***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 The purpose of this study was to evaluate the effect of a physical activity telemonitoring program on daily physical activity level , oxygen uptake capacity ( VO2peak ) , and cardiovascular risk profile in coronary artery disease ( CAD ) patients who completed phase II cardiac rehabilitation ( CR ) . Methods Eighty CAD patients who completed phase II CR were r and omly assigned to an additional telemonitoring intervention or st and ard CR . The patients in the intervention group ( n = 40 ) wore a motion sensor continuously for 18 weeks . Each week these patients received a step count goal , with the aim to gradually increase the patients ’ physical activity level . In the control group ( n = 40 ) , the patients wore an unreadable motion sensor for seven days for measurement purpose s only ( at start of follow-up , and after six and 18 weeks ) . At start of follow-up and after 18 weeks blood lipid profile , glycemic control , waist circumference and body mass index was assessed . VO2peak was assessed at start of follow-up , and after six and 18 weeks . Re-hospitalisation rate was followed during this timeframe . Results In the intervention group , VO2peak increased significantly during follow-up ( P = 0.001 ) , in the control group it did not ( P = 0.273 ) . A significant correlation was found between daily aerobic step count and improvement in VO2peak ( P = 0.030 , r = 0.47 ) . Kaplan-Meier curve analysis showed a trend towards fewer re-hospitalisations for patients in the telemonitoring group ( P = 0.09 ) . Conclusions The study showed that , to maintain exercise tolerance and lower re-hospitalisation rate after hospital-based CR in CAD patients , a physical activity telemonitoring program might be an effective intervention Background Smartphone manufacturers offer mobile health monitoring technology to their customers , including apps using the built-in camera for heart rate assessment . This study aim ed to test the diagnostic accuracy of such heart rate measuring apps in clinical practice . Methods The feasibility and accuracy of measuring heart rate was tested on four commercially available apps using both iPhone 4 and iPhone 5 . ‘ Instant Heart Rate ’ ( IHR ) and ‘ Heart Fitness ’ ( HF ) work with contact photoplethysmography ( contact of fingertip to built-in camera ) , while ‘ What s My Heart Rate ’ ( WMH ) and ‘ Cardiio Version ’ ( CAR ) work with non-contact photoplethysmography . The measurements were compared to electrocardiogram and pulse oximetry-derived heart rate . Results Heart rate measurement using app-based photoplethysmography was performed on 108 r and omly selected patients .  The electrocardiogram-derived heart rate correlated well with pulse oximetry ( r = 0.92 ) , IHR ( r = 0.83 ) and HF ( r = 0.96 ) , but somewhat less with WMH ( r = 0.62 ) and CAR ( r = 0.60 ) . The accuracy of app-measured heart rate as compared to electrocardiogram , reported as mean absolute error ( in bpm ± st and ard error ) was 2 ± 0.35 ( pulse oximetry ) , 4.5 ± 1.1 ( IHR ) , 2 ± 0.5 ( HF ) , 7.1 ± 1.4 ( WMH ) and 8.1 ± 1.4 ( CAR ) . Conclusions We found substantial performance differences between the four studied heart rate measuring apps . The two contact photoplethysmography-based apps had higher feasibility and better accuracy for heart rate measurement than the two non-contact photoplethysmography-based apps Background In contrast to the well-accepted benefits of moderate exercise , recent research has suggested potential deleterious effects of repeated marathon running on the cardiovascular system . We thus performed a comprehensive analysis of markers of sub clinical vascular damage in a cohort of runners having finished multiple marathon races successfully . Design This was a prospect i ve , observational study . Methods A total of 97 healthy male Munich marathon participants ( mean age 44 ± 10 years ) underwent detailed training history , cardiopulmonary exercise testing for assessment of peak oxygen uptake , ultrasound for assessment of intima-media-thickness as well as non-invasive assessment s of ankle-brachial index , augmentation index , pulse wave velocity and reactive hyperaemia index . Results Runners had previously completed a median of eight ( range 1–500 ) half marathons , six ( 1–100 ) full marathons and three ( 1–40 ) ultramarathons ; mean weekly and annual training volumes were 59 ± 23 and 1639 ± 979 km . Mean peak oxygen uptake was 50 ± 8 