***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background Significant regression of coronary and femoral atherosclerotic lesions has been documented by angiographic studies using aggressive lipid-lowering treatment . This study tested the applicability and effects of intensive physical exercise and low-fat diet on coronary morphology and myocardial perfusion in nonselected patients with stable angina pectoris . Methods and Results Patients were recruited after routine coronary angiography for stable angina pectoris ; they were r and omized to an  intervention group ( n = 56 ) and a  control group on “ usual care ” ( n = 57 ) . Treatment comprised intensive physical exercise in group training sessions ( minimum , 2 hr/wk ) , daily home exercise periods ( 20 min/d ) , and low-fat , low-cholesterol diet ( American Heart Association recommendation , phase 3 ) . No lipid-lowering agents were prescribed . After 12 months of participation , repeat coronary angiography was performed ; relative and minimal diameter reductions of coronary lesions were measured by digital image processing . Change in myocardial perfusion was assessed by 201TI scintigraphy . In patients participating in the intervention group , body weight decreased by 5 % ( p<0.001 ) , total cholesterol by 10 % ( p<0.001 ) , and triglycerides by 24 % ( p<0.001 ) ; high density lipoproteins increased by 3 % ( p = NS ) . Physical work capacity improved by 23 % ( p<0.0001 ) , and myocardial oxygen consumption , as estimated from maximal rate-pressure product , by 10 % , ( p<0.05 ) . Stress-induced myocardial ischemia decreased concurrently , indicating improvement of myocardial perfusion . Based on minimal lesion diameter , progression of coronary lesions was noted in nine patients ( 23 % ) , no change in 18 patients ( 45 % ) , and regression in 13 patients ( 32 % ) . In the control group , metabolic and hemodynamic variables remained essentially unchanged , whereas progression of coronary lesions was noted in 25 patients ( 48 % ) , no change in 18 patients ( 35 % ) , and regression in nine patients ( 17 % ) . These changes were significantly different from the intervention group ( p<0.05 ) . Conclusions In patients participating in regular physical exercise and low-fat diet , coronary artery disease progresses at a slower pace compared with a control group on usual care The intravenous infusion of adenosine provokes  anginalike chest pain .  To establish its origin , an intracoronary infusion of increasing adenosine concentrations was given in 22 patients with stable angina pectoris . During adenosine infusion , 20 patients had chest pain without electrocardiographic signs of ischemia . They all reported that the chest pain was similar to their usual anginal pain . In 10 of the 22 patients adenosine was also infused into the right atrium , but it never produced symptoms at the doses that had provoked chest pain during intracoronary infusion . In seven other patients , the intracoronary adenosine infusion was repeated after intravenous administration of aminophylline , an antagonist of adenosine P1-receptors . Aminophylline decreased the severity of adenosine-induced chest pain ( assessed with a visual analog scale ) from 42 + /- 22 to 23 + /- 17 mm ( p less than 0.002 ) . In the remaining five of the 22 patients , monitoring of blood oxygen saturation in the coronary sinus during intracoronary adenosine administration showed that maximum coronary vasodilation was achieved at doses lower than those responsible for chest pain . A single-blind , placebo-controlled , r and omized trial of the effect of aminophylline on exercise-induced chest pain was also performed in 20 other patients with stable angina .  Aminophylline , compared with placebo , decreased the severity of chest pain at peak exercise from 67 + /- 21 to 51 + /- 23 mm ( p less than 0.02 ) , despite the achievement of a similar degree of ST-segment depression . Finally , the effect of intravenous adenosine was compared in 10 patients with predominantly painful myocardial ischemia and in 10 patients with predominantly silent ischemia . ( ABSTRACT TRUNCATED AT 250 WORDS Background Angina affects more than 50 million people worldwide . Secondary prevention interventions such as cardiac rehabilitation are not widely available for this population . An Internet-based version could offer a feasible alternative . Objective Our aim was to examine the effectiveness of a Web-based cardiac rehabilitation program