***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: OBJECTIVE To assess the effects of a comprehensive , integrated community-based lifestyle intervention on diet , physical activity and smoking in two Iranian communities . METHODS Within the framework of the Isfahan Healthy Heart Program , a community trial was conducted in two intervention counties ( Isfahan and Najaf-Abad ) and a control area ( Arak ) .  Lifestyle interventions targeted the urban and rural population s in the intervention counties but were not implemented in Arak . In each community , a r and om sample of adults was selected yearly by multi-stage cluster sampling . Food consumption , physical exercise and smoking behaviours were quantified and scored as 1 ( low-risk ) or 0 ( other ) at baseline ( year 2000 ) and annually for 4 years in the intervention areas and for 3 years in the control area . The scores for all behaviours were then added to derive an overall lifestyle score . FINDINGS After 4 years , changes from baseline in mean dietary score differed significantly between the intervention and control areas ( + 2.1 points versus -1.2 points , respectively ; P < 0.01 ) , as did the change in the percentage of individuals following a healthy diet ( + 14.9 % versus -2.0 % , respectively ; P < 0.001 ) . Daily smoking had decreased by 0.9 % in the intervention areas and by 2.6 % in the control area at the end of the third year , but the difference was not significant . Analysis by gender revealed a significant decreasing trend in smoking among men ( P < 0.05 ) but not among women . Energy expenditure for total daily physical activities showed a decreasing trend in all areas , but the mean drop from baseline was significantly smaller in the intervention areas than in the control area ( -68 metabolic equivalent task ( MET ) minutes per week versus -114 MET minutes per week , respectively ; P < 0.05 ) . Leisure time devoted to physical activities showed an increasing trend in all areas . A significantly different change from baseline was found between the intervention areas and the control area in mean lifestyle score , even after controlling for age , sex and baseline values . CONCLUSION The results suggest that community-based lifestyle intervention programmes can be effective in a developing country setting OBJECTIVE To evaluate the effectiveness of a worksite health promotion program on improving cardiovascular disease risk factors . METHODS In St Louis , Missouri from 2005 to 2006 , 151 employees ( 134 F , 17 M , 81 % overweight/obese ) participated in a cohort-r and omized trial comparing assessment s + intervention ( worksite A ) with assessment s only ( worksite B ) for 1 year . All participants received personal health reports containing their assessment results . The intervention was design ed to promote physical activity and favorable dietary patterns using pedometers , healthy snack cart , WeightWatchers(R ) meetings , group exercise classes , seminars , team competitions , and participation rewards . Outcomes included BMI , body composition , blood pressure , fitness , lipids , and Framingham 10-year coronary heart disease risk . RESULTS 123 participants , aged 45+/-9 yr , with BMI 32.9+/-8.8 kg/m(2 ) completed 1 year . Improvements ( P < or = 0.05 ) were observed at both worksites for fitness , blood pressure , and total- , HDL- , and LDL-cholesterol . Additional improvements occurred at worksite A in BMI , fat mass , Framingham risk score , and prevalence of the metabolic syndrome ; only the changes in BMI and fat mass were different between worksites . CONCLUSION A multi-faceted worksite intervention promoted favorable changes in cardiovascular disease risk factors , but many of the improvements were achieved with worksite health assessment s and personalized health reports in the absence of an intervention The purpose of this paper is to present key points of an intervention programme ( Agita São Paulo Program ) to promote physical activity in a developing country . Agita is a multi-level , community-wide intervention design ed to increase knowledge about the benefits and the level of physical activity in a mega- population of 34 million inhabitants of São Paulo State , Brazil . The main message was taken from the Centers for Disease Control/American College of Sports Medicine ( CDC/ACSM ) recommendation that : ' everyone should accumulate at least 30 minutes of physical activity , on most days of the weeks , of moderate intensity , in one single or in multiple sessions ' . Activities were encouraged in three setting s : home , transport and leisure time . Focus groups were students from elementary schools through to college , white and blue collar workers , and elderly people . Innovative aspects included : ( 1 ) a research centre leading the process , ( 2 ) scientific and institutional partnerships ( over 160 groups ) , ( 3 ) a feasible approach -- the ' one-step-ahead ' model , ( 4 ) empowerment , ( 5 ) inclusion , ( 6 ) non-paid media , ( 7 ) social marketing , and ( 8) culture-linked . Data were obtained from 645 r and om , home-based question naires over four years -- stratified by sex , age , education and socio-economic level . These data show that the Agita message reached 55.7 % of the population , and among these , 23.1 % knew the main message . Recall of Agita and knowledge of its purpose were well distributed among different socioeconomic levels , being known by 67 % of the most educated . The prevalence of people reaching the recommendation was 54.8 % ( men 48.7 % , women 61 % ) ; and risk of being sedentary was quite smaller among those who knew the Agita message ( 7.1 % ) compared with those who did not know ( 13.1 % ) . In conclusion , based upon the Agita São Paulo experience , it appears that a multi-level , community-wide intervention to promote physical activity may obtain good results if the model contains the items listed above Background Research and practice partnerships have the potential to enhance the translation of research findings into practice . Purpose This paper describes such a partnership in the development of Walk Kansas ( WK ) and highlights individual and organizational level outcomes . Method Phase 1 examined : ( a ) the reach of WK , ( b ) physical activity changes , and ( c ) maintenance of physical activity changes 6 months after the program was completed . Phase 2 explored WK adoption and sustainability over 5 years . Results WK attracted a large number of participants who were more likely to be female , more active , and older than the adult population within the counties where they resided . Inactive or insufficiently active participants at baseline experienced significant increases in both moderate ( p < 0.001 ) and vigorous ( p < 0.001 ) physical activity . A r and om selection of participants who were assessed 6 months post-program did not demonstrate a significant decrease in moderate or vigorous activity between program completion and 6-month follow-up . The number of counties adopting the program increased across years , peaking at 97 in 2006 and demonstrated the sustainability of the WK over 5 years . Conclusions WK is effective , has a broad reach , and enables participants to maintain increased activity . It also shows promise for broad adoption and sustainability Background U.S. adults are at unprecedented risk of becoming overweight or obese , and most scientists believe the primary cause is an obesogenic environment . Worksites provide an opportunity to shape the environments of adults to reduce obesity risk . The goal of this group-r and omized trial was to implement a four-component environmental intervention at the worksite level to positively influence weight gain among employees over a two-year period . Environmental components focused on food availability and price , physical activity promotion , scale access , and media enhancements . Methods Six worksites in a U.S. metropolitan area were recruited and r and omized in pairs at the worksite level to either a two-year intervention or a no-contact control . Evaluations at baseline and two years included : 1 ) measured height and weight ; 2 ) online surveys of individual dietary intake and physical activity behaviors ; and 3 ) detailed worksite environment assessment . Results Mean participant age was 42.9 years ( range 18 - 75 ) , 62.6 % were women , 68.5 % were married or cohabiting , 88.6 % were white , 2.1 % Hispanic . Mean  baseline BMI  was 28.5 kg/m2 ( range 16.9 - 61.2 kg/m2 ) . A majority of intervention components were successfully implemented . However , there were no differences between sites in the key outcome of weight change over the two-year study period ( p = .36 ) . Conclusions Body mass was not significantly affected by environmental changes implemented for the trial . Results raise questions about whether environmental change at worksites is sufficient for population weight gain prevention . Trial Registration Clinical Trials.gov : Background Effectiveness of and engagement with  website-delivered physical activity interventions  is moderate at best . Increased exposure to Internet interventions is reported to increase their effectiveness ; however , there is a lack of knowledge about which specific intervention elements are able to maintain website engagement . Objective To prospect ively study the associations of website engagement and exposure to intervention components for a publicly available physical activity website ( 10,000 Steps Australia ) . Methods Between June and July 2006 a total of 348 members of 10,000 Steps completed a Web-based survey to collect demographic characteristics .  