***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: Study Design . A population -based , prospect i ve cohort study . Objective . To determine whether overweight , obesity , or more generally an elevated body mass index ( BMI ) increase the probability of experiencing  chronic low back pain ( LBP ) after an 11-year period , both among participants with and without LBP at baseline . Summary of Background Data . Chronic LBP is a common disabling disorder in modern society . Cross-sectional studies suggest an association between an elevated BMI and LBP , but it is not clear whether this is a causal relationship . Methods . Data were obtained from the community-based HUNT 2 ( 1995–1997 ) and HUNT 3 ( 2006–2008 ) studies of an entire Norwegian county . Participants were 8733 men and 10,149 women , aged 30 to 69 years , who did not have chronic LBP at baseline , and 2669 men and 3899 women with LBP at baseline . After 11 years , both groups indicated whether they currently had chronic LBP , defined as pain persisting for at least 3 months continuously during the last year . Results . A significant positive association was found between BMI and risk of LBP among persons without LBP at baseline . The odds ratio for BMI 30 or more versus BMI less than 25 was 1.34 ( 95 % confidence interval [ CI ] , 1.08–1.67 ) for men and 1.22 ( 95 % CI , 1.03–1.46 ) for women , in analyses adjusted for age , education , work status , physical activity at work and in leisure time , smoking , blood pressure , and serum lipid levels . A significant positive association was also established between BMI and recurrence of LBP among women . LBP status at baseline had negligible influence on subsequent change in BMI . Conclusion . High values of BMI may predispose to chronic LBP 11 years later , both in individuals with and without LBP . The association between BMI and LBP is not explained by an effect of LBP on later change in BMI This study examined the effects of dietary weight loss and exercise on the health-related quality of life ( HRQL ) of overweight and obese , older adults with knee osteoarthritis . A total of 316 older men and women with documented evidence of knee osteoarthritis were r and omly assigned to 1 of 4 18-month interventions : dietary weight loss , exercise , dietary weight loss and exercise , or healthy lifestyle control . Measures included the SF-36 Health Survey and satisfaction with body function and appearance . Results revealed that the combined diet and exercise intervention had the most consistent , positive effect on HRQL compared with the control group ; however , findings were restricted to measures of physical health or psychological outcomes that are related to the physical self Background To study the predictive value of baseline radiographs and low-field ( 0.2 T ) MRI scans for the symptomatic outcome of clinical ly significant weight loss in obese patients with knee osteoarthritis . Methods In this study we hypothesize that imaging variables assessed with radiographs and MRI scans pre-treatment can predict the symptomatic changes following a recommended clinical ly significant weight reduction Patients were recruited from the Department of Rheumatology , Frederiksberg Hospital , Denmark . Eligibility criteria were : age > 18 years ; primary osteoarthritis according to ACR ; BMI > 28 kg/m2 ; motivation for weight loss . Subjects were r and omly assigned to either intervention by low-energy diet ( LED ) for 8 weeks followed by another 24 weeks of dietary instruction or control-group . MRI scans and radiographs were scored for structural changes and these parameters were examined as independent predictors of changes in osteoarthritis symptoms after 32 weeks . The outcome assessor and statistician were blinded to group allocation . Results No significant correlations were found between imaging variables and changes in Western Ontario and McMaster Universities Index of Osteoarthritis ( Spearman 's test , r < 0.33 and P > 0.07).Only the LED group achieved a weight loss , with a mean difference of 16.3 kg ( 95%CI : 13.4 - 19.2;P < 0.0001 ) compared to the control group . The total WOMAC index showed a significant difference favouring LED , with a group mean difference of - 321.3 mm ( 95%CI : -577.5 to -65.1 mm ; P = 0.01 ) . No significant adverse events were reported . ConclusionS tage of joint destruction , assessed