***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 : Capacity to exercise may not be fully restored in patients with heart failure even in the long term after ventricular assist device ( VAD ) implantation . The benefits of exercise training in patients with VAD are unknown . Design and methods : Fifteen patients , aged 38.3 ± 15.9 years , bridged to heart transplantation with left ventricular assist device or biventricular assist device were r and omized at a ratio of 2 : 1 to a  training group  ( TG , n = 10 ) or a control group ( n = 5 ) , 6.3 ± 4 months after implantation . Both the groups were advised to walk 30–45 min/day . TG also underwent moderate-intensity aerobic exercise using a bike or treadmill for 45 min , three to five times a week , combined with high-intensity inspiratory muscle training using a computer- design ed software to respiratory exhaustion , two to three times a week for 10 weeks . The patients were tested using cardiopulmonary exercise testing , 6-min walk test , spirometry and electronic pressure manometer for inspiratory muscle strength ( Pimax ) and endurance ( sustained Pimax ) measurement . Quality of life was assessed with the Minnesota Living with Heart Failure question naire . Results : TG improved peak oxygen consumption ( 19.3 ± 4.5 vs. 16.8 ± 3.7 ml/kg per min , P = 0.008 ) and VO2 at ventilatory threshold ( 15.1 ± 4.2 vs. 12 ± 5.6 ml/kg per min , P = 0.01 ) , whereas the ventilation/carbon dioxide slope decreased ( 35.9 ± 5.6 vs. 40 ± 6.5 , P = 0.009 ) . The 6-min walk test distance increased ( 527 ± 76 vs. 462 ± 88 m , P = 0.005 ) and quality of life was improved ( 38.2 ± 11.6 vs. 48.9 ± 12.8 , P = 0.005 ) , as well as Pimax ( 131.8 ± 33 vs. 95.5 ± 28cmH2O , P = 0.005 ) , sustained Pimax ( 484 ± 195 vs. 340 ± 193cmH2O/s/10 3 , P = 0.005 ) , and inspiratoty lung capacity ( 2.4 ± 0.9 vs. 1.7 ± 0.7 L , P = 0.008 ) were improved . No significant changes were noted in the control group . Conclusion : Our findings indicate that exercise training may improve the functional status of VAD recipients  even at a later period after implantation and thus , may have additional importance in cases of destination therapy OBJECTIVE Our purpose was to measure the agreement , reliability , construct validity , and feasibility of a measurement tool to assess  systematic review s ( AMSTAR ) . STUDY DESIGN AND SETTING We r and omly selected 30 systematic review s from a data base . Each was assessed by two review ers using : ( 1 ) the enhanced quality assessment question naire ( Overview of Quality Assessment Question naire [ OQAQ ] ) ; ( 2 ) Sacks ' instrument ; and ( 3 ) our newly developed measurement tool ( AMSTAR ) . We report on reliability ( interobserver kappas of the 11 AMSTAR items ) , intraclass correlation coefficients ( ICCs ) of the sum scores , construct validity ( ICCs of the sum scores of AMSTAR compared with those of other instruments ) , and completion times . RESULTS The interrater agreement of the individual items of AMSTAR was substantial with a mean kappa of 0.70 ( 95 % confidence interval [ CI ] : 0.57 , 0.83 ) ( range : 0.38 - 1.0 ) . Kappas recorded for the other instruments were 0.63 ( 95 % CI : 0.38 , 0.78 ) for enhanced OQAQ and 0.40 ( 95 % CI : 0.29 , 0.50 ) for the Sacks ' instrument . The ICC of the total score for AMSTAR was 0.84 ( 95 % CI : 0.65 , 0.92 ) compared with 0.91 ( 95 % CI : 0.82 , 0.96 ) for OQAQ and 0.86 ( 95 % CI : 0.71 , 0.94 ) for the Sacks ' instrument . AMSTAR proved easy to apply , each review taking about 15 minutes to complete . CONCLUSIONS AMSTAR has good agreement , reliability , construct validity , and feasibility . These findings need confirmation by a broader range of assessors and a more diverse range of review OBJECTIVES We evaluated the benefits of additional exercise training  after cardiac resynchronization therapy ( CRT ) .  