave /dotlessi/circumflex/tilde/macron/breve/dotaccent /ring/cedilla/hungarumlaut/ogonek/caron /F16/Berkeley-Italic -1 TZ %PDF_EndEncoding 0 0 612 792 RC userdict /DefaultRGB /DeviceRGB put BT /F9 1 Tf 11 0 0 11 288.5 41 Tm 0 Tr 0 g 0.006 Tc (168)Tj /F5 1 Tf -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 -0.035 Tw (Schranz A, Tuomilehto J, Marti B, Jarrett RJ, Grabauskas)Tj 1.2 -1.2 TD -0.027 Tw (V, Vassallo A. Low physical activity and worsening of)Tj T* -0.041 Tw (glucose tolerance: results from a 2-year follow-up of a)Tj T* 0.206 Tw (population sample in Malta. )Tj /F16 1 Tf 12.85 0 TD 0.199 Tw (Diabetes Research and)Tj -12.85 -1.2 TD 0 Tw (Clinical Practice)Tj /F7 1 Tf 6.7 0 TD ( 1991;11:127\320136.)Tj -7.9 -1.75 TD -0.079 Tw (Schuler G, Hambrecht R, Schlierf G, Niebauer J, Hauer K,)Tj 1.2 -1.2 TD -0.089 Tw (Neumann J, et al. Regular physical exercise and low fat)Tj T* -0.047 Tw (diet: effects on progression of coronary artery disease.)Tj /F16 1 Tf T* (Circulation)Tj /F7 1 Tf 4.55 0 TD -0.002 Tw ( 1992;86:1\32011.)Tj -5.75 -1.75 TD 0.045 Tw (Seccareccia F, Menotti A. Physical activity, physical fit-)Tj 1.2 -1.2 TD 0.076 Tw (ness, and mortality in a sample of middle-aged men)Tj T* 0.083 Tw (followed up 25 years. )Tj /F16 1 Tf 9.6 0 TD 0.08 Tw (Journal of Sports Medicine and)Tj -9.6 -1.2 TD 0.001 Tw (Physical Fitness)Tj /F7 1 Tf 6.45 0 TD ( 1992; 32:206\320213.)Tj -7.65 -1.7 TD 0.245 Tw (Seidell JC, Cigolini M, Deslypere J-P, Charzewska J,)Tj 1.2 -1.2 TD -0.098 Tw (Ellsinger B-M, Cruz A. Body fat distribution in relation)Tj T* -0.044 Tw (to physical activity and smoking habits in 38-year-old)Tj T* 0.018 Tc 0.258 Tw (European men.)Tj /F16 1 Tf 6.85 0 TD 0.017 Tc 0.25 Tw [( American Journal of Epidemiology)]TJ /F7 1 Tf -6.85 -1.2 TD 0.005 Tc (1991;133:257\320265.)Tj -1.2 -1.75 TD -0.003 Tc -0.07 Tw (Severson RK, Nomura AMY, Grove JS, Stemmermann GN.)Tj 1.2 -1.2 TD 0.04 Tw (A prospective analysis of physical activity and cancer.)Tj /F16 1 Tf T* 0 Tw (American Journal of Epidemiology)Tj /F7 1 Tf 13.45 0 TD ( 1989;130:522\320529.)Tj -14.65 -1.75 TD 0.005 Tc 0.011 Tw (Shangold MM. Exercise and the adult female: hormonal)Tj 1.2 -1.2 TD 0.024 Tw (and endocrine effects. )Tj /F16 1 Tf 9.55 0 TD 0.023 Tw (Exercise and Sport Sciences Re-)Tj -9.55 -1.2 TD (views)Tj /F7 1 Tf 2.2 0 TD 0.003 Tw ( 1984;12:53\32079.)Tj -3.4 -1.75 TD 0.02 Tc 0.259 Tw (Shaper AG, Wannamethee G. Physical activity and)Tj 1.2 -1.2 TD 0.005 Tc 0.089 Tw (ischaemic heart disease in middle-aged British men.)Tj /F16 1 Tf T* -0.002 Tw (British Heart Journal )Tj /F7 1 Tf 8.7 0 TD (1991;66:384\320394.)Tj -9.9 -1.75 TD 0.015 Tw (Shaper AG, Wannamethee G, Walker M. Physical activ-)Tj 1.2 -1.2 TD 0.212 Tw (ity, hypertension, and risk of heart attack in men)Tj T* -0.082 Tw (without evidence of ischaemic heart disease.)Tj /F16 1 Tf 18.2 0 TD -0.079 Tw [( Journal of)]TJ -18.2 -1.2 TD 0.001 Tw (Human Hypertension)Tj /F7 1 Tf 8.5 0 TD ( 1994;8:3\32010.)Tj -9.7 -1.7 TD -0.045 Tw (Shear CL, Freedman DS, Burke GL, Harsha DW, Webber)Tj 1.2 -1.2 TD -0.078 Tw (LS, Berenson GS. Secular trends of obesity in early life:)Tj T* 0.056 Tw (the Bogalusa Heart Study.)Tj /F16 1 Tf 10.95 0 TD 0.054 Tw [( American Journal of Public)]TJ -10.95 -1.2 TD (Health)Tj /F7 1 Tf 2.65 0 TD 0 Tw ( 1988;78:75\32077.)Tj -3.85 -1.75 TD -0.062 Tw (Shephard RJ. Exercise in the prevention and treatment of)Tj 1.2 -1.2 TD 0 Tw (cancer: an update. )Tj /F16 1 Tf 7.9 0 TD (Sports Medicine)Tj /F7 1 Tf 6.4 0 TD ( 1993;15:258\320280.)Tj -15.5 -1.75 TD 0.165 Tw (Shephard RJ, Verde