***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: ABSTRACT BACKGROUND Physical inactivity is a significant risk factor for cardiovascular disease and remains highly prevalent in middle-aged women . OBJECTIVE We hypothesized that an interventionist-led ( IL ) , primary -care – based physical activity ( PA ) and weight loss intervention would increase PA levels and decrease weight to a greater degree than a self-guided ( SG ) program . DESIGN We conducted a r and omized trial . PARTICIPANTS Ninety-nine inactive women aged 45–65 years and with BMI ≥ 25 kg/m2 were recruited from three primary care clinics . INTERVENTIONS The interventionist-led ( IL ) group ( n = 49 ) had 12 weekly sessions of 30 min discussion s with 30 min of moderate-intensity PA . The self-guided ( SG ) group ( n = 50 ) received a manual for independent use . MAIN MEASURES Assessment s were conducted at 0 , 3 , and 12 months ; PA and weight were primary outcomes . Weight was measured with a st and ardized protocol . Leisure PA levels were assessed using the Modifiable Activity Question naire . Differences in changes by group were analyzed with a t-test or Wilcoxon rank-sum test . Mixed models were used to analyze differences in changes of outcomes by group , using an intention-to-treat principle . KEY RESULTS Data from 98 women were available for analysis . At baseline , mean ( SD ) age was 53.9 ( 5.4 ) years and 37 % were black . Mean weight was 92.3 ( 17.7 ) kg and mean BMI was 34.7 ( 5.9 ) kg/m2  . Median PA level was 2.8 metabolic equivalent hours per week ( MET-hour/week ) ( IQR 0.0 , 12.0 ) . At 3 months , IL women had a significantly greater increase in PA levels ( 7.5 vs. 1.9 MET-hour/week ; p = 0.02 ) than SG women ; there was no significant difference in weight change . At 12 months , the difference between groups was no longer significant ( 4.7 vs. 0.7 MET-hour/week ; p = 0.38 ) . Mixed model analysis showed a significant ( p = 0.048 ) difference in PA change between groups at 3 months only . CONCLUSIONS The IL intervention was successful in increasing the physical activity levels of obese , inactive middle-aged women in the short-term . No significant changes in weight were observed There is limited evidence demonstrating the benefits of physical activity with regard to mortality risk or the harms associated with sedentary behavior in black adults , so we examined the relationships between these health behaviors and cause-specific mortality in a prospect i ve study that had a large proportion of black adults . Participants ( 40 - 79 years of age ) enrolled in the Southern Community Cohort Study between 2002 and 2009 ( n = 63,308 ) were prospect ively followed over 6.4 years , and 3,613 and 1,394 deaths occurred in blacks and whites , respectively . Black adults who reported the highest overall physical activity level ( ≥32.3 metabolic equivalent-hours/day vs. < 9.7 metabolic equivalent-hours/day ) had lower risks of death from all causes ( hazard ratio ( HR ) = 0.76 . 95 % confidence interval ( CI ) : 0.69 , 0.85 ) , cardiovascular disease ( HR = 0.81 , 95 % CI : 0.67 , 0.98 ) , and cancer ( HR = 0.76 , 95 % CI : 0.62 , 0.94 ) . In whites , a higher physical activity level was associated with a lower risk of death from all causes ( HR = 0.76 , 95 % CI : 0.64 , 0.90 ) and cardiovascular disease ( HR = 0.69 , 95 % CI : 0.49 , 0.99 ) but not cancer ( HR = 0.95 , 95 % CI : 0.67 , 1.34 ) . Spending more time being sedentary ( > 12 hours/day vs. < 5.76 hours/day ) was associated with a 20%-25 % increased risk of all-cause mortality in blacks and whites . Blacks who reported the most time spent being sedentary ( ≥10.5 hours/day ) and lowest level of physical activity ( < 12.6 metabolic equivalent-hours/day ) had a greater risk of death ( HR = 1.47 , 95 % CI : 1.25 , 1.71 ) . Our study provides evidence that suggests that health promotion efforts to increase physical activity level and decrease  sedentary time could help reduce mortality risk in black adults BACKGROUND Few primary care physicians routinely counsel for exercise , despite the benefits of physical activity and the high prevalence of inactivity . The objective of this study is to assess the effectiveness of Physician-Based Assessment and Counseling for Exercise ( PACE ) , a brief , behavior-based tool for primary care providers counseling healthy adults . METHODS This study is a r and omized controlled trial of 812 patients age 30 years or older registered for well visits at 32 primary care physician offices at a staff model health maintenance organization . Intervention physicians were trained to deliver PACE exercise