on either radiographs or low-field MRI ( 0.2 T ) , does not preclude a symptoms relief following a clinical ly relevant weight loss in elderly obese female patients with knee osteoarthritis BACKGROUND Persistent , low- grade inflammation is an independent predictor of several chronic diseases and all-cause mortality . OBJECTIVE The intention of this study was to determine the independent and combined effects of diet-induced weight loss and exercise on markers of chronic inflammation . DESIGN Three hundred sixteen community-dwelling , older ( > or = 60 y ) , overweight or obese [ body mass index ( in kg/m2 ) > or = 28 ] , sedentary men and women with radiographic evidence of knee osteoarthritis were r and omly assigned to four 18-mo treatments : healthy lifestyle control , diet-induced weight loss , exercise , and diet plus exercise . The exercise intervention consisted of combined weight training and walking for 1 h 3 times/wk . The weight-loss intervention consisted of a weekly session with a registered dietitian to provide education and support for lowering energy intake . RESULTS The diet-induced weight-loss intervention result ed in significantly greater reductions in concentrations of C-reactive protein ( P = 0.01 ) , interleukin 6 ( P = 0.009 ) , and soluble tumor necrosis factor alpha receptor 1 ( P = 0.007 ) than did no weight-loss treatment . Changes in soluble tumor necrosis factor alpha receptor 1 but not in C-reactive protein or interleukin 6 correlated with changes in body weight .  Exercise training did not have a significant effect on these inflammatory biomarkers , and there was no significant interaction between weight loss and exercise training . CONCLUSIONS These findings provide evidence from a r and omized controlled trial that a dietary intervention design ed to elicit weight loss reduces overall inflammation in older , obese persons . Additional studies are needed to assess the effects of different modes and intensities of exercise on inflammation OBJECTIVE To compare structural knee joint changes in obese patients with knee osteoarthritis ( OA ) that after an intensive weight loss therapy were r and omized to continuous dietetic support , a specialized knee exercise program , or ' no attention ' for 1 year . METHODS 192 obese individuals with knee OA underwent an intensive 16-week weight loss program with subsequent r and omization to one of the three treatment groups . Changes in cartilage loss , bone marrow lesions ( BMLs ) , synovitis , and effusion were assessed using semi quantitative assessment s of magnetic resonance imaging ( MRI ) obtained at weeks 0 and 68 applying the BLOKS score . RESULTS During the 52 weeks maintenance period the continuous dietary maintenance group support on average gained 1.1 kg ( 95 % CI : -0.3:2.5 ) body mass , the exercise group gained 6.6 kg ( 95 % CI 5.4:7.8 ) and the no-attention group gained 4.8 kg ( 95 % CI : 2.9:6.7 ) . There were no statistically significant between-group differences in changes in cartilage loss , synovitis or effusion at the follow-up ( analysis of covariance ; ANCOVA , P > 0.16 ) , while there was an increased number of medial tibiofemoral BMLs in the exercise group ( ANCOVA , P = 0.015 ) compared to both diet ( difference : -0.21 [ 95%CI -0.40:-0.03 ] ) and " no attention " ( difference : -0.26 [ 95%CI -0.44:-0.07 ] ) groups . CONCLUSION In this 1 year follow-up after weight-loss in obese knee OA patients , we found a potentially increased number of BMLs in the exercise group compared to the diet and no attention groups , with no between-group differences in changes in cartilage loss , synovitis or effusion . These findings should be interpreted with caution for exercise compliance , MRI methodology and follow-up time . ( Clinical Trials.gov identifier : NCT00655941 ) OBJECTIVE The Arthritis , Diet , and Activity Promotion Trial ( ADAPT ) was a r and omized , single-blind clinical trial lasting 18 months that was design ed to determine whether long-term exercise and dietary weight loss are more effective , either separately or in combination , than usual care in improving physical function , pain , and mobility in older overweight and obese adults with knee osteoarthritis ( OA ) . METHODS Three hundred sixteen community-dwelling overweight and obese adults ages 60 years and older , with a body mass index of > or = 28 kg/m(2 ) , knee pain , radiographic evidence of knee OA , and self-reported physical disability , were r and omized into healthy lifestyle ( control ) , diet only , exercise only , and diet plus exercise groups . The primary outcome was self-reported physical function as measured with the Western Ontario and McMaster Universities Osteoarthritis Index ( WOMAC ) . Secondary outcomes included weight loss , 6-minute walk distance , stair-climb time , WOMAC pain and stiffness scores , and joint space width . RESULTS Of the 316 r and omized participants , 252 ( 80 % ) completed the study .  