***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 compare training and follow-up effects of combined aerobic and strength training versus aerobic-only training on cognitive and motor function in institutionalized patients with dementia and to explore whether improved motor function mediates improved cognitive function . METHODS Using a 9-week , parallel , three-group , single-blind , r and omized , controlled trial with a follow-up assessment at week 18 , we assessed 109 patients with dementia ( age 85.5 ± 5.1 years ) in a psycho-geriatric nursing home . Each 9-week intervention consisted of 36 , 30-minute sessions . A combined group ( N = 37 ) received and completed two strength and two walking sessions per week , an aerobic group ( N = 36 ) completed four walking sessions , and a social group ( N = 36 ) completed four social visits per  week . Cognitive and motor functions were assessed at baseline , after the 9-week intervention , and after a consecutive 9 weeks of usual care . RESULTS Baseline corrected post-test scores in the combined versus the social group were higher for global cognition , visual memory , verbal memory , executive function , walking endurance , leg muscle strength , and balance . Aerobic versus social group scores were higher for executive function . Follow-up effects reversed toward baseline values . Motor improvement did not significantly mediate cognitive improvement . CONCLUSION Compared with a nonexercise control group , a combination of aerobic and strength training is more effective than aerobic-only training in slowing cognitive and motor decline in patients with dementia . No mediating effects between improvements in cognitive function via improved motor function were found . Future research into the underlying mechanistic associations is needed OBJECTIVES To determine the independent and combined effects of progressive resistance muscle strength training ( PRMST ) and megestrol acetate ( MA ) on strength , muscle mass , and function in older recuperative care patients . DESIGN Double-blind , r and omized , controlled intervention using a two-by-two factorial design and conducted between 1999 and 2001 . SETTING University-affiliated Department of Veterans Affairs hospital . PARTICIPANTS Twenty-nine patients ( mean age 79.4 + /- 7.4 , 90 % white ) aged 65 and older and had recent functional decline . INTERVENTIONS After r and omization to one of four treatment groups ( low-resistance exercises plus 800 mg per day of MA or a placebo or high-intensity PRMST plus 800 mg/d of MA or placebo ) , subjects received training and the drug or placebo for 12 weeks . MEASUREMENTS Change in muscle strength , mid-thigh muscle area , and aggregate functional performance score as assessed using analysis of covariance . RESULTS Five subjects withdrew from the study before its completion . Based on intent-to-treat analyses , subjects who received high-intensity PRMST and placebo experienced the greatest strength gains . The addition of MA was associated with worse outcomes than with high-intensity exercise training alone , especially with regard to the leg exercises . Post hoc analysis demonstrated that subjects who received high-intensity PRMST and placebo experienced significantly greater percentage increases in leg strength than subjects in either of the MA treatment groups ( P<.05 for each comparison ) . There was also a significant negative effect of MA on physical function . In general , subjects who received MA experienced a deterioration in aggregate physical function scores , whereas the remaining subjects improved ( -0.80+/-0.40 vs 0.48+/-0.41 , P=.04 ) . There was not a significant interaction between exercise and MA for any outcome . CONCLUSION High-intensity PRMST is a safe and well-tolerated exercise regimen for frail elderly patients . The addition of MA appears to blunt the beneficial effects of PRMST , result ing in less muscle strength and functional performance gains OBJECTIVES To examine the effects of exercise training on cognitive function in individuals at risk of or diagnosed with Alzheimer 's disease ( AD ) . DESIGN Meta- analysis . SETTING PubMed , Scopus , Clinical Trials.gov , and ProQuest were search ed from inception until August 1 , 2017 . PARTICIPANTS Nineteen studies with 23 interventions including 1,145 subjects with a mean age of 77.0 ± 7.5 were included . Most subjects were at risk of AD because they had mild cognitive impairment ( 64 % ) or a parent diagnosed with AD ( 1 % ) , and 35 % presented with AD . INTERVENTION Controlled studies that included an