***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: To comprehend the results of a r and omised controlled trial ( RCT ) , readers must underst and its design , conduct , analysis , and interpretation . That goal can be achieved only through total transparency from authors . Despite several decades of educational efforts , the reporting of RCTs needs improvement . Investigators and editors developed the original CONSORT ( Consoli date d St and ards of Reporting Trials ) statement to help authors improve reporting by use of a checklist and flow diagram . The revised CONSORT statement presented here incorporates new evidence and addresses some criticisms of the original statement . The checklist items pertain to the content of the Title , Abstract , Introduction , Methods , Results , and Discussion . The revised checklist includes 22 items selected because empirical evidence indicates that not reporting this information is associated with biased estimates of treatment effect , or because the information is essential to judge the reliability or relevance of the findings . We intended the flow diagram to depict the passage of participants through an RCT . The revised flow diagram depicts information from four stages of a trial ( enrolment , intervention allocation , follow- up , and analysis ) . The diagram explicitly shows the number of participants , for each intervention group , included in the primary data analysis . Inclusion of these numbers allows the reader to judge whether the authors have done an intention- to-treat analysis . In sum , the CONSORT statement is intended to improve the reporting of an RCT , enabling readers to underst and a trial 's conduct and to assess the validity of its results Twenty-five hemodialysis patients were r and omized into comparable exercising ( E , N = 14 ) and sedentary control ( N = 11 ) groups . After baseline testing , training was 3 to 5 times weekly for a mean of 12 + /- 4 ( SD ) months . Maximal aerobic capacity increased 21 % ( P less than 0.01 ) , and the duration s for the grade d exercise stress  test improved 19 % ( P less than 0.01 ) in E , but did not change in controls ( 8 + /- 4 months ) . Declining blood pressures in 8 hypertensive E led to reductions in antihypertensive medications ; no changes occurred in 9 hypertensive controls . Exercise lowered plasma total triglyceride levels 33 % ( 280 + /- 258 to 175 + /- 95 mg/dl ; P less than 0.01 ) , but no change occurred in total and low-density lipoprotein cholesterol concentrations . High-density lipoprotein cholesterol levels rose 16 % in E ( 31 + /- 9 to 36 + /- 12 mg/dl ; P less than 0.02 ) , but did not change in controls . An increase in the affinity of insulin for receptors on mononuclear cells was associated with a 20 % decrease in fasting plasma insulin levels ( 24 + /- 7 to 19 + /- 2 microU/ml , N = 8 ; P less than 0.05 ) and a 42 % improvement in glucose disappearance rates ( 1.9 + /- 1.0 to 2.6 + /- 1.2 % per min , N = 6 ) in E. There were no changes in the body weights or diets of the patients . A 27 % increase in red blood cell mass ( P less than 0.02 ) with no change in plasma volume result ed in a 27 % increase in hematocrit ( 24 + /- 3 % to 31 + /- 5 % , P less than 0.01 ) and a 20 % increase in hemoglobin ( 8 + /- 1 to 10 + /- 2 g/dl ; P less than 0.01 ) in E. ( ABSTRACT TRUNCATED AT 250 WORDS BACKGROUND Patients with end-stage renal disease on haemodialysis ( HD ) have limited work capacity . Many structural and functional alterations in skeletal muscles contribute to this disability . METHODS To evaluate the effects of exercise training on uraemic myopathy , seven HD patients ( mean age 44.1+/-17.2 years ) were studied . Open muscle biopsies were taken from their vastus lateralis muscle before and after a 6-month exercise rehabilitation programme and examined by routine light- and transmission electron-microscopy . Histochemical stainings of frozen sections were performed and morphometric analysis was also applied to estimate the proportion of each fibre type and the muscle fibre area . Spiroergometric and neurophysiological testing and peak extension forces of the lower limbs were measured before and after exercise training . RESULTS All patients showed impaired exercise capacity , which was associated with marked muscular atrophy ( mean area 2548+/-463 microm2 ) and reduction in muscle strength and nerve conduction velocity . All types of fibres were atrophied , but type II were more affected . The ultrastructural study showed severe degenerative changes in skeletal muscle fibres , mitochondria , and capillaries .  