***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: Overweight and physical inactivity are associated with elevated reactive oxygen species and chronic low- grade inflammation . Exercise training studies have measured changes in systemic inflammatory and oxidative/antioxidative biomarkers but predominantly at moderate-high intensities . Few low-intensity , lifestyle-based physical activity ( PA ) studies have been conducted . The purpose of this study was to determine whether improvements in lifestyle-oriented PA result ing from a 16-wk Internet-delivered PA program [ Active Living Every Day-Internet ( ALED-I ) ] elicit cardioprotective improvements in measures of inflammation , oxidation , or antioxidant enzyme capacity .  Forty-one men and women ( age 23 - 62 yr ) were r and omized to either the ALED-I intervention [ n = 19 ; age = 40.4 + /- 1.9 yr ; body mass index ( BMI ) = 31.4 + /- 1.1 kg/m(2 ) ] or a delayed intent-to-treat control condition ( n = 22 ; age = 46.6 + /- 1.3 yr ; BMI = 31.0 + /- 0.7 kg/m(2 ) ) . TNF-alpha , C-reactive protein , myeloperoxidase , superoxide dismutase , catalase , total antioxidative capacity , change in PA , and other cardiometabolic disease risk factors were measured at baseline and postintervention . The ALED-I group increased PA and decreased central adiposity without changes in the control group . There was no change in the control group for any inflammation , oxidation , or antioxidant biomarkers . TNF-alpha decreased ( P = 0.01 ) in the intervention group but was not statistically different from the control group . In conclusion , modest improvements in daily low-intensity ambulatory PA as a result of an Internet-delivered lifestyle PA intervention may be cardioprotective in sedentary and overweight adults through reductions in central adiposity and inflammation . However , the absence of favorable changes in other inflammation , oxidation , and antioxidant biomarkers highlights the need for further attention to the dose response of lifestyle-structured PA promotion strategies for health maintenance/improvement The independent effects of exercise and weight loss on markers of inflammation ( MOI ) in obese individuals have not been clearly characterized . The objectives of this study were to : ( i ) identify the independent effects of exercise and weight loss on MOI and ( ii ) determine whether changes in MOI were associated with changes in fat distribution . Subjects were 126 healthy , premenopausal women , BMI 27 - 30 kg/m(2 ) . They were r and omized to one of three groups : diet only , diet + aerobic- , or diet + resistance training until a BMI < 25 kg/m(2 ) was achieved . Fat distribution was measured with computed tomography , and body composition with dual-energy X-ray absorptiometry .  Serum concentrations of tumor necrosis factor (TNF)-α , soluble TNF receptor 1 ( sTNF-R1 ) , soluble TNF receptor 2 ( sTNF-R2 ) , C-reactive protein ( CRP ) , and interleukin (IL)-6 were assessed . Results of repeated- measures ANOVA indicated a significant effect of time on MOI , such that MOI decreased with weight loss . Results of mixed-model analysis indicated that adjusting for intra-abdominal adipose tissue ( IAAT ) and total fat mass explained the decreases in TNF-α and sTNF-R1 , whereas only total fat mass explained the decreases in sTNF-R2 , IL-6 , and CRP . In conclusion , weight loss was associated with decreases in MOI . The effect of weight loss appeared to be mediated by changes in total fat mass or IAAT . Addition of exercise did not alter the response , suggesting that weight loss has a more profound impact for reducing MOI in overweight women than exercise The activity of the hypothalamic-pituitary-adrenal axis is usually modulated by several stress factors , including exercise . Different responses are induced by physical training according to duration and intensity of exercise . During prolonged training , cortisol remains normal or decreased as a consequence of altered cortisol secretion , metabolism and excretion , and possibly by changes in glucocorticoid sensitivity . The aim of this study was to evaluate the impact of prolonged physical training on the glucocorticoid sensitivity .  