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< Top 20 Athletes
< celebrates its 20th anniversary this week. We'll be highlighting some of the top teams, athletes and moments that characterized greatness in sports from 1995 to 2015.Michael Jordan, Michael Phelps, Serena Williams, Tiger Woods -- which athletes defined the pinnacle of sports over the past two decades? Our staff chose the following athletes as the best of the best. Athletes were limited to those whose careers existed or their crowning achievements occurred within the last 20 years.No. 20: Sidney CrosbyHe is still shy of 30, but if Crosby never stepped foot on the rink again, he'd still be a Hall of Famer. He passed the century mark in points in four of his first five seasons. In his third season, he led the Pittsburgh Penguins to a Stanley Cup finals berth. In his fourth, he hoisted the Cup himself. The following February at the 2010 Vancouver Olympics, he scored the gold medal-winning goal in overtime on home soil against the United States. And when he played his 600th NHL game this February, he had accrued 825 career points. The only players with more through their first 600 games? Wayne Gretzky (1,451), Mario Lemieux (1,215), Mike Bossy (921), Peter Stastny (901), Bobby Orr (864), Jari Kurri (848), Bryan Trottier (830) and Denis Savard (827). Hall of Famers, all.No. 19: Barry BondsOh, that swing. It was quick. And compact. And smooth. And masterful enough to log 73 home runs in a season and 762 in a career, both major league standard-setters. Bonds would go on to become one of the faces of baseball's darkest eras -- his milestones and career always, in some way, connected to performance enhancement. But on Aug. 7, 2007, Bonds passed baseball great Hank Aaron to stand alone as the all-time home run king. And there is at least one person for whom that is just fine. Said Bonds on the night the record fell: "This record is not tainted at all, at all."No. 18: Mia Hamm"When Mia came along, our game was nothing and nowhere," North Carolina's longtime women's soccer coach Anson Dorrance once said. "When she left it, it was something and significant." Yes, when Hamm retired in 2004, she left her mark. Her 158 goals in 275 matches stood as an all-time U.S. best until June 2013. She won a gold medal in Atlanta in 1996, then again in Athens in 2004. Oh, and in between, there was that Women's World Cup victory in 1999. She was something and significant, alright.No. 17: Floyd Mayweather Jr.Mayweather has stepped into the ring 47 times since 1996, and 47 times he has emerged victorious. But 47 times he faced an opponent not named Manny Pacquiao. The bout boxing fans the world over wanted to see was the one fight they never could ... until May 2, 2015. Until then -- and maybe after, too -- Mayweather's perfect record remains one of the Sweet Science's sweetest feats.No. 16: Usain BoltHis name is Bolt, which is appropriate, because he does. He. Flat. Out. Bolts. It took the Jamaican sprinter an Olympic-record 9.63 seconds in August 2012 to take home the gold in the Summer Games' marquee track event, the 100 meters. In true Bolt form, he repeated his unprecedented 2008 Beijing feat, winning the 100, 200 and 4x100 relay in a single Games. And in truest Bolt form, he crossed the finish line in London wagging his finger before taking a high-fiving victory lap around the track.No. 15: Brett FavreWhen your name is Brett Favre and you play in a cathedral called Lambeau Field, history nearly writes itself, even when you're not actually in Lambeau. There was the quarterback's 399-yard game, played in Oakland, California, just one day after his father's unexpected death in December 2003. Before that, he threw two touchdowns and ran for one more in his Super Bowl-winning performance in January 1997. But there was nothing quite like Favre in the frozen tundra, where he started his career 39-6 in sub-40-degree outings. Turns out a boy from Mississippi found his way to Wisconsin, and magic happened.No. 14: Tim DuncanIf there is such a thing as a quiet five-time NBA champion, Duncan is it. Who else, after all, could earn a nickname as unassuming and flashless as "The Big Fundamental?" But for 17-plus seasons, he has anchored the San Antonio Spurs -- the league's most consistent franchise this century -- not once missing the postseason. That means there is an entire generation of San Antonians that knows nothing but Duncan's penchant for sustained excellence. And for those convinced outlet passes, layups and rebounds do not a highlight reel make, Duncan's best asset as a player just might be his ability to elevate the four Spurs taking the court with him. And that a (five-time) champion does make.No. 13: Lance ArmstrongWho is Lance Armstrong? Is he the Tour de France legend who beat cancer and