You bought a program for one reason: you want your chest to look and feel better. I'm going to get you there the honest way - the way that's backed by research, not by hype. But first, give me ten minutes to explain why this is built the way it is. It'll make everything else click.

Most pectus advice online is garbage. It's either "exercise can't do anything, get surgery," or "do this one secret stretch and your sternum pops out." Both are wrong. The truth sits in the middle, and the truth is genuinely good news: there is a lot you can change - you just have to train the right things, in the right order, consistently.

After a decade fixing my own chest, I boiled everything down to a simple framework I call the Pectus Priority Pyramid. The idea is simple but powerful - training has a hierarchy of importance. Some things matter enormously (showing up, total work, getting stronger over time). Some things barely matter (exact rep tempo, rest timing). Most people obsess over the small stuff and ignore the big stuff, then wonder why nothing changes.² My whole system is just: do the things that matter most, first.

The four parts

• Part 1 - Understand. What pectus excavatum actually is, and the anatomy of the muscles we're going to build. This is where the "reverse origin" trick lives - the single most important concept in the whole program.
• Part 2 - The Science. Why bone responds to load, how muscle grows, why four full-body days a week beats fancy splits, and why training in a stretched position is the secret weapon for a chest with pectus.
• Part 3 - The Framework. The Pectus Priority Pyramid: what to prioritize, in order.
• Part 4 - Do It. Assess yourself, learn the clinically-studied pectus exercise plan, then run the 16-week program with breathing and posture work layered on top.

Most "pectus workouts" online say the same thing: just build a big chest to fill in the dip. That advice can backfire - piling muscle onto a sunken chest can make the hollow look deeper and the chest stiffer. This program is built differently, on real evidence.

It rests on two things. First, the only published clinical exercise plan made specifically for pectus excavatum - Dr Cheung’s method - which uses a clever trick: with your arms fixed overhead under load, your chest muscles pull up on your breastbone instead of just bulking outward.¹ Second, a 4,012-patient study showing the front of your chest is flexible cartilage that genuinely reshapes under steady, gentle force applied over months.¹⁷

So instead of chasing a heavier bench, you train the chest in a deep, stretched position with big breaths - to reshape it, open it, and fix the posture around it. The full step-by-step method is in Part 4; first, a quick tour of how this works and why.

Before a single exercise, you need to understand one study. It's the reason this program looks nothing like the "just build your chest" advice you'll find everywhere else - and the reason it actually works.

In 2009, two orthopedic doctors - Sydney and Davi Haje - published the results of 32 years of treating pectus, non-surgically, in their clinic in Brazil.¹⁷ They followed 4,012 patients. That isn't a small lab trial; it's one of the largest real-world records of fixing pectus without an operation that exists. Almost everything I do is built on what they learned. Here is the whole thing, in plain English.

1. Your chest wall is mostly cartilage - and cartilage can be reshaped

Most people assume the chest is a fixed cage of bone. It isn't. The Hajes showed that the front of your chest grows like a long bone does: through growth plates made of cartilage sitting between the segments of the breastbone and where the ribs meet it.¹⁷ Pectus happens when those cartilage growth plates grow unevenly - too much here, too little there - so the breastbone gets pulled in (excavatum) or pushed out (carinatum). The takeaway that changes everything: the front of your chest is a flexible, living, re-shapeable region, not a sealed box.

2. Steady force, repeated for months, reshapes it - and it works

Their method was simple in principle: a gentle external pressure on the chest, combined with exercises that raise the pressure inside the chest (big breaths under effort), done daily over many months. The result? Good-to-excellent improvement in 60.6% of children and teens, and 27% of adults.¹⁷ Kids respond best because their chests are most flexible - but adults improved too. The principle behind it is over a century old: Wolff's law - bone and cartilage remodel in the direction of the forces you regularly put through them.^6,17

3. The part nobody tells you: just lifting weights can make it worse

This is the line that separates this program from every "pectus workout" on YouTube. The Hajes were blunt about it:

So the goal of smart training isn't to slab on as much chest mass as possible. It's to move the rib cage, raise internal pressure, keep the chest flexible, and fix posture - prioritizing higher reps and full range over ego-lifting heavy weight. Build muscle, yes - but in the positions and the way that reshape the chest instead of fighting it. That's exactly how this program is designed.

Pectus is far more common than people think. The Haje study found about 1 in 100 children examined had a pectus deformity^17,18 - so if a school assembly has 500 kids in it, roughly five of them have a version of what you have. In plain English: your breastbone (the sternum) sits deeper than usual, so the middle of your chest looks sunken - like a shallow bowl. You didn't cause it. It's not a muscle you forgot to train.

It happens because the cartilage connecting your ribs to your sternum overgrows and grows unevenly, pushing the sternum inward.^1,3 It usually becomes obvious during the teenage growth spurt, when everything is changing fast.

The whole package, not just the dip

PE rarely travels alone. The sunken sternum drags a postural chain with it, and these are the parts training can move:

• The sternum is pulled back toward the spine.
• The ribs and rib cartilage angle inward to follow it.
• The shoulders round forward and the head drifts forward to "match" the dip - classic upper-crossed posture.
• Rib flare - the lower front ribs pop outward - is extremely common alongside it.
• Thoracic kyphosis - an exaggerated rounding of the upper back - often rides along too.

Here's the key insight that drives this whole program: the bone is fixed, but the frame around it is not. Muscle, posture, breathing mechanics, and how the whole package presents itself - all trainable.

The Haller Index, in plain terms

Doctors measure PE depth with the Haller Index (HI): on a CT scan, the width of the chest divided by the distance from the sternum to the spine at the deepest point.³ Wider-and-shallower = low number. Narrow-and-deep = high number.

You don't need a CT to start. Section 8 gives you a no-imaging way to estimate your severity and pick your version.

What training CAN and CANNOT do (no hype)

I'm going to be blunt, because overselling this is how people end up disappointed and quit. Here's the honest line:

This is the most important section in Part 1. If you understand which muscles attach to your chest wall and how they pull, the entire program stops being a list of exercises and becomes obvious. Read it twice.

Bone vs cartilage - why your chest can change at all

Here's something most people get wrong: they think the front of the chest is solid bone, so nothing can move it but surgery. Not true. Yes, the breastbone (sternum) and the ribs are bone - but they're joined by costal cartilage, and the whole front of the chest grows through cartilage growth plates.¹⁷ Cartilage is softer, more flexible, and far more responsive to steady force than bone. The pectus dip itself is driven by overgrown cartilage - and cartilage is exactly the tissue that remodels when you load it consistently. That's why your chest is changeable, not fixed.

On top of all that bone and cartilage sits a sheet of muscle - and muscle is the thing we can grow and re-train directly. Cheung's clinical work is built on a simple anatomical fact: the muscles that move your arms also attach to your chest wall, so if you fix your arms in place, those same muscles can pull on your chest instead.¹ That's the whole game. Let's meet the players.

Pectoralis major - the engine

This is the big fan-shaped chest muscle. Crucially for us, it has two heads with two origins: the clavicular head (from the collarbone) and the larger sternocostal head - which originates directly from the sternum and the cartilage of the first through sixth ribs.¹ Both heads converge and insert on the upper arm bone (the humerus).

Normally, when you do a push, the pec pulls the arm toward the midline. The sternum is the anchor; the arm is what moves. But watch what happens when we flip that.

The "reverse origin and insertion" - the key to everything

This is Cheung's central idea, and it's brilliant in its simplicity.¹ A muscle pulls its two ends toward each other. Which end moves depends on which end is fixed. So:

• Normally: sternum fixed → arm moves toward body. (A normal press.)
• Reversed: arm fixed overhead, gripping something solid → now the pec pulls the sternum and ribs up toward the arm instead.

In Cheung's words, when the arm is fixed in a stretched overhead position, the pec major's sternocostal fibers "can directly and forcibly pull the sunken sternum and infolding ribs up during the muscle contraction."¹ And because the muscle is held at its mid-to-long length in that position, it can produce its greatest pulling force.

