***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 We investigated the effectiveness of a low-cost , multifactor fall risk reduction program in a group of rural community-dwelling older adults . The goal of the program was to provide health care workers and communities with a primary prevention tool that can be used to teach seniors about fall-related risks . The long-term goal of this program is to reduce the incidence of falling among community-dwelling older adults . METHODS Complete data were collected on 37 community-dwelling subjects , aged 67 to 90 , who participated in a 10-week fall risk reduction program . The subjects were r and omly assigned to an intervention group or to a control group . The intervention group received fall risk education , home-based exercise programming , nutrition counseling , and environmental hazards education . Both groups completed a variety of physiologic , psychometric , and environmental fall-related risk assessment s before and after the intervention period . RESULTS The intervention group showed statistically significant improvement in balance , bicep endurance , lower extremity power , reduction of environmental hazards , falls efficacy , and nutritious food behavior during the study period . CONCLUSIONS The low-cost , home-based fall risk reduction program for community-dwelling older adults was effective in reducing some of the studied fall-related risk factors over a 10-week period BACKGROUND Sedentary lifestyle is associated with adverse health outcomes . Available evidence suggests that , despite positive attitudes toward regular exercise in promoting a healthy lifestyle , few physicians actually prescribe exercise for their patients . Barriers include lack of skills and st and ard office instruments . Because primary care physicians have regular contact with a large proportion of the population , the impact of preventive health interventions may be great . OBJECTIVES To determine the effect of an exercise prescription instrument ( i.e. , Step Test Exercise Prescription [ STEP ] ) , compared to usual-care exercise counseling delivered by primary care doctors on fitness and exercise self-efficacy among elderly community-dwelling patients . DESIGN R and omized controlled trial ; baseline assessment and intervention delivery with postintervention follow-up at 3 , 6 , and 12 months . SETTING Four large ( > 5000 active patient files ) academic , primary care practice s : three in urban setting s and one in a rural setting , each with four primary care physicians ; two clinics provided the STEP intervention and two provided usual care control . PARTICIPANTS A total of 284 healthy community-dwelling patients ( 72 per clinic ) aged > 65 years were recruited in 1998 - 1999 . INTERVENTION STEP included exercise counseling and prescription of an exercise training heart rate . MAIN OUTCOME MEASURES The primary outcome measure was aerobic fitness ( VO(2max ) ) . Secondary outcomes included predicted VO(2max ) from the STEP test , exercise self-efficacy ( ESE ) , and clinical anthropometric parameters . RESULTS A total of 241 subjects ( 131 intervention , 110 control ) completed the trial .  VO(2max ) was significantly increased in the STEP intervention group ( 11 % ; 21.3 to 24ml/kg/min ) compared to the control group ( 4 % ; 22 to 23ml/kg/min ) over 6 months ( p < 0.001 ) , and 14 % ( 21.3 to 24.9ml/kg/min ) and 3 % ( 22.1 to 22.8ml/kg/min ) , respectively , at 12 months ( p < 0.001 ) . A similar significant increase in ESE ( 32 % ; 4.6 vs 6.8 ) was observed for the STEP group compared to the control group ( 22 % ; 4.2 vs 5.4 ) at 12 months ( p < 0.001 ) . Systolic blood pressure decreased 7.3 % and body mass index decreased 7.4 % in the STEP group , with no significant change in the control group ( p < 0.05 ) . Exercise counseling time was significantly ( p < 0.02 ) longer in the STEP ( 11.7+/-3.0 min ) compared to the control group ( 7.1+/-7.0 min ) , but more ( p < 0.05 ) subjects completed > or = 80 % of available exercise opportunities in the STEP group . CONCLUSIONS Primary care physicians can improve fitness and exercise confidence of their elderly patients using a tailored exercise prescription ( e.g. , STEP ) . Further , STEP appears to maintain benefits to 12 months and may improve exercise adherence . Future study should determine the impact of combining cognitive/behavior change strategies with STEP BACKGROUND Limited research has investigated how to promote physical activity in people with