***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 examine the influence of intramuscular adipose tissue ( IMAT ) on muscle quality ( MQ ) changes in older adults after 12 weeks of exercise training . Design Prospect i ve cohort design . Setting Academic health science center clinical exercise facility . Participants 70 older ( mean age 73.4 ± 6.3 years ) adults with a history of falls . InterventionResistance , endurance and balance exercise three times weekly for 12 weeks . Measurements Quadriceps strength was determined by maximum voluntary isometric contraction . An MRI of the thigh was used to determine cross-sectional area of lean tissue and IMAT . MQ was calculated as the force per unit area of lean tissue . Individuals were stratified into tertiles ( Low IMAT , Middle IMAT , High IMAT ) based on pre-IMAT levels . Changes in MQ , lean and IMAT were compared across groups . Results No significant changes in lean or IMAT occurred in any group with training . MQ increased only in the Low IMAT group . The Middle and High IMAT groups did not demonstrate a significant change in MQ following 12 weeks of training . Low IMAT , pre = 2.7 [ 0.6 ] post= 3.0 [ 0.6 ] ; Middle IMAT , pre = 2.54 [ 0.8 ] post = 2.75 [ 0.7 ] ; High IMAT , pre = 2.6 [ 0.6 ] to post = 2.5 [ 0.6 ] . Conclusion High levels of thigh IMAT appear to blunt the adaptive MQ response to training . High levels of thigh IMAT may be a potential reason why some older adults do not change their MQ following training . Future research should confirm these results and determine why IMAT impairs MQ and the adaptive response to training in older adults Intermuscular adipose tissue ( IMAT ) , a novel fat depot linked with metabolic abnormalities , has been measured by whole body MRI . The cross-sectional slice location with the strongest relation to total body IMAT volume has not been established . The aim was to determine the predictive value of each slice location and which slice locations provide the best estimates of whole body IMAT .  MRI quantified total adipose tissue of which IMAT , defined as adipose tissue visible within the boundary of the muscle fascia , is a subcomponent . Single-slice IMAT areas were calculated for the calf , thigh , buttock , waist , shoulders , upper arm , and forearm locations in a sample of healthy adult women , African-American [ n = 39 ; body mass index ( BMI ) 28.5 + /- 5.4 kg/m2 ; 41.8 + /- 14.8 yr ] , Asian ( n = 21 ; BMI 21.6 + /- 3.2 kg/m2 ; 40.9 + /- 16.3 yr ) , and Caucasian ( n = 43 ; BMI 25.6 + /- 5.3 kg/m2 ; 43.2 + /- 15.3 yr ) , and Caucasian men ( n = 39 ; BMI 27.1 + /- 3.8 kg/m2 ; 45.2 + /- 14.6 yr ) and used to estimate total IMAT groups using multiple-regression equations . Midthigh was the best , or near best , single predictor in all groups with adjusted R2 ranging from 0.49 to 0.84 . Adding a second and third slice further increased R2 and reduced the error of the estimate . Menopausal status and degree of obesity did not affect the location of the best single slice . The contributions of other slice locations varied by sex and race , but additional slices improved predictions . For group studies , it may be more cost-effective to estimate IMAT based on one or more slices than to acquire and segment for each subject the numerous images necessary to quantify whole body IMAT 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 of raters in the assessment of external validity OBJECTIVES To investigate the relations between cross-sectional area and concentric and eccentric torques in the quadriceps and hamstring muscles and to determine how functional capacity relates to pain , muscle mass , and concentric and eccentric knee torques in women who have bilateral osteoarthritis ( OA ) of the knee . DESIGN R and omized , descriptive study . SETTING A university exercise physiology laboratory in Turkey . PARTICIPANTS Eighteen women with bilateral knee OA ( grade s 2 or 3 ) grade d radiographically . INTERVENTIONS Not applicable . MAIN OUTCOME MEASURES Selected functional tests included the  15-m walk , rising from a chair , descending stairs , and stair climbing . Pain during the functional tests was subjectively measured on an 11-point scale ( range , 0 - 10 ) .  