The supporting cast

• Pectoralis minor. A smaller muscle beneath the pec major, attaching to ribs 3–5. It also participates in forced inspiration and assists the lift of the chest wall when the arm is fixed.¹
• Serratus anterior. The "boxer's muscle" that wraps the ribs and holds the shoulder blade flat against them. It's a key forced-inspiration muscle, expands the rib cage, and directly fights the winged, rounded-shoulder look of PE. We hammer it.¹
• Scalenes & sternocleidomastoid (SCM). Neck muscles that elevate the upper ribs when you breathe in hard.¹ Training your inspiratory effort recruits them and helps "open" the upper chest.
• Intercostals & diaphragm. The intercostals sit between the ribs; the diaphragm is the dome-shaped primary breathing muscle. Better diaphragmatic breathing and rib expansion improve mobility and the "tight chest" feeling.¹⁰
• Upper back: mid/lower trapezius, rhomboids, rear deltoids. Not on the chest - but they pull your shoulders back. Cheung is explicit that you must strengthen the back to balance the strong anterior pull, or you'll worsen kyphosis.¹ This is why the program is never "just chest."

"But it's bone - you can't change bone with exercise." You hear this constantly. It's mostly true, and partly not, and the nuance matters. Let's be precise and honest.

Bone is a living, adapting tissue

Bone isn't an inert rod. It's constantly being torn down and rebuilt by cells (a process called remodeling). The rule governing it is Wolff's Law: bone adapts its structure to the mechanical loads placed on it.⁶ Load it, and it lays down more bone where stress is highest. Harold Frost refined this into the mechanostat model - bone has a threshold of strain above which it grows.⁷

Cheung's discussion leans directly on this.¹ The reasoning: high-intensity, low-frequency mechanical loading stimulates bone formation and remodeling. There's also evidence that bigger muscle forces drive bone development - the "muscle-bone unit." So if training builds stronger muscles that pull harder on the chest wall, it may, over a long time and especially in younger people, nudge the shape and density of that bone.¹

What this means practically

• We use real load - meaningful resistance, taken close to failure - not endless light reps. That's what crosses the threshold bone and muscle respond to.^7,9
• We bias exercises that load the chest wall in a stretched, lengthened position (Sections 6 & 9), the exact position Cheung used for the "reverse origin" lift.¹
• We're patient. Bone and muscle remodel over months and years, not weeks. The program is 16 weeks to build the habit and the base - but this is a multi-year project, and that's fine.

Building muscle around the dip is the single most reliable way to change how a chest with pectus looks. Good news: the science of hypertrophy is settled enough to be simple. You don't need to overcomplicate it.

Mechanical tension is the boss

The primary driver of muscle growth is mechanical tension - challenging your muscles against meaningful resistance through a full range of motion.⁸ Not "the pump," not soreness, not chasing a burn. Tension. Everything else is a detail.

The three rules that matter

• Take sets close to failure. The last few reps - when it's genuinely hard - are where the growth signal lives. Aim to stop with about 0–3 reps in reserve (RIR). If you could've done 6 more, it was a warm-up.
• Progressively overload. Over weeks, add reps or add weight. If the bar never gets heavier and the reps never climb, your body has no reason to change. Write your numbers down.
• Do enough total work - but not endless. More on the exact dose in Section 5. Volume drives growth, but with diminishing returns.¹⁵

This is the structural choice that makes the program work for a normal human with a normal life. You do not need to live in the gym. Four full-body sessions a week is the sweet spot - and here's the research behind why.

Weekly volume is what counts

The biggest meta-analysis on the topic - Schoenfeld, Ogborn & Krieger, pooling data across many studies - found a clear dose-response: more weekly sets per muscle group means more growth, with the benefits stacking up well past 10 sets per muscle per week, into the ~10–20 range for most people.¹⁵ Volume is the dial that matters most after effort.

