***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 assess the effects of a comprehensive , integrated community-based lifestyle intervention on diet , physical activity and smoking in two Iranian communities . METHODS Within the framework of the Isfahan Healthy Heart Program , a community trial was conducted in two intervention counties ( Isfahan and Najaf-Abad ) and a control area ( Arak ) .  Lifestyle interventions targeted the urban and rural population s in the intervention counties but were not implemented in Arak . In each community , a r and om sample of adults was selected yearly by multi-stage cluster sampling . Food consumption , physical exercise and smoking behaviours were quantified and scored as 1 ( low-risk ) or 0 ( other ) at baseline ( year 2000 ) and annually for 4 years in the intervention areas and for 3 years in the control area . The scores for all behaviours were then added to derive an overall lifestyle score . FINDINGS After 4 years , changes from baseline in mean dietary score differed significantly between the intervention and control areas ( + 2.1 points versus -1.2 points , respectively ; P < 0.01 ) , as did the change in the percentage of individuals following a healthy diet ( + 14.9 % versus -2.0 % , respectively ; P < 0.001 ) . Daily smoking had decreased by 0.9 % in the intervention areas and by 2.6 % in the control area at the end of the third year , but the difference was not significant . Analysis by gender revealed a significant decreasing trend in smoking among men ( P < 0.05 ) but not among women . Energy expenditure for total daily physical activities showed a decreasing trend in all areas , but the mean drop from baseline was significantly smaller in the intervention areas than in the control area ( -68 metabolic equivalent task ( MET ) minutes per week versus -114 MET minutes per week , respectively ; P < 0.05 ) . Leisure time devoted to physical activities showed an increasing trend in all areas . A significantly different change from baseline was found between the intervention areas and the control area in mean lifestyle score , even after controlling for age , sex and baseline values . CONCLUSION The results suggest that community-based lifestyle intervention programmes can be effective in a developing country setting OBJECTIVE To test the feasibility , acceptability , and potential efficacy of after-school dance classes and a family-based intervention to reduce television viewing , thereby reducing weight gain , among African-American girls . DESIGN Twelve-week , 2-arm parallel group , r and omized controlled trial . SETTING Low-income neighborhoods . PARTICIPANTS Sixty-one 8 - 10-year-old African-American girls and their parents/guardians . INTERVENTIONS The treatment intervention consisted of after-school dance classes at 3 community centers , and a 5-lesson intervention , delivered in participants ' homes , and design ed to reduce television , videotape , and video game use . The active control intervention consisted of disseminating newsletters and delivering health education lectures . MAIN OUTCOME MEASURES Implementation and process measures , body mass index , waist circumference , physical activity measured by accelerometry , self-reported media use , and meals eaten with TV . RESULTS Recruitment and retention goals were exceeded . High rates of participation were achieved for assessment s and intervention activities , except where transportation was lacking . All interventions received high satisfaction ratings . At follow up , girls in the treatment group , as compared to the control group , exhibited trends toward lower body mass index ( adjusted difference = -.32 kg/m2 , 95 % confidence interval [ CI ] -.77 , .12 ; Cohen 's d = .38 st and ard deviation units ) and waist circumference ( adjusted difference = -.63 cm , 95 % CI -1.92 , .67 ; d = .25 ) ; increased after-school physical activity ( adjusted difference = 55.1 counts/minute , 95 % CI -115.6 , 225.8 ; d = .21 ) ; and reduced television , videotape , and video game use ( adjusted difference = -4.96 hours/week , 95 % CI -11.41 , 1.49 ; d = .40 ) . The treatment group reported significantly reduced household television viewing ( d = .73 , P = .007 ) and fewer dinners eaten while watching TV ( adjusted difference = -1.60 meals/week , 95 % CI -2.99 , -.21 ; d = .59 ; P = .03 ) . Treatment group girls also reported less concern about weight ( d = .60 ; P = .03 ) , and a trend toward improved school grade s ( d = .51 ; P = .07 ) . CONCLUSIONS This study confirmed the feasibility , acceptability , and potential efficacy of using dance classes and a family-based intervention to reduce television viewing , thereby reducing weight gain , in African-American girls CONTEXT Rapid increases in access to the Internet have made it a viable mode for public health intervention . No controlled