for those with angina . Methods We conducted a r and omized controlled trial , recruiting those diagnosed with angina from general practitioners ( GPs ) in primary care to an intervention or control group . Intervention group participants were offered a 6-week Web-based rehabilitation program ( “ ActivateYourHeart ” ) . The program was introduced during a face-to-face appointment and then delivered via the Internet ( no further face-to-face contact ) . The program contained information about the secondary prevention of coronary heart disease ( CHD ) and set each user goals around physical activity , diet , managing emotions , and smoking . Performance against goals was review ed throughout the program and goals were then reset/modified . Participants completed an online  exercise diary and communicated with rehabilitation specialists through an email link/synchronized chat room . Participants in the control group continued with GP treatment as usual , which consisted of being placed on a CHD register and attending an annual review . Outcomes were measured at 6-week and 6-month follow-ups during face-to-face assessment s. The primary outcome measure was change in daily steps at 6 weeks , measured using an accelerometer . Secondary outcome measures were energy expenditure ( EE ) , duration of sedentary activity ( DSA ) , duration of moderate activity ( DMA ) , weight , diastolic/systolic blood pressure , and body fat percentage . Self-assessed question naire outcomes included fat/fiber intake , anxiety/depression , self-efficacy , and quality of life ( QOL ) . Results A total of 94 participants were recruited and r and omized to the intervention ( n=48 ) or the usual care  ( n=46 ) group ; 84 and 73 participants completed the 6-week and 6-month follow-ups , respectively . The mean number of log-ins to the program was 18.68 ( SD 13.13 , range 1 - 51 ) , an average of 3 log-ins per week per participant . Change in daily steps walked at the 6-week follow-up was + 497 ( SD 2171 ) in the intervention group and –861 ( SD 2534 ) in the control group ( 95 % CI 263 - 2451 , P=.02 ) . Significant intervention effects were observed at the 6-week follow-up in EE ( + 43.94 kcal , 95 % CI 43.93 - 309.98 , P=.01 ) , DSA ( –7.79 minutes , 95 % CI –55.01 to –7.01 , P=.01 ) , DMA ( + 6.31 minutes , 95 % CI 6.01 - 51.20 , P=.01 ) , weight ( –0.56 kg , 95 % CI –1.78 to –0.15 , P=.02 ) , self-efficacy ( 95 % CI 0.30 - 4.79 , P=.03 ) , emotional QOL score ( 95 % CI 0.01 - 0.54 , P=.04 ) , and angina frequency ( 95 % CI 8.57 - 35.05 , P=.002 ) . Significant benefits in angina frequency ( 95 % CI 1.89 - 29.41 , P=.02 ) and social QOL score ( 95 % CI 0.05 - 0.54 , P=.02 ) were also observed at the 6-month follow-up . Conclusions An Internet-based secondary prevention intervention could be offered to those with angina . A larger pragmatic trial is required to provide definitive evidence of effectiveness and cost-effectiveness . Trial Registration International St and ard R and omized Controlled Trial Number ( IS RCT N ) : 90110503 ; http://www.controlled-trials.com/IS RCT N90110503/IS RCT N90110503 ( Archived by WebCite at http://www.webcitation.org/6RYVOQFKM ) Background Exercise training has been shown to reduce angina and promote collateral vessel development in patients with coronary artery disease . However , the mechanism whereby exercise exerts these beneficial effects is unclear . There has been increasing interest in the use of whole genome peripheral blood gene expression in a wide range of conditions to attempt to identify both novel mechanisms of disease and transcriptional biomarkers . This protocol describes a study in which we will assess the effect of a structured exercise programme on peripheral blood gene expression in patients with stable angina , and correlate this with changes in angina level , anxiety , depression , and exercise capacity . Methods / Design Sixty patients with stable angina will be recruited and r and omised 1:1 to exercise training or conventional care . Patients r and omised to exercise training will attend an exercise physiology laboratory up to three times weekly for supervised aerobic interval training sessions of one hour in total duration . Patients will undergo assessment s of angina , anxiety , depression , and peripheral blood gene expression at baseline , after six and twelve weeks of training , and twelve weeks after formal exercise training ceases . Discussion This study will provide comprehensive data