TJ, Thomas SG, Shek P. Physical)Tj 1.2 -1.2 TD 0.036 Tw (activity and the immune system. )Tj /F16 1 Tf 14.05 0 TD 0.035 Tw (Canadian Journal of)Tj -14.05 -1.2 TD -0.001 Tw (Sport Sciences )Tj /F7 1 Tf 6 0 TD (1991;16:163\320185.)Tj -7.2 -1.75 TD -0.07 Tw (Sherman SE, D\325Agostino RB, Cobb JL, Kannel WB. Physi-)Tj 1.2 -1.2 TD -0.123 Tw (cal activity and mortality in women in the Framingham)Tj T* 0.116 Tw (Heart Study. )Tj /F16 1 Tf 5.75 0 TD 0.113 Tw (American Heart Journal )Tj /F7 1 Tf 10.2 0 TD (1994;128:879\320)Tj -15.95 -1.2 TD (884.)Tj -1.2 -1.75 TD 0.054 Tw (Shimegi S, Yanagita M, Okano H, Yamada M, Fukui H,)Tj 1.2 -1.2 TD 0.08 Tw (Fukumura Y, et al. Physical exercise increases bone)Tj T* -0.09 Tw (mineral density in postmenopausal women. )Tj /F16 1 Tf 18.1 0 TD (Endocrine)Tj -18.1 -1.2 TD (Journal )Tj /F7 1 Tf 3.2 0 TD (1994;41:49\32056.)Tj 21.95 62.9 TD 0.189 Tw (Shu XO, Hatch MC, Zheng W, Gao YT, Brinton LA.)Tj 1.2 -1.2 TD -0.117 Tw (Physical activity and risk of endometrial cancer. )Tj /F16 1 Tf 19.55 0 TD (Epide-)Tj -19.55 -1.2 TD (miology )Tj /F7 1 Tf 3.45 0 TD (1993;4:342\320349.)Tj -4.65 -1.75 TD 0.131 Tw (Shumaker SA, Anderson RT, Czajkowski SM. Psycho-)Tj 1.2 -1.2 TD -0.058 Tw (logical tests and scales. In: Spilker B, editor. )Tj /F16 1 Tf 18.2 0 TD -0.056 Tw (Quality of)Tj -18.2 -1.2 TD 0.209 Tw (life assessments in clinical trials. )Tj /F7 1 Tf 14.45 0 TD 0.217 Tw (New York: Raven)Tj -14.45 -1.2 TD -0.002 Tw (Press, 1990:95\320113.)Tj -1.2 -1.75 TD 0.002 Tc -0.128 Tw (Sime WE. Discussion: exercise, fitness, and mental health.)Tj 1.2 -1.2 TD 0.005 Tc 0.014 Tw (In: Bouchard C, Shephard RJ, Stephens T, Sutton JR,)Tj T* 0.025 Tc -0.073 Tw (McPherson BD, editors.)Tj /F16 1 Tf 10.2 0 TD -0.07 Tw [( Exercise, fitness, and health:)]TJ -10.2 -1.2 TD 0.135 Tw (a consensus of current knowledge)Tj /F7 1 Tf 14.5 0 TD 0.14 Tw (. Champaign, IL:)Tj -14.5 -1.2 TD 0.005 Tc 0 Tw [(H)-20 (u)-42 (man Kinetics, 1990:627\320633.)]TJ -1.2 -1.7 TD 0.01 Tc 0.259 Tw (Simons AD, McGowan CR, Epstein LH, Kupfer DJ,)Tj 1.2 -1.2 TD 0.005 Tc -0.005 Tw (Robertson RJ. Exercise as a treatment for depression:)Tj T* 0.201 Tw (an update. )Tj /F16 1 Tf 5.05 0 TD 0.194 Tw (Clinical Psychology Review)Tj /F7 1 Tf 11.4 0 TD 0.201 Tw [( 1985;5;553\320)]TJ -16.45 -1.2 TD (568.)Tj -1.2 -1.75 TD -0.01 Tw (Simons CW, Birkimer JC. An exploration of factors pre-)Tj 1.2 -1.2 TD 0.092 Tw (dicting the effects of aerobic conditioning on mood)Tj T* (state. )Tj /F16 1 Tf 2.5 0 TD 0.059 Tw (Journal of Psychosomatic Research)Tj /F7 1 Tf 14.1 0 TD 0.061 Tw [( 1988;32:63\320)]TJ -16.6 -1.2 TD 0.004 Tc (75.)Tj -1.2 -1.75 TD 0.005 Tc 0.01 Tw (Sinaki M, McPhee MC, Hodgson SF, Merritt JM, Offord)Tj 1.2 -1.2 TD 0.2 Tw (KP. Relationship between bone mineral density of)Tj T* -0.005 Tw (spine and strength of back extensors in healthy post-)Tj T* 0.063 Tc 0.259 Tw (menopausal women. )Tj /F16 1 Tf 10.45 0 TD 0.061 Tc 0.25 Tw (Mayo Clinic Proceedings)Tj /F7 1 Tf -10.45 -1.2 TD 0.005 Tc (1986;61:116\320122.)Tj -1.2 -1.75 TD -0.097 Tw (Sinaki M, Offord KP. Physical activity in postmenopausal)Tj 1.2 -1.2 TD 0.231 Tw (women: effect on back muscle strength and bone)Tj T* -0.091 Tw (mineral density of the spine. )Tj /F16 1 Tf 11.75 0 TD -0.088 Tw (Archives of Physical Medi-)Tj -11.75 -1.2 TD 0 Tw (cine and Rehabilitation)Tj /F7 1 Tf 9.25 0 TD ( 1988;69:277\320280.)Tj -10.45 -1.75 TD 0.003 Tw (Sinert R, Kohl L, Rainone T, Scalea T. Exercise-induced)Tj 1.2 -1.2 TD 0.045 Tc (rhabdomyolysis.)Tj /F16 1 Tf 7.5 0 TD 0.044 Tc 0.25 Tw [( Annals of Emergency