***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 —Whether cardiac rehabilitation ( CR ) is effective in patients older than 75 years , who have been excluded from most trials , remains unclear . We enrolled patients 46 to 86 years old in a r and omized trial and assessed the effects of 2 months of post-myocardial infa rct ion ( MI ) CR  on total work capacity ( TWC , in kilograms per meter ) and health-related quality of life ( HRQL ) . Methods and Results —Of 773 screened patients , 270 without cardiac failure , dementia , disability , or contraindications to exercise were r and omized to outpatient , hospital-based CR ( Hosp-CR ) , home-based CR ( Home-CR ) , or no CR within 3 predefined age groups ( middle-aged , 45 to 65 years ; old , 66 to 75 years ; and very old , > 75 years ) of 90 patients each .  TWC and HRQL were determined with cycle ergometry and Sickness Impact Profile at baseline , after CR , and 6 and 12 months later . Within each age group , TWC improved with Hosp-CR and Home-CR and was unchanged with no CR . The improvement was similar in middle-aged and old persons but smaller , although still significant , in very old patients . TWC reverted toward baseline by 12 months with Hosp-CR but not with Home-CR .  HRQL improved in middle-aged and old CR and control patients but only with CR in very old patients . Complications were similar across treatment and age groups . Costs were lower for Home-CR than for Hosp-CR . Conclusions —Post-MI Hosp-CR and Home-CR are similarly effective in the short term and improve TWC and HRQL in each age group . However , with lower costs and more prolonged positive effects , Home-CR may be the treatment of choice in low-risk older patients OBJECTIVES For millions of disabled older adults each year , postacute care in skilled nursing facilities is a brief window of opportunity to regain enough function to return home and live independently . Too often this goal is not achieved , possibly because of therapy that is inadequately intense or engaging . This study tested Enhanced Medical Rehabilitation , an intervention design ed to increase patient engagement in , and intensity of , daily physical and occupational therapy sessions in postacute-care rehabilitation . DESIGN R and omized controlled trial of Enhanced Medical Rehabilitation versus st and ard-of-care rehabilitation . SETTING Postacute care unit of a skilled nursing facility in St Louis , MO . PARTICIPANTS Twenty-six older adults admitted from a hospital for postacute rehabilitation . INTERVENTION Based on models of motivation and behavior change , Enhanced Medical Rehabilitation is a set of behavioral skills for physical and occupational therapists that increase patient engagement and intensity , with the goal of improving functional outcome , through ( 1 ) a patient-directed , interactive approach , ( 2 ) increased rehabilitation intensity , and ( 3 ) frequent feedback to patients on their effort and progress . MEASUREMENTS Therapy intensity : assessment of patient active time in therapy sessions . Therapy engagement : Rehabilitation Participation Scale . Functional and performance outcomes : Barthel Index , gait speed , and 6-minute walk . RESULTS Participants r and omized to Enhanced Medical Rehabilitation had higher intensity therapy and were more engaged in their rehabilitation sessions ; they had more improvement in gait speed ( improving from 0.08 to 0.38 m/s versus 0.08 to 0.22 in st and ard of care , P = .003 ) and 6-minute walk ( from 73 to 266 feet versus 40 to 94 feet in st and ard of care , P = .026 ) , with a trend for better improvement of Barthel Index ( + 43 points versus 26 points in st and ard of care , P = .087 ) , compared with participants r and omized to st and ard-of-care rehabilitation . CONCLUSION Higher intensity and patient engagement in the postacute rehabilitation setting is achievable , with result ant better functional outcomes for older adults . Findings should be confirmed in a larger r and omized controlled trial OBJECTIVE During hospitalization older people often experience functional decline which impacts on their future independence . The objective of this study was to evaluate a multifaceted transitional care intervention including home-based exercise strategies for at-risk older people on functional status , independence in activities of daily living ( ADLs ) and walking ability . METHODS A r and omized controlled trial was undertaken in a metropolitan hospital in Australia with 128 patients ( 64 intervention , 64 control ) aged over 65 years with an acute medical admission and at least one risk factor for hospital readmission . The intervention group received an individually