But per session, there's a ceiling

Here's the catch the "more is always better" crowd misses: within a single session, the growth you get per set drops off as you pile them on. Cram 15 sets for your chest into one day and the late sets are mostly fatigue, not stimulus.¹⁵ The fix is obvious once you see it: spread your weekly volume across more days.

Higher frequency = fresher, higher-quality work

When you train each muscle ~3×/week instead of once, you hit your weekly volume target with fresh, hard sets every time, and you practice the movements more often. Frequency itself isn't magic - but it's the most practical way to accumulate quality volume.¹⁶ For a chest with pectus, training the chest, serratus, and upper back three times a week also just means more total exposure to the corrective work.

Three days is enough - and it's sustainable

A six-day bodybuilding split looks hardcore, but most people can't recover from it or stick to it, and adherence sits at the very bottom of the pyramid. Three honest full-body sessions a week:

• Hit every PE-priority muscle 2–3× weekly - easy to accumulate 10–20 quality sets per muscle.
• Leave 3–4 rest days for recovery and the rest of your life.
• Are forgiving - miss one day and you still trained everything that week.

This is the most pectus-specific science in the program, and it's where modern hypertrophy research and Cheung's 2005 plan point in exactly the same direction.

Long muscle lengths grow muscle best

A wave of recent studies shows that training a muscle in its lengthened (stretched) position drives more growth than training it short. In a controlled comparison, "lengthened partials" produced equal or greater hypertrophy than full range of motion;¹³ a 2023 meta-analysis confirmed a small but real advantage to emphasizing the lengthened position.¹⁴ The lengthened portion of a rep does most of the muscle-building work.

Why this is gold for a chest with pectus

Look at what this means for your pecs. The stretched position of the pec major is arms back and overhead - exactly the position where, via reverse origin, the muscle pulls hardest on the sternum (Section 2).¹ So loading the chest in a deep stretch does two jobs at once:

• Builds the most muscle over the dip (the lengthened-position growth advantage).^13,14
• Applies the strongest corrective pull on the chest wall (Cheung's reverse-origin mechanism).¹
• Improves flexibility of the tight anterior chest - loaded stretching builds range of motion as it builds muscle.

This is exactly why Cheung's signature exercise is a weight-lift performed in a stretched, supine position with the arms overhead.¹ Modern science just explains why it works so well. Throughout this program, you'll see a bias toward deep-stretch chest work: dumbbell pullovers, deep flyes, the stretched-supine lift, and a full range on every press.

What actually matters for fixing a chest with pectus - in order. The stuff at the bottom changes your chest. The stuff at the top barely moves the needle. Most people do the opposite. Get the bottom right first.²

1 - Show up for months

The foundation, and the only level that's truly non-negotiable. A chest changes from steady work repeated over months - not from a perfect plan you quit in week five. Four short sessions a week you'll actually keep beat a heroic plan you won't. If you get nothing else right, get this.

2 - Do enough hard work

Once you're consistent, the biggest lever is total work: aim for roughly 10–20 hard sets per muscle each week, with each set taken close to failure (a rep or two left in the tank). That's the dose muscle actually grows on - more than that mostly adds fatigue.

3 - Get a little stronger over time

Beat your logbook by a hair each week - one more rep, a touch more range, or a little more weight. Tiny steps repeated for months are what add up. No need to force big jumps.

4 - Do the right exercises

Now it matters which exercises. For a chest with pectus we lean on deep-stretch chest work (the Cheung Method, Section 9) and plenty of back and posture work - and we avoid simply over-bulking the pecs, which can make the dip look deeper.¹⁷ The right moves, in the right positions.

5 - Breathe big & stay mobile

Ribs down, shoulders back, tall through the crown, and full diaphragm breaths - every day (Section 11). A flexible, well-positioned chest is one that can actually change; a stiff, slumped one hides any progress you make.

6 - The fine details

Rest timing and exact tempo are the fine print. The one tempo cue worth keeping: control the lowering and own the stretch - a 2-3 second lower with a brief pause at the bottom. Rest 2-3 min on big lifts, less on small ones. Beyond that, don't overthink it.