type 2 diabetes . This study evaluated physical activity counseling over 12 months in people with type 2 diabetes . DESIGN Participants were given st and ard exercise information and r and omly assigned to receive physical activity counseling or not . Data were collected from September 2000 through to September 2002 and analyzed from October 2002 to February 2003 . SETTING / PARTICIPANTS Diabetes outpatient clinic . Seventy inactive people with type 2 diabetes . INTERVENTION Physical activity counseling , based on the transtheoretical model , combined motivational theory and cognitive behavioral strategies into an individualized intervention to promote physical activity . Consultations were delivered at baseline and 6 months , with phone calls at 1 and 3 months post-consultation . MAIN OUTCOME MEASURES Changes from baseline at 12 months in physical activity ( 7-day recall and accelerometer ) , stages and processes of exercise behavior change . RESULTS Between-group differences were recorded in physical activity ( recall and accelerometer ) at 12 months ( p < 0.01 ) . Experimental participants significantly increased total activity ( median difference , 115 minutes ; 95 % confidence interval [CI]=73 - 150 minutes ) . Control participants recorded no significant change ( median difference , -15 minutes ; 95 % CI=-53 - 13 minutes ) . The accelerometer experimental participants recorded no significant change ( mean difference , 416,632 counts ; 95 % CI=-27,743 , 1,051,007 counts/week ) , while control participants recorded a significant decrease ( mean difference , -669,061 counts ; 95 % CI=-1,292,285 , -45,837 counts/week ) . At 12 months , more experimental participants compared to controls were in active stages of behavior(6-month chi(2)=26.4 , p < 0.01 ; 12-month chi(2)=19.9 , p < 0.01 , respectively ) . Between-group differences were recorded at 12 months for the frequency of using all processes ( p < 0.01 ) , except dramatic relief and stimulus control . CONCLUSIONS Physical activity counseling was effective for promoting physical activity over 12 months in people with type 2 diabetes 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 The purpose of this study was to assess the effects of a water-based exercise and self-management program on balance , fear of falling , and quality of life in community-dwelling women 65 years of age or older with a diagnosis of osteopenia or osteoporosis . Fifty women with an average age of 73.3 years ( range 65.5 - 82.4 , SD 3.9 ) were r and omised to intervention or control groups . The intervention group received a 10-week water-based exercise and self-management program compiled by Community Physiotherapy Services and conducted by a physiotherapist at an aquatic centre twice a week for one hour . The control group did not receive any instructions and were not encouraged to change their physical activity , activities of daily living or social habits during the study .  Change in balance , measured using the step test , from baseline to follow-up differed between intervention and control groups , with mean ( 95 % CI ) between-group differences of 1.7 ( 0.9 to 2.6 ) and 2.1 ( 1.1 to 3.1 ) steps on the left and right sides respectively . Between-group differences in score changes were also significant in four of the eight domains of quality of life measured using the Short Form 36 question naire ( SF36 ; physical function 8.6 ( 0.4 to 16.8 ) , vitality 12.0 ( 2.3 to 21.8 ) , social function , and 14.1 ( 0.6 to 27.7 ) mental health 10.2 ( 2.0 to 18.4 ) ) , but not fear of falling measured using the modified falls efficacy scale ( 0.25 ( -0.3 to 0.81 ) . It is concluded that a water-based exercise and self-management program produced significant changes in balance and quality of life , but not fear of falling , in this group of community-dwelling women 65 years of age or older with a diagnosis of osteopenia or osteoporosis OBJECTIVE To examine and compare urban and rural palliative care service availability and patterns of care from r and omised , population -based surveys of caregivers of people at the end of life . DESIGN , SETTING & PARTICIPANTS Survey responses on the death of ' someone close ' from 23,588 interviews of South Australians conducted between 2001 and 2007 are analysed . INTERVENTIONS A r and omised population survey . MAIN OUTCOME MEASURES Explored  palliative care service availability , caregiving provided , and characteristics of the deceased and their caregivers . RESULTS There was no difference