***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 Background : The knowledge concerning balance training actually lowering fall rates among frail older persons is limited . Objective : The aim of this study was to examine the effects of a 4-week individualized visual feedback-based balance training on the fall incidence during 1-year follow-up among frail older women living in residential care . Methods : Twenty-seven older women from 2 residential care homes were r and omized into  exercise ( n = 20 ) and  control ( n = 7 ) groups . Balance measurements were carried out before and after a 4-week training period and falls were monitored by monthly diaries for 1 year . An interview about fear of falling and physical activity was completed before and after the intervention and after the 1-year follow-up . Results : A positive effect of  balance training on fall incidence was found . A dynamic Poisson regression model showed that during the follow-up the monthly risk of falling was decreased in the exercise group compared to controls ( risk ratio 0.398 , 95 % CI 0.174–0.911 , p = 0.029 ) . In addition , the exercise group reported a reduced fear of falling and increased physical activity after a training period but these changes declined during the follow-up period . Conclusion : Individualized visual feedback-based balance training was shown to be a promising method for fall prevention among frail older women . High compliance ( 97.5 % ) with the training program showed that carefully targeted training programs can be carried out among older people with health limitations BACKGROUND Falls prevention is an international priority , and residents of long-term aged care fall approximately 3 times more often than community dwellers . There is a relative scarcity of published trials in this setting . OBJECTIVES Our objective was to undertake a r and omized controlled trial to test the effect of published best practice exercise in long-term residential aged care . The trial was design ed to determine if combined high level balance and moderate intensity progressive resistance training ( the Sunbeam Program ) is effective in reducing the rate of falls in residents of aged care facilities . METHOD A cluster r and omized controlled trial of 16 residential aged care facilities and 221 participants was conducted . The broad inclusion criterion was permanent residents of aged care . Exclusions were diagnosed terminal illness , no medical clearance , permanent bed- or wheelchair-bound status , advanced Parkinson 's disease , or insufficient cognition to participate in group exercise . Assessment s were taken at baseline , after intervention , and at 12 months . R and omization was performed by computer-generated sequence to receive either the Sunbeam program or usual care . A cluster refers to an aged care facility . INTERVENTION The program consisted of individually prescribed progressive resistance training plus balance exercise performed in a group setting for 50 hours over a 25-week period , followed by a maintenance period for 6 months . OUTCOME MEASURES The primary outcome measure was the rate of falls ( number of falls and days followed up ) . Secondary outcomes included physical performance ( Short Physical Performance Battery ) , quality of life ( 36-item Short-Form Health Survey ) , functional mobility ( University of Alabama Life Space Assessment ) , fear of falling ( Falls Efficacy Scale International ) , and cognition ( Addenbrooke 's Cognitive Evaluation-revised ) . RESULTS The rate of falls was reduced by 55 % in the exercise  group ( incidence rate ratio = 0.45 , 95 % confidence interval 0.17 - 0.74 ) ; an improvement was also seen in physical performance ( P = .02 ) . There were no serious adverse events . CONCLUSION The Sunbeam Program significantly reduced the rate of falls and improved physical performance in residents of aged care . This finding is important as prior work in this setting has returned inconsistent outcomes , result ing in best practice guidelines being cautious about recommending exercise in this setting . This work provides an opportunity to improve clinical practice and health outcomes for long-term care residents Falls are the leading cause of injury among older adults in the United States , with the institutionalized elderly at elevated risk for injury and death . Physical weakness and mental frailty , prevalent in institutionalized elderly , are major risk factors for falls . The purpose of this study was to evaluate a program that addresses both the physical and mental aspects of exercise to reduce falls in institutionalized elderly . Twenty-seven volunteer subjects residing in an assisted living facility participated in the 24 week r and omized crossover study . After demographic , fall history , and mental status examinations , subjects were r and omly assigned first to ten weeks of either an exercise class or a control group , followed by a four