University of Minnesota

Ralph Paffenbarger, Jr.

Year: April 30th, 2001
Location: Berkeley, California
Interviewed by: Blackburn, Henry


Ralph Paffenbarger is a pioneer of CVD epidemiology who combined his passion for running and athletics with expertise in the epidemiology of physical activity and coronary heart disease (CHD). He describes how James Watt, his USPHS colleague in the study of diarrheal diseases, after heading up the National Heart Institute, facilitated his entry into cardiovascular disease epidemiology, assigned him to the Framingham Study and then promoting him in his hobby. The hobby, studying the association of youthful athletism and continued activity with CVD risk, became his lifetime preoccupation in the pioneering Alumni Study of alumni from Harvard University and the University of Pennsylvania. This he accomplished with careful design and simple, straightforward, verifiable records and questionnaires.

Here he speaks about this work and about his long collegial relations with Jeremy Morris from the London School of Hygiene and some of the limitations of the early research on physical activity. He has gone on to expand these studies in a many-decades collaboration with I-Min Lee at Harvard to examine continuing questions about frequency, duration, intensity, and continuity of activity in regard to subsequent CVD risk.

Paffenbarger remains productive despite a dramatic change in lifestyle from marathon and 100K-run awards to post-myocardial infarction disability. With his wife and bull terrier Herr Morgen, he builds an adobe home in the southwest and enjoys regular telephone conversations with his long-term friend and Olympic Gold Medalist companion, Jeremy Morris of London. (HB)


Mentored by Paul Dudley White

In 1958 I had an interview with him (Paul White) when Watt was getting me ready to come to Framingham. And at the end of our conversation, and chicken sandwich and malted milk – three of us, Paul Dudley White, myself and another fellow from CDC, I said, “Dr. White, what do I need to know about coronary heart disease?”

He said, “Well, if I were going to start over at the moment, I would look at energy expenditure, physical activity, how does it influence the risk of disease and risk of recurrence; what kind of secondary preventive measures are available?” So here I am now at Framingham, half way between Framingham and the School of Hygiene and I was the lowest grade instructor. . .still in service and an instructor under Brian McMahon at the School of Public Health.

Origins of the Classic Alumni Study

I had the idea that if I could get back to some predocumented data and bring it up to date and then continue with the follow-up study, that I could look at prediction in university health records. [And the rest is history!]

Well, yes. Except there’s more to it. Jim Watt didn’t push me to do this right away. So I said, “Gee, I’d better go around and look at university records. So I came to Ohio State, my old red brick university. I also came to UC Berkeley and they got their old records out. I even went to the University of Minnesota briefly and to military academies…..What I needed were records of people from long ago and adequate alumni activity for the follow-up, and permission to use those records, plus a way to get death certificates. Those kinds of things. Here I was in Boston where I looked at Harvard and I at MIT and at Yale. I looked at all the women’s records, too. I just made a little trip around and spent a whole year at it.

I chose Harvard partially because it was close and the records were very good from 1916 to 1950, extensive records taken within the first six weeks of entering Harvard. You have to take your six-week exam in order to be considered an alumnus of Harvard. You can take that exam and never come back to a day of class and you’re still a Harvard College alumnus. So all those people are followed by alumni activity, you see. Then I went down to Pennsylvania because I knew that students there between 1928 and 1950 had a pulmonary test of some kind. I thought it would be good to follow these people up.

So I’m making a long story longer, I’ve included both Harvard and Pennsylvania alumni, covering the period of college entrance between 1916 and 1950, men born essentially between 1896 and 1934. So these men we followed now and I have just a magnificent associate, my boss now back at Harvard, I-Min Lee who will take these data over and I hope that we’ll follow that group of 71,000 people until the last man’s gone. Just like Framingham is doing. (6)

Jeremy Morris; Friend and Colleague and fellow Olympic Gold Medal awardee.

I just finished a little paper on the occasion of Jerry Morris’ 90th birthday. I talk with Jerry every four to six weeks. I have some longtime friends. And Jerry, I suppose, is number one on the list because we’ve had honors together and we’ve worked together. . . He takes a common carrier into the London School of Hygiene and Tropical Medicine three times a week. You know, common carriers: a bus to the train, then a train to a place where he can walk. And he still exercises six days a week, three days in the gym, three days in the pool. It’s astonishing. Well, I see him a couple of times each year and we’ll have a meeting together at the International Olympic Committee in Salt Lake City in September. But on my way to Kuopio I’ll stop for two or three days and be with Jerry in London. (9)

Asked about the London Transport conductors and the drivers study of Jerry Morris?

He got himself out of trouble in that. By 1966 he had looked at physical activity among bus drivers and conductors, having looked at their respective cholesterol levels at some time or other. Getting data on their blood pressure levels, detailed data on occupational and leisure time exercise [and entry weight and waist size]. And he went all the way through Bradford Hill’s Canons of Causality.

So by 1966 he had gotten himself out of trouble and I think very few people would disagree today that it is healthy to be active and fit and that being active and fit is part of the reason for being healthy. It’s a two-way street, quite obviously. And he’s never really admitted that or talked of that as he should have. I’ve tried to do it. . . people who have coronary heart disease were sedentary in their prior-disease time. And people who have disease clinically are sedentary now because they have the disease. So I think that’s one way to think of it. Two-way street. Busy traffic. Goes both ways. (10)

Theophrastus Bombastus Paracelsus

In 1770 he came up with the idea that all things are dose/response related. There was a minimal amount, an optimal amount, and a hazardous amount of everything. And in his writings, I’ve had these out within the last year, he talked about physical activity. There has to be too much [as well as too little]. (17)

Ramazzini was an Italian who was the first industrial hygienist or occupational health physician. Ramazzini’s book was translated and published maybe as recently as 1980, half in Latin and the opposite page in English. Per Olaf asked me the other day why I didn’t refer to it in Latin. . . De Morbus Artiforum in Latin and English. It has some very important notes in there. You know if you compare tailors with what were called “runners”, I think they were messengers, the kind of guy who ran up in front of a carriage and cleared the road of bricks and stones. 1713. . . . One M, two Zs and two Is. Some people refer to him as arguably, the way the term goes, as the first epidemiologist. (18)

Full Transcript Access

Full transcripts of interviews may be made available to those engaged with original materials for scholarly studies by contacting us.