***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 use two different exercise programs over a 2-year period to reduce falls and their sequelae among residents of two long-term care facilities . DESIGN R and omized , controlled trial . SETTING The study took place at two long-term care facilities with services ranging from independent living to skilled nursing . PARTICIPANTS One hundred and ten participants whose average age was 84 and who were capable of ambulating with or without assistive devices and could follow simple directions . INTERVENTION Participants were r and omized to one of two exercise groups ( resistance/endurance plus basic enhanced programming or tai chi plus basic enhanced programming ) or to a control group ( basic enhanced programming only ) . Exercise classes were held three times per week throughout the study . MEASUREMENTS Participants were evaluated for cognitive and physical functioning at baseline and 6 , 12 , and 24 months . Falls were determined from incident reports filed by the nursing staffs at the facilities . RESULTS Time to first fall , time to death , number of days hospitalized , and incidence of falls did not differ among the treatment and control groups ( P>.05 ) . Among all participants , those who fell had significantly lower baseline Folstein Mini-Mental State Examination and instrumental activities of daily living scores and experienced significantly greater declines in these measures over the 2-year program . CONCLUSION There were no significant differences in falls among the two exercise groups and the control group . Lack of treatment differences and low adherence rates suggest that residents of long-term care facilities may require individualized exercise interventions that can be adapted to their changing needs Multimodal exercise programs incorporating traditional progressive resistance training ( PRT ) , weight-bearing impact training and /or balance training are recommended to reduce risk factors for falls and fracture . However , muscle power , or the ability to produce force rapidly , has emerged as a more crucial variable to functional decline than muscle strength or mass . The aim of this 12-month community-based r and omized controlled trial , termed Osteo-cise : Strong Bones for Life , was to evaluate the effectiveness and feasibility of a multimodal exercise program incorporating high-velocity (HV)-PRT , combined with an osteoporosis education and behavioral change program , on bone mineral density ( BMD ) , body composition , muscle strength and functional muscle performance in older adults . Falls incidence was evaluated as a secondary outcome . A total of 162 older adults ( mean ± SD ; 67 ± 6 years ) with risk factors for falls and /or low BMD were r and omized to the Osteo-cise program ( n = 81 ) or a control group ( n = 81 ) . Exercise consisted of fitness center-based HV-PRT , weight-bearing impact and challenging balance/mobility activities performed three times weekly . After 12 months , the Osteo-cise program led to modest but significant net gains in femoral neck and lumbar spine BMD ( 1.0 % to 1.1 % , p < 0.05 ) , muscle strength ( 10 % to 13 % , p < 0.05 ) , functional muscle power ( Timed Stair Climb , 5 % , p < 0.05 ) and dynamic balance ( Four Square Step Test 6 % , p < 0.01 ; Sit-to-St and , 16 % , p < 0.001 ) relative to controls . There was no effect on total body lean mass or mobility ( timed-up- and -go ) , and no difference in falls rate ( incidence rate ratio [ IRR ] , 1.22 ; 95 % confidence interval [ CI ] , 0.72 - 2.04 ) . In conclusion , this study demonstrates that the Osteo-cise : Strong Bones for Life community-based , multimodal exercise program represents an effective approach to improve multiple musculoskeletal and functional performance measures in older adults with risk factors for falls and /or low BMD . Although this did not translate into a reduction in the rate of falls , further large-scale trials are needed to evaluate the efficacy of this multimodal approach on reducing falls and fracture BACKGROUND Obesity exacerbates the age-related decline in physical function and causes frailty in older adults ; however , the appropriate treatment for obese older adults is controversial . METHODS In this 1-year , r and omized , controlled trial , we evaluated the independent and combined effects of weight loss and exercise in 107 adults who were 65 years of age or older and obese . Participants were r and omly assigned to a control group , a weight-management ( diet ) group , an exercise group , or a weight-management-plus-exercise ( diet-exercise ) group . The primary outcome was the change in score on the modified Physical Performance Test . Secondary outcomes included other measures of frailty , body composition , bone mineral