exercise-only intervention and a nondiet , nonexercise control group and reported pre- and post-intervention cognitive function measurements . MEASUREMENTS Cognitive function before and after the intervention and features of the exercise intervention . RESULTS Exercise interventions were performed 3.4 ± 1.4 days per week at moderate intensity ( 3.7 ± 0.6 metabolic equivalents ) for 45.2 ± 17.0 minutes per session for 18.6 ± 10.0 weeks and consisted primarily of aerobic exercise ( 65 % ) . Overall , there was a modest favorable effect  of exercise on cognitive function ( d+ = 0.47 , 95 % confidence interval ( CI ) = 0.26 - 0.68 ) . Within-group analyses revealed  that exercise improved cognitive function ( d+w = 0.20 , 95 % CI = 0.11 - 0.28 ) , whereas cognitive function declined in the control group ( d+w = -0.18 , 95 % CI = -0.36 to 0.00 ) . Aerobic exercise had a moderate favorable effect on cognitive function ( d+w = 0.65 , 95 % CI = 0.35 - 0.95 ) , but other exercise types did not ( d+w = 0.19 , 95 % CI = -0.06 - 0.43 ) . CONCLUSION Our findings suggest that exercise training may delay the decline in cognitive function that occurs in individuals who are at risk of or have AD  , with aerobic exercise possibly having the most favorable effect . Additional r and omized controlled clinical trials that include objective measurements of cognitive function are needed to confirm our findings Background : Although physical exercise has been suggested to influence cognitive function , previous exercise studies show inconsistent results in people with dementia . Objectives : To investigate effects of exercise on cognitive function in people with dementia . Method : The Umeå Dementia and Exercise ( UMDEX ) study , a cluster-r and omized controlled trial , was set in 16 nursing homes in Umeå , Sweden . One hundred- and -forty-one women and 45 men with dementia ; mean age of 85 y and mean Mini-Mental State Examination ( MMSE ) score of 15 , were r and omized to a High-Intensity Functional Exercise program or a seated attention control activity . Blinded assessors measured global cognitive function using the MMSE and the Alzheimer ’s disease Assessment Scale – Cognitive subscale ( ADAS-Cog ) , and executive function using Verbal fluency ( VF ) at baseline and 4 months ( directly after intervention completion ) , and MMSE and VF at 7 months . Results : Linear mixed models showed no between-group effects in mean difference from baseline ( 95 % confidence intervals , CI ) at 4 months in MMSE ( –0.27 ; 95 % CI –1.4 to 0.87 , p = 0.644 ) , ADAS-Cog ( –1.04 , 95 % CI –4 to 1.92 , p = 0.491 ) , or VF ( –0.53 , 95 % CI –1.42 to 0.35 , p = 0.241 ) or at 7 months in MMSE ( –1.15 , 95 % CI –2.32 to 0.03 , p = 0.056 ) or VF ( –0.18 , 95 % CI –1.09 to 0.74 , p = 0.707 ) . Conclusion : A 4-month , high-intensity functional exercise program had no superior effects on global cognition or executive function in people with dementia living in nursing homes when compared with an attention control activity BACKGROUND Physical activity programs in nursing homes typically consist of seated , range of motion ( ROM ) exercises , regardless of resident abilities . The Functional Fitness for Long-Term Care ( FFLTC ) Program was design ed not only to maintain ROM , but also to improve strength , balance , flexibility , mobility , and function . In addition , it was tailored to meet the needs of both high and low mobility residents . METHODS The feasibility and efficacy of the FFLTC Program were evaluated with 68 residents ( mean age 80 ) from five institutions . Persons were classified as low or high mobility and r and omized into either the FFLTC program or a seated ROM program . Classes were conducted in groups of 4 to 10 residents by trained facility staff for 45 minutes , three times per week . Assessment s at baseline and 4 months consisted of mobility , balance , gait , flexibility , functional capacity , and several upper and lower extremity strength measures . RESULTS Attendance averaged 86 % for the FFLTC and 79 % for the ROM classes . Four months of exercise led to significant improvements in mobility ( 16 % ) , balance ( 9 % ) , flexibility ( 36 % ) , knee ( 55 % ) , and hip ( 12 % ) strength for the FFLTC group . Shoulder strength was the only improvement found for the ROM group . The ROM group significantly deteriorated in some areas , particularly hip strength , mobility , and functional ability . CONCLUSIONS Institutionalized seniors , even those who are physically frail , incontinent and /or have mild dementia , can respond positively