***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 
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    ***EXAMPLES*** 
    Input: Background Few medical therapies improve lower extremity functioning in people with lower extremity peripheral artery disease ( PAD ) . Among people with PAD , we studied whether a group-mediated cognitive behavioral intervention promoting home-based unsupervised exercise prevented mobility loss and improved functional performance compared to control . Methods and Results One hundred ninety-four PAD participants were r and omized . During months 1 to 6 , the intervention group met weekly with other PAD participants and a facilitator . Group support and self-regulatory skills were used to help participants adhere to walking exercise . Ninety-percent of exercise was conducted at or near home . The control group attended weekly lectures . During months 6 to 12 , each group received telephone contact only . Primary outcomes have been reported . Here we compare changes in exploratory outcomes of mobility loss ( the inability to climb a flight of stairs or walk one-quarter mile without assistance ) , walking velocity , and the Short Physical Performance Battery . Compared to controls , fewer participants r and omized to the intervention experienced mobility loss at 6-month follow-up : 6.3 % versus 26.5 % , P=0.002 , odds ratio=0.19 ( 95 % CI=0.06 to 0.58 ) and at 12-month follow-up : 5.2 % versus 18.5 % , P=0.029 , odds ratio=0.24 ( 95 % CI=0.06 to 0.97 ) . The intervention improved fast-paced 4-m walking velocity at 6-month follow-up ( P=0.005 ) and the Short Physical Performance Battery at 12-month follow-up ( P=0.027 ) , compared to controls . Conclusions In exploratory analyses , a group-mediated cognitive behavioral intervention promoting unsupervised walking exercise prevented mobility loss and improved functioning at 6- and 12-month follow-up in PAD patients . Clinical Trial Registration URL : http:// clinical trials.gov . Unique identifier : NCT00693940 We estimated minimal clinical ly important differences ( MCIDs ) for small , moderate , and large changes in measures obtained from a st and ardized treadmill test , a 6-minute walk test , and patient-based outcomes following supervised and home-based exercise programs in symptomatic patients with peripheral artery disease ( PAD ) . Patients were r and omized to either 12 weeks of a supervised exercise program ( n=60 ) , a home-based exercise program ( n=60 ) , or an attention-control group ( n=60 ) . Using the distribution-based method to determine MCIDs , the MCIDs for small , moderate , and large changes in peak walking time ( PWT ) in the supervised exercise group were 38 , 95 , and 152 seconds , respectively , and the changes in claudication onset time ( COT ) were 35 , 87 , and 138 seconds . Similar MCID scores were noted for the home-based exercise group . An anchor-based method to determine MCIDs yielded similar patterns of small , moderate , and large change scores in PWT and COT , but values were 1–2 minutes longer than the distribution approach . In conclusion , 3 months of supervised and home-based exercise programs for symptomatic patients with PAD results in distribution-based MCID small , moderate , and large changes ranging from 0.5 and 2.5 minutes for PWT and COT . An anchor-based approach yields higher MCID values , ranging from a minimum of 73 seconds for COT to a maximum of 4 minutes for PWT . The clinical implication is that a goal for eliciting MCIDs in symptomatic PAD patients through a walking exercise intervention is to increase PWT and COT by up to 4 minutes , which corresponds to two work stages during the st and ardized progressive treadmill test The aim of this study was to develop and pilot a group education programme for promoting walking in people with intermittent claudication . Patient focus groups ( n=24 ) and literature review s were conducted to inform the development of the education programme , which involves a three-hour group-based education workshop and follow-up telephone support . A pilot study was subsequently conducted in which 23 new patients ( Rutherford category 1–3 ) were r and omly assigned to usual care ( control ) or usual care plus the education programme . Outcomes were assessed at baseline and six weeks including daily steps ( tri-axial accelerometer ) , walking capacity ( six-minute walk test and Gardner treadmill test ) , and quality of life ( Intermittent Claudication Question naire [ ICQ ] ) . Exit interviews were conducted to assess the acceptability and usefulness of the programme . Compared with controls , the intervention group had superior walking capacity and quality of life at six weeks . Mean differences in six-minute walk distance , treadmill maximum walking distance and ICQ score were 44.9 m ( 95 % confidence interval [ CI ] , 6.9 to 82.9 ) , 173 m ( 95 % CI , 23 to 322 ) , and −10.6 ( 95 % CI , −18.9 to −2.3 ) , respectively . The daily step count did not differ between groups . The exit interviews indicated that participants valued attending the programme , that it gave them a greater underst and ing of their condition , and that they had been walking more for exercise since attending . The results suggest that the education programme is feasible , acceptable , and potentially useful for improving walking capacity and quality of life . A fully-powered trial exploring clinical and cost effectiveness is needed . TRIAL REGISTRATION NUMBER : IS RCT N06733130 ( http://www.controlled-trials.com ) The aims of the study were to determine whether heart rate variability ( HRV ) measured at rest and during exercise could be altered by an exercise training programme design ed to increase walking performance in patients with peripheral arterial disease . Forty-four volunteers were r and omised into 12 weeks of either : supervised walking training twice weekly for 30 min at 75 % VO2peak ( SU ) , home-based walking training sessions : twice weekly , 30 min per week ( HB ) or no exercise ( CT ) .  HRV measures were calculated from a 5-min resting ECG . Each patient then underwent maximal , grade d exercise treadmill testing . All measures were repeated after 12 weeks . The SU group showed significantly ( p < 0.001 ) increased maximal walking time ( MWT ) but no change in VO2peak . There were no statistically significant changes in any of the measures of HRV in any group . Effect sizes for change in HRV measures were all very small and in some cases negative . Improved walking performance was not accompanied by central cardiorespiratory or neuroregulatory adaptations in the present study . The lack of any change in HRV was possibly due to either the low intensity or discontinuous nature of exercise undertaken . Key pointsIt is known that exercise can positively influence heart rate variability in some cardiac patients .It is known that exercise can increase walking performance in peripheral vascular disease patients .Exercise  training improved walking performance in peripheral vascular disease patients but HRV was unaltered . This may be due to low overall physiological dem and s on the cardiovascular system or the intermittent nature of the exercise OBJECTIVE Determine the efficacy of a home-based walking intervention to improve walking ability and quality of life in people with diabetes and peripheral arterial disease ( PAD ) . RESEARCH DESIGN AND METHODS We conducted a r and omized , controlled , single-blind trial within university-affiliated clinics in our local community . We r and omized 145 participants ( 45 women ) with diabetes and PAD to our intervention — a 6-month behavioral intervention targeting levels of readiness to engage in routine walking for exercise — versus attention control . Our primary outcome was 6-month change in maximal treadmill walking distance . Secondary outcomes included 3-month change in maximal walking distance , lower limb function ( i.e. , walking impairment scores ) , quality of life ( Medical Outcomes Short Form Survey ) , exercise behaviors , depressive symptoms , and self-efficacy at 3 and 6 months . RESULTS The mean age of participants was 66.5 ( SD 10.1 ) years . Intervention and control groups did not differ significantly in 6-month change in maximal treadmill walking distance ( average [ SE ] 24.5 [ 19.6 ] meters vs. 39.2 [ 19.6 ] meters ; P = 0.60 ) . Among secondary outcomes , for the intervention and control groups , respectively , average walking speed scores increased by 5.7 [ 2.2 ] units and decreased by 1.9 [ 2.8 ] units ( P = 0.03 ) ; the mental health quality of life subscale score increased by 3.2 [ 1.5 ] and decreased by 2.4 [ 1.5 ] units ( P = 0.01 ) . CONCLUSIONS A home-based walking intervention did not improve walking distance but did improve walking speed and quality of life in people with diabetes and PAD . Clinicians should consider recommending home-based walking therapy for such patients Background This prospect i ve , r and omized , controlled clinical trial