in reported rates of accessing specialist palliative care services  between rural and urban respondents ( in unadjusted and adjusted analyses ) nor did the proportion of people for whom cancer was their life-limiting illness . There was greater reliance on friends than first degree relatives in h and s-on care provided at the end of life in rural setting s. The rates of reported need for more support did not differ between urban and rural respondents for caregivers of people at the end of life . CONCLUSION Use of  palliative care services was similar for rural and urban caregivers for someone close at the end of life with similar levels of met and unmet needs OBJECTIVES To determine whether a home-based multicomponent physical activity counseling ( PAC ) intervention is effective in reducing glycemic measures in older out patients with prediabetes mellitus . DESIGN Controlled clinical trial . SETTING Primary care clinics of the Durham Veterans Affairs ( VA ) Medical Center between September 29 , 2008 , and March 25 , 2010 . PARTICIPANTS Three hundred two overweight ( body mass index 25 - 45 kg/m(2 ) ) , older ( 60 - 89 ) out patients with impaired glucose tolerance ( fasting blood glucose 100 - 125 mg/dL , glycosylated hemoglobin ( HbA1c ) < 7 % ) r and omly assigned to a  PAC intervention group  ( n = 180 ) or a usual care control group ( n = 122 ) . INTERVENTION A 12-month , home-based multicomponent PAC program including one in-person baseline counseling session , regular telephone counseling , physician endorsement in clinic with monthly automated encouragement , and customized mailed material s. All study participants , including controls , received a consultation in a VA weight management program . MEASUREMENTS The primary outcome was a homeostasis model assessment of insulin resistance ( HOMA-IR ) , calculated from fasting insulin and glucose levels at baseline and 3 and 12 months . HbA1c was the secondary indicator of glycemic control . Other secondary outcomes were anthropometric measures and self-reported physical activity , health-related quality of life , and physical function . RESULTS There were no significant differences between the PAC and control groups over time for any of the glycemic indicators . Both groups had small declines over time of approximately 6 % in fasting blood glucose ( P < .001 ) , and other glycemic indicators remained stable . The declines in glucose were not sufficient to affect the change in HOMA-IR scores due to fluctuations in insulin over time . Endurance physical activity increased significantly in the PAC group ( P < .001 ) and not in the usual care group . CONCLUSION Home-based telephone counseling increased physical activity levels but was insufficient to improve glycemic indicators in older out patients with prediabetes mellitus Previous research has pointed to the efficacy of physical activity in individuals suffering from type 2 diabetes mellitus ( type 2 DM ) . However , as with other population s , adherence to exercise programs is often problematic . This study assessed the effectiveness of a combination of exercise and psychological interventions in type 2 diabetics in terms of disease management and exercise adherence . Forty newly diagnosed type 2 diabetic subjects ( 54 + /- 6.5 years ) took part in the study . Subjects were allocated to an exercise-only intervention ( EO ) or a combined exercise and psychological adherence intervention ( EP ) group . Adherence to the program was also monitored at a 6-month follow-up . The results confirmed a significant improvement in physiological parameters ( total mass , fat mass , grip strength , peak flow , flexibility , and VO2 max ) after the 12-week program in both groups ( P < 0.001 ) . The EP group had significant changes in body fat , grip strength , and peak flow ( P < 0.05 ) in comparison to the EO group . Components of the visual analog mood scale ( VAMS ) were positively influenced in both groups from the therapy program ( P < 0.001 
    Output:
    
Few consistencies existed between intervention types , duration , outcome measures , and follow-up .
Results provide some evidence to support the effectiveness of community-based interventions that include low- to moderate-intensity exercise to increase physical activity , physical function , and psychological state .
However , without more rigorous studies it is difficult to identify the most critical characteristics of community-based interventions for older adults in rural and regional setting