ml/min/kg , and the Munich marathon was finished in 3:45 ± 0:32 h. Runners showed normal mean values for intima-media-thickness ( 0.60 ± 0.14 mm ) , ankle-brachial index ( 1.2 ± 0.1 ) , augmentation index ( 17 ± 13 % ) , pulse wave velocity ( 8.7 ± 1.4 cm/s ) and reactive hyperaemia index ( 1.96 ± 0.50 ) . Age was significantly and independently associated with intima-media-thickness ( r = 0.531 ; p < 0.001 ) , augmentation index ( r = 0.593 ; p < 0.001 ) and pulse wave velocity ( r = 0.357 ; p < 0.001 ) . However , no independent associations of peak oxygen uptake , marathon finishing time , number of completed races or weekly and annual training km with any of the vascular parameters were observed . Conclusions In this cohort of healthy male runners , running multiple marathon races did not pose an additional risk factor for premature sub clinical vascular impairment beyond age Aim Although cardiac rehabilitation improves physical fitness after a cardiac event , many eligible patients do not participate in cardiac rehabilitation and the beneficial effects of cardiac rehabilitation are often not maintained over time . Home-based training with telemonitoring guidance could improve participation rates and enhance long-term effectiveness . Methods and results We r and omised 90 low-to-moderate cardiac risk patients entering cardiac rehabilitation to three months of either home-based training with telemonitoring guidance or centre-based training . Although training adherence was similar between groups , satisfaction was higher in the home-based group ( p = 0.02 ) . Physical fitness improved at discharge ( p < 0.01 ) and at one-year follow-up ( p < 0.01 ) in both groups , without differences between groups ( home-based p = 0.31 and centre-based p = 0.87 ) . Physical activity levels did not change during the one-year study period ( centre-based p = 0.38 , home-based p = 0.80 ) . Healthcare costs were statistically non-significantly lower in the home-based group ( € 437 per patient , 95 % confidence interval –562 to 1436 , p = 0.39 ) . From a societal perspective , a statistically non-significant difference of € 3160 per patient in favour of the home-based group was found ( 95 % confidence interval –460 to 6780 , p = 0.09 ) and the probability that it was more cost-effective varied between 97 % and 75 % ( willingness-to-pay of € 0 and € 100,000 per quality -adjusted life-years , respectively ) . Conclusion We found no differences between home-based training with telemonitoring guidance and centre-based training on physical fitness , physical activity level or health-related quality of life . However , home-based training was associated with a higher patient satisfaction and appears to be more cost-effective than centre-based training . We conclude that home-based training with telemonitoring guidance can be used as an alternative to centre-based training for low-to-moderate cardiac risk patients entering cardiac rehabilitation Background Exercise training as part of a comprehensive cardiac rehabilitation is recommended for patients with cardiac heart failure . It is a valuable method for the improvement of exercise tolerance . Some studies reported a similar improvement with quadricipital electrical myostimulation , but the effect of combined exercise training and electrical myostimulation in cardiac heart failure has not been yet evaluated in a large prospect i ve multicentre study . Purpose The aim of this study was to determine whether the addition of low frequency electrical myostimulation to exercise training may improve exercise capacity and /or muscular strength in cardiac heart failure patients . Methods Ninety-one patients were included ( mean age : 58 ± 9 years ; New York Heart Association II/III : 52/48 % , left ventricular ejection fraction : 30 ± 7 % ) in a prospect i ve French study . The patients were r and omised into two groups : 41 patients in exercise training and 50 in exercise training + electrical myostimulation . All patients underwent 20 exercise training sessions . In addition , in the exercise training + electrical myostimulation group , patients underwent 20 low frequency ( 10 Hz ) quadricipital electrical myostimulation sessions . Each patient underwent a cardiopulmonary exercise test , a six-minute walk test , a muscular function evaluation and a quality of life question naire , before and at the end of the study . Results A significant improvement of exercise capacity ( Δ peak oxygen uptake+15 % in exercise training group and + 14 % in exercise training + electrical myostimulation group ) and of quality of life was observed in both groups without statistically significant differences between the two groups . Mean creatine kinase level increased in the exercise training group whereas it remained stable in the combined group . Conclusions This prospect i ve multicentre study shows that electrical myostimulation on top of exercise training does not demonstrate any significant additional improvement in exercise capacity in cardiac heart failure patients Background Exercise training is an established modality in chronic heart failure .  