captured an unprecedented seven consecutive yellow jerseys from 1999 until 2005? Or is he merely cycling's exiled ex-star living in self-made purgatory, who lost those same jerseys (at least in the history books) amid a haze of performance-enhancing drugs and elaborate lies? Perhaps he is both -- at once the sport's most successful competitor and most abhorred history-maker.No. 12: Lionel Messi"I have seen the player who will inherit my place in Argentine football, and his name is Messi," said Diego Maradona, the Argentine great himself. And in January 2013, after claiming his fourth consecutive Ballon d'Or, Messi left little doubt. If there ever was such doubt to begin with. Because with Messi, it's another day, another broken record. Case in point: Just this month, the Barcelona forward tallied his 32nd career hat trick -- the most in Spanish football history. Don't blink or you'll miss another.No. 11: Shaquille O'NealThe Big Aristotle. The Big Cactus. The Big Shaqtus. Shaq. It was almost as though no one name was big enough to capture all 7-foot-1, 28,596 points worth of the four-time NBA champion. Nor one team. In all, O'Neal called six cities home, but he spent eight seasons -- by far his longest stint -- with the Los Angeles Lakers, much of it on a love-him-today-hate-him-tomorrow roller-coaster ride with Kobe Bryant. Still, they -- and we -- will always have their Game 7, 2000 Western Conference finals, comeback-sealing alley-oop. O'Neal's post-shot, arms-to-the-heavens, mouth-agape celebration was pure joy. In other words: pure Shaq.No. 10: Derek JeterOnce upon a time, a fourth-grader from Kalamazoo, Michigan, told his teacher he'd be a New York Yankee. And for 20 years, he was. He won five Fall Classics in Bronx pinstripes. He sent his 3,000th hit into the left-field stands, a home run. And in his last-ever trip to home plate in Yankee Stadium, he launched a first-pitch fastball into right field, heading into that Yankee sunset with a walk-off hit. The end. Was it a fairy tale? No, just Derek Jeter's Bronx tale.No. 9: Michael PhelpsThe summer of 2008 belonged to a 23-year-old and his swimming pool. Because that August, Phelps went to Beijing, collected eight gold medals and left China the most decorated gold medalist in Olympics history. In all, he has reached the Olympics podium on 22 occasions in his career, and a staggering 82 percent of the time, he did so with gold in hand.No. 8: Kobe BryantForget, for a moment, April 2013, when Bryant collapsed to the court, his Achilles ruptured and his season over. Look past March 2014, when the Lakers shut Bryant down again, this time with a fractured knee. Pay no mind to January 2015, when the L.A. institution succumbed to season-ending shoulder injury. Before all that, there was a shooting guard so singularly focused on winning, he returned to Philadelphia for the 2001 NBA Finals, telling his hometown the Lakers would "cut their hearts out." There was a Laker who dropped 81 points, second most for a single game in NBA history -- on a night in January 2006. And there was a Bryant who brought five titles (in 11 seasons) to Hollywood.No. 7: Peyton ManningPeyton Manning? "[He's] the best quarterback I've coached against," says Bill Belichick, who knows a thing or two about Canton-bound signal-callers. Manning's 530 touchdown passes are an NFL record. His 55 in 2013 alone are also. He has accrued more than 4,000 yards passing in 14 seasons, and that too is an NFL standard. And he stands with Favre as the only quarterbacks in NFL history to beat all 32 teams. Manning doesn't just win. He wins ... and wins ... and wins ... and wins.No. 6: Serena WilliamsThere is dominant, and then, there is Serena Williams. She is the No. 1 women's tennis player in the world yet hasn't lost to Maria Sharapova -- second-ranked and no slouch herself -- in 11 years. She has emerged victorious in 23 of her past 25 matches against top-10 players. And with 19 Grand Slam titles to her name, she has Steffi Graf's record (22) in her sights, with no sign of slowing down. "I feel like I'm doing everything better," the 33-year-old says. "Thirty is the new 20, I guess."No. 5: Roger Federer"Personally, I've gotten used to Roger breaking my records," Pete Sampras once said. What record, after all, has Federer not chased? He eclipsed Sampras' 14 Grand Slam titles in 2009, then tallied two more for good measure. He spent 302 weeks atop the ATP rankings, 16 more than Sampras, his closest competitor. And yet, there remains one record Federer hasn't yet claimed outright: He has matched, but not surpassed, Sampras' seven Wimbledon championships. Not even Federer, immortal though he once may have seemed, can fend off age and injury ... But there is one who believes the Swiss has one more left in him, and who knows better than Pete