counseling protocol s at the index visit , and one reminder telephone call occurred at 1 month . An enhanced intervention group received additional activity reminders . RESULTS At the 6-month follow-up , the control group did not differ significantly from the intervention group for energy expended ( 2,048 kcal/week versus 2,108 kcal/ week , P = 0.77 ) , time spent in walking or other moderate to vigorous activities ( 202 min/week versus 187 min/ week , P = 0.99 ) , mental health , physical function , or behaviors previously shown to predict activity change . Among the intervention patients , the stages-of-change score for Contemplators increased significantly compared with controls ( P = 0.03 ) , but without a significant change in energy expended . Baseline levels of physical activity counseling were high ( 50 % ) , as were baseline patient physical activity levels ( 61 % exercised at least three times a week ) . CONCLUSIONS These results suggest that a one-time PACE counseling session with minimal reinforcement , in a setting with high baseline levels of activity , does not further increase activity . The finding that Contemplators advanced in stage of behavior change suggests that further studies are needed to examine long-term , repeated counseling interventions OBJECTIVE To determine if lifestyle improved at a short term through an intervention to involve patients in cardiovascular risk management by the practice nurse . METHODS The IMPALA study ( 2006 , the Netherl and s ) was a cluster-r and omised controlled trial involving 25 general practice s and 615 patients who were eligible for cardiovascular risk management . The intervention consisted of ( 1 ) individual 10-year cardiovascular risk assessment , ( 2 ) risk communication , ( 3 ) use of a decision aid and ( 4 ) adapted motivational interviewing , applied by practice nurses in two consultations . Outcomes were smoking , alcohol , diet , physical activity and the secondary outcomes risk perception , anxiety , confidence about the decision and satisfaction with the communication , measured at baseline and after 12 weeks . RESULTS Patients of both groups improved their lifestyle , but no relevant significant differences between the groups were found . Intervention group patients improved in terms of the appropriateness of risk perception , although not significantly . Intervention group patients improved significantly in terms of appropriateness of anxiety and were more satisfied with the communication compared to control group patients . CONCLUSION The intervention seems to have improved the patients ' risk perception , anxiety and satisfaction with the communication , which are important conditions for shared decision making . However , we found no additional effect of the intervention on lifestyle Background The Health through Sport conceptual model links sport participation with physical , social and psychological outcomes and stresses the need for more underst and ing between these outcomes . The present study aims to uncover how sport participation , physical activity , social capital and mental health are interrelated by examining these outcomes in one model . Methods A cross-sectional survey was conducted in nine disadvantaged communities in Antwerp ( Belgium ) . Two hundred adults ( aged 18–56 ) per community were r and omly selected and visited at home to fill out a question naire on socio-demographics , sport participation , physical activity , social capital and mental health . A sample of 414 adults participated in the study . Results Structural Equation Modeling analysis showed that sport participation ( β = .095 ) and not total physical activity ( β = .027 ) was associated with better mental health . No association was found between sport participation and community social capital ( β = .009 ) or individual social capital ( β = .045 ) . Furthermore , only community social capital was linked with physical activity ( β = .114 ) , individual social capital was not ( β = -.013 ) . In contrast , only individual social capital was directly associated with mental health ( β = .152 ) , community social capital was not ( β = .070 ) . Conclusion This study emphasizes the importance of sport participation and individual social capital to improve mental health in disadvantaged communities . It further gives a unique insight into the functionalities of how sport participation , physical activity , social capital and mental health are interrelated . Implication s for policy are that cross-sector initiatives between the sport , social and health sector need to be supported as their outcomes are directly