Fifteen minutes, no scan needed. This sets your starting version and gives you numbers to beat. Do it today, then re-check every 4 weeks.

8.1 Severity check (no imaging)

Look in a mirror standing, then lying down. Score honestly:

• Mild: shallow dip, only obvious when pointed out. No symptoms with exercise.
• Moderate: clearly visible bowl, but you breathe fine and keep up with peers.
• Severe: deep, wide depression, OR you get unusually winded / lightheaded / your heart races with exertion. A coin can sit in the dip lying down.

Your tracking number: lie on your back, lay a ruler flat across the dip, and measure the depth from ruler to the deepest point with a second ruler. Write it down. Re-measure monthly. (This isn't a Haller Index - it's your number to watch.)

8.2 Posture checklist

Have someone photograph you from the side, relaxed, shirt off. Tick what applies:

More boxes ticked = more upside from the posture & upper-back work in this program.

8.3 Breathing check

Hand test: lie down, one hand on chest, one on belly, breathe normally 30s. The belly hand should rise more. If the chest hand dominates, you're a chest-breather - common in PE - and Section 11 fixes it.

Expansion test: wrap a tape measure around the base of your ribs. Measure at full exhale, then full inhale. Less than ~2–3 cm of difference suggests stiff ribs / weak inspiratory muscles worth training.¹⁰

8.4 Which version?

Everyone, regardless of version, does the Cheung Method (Section 9) and the breathing & posture work (Section 11). Those are the pectus-specific core.

This is the heart of the program - the only published exercise plan made specifically to fix pectus excavatum, from Cheung's 2005 paper.¹ I kept his exercises exactly as he laid them out, and just turned his clinic-style instructions into simple sets and reps you can actually follow each week.

Cheung's plan follows four steps, in order:¹

• Increase the mobility and flexibility of the spine and chest wall.
• Lengthen any tightened and shortened structures.
• Strengthen the muscles that elevate and expand the depressed chest wall.
• Restore normal posture.

The first two are your warm-up. The third is your strength work. The fourth runs through the whole program.

Part A - Mobilize & stretch (your warm-up)

Do these before every session. Each loosens the tight anterior chest and stiff thoracic spine so the chest can actually be elevated by the strength work that follows.¹

Part B - Strengthen & elevate the chest

These are the working exercises. B1 is the signature movement - the "reverse origin" lift that pulls the sternum upward (Section 2).¹

Four full-body sessions a week, every other day. Each one is biased toward deep-stretch chest work + a balanced back. You run the same Day 1-4 for all 16 weeks - what changes week to week is the load and reps (the Progression Map below). Every session starts with the warm-up stretches (Part A of the Cheung Method), and you finish with a few minutes of breathing/posture (Section 11). On the in-between days you do just the 10-minute breathing + posture work.

Your week at a glance

Your 16-Week Progression Map

Same four days every week - this table tells you what to change. Find the week, apply the sets/reps/effort to your ★ key lifts (the pullover, presses and rows); others stay similar. "RIR" = reps in reserve. On the stretch lifts (pullover, flye), keep reps higher and the stretch deep even on heavy weeks.

This is a multi-year build. After the deload, loop back to Phase B (Week 6) using your new, heavier baseline - and keep the daily stretch & breathing forever.

The daily layer. Five to ten minutes a day. This trains the inspiratory muscles, opens the rib cage, and rewires the posture pattern that exaggerates the dip.

11.1 Diaphragmatic breathing

Many people with PE default to shallow chest breathing. Retrain it: lie down, hand on belly, breathe so the belly rises first and most, chest stays quiet. Slow inhale through the nose ~4s, easy exhale ~6s. 5 minutes daily. This restores the diaphragm as your primary breathing muscle.

11.2 Inspiratory muscle training (IMT)

Breathing against resistance strengthens the muscles that lift the upper ribs (scalenes, SCM, intercostals - Section 2). Respiratory-muscle training meaningfully improves respiratory muscle strength and can aid exercise tolerance.¹⁰ Use a cheap IMT device or simply perform forceful, resisted deep inhales. 2 sets of 10–15 hard breaths, ~5–6 days/week.