Sampras?No. 4: Tom Brady6: The draft round in which the New England Patriots tapped former Michigan quarterback Tom Brady 15 3: The times he has earned Super Bowl MVP 13: The years separating Brady's first Super Bowl win -- a 20-17 victory over the St. Louis Rams on Feb. 3, 2002 -- and his fourth, 0: The number of quarterbacks with more Super Bowl wins to his name. Only Joe Montana and Terry Bradshaw join Brady as four-time champions, and that, we think, is some all-time company.No. 3: Tiger WoodsOn June 15, 2008, Tiger Woods stood 15 treacherous feet away from Torrey Pines' 18th hole. One shot shy of U.S. Open leader Rocco Mediate, it was birdie or bust for the world's best golfer on Father's Day. He pulled his putter back. He struck the ball. The ball nearly lipped out, and then:"Expect anything different?" NBC announcer Dan Hicks said.The ball found the hole. Of course, it found the hole. It might seem like an eternity ago -- seven years is an eternity in the life of an athlete -- but for a moment, there was no surer thing than Woods. He collected 14 majors in 12 years' time, and even if there are no more to come, even if today's Woods is but a shell of the early-aughts era legend, we saw Tiger prowling the greens in red and black. So we saw greatness.No. 2: LeBron JamesWhen the Cleveland Cavaliers selected hometown kid James with the first pick of the 2003 NBA draft, we were all witnesses. When the King took his talents to South Beach seven years later, we were all witnesses. And four years after that, when James announced he was coming home, we were all witnesses. There were five championship appearances, two titles won and four MVP honors in between. He was beloved, reviled, then beloved again, and all before he was 30.No. 1: Michael JordanThe tongue. The clincher. The flu. The fax. Yes, the '90s belonged to His Airness -- and every last moment he left in his iconic wake. Jordan won back-to-back-to-back championships starting in the 1995-96 season -- and as many Finals MVPs -- but above all else, he gave rise to an entire generation that just wanted to be like Mike. "I think he's God, disguised as Michael Jordan," Larry Bird once said ... along with just about every other sports fan who had the privilege to watch Jordan elevate the game of basketball to an art form.Captions written by ESPN The Magazine writer Hallie Grossman.Heart attack risks are greater for athletes who compete in endurance sports
Endurance athletes who exercise for three hours or more have an increased chance of dying from a cardiac arrest
About 1 in 50,000: if you run marathons or participate in other forms
of exercise which last for three hours or more, that's your approximate
risk of suffering an acute heart attack or sudden cardiac death during
- or within 24 hours of - your effort. For every 50,000 athletes,
one will be stricken during such prolonged activity(1). Running a
marathon or cycling intensely for three hours is riskier than taking
a commercial airline flight, even in these troubled times!
You might think we shouldn't make such a claim in a newsletter which
appeals to serious competitors, including a large number of marathon
runners. But at Peak Performance our job is to provide you with all
the facts about your sport, not just the pretty ones.
The truth is that marathon runners, ironman triathletes and long-distance
cyclists, swimmers, rowers and cross-country skiers are all in the
same boat. In fact, any athlete who participates in a strenuous test
of endurance lasting about three hours or more has an increased chance
of dying during - and for 24 hours following - the exertion, even
when the athlete's chance of a death-door knock is compared with the
risk incurred by a cigarette-smoking, sedentary layabout who spends
the same 24 hours drinking beer and watching TV. The reasons for this
are not entirely clear, but the heightened risks of a visit from the
Grim Reaper are unsettling to most athletes, especially those who
exercise in the hope of improving cardiovascular and overall health.
To find out why strenuous exercise temporarily increases the risk
of death, researchers at the University of Innsbruck in Austria recently
studied 38 male participants in the 1999 Tyrolean Otztaler Radmarathon,
a cycling race which covers 230k, with an altitude change of 5,500m.
The Radmarathon is often said to be comparable in difficulty to the
hardest mountain stages of the Tour de France (2).
All 38 subjects were experienced, well-trained amateur cyclists who were free of cardiovascular risk factors and without evidence of heart disease. The Austrian researchers were especially interested in monitoring their blood levels of a specific heart
called cardiac troponin I, which happens to be the most sensitive and specific marker for the detection of heart-muscle death.
