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December 5, 1980

Cardiac Rehabilitation

Author Affiliations

Lifestyle Corporation Lawndale, Calif

JAMA. 1980;244(22):2521. doi:10.1001/jama.1980.03310220023015

To the Editor.—  I object to the defeatism in Wenger's article on cardiac rehabilitation. The studies she cites to support her views that physical activity after myocardial infarction cannot alter the natural history of the illness are not really relevant. Bassler1 has estimated that 16,000 km are needed to improve angiograms—an awesome exercise prescription to say the least. Exercise must be performed in units above the threshold of 10 km to be effective (242:322, 1979). However, Wenger cites the work of Nolewajka and associates2 that involves patients who smoke and exercise below the protective threshold. No one could expect angiograms to improve in seven months under these conditions, and, certainly, Wenger cannot use this study as an index of limitations of exercise therapy.I am using the prescription of "10,000 miles in 6-mile units" with the goal of altering the natural course of the disease. I believe that