Rheumatoid arthritis is an inflammatory disease of unknown etiology in which the adverse vascular effects are perpetuated by activity which causes pain, and by cooling of the body. These conditions stimulate a reflex sympathetic neurovascular response, or reflex sympathetic dystrophy, which interferes with the circulation and nutrition of the synovea, the periarticular bone and the connective tissues around the joints. The reflex sympathetic dystrophy causes arteriolar construction reducing blood flow through the capillaries, dilatation of arteriovenous anastomoses bypassing the capillary beds, venous constriction causing venous congestion and backflow into the capillaries with stasis and edema. As a result of this dystrophic response the oxygenation and nutrition of the joints is diminished, stasis causes a retention of metabolites, the pO₂ and pH are decreased, the pCO₂ increased, and edema persists in the area. All of these responses aggravate and prolong the inflammation. Removal of the critical stimuli of mechanical pain and cold allows a more normal circulation and the inflammation subsides. This response in bone promotes osteoporosis. In connective tissue the dystrophic response produces edema with increased fibrosis or distortion of tissues in the presence of prolonged stretch.

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Modification of the Master's two step test was attempted in order to apply for the rehabilitation of cardiac patients. Our modified method was called “Variable Intensity Method”. In this method, the intensities of the exercises were classified as 25% (I 25%), 50% (I 50%), 75% (I 75%) and 100% of double two step test's trips (I 100%). Three minutes of exercise period was employed in this method. Patients who had suffered from myocardial infarction within three months or more than six months before and healthy individuals as control were examined in the present study. Heart rate (HR), blood pressure (BP), pressure rate product (PRP), Katz' cardiac effort index, electrocardiography (ECG) and O₂ consumption (VO₂) of the subjects were assessed.
Comparison was made between our “Variable Intensity Method” and ordinary “Variable Duration Method” in which intensity of exercise was 100% of double two step test's trips, and its durations were set to 25% (D 25%; 45 seconds), 50% (D 50%; 1.5 minutes, single two step test) and 100% of double two step test's duration (D 100%; 3 minutes, double two step test).
The results were as follows:
1. HR, PRP, Katz' Index and VO₂ increased clearly correlated with the work load in the “Variable Intensity Method”. On the other hand, in the “Variable Duration Method”, VO₂ and cardiovascular responses except BP were significantly higher at D 25% or D 50% than I 25% or I 50%.
2. There were no significant differences between patients with old myocardial infarction and age matched healthy individuals in terms of all the parameters. However elderly people with or without myocardial infarction showed some significant differences from young healthy subjects in HR, diastolic BP, Katz' index and VO₂.
3. Among the seven patients in recovery phase of myocardial infarction, only one could tolerate all work loads. The increase in the work load had to be given up in most of the cases because of fatigue in the lower extremities, abnormal responses of ECG pattern, excess responses of HR, and inability of stepping in the scheduled speed.
The results collectively showed the usefulness of “Variable Intensity Method” for cardiac rehabilitation. This method was safe and simple to perform and those advantages should be appreciated.

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