Eighteen cadets of the Air Force Academy , mean ( SD ) age : 18.7 ( 1.0 ) years , underwent an intensive 6-week preparatory training-period considered adequate by inducing significant changes on body composition measured by bioelectrical impedance . Measurement of individual 's pituitary glucocorticoid sensitivity was done by an intravenous very low dose dexamethasone suppression test ( 20 microg/m ( 2 ) ) that was performed before and after the training period . Cortisol levels were obtained at basal condition and 120 minutes after the dexamethasone infusion . Basal cortisol showed a significant decrease after prolonged training . The percent cortisol suppression after dexamethasone tended to be lower after the training period . Overall , our data suggest that prolonged physical training is able to reduce glucocorticoid sensitivity , which can have a beneficial impact in chronic stress conditions Increased circulating adiponectin and insulin sensitivity are usually observed after body fat loss induced by a weight-loss diet . Progressive resistance training ( PRT ) without a concomitant weight-loss diet significantly decreases visceral fat , thus improving insulin sensitivity . Therefore , the purpose of this study was to ascertain the effects of combined 16-week PRT and weight-loss diet on circulating adiponectin and insulin sensitivity index .  Thirty-four obese ( BMI : 30 - 40 kg/m(2 ) ) women , aged 40 - 60 year , were r and omized to three groups : a control group ( C ; n = 9 ) ; a diet group ( WL ; n = 12 ) with a caloric restriction of 500 kcal/d ; and a diet plus resistance training group ( WL+RT ; n = 13 ) with the same caloric restriction as group WL and a 16-week supervised whole body PRT of two sessions/week . Both WL and WL+RT groups showed similar decreases in body mass ( -6.3 % and -7.7 % ) and visceral fat ( -19.9 % and -20.5 % ) . WL result ed in an expected increase in circulating levels of adiponectin ( P = 0.07 ) and insulin sensitivity . However , circulating total adiponectin decreased ( P < 0.05 ) in WL+RT group , whereas an improvement in different cardiovascular risk factors ( insulin sensitivity , low-density lipoprotein cholesterol ( LDL-C ) , etc . ) was observed . In conclusion , in obese women a 16-week combined PRT and weight-loss diet is accompanied by significant improvements in different cardiovascular risk factors in spite of a significant decrease of circulating adiponectin Background —Visceral fat is a key regulator site for the process of inflammation , and atherosclerotic lesions are essentially an inflammatory response . Methods and Results —Fifty-six healthy premenopausal obese women ( age range 25 to 44 years , body mass index 37.2±2.2 , waist to hip ratio range 0.78 to 0.92 ) and 40 age-matched normal weight women were studied . Compared with nonobese women , obese women had increased basal concentrations of tumor necrosis factor-&agr ; ( TNF-&agr ; , P < 0.01 ) , interleukin-6 ( IL-6 , P < 0.01 ) , P-selectin ( P < 0.01 ) , intercellular adhesion molecule-1 ( ICAM-1 , P < 0.02 ) , and vascular adhesion molecule-1 ( VCAM-1 , P < 0.05 ) . Vascular responses to l-arginine ( 3 g IV ) , the natural precursor of nitric oxide , were impaired in obese women : reductions in mean blood pressure ( P < 0.02 ) , platelet aggregation to adenosine diphosphate ( P < 0.05 ) , and blood viscosity ( P < 0.05 ) were significantly lower as compared with those in the nonobese group . Concentrations of TNF-&agr ; and IL-6 were related ( P < 0.01 ) to visceral obesity , as well as to adhesin levels and responses to l-arginine . After 1 year of a multidisciplinary program of weight reduction ( diet , exercise , behavioral counseling ) , all obese women  lost at least 10 % of their original weight ( 9.8±1.5 kg , range 7.5 to 13 kg ) . Compared with baseline , sustained weight loss was associated with reduction of cytokine ( P < 0.01 ) and adhesin ( P < 0.02 ) concentrations and with improvement of vascular responses to l-arginine . Conclusion —In obese women , endothelial activation correlates with visceral body fat , possibly through inappropriate secretion of cytokines . Weight loss represents a safe method for downregulating the inflammatory state and ameliorating endothelial dysfunction in obese women QUESTIONS Does the PEDro scale measure only one construct ie , the method ological quality of clinical trials ? What is the hierarchy of items of the PEDro scale from least to most adhered to ? Is there any effect of year of publication of trials on item adherence ? Are PEDro scale ordinal scores equivalent to interval data ? DESIGN Rasch analysis of two independent sample s of 100 clinical trials from the PEDro data base scored using the PEDro scale . RESULTS Both sample s of PEDro data showed fit to the Rasch model with no item