***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 : Dizziness is a very common complaint . The frequency of dizziness increases with age . It affects quality of life negatively for older persons in several ways . Objectives : This study intended to investigate which variables ( physical activity , loneliness , health complaints , need of help for daily living and falls ) differed between those with and without dizziness and also to investigate which factors affected quality of life among older persons with dizziness . Method : An age-stratified , r and omised sample of senior citizens – aged 75 or older – living in the south of Sweden ( n = 4,360 ) answered a question naire concerning demographic data , social network , health complaints and diseases , feelings of loneliness , quality of life ( Short Form 12 ) , frequency of falls and activities . Results : Dizziness was associated with an increased risk of falling . Falls in the last 3 months were reported in 31 % of the subjects with dizziness compared to 15 % among those without ( p < 0.001 ) . Dizziness also correlated with depression , with 42.5 % feeling depressed among the elderly reporting dizziness as compared with 13.2 % . Exercise , both light ( i.e. go for a walk ) or heavy ( i.e. work in the garden ) , correlated with reduced risk of low quality of life among older , dizzy persons , both mental ( light exercise OR 0.58 ; heavy OR 0.48 ) and physical ( light OR 0.62 ; heavy OR 0.21 ) . The proportion of dizzy persons doing light exercise  was 75.6 % versus 87.4 % among the not dizzy ( p < 0.001 ) . Exercise  reduces the risk of falling and the risk of being depressed , and increases quality of life . Conclusion : Even light exercise seems beneficial both for improving quality of life and to decrease the risk of falling , which in turn will lower the mortality rate .  Older persons reporting dizziness should be encouraged and perhaps helped to exercise . If one could increase physical activity among the elderly , it would reduce the number of falls , diminish medical costs , suffering for the individual , and be of paramount medicosocial importance for society Background : Physical activity has been effective in enhancing quality of life ( QOL ) of older adults over relatively short periods of time . However , little is known about the longterm effects of physical activity and even less about the possible mediators of this relationship . Purpose : We examined the mediating effects of psychological variables on the relationship between  physical activity  and global QOL ( satisfaction with life ) in older adults over a 4-year period . Methods : Participants ( N = 174 , M age = 66.7 years ) completed a battery of psychosocial measures at 1 and 5 years following enrollment in a 6-month r and omized controlled exercise trial .  Results : Panel analysis conducted within a covariance modeling framework indicated that physical activity was related to self-efficacy , physical self-esteem , and positive affect at 1 year , and in turn , greater levels of self-efficacy and positive affect were associated with higher levels of QOL . Analyses indicated that changes in physical activity over the 4-year period were related to increases in physical self-esteem and positive affect , but only positive affect directly influenced improvements in QOL . Conclusions : The findings lend support to the position that physical activity effects on QOL are in part mediated by intermediate psychological outcomes and that physical activity can have long-term effects on well-being Background : Physical activity has been positively linked to quality of life ( QOL ) in older adults . Measures of health status and global well-being represent common methods of assessing QOL outcomes , yet little has been done to determine the nature of the relationship of these outcomes with physical activity . Purpose : We examined the roles played by physical activity , health status , and self-efficacy in global QOL ( satisfaction with life ) in a sample of older Black and White women . Method : Participants ( N = 249 , M age = 68.12 years ) completed multiple indicators of physical activity , self-efficacy , health status , and QOL at baseline of a 24-month prospect i ve trial . Structural equation modeling examined the fit of 3 models of the physical activity and QOL relationship . Results : Analyses indicated that relationships between physical activity and QOL , self-efficacy and QOL were all indirect . Specifically , physical activity influenced self-efficacy and QOL through physical and mental health status , which in turn influenced global QOL . Conclusions : Our findings support a social cognitives model of physical activity ’s relationship with QOL . Subsequent tests of hypothesized relationships across time are recommended Background In spite of consistent evidence to suggest that being more physically active is associated with enhanced quality of life ( QOL ) , there have been remarkably few attempts to determine the possible underlying mechanisms in this relationship . Purpose To prospect ively examine the roles played by self-efficacy and physical and mental health