Concentric and eccentric torques  of the quadriceps and hamstring muscles were measured by isokinetic dynamometry with angular velocities of 60 degrees , 120 degrees , and 180 degrees /s ; cross-sectional areas of the quadriceps and hamstring muscles were measured by computed tomography . RESULTS Eccentric torque was significantly ( P range , < .05 to.001 ) greater than concentric torque for the quadriceps ( range , 16%-100 % ) and hamstring ( range , 50%-158 % ) muscles at all angular velocities . Torque-velocity curves for concentric and eccentric contractions were almost identical to those found in healthy young and elderly people . According to r(2 ) values , cross-sectional area of the quadriceps and hamstring muscles explained 24 % to 61 % ( r(2 ) range,.24-.61 ) and 38 % to 51 % ( r(2 ) range,.38-.51 ) of the variations in concentric and eccentric peak torques , respectively . Very small to moderate correlations ( .01-.75 ) were observed among torque at any velocity and the variables of functional capacity and pain . For stair-climbing times , the best predictor variable was the eccentric hamstring to concentric quadriceps torque ratio . For stair descending , it was the concentric hamstring to eccentric quadriceps torque ratios . These torque ratios explained 81 % ( r(2)=.81 ) and 61 % ( r(2)=.61 ) of the variations , respectively . CONCLUSIONS The findings in a patient group with bilateral OA of the knee showed that ( 1 ) eccentric torque is greater than concentric torque in knee muscles ; ( 2 ) the correlation coefficients ( r ) between concentric and eccentric torques at different velocities ( r range,.63-.86 ) , but not between reciprocal torque ratios ( r range,.02-.69 ) , are good ; ( 3 ) cross-sectional area can not be considered as a single predictor of peak torque for either quadriceps or hamstring muscles ; and ( 4 ) the variation in descending stairs and stair-climbing capacities can be explained by the reciprocal torque ratios of knee muscles IMPORTANCE Knee osteoarthritis ( OA ) , a common cause of chronic pain and disability , has biomechanical and inflammatory origins and is exacerbated by obesity . OBJECTIVE To determine whether a ≥10 % reduction in body weight induced by diet , with or without exercise , would improve mechanistic and clinical outcomes more than exercise alone . DESIGN , SETTING , AND PARTICIPANTS Single-blind , 18-month , r and omized clinical trial at Wake Forest University between July 2006 and April 2011 . The diet and exercise interventions were center-based with options for the exercise groups to transition to a home-based program . Participants were 454 overweight and obese older community-dwelling adults ( age ≥55 years with body mass index of 27 - 41 ) with pain and radiographic knee OA . INTERVENTIONS Intensive diet-induced weight loss plus exercise , intensive diet-induced weight loss , or exercise . MAIN OUTCOMES AND MEASURES Mechanistic primary outcomes : knee joint compressive force and plasma IL-6 levels ; secondary clinical outcomes : self-reported pain ( range , 0 - 20 ) , function ( range , 0 - 68 ) , mobility , and health-related quality of life ( range , 0 - 100 ) . RESULTS Three hundred ninety-nine participants ( 88 % ) completed the study . Mean weight loss for diet + exercise participants was 10.6 kg ( 11.4 % ) ; for the diet group , 8.9 kg ( 9.5 % ) ; and for the exercise group , 1.8 kg ( 2.0 % ) . After 18 months , knee compressive forces were lower in diet participants ( mean , 2487 N ; 95 % CI , 2393 to 2581 ) compared with exercise participants ( 2687 N ; 95 % CI , 2590 to 2784 , pairwise difference [Δ](exercise vs diet ) = 200 N ; 95 % CI , 55 to 345 ; P = .007 ) . Concentrations of IL-6 were lower in diet + exercise ( 2.7 pg/mL ; 95 % CI , 2.5 to 3.0 ) and diet participants ( 2.7 pg/mL ; 95 % CI , 2.4 to 3.0 ) compared with exercise participants ( 3.1 pg/mL ; 95 % CI , 2.9 to 3.4 ; Δ(exercise vs diet + exercise ) = 0.39 pg/mL ; 95 % CI , -0.03 to 0.81 ; P = .007 ; Δ(exercise vs diet ) = 0.43 pg/mL ; 95 % CI , 0.01 to 0.85 , P = .006 ) . The diet + exercise group had less pain ( 3.6 ; 95 % CI , 3.2 to 4.1 ) and better function ( 14.1 ; 95 % CI , 12.6 to 15.6 ) than both the diet group ( 4.8 ; 95 % CI , 4.3 to 5.2 ) and exercise group ( 4.7 ; 95 % CI , 4.2 to 5.1 , Δ(exercise vs diet + exercise ) = 1.02 ; 95 % CI , 0.33 to 1.71 ; P(pain ) = .004 ; 18.4 ; 95 % CI , 16.9 to 19.9 ; Δ(exercise vs diet + exercise ) , 4.29 ; 95 % CI , 2.07 to 6.50 ; P(function ) < .001 ) . The diet + exercise group ( 44.7 ; 95 % CI , 43.4 to 46.0 ) also had better physical health-related quality of life scores than the exercise group ( 41.9 ; 95 % CI , 40.5 to 43.2 ; Δ(exercise vs diet + exercise ) = -2.81 ; 95 % CI , -4.76 to -0.86 ; P = .005 ) . CONCLUSIONS AND RELEVANCE Among overweight and obese adults with knee OA , after 18 months , participants in the diet + exercise and diet groups had more weight loss and greater reductions in IL-6 levels than those in the exercise group ; those in the diet group had greater reductions in knee compressive force than those in the exercise group . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00381290 
    Output:
    
People with knee osteoarthritis have more fatty infiltration around the thigh than people with no knee osteoarthritis .
That conclusion is stronger for intermuscular fat than intramuscular fat , based on the quality and number of studies analyzed