BACKGROUND Cardiac resynchronization therapy results in improved morbidity and mortality in appropriate patients . We hypothesized that a structured exercise training program in addition to CRT would maximize the improvements in exercise capacity , symptoms , and quality of life ( QOL ) . METHODS Fifty patients referred for CRT were recruited . Patients were assessed before and 3 and 6 months after CRT . Functional class and QOL scores were recorded , and exercise tests were performed with hemodynamic measurements . Peak lower limb skeletal muscle torque was measured during extension , and echocardiography was undertaken at each visit . At 3 months , patients were r and omized with a simple sealed envelope method to exercise training ( n = 25 ) or control group ( n = 25 ) . The exercise group underwent an exercise program consisting of 3 visits/week for 3 months . Paired sample t tests were used to look for in-group differences and independent sample t tests for between-group differences . RESULTS Three months after CRT there were significant improvements in all functional , exercise hemodynamic , and echocardiographic measures . After r and omization the exercise group showed further significant improvements in functional , exercise hemodynamic , and QOL measures compared with the control group . There were also significant in-group improvements in peak skeletal muscle function and ejection fraction that did not reach statistical significance on intergroup analysis . CONCLUSIONS Exercise training leads to further improvements in exercise capacity , hemodynamic measures , and QOL in addition to the improvements seen after CRT . Therefore , exercise training allows maximal benefit to be attained after CRT OBJECTIVE Newer generation left ventricular assist devices ( LVADs ) are established for long-term support . The aim of this multi-modal intervention was to improve the body weight , exercise tolerance and psychosocial status in out patients on long-term LVAD support . METHODS Seventy patients participated in this non-r and omized intervention study [ intervention group ( IGr ) n = 34 ; control group ( CGr ) n = 36 ] over 18 months ( T1-T4 ) ; the baseline sample characteristics showed no differences between groups . Dietary counselling and weight management intervention was performed by a dietician based on a specific algorithm . Physical reconditioning followed a home ergometry protocol and was supplemented by psychosocial counselling . The outcomes were measured based on the body mass index ( BMI ) , cardiopulmonary exercise testing and self-report [ hospital anxiety and depression scale ( HADS ) , SF-36 ] . RESULTS The intervention showed a strong positive effect on nutrition and weight management [ 95 % confidence interval ( CI ) : -0.71 - 0.69 ; effect size ( ES ) : 0.907 ; P = 0.02 ) ] , result ing in the normal BMI ( kg/m(2 ) ) values in the IGr ( T1 : 24.0 ± 0.6 ; T4 : 24.5 ± 1.1 ; P = 0.35 ) compared with a significant BMI increase in the CGr ( T1 : 23.8 ± 0.6 ; T4 : 29.7 ± 0.8 ; P = 0.05 ) . Significant differences appeared regarding exercise tolerance ( VO(2)max/% predicted ) in favour of IGr patients ( IGr : 69 ± 2.9 ; CGr 62 ± 3.7 ; P = 0.04 ) . This increase was reflected by patients ' self-reporting based on the SF-36 physical component score ( IGr : P = 0.04 ; CGr : P = 0.54 ) . SF-36 psychosocial component scores showed no changes for both groups . However , CGr showed a tendency for increased anxiety scores relative to their counterparts ( IGr : 4.95 ± 0.4 ; CGr : 6.6 ± 0.9 ; P = 0.03 ) . CONCLUSIONS IGr patients showed a strong benefit from a multi-modal intervention , including dietary counselling , controlled exercise and psychosocial support . Dietary counselling holds potential to prevent obesity in this patient population BACKGROUND Because as many as 46 % of implantable cardioverter defibrillator ( ICD ) patients experience clinical symptoms of shock anxiety , this r and omized controlled study evaluated the efficacy of adapted yoga ( vs usual care ) in reducing clinical psychosocial risks shown to impact morbidity and mortality in ICD recipients . METHODS Forty-six participants were r and omized to a  control group  or an 8-week adapted yoga group  that followed a st and ardized protocol with weekly classes and home practice . Medical and psychosocial data were collected at baseline and follow-up , then compared and analyzed . RESULTS Total shock anxiety decreased for the yoga group and increased for the control group , t(4.43 , 36 ) , P < 0.0001 , with