11.3 Rib expansion & thoracic mobility

Daily: the Cheung warm-up stretches (A1–A3), plus a foam-roll thoracic extension (lie back over the roll, breathe into the stretch). Re-test your rib-expansion tape measurement monthly - you want the inhale-to-exhale difference to grow.

11.4 Your daily routine

11.5 Why this beats just "lifting more"

Worth repeating, because it's the whole point of the program. The Haje team's 32-year record is blunt: lifting weights on its own does not correct a chest with pectus - it can only disguise it with muscle, and over-building the pecs can make a dip look deeper and the chest stiffer.¹⁷ Real change comes from moving the rib cage and raising the pressure inside the chest during effort - which is exactly why this plan leads with deep-stretch chest work and big breaths, chases reps and range over a heavy max, and pairs every session with mobility and posture work.

Swimming is a useful add-on: freestyle and backstroke keep the chest flexible and the posture tall, and they're worth doing on off-days at any age.¹⁷

Honest timelines so you don't quit early. Nobody changes their chest in two weeks - but the people who stick with it are unrecognisable in a year. Here's the realistic arc.

The errors that stall pectus excavatum progress - and the fixes.

A sunken chest carries a real psychological weight, and managing the anxiety around it is part of the work. People with pectus report measurably higher anxiety and a more negative body image than their peers.^19,20

A daily meditation practice is one of the best-evidenced, lowest-cost tools for that anxiety, supported by randomized trials and large meta-analyses.^{21,22,23,24,25} It won't change the shape of your chest; it changes your relationship to the worry about it. Ten minutes a day is enough to start.

How to start, 10 minutes a day

• Guided first. Don't sit in silence wondering if you're doing it right, follow a guided session. Waking Up is what I use; choose the scholarship / $0 option to try it free.
• Same time daily. 10 minutes, ideally in the morning before you reach for your phone. Consistency beats length.
• Notice, don't fight. When a thought about your chest shows up, label it and return to the breath. That's the whole rep.

The evidence behind this program. The backbone is reference 1 - Cheung's clinical plan - supported by modern sports-science meta-analyses and the pectus literature.