week " washout period " of no activity , then cross assigned to ten weeks as either a control group or exercise class , respectively . Falls as well as mental status changes were monitored during the study . After adjusting for differences in baseline risk between the control and treatment groups , and for potential residual effects of the treatment during the crossover phase , a statistically significant ( P = .025 ) reduction in falls was found during treatment compared to the control periods . No change in mental status was seen . This small , pilot study shows that exercise programs , which emphasize mental strengthening as well as physical fitness , have the potential to reduce falls among mentally impaired , institutionalized seniors Objective To assess the effectiveness of an activity programme in improving function , quality of life , and falls in older people in residential care . Design Cluster r and omised controlled trial with one year follow-up . Setting 41 low level dependency residential care homes in New Zeal and . Participants 682 people aged 65 years or over . Interventions 330 residents were offered a goal setting and individualised activities of daily living activity programme by a gerontology nurse , reinforced by usual healthcare assistants ; 352 residents received social visits . Main outcome measures Function ( late life function and disability instruments , elderly mobility scale , FICSIT-4 balance test , timed up and go test ) , quality of life ( life satisfaction index , EuroQol ) , and falls ( time to fall over 12 months ) . Secondary outcomes were depressive symptoms and hospital admissions . Results 473 ( 70 % ) participants completed the trial . The programme had no impact overall . However , in contrast to residents with impaired cognition ( no differences between intervention and control group ) , those with normal cognition in the intervention group may have maintained overall function ( late life function and disability instrument total function , P=0.024 ) and lower limb function ( late life function and disability instrument basic lower extremity , P=0.015 ) . In residents with cognitive impairment , the likelihood of depression increased in the intervention group . No other outcomes differed between groups . Conclusion A programme of functional rehabilitation had minimal impact for elderly people in residential care with normal cognition but was not beneficial for those with poor cognition . Trial registration Australian Clinical Trials Register ACTRN12605000667617 In the GRADE approach , r and omized trials start as high- quality evidence and observational studies as low- quality evidence , but both can be rated down if most of the relevant evidence comes from studies that suffer from a high risk of bias . Well-established limitations of r and omized trials include failure to conceal allocation , failure to blind , loss to follow-up , and failure to appropriately consider the intention-to-treat principle . More recently recognized limitations include stopping early for apparent benefit and selective reporting of outcomes according to the results . Key limitations of observational studies include use of inappropriate controls and failure to adequately adjust for prognostic imbalance . Risk of bias may vary across outcomes ( e.g. , loss to follow-up may be far less for all-cause mortality than for quality of life ) , a consideration that many systematic review s ignore . In deciding whether to rate down for risk of bias -- whether for r and omized trials or observational studies -- authors should not take an approach that averages across studies . Rather , for any individual outcome , when there are some studies with a high risk , and some with a low risk of bias , they should consider including only the studies with a lower risk of bias Background Falls are common in older adults and can result in serious injuries . Due to demographic changes , falls and related healthcare costs are likely to increase over the next years . Participation and motivation of older adults in fall prevention measures remain a challenge . The iStoppFalls project developed an information and communication technology (ICT)-based system for older adults to use at home in order to reduce common fall risk factors such as impaired balance and muscle weakness . The system aims at increasing older adults ’ motivation to participate in ICT-based fall prevention measures . This article reports on usability , user-experience and user-acceptance aspects affecting the use of the iStoppFalls system by older adults . Methods In the course of a 16-week international multicenter study , 153 community-dwelling older adults aged 65 + participated in the iStoppFalls r and omized controlled trial , of which half used the system in their home to exercise and assess their risk of falling . During the study , 60 participants completed question naires regarding the usability , user experience and user acceptance of the iStoppFalls system .  