Exercise training had an impressive effect on muscular atrophy ; in particular the proportion of type II fibres increased by 51 % and mean muscle fibre area by 29 % . Favourable changes were also seen on the structure and number of capillaries and mitochondria . These results were confirmed by a 48 % increase in VO2 peak and a 29 % in exercise time , as well as an improvement in the peak muscle strength of the lower limbs and in nerve conduction velocity . CONCLUSIONS Skeletal muscle atrophy in HD patients contribute to their poor exercise tolerance . The application of an exercise training rehabilitation programme improved muscle atrophy markedly , and therefore had beneficial effects in overall work performance The aim of this study was to assess the psychosocial effects of exercise training on hemodialysis ( HD ) patients . Thirty-one uremic patients , aged 50.6+/-11.6 years , on maintenance HD were studied . Twenty patients were selected at r and om for a 6-month  exercise renal rehabilitation program ( ERRP ) consisting of 3 weekly sessions of exercise training . The other 11 patients were assigned to sedentary control status . A formal psychosocial assessment , which included affective ( Beck Depression Inventory , BDI ) , quality of life ( Quality of Life Index , QLI ) and personality ( Eysenck Personality Question naire , EPQ ) parameters , was performed with vali date d question naires at the beginning and the end of the ERRP . After training significant improvement occurred in physical capacity ( VO2max increased from 16.8+/-6.2 to 23.2+/-7.6 ml/kg/min , p < 0.05 ) . Although the level of depression did not differ betwen the 2 groups at pretesting , the ERRP group showed a decrease in their self-report of depression ( decrease in BDI score value , from 21.0+/-10.4 to 13.7+/-9.5 , p < 0.05 ) after the training program . From the relationship between the baseline levels of BDI depression and changes in VO2max in the ERRP group it was suggested that the most severely depressed patients got the greatest beneficial effects from exercise training . Moreover , trained patients demonstrated an improvement in QLI ( from 6.3+/-1.5 to 9.0+/-0.9 , p < 0.05 ) . This improvement was found to be dependent on the participation in ERRP , the effects of the training and the improvement in the depression . All the above functional and psychosocial parameters remained unchanged in the controls . The results demonstrate that ERRP is an effective emotional therapeutic method for HD patients and improves their quality of life Dialysis saves lives . However , dialysis alone can not make those lives active and meaningful . Exercise , in particular , is critical in the rehabilitation of many individuals with chronic renal insufficiency The purpose of this pilot study was to : 1 ) examine changes in participants ' physical capacity and quality of life with the intervention of a 12-week exercise program ; 2 ) investigate whether erythropoietin ( EPO ) and antihypertensive medication dosages were reduced in the participants ; 3 ) examine the feasibility of incorporating exercise into the London Health Sciences Centre ( LHSC ) hemodialysis program . A quasi-experimental one-group pre- and post-test design was utilized . Eight subjects completed the 12-week study . The exercise program involved a warm-up , stretching , strengthening , and cardiovascular training . The results demonstrated improvements in the participants ' physical capacity , quality of life , and ability to perform activities of daily living ( ADLs ) . There were no discernable trends in the participants ' hemoglobin levels or EPO dosages . Although there were no statistically significant changes in participants ' blood pressures , five out of the six participants who began the program on antihypertensive medications either had the dosages decreased or the drug(s ) discontinued . Data from this small prospect i ve study supports previous research that an exercise during dialysis program is safe and has the potential to result in positive patient outcomes This study examines the effects of 12 months of endurance exercise training ( cycling , walking and jogging ) on lipid profiles , glucose metabolism , blood pressure , anemia and psychological function in 14 hemodialysis patients .  