Medicine)]TJ /F7 1 Tf -7.5 -1.2 TD 0.005 Tc (1994;23:1301\3201306.)Tj -1.2 -1.7 TD 0.239 Tw (Siscovick DS, Weiss NS, Fletcher RH, Lasky T. The)Tj 1.2 -1.2 TD 0.1 Tw (incidence of primary cardiac arrest during vigorous)Tj T* 0.019 Tc (exercise. )Tj /F16 1 Tf 4.3 0 TD 0.25 Tw (New England Journal of Medicine)Tj /F7 1 Tf 14.9 0 TD 0.259 Tw [( 1984;)]TJ -19.2 -1.2 TD 0.005 Tc (311:874\320877.)Tj -1.2 -1.75 TD -0.071 Tw (Slattery ML, Jacobs DR Jr. Physical fitness and cardiovas-)Tj 1.2 -1.2 TD -0.126 Tw (cular disease mortality: the U.S. Railroad Study.)Tj /F16 1 Tf 19.25 0 TD -0.122 Tw [( Ameri-)]TJ -19.25 -1.2 TD 0 Tw (can Journal of Epidemiology)Tj /F7 1 Tf 11.3 0 TD ( 1988;127:571\320580.)Tj -12.5 -1.75 TD 0.053 Tw (Slattery ML, Jacobs DR Jr, Nichaman MZ. Leisure-time)Tj 1.2 -1.2 TD -0.074 Tw (physical activity and coronary heart disease death: the)Tj T* -0.001 Tw (U.S. Railroad Study. )Tj /F16 1 Tf 8.7 0 TD (Circulation)Tj /F7 1 Tf 4.55 0 TD ( 1989;79:304\320311.)Tj -14.45 -1.75 TD 0.048 Tw (Slattery ML, McDonald A, Bild DE, Caan BJ, Hilner JE,)Tj 1.2 -1.2 TD 0.103 Tw (Jacobs DR Jr, et al. Associations of body fat and its)Tj T* 0.015 Tw (distribution with dietary intake, physical activity, al-)Tj T* 0.094 Tw (cohol, and smoking in blacks and whites. )Tj /F16 1 Tf 18.3 0 TD (American)Tj -18.3 -1.2 TD -0.001 Tw (Journal of Clinical Nutrition)Tj /F7 1 Tf 11.4 0 TD ( 1992;55:943\320950.)Tj ET PDFVars/TermAll get exec restore gsave showpage grestore %%Page: 89 89 save PDFVars/InitAll get exec %PDF_BeginEncoding: F5 Optima-Bold [ 39/quotesingle 96/grave 127/.notdef/Adieresis/Aring/Ccedilla /Eacute/Ntilde/Odieresis/Udieresis/aacute/agrave /acircumflex/adieresis/atilde/aring/ccedilla/eacute /egrave/ecircumflex/edieresis/iacute/igrave/icircumflex /idieresis/ntilde/oacute/ograve/ocircumflex/odieresis /otilde/uacute/ugrave/ucircumflex/udieresis/dagger /degree/cent/sterling/section/bullet/paragraph /germandbls/registered/copyright/trademark/acute/dieresis /notequal/AE/Oslash/infinity/plusminus/lessequal /greaterequal/yen/mu/partialdiff/summation/product 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Physical activity, diet, and risk of colon)Tj T* 0.012 Tc 0.258 Tw (cancer in Utah.)Tj /F16 1 Tf 7 0 TD 0.011 Tc 0.25 Tw [( American Journal of Epidemiology)]TJ /F7 1 Tf -7 -1.2 TD 0.005 Tc (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 (Coronary heart disease: a behavioral)Tj -7.55 -1.2 TD (perspective)Tj /F7 1 Tf 4.4 0 TD 0.084 Tw (. Champaign, IL: Research Press, 1992:9\320)Tj -4.4 -1.2 TD 0.004 Tc (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 0.005 Tc 0.25 Tw (Abramowicz M, Degre S, et al. Protection against)Tj T* -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 -0.002 Tw (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 0 Tw (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 0.028 Tc 0.258 Tw (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 0.001 Tw (netics, 1994:417\320431.)Tj -1.2 -1.75 TD -0.013 Tc -0.05 Tw (Stefanik PA, Heald FP, Mayer J. Caloric intake in relation to)Tj 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 T* -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 /F7 1 Tf 5.45 0 TD -0.003 Tw ( 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 -0.115 Tw (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 -0.038 Tw (Medicine and Science in Sports and Exer-)Tj -5.95 -1.2 TD (cise)Tj /F7 1 Tf 1.5 0 TD 0 Tw ( 1993;25\(5 Suppl\):S147.)Tj -2.7 -1.75 TD -0.065 Tw (Stewart AL, Hays RD, Wells KB, Rogers WH, Spritzer KL,)Tj 1.2 -1.2 TD 0.103 