Adherence was as follows : for healthy lifestyle , 73 % ; for diet only , 72 % ; for exercise only , 60 % ; and for diet plus exercise , 64 % . In the diet plus exercise group , significant improvements in self-reported physical function ( P < 0.05 ) , 6-minute walk distance ( P < 0.05 ) , stair-climb time ( P < 0.05 ) , and knee pain ( P < 0.05 ) relative to the healthy lifestyle group were observed . In the exercise group , a significant improvement in the 6-minute walk distance ( P < 0.05 ) was observed . The diet-only group was not significantly different from the healthy lifestyle group for any of the functional or mobility measures . The weight-loss groups lost significantly ( P < 0.05 ) more body weight ( for diet , 4.9 % ; for diet plus exercise , 5.7 % ) than did the healthy lifestyle group ( 1.2 % ) . Finally , changes in joint space width were not different between the groups . CONCLUSION The combination of modest weight loss plus moderate exercise provides better overall improvements in self-reported measures of function and pain and in performance measures of mobility in older overweight and obese adults with knee OA compared with either intervention alone OBJECTIVE : To determine the effect of weight loss and exercise interventions on serum leptin and to investigate the relationship of physical function and osteoarthritis ( OA ) severity with serum leptin in older overweight and obese adults with knee OA . In addition , the study examined if serum leptin predicts weight loss . DESIGN : Longitudinal , controlled clinical trial of weight loss and exercise interventions .SUBJECTS : Community dwelling , older , overweight and obese adults ( n=316 ; > 60 years of age ; body mass index ≥28.0 kg m−2 ) with symptomatic knee OA and self-reported difficulty in performing selected physical activities were recruited . INTERVENTIONS : Participants were r and omized into one of four groups for the 18-month study duration : Healthy Lifestyle Controls , Dietary Weight Loss ( Diet ) , Exercise Training ( Exercise ) , and a combination of Dietary Weight Loss and Exercise Training ( Diet+Exercise ) . The weight loss goal for the two Diet groups was 5 % from baseline at 18 months . Participants in the Exercise groups were trained for 3 days week−1 , 60 min day−1 . MEASUREMENTS : Body weight , body mass index , serum leptin , physical function , and OA severity were measured at baseline , 6 months , and 18 months . RESULTS : Diet and Diet+Exercise groups lost 5.3 and 6.1 % of their weight , respectively , at 18 months with the Exercise group losing 2.9 % . There was a significant main effect of weight loss on serum leptin with a decrease in serum leptin averaged across the 6- and 18-month time points for the Diet and Diet+Exercise groups compared to the other two groups ( β=0.245 ; P<0.01 ) . No main effect  for exercise training was observed . Serum leptin was related to self-reported physical function . In all participants , a mixed model analysis demonstrated that lower levels of baseline serum leptin predict larger weight loss ( β=−2.779 ; P=0.048 ) . CONCLUSION : Decreases in serum leptin may be one mechanism by which weight loss improves physical function and symptoms in OA patients PURPOSE The purpose of this study was to compare the cost-effectiveness of dietary and exercise interventions in overweight or obese elderly patients with knee osteoarthritis ( OA ) enrolled in the Arthritis , Diet , and Physical Activity Promotion Trial ( ADAPT ) . METHODS ADAPT was a single-blinded , 
    Output:
    
Meta- synthesis of qualitative findings result ed in two synthesized findings ; the importance of healthcare professionals underst and ing the effects of pain on ability to control weight and developing management/education programmes that address comorbidity