density , specific physical functions , and quality of life . RESULTS A total of 93 participants ( 87 % ) completed the study . In the intention-to-treat analysis , the score on the Physical Performance Test , in which higher scores indicate better physical status , increased more in the diet-exercise group than in the diet group or the exercise group ( increases from baseline of 21 % vs. 12 % and 15 % , respectively ) ; the scores in all three of those groups increased more than the scores in the control group ( in which the score increased by 1 % ) ( P<0.001 for the between-group differences ) . Moreover , the peak oxygen consumption improved more in the diet-exercise group than in the diet group or the exercise group ( increases of 17 % vs. 10 % and 8 % , respectively ; P<0.001 ) ; the score on the Functional Status Question naire , in which higher scores indicate better physical function , increased more in the diet-exercise group than in the diet group ( increase of 10 % vs. 4 % , P<0.001 ) . Body weight decreased by 10 % in the diet group and by 9 % in the diet-exercise group , but did not decrease in the exercise group or the control group ( P<0.001 ) . Lean body mass and bone mineral density at the hip decreased less in the diet-exercise group than in the diet group ( reductions of 3 % and 1 % , respectively , in the diet-exercise group vs. reductions of 5 % and 3 % , respectively , in the diet group ; P<0.05 for both comparisons ) . Strength , balance , and gait improved consistently in the diet-exercise group ( P<0.05 for all comparisons ) . Adverse events included a small number of exercise-associated musculoskeletal injuries . CONCLUSIONS These findings suggest that a combination of weight loss and exercise provides greater improvement in physical function than either intervention alone . ( Funded by the National Institutes of Health ; Clinical Trials.gov number , NCT00146107 . ) OBJECTIVES To determine the effects of primary care-based , multicomponent physical activity counseling ( PAC ) promoting physical activity ( PA ) guidelines on gait speed and related measures of PA and function in older veterans . DESIGN R and omized controlled trial . SETTING Veterans Affairs Medical Center of Durham , North Carolina . PARTICIPANTS Three hundred ninety-eight male veterans aged 70 and older . INTERVENTION Twelve months of usual care ( UC ) or multicomponent PAC consisting of baseline in-person and every other week and then monthly telephone counseling by a lifestyle counselor , one-time clinical endorsement of PA , monthly automated telephone messaging from the primary care provider , and quarterly tailored mailings of progress in PA . MEASUREMENTS Gait speed ( usual and rapid ) , self-reported PA , function , and disability at baseline and 3 , 6 , and 12 months . RESULTS Although no between-group differences were noted for usual gait speed , rapid gait speed improved significantly more for the PAC group ( 1.56 + /- 0.41 m/s to 1.68 + /- 0.44 m/s ) than with UC ( 1.57 + /- 0.40 m/sec to 1.59 + /- 0.42 m/sec , P=.04 ) . Minutes of moderate/vigorous PA increased significantly in the PAC group ( from 57.1 + /- 99.3 to 126.6 + /- 142.9 min/wk ) but not in the UC group ( from 60.2 + /- 116.1 to 69.6 + /- 116.1 min/wk , P<.001 ) . Changes in other functional/disability outcomes were small . CONCLUSION In this group of older male veterans , multicomponent PA significantly improved rapid gait and PA . Translation from increased PA to overall functioning was not observed . Integration with primary care was successful Background Epidemiologic evidence suggests that cognitive and physical activities are associated with better cognition in late life . The present study was conducted to examine the possible benefits of four structured lifestyle activity interventions and compare their effectiveness in optimizing cognition for older adults with mild cognitive impairment ( MCI ) . Method and Findings This was a 12-month cluster r and omized controlled trial . 555 community-dwelling Chinese older adults with MCI ( 295 with multiple-domain deficits ( mdMCI ) , 260 with single-domain deficit ( sdMCI ) ) were recruited . Participants were r and omized into physical exercise ( P ) , cognitive activity ( C ) , integrated cognitive and physical exercise ( CP ) , and social activity ( S , active control ) groups . Interventions comprised of one-hour structured activities three times per week . Primary outcome was Clinical Dementia Rating sum of boxes ( CDR-SOB ) scores . Secondary outcomes included Chinese versions of Alzheimer ’s Disease Assessment Scale - Cognitive subscale ( ADAS-Cog ) , delayed recall , Mini-Mental State Examination , Category Verbal Fluency Test ( CVFT ) and Disability Assessment for Dementia – Instrumental Activities