status in the physical activity and QOL relationship in older women . Method Older women ( M age = 68.12 years ) completed measures of physical activity , self-efficacy relative to balance , mental and physical health status , and global QOL at baseline  ( N = 249 ) and 24-month follow-up ( N = 217 ) . Demographics and general health information were assessed at baseline . A panel analysis within a covariance modeling framework was used to analyze the data . Results Analyses indicated that changes in physical activity over time were associated with residual changes in self-efficacy . Changes in self-efficacy were significantly associated with residual changes in physical and mental health status . Only changes in mental health status were significantly related to residual changes in global QOL . Conclusion Results from this study support the role of self-efficacy in the relationship between physical activity and QOL . Future physical activity promotion programs should include strategies to enhance self-efficacy for physical activity to be most effective for this population Background Although studies suggest that exercise training improves physical performance and health-related quality of life ( HRQOL ) among elderly people , most of these studies have investigated relatively healthy persons . The objective of the present study was to determine the effects of a 12-month multicomponent exercise program on physical performance , daily physical activity , and HRQOL among very elderly people with minor disabilities . Methods The subjects consisted of 65 elders ( median age : 84 years ) who were certified to receive long-term care in the form of support only or Level 1 care ( the lowest level of care required ) ; 31 were allocated to the intervention group and 34 to the control group . The intervention group participated in supervised exercises once a week for 12 months and in home-based exercises . The exercise program consisted of various exercises related to flexibility , muscle strength , balance , and aerobic performance . Results After 12 months of exercise training , the intervention group had significant improvements in lower-limb strength and on the sit- and -reach test ; these effects were not observed in the control group . The control group had significant decreases in grip strength , 6-minute walking distance , walking speed , and stride length ; these decreases were not observed in the intervention group . No clear differences in HRQOL measurements or changes in physical activity were detected between groups . Conclusions The 12-month multicomponent exercise program may effectively improve and maintain the physical performance of very elderly individuals with minor disabilities OBJECTIVES To determine whether elderly people who meet national guidelines have higher physical function ( PF ) scores than those who do not and the effect on functional trajectory when physical activity ( PA ) levels change from above to below this threshold , or vice versa . DESIGN Pooled data . SETTING Two 6-month r and omized controlled trials aim ed at increasing PA in adults . PARTICIPANTS Adults aged 65 to 94 ( N=357 ) . INTERVENTION PA counseling over the telephone and through mailed material s. MEASUREMENTS  Self-reported PA  dichotomized at 150 minutes/week and PF using the Medical Outcomes Study 36-item Short Form Question naire PF subscale . RESULTS At baseline , individuals reporting 150 minutes or more of moderate PA/week had mean PF scores that were 20.3 points higher than those who did not ( P<.001 ) . Change in PA minutes from above threshold to below threshold or from below threshold to above threshold from baseline to 6 months result ed in an average change in PF of -11.18 ( P<.001 ) and + 5.10 ( P=.05 ) , respectively . CONCLUSION These findings suggest that PA is an important predictor of functional status . Older sedentary adults can improve PF by meeting recommended PA levels . Conversely , dropping below recommended PA levels has a deleterious effect on PF . Given the importance of PF in maintenance of independence and quality of life in older adults , adherence to recommended PA guidelines should be endorsed Purpose This study examined relationships between health-related quality of life ( HRQOL ) and objective assessment s of habitual physical activity in older adults , focusing on interactions between the amount and intensity of activity . Methods Subjects were healthy Japanese aged 65–85 years ( 74 men and 109 women ) .  