to a challenging exercise program . The FFLTC program demonstrated clear benefits over typical , seated ROM exercises . Moreover , with minimal training , the program can be safely delivered at low cost by institutional staff and volunteers The goal of this study was to determinate the effects of physical training in older adults with mobility limitations . Thirty frail women ( 84 ± 6 years ) were r and omly assigned to a training or control group for 12 weeks of upper body physical training ( UBT ) performed sitting on wheelchairs . Trained subjects showed a significant improvement in arms strength ( + 29 % ) , and shoulder flexibility ( + 10 cm ) but did not improve in arms circumference . The activities of daily living ( ADLs ) were improved ( + 77 % ) , cognitive function as defined by the Mini-Mental State Examination ( MMSE ) was maintained in the trained group ( + 3 % ) and declined in the control group ( −21 % ) . These results demonstrate that UBT in dependent older women with mobility limitations can increase strength and improve ADLs BACKGROUND The health benefits of leisure-time physical activity are well known , but whether less exercise than the recommended 150 min a week can have life expectancy benefits is unclear . We assessed the health benefits of a range of volumes of physical activity in a Taiwanese population . METHODS In this prospect i ve cohort study , 416,175 individuals ( 199,265 men and 216,910 women ) participated in a st and ard medical screening programme in Taiwan between 1996 and 2008 , with an average follow-up of 8·05 years ( SD 4·21 ) . On the basis of the amount of weekly exercise indicated in a self-administered question naire , participants were placed into one of five categories of exercise volumes : inactive , or low , medium , high , or very high activity . We calculated hazard ratios ( HR ) for mortality risks for every group compared with the inactive group , and calculated life expectancy for every group . FINDINGS Compared with individuals in the inactive group , those in the low-volume activity group , who exercised for an average of 92 min per week ( 95 % CI 71 - 112 ) or 15 min a day ( SD 1·8 ) , had a 14 % reduced risk of all-cause mortality ( 0·86 , 0·81 - 0·91 ) , and had a 3 year longer life expectancy . Every additional 15 min of daily exercise beyond the minimum amount of 15 min a day further reduced all-cause mortality by 4 % ( 95 % CI 2·5 - 7·0 ) and all-cancer mortality by 1 % ( 0·3 - 4·5 ) . These benefits were applicable to all age groups and both sexes , and to those with cardiovascular disease risks . Individuals who were inactive had a 17 % ( HR 1·17 , 95 % CI 1·10 - 1·24 ) increased risk of mortality compared with individuals in the low-volume group . INTERPRETATION 15 min a day or 90 min a week of moderate-intensity exercise might be of benefit , even for individuals at risk of cardiovascular disease . FUNDING Taiwan Department of Health Clinical Trial and Research Center of Excellence and National Health Research Institutes Objective : To evaluate the effect of a musical exercise programme on mood state and cognitive function in women with dementia . Design : R and omized controlled trial . Setting : Public Psychiatric Hospital Rekem , Belgium . Patients : Twenty-five patients with dementia . Interventions : Fifteen patients attended exercise training for three months , which consisted of daily physical exercises supported by music for 30 min/session . They were compared with a group of 10 control patients , who received an equal amount of attention through daily conversation . Main measures : The effect on cognition was measured by the Mini-Mental State Examination ( MMSE ) and the Amsterdam Dementia Screening Test 6 ( ADS 6 ) . Behaviour was evaluated with the abbreviated Stockton Geriatric Rating Scale ( BOP scale ) . The assessment s were made before , after six weeks of intervention and immediately after the three-month experimental period . Results : The exercise group 
    Output:
    
Compared to usual care or social activities , seated exercise had a large positive effect on cognition ( SMD 1.20 , 95 % confidence interval 0.25 , 2.16 ) with smaller effects on strength , spinal flexion , activity , depression and quality of life .
There was no effect on balance or mobility .
There were no positive effects when seated exercise was compared to weight-bearing and functional exercise .
CONCLUSION Seated exercise has a positive effect on cognition and is also of some benefit for older adults who are unable to exercise in upright positions