of Daily Living ( DAD-IADL ) . Percentage adherence to programs and factors affecting adherence were also examined . At 12th month , 423 ( 76.2 % ) completed final assessment . There was no change in CDR-SOB and DAD-IADL scores across time and intervention groups . Multilevel normal model and linear link function showed improvement in ADAS-Cog , delayed recall and CVFT with time ( p<0.05 ) . Post-hoc subgroup analyses showed that the CP group , compared with other intervention groups , had more significant improvements of ADAS-Cog , delayed recall and CVFT performance with sdMCI participants ( p<0.05 ) . Overall adherence rate was 73.3 % . Improvements in ADAS-Cog and delayed recall scores were associated with adherence after controlling for age , education , and intervention groups ( univariate analyses ) . Conclusions Structured lifestyle activity interventions were not associated with changes in everyday functioning , albeit with some improvements in cognitive scores across time . Higher adherence was associated with greater improvement in cognitive scores . Factors to enhance adherence should be specially considered in the design of psychosocial interventions for older adults with cognitive decline . Trial Registration Clinical Trials.gov Objective : To investigate the effect of a 12-month sensomotor balance exercise programme on postural control and the frequency of falling in women with established osteoporosis . Design : R and omized controlled trial where the intervention group was assigned the 12-month Balance Training Programme and the control group did not undertake any intervention beyond regular osteoporosis treatment . Subjects : A total of 100 osteoporotic women – at least with one osteoporotic fracture – aged 65 years old and above . Main measures : Balance was assessed in static and dynamic posture both with performance-based measures of balance , such as the Berg Balance Scale and the Timed Up and Go Test , and with a stabilometric computerized platform . Interventions : Patients in the intervention group completed the 12-month sensomotor Balance Training Programme in an outpatient setting , guided by physical therapists , three times a week , for 30 minutes . Results : The Berg Balance Scale and the Timed Up and Go Test showed a statistically significant improvement of balance in the intervention group ( p = 0.001 and p = 0.005 , respectively ) . Balance tests using the stabilometer also showed a statistically significant improvement in static and dynamic postural balance for osteoporotic women after the completion of the Balance Training Programme . As a consequence , the one-year exercise programme significantly decreased the number of falls in the exercise group compared with the control group . Conclusion : The Balance Training Programme significantly improved the balance parameters and reduced the number of falls in postmenopausal women who have already had at least one fracture in the past This study aim ed to investigate the effects of a long-term resistance exercise intervention on executive functions in healthy elderly males , and to further underst and the potential neurophysiological mechanisms mediating the changes . The study assessed forty-eight healthy elderly males r and omly assigned to exercise ( n = 24 ) or control ( n = 24 ) groups . The assessment included neuropsychological and neuroelectric measures during a variant of the oddball task paradigm , as well as growth hormone ( GH ) , insulin-like growth factor-1 ( IGF-1 ) , and homocysteine levels at baseline and after either a 12 month intervention of resistance exercise training or control period . The results showed that the control group had a significantly lower accuracy rate and smaller P3a and P3b amplitudes in the oddball condition after 12 months . The exercise group exhibited improved reaction times ( RTs ) , sustained P3a and P3b amplitudes , increased levels of serum IGF-1 , and decreased levels of serum homocysteine . The changes in IGF-1 levels were significantly correlated with the changes in RT and P3b amplitude of the oddball condition in the exercise group . In conclusion , significantly en 
    Output:
    
Exercise significantly reduced the number of falls and fall-associated injuries , and improved physical function and cognition .
These results seemed independent of participants ’ baseline characteristics ( age , physical function , and cognitive status ) and exercise frequency .
Long-term exercise training does not overall influence the risk of dropouts due to health issues or mortality in older adults , and results in a reduced mortality risk in clinical population s. Moreover , exercise  reduces the number of falls and fall-associated injuries , and improves physical function and cognition in this population