Pedometer/accelerometers measured their step counts and the intensity of physical activity in metabolic equivalents ( METs ) continuously 24 h per day for 1 year . Each individual ’s final HRQOL was assessed using the Medical Outcomes Study 36-Item Short-Form Health Survey ( SF-36 ) instrument . Results The daily step count and the daily duration of physical activity at an intensity > 3 METs were quite closely correlated ( quadratic r2 = 0.93 , P < 0.05 ) . After controlling for age , sex , and daily step count , the overall SF-36 score and four constituent dimensions ( physical functioning , freedom from pain , vitality , and mental health ) were all significantly higher in individuals spending > 25 % of their total activity at an intensity > 3 METs . However , engagement in activity > 3 METs was not significantly associated with the remaining SF-36 components ( physical limitations , general health , social functioning , and emotional limitations ) . Conclusions Associations between moderate-intensity physical activity and HRQOL in older adults merit further evaluation by prospect i ve studies and /or r and omized controlled trials BACKGROUND Our objective was to assess the effects of targeted exercise programs on health-related quality of life compared with usual care based on the ability to perform activities of daily living ( ADL ) and the Neuropsychiatric Inventory scores in geriatric institutionalized persons . METHODS A r and omized controlled trial of 2 exercise programs vs usual care was conducted in 160 institutionalized persons 65 years or older who were able to underst and basic motor comm and s and to move from one position to another . Interventions were performed over 6 months and were either an adapted tai chi program ( 4 times 30 min/wk ) or a cognition-action program ( 2 times 30 - 45 min/wk ) that focused primarily on an adapted guidance of patient-centered communication skills . The control group received usual care . The study was conducted at 4 setting s. The main outcomes were changes in health-related quality of life based on ADL and Neuropsychiatric Inventory scores after 12 months . RESULTS The control group experienced a decline in ADL over the 12-month period compared with the adapted tai chi and cognition-action groups , but the differences were not significant ( P = .24 and P = .15 , respectively ) . Also , the components of ADL , eg , ability to walk , continence , and nutrition , were maintained better in the intervention groups than in the control group . The total Neuropsychiatric Inventory score also worsened significantly in the control group , while it was unchanged or improved in the intervention groups . The differences between the cognition-action group and the control group were significant ( P > .001 ) . Neuropsychiatric diagnosis subgroups ( such as dementia and psychosis ) did not show a specific response from any intervention . CONCLUSION Adapted exercise programs can slow down the decline in health-related quality of life among heterogeneous , institutionalized elderly persons . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00623532 OBJECTIVE : To test the feasibility of creating a valid and reliable checklist with the following features : appropriate for assessing both r and omised and non-r and omised studies ; provision of both an overall score for study quality and a profile of scores not only for the quality of reporting , internal validity ( bias and confounding ) and power , but also for external validity . DESIGN : A pilot version was first developed , based on epidemiological principles , review s , and existing checklists for r and omised studies . Face and content validity were assessed by three experienced review ers and reliability was determined using two raters assessing 10 r and omised and 10 non-r and omised studies . Using different raters , the checklist was revised and tested for internal consistency ( Kuder-Richardson 20 ) , test-retest and inter-rater reliability ( Spearman correlation coefficient and sign rank test ; kappa statistics ) , criterion validity , and respondent burden . MAIN RESULTS : The performance of the checklist improved considerably after revision of a pilot version . The Quality Index had high internal consistency ( KR-20 : 0.89 ) as did the subscales apart from external validity ( KR-20 : 0.54 ) . Test-retest ( r 0.88 ) and inter-rater ( r 0.75 ) reliability of the Quality Index were good . Reliability of the subscales varied from good ( bias ) to poor ( external validity ) . The Quality Index correlated highly with an existing , established instrument for assessing r and omised studies ( r 0.90 ) . There was little difference between its performance with non-r and omised and with r and omised studies . Raters took about 20 minutes to assess each paper ( range 10 to 45 minutes ) . CONCLUSIONS : This study has shown that it is feasible to develop a checklist that can be used to assess the method ological quality not only of r and omised controlled trials but also non-r and omised studies . It has also shown that it is possible to produce a checklist that provides a profile of the paper , alerting review ers to its particular method ological strengths and weaknesses . Further work is required to improve the checklist and the training 
    Output:
    
Most studies demonstrated a positive association between  PA  and QoL in the elderly .
PA had a consistent association with the following QoL domains : functional capacity ; general QoL ; autonomy ; past , present and future activities ; death and dying ; intimacy ; mental health ; vitality ; and psychological .
CONCLUSION PA was positively and consistently associated with some QoL domains among older individuals , supporting the notion that promoting PA in the elderly may have an impact beyond physical health .