misfit . The  PEDro scale item hierarchy was the same in both sample s , ranging from the most adhered to item r and om allocation , to the least adhered to item therapist blinding . There was no differential item functioning by year of publication . Original PEDro ordinal scores were highly correlated with transformed PEDro interval scores ( r = 0.99 ) . CONCLUSION The PEDro scale is a valid measure of the method ological quality of clinical trials . It is valid to sum PEDro scale item scores to obtain a total score that can be treated as interval level measurement and subjected to parametric statistical analysis Most systematic review s rely substantially on the assessment of the method ological quality of the individual trials . The aim of this study was to obtain consensus among experts about a set of generic core items for quality assessment of r and omized clinical trials ( RCTs ) . The invited participants were experts in the field of quality assessment of RCTs . The initial item pool contained all items from existing criteria lists . Subsequently , we reduced the number of items by using the Delphi consensus technique . Each Delphi round comprised a question naire , an analysis , and a feedback report . The feedback report included staff team decisions made on the basis of the analysis and their justification . A total of 33 international experts agreed to participate , of whom 21 completed all question naires . The initial item pool of 206 items was reduced to 9 items in three Delphi rounds . The final criteria list ( the Delphi list ) was satisfactory to all participants . It is a starting point on the way to a minimum reference st and ard for RCTs on many different research topics . This list is not intended to replace , but rather to be used alongside , existing criteria lists BACKGROUND Cross-sectional studies suggest that regular exercise has anti-inflammatory effects , leading to lower levels of several proatherogenic inflammatory markers . However , this has yet to be confirmed by r and omized prospect i ve trials . We performed a r and omized controlled trial to assess whether exercise training decreases levels of 5 inflammatory markers linked to future cardiovascular risk : white blood cell count , fibrinogen , C-reactive protein , soluble intercellular adhesion molecule 1 , and soluble CD40 lig and . METHODS One hundred fifty-two healthy female smokers were r and omized to either 12 weeks of exercise training or health education as part of a smoking cessation program . Smoking was held steady for the first 6 weeks , and thereafter , smoking cessation was actively attempted . One hundred four participants completed 6 weeks , and 88 completed 12 weeks . Fitness and circulating inflammatory marker levels were measured at baseline , 6 weeks , and 12 weeks . To avoid potential confounding from changes in smoking exposure during the second 6 weeks of the trial , the primary end point was change in inflammatory marker levels from baseline to 6 weeks . Change in inflammatory markers from baseline to 12 weeks was a secondary end point . RESULTS At baseline , greater physical fitness was associated with lower white blood cell , fibrinogen , and C-reactive protein levels , but these associations were not statistically significant after adjusting for body mass index ( P > .1 for all ) . Fitness improved significantly in the exercise group at both 6 and 12 weeks . However , there were no differences in levels of any inflammatory marker between the exercise and control groups at either 6 weeks ( primary end point ) or 12 weeks ( secondary end point ) ( P > .05 for all comparisons ) . CONCLUSION In female smokers , baseline associations between fitness and inflammatory markers were largely attributable to differences in body fat ; regular exercise did not reduce levels of any of the inflammatory markers studied despite a significant improvement in fitness at both 6 and 12 weeks CONTEXT Obesity is an independent risk factor for cardiovascular disease , which may be mediated by increased secretion of proinflammatory cytokines by adipose tissue . OBJECTIVE To determine the effect of a program of 
    Output:
    
Integrative interventions , including diet , moderate aerobic ( 60 % to 80 % of maximum heart rate , or 50 % to 60 % of VO2max ) and circuit resistance training ( 8 to 10 exercises , 8 to 12 repetitions ) , health education , and counseling , used together , appeared to be effective strategies to improve inflammatory biomarkers in women