***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 Analyzing drop out rates and when they occur may give important information about the patient characteristics and trial characteristics that affect the overall uptake of an intervention . Methods We search ed Medline and the Cochrane library from the beginning of the data bases to May 2006 for published systematic review s that compared the effects of self-monitoring ( self-testing ) or self-management ( self-testing and self-dosage ) of oral anticoagulation or self-monitored blood glucose in type 2 diabetics who were not using insulin .  We assessed all study withdrawals pre-r and omization and post r and omization and sought information on the reasons for discontinuation of all participants .To measure the differential between groups in attrition we used the relative attrition ( RA ) , which is equivalent to relative risk but uses attrition as the outcome ( i.e. attrition in intervention group/attrition in control group ) . We determined the percentage drop outs for control and intervention groups and used DerSimonian and Laird r and om effects models to estimate a pooled relative attrition . L'abbe type plots created in R ( version 2.0.2 ) were used to represent the difference in the relative attrition among the trials with 95 % confidence areas and weights derived from the r and om effects model . Results With  self-monitoring of blood glucose in type 2 diabetes , attrition ranged from 2.3 % to 50.0 % in the intervention groups and 0 % to 40.4 % in the control groups . There was no significant difference between the intervention and control , with an overall RA of 1.18 [ 95 % CI , 0.70–2.01 ] . With  self-monitoring of oral anticoagulation attrition ranged from 0 % to 43.2 % in the intervention groups and 0 % to 21.4 % in the control group . The RA was significantly greater in the intervention group , combined RA , 6.05 [ 95 % CI , 2.53–14.49 ] . Conclusion This paper demonstrates the use of relative attrition as a new tool in systematic review methodology which has the potential to identify patient , intervention and trial characteristics which influences attrition in trials Proper r and omisation means little if investigators can not include all r and omised participants in the primary analysis . Participants might ignore follow-up , leave town , or take aspartame when instructed to take aspirin . Exclusions before r and omisation do not bias the treatment comparison , but they can hurt generalisability . Eligibility criteria for a trial should be clear , specific , and applied before r and omisation . Readers should assess whether any of the criteria make the trial sample atypical or unrepresentative of the people in which they are interested . In principle , assessment of exclusions after r and omisation is simple : none are allowed . For the primary analysis , all participants enrolled should be included and analysed as part of the original group assigned ( an intent-to-treat analysis ) . In reality , however , losses frequently occur . Investigators should , therefore , commit adequate re sources to develop and implement procedures to maximise retention of participants . Moreover , research ers should provide clear , explicit information on the progress of all r and omised participants through the trial by use of , for instance , a trial profile . Investigators can also do secondary analyses on , for instance , per- protocol or as-treated participants . Such analyses should be described as secondary and non-r and omised comparisons . Mish and ling of exclusions causes serious method ological difficulties . Unfortunately , some explanations for mish and ling exclusions intuitively appeal to readers , disguising the seriousness of the issues . Creative mismanagement of exclusions can undermine trial validity This r and omized controlled trial examined benefits of adding active health promotion to basic primary care ( BPC ) services for SMI adults . It compared BPC with BPC plus wellness training ( WT ) , a 12 months intervention promoting individual skills in self-management .  