Functional electrical stimulation ( FES ) is an effective alternative mode of training in patients unwilling or unable to exercise ; however , it has not been investigated in elderly patients . We sought to investigate the effects of FES on functional status , quality of life , emotional status and endothelial function in chronic heart failure patients aged 70 years or higher . Methods Thirty patients with stable systolic chronic heart failure ( mean age 75 ± 3 years , New York Heart Association ( NYHA ) class II/III , 37%/63 % ) r and omly underwent a six-week FES training programme or placebo . Question naires addressing quality of life ( Kansas City Cardiomyopathy Question naire ( KCCQ ) , functional and overall ) and emotional stress ( Zung self-rating depression scale ( SDS ) , Beck Depression Inventory ( BDI ) ) , as well as endothelial function ( flow-mediated dilatation ) were assessed at baseline and upon protocol completion . Results A significant improvement in NYHA class ( p = 0.005 ) , KCCQ-functional ( F = 68.6 , p for interaction < 0.001 ) , KCCQ-overall ( F = 66.9 , p < 0.001 ) , BDI ( F = 66.3 , p < 0.001 ) and Zung SDS ( F = 95.1 , p < 0.001 ) was observed in the FES group compared to placebo . Patients in the FES group also had a significant increase in flow-mediated dilatation compared with placebo ( F = 59.1 , p < 0.01 ) . FES-induced per cent change in flow-mediated dilatation was significantly correlated with respective per cent change in KCCQ functional ( r = 0.386 , p = 0.039 ) . Conclusion In this pilot study , FES  effectively improved functional status , quality of life , motional stress and endothelial function in elderly chronic heart failure patients and warrants further investigation in this particular group of patients 
    Output:
    
No differences between home-based training with telemonitoring control guidance and centre-based training on physical fitness , physical activity level or health-related quality of life have been observed .
Instead , home-based training was associated with greater patient satisfaction and appears to be more cost-effective than centre-based training .
In the above group , heart rate was monitored by a chest strap and data were uploaded to a web application , allowing the patient , therapist and exercise specialist to review the data .
Thus home-based training with telemonitoring guidance can be used as an alternative to centre-based training for low-to-moderate cardiac risk patients .
Electrical myostimulation ( EMS ) on top of exercise training has no significant additional improvement in exercise capacity in heart failure patients .
EMS has shown potential beneficial effects such as improvement of muscle function , exercise capacities , endothelial function and quality of life , in those patients who are unable or unwilling to adhere to conventional exercise .
However , in a r and omised prospect i ve French trial , the combination of physical exercise with EMS was not associated with greater improvement in oxygen uptake or quality of life .
The study population included only moderately severe and stable heart failure patients with baseline peak oxygen uptake around 16–17ml/kg/min ; thus the results may not be extrapolated to more severe patients .
In a systematic review of the existing literature , progressive resistance training result ed in an increase in lower and upper body strength , and improved aerobic fitness to a similar degree as aerobic training in coronary heart disease cohorts .
Importantly , when progressive resistance training was added to aerobic training , effects on both fitness and strength were enhanced compared to aerobic training alone .
The two contact photoplethysmography-based apps had higher feasibility and better accuracy for heart rate measurement than the two non-contact photoplethysmography-based apps