studies have evaluated this re source for weight loss . OBJECTIVE To determine whether a structured Internet behavioral weight loss program produces greater initial weight loss and changes in waist circumference than a weight loss education Web site . DESIGN R and omized , controlled trial conducted from April to December 1999 . SETTING AND PARTICIPANTS Ninety-one healthy , overweight adult hospital employees aged 18 to 60 years with a body mass index of 25 to 36 kg/m(2 ) . Analyses were performed for the 65 who had complete follow-up data . INTERVENTIONS Participants were r and omly assigned to a 6-month weight loss program of either Internet education ( education ; n = 32 with complete data ) or Internet behavior therapy ( behavior therapy ; n = 33 with complete data ) . All participants were given 1 face-to-face group weight loss session and access to a Web site with organized links to Internet weight loss re sources . Participants in the behavior therapy group received additional behavioral procedures , including a sequence of 24 weekly behavioral lessons via e-mail , weekly online su bmi ssion of self-monitoring diaries with individualized therapist feedback via e-mail , and an online bulletin board . MAIN OUTCOME MEASURES Body weight and waist circumference , measured at 0 , 3 , and 6 months , compared the 2 intervention groups . RESULTS Repeated- measures analyses showed that the behavior therapy group lost more weight than the education group ( P = .005 ) . The behavior therapy group lost a mean ( SD ) of 4.0 ( 2.8 ) kg by 3 months and 4.1 ( 4.5 ) kg by 6 months . Weight loss in the education group was 1.7 ( 2.7 ) kg at 3 months and 1.6 ( 3.3 ) kg by 6 months . More participants in the behavior therapy than education group achieved the 5 % weight loss goal ( 45 % vs 22 % ; P = .05 ) by 6 months . Changes in waist circumference were also greater in the behavior therapy group than in the education group at both 3 months ( P = .001 ) and 6 months ( P = .005 ) . CONCLUSIONS Participants who were given a structured behavioral treatment program with weekly contact and individualized feedback had better weight loss compared with those given links to educational Web sites . Thus , the Internet and e-mail appear to be viable methods for delivery of structured behavioral weight loss programs Background : Theory-based interventions accessible to large groups of people are needed to induce favorable shifts in health behaviors and body weight . Purpose : The aim was to assess nutrition ; physical activity ; and , secondarily , body weight in the tailored , social cognitive Guide to Health ( GTH ) Internet intervention delivered in churches . Methods : Participants ( N=1,071 ; 33 % male , 23 % African American , 57 % with body mass index ≥25 , 60 % sedentary , Mdn age=53 years ) within 14 Baptist or United Method ist churches were r and omized to the GTH intervention only ( GTH-Only ; 5 churches ) , with church-based supports ( GTH-Plus ; 5 churches ) , or to a waitlist ( control ; 4 churches ) . Verified pedometer step counts , measured body weight , fat , fiber , and fruit and vegetable ( F&V ) servings from food frequency and supermarket receipts were collected at pretest , posttest ( 7 months after pretest ) , and follow-up ( 16 months after pretest ) . Results : Participants in GTH-Only  increased F&V at post ( ∼1.50 servings ) compared to control ( ∼0.50 servings ; p=.005 ) and at follow-up ( ∼1.20 vs. ∼0.50 servings ; p=.038 ) and increased fiber at post ( ∼3.00 g ) compared to control ( ∼1.5 g ; p=.006 ) and follow-up ( ∼3.00 g vs. ∼2.00 g ; p=.040 ) . GTH-Plus participants compared to control increased steps at post ( ∼1,500 steps/day vs. ∼400 steps/day ; p=.050 ) and follow-up ( ∼1,000 steps/day vs. ∼−50 steps/day ; p=.010 ) , increased F&V at post ( ∼1.5 servings ; p=.007 ) and follow-up ( ∼1.3 servings ; p=.014 ) , increased fiber at post ( ∼3.00 g ; p=.013 ) , and follow-up ( ∼3.00 ; p=.050 ) and decreased weight at post ( ∼−0.30 kg vs. ∼+0.60 kg ; p=.030 ) . Conclusions : Compared to control , both GTH treatments improved nutrition at posttest , but church supports improved physical activity and nutrition at posttest and follow-up , suggesting environmental supports may improve Internet-based interventions Background : Little evidence exists about the effectiveness of “ interactive ” computer-tailored interventions and about the combined effectiveness of tailored interventions on physical activity and diet . Furthermore , it is unknown whether they should be executed sequentially or simultaneously . Purpose : The purpose of this study was to examine ( a ) the effectiveness of interactive computer-tailored interventions for increasing physical activity and decreasing fat intake and ( b ) which intervening mode , sequential or simultaneous , is most effective in behavior change . Methods : Participants ( N = 771 ) were r and omly assigned to receive ( a ) the physical activity and fat intake interventions simultaneously at baseline , ( b ) the physical activity intervention at baseline and the fat intake intervention 3 months later , ( c ) the fat intake intervention at baseline and the physical activity intervention 3 months later , or ( d ) a place in the control group . Results : Six months postbaseline , the results showed that the tailored interventions produced significantly higher physical activity scores , F(2 , 573 ) = 11.4 , p < .001 , and lower fat intake scores , F(2 , 565 ) = 31.4 , p < .001 , in the experimental groups when compared to the control group . Conclusions : For both behaviors , the sequential and simultaneous intervening modes showed to be effective ; however , for the fat intake intervention and for the participants who did not meet the recommendation in the physical activity intervention , the simultaneous mode appeared to work better than the sequential mode The authors studied the effectiveness of community-wide health education on physical activity knowledge , attitudes , self-efficacy , and behavior . R and om sample s of residents aged 18 - 74 years who lived in four central California cities ( baseline , n = 1,056 men and 1,183 women ) were evaluated in 1979 - 1980 and approximately every 2 years thereafter to obtain four independent sample s. Moreover , every subject in the initial independent sample s was asked to return for follow-up every 2 years thereafter ; subjects who completed all four examinations constituted the cohort sample ( n = 408 men and 499 women ) . Two medium-sized cities received health education and two similarly sized cities served as controls . Results indicated little consistent evidence of a treatment effect on physical activity knowledge , attitudes , or self-efficacy in either men or women . Among physical activity measures , there was an indication of a positive treatment effect for men in the independent sample s for estimated daily energy expenditure and percent participation in vigorous activities ( p < 0.01 ) , and for women in the independent ( p = 0.014 ) and cohort ( p < 0.01 ) sample s for engagement in the number of moderate activities . These results underscore the need for development of more effective interventions to change physical activity than is provided by a broad-based , community-wide health education program and for more sensitive and reliable measures of knowledge , attitudes , and behavior with regard to physical activity OBJECTIVE To evaluate the cost-effectiveness of non-face-to-face interventions for increasing physical activity in sedentary adults . The study took place in Providence , Rhode Isl and between the years 2000 and 2004 . METHODS Two hundred and thirty-nine participants were r and omized to Phone , Print or a contact control . Phone and Print groups were mailed regular surveys regarding their level of physical activity , motivational readiness and self-efficacy . Surveys were scanned by a computer expert system to generate feedback reports . Phone group participants received feedback by telephone . Print group participants received feedback by mail . The contact control group received mailings unrelated to physical activity . Intervention costs were assessed prospect ively , from a payer perspective . Physical activity was measured using the 7-day Physical Activity Recall . Ambulatory health service use was assessed via monthly surveys . RESULTS The Print intervention was more economically efficient than the Phone intervention in engaging participants in a more active lifestyle . CONCLUSION The Print intervention provides an efficient approach to increasing physical activity . Research is needed to determine the cost-effectiveness of the intervention in a more diverse population , within the context of the health service delivery system and over a longer period of time Background  Girl Scouting may offer a viable channel for health promotion and obesity prevention programs . This study evaluated the effectiveness of an intervention program delivered 
    Output:
    
We narratively summarized the results of 18 systematic review s. Among children and adolescents , we found moderate evidence for effects on weight change in primary school-aged children for interventions containing a school component .
The evidence for interventions aim ed at general adult population s was inconclusive .
Self-monitoring , group-based components , and motivational signs to encourage stair use were identified as promising strategies to increase physical activity .
Among adults at risk for type II diabetes , evidence was found for beneficial effects on weight change and diabetes incidence .
However , interventions for this group were not integrated in more comprehensive community-based approaches