Cardiac troponin I values, which were essentially at zero in all athletes before the beginning of the Radmarathon (thankfully, since you don't want your heart to start dying on you just before you begin a 230k bike race!) increased in 13 (34%) of the cyclists immediately after the competition. The risk factors for elevated cardiac troponin I included:
age - being young was 'bad';
race time - racing fast increased the risk, and the highest post-race cardiac troponin 1 level was detected in the athlete with the fastest R
pre-race training distance - the higher the overall training volume, the greater the chances of increased cardiac troponin I after the race.
Taken together, these results suggested that younger, fitter athletes, who put more stress on their hearts (via greater training volume and higher racing intensities), were the ones most likely to incur myocardial damage.
Why heart muscle cells may die during prolonged exercise
Why were cardiac troponin I concentrations up after the Austrian race?
According to the researchers, many of the well-trained athletes probably
experienced sub-clinical cardiac injury during the event and this
was associated with the actual deaths of heart-muscle cells. The mechanism
underlying such cardiac cell deaths is unknown, although one popular
theory suggests that the heightened adrenaline/noradrenaline levels
sometimes observed during prolonged exercise rather perversely lead
to the constriction of coronary arteries, which results in localised
cell death within the heart. (Adrenaline and noradrenaline - also
known as epinephrine and norepinephrine - are hormones released by
the adrenal glands in response to stressful situations.)
Heart-cell death during strenuous exercise? Yes, it is a bit like
having a small heart attack at the same time that your heart is performing
magnificently! In fact, cardiac troponin I is usually undetectable
in the blood serum of healthy people but is typically found in those
who have suffered a myocardial infarction (heart attack), congestive
heart failure, or myocarditis (inflammation of the heart muscle).
In fact, the enzyme is used predictively by heart specialists: the
higher the level in a particular patient, the poorer his prognosis.
This sounds bad! But has anyone besides the Austrians uncovered evidence
of heart-structure damage after strenuous exercise? Actually, yes:
one study of finishers in the Hawaii Ironman Triathlon found that
9% displayed elevated cardiac troponin 1 levels and, further, that
these individuals also exhibited abnormal heart wall action and function
during echocardiographic analyses(3). Another investigation found
cardiac-troponin increases in 11% of the finishers of an alpine cross-country
marathon (4).
Is the positive post-exercise increase in cardiac troponin I really something to worry about? Were the heart cell deaths merely a small piece of the cardiac pie? Could the lost cells be replaced by regrowth of healthy heart tissue? These key questions are very difficult to answer, especially as no histological analyses of heart tissue were performed as part of these studies, and neither were echocardiograms or electrocardiograms (ECG) carried out to determine whether heart function was impaired. To play it safe, the Austrian researchers suggested that endurance athletes 'should at least undergo serial cardiovascular examinations looking for subtle evidence of myocardial dysfunction'.
The good news for endurance athletes on the cardiac front
Before you get too spooked by these findings, bear in mind that there
is also some good news for endurance athletes on the cardiac front.
For one thing, it's clear that regular exercise protects you from
heart attacks ov for example, over the course
of a year regular exercisers will have fewer cardiac failures than
their sedentary counterparts. Also, some studies have not linked extremely
strenuous exercise with cardiac damage: for example, when sports medicine
specialists at the University of California studied 23 ultramarathon
runners who completed the 100-mile Western States Endurance Run, a
rugged race through the Sierra Mountains over steep terrain and through
temperature extremes, they were unable to find any race-related cardiac
damage (5).
The 23 runners completed the 100-mile race in an average time of 23.5
hours, with a range of 18.9-27.1; their ages ranged from 29 to 62
(with an average of 45) and all but three were men, none with a history
of heart disease. Although all of the subjects suffered massive skeletal
muscle damage during the competition (as evidenced by huge increases
in serum creatine kinase levels after the race), not a single runner
exhibited heightened cardiac troponin levels after the extremely prolonged
exertion was over.
None the less, an increasing body of evidence indicates that some heart damage can occur during extreme exercise. In the very latest study completed at Massachusetts General Hospital and the Harvard Medical School, researchers tracked 82 runners with an average age of 47 who ran the Boston Athletic Association Marathon for five consecutive years, from 1997 to 2001. These runners had no history of coronary disease, were non-smokers and averaged 25 training miles per week(6). But their cardiac troponin I levels increased roughly 6.5-fold both four and 24 hours post-race.