Tw (Greenfield S. Long-term functioning and well-being)Tj T* 0.047 Tw (outcomes associated with physical activity and exer-)Tj 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 (47:719\320730.)Tj -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 5.4 0 TD -0.001 Tw ( 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 T* 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 -0.101 Tw (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 -0.078 Tw (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 0.214 Tw (Bone and)Tj -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 -0.115 Tw (Prostaglandin E)Tj 7 0 0 7 407 187 Tm (2)Tj 10 0 0 10 410.5 190 Tm [( increases skeletal response.)]TJ /F16 1 Tf 11.35 0 TD -0.111 Tw [( Journal of)]TJ -18.25 -1.2 TD 0 Tw (Bone and Mineral Research)Tj /F7 1 Tf 10.95 0 TD ( 1995;10:S246.)Tj -12.15 -1.75 TD 0.046 Tw (Task Force on Blood Pressure Control in Children. Re-)Tj 1.2 -1.2 TD 0.222 Tw (port of the Second Task Force on Blood Pressure)Tj T* -0.003 Tw (Control in Children\3211987. )Tj /F16 1 Tf 12 0 TD (Pediatrics)Tj /F7 1 Tf 4 0 TD ( 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 (activity and exercise to mental health.)Tj /F16 1 Tf 16.4 0 TD 0.09 Tw [( Public Health)]TJ -16.4 -1.2 TD (Reports)Tj /F7 1 Tf 3 0 TD 0.001 Tw ( 1985;100:195\320202.)Tj ET PDFVars/TermAll get exec restore gsave showpage grestore %%Page: 90 90 save PDFVars/InitAll get exec %PDF_BeginEncoding: F5 Optima-Bold [ 39/quotesingle 96/grave 127/.notdef/Adieresis/Aring/Ccedilla /Eacute/Ntilde/Odieresis/Udieresis/aacute/agrave /acircumflex/adieresis/atilde/aring/ccedilla/eacute /egrave/ecircumflex/edieresis/iacute/igrave/icircumflex /idieresis/ntilde/oacute/ograve/ocircumflex/odieresis /otilde/uacute/ugrave/ucircumflex/udieresis/dagger /degree/cent/sterling/section/bullet/paragraph /germandbls/registered/copyright/trademark/acute/dieresis /notequal/AE/Oslash/infinity/plusminus/lessequal /greaterequal/yen/mu/partialdiff/summation/product /pi/integral/ordfeminine/ordmasculine/Omega/ae /oslash/questiondown/exclamdown/logicalnot/radical/florin 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Death rates among physically active and)Tj T* 0.043 Tw (sedentary employees of the railroad industry.)Tj /F16 1 Tf 19.15 0 TD 0.041 Tw [( Ameri-)]TJ -19.15 -1.2 TD 0.001 Tw (can Journal of Public Health)Tj /F7 1 Tf 11.3 0 TD ( 1962;52:1697\3201707.)Tj -12.5 -1.75 TD 0.233 Tw (Taylor R, Ram P, Zimmet P, Raper LR, Ringrose H.)Tj 1.2 -1.2 TD 0.037 Tc 0.259 Tw (Physical activity and prevalence of diabetes in)Tj T* 0.019 Tc (Melanesian and Indian men in Fiji.)Tj /F16 1 Tf 16.5 0 TD 0.25 Tw [( Diabetologia)]TJ /F7 1 Tf -16.5 -1.2 TD 0.005 Tc (1984;27:578\320582.)Tj -1.2 -1.75 TD -0.097 Tw (Taylor RJ, Bennett PH, LeGonidec G, Lacoste J, Combe D,)Tj 1.2 -1.2 TD -0.028 Tw (Joffres M, et al. The prevalence of diabetes mellitus in)Tj T* -0.002 Tw (a traditional-living Polynesian population: the Wallis)Tj 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 -0.09 Tw (Tell GS, Vellar OD. Physical fitness, physical activity, and)Tj 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 7.65 0 TD -0.097 Tw (Preventive Medicine)Tj /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 (Stephens T, editors. )Tj /F16 1 Tf 8.15 0 TD -0.123 Tw (Physical activity, fitness, and health:)Tj -8.15 -1.2 TD 0.022 Tc 0.25 Tw (international proceedings and consensus statement)Tj /F7 1 Tf 22 0 TD (.)Tj -22 -1.2 TD 0.005 Tc 0 Tw (Champaign, IL: Human Kinetics, 1994:521\320529.)Tj -1.2 -1.75 TD -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 -10.05 -1.75 TD 0.258 Tw (Thompson PD, Funk EJ, Carleton RA, Sturner WQ.)Tj 1.2 -1.2 TD 0.167 Tw (Incidence of death during jogging in Rhode Island)Tj T* 0.195 Tw (from 1975 through 1980. )Tj /F16 1 Tf 11.7 0 TD 0.189 Tw [( Journal of the American)]TJ -11.7 -1.2 TD -0.002 Tw (Medical Association)Tj /F7 1 Tf 8 0 TD ( 1982;247:2535\3202538.)Tj -9.2 -1.75 TD -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 (can Journal of Physiology)Tj /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 (and testicular cancer: a cohort study of 53,000 Norwe-)Tj T* -0.074 Tw (gian men. )Tj /F16 1 Tf 4.25 0 TD -0.071 Tw (Cancer Causes and Control)Tj /F7 1 Tf 10.75 0 TD -0.074 Tw [( 1994;5:549\320556.)]TJ -16.2 -1.75 TD 0.095 Tw (Tinetti ME, Baker DI, McAvay G, Claus EB, Garrett P,)Tj 1.2 -1.2 TD 0.084 Tw (Gottschalk M, et al. A multifactorial intervention to)Tj T* -0.115 Tw (reduce the risk of falling among elderly people living in)Tj T* 0.012 Tc 0.259 Tw (the community. )Tj /F16 1 Tf 7.55 0 TD 0.25 Tw (New England Journal of Medicine)Tj /F7 1 Tf -7.55 -1.2 TD 0.005 Tc (1994;331:821\320827.)Tj -1.2 -1.75 TD -0.035 Tw (Tinetti ME, Speechley M, Ginter SF. Risk factors for falls)Tj 1.2 -1.2 TD 0.002 Tw (among elderly persons living in the community. )Tj /F16 1 Tf 20.45 0 TD (New)Tj -20.45 -1.2 TD -0.001 Tw (England Journal of Medicine)Tj /F7 1 Tf 11.4 0 TD ( 1988;319:1701\3201707.)Tj 13.75 58.75 TD 0.236 Tw (Tipton CM. Exercise and resting blood pressure. In:)Tj 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 8.1 0 TD (.)Tj -22 -1.2 TD 0 Tw (Champaign, IL: Human Kinetics, 1984:32\32041.)Tj -1.2 -1.75 TD -0.009 Tw (Tomanek RJ. 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Influence of physical training on)Tj T* 0.077 Tw (blood glucose control, glucose tolerance, insulin se-)Tj T* 0.029 Tw (cretion, and insulin action in noninsulin-dependent-)Tj T* 0 Tw (diabetes patients. )Tj /F16 1 Tf 7.5 0 TD (Diabetes Care)Tj /F7 1 Tf 5.65 0 TD ( 1984;7:416\320420.)Tj -14.35 -1.75 TD 0.231 Tw (Tsopanakis AD, Sgouraki EP, Pavlou KN, Nadel ER,)Tj 1.2 -1.2 TD 0.103 Tw (Bussolari SR. Lipids and lipoprotein profiles in a 4-)Tj 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 -16.4 -1.7 TD -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 -19.05 -1.2 TD 0 Tw (of Bone and Mineral Research)Tj /F7 1 Tf 11.95 0 TD ( 1995;10:240.)Tj -13.15 -1.75 TD (Tutton PJM, Barkla DH. Influence of prostaglandin ana-)Tj 1.2 -1.2 TD 0.12 Tw (logues on epithelial cell proliferation and xenograft)Tj T* (growth.)Tj /F16 1 Tf 3.25 0 TD -0.001 Tw ( British Journal of Cancer )Tj /F7 1 Tf 10.55 0 TD (1980;41:47\32051.)Tj -15 -1.75 TD -0.039 Tw (Underwood FB, Laughlin MH, Sturek M. Altered control)Tj 1.2 -1.2 TD -0.11 Tw (of calcium in coronary smooth muscle cells by exercise)Tj T* (training. )Tj /F16 1 Tf 3.95 0 TD 0.103 Tw (Medicine and Science in Sports and Exercise)Tj /F7 1 Tf -3.95 -1.2 TD (1994;26:1230\3201238.)Tj -1.2 -1.75 TD -0.041 Tw (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* -0.06 Tw (abnormalities, age at puberty, infertility, and exercise.)Tj /F16 1 Tf T* 0 Tw (British Medical Journal )Tj /F7 1 Tf 9.6 0 TD (1994;308:1393\3201399.)Tj ET PDFVars/TermAll get exec restore gsave showpage grestore %%Page: 91 91 save PDFVars/InitAll get exec %PDF_BeginEncoding: F5 Optima-Bold [ 39/quotesingle 96/grave 127/.notdef/Adieresis/Aring/Ccedilla /Eacute/Ntilde/Odieresis/Udieresis/aacute/agrave /acircumflex/adieresis/atilde/aring/ccedilla/eacute /egrave/ecircumflex/edieresis/iacute/igrave/icircumflex /idieresis/ntilde/oacute/ograve/ocircumflex/odieresis /otilde/uacute/ugrave/ucircumflex/udieresis/dagger /degree/cent/sterling/section/bullet/paragraph /germandbls/registered/copyright/trademark/acute/dieresis /notequal/AE/Oslash/infinity/plusminus/lessequal /greaterequal/yen/mu/partialdiff/summation/product /pi/integral/ordfeminine/ordmasculine/Omega/ae 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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 -0.08 Tw (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 /F16 1 Tf 2.9 0 TD -0.005 Tc -0.125 Tw [( 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* -0.094 Tw (colon cancer risk in Turkey. )Tj /F16 1 Tf 11.65 0 TD -0.091 Tw (European Journal of Epide-)Tj -11.65 -1.2 TD (miology)Tj /F7 1 Tf 3.2 0 TD -0.003 Tw ( 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 -0.014 Tw (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 -0.041 Tw (GM. Effect of habitual physical activity on age-related)Tj T* -0.038 Tw (glucose intolerance. )Tj /F16 1 Tf 8.55 0 TD -0.037 Tw (Journal of the American Geriatrics)Tj -8.55 -1.2 TD (Society)Tj /F7 1 Tf 2.85 0 TD -0.001 Tw [( 1989; )-14 (37:203\320209.)]TJ -4.05 -1.75 TD -0.086 Tw (Wannamethee G, Shaper AG. Physical activity and stroke)Tj 1.2 -1.2 TD 0.161 Tw (in British middle-aged men.)Tj /F16 1 Tf 12.15 0 TD 0.155 Tw [( British Medical Journal)]TJ /F7 1 Tf -12.15 -1.2 TD (1992;304:597\320601.)Tj -1.2 -1.7 TD 0.015 Tc -0.102 Tw (Webber LS, Srinivasan SR, Wattigney WA, Berenson GS.)Tj 1.2 -1.2 TD -0.094 Tw (Tracking of serum lipids and lipoproteins from child-)Tj T* -0.054 Tw (hood to adulthood: the Bogalusa Heart Study.)Tj /F16 1 Tf 19.25 0 TD -0.052 Tw [( Ameri-)]TJ -19.25 -1.2 TD 0 Tw (can Journal of Epidemiology)Tj /F7 1 Tf 11.6 0 TD ( 1991;133:884\320899.)Tj -12.8 -1.75 TD 0.004 Tc -0.127 Tw (West DW, Slattery ML, Robison LM, French TK, Mahoney)Tj 1.2 -1.2 TD 0.005 Tc 0.038 Tw (AW. Adult dietary intake and prostate cancer risk in)Tj T* 0.075 Tw (Utah: a case-control study with special emphasis on)Tj T* 0.052 Tc 0.259 Tw (aggressive tumors. )Tj /F16 1 Tf 9.45 0 TD 0.05 Tc 0.25 Tw (Cancer Causes and Control)Tj /F7 1 Tf -9.45 -1.2 TD 0.005 Tc (1991;2:85\32094.)Tj -1.2 -1.75 TD -0.092 Tw (West KM. )Tj /F16 1 Tf 4.25 0 TD -0.089 Tw (Epidemiology of diabetes and its vascular lesions)Tj /F7 1 Tf 18.95 0 TD (.)Tj -22 -1.2 TD 0 Tw (New York: Elsevier, 1978.)Tj -1.2 -1.75 TD 0.242 Tw (Weyerer S. Physical inactivity and depression in the)Tj 1.2 -1.2 TD 0.035 Tw (community: evidence from the Upper Bavarian Field)Tj T* 0.049 Tc (Study.)Tj /F16 1 Tf 2.9 0 TD 0.048 Tc 0.25 Tw [( International Journal of Sports Medicine)]TJ /F7 1 Tf -2.9 -1.2 TD 0.005 Tc (1992;13:492\320496.)Tj -1.2 -1.75 TD -0.002 Tc -0.129 Tw (Whittemore AS, Wu-Williams AH, Lee M, Shu Z, Gallagher)Tj 1.2 -1.2 TD -0.005 Tc -0.13 Tw (RP, Deng-ao J, et al. Diet, physical activity, and colorectal)Tj T* 0.005 Tc 0.035 Tw (cancer among Chinese in North America and China.)Tj /F16 1 Tf T* 0.059 Tw (Journal of the National Cancer Institute)Tj /F7 1 Tf 16.2 0 TD 0.061 Tw [( 1990;82:915\320)]TJ -16.2 -1.2 TD (926.)Tj -1.2 -1.7 TD -0.046 Tw (Wilfley D, Kunce J. Differential physical and psychologi-)Tj 1.2 -1.2 TD -0.074 Tw (cal effects of exercise. )Tj /F16 1 Tf 9.05 0 TD -0.072 Tw (Journal of Counseling Psychology)Tj /F7 1 Tf -9.05 -1.2 TD (1986;33:337\320342.)Tj -1.2 -1.75 TD -0.107 Tw (Willett WC, Manson JE, Stampfer MJ, Colditz GA, Rosner)Tj 1.2 -1.2 TD -0.032 Tw (B, Speizer FE, et al. Weight, weight change, and coro-)Tj T* -0.007 