linked to one another Background Brisk walking in older people can increase step-counts and moderate to vigorous intensity physical activity ( MVPA ) in ≥10-minute bouts , as advised in World Health Organization guidelines . Previous interventions have reported step-count increases , but not change in objective ly measured MVPA in older people . We assessed whether a primary care nurse-delivered complex intervention increased objective ly measured step-counts and MVPA . Methods and Findings A total of 988 60–75 year olds , able to increase walking and r and omly selected from three UK family practice s , were invited to participate in a parallel two-arm cluster r and omised trial ; r and omisation was by household . Two-hundred-ninety-eight people from 250 households were r and omised between 2011 and 2012 ; 150 individuals to the intervention group , 148 to the usual care control group .  Intervention participants received four primary care nurse physical activity ( PA ) consultations over 3 months , incorporating behaviour change techniques , pedometer step-count and accelerometer PA intensity feedback , and an individual PA diary and plan . Assessors were not blinded to group status , but statistical analyses were conducted blind . The primary outcome was change in accelerometry assessed average daily step-counts between baseline and 3 months , with change at 12 months a secondary outcome . Other secondary outcomes were change from baseline in time in MVPA weekly in ≥10-minute bouts , accelerometer counts , and counts/minute at 3 months and 12 months . Other outcomes were adverse events , anthropometric measures , mood , and pain . Qualitative evaluations of intervention participants and practice nurses assessed the intervention ’s acceptability . At 3 months , eight participants had withdrawn or were lost to follow-up , 280 ( 94 % ) individuals provided primary outcome data . At 3 months changes in both average daily step-counts and weekly MVPA in ≥10-minute bouts were significantly higher in the intervention than control group : by 1,037 ( 95 % CI 513–1,560 ) steps/day and 63 ( 95 % CI 40–87 ) minutes/week , respectively . At 12 months corresponding differences were 609 ( 95 % CI 104–1,115 ) steps/day and 40 ( 95 % CI 17–63 ) minutes/week . Counts and counts/minute showed similar effects to steps and MVPA . Adverse events , anthropometry , mood , and pain were similar in the two groups . Participants and practice nurses found the intervention acceptable and enjoyable . Conclusions The PACE-Lift trial increased both step-counts and objective ly measured  MVPA  in ≥10-minute bouts in 60–75 year olds at 3 and 12 months , with no effect on adverse events . To our knowledge , this is the first trial in this age group to demonstrate objective MVPA increases and highlights the value of individualised support incorporating objective PA assessment in a primary care setting . Trial Registration Controlled-Trials.com IS RCT CONTEXT Physical activity is important for health , yet few studies have examined the effectiveness of physical activity patient counseling in primary care . OBJECTIVE To compare the effects of 2 physical activity counseling interventions with current recommended care and with each other in a primary care setting . DESIGN The Activity Counseling Trial , a r and omized controlled trial with recruitment in 1995 - 1997 , with 24 months of follow-up . SETTING Eleven primary care facilities affiliated with 3 US clinical research centers . PARTICIPANTS Volunteer sample of 395 female and 479 male inactive primary care patients aged 35 to 75 years without clinical cardiovascular disease . INTERVENTIONS Participants were r and omly assigned to 1 of 3 groups : advice ( n = 292 ) , which included physician advice and written educational material s ( recommended care ) ; assistance ( n = 293 ) , which included all the components received by the advice group plus interactive mail and behavioral counseling at physician visits ; or counseling ( n = 289 ) , which included the assistance and advice group components plus regular telephone counseling and behavioral classes . MAIN OUTCOME MEASURES Cardiorespiratory fitness , measured by maximal oxygen uptake ( VO(2)max ) , and self-reported total 
    Output:
    
Conclusion The majority of RCTs of physical activity interventions in primary care record sufficient information on PROGRESS-Plus factors to allow differential effects to be studied .
However , very few actually report details of relevant analyses to determine which population subgroups may st and to benefit or be further disadvantaged by intervention efforts