No one knows how long exertion related heart damage lasts
Again, we must pose the key question - is this exertion-related damage to the heart long-lasting, or does the heart recover promptly without long-term negative effects? Unfortunately, no one knows the answer to this question right now. If you are interested in running marathons, you will have to decide for yourself if the real risk associated with the race is tolerable or not - and whether the long-term perceived risk is serious enough to warrant changing your competitive activities.
Our traditional argument that prolonged endurance activity is not
bad for the heart is based on evidence that marathon runners have
fairly low death rates from cardiovascular disease (when you look
at them away from the race itself and the 24-hour 'window' that follows
it). Essentially, research indicates that well-trained endurance athletes
have about 40% of their sedentary counterpart's risk of dying from
a cardiac problem on a typical day (7). If strenuous exercise is really
so bad for the heart, why aren't endurance athletes keeling over at
higher rates?
Note, though, that this latter argument is not entirely compelling.
It is possible that marathoners might have even lower frequencies
of heart attacks if they gave up marathoning and focused on shorter
events which are less taxing for the heart. In support of this theory,
former marathon runner Dr Arthur J Siegel of McLean Hospital in Belmont,
Massachusetts (one of the investigators in the study cited above)
recently told Reuters Health that running a marathon is, in effect,
like overdosing on a good thing. With a more moderate approach, cardiovascular
risk would still be lowered, while the elevated risks associated with
marathon-like events would be avoided. Add marathon efforts to the
brew, and you get the general reduction in risk but with an added
risk associated with the race itself (and perhaps its long preparatory
If you are having second thoughts about running marathons, you should know that the previously quoted rate of one death per 50,000 marathon runners might be a bit high. For example, there is evidence that in male runners aged 30-64 who have not been diagnosed with heart disease, there is approximately one death for each 800,000 'person-hours' of running or jogging (8). This implies that if 800,000 healthy middle-aged males began running the New York City Marathon, one of them would probably die during the first hour of the event, another during the second hour and another during the third. This kind of death rate would create some bad publicity, so it is a good thing that the New York Marathon limits the number of entrants to less than 30,000 (thus trimming the incidence of death to about one every seven years). If one assumes an average finishing time of four hours, the 800,000 figure projects a death rate of one per 200,000 marathon entrants, considerably lower than the earlier estimate of one in 50,000. Incidentally, it is known that females have a much lower risk, although the relative mortality rate has not been quantified.
Expressing the 800,000 statistic in a different way, we can say that healthy, middle-aged males who run for one hour each day can expect to die while running once every 2,192 years (800,000 hours divided by 365 hours of running per year = 2,192 years). By the same token, individuals who run two hours per day should die while running about once every 1,096 years. When the risks are seen in this light, many endurance athletes will consider them acceptably low, especially as the general risk of heart disease is reduced by strenuous training.
Heart deaths are not random events
In addition, when deaths do occur, they are certainly not random providential events. Post-mortem analyses usually reveal that something was wrong with a dead athlete's heart prior to the race (no surprise there). For example, in the study which led to the death estimate of one per 50,000 marathon entrants, a total of 215,413 runners who competed in either the Marine Corps Marathon from 1976 to 1994 or the Twin Cities Marathon from 1982 to 1994 were monitored. Three of these 215,413 runners died during their races (always after the 15-mile point) and one succumbed shortly after completion of the event. Autopsies revealed that three of the runners actually had atherosclerotic coronary artery disease (narrowing of two or three key coronary vessels), even though they were symptom-free before the races. The fourth victim (also symptom-free before death) had an anatomical defect related to the left main coronary. Thus, marathon racing didn't destroy these athletes' hearts as they paced along the streets of Washington or Minneapolis but rather uncovered 'weak links' in their cardiac systems which could not stand up to several hours of strenuous, continuous exercise.
This brings us to the issue of screening: could you take a test which might reveal that your heart was vulnerable to trouble during strenuous exercise? The relevant test in this case would, of course, be an exercise stress test, during which an ECG reading is taken as you run at increasing intensities on a treadmill. These 'exams' can frequently unmask fat-filled coronary arteries.
Unfortunately, the tests do not have a very high predictive value since as many as 63% of those who 'fail' a stress test actually have completely normal cardiovascular systems(9). Furthermore, the rate of such 'false positives' among endurance athletes can be 100% (ibid), because the natural thickening of the heart in response to endurance training changes ECG readings!