Tw (nary heart disease in women: risk within the \324normal\325)Tj T* -0.065 Tw (weight range.)Tj /F16 1 Tf 5.6 0 TD -0.063 Tw [( Journal of the American Medical Associa-)]TJ -5.6 -1.2 TD (tion)Tj /F7 1 Tf 1.55 0 TD -0.001 Tw ( 1995;273:461\320465.)Tj -2.75 -1.75 TD -0.102 Tw (Willett WC, Stampfer MJ, Colditz GA, Rosner BA, Speizer)Tj 1.2 -1.2 TD -0.062 Tw (FE. Relation of meat, fat, and fiber intake to the risk of)Tj T* 0.107 Tw (colon cancer in a prospective study among women.)Tj /F16 1 Tf T* -0.123 Tw (New England Journal of Medicine)Tj /F7 1 Tf 12.95 0 TD -0.127 Tw [( 1990;323:1664\3201672.)]TJ -14.15 -1.75 TD -0.021 Tw (Williamson DF, Madans J, Anda RF, Kleinman JC, Kahn)Tj 1.2 -1.2 TD -0.127 Tw (HS, Byers T. Recreational physical activity and ten-year)Tj T* 0.064 Tw (weight change in a US national cohort. )Tj /F16 1 Tf 17 0 TD (International)Tj -17 -1.2 TD 0 Tw (Journal of Obesity)Tj /F7 1 Tf 7.25 0 TD ( 1993;17:279\320286.)Tj ET PDFVars/TermAll get exec restore gsave showpage grestore %%Page: 92 92 save PDFVars/InitAll get exec %PDF_BeginEncoding: F5 Optima-Bold [ 39/quotesingle 96/grave 127/.notdef/Adieresis/Aring/Ccedilla /Eacute/Ntilde/Odieresis/Udieresis/aacute/agrave /acircumflex/adieresis/atilde/aring/ccedilla/eacute /egrave/ecircumflex/edieresis/iacute/igrave/icircumflex /idieresis/ntilde/oacute/ograve/ocircumflex/odieresis /otilde/uacute/ugrave/ucircumflex/udieresis/dagger /degree/cent/sterling/section/bullet/paragraph /germandbls/registered/copyright/trademark/acute/dieresis /notequal/AE/Oslash/infinity/plusminus/lessequal /greaterequal/yen/mu/partialdiff/summation/product /pi/integral/ordfeminine/ordmasculine/Omega/ae /oslash/questiondown/exclamdown/logicalnot/radical/florin 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Physical exertion as a trigger of acute)Tj T* 0.07 Tw (myocardial infarction. )Tj /F16 1 Tf 9.7 0 TD 0.067 Tw (New England Journal of Medi-)Tj -9.7 -1.2 TD (cine)Tj /F7 1 Tf 1.6 0 TD -0.004 Tw ( 1993;329:1684\3201690.)Tj -2.8 -1.75 TD 0.138 Tw (Wilmore JH. Body composition in sport and exercise:)Tj 1.2 -1.2 TD -0.026 Tw (directions for future research. )Tj /F16 1 Tf 12.65 0 TD -0.025 Tw (Medicine and Science in)Tj -12.65 -1.2 TD 0.001 Tw (Sports and Exercise)Tj /F7 1 Tf 7.85 0 TD ( 1983;15:21\32031.)Tj -9.05 -1.75 TD 0 Tc -0.129 Tw (Wing RR, Matthews KA, Kuller LH, Meilahn EN, Plantinga)Tj 1.2 -1.2 TD 0.005 Tc -0.026 Tw (P. Waist-to-hip ratio in middle-aged women: associa-)Tj T* 0.161 Tw (tions with behavioral and psychosocial factors and)Tj T* 0.092 Tw (with changes in cardiovascular risk factors. )Tj /F16 1 Tf 18.95 0 TD (Arterio-)Tj -18.95 -1.2 TD 0 Tw (sclerosis and Thrombosis)Tj /F7 1 Tf 10.05 0 TD ( 1991;11:1250\3201257.)Tj -11.25 -1.75 TD 0.025 Tc -0.055 Tw (Wolf AM, Gortmaker SL, Cheung L, Gray HM, Herzog)Tj 1.2 -1.2 TD 0.135 Tw (DB, Colditz GA. Activity, inactivity, and obesity:)Tj T* 0.131 Tw [(racial, ethnic, and age differences among s)-7 (c)19 (hool-)]TJ T* (girls.)Tj /F16 1 Tf 2.2 0 TD 0.194 Tw [( American Journal of Public Health)]TJ /F7 1 Tf 15.65 0 TD 0.2 Tw [( 1993;83:)]TJ -17.85 -1.2 TD (1625\3201627.)Tj -1.2 -1.7 TD 0.005 Tc -0.001 Tw (Wolf SL, Barnhart HX, Kutner NG, McNeely E, Coogler)Tj 1.2 -1.2 TD 0.199 Tw (C, Xu T, et al. Reducing frailty and falls in older)Tj T* -0.087 Tw (persons: an investigation of Tai Chi and computerized)Tj T* 0.176 Tw (balance training. )Tj /F16 1 Tf 7.6 0 TD 0.17 Tw (Journal of the American Geriatrics)Tj -7.6 -1.2 TD (Society)Tj /F7 1 Tf 2.85 0 TD -0.002 Tw ( 1996;44:489\320497.)Tj -4.05 -1.75 TD 