Three hundred nine participants enrolled during short-term residential treatment completed baseline assessment s and were assigned to treatment groups , before discharge . Outcomes of perceived health status ( SF-36 ) , global assessment of function , and ratings of self-efficacy were assessed at follow-up interviews at 6 , 12 , and 18 months . The intent-to-treat analysis employed multilevel regression to examine differences by group on outcomes across time , controlling for health related covariates . The WT group showed significantly better outcomes on the SF-36 physical functioning and general health scales . Findings affirm ability of SMI adults to benefit from active health promotion CONTEXT Although commercial weight loss programs provide treatment to millions of clients , their efficacy has not been evaluated in rigorous long-term trials . OBJECTIVE To compare weight loss and health benefits achieved and maintained through self-help weight loss vs with a structured commercial program . DESIGN AND SETTING A 2-year , multicenter r and omized clinical trial with clinic visits at 12 , 26 , 52 , 78 , and 104 weeks conducted at 6 academic research centers in the United States between January 1998 and January 2001 . PARTICIPANTS Overweight and obese men ( n = 65 ) and women ( n = 358 ) ( body mass index , 27 - 40 ) aged 18 to 65 years . INTERVENTION R and om assignment to either a self-help program ( n = 212 ) consisting of two 20-minute counseling sessions with a nutritionist and provision of self-help re sources or to a commercial weight loss program ( n = 211 ) consisting of a food plan , an activity plan , and a cognitive restructuring behavior modification plan , delivered at weekly meetings . MAIN OUTCOME MEASURES Weight change was the primary outcome measure . Secondary outcomes included waist circumference , body mass index , blood pressure , serum lipids , glucose , and insulin levels . RESULTS At 2 years , 150 participants ( 71 % ) in the commercial group and 159 ( 75 % ) in the self-help group completed the study . In the intent-to-treat analysis , mean ( SD ) weight loss of participants in the commercial group was greater than in the self-help group at 1 year ( -4.3 [ 6.1 ] kg vs -1.3 [ 6.1 ] kg , respectively ; P<.001 ) and at 2 years ( -2.9 [ 6.5 ] kg vs -0.2 [ 6.5 ] kg , respectively ; P<.001 ) . Waist circumference ( P = .003 ) and body mass index ( P<.001 ) decreased more in the commercial group . Changes in blood pressure , lipids , glucose , and insulin levels were related to changes in weight in both groups , but between-group differences in biological parameters were mainly nonsignificant by year 2 . CONCLUSION The structured commercial weight loss program provided modest weight loss but more than self-help over a 2-year period Although the benefits of exercise are well documented , few published research studies have examined exercise in persons with schizophrenia . This pilot examined a 16-week walking program for out patients diagnosed with schizophrenia ( N = 10 ) .  Six-minute walking distance , body mass index , percent body fat and severity of psychiatric symptoms were measured . Experimental participants in the walking group experienced significant reductions in body fat ( p = 0.03 ) compared to a control group not participating in the exercises during the same time period . Experimental participants also had greater aerobic fitness , lower body mass indexes , and fewer psychiatric symptoms than controls at the conclusion of the program . Research is needed to identify effective exercise interventions and feasible delivery modalities for persons with schizophrenia in community setting OBJECTIVE St and ardized mortality rates are elevated in schizophrenia compared to the general population . The incidence of coronary heart disease ( CHD ) and the relative contribution of CHD to increased mortality in schizophrenia patients are not clear , despite recent concerns about metabolic complications of certain atypical antipsychotics . METHOD Ten-year risk for CHD was calculated for 689 subjects who participated in the Clinical Trials of Antipsychotic Treatment Effectiveness ( CATIE ) Schizophrenia Trial at baseline using the Framingham CHD risk function and were compared with age- , race- and gender-matched controls from the National Health and Nutrition Examination Survey ( NHANES ) III . RESULTS Ten-year CHD risk was significantly elevated in male ( 9.4 % vs. 7.0 % ) and female ( 6.3 % vs. 4.2 % ) schizophrenia patients compared to controls ( p = 0.0001 ) . Schizophrenia patients had significantly higher rates of smoking ( 68 % vs. 35 % ) , diabetes ( 13 % vs. 3 % ) , and hypertension ( 27 % vs. 17 % ) and lower HDL cholesterol levels ( 43.7 vs. 49.3 mg/dl ) compared to controls ( p < 0.001 ) . Only total cholesterol levels did not differ between groups . Ten-year CHD risk remained significantly elevated in schizophrenia patients after controlling for body mass