tailored programme for exercise and follow-up care which was commenced in hospital and included regular visits in hospital by a physiotherapist and a registered nurse , a home visit following discharge and regular telephone follow-up for 24 weeks following discharge . The programme was design ed to improve health-promoting behaviours , strength , stability , endurance and mobility . Data were collected at baseline , then 4 , 12 and 24 weeks following discharge using the Index of ADL , Instrumental Activities of Daily Living ( IADL ) and the Walking Impairment Question naire ( WIQ ; modified ) . RESULTS Significant improvements were found in the intervention group in IADL scores ( P < 0.001 ) , ADL scores ( P < 0.001 ) and WIQ scale scores ( P < 0.001 ) in comparison to the control group . The greatest improvements were found in the first 4 weeks following discharge . CONCLUSIONS Early introduction of a transitional model of care incorporating a tailored exercise programme and regular telephone follow-up for hospitalized at-risk older adults can improve independence and functional ability Background : The CardioFit internet-based expert system was design ed to promote physical activity in patients with coronary heart disease ( CHD ) who were not participating in cardiac rehabilitation . Design : This r and omized controlled trial compared CardioFit to usual care to assess its effects on physical activity following hospitalization for acute coronary syndromes . Methods : A total of 223 participants were recruited at the University of Ottawa Heart Institute or London Health Sciences Centre and r and omly assigned to either  CardioFit  ( n = 115 ) or  usual care ( n = 108 ) . The CardioFit group received a personally tailored physical-activity plan upon discharge from the hospital and access to a secure website for activity planning and tracking . They completed five online tutorials over a 6-month period and were in email contact with an exercise specialist . Usual care consisted of physical activity guidance from an attending cardiologist .  Physical activity was measured by pedometer and self-reported over a 7-day period , 6 and 12 months after r and omization . Results : The CardioFit internet-based physical activity expert system significantly increased objective ly measured ( p = 0.023 ) and self-reported physical activity ( p = 0.047 ) compared to usual care . Emotional ( p = 0.038 ) and physical ( p = 0.031 ) dimensions of heart disease health-related quality of life were also higher with CardioFit compared to usual care . Conclusions : Patients with CHD using an internet-based activity prescription with online coaching were more physically active at follow up than those receiving usual care . Use of the CardioFit program could extend the reach of rehabilitation and secondary -prevention services The purpose of this pilot study was to test the initial efficacy , feasibility , and safety of a specially design ed postacute care transitional rehabilitation intervention for cardiac patients .  Cardiac Transitional Rehabilitation Using Self-Management Techniques ( Cardiac TRUST ) is a family-focused intervention that includes progressive low-intensity walking and education in self-management skills to facilitate recovery following a cardiac event . Using a r and omized two-group design , exercise self-efficacy , steps walked , and participation in an outpatient cardiac rehabilitation ( CR ) program  were compared in a sample of 38 older adults ( 17 Cardiac TRUST , 21 usual care ) . At discharge from postacute care , the intervention group trended toward higher levels of self-efficacy for exercise outcomes than the usual care group . During the 6 weeks following discharge , the intervention group had greater attendance in outpatient CR and a trend toward more steps walked during the first week . The feasibility of the intervention was better for the home health care participants than for those in the skilled nursing facility . The provision of CR during postacute care has the potential to bridge the gap in transitional services from hospitalization to outpatient CR for these patients at high risk for future cardiac events . Further evidence of the efficacy of Cardiac TRUST is warranted The transitional period from hospital to home is critical to decreasing rates of preventable , poor post-discharge outcomes . Older adults with chronic heart failure ( CHF ) may be challenged to exercise during the transitional period . The purpose of the current study was to test the effects of low-intensity exercise on health-related quality of life ( HRQoL ) , physical function , and heart function in Chinese older adults with CHF during