0.015 Tc 0.227 Tw (Wolfson L, Whipple R, Derby C, Judge J, King M,)Tj 1.2 -1.2 TD 0.059 Tw (Amerman P, et al. Balance and strength training in)Tj T* -0.024 Tw (older adults: intervention gains and Tai Chi mainte-)Tj T* 0.019 Tc (nance. )Tj /F16 1 Tf 3.35 0 TD 0.25 Tw (Journal of the American Geriatrics Society)Tj /F7 1 Tf -3.35 -1.2 TD 0.015 Tc (1996;44:498\320506.)Tj -1.2 -1.75 TD 0.005 Tc 0.06 Tw (Woo R, Garrow JS, Pi-Sunyer FX. Effect of exercise on)Tj 1.2 -1.2 TD -0.011 Tw (spontaneous calorie intake in obesity. )Tj /F16 1 Tf 16.05 0 TD -0.01 Tw (American Jour-)Tj -16.05 -1.2 TD 0 Tw (nal of Clinical Nutrition)Tj /F7 1 Tf 9.7 0 TD ( 1982a;36:470\320477.)Tj 15.4 38.1 TD -0.03 Tw (Woo R, Garrow JS, Pi-Sunyer FX. Voluntary food intake)Tj 1.2 -1.2 TD -0.052 Tw (during prolonged exercise in obese women. )Tj /F16 1 Tf 18.25 0 TD (American)Tj -18.25 -1.2 TD 0 Tw (Journal of Clinical Nutrition)Tj /F7 1 Tf 11.4 0 TD ( 1982b;36:478\320484.)Tj -12.6 -1.75 TD 0.051 Tw (World Health Organization. Constitution of the World)Tj 1.2 -1.2 TD 0.16 Tw (Health Organization. )Tj /F16 1 Tf 9.4 0 TD 0.154 Tw (Chronicle of the World Health)Tj -9.4 -1.2 TD (Organization)Tj /F7 1 Tf 5.35 0 TD 0 Tw ( 1947;1:29\32043.)Tj -6.55 -1.75 TD -0.018 Tw (Wu AH, Paganini-Hill A, Ross RK, Henderson BE. Alco-)Tj 1.2 -1.2 TD 0.018 Tc 0.259 Tw (hol, physical activity, and other risk factors for)Tj T* 0.005 Tc -0.009 Tw (colorectal cancer: a prospective study.)Tj /F16 1 Tf 15.95 0 TD [( British Journal)]TJ -15.95 -1.2 TD 0 Tw (of Cancer )Tj /F7 1 Tf 4.1 0 TD (1987;55:687\320694.)Tj -5.3 -1.7 TD -0.003 Tc 0.189 Tw (Yano K, Reed DM, McGee DL. Ten\320year incidence of)Tj 1.2 -1.2 TD -0.064 Tw (coronary heart disease in the Honolulu Heart Program:)Tj T* 0.207 Tw (relationship to biologic and lifestyle characteristics.)Tj /F16 1 Tf T* 0 Tw (American Journal of Epidemiology)Tj /F7 1 Tf 13.45 0 TD [( 1984;119: 653)7 (\320666.)]TJ -14.65 -1.75 TD 0.015 Tc 0.259 Tw [(Yanowitz FG. Atherosclerosis: processes vs origins.)]TJ 1.2 -1.2 TD 0.005 Tc 0.022 Tw (In:Yanowitz F, editor.)Tj /F16 1 Tf 9.2 0 TD 0.021 Tw [( Coronary heart disease preven-)]TJ -9.2 -1.2 TD (tion)Tj /F7 1 Tf 1.55 0 TD -0.001 Tw (. New York: Marcel Dekker, 1992:17\32031.)Tj -2.75 -1.75 TD 0.213 Tw (Yu H, Harris RE, Wynder EL. Case-control study of)Tj 1.2 -1.2 TD 0.109 Tw (prostate cancer and socioeconomic factors. )Tj /F16 1 Tf 18.8 0 TD (Prostate)Tj /F7 1 Tf -18.8 -1.2 TD (1988;13:317\320325.)Tj -1.2 -1.75 TD -0.016 Tw (Zheng W, Shu XO, McLaughlin JK, Chow WH, Gao YT,)Tj 1.2 -1.2 TD 0.011 Tw (Blot WJ. Occupational physical activity and the inci-)Tj T* -0.017 Tw (dence of cancer of the breast, corpus uteri, and ovary)Tj T* 0.001 Tw (in Shanghai. )Tj /F16 1 Tf 5.45 0 TD (Cancer)Tj /F7 1 Tf 2.9 0 TD ( 1993;71:3620\3203624.)Tj -9.55 -1.75 TD 0.015 Tc 0.004 Tw (Zimmet P, Faaiuso S, Ainuu J, Whitehouse S, Milne B,)Tj 1.2 -1.2 TD 0.082 Tw (DeBoer W. The prevalence of diabetes in the rural)Tj T* -0.072 Tw (and urban Polynesian population of Western Samoa.)Tj /F16 1 Tf T* (Diabetes)Tj /F7 1 Tf 3.5 0 TD 0.001 Tw ( 1981;30:45\32051.)Tj -4.7 -1.7 TD 0.005 Tc -0.107 Tw (Zimmet PZ. Kelly West Lecture 1991 challenges in diabe-)Tj 1.2 -1.2 TD 0.189 Tw (tes epidemiology\321from West to the rest. )Tj /F16 1 Tf 18.7 0 TD (Diabetes)Tj -18.7 -1.2 TD (Care)Tj /F7 1 Tf 1.95 0 TD -0.001 Tw ( 1992;15:232\320252.)Tj ET PDFVars/TermAll get exec restore PDFVars/TermAll get exec %%EndDocument LH (%%[ Page: 1 ]%%) = %%PageTrailer %%Trailer Pscript_Win_Driver_Min dup /terminate get exec %%EOF 国产精品久久久久久一级毛片