significant differences between these changes . Similarly , consequential anxiety decreased for the yoga group but increased for the control group t(2.86,36 ) P = 0.007 . Compared to the control , the yoga group had greater overall self-compassion , t(-2.84,37 ) , P = 0.007 , and greater mindfulness , t(-2.10,37 ) P = 0.04 , at the end of the study . Exploratory analyses utilizing a linear model ( R(2 ) = 0.98 ) of observed device-treated ventricular ( DTV ) events revealed that the expected number of DTV events in the yoga group was significantly lower than in the control group ( P < 0.0001 ) . Compared to the control , the yoga group had a 32 % lower risk of experiencing device-related firings at end of follow-up . CONCLUSIONS Our study demonstrated psychosocial benefits from a program of adapted yoga ( vs usual care ) for ICD recipients . These data support continued research to better underst and the role of complementary medicine to address ICD-specific stress in cardiac outcomes OBJECTIVES This study examined the effects of a cardiac rehabilitation ( CR ) program on functional capacity and health status ( HS ) in patients with newly implanted left ventricular assist devices ( LVADs ) . BACKGROUND Reduced functional capacity and HS are independent predictors of mortality in patients with heart failure .  CR improves both , and is related to improved outcomes in patients with heart failure ; however , there is a paucity of data that describe the effects of CR in patients with LVADs . METHODS Enrolled subjects ( n = 26 ; 7 women ; age 55 ± 13 years ; ejection fraction 21 ± 8 % ) completed a symptom-limited cardiopulmonary exercise test , the Kansas City Cardiomyopathy Question naire ( KCCQ ) , a 6-min walk test ( 6MW ) , and single-leg isokinetic strength test before 2:1 r and omization to CR versus usual care . Subjects in the CR group underwent 18 visits of aerobic exercise at 60 % to 80 % of heart rate reserve . Within-group changes from baseline to follow-up were analyzed with a paired t-test , whereas an independent t-test was used to determine differences in the change between groups . RESULTS Within-group improvements were observed in the CR group for peak oxygen uptake ( 10 % ) , treadmill time ( 3.1 min ) , KCCQ score ( 14.4 points ) , 6MW distance ( 52.3 m ) , and leg strength ( 17 % ) . Significant differences among groups were observed for KCCQ , leg strength , and total treadmill time . CONCLUSIONS Indicators of functional capacity and HS are improved in patients with continuous-flow LVADs who attend CR . Future trials should examine the mechanisms responsible for these improvements , and if such improvements translate into improved clinical outcomes . ( Cardiac Rehabilitation in Patients With Continuous Flow Left Ventricular Assist Devices : Rehab VAD Trial [ RehabVAD ] ; NCT01584895 ) BACKGROUND We sought to determine if outcomes with exercise training in heart failure ( HF ) vary according to ventricular pacing type . METHODS AND RESULTS Heart Failure : A Controlled Trial Investigating Outcomes of Exercise Training ( HF-ACTION ) r and omized 2,331 out patients with HF and left ventricular ejection fraction ≤35 % to usual care plus exercise training or usual care alone .  We examined the relationship between outcomes and r and omized treatment according to ventricular pacing status with the use of Cox proportional hazards modeling . In HF-ACTION 1,118 patients ( 48 % ) had an implanted cardiac rhythm device : 683 with right ventricular ( RV ) and 435 with biventricular ( BiV ) pacemakers . Patients with pacing devices were older , more frequently white , and had lower peak VO2 ( P < .001 for all ) . Peak VO2 improved similarly with training in groups with and without pacing devices . The primary composite end point-all-cause 
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These incremental increases were statistically significant when compared with the usual care or other comparison groups .
Conclusion : Exercise interventions tested to date in the CID population ( ICD , CRT , and VAD ) indicate that exercise training at moderate to high intensity is safe and effective in improving cardiopulmonary outcomes without adverse events .