on the effect of exercise training on peripheral blood gene expression in patients with angina . By correlating this with improvement in angina status we will identify c and i date peripheral blood transcriptional markers predictive of improvements in angina level in response to exercise training . Trial Registration Clinical trials.gov identifier : OBJECTIVE To determine the importance of the duration and intensity of “ warm up ” exercise for reducing ischaemia during second exercise in patients with exertional angina . DESIGN R and omised crossover comparison of three warm up exercise protocol s. PATIENTS 18 subjects with stable ischaemic heart disease and > 0.1 mV ST segment depression on treadmill exercise testing . INTERVENTIONS The warm up protocol s were 20 minutes of slow exercise at 2.7 km/h , symptom limited grade d exercise for a mean of 7.4 ( range 5.0 to 10.5 ) minutes , and three minutes of symptom limited fast exercise of similar maximum intensity . MAIN OUTCOME MEASURES ST segment depression during grade d treadmill exercise  undertaken 10 minutes after each warm up protocol or no warm up exercise . RESULTS Compared with exercise with no warm up , the duration of grade d exercise after earlier slow warm up increased by 4.9 % ( 95 % confidence interval ( CI ) , −3.3 % to 13.7 % ) , after grade d warm up by 10.3 % ( 95 % CI , 5.6 % to 15.2 % ) , and after fast warm up by 16 % ( 95 % CI , 6.2 % to 26.7 % ) . ST segment depression at equivalent submaximal exercise decreased after slow warm up by 27 % ( 95 % CI , 5 % to 44 % ) , after grade d warm up by 31 % ( 95 % CI , 17 % to 44 % ) , and after fast warm up by 47 % ( 95 % CI , 27 % to 61 % ) . Compared with slow warm up exercise , the more intense grade d and fast warm up protocol s significantly increased the duration of second exercise ( p = 0.0072 ) and reduced both peak ST depression ( p = 0.0026 ) and the rate of increase of ST depression ( p = 0.0069 ) . CONCLUSIONS In patients with exertional angina the size of the warm up response is related to the maximum intensity rather than the duration of first exercise This study aims to develop and test the feasibility of a 12-week Mobile Application Programme ( M.A.P. ) to support self-management in cardiac patients with stable angina . A Mobile Application Programme will be developed by the study team . A pilot r and omized controlled trial will be adopted to examine the feasibility and potential effectiveness of the M.A.P .. A convenience sample of 40 stable angina patients recruited from the National University Heart Centre will be r and omly assigned either to the 12-week M.A.P. intervention group or the control group . Data will be collected at baseline , at the 4th and 12th week of the programme . At the end of the intervention period , a process evaluation will be conducted to further assess the acceptability , usability , strengths and weaknesses of the  M.A.P.  intervention based on the participants ' perspectives . All quantitative data obtained will be analysed using IBM SPSS 21.0 , while content analysis will be used for qualitative data sets Background It is unclear how much of the reduction in cardiac mortality in coronary heart disease ( CHD ) patients with exercise training  is the result of direct effects on the heart and coronary vasculature , or to indirect effects , via primary risk factors . Objective The aim of this article was to quantify the cardiac mortality benefits of exercise-based rehabilitation attributable to risk factor reductions versus the direct effects on the heart and vasculature . Methods The IMPACT coronary heart disease model was used to examine the reduction in cardiac mortality attributable to changes in risk factors from a meta- analysis of cardiac rehabilitation r and omized , controlled trials . Patients were receiving rehabilitation following an acute myocardial infa rct ion , angina pectoris or revascularization . Outcomes considered were primary risk 
    Output:
    
Due to the small number of trials and their small size , potential risk of bias and concerns about imprecision and lack of applicability , we are uncertain of the effects of exercise-based CR compared to control on mortality , morbidity , cardiovascular hospital admissions , adverse events , return to work and health-related quality of life in people with stable angina .
Low- quality evidence indicates that exercise-based CR may result in a small increase in exercise capacity compared to usual care .