compared changes in primary outcome measures of claudication onset time ( COT ) and peak walking time ( PWT ) , and secondary outcomes of submaximal exercise performance , daily ambulatory activity , vascular function , inflammation , and calf muscle hemoglobin oxygen saturation ( StO2 ) in patients with symptomatic peripheral artery disease ( PAD ) following new exercise training using a step watch ( NEXT Step ) home‐exercise program , a supervised exercise program , and an attention‐control group . Methods and Results One hundred eighty patients were r and omized . The NEXT Step program and the supervised exercise program consisted of intermittent walking to mild‐to‐moderate claudication pain for 12 weeks , whereas the controls performed light resistance training . Change scores for COT ( P<0.001 ) , PWT ( P<0.001 ) , 6‐minute walk distance ( P=0.028 ) , daily average cadence ( P=0.011 ) , time to minimum calf muscle StO2 during exercise ( P=0.025 ) , large‐artery elasticity index ( LAEI ) ( P=0.012 ) , and high‐sensitivity C‐reactive protein ( hsCRP ) ( P=0.041 ) were significantly different among the 3 groups . Both the NEXT Step home program and the supervised exercise program demonstrated a significant increase from baseline in COT , PWT , 6‐minute walk distance , daily average cadence , and time to minimum calf StO2 . Only the NEXT Step home group had improvements from baseline in LAEI , and hsCRP ( P<0.05 ) . Conclusions NEXT Step home exercise utilizing minimal staff supervision has low attrition , high adherence , and is efficacious in improving COT and PWT , as well as secondary outcomes of submaximal exercise performance , daily ambulatory activity , vascular function , inflammation , and calf muscle StO2 in symptomatic patients with PAD . Clinical Trial Registration URL : Clinical Trials.gov . Unique Identifier : NCT00618670 Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more Background We studied whether a 6‐month group‐mediated cognitive behavioral ( GMCB ) intervention for peripheral artery disease ( PAD ) participants , which promoted home‐based walking exercise , improved 6‐minute walk and other outcomes at 12‐month follow‐up , 6 months after completing the intervention , compared to a control group . Methods and Results We r and omized PAD participants to a GMCB intervention or a  control group . During phase I ( months 1 to 6 ) , the intervention used group support and self‐regulatory skills during weekly on‐site meetings to help participants adhere to home‐based exercise . The control group received weekly on‐site lectures on topics unrelated to exercise . Primary outcomes were measured at the end of phase I. During phase II ( months 7 to 12 ) , each group received telephone contact . Compared to controls , participants r and omized to the intervention increased their 6‐minute walk distance from baseline to 12‐month follow‐up , ( from 355.4 to 381.9 m in the intervention versus 353.1 to 345.6 m in the control group ; mean difference=+34.1 m ; 95 % confidence interval [CI]=+14.6 , + 53.5 ; P<0.001 ) and their Walking Impairment Question naire ( WIQ ) speed score ( from 36.1 to 46.5 in the intervention group versus 34.9 to 36.5 in the control group ; mean difference = + 8.8 ; 95 % CI=+1.6 , + 16.1 ; P=0.018 ) . Change in the WIQ distance score was not different between the 2 groups at 12‐month follow‐up ( P=0.139 ) . Conclusions A weekly on‐site GMCB intervention that promoted home‐based walking exercise intervention for people with PAD demonstrated continued benefit at 12‐month follow‐up , 6 months after the GMCB intervention was completed . Clinical Trial Registration URL : Clinical Trials.gov . Unique identifier : NCT00693940 Supervised walking exercise is an effective treatment to improve walking ability of patients with peripheral artery disease ( PAD ) , but few exercise programs in community setting s have been effective . The aim of this study was to determine the efficacy of a community-based walking exercise program with training , monitoring and coaching ( TMC ) components to improve exercise performance and patient-reported outcomes in PAD patients . This was a r and omized , controlled trial including PAD patients ( n=25 ) who previously received peripheral endovascular therapy or presented with stable claudic 
    Output:
    
This meta- analysis suggests that structured home exercise programmes are effective at improving walking performance and physical activity in the short term for patients with PAD