the transitional period . The study was r and omized , single-blinded , and controlled . Seventy-eight older adults with stable CHF were evaluated . The intervention group ( n = 41 ) participated in a regular low-intensity walking protocol and the control group ( n = 38 ) did not . Measures included the Minnesota Living with Heart Failure Question naire ( MLHFQ ) , 6-minute walk distance ( 6MWD ) , Timed Up and Go ( TUG ) test , resting heart rate ( RHR ) , and left ventricular ejection fraction ( LVEF ) . After 12 weeks , the intervention group showed significant improvements in MLHFQ , 6MWD , and TUG scores compared to the control group ( p < 0.05 ) , and no significant improvements in RHR and LVEF ( p > 0.05 ) . Low-intensity exercise during the transitional period is an effective way to improve HRQoL and physical function in older adults . [ Res Gerontol Nurs . 2017 ; 10(3):121 - 128 . ] Aim : To investigate whether phase II cardiac rehabilitation ( CR ) conducted by a community model of shared care CR ( SC-CR ) including health care centres and general practice was feasible and provided acceptable results and to compare SC-CR to hospital-based CR ( H-CR ) in a r and omised controlled trial . Methods : Patients were r and omised to H-CR or SC-CR after admission for acute coronary syndrome . In SC-CR , the general practitioner took over the responsibility of the remaining rehabilitation , pharmacological treatment and risk factor management after the initial visit to the hospital outpatient clinic . The Municipal Health Care Centres provided courses on smoking cessation , nutrition , and exercise training and contributed to disease education and psychosocial support . The main endpoint was adherence to the CR programme and compliance with lifestyle modifications . Results : In total , 1364 patients were screened , 327 ( 24 % ) were eligible , and 212 ( 65 % ) accepted participation . Phase II CR was completed by 192 ( 91 % ) of the participants . Full adherence to the CR programme was seen in 53 % in SC-CR versus 54 % in H-CR ( relative risk ( RR ) : 0.98 , 95 % confidence interval : 0.73–1.32 ) . In H-CR , patients had higher rates of adherence to dietary advice and health education . In SC-CR , 12 % of patients did not attend the risk factor evaluation and clinical assessment with their general practitioner . No difference in risk factor improvement was found . Exercise training was declined by 25 % in both groups . Conclusion : Adherence to phase II CR was high in both groups . SC-CR did not improve adherence and efficacy , but had comparable effects on medication and risk factors . Thus , SC-CR was safe and effective OBJECTIVES This study sought to assess a novel physical rehabilitation intervention in older patients hospitalized for acute decompensated heart failure ( ADHF ) . BACKGROUND After ADHF , older patients , who are frequently frail with multiple comorbidities , have prolonged and incomplete recovery of physical function and remain at high risk for poor outcomes . METHODS The REHAB-HF ( Rehabilitation Therapy in Older Acute Heart Failure Patients ) pilot study was a 3-site , r and omized , attention-controlled pilot study of a tailored , progressive , multidomain physical rehabilitation intervention beginning in the hospital and continuing for 12 weeks post-discharge in patients ≥60 years hospitalized with ADHF . The primary purpose was to assess the feasibility and reasonableness of the hypothesis that the novel rehabilitation intervention would improve physical function ( Short Physical Performance Battery [ SPPB ] ) over 3 months and reduce all-cause rehospitalizations over 6 months . RESULTS The study enrolled 27 patients with ADHF ( ages 60 to 98 years ; 59 % women ; 56 % African American ; 41 % with preserved ejection fraction [ ≥45 % ] ) . At baseline , participants had marked impairments in physical function , multiple comorbidities , and frailty . Study retention ( 89 % ) and intervention adherence ( 93 % ) were excellent . At 3 months , an intervention effect size was measured for the SPPB score of + 1.1 U ( 7.4 ± 0.5 U vs. 6.3 ± 0.5 U ) , and at 6 months an effect size was observed for an all-cause rehospitalization rate of -0.48 ( 1.16 ± 0.35 vs. 1.64 ± 0.39 ) . The change in SPPB score was strongly related to all-cause rehospitalizations , explaining 91 % of change . CONCLUSIONS These findings support the feas 
    Output:
    
OOHS-based multidisciplinary rehabilitation leads to improved mobility in older patients 3 months after they are discharged from hospital following an acute illness and is not associated with a lower risk of unplanned hospital readmission within 3 months of discharge .