This high frequency of 'wrong calls' is troubling, not only because of the inaccuracies associated with stress testing it reveals but because many of those with false positive results are then subjected to more rigorous and invasive medical procedures, including thallium stress testing (in which a dye is placed in the bloodstream during exercise) or coronary catheterisation (in which a long tube is snaked through blood vessels into the heart). These tests are expensive
in fact, coronary catheterisations may be riskier than marathons!
None the less, about 34% of physicians who run the Boston Marathon believe that people should undergo an exercise stress test before beginning a strenuous exercise programme(10). Interestingly enough, though, only about half of these doctors actually permitted stress tests to be performed on themselves before they began training for Boston!
Stress tests carry their own risks
One reason for this 'do as I say, not as I do' attitude may be that stress tests themselves are not without risk. The risk of dying during a stress test is a matter for debate, but has been estimated at anything between 1-in-20,000(11) and 1-in-500,000 tests(12). As you can quickly calculate for yourself, if the true stress test death rate happened to be 1-in-25,000 and the true marathon death rate stayed at 1-in-50,000, and if stress testing was used to 'screen' marathon entrants, two people would be killed during stress testing for every one athlete potentially saved!
There's more! The vast majority of individuals who die during or shortly after exercise would have had completely normal stress tests, even if the tests were given the day before they died (13). Some experts believe that stress testing can only detect about 20-25% of the likely victims of sudden, exercise-related death.
None the less, if you have one or more of the known risk factors for coronary disease (obesity, diabetes, cigarette smoking, high total cholesterol, low HDL-cholesterol, high blood pressure, high stress levels, or a family history of heart disease) you may want to talk to your doctor about stress testing. If you happened to be in that 20-25% group, it would be helpful to have your cardiovascular problem detected.
Distance eventers should look for signs of heart trouble
Whether or not you have risk factors for heart disease, if you compete in distance events you should monitor yourself closely for premonitory symptoms of heart trouble. The warning signs we all know about include chest discomfort or squeezing, throat tightness, and pain that radiates into the jaw or left arm. There are other signs of trouble which are less well-known, including unusual fatigue. If you are uncharacteristically tired and are confident that this is not due to an increased training load or a recent infection, don' mention the problem to your doctor and see if you can arrange for a routine physical examination.
In addition, a sudden, unexplained drop-off in performance which is
not associated with overtraining could also indicate that something
is amiss with your ticker, as could the sudden onset of heart palpitations.
Finally, be particularly wary of chest discomfort of any kind which
appears during exercise and then disappears afterwards. Angina often
does not express
typical symptoms include squeezing
sensations in the chest, and feelings of pressure or chest tightness.
It is possible that up to 50% of people who have heart attacks while
exercising experience a fair number of small warning signals during
the days or weeks leading up to the attack - so watch out! As noted
US cardiologist Paul Thompson points out, 'If you think there is something
wrong, there usually is, and a physician should be consulted'.
Pheidippides, one of the first endurance athletes in recorded history, dropped dead shortly after his 21-mile, 1,470-yard run from the plain of Marathon to the agora of Athens in 490 BC. True, no autopsy was performed on the Greek messenger, and his death could have been caused by dehydration or an unsettling encounter with the god Pan in the mountains north of Athens (described in some early accounts of this first 'marathon'). In addition, we don't know how fit Pheidippides was before his fateful run, which certainly would have delivered a great shock to an untrained cardiovascular system. None the less, it is certain that exertion-related deaths do occur at a low frequency, even in well-trained athletes. The paradox of exercise is that it increases your risk of dying at the same time that it reduces it.
Owen Anderson
References
1. Journal of the American College of Cardiology, vol 28, pp 428-431, 1996
2. American Journal of Cardiology, vol 87, pp 369-371, 2000
3. American Journal of Cardiology, vol 83, pp , 1999
4. Journal of the American Medical Association, vol 282, p19, 1999
5. American Journal of Cardiology, vol 80, pp 379-380, 1997
6. American Journal of Cardiology, vol 88, pp 920-923, 2001
7. New England Journal of Medicine, vol 311, pp 874-877, 1984
8. Journal of the American Medical Association, vol 247(18), pp , 1982
9. New England Journal of Medicine, vol 293, pp 367-371, 1975
10. The New England Journal of Medicine, vol 301, pp 792-793, 1979
11. Chest, vol 77, pp 94-97, 1980
12. Running Research News, vol 5(6), pp 1, 6-10, November-December 1989
13. The New England Journal of Medicine, vol 321, pp 320-324, 1989
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