Website engagement was subsequently assessed over a 2-year period and included engagement data on website components ; individual challenges , team challenges , and virtual walking buddies ; and indicators of website engagement ( average steps logged , days logging steps , and active users ) . Results On average participants logged steps on 169 ( SD 228.25 ) days . Over a 2-year period this equated to an average of 1.6 logons per week . Binary logistic regression showed that individuals who participated in individual challenges were more likely to achieve an average of 10,000 steps per day ( odds ratio [ OR ] = 2.80 , 95 % confidence interval [ CI ] 1.45–5.40 ) , log steps on a higher than average number of days ( OR = 6.81 , 95 % CI 2.87–13.31 ) , and remain an active user ( OR = 4.36 , 95 % CI 2.17–8.71 ) . Additionally , those using virtual walking buddies ( OR = 5.83 , 95 % CI 1.27–26.80 ) and of older age logged steps on a higher than average number of days . No significant associations were found for team challenges . Conclusions Overall engagement with the 10,000 Steps website was high , and the results demonstrate the relative effectiveness of interactive components to enhance website engagement . However , only exposure to the interactive individual challenge feature was positively associated with all website engagement indicators . More research is needed to examine the influence of intervention components on website engagement , as well as the relationship between website engagement and physical activity change OBJECTIVES Body and Soul was a collaborative effort among two research universities , a national voluntary agency ( American Cancer Society ) , and the National Institutes of Health to disseminate and evaluate under real-world conditions the impact of previously developed dietary interventions for African Americans . METHODS Body and Soul was constructed from two successful research -based interventions conducted in African-American churches . Components deemed essential from the prior interventions were combined , and then tested in a cluster r and omized-effectiveness trial . The primary outcome was fruit and vegetable intake measured with two types of food frequency question naires  at baseline and 6-month follow-up . RESULTS At the 6-month follow-up , intervention participants showed significantly greater fruit and vegetable ( F&V ) intake relative to controls . Post-test differences were 0.7 and 1.4 servings for the 2-item and 17-item F&V frequency measures , respectively . Statistically significant positive changes in fat intake , motivation to eat F&V , social support , and efficacy to eat F&V were also observed . CONCLUSIONS The results suggest that research -based interventions , delivered collaboratively by community volunteers and a health-related voluntary agency , can be effectively implemented under real-world conditions Background The Well London program used community engagement , complemented by changes to the physical and social neighborhood environment , to improve physical activity levels , healthy eating , and mental wellbeing in the most deprived communities in London . The effectiveness of Well London is being evaluated in a pair-matched cluster r and omized trial ( CRT ) . The baseline survey data are reported here . Methods The CRT involved 20 matched pairs of intervention and control communities ( defined as UK census lower super output areas ( LSOAs ) ; ranked in the 11 % most deprived LSOAs in London by the English Indices of Multiple Deprivation ) across 20 London boroughs . The primary trial outcomes , sociodemographic information , and environmental neighbourhood characteristics were assessed in three quantitative components within the Well London CRT at baseline : a cross-sectional , interviewer-administered adult household survey ; a self-completed , school-based adolescent question naire ; a fieldworker completed neighborhood environmental audit . Baseline data collection occurred in 2008 . Physical activity , healthy eating , and mental wellbeing were assessed using st and ardized , vali date d question naire tools . Multiple imputation was used to account for missing data in the outcomes and other variables in the adult and adolescent surveys . Results There were 4,107 adults and 1,214 adolescent respondents in the baseline surveys . The intervention and control areas were broadly comparable with respect to the primary outcomes and key sociodemographic characteristics . The environmental characteristics of the intervention and control neighborhoods were broadly similar . There was greater between-cluster variation in the primary outcomes in the adult population compared to the adolescent population . Levels of healthy eating , smoking , and self-reported anxiety/depression were similar in the Well London adult population and the national Health Survey for Engl and . Levels of physical activity were higher in the Well London adult population but this is likely to be due to the different measurement tools used in the two surveys . Conclusions R and omization of social interventions such as Well London is acceptable and feasible and in this study the intervention 
    Output:
    
The highest potential public health impact was found in multi-level interventions that : 1 ) focused on all levels at the beginning of the planning process , 2 ) guided the implementation process using diffusion theory , and 3 ) used a website to disseminate the intervention .
Conclusions Although most studies underreported results within the RE- AIM dimensions , the reported Reach , Effectiveness , Adoption , Implementation and Maintenance were positively evaluated .
However , more information on external validity and sustainability is needed in order to take informed decisions on the choice of interventions that should be implemented in real-world setting s to accomplish long-term changes in obesity-related behaviours