1. Cheung SY-K. Exercise therapy in the correction of pectus excavatum. J Paediatr Respir Crit Care. 2005;1(2):10–13. - The primary source: warm-up + strengthening plan and the "reverse origin and insertion" mechanism.
2. Kraemer WJ, Ratamess NA. Fundamentals of resistance training: progression and exercise prescription. Med Sci Sports Exerc. 2004;36(4):674–688. - Training variables have a hierarchy; progression and prioritization drive results.
3. Jaroszewski D, Notrica D, McMahon L, et al. Current management of pectus excavatum: a review and update of therapy and treatment recommendations. J Am Board Fam Med. 2010;23(2):230–239. - Prevalence, Haller Index, surgical thresholds.
4. Das BB, Recto MR, Yeh T. Improvement in cardiopulmonary function after corrective surgery for pectus excavatum. (cardiopulmonary effects of severe PE).
5. Stagnaro N, et al. Cardiovascular MRI assessment of pectus excavatum in pediatric patients. (normal resting cardiac function in most PE). [studies/pectus-excavatum, PMID 33256973]
6. Wolff J. Das Gesetz der Transformation der Knochen (The Law of Bone Remodeling). Berlin: Hirschwald; 1892. - Bone adapts its structure to mechanical load.
7. Frost HM. Bone's mechanostat: a 2003 update. Anat Rec A Discov Mol Cell Evol Biol. 2003;275(2):1081–1101. - Strain threshold model of bone adaptation.
8. Schoenfeld BJ. The mechanisms of muscle hypertrophy and their application to resistance training. J Strength Cond Res. 2010;24(10):2857–2872. - Mechanical tension as the primary driver of growth.
9. Robling AG, Duijvelaar KM, Geevers JV, et al. Modulation of appositional and longitudinal bone growth by applied static and dynamic load. Bone. 2001;29(2):105–113. - Dynamic loading drives bone adaptation.
10. Illi SK, Held U, Frank I, Spengler CM. Effect of respiratory muscle training on exercise performance in healthy individuals: a systematic review and meta-analysis. Sports Med. 2012;42(8):707–724. - IMT improves respiratory muscle strength/performance.
11. Haecker FM, et al. Vacuum bell therapy for pectus excavatum. Long-term experience at a single center. [studies/pectus-excavatum, PMID 39488480] - Sternal elevation; younger/milder/flexible respond best.
12. Obermeyer RJ, et al. Vacuum bell treatment of pectus excavatum: an early North American experience & determinants of success. [studies/pectus-excavatum, PMID 30414687, 35525808] - Compliance is key.
13. Pedrosa GF, Lima FV, Schoenfeld BJ, et al. Partial range of motion training at long muscle lengths elicits favorable muscular adaptations. Eur J Sport Sci. 2022;22(8):1250–1260. - Lengthened partials ≥ full ROM for hypertrophy.
14. Wolf M, Androulakis-Korakakis P, Fisher J, Schoenfeld B, Steele J. Partial vs full range of motion resistance training: a systematic review and meta-analysis. 2023. - Small advantage to training at long muscle lengths.
15. Schoenfeld BJ, Ogborn D, Krieger JW. Dose-response relationship between weekly resistance training volume and increases in muscle mass: a systematic review and meta-analysis. J Sports Sci. 2017;35(11):1073–1082. - More weekly sets → more growth, with diminishing returns.
16. Schoenfeld BJ, Ogborn D, Krieger JW. Effects of resistance training frequency on measures of muscle hypertrophy: a systematic review and meta-analysis. Sports Med. 2016;46(11):1689–1697. - Higher frequency aids accumulating quality volume.
17. Haje SA, Haje DP. Orthopedic Approach to Pectus Deformities: 32 Years of Studies. Rev Bras Ortop. 2009;44(3):191-8. - 4,012 patients over 32 years: the dynamic-remodeling method, the bone-and-cartilage growth-plate basis of pectus, 60.6% good results in kids / 27% in adults, and the warning that exercise alone only disguises pectus while over-developing the pecs can worsen a sunken chest.
18. Haje DP, Haje SA, Simioni MA. Prevalencia das deformidades pectus carinatum e pectus excavatum em escolares do Distrito Federal. Brasilia Med. 2002;39(1/4):10-5. - Found about one case of pectus for every 100 children examined.
19. Body-image, self-concept and mental exposure in patients with pectus excavatum. mrpectus research library, PMID 21290134. - Measurable impact on body image and self-concept.
20. Pectus excavatum and pectus carinatum patients suffer from lower quality of life and impaired body image. mrpectus research library, PMID 21440452. - Lower QoL and more negative body image vs peers.
21. Goyal M, et al. Meditation programs for psychological stress and well-being: a systematic review and meta-analysis. JAMA Intern Med. 2014;174(3):357–368; PMID 24395196. - Mindfulness meditation programs reduce anxiety.
22. Hofmann SG, et al. The effect of mindfulness-based therapy on anxiety and depression: a meta-analytic review. J Consult Clin Psychol. 2010;78(2):169–183; PMID 20350028. - Robust anxiety reduction across studies.
23. Hoge EA, et al. Randomized controlled trial of mindfulness meditation for generalized anxiety disorder. J Clin Psychiatry. 2013;74(8):786–792; PMID 23541163. - RCT evidence in clinical anxiety.
24. Kabat-Zinn J, et al. Effectiveness of a meditation-based stress reduction program in the treatment of anxiety disorders. Am J Psychiatry. 1992;149(7):936–943; PMID 1609875. - Early MBSR anxiety trial.
25. Khoury B, et al. Mindfulness-based therapy: a comprehensive meta-analysis. Clin Psychol Rev. 2013;33(6):763–771; PMID 23796855. - Large meta-analysis supporting mindfulness for anxiety.

© mrpectus · The Pectus Excavatum Program v1.0 · Mihail Veleski · For education, not medical advice.