Maximal aerobic capacity ( VO2max ) increased 18 % in the exercisers ( p less than 0.01 ) , but did not change in 11 controls . This was associated with a reduction in depression , a decrease in dosages of antihypertensive medications , a significant increase in hematocrit and hemoglobin levels ( red cell mass rose , plasma volume did not change ) , a decrease in plasma triglyceride by 23 % ( p less than 0.05 ) and an increase in high-density lipoprotein cholesterol ( HDL-C ) levels by 21 % ( p less than 0.01 ) ( both HDL-C and triglyceride levels worsened in the sedentary controls ) , and an 18 % increase in glucose disappearance rates ( p less than 0.05 ) in spite of a 52 % decrease in fasting insulin levels ( p less than 0.01 ) , suggesting that insulin sensitivity improved . These results demonstrate that some of the complications present in hemodialysis patients may be caused by their sedentary life-style , rather than endstage renal disease itself . This suggests that rehabilitation through exercise is possible for these patients . By reducing coronary risk factors in hemodialysis patients , exercise training may also decrease their heightened morbidity and mortality from atherosclerotic complications . These possibilities need to be examined in a longitudinal study Cardiovascular disease remains the primary cause of mortality in patients who are maintained on hemodialysis .  Arterial stiffness and insulin resistance are independent risk factors for cardiovascular mortality in this population . In healthy individuals , higher physical conditioning is associated with reduced arterial stiffness . Exercise reduces insulin resistance and glucose intolerance in sedentary , overweight individuals and diabetic patients . The purpose of this study was to determine the impact of an exercise program on arterial stiffness and insulin resistance in a group of patients on hemodialysis . The effect of exercise training on arterial stiffness and insulin resistance in 11 patients who were on chronic hemodialysis was evaluated . Exercise classes of 1-h duration were conducted twice weekly for 3 mo . Arterial stiffness was assessed using the radial artery pressure waveform analysis . Aerobic exercise improved arterial stiffness from 17 + /- 3 u at baseline to 12.2 + /- 3 u at the end of the intervention ( P = 0.01 ) . After 1 mo of detraining , arterial stiffness reverted to pre-exercise levels ( 17.3 + /- 3 u ) . Pulse pressure paralleled arterial stiffness changes , and the correlation between them was statistically significant ( r = 0.725 , P = 0.012 ) . Insulin resistance was calculated using the homeostatic model assessment formula .  Exercise at the intensity and duration used in our study had no impact on insulin resistance ( P = 0.38 ) . These findings suggest that 3 mo of aerobic exercise training improves arterial stiffness , an independent risk factor for cardiovascular mortality in patients who are on hemodialysis , and has no impact on insulin resistance . The beneficial effect on arterial stiffness dissipates within 1 mo of detraining . To obtain therapeutic benefits , an exercise program for patients who are maintained on hemodialysis should be design ed to promote regular long term exercise , > 3 h/wk This study compares the effects of a structured exercise training program to the therapeutic benefits of a ' support ' group on the depressed mood and reduced performance of pleasant activities by hemodialysis patients . After 6 months of an aerobic exercise training program , the 10 exercisers showed a significant increase in maximal aerobic capacity ( VO2max ) and a significant decrease in dysphoric mood when compared to 7 patients attending the support group . Support group participants reported a significant decrease in pleasant activities while there was no change in the exercisers . Eighteen months after the exercise training program , the exercisers reported continued low levels of depressed mood , and were performing significantly more pleasant activities than they reported prior to the exercise program . The results of this study suggest an exercise training program may be useful in the psychosocial rehabilitation of some hemodialysis patients BACKGROUND Individuals with end-stage renal disease on hemodialysis therapy have reduced aerobic exercise capacity and reduced muscle strength . METHODS This was a single-blind , r and omized , placebo-controlled trial of an exercise intervention in hemodialysis patients administered erythropoietin . The intervention consisted of progressive resisted isotonic quadriceps and hamstrings exercise and training on a cycle ergometer three times weekly for 12 weeks . Individuals in the control group underwent a nonprogressive program of range-of-motion exercises . Both groups were observed for an additional 5 months without intervention . Outcomes were assessed without knowledge of treatment assignment at baseline , 12 weeks , and 5 months . A health 
    Output:
    
Results : According to the 29 trials review ed , HD patients can safely derive a myriad of health-related adaptations from engaging in appropriately structured exercise regimens involving aerobic and /or resistance training .
However , method ological limitations within this body of literature may be partially responsible for minimal advocacy for exercise in this cohort .