Usability was measured with the System Usability Scale ( SUS ) . For user experience the Physical Activity Enjoyment Scale ( PACES ) was applied . User acceptance was assessed with the Dynamic Acceptance Model for the Re-evaluation of Technologies ( DART ) . To collect more detailed data on usability , user experience and user acceptance , additional qualitative interviews and observations were conducted with participants . Results Participants evaluated the usability of the system with an overall score of 62 ( St and ard Deviation , SD 15.58 ) out of 100 , which suggests good usability . Most users enjoyed the iStoppFalls games and assessment s , as shown by the overall PACES score of 31 ( SD 8.03 ) . With a score of 0.87 ( SD 0.26 ) , user acceptance results showed that participants accepted the iStoppFalls system for use in their own home . Interview data suggested that certain factors such as motivation , complexity or graphical design were different for gender and age . Conclusions The results suggest that the iStoppFalls system has good usability , user experience and user acceptance . It will be important to take these along with factors such as motivation , gender and age into consideration when design ing and further developing ICT-based fall prevention systems OBJECTIVES To determine the effects of moderate intensity group-exercise programs on falls , functional performance , and disability in older adults ; and to investigate the influence of frailty on these effects . DESIGN A 20-week , multicenter r and omized controlled trial , with 52-week follow-up . SETTING Fifteen homes for the elderly . PARTICIPANTS Two hundred seventy-eight men and women ( mean age + /- st and ard deviation , 85+/-6y ) . INTERVENTIONS Two exercise programs were r and omly distributed across 15 homes . The first program , functional walking ( FW ) , consisted of exercises related to daily mobility activities . In the second program , in balance ( IB ) , exercises were inspired by the principles of Tai Chi . Within each home participants were r and omly assigned to an intervention or a control group . Participants in the control groups were asked not to change their usual pattern of activities . The intervention groups followed a 20-week exercise program with 1 meeting a week during the first 4 weeks and 2 meetings a week during the remaining weeks . MAIN OUTCOME MEASURES Falls , Performance Oriented Mobility Assessment ( POMA ) , physical performance score , and the Groningen Activity Restriction Scale ( GARS ) ( measuring self-reported disability ) . RESULTS Fall incidence rate was higher in the FW group ( 3.3 falls/y ) compared with the IB ( 2.4 falls/y ) and control ( 2.5 falls/y ) groups , but this difference was not statistically significant . The risk of becoming a faller in the exercise groups increased significantly in the subgroup of participants who were classified as being frail ( hazard ratio [ HR ] = 2.95 ; 95 % confidence interval [ CI ] , 1.64 - 5.32 ) . For participants who were classified as being pre-frail , the risk of becoming a faller decreased ; this effect became significant after 11 weeks of training ( HR = .39 ; 95 % CI , .18-.88 ) . Participants in both exercise groups showed a small , but significant improvement in their POMA and physical performance scores . In the FW group , this held true for the GARS score as well . Post hoc analyses revealed that only the pre-frail participants improved their POMA and physical performance scores . CONCLUSIONS Fall-preventive moderate intensity group-exercise programs have positive effects on falling and physical performance in pre-frail , but not in frail elderly OBJECTIVE Falls and fall-related injuries are leading problems in residential aged care facilities . The objective of this study was to provide descriptive 
    Output:
    
Results Exercises with a balance component or with technical devices  reduced falls significantly , however , with low confidence in the evidence .
The evidence indicated that exercises conducted longer than 6 months were beneficial .
In frail residents , exercise interventions seemed to have substantially negative effects on falls .
Conclusions Exercise interventions with technical devices , those with a balance component , and those performed longer than 6 months are recommended in long‐term care setting s. Frail residents need special attention when performing exercises due to their increased risk of falling .
Impact Exercises with a balance component and exercises carried out with technical devices have beneficial effects , whereas exercises performed longer than 6 months are more effective than short‐term performances .
No significant reduction or decrease in the number of falls was found for exercise in cognitively impaired residents .
In frail residents , however , the number of fall events increased substantially as a result of exercise interventions .