index ( p = 0.0001 ) . CONCLUSIONS These results are consistent with recent evidence of increased cardiac mortality in schizophrenia patients . While the impact of cigarette smoking is clear , the relative contributions to cardiac risk of specific antipsychotic agents , diet , exercise , and quality of medical care remain to be clarified Background : Increasingly alarmed by the health risks ( that is , weight gain , elevated lipids , and poor glucose tolerance ) posed by novel antipsychotic medications , clinicians who treat schizophrenia are attempting to help patients improve lifestyle factors . Unfortunately , schizophrenia research has neglected exercise as a legitimate adjunctive treatment for schizophrenia . Objective : To assess the extent to which stable patients with schizophrenia would adhere to an exercise program if offered access to a fitness facility . Methods : Ten of 20 stable patients with schizophrenia or schizoaffective disorder who were treated with olanzapine for at least 4 weeks had the opportunity to receive access to a Young Men 's Christian Association ( YMCA ) fitness facility , based on r and om allocation . The intervention included a free membership to the YMCA for 6 months , with access to all the fitness amenities and equipment . The mean dosage of olanzapine was 11.5 mg daily for the YMCA group . Results : Of the 10 subjects , 2 did not attend at all . One subject met criteria for full attendance for each of the 6 months and lost 15 kg . Dropout rates were as follows : 90 % at 6 months , 70 % at 5 months , and 40 % at 4 months . The main reason they gave for poor attendance was lack of motivation . The mean weight gain was 2 kg in the YMCA group . Conclusion : Most subjects did not regularly exercise or attend . They cited poor motivation as the main reason . The subject who exercised regularly lost a significant amount of weight Ninety seven out patients with schizophrenia spectrum disorders ( SSDs ) were r and omly assigned to the Walk , Address Sensations , Learn About Exercise , Cue Exercise Behavior for SSDs ( WALC-S ) , a motivational intervention design ed to increase exercise in SSDs ( n = 48 ) , or a time and attention control group ( TAC , n = 49 ) . WALC-S and TAC groups met weekly for 4 weeks before a 16 week walking program was offered to all subjects . We compared the exercise attendance , persistence and compliance of the groups during the walking program . WALC-S recipients attended more walking groups , for more weeks and walked more minutes than those receiving TAC . Percent of WALC-S or TAC groups attended was significantly correlated with overall attendance ( r = 0.38 , P = 0.001 ) and persistence ( r = −.29 , P = 0.01 ) , as well as number of minutes walked . This study is among the first to examine interventions design ed to enhance exercise motivation in SSDs BACKGROUND Increased mortality in schizophrenia is caused largely by coronary heart disease ( CHD ) . Low cardiorespiratory fitness ( CRF ) is a key factor for CHD mortality . We compared CRF in patients with schizophrenia to CRF of matched healthy controls and reference values . Also , we examined the effects of exercise therapy on CRF in patients with schizophrenia and in controls . METHODS Sixty-three patients with schizophrenia and 55 controls , matched for gender , age , and socioeconomic status , were r and omized  to exercise ( n = 31 ) or occupational therapy ( n = 32 ) and controls to exercise ( n = 27 ) or life as usual ( n = 28 ) . CRF was assessed with an incremental cardiopulmonary exercise test and defined as the highest relative oxygen uptake ( VO(2peak ) ) and peak work rate ( W(peak ) ) . Minimal compliance was 50 % of sessions ( n = 52 ) . RESULTS Male and female patients with schizophrenia had a relative VO(2peak ) of 34.3 ± 9.9 and 24.0 ± 4.5 mL.kg(-1).min(-1 ) , respectively . Patients had higher resting HR ( P < 0.01 ) and lower peak HR ( P < 0.001 ) , peak systolic blood pressure ( P = 0.02 ) , relative VO(2peak ) ( P < 0.01 ) , W(peak ) ( P < 0.001 ) , RER ( P < 0.001 ) , minute ventilation ( P = 0.02 ) , and HR recovery ( P < 0.001 ) than controls . Relative VO(2peak ) was 90.5 % ± 19.7 % ( P < 0.01 ) of predicted relative VO(2peak ) in male and 95.9 % ± 14.9 % ( P = 0.18 ) in female 
    Output:
    
Conclusions This systematic review showed that exercise therapies can lead to a modest increase in levels of exercise activity but overall there was no noticeable change for symptoms of mental health , body mass index , and body weight