***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: The EBN users ’ guide in the previous issue of Evidence -Based Nursing outlined the primary and secondary questions for evaluating studies of healthcare interventions . One of the primary questions for assessing the validity of a study ’s findings is whether the assignment of patients to treatments was r and omised and whether r and omisation was concealed . One of the secondary questions is whether patients , clinicians , outcome assessors , and data analysts were unaware of ( blinded to or masked from ) patient allocation . Beginning with the October 1999 issue of Evidence -Based Nursing , allocation concealment and blinding have been given more attention . The “ design ” section of abstract s of r and omised trials now includes a statement of whether r and omisation was concealed from those responsible for entering patients into trials , and who was blinded to treatment allocation during the trials . These additional specifications provide readers with more information to judge the internal validity of trials . In this editorial , the background and rationale for these decisions are addressed The authors estimated components of variance and intraclass correlation coefficients ( ICCs ) to aid in the design of complex surveys and community intervention studies by analyzing data from the Health Survey for Engl and 1994 . This cross-sectional survey of English adults included data on a range of lifestyle risk factors and health outcomes . For the survey , households were sample d in 720 postal code sectors nested within 177 district health authorities and 14 regional health authorities . Study subjects were adults aged 16 years or more .  ICCs and components of variance were estimated from a nested r and om-effects analysis of variance . Results are presented at the district health authority , postal code sector , and household levels . Between-cluster variation was evident at each level of clustering . In these data , ICCs were inversely related to cluster size , but design effects could be substantial when the cluster size was large . Most ICCs were below 0.01 at the district health authority level , and they were mostly below 0.05 at the postal code sector level . At the household level , many ICCs were in the range of 0.0 - 0.3 . These data may provide useful information for the design of epidemiologic studies in which the units sample d or allocated range in size from households to large administrative areas 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 OBJECTIVE Patients with schizophrenia treated with clozapine  often gain weight . This study evaluated the effects of dietary control and physical activity among obese in patients with schizophrenia being treated with clozapine . METHODS Fifty-three clozapine-treated obese patients with schizophrenia in a veterans hospital in eastern Taiwan who had a body mass index greater than 27 ( weight divided by height in meters squared ) and who were taking clozapine  were r and omly assigned to a study group of 28 or a control group of 25 . The study group was placed on a diet that reduced calorie intake by 200 to 300 kcal per day ( to 1,300 to 1,500 kcal per day for women and to 1,600 to 1,800 kcal per day for men ) and a six-month regimen of regular physical activity in which participants used approximately 600 to 750 kcal per week ( level walking and walking on stairs for 60 minutes three days per week ) . Anthropometric , metabolic , and hormonal parameters were measured after three and six months by using anthropometry , an enzyme autoanalyzer , immunoassay , and enzyme-linked immunosorbent assay . RESULTS Compared with the control group , the study group showed a significant decrease in body weight , body mass index ( 5.4 % reduction ) , waist circumference ( 3.3 cm ) , and hip circumference ( 3.3 cm ) after three months and after six months . Triglyceride and insulin-like growth factor-binding protein-3 ( IGFBP-3 ) decreased significantly only after six months . CONCLUSIONS A program of dietary control and regular physical activity can significantly reduce body weight and improve metabolic profiles of insulin , triglyceride , and IGFBP-3 among obese in patients taking clozapine for the treatment of schizophrenia OBJECTIVE To compare the feasibility of blinding and the perceived risk of unblinding in trials evaluating  pharmacologic ( PT ) and nonpharmacologic treatments ( NPT ) of hip or knee osteoarthritis . STUDY DESIGN AND SETTING Two independent review ers assessed the feasibility of blinding  patients , care providers , and outcome assessors , the perceived risk of unblinding , and whether blinding was reported in 110 reports of r and omized controlled trials ( RCTs ) evaluating PT and NPT in patients with hip or knee osteoarthritis . RESULTS Blinding was considered to be possible less often in NPT trials than in PT trials for patients ( 42 vs. 96 % ; P < .001 ) , care providers ( 12 vs. 96 % ; P < .001 ) , and outcome assessors ( 34 vs. 98 % ; P < .001 ) . When blinding was judged feasible , the perceived risk of unblinding was more often considered moderate or important in NPT than PT trials for patients ( 35 vs. 14 % , P=.02 ) and outcome assessors ( 44 vs. 10 % , P=.0004 ) . When blinding was judged feasible , it was reported less often in NPT reports than in PT reports for patients ( 46 vs. 98 % , P < .001 ) , care providers ( 43 vs. 83 % , P=.03 ) , and outcome assessors ( 72 vs. 98 % , P=.0006 ) . CONCLUSION Blinding appears to be more difficult to achieve and unblinding may occur more often in NPT than PT trials A modification of an earlier rating scale for extrapyramidal system disturbance is described , and evidence for the validity and reliability of the scale is presented . The usefulness of the scale in studies of neuroleptic drugs is discussed . By its application it is possible to quantify extrapyramidal side effects and to separate them into four principal factors BACKGROUND A recent review suggested an association between using unpublished scales in clinical trials and finding significant results . AIMS To determine whether such an association existed in schizophrenia trials . METHOD Three hundred trials were r and omly selected from the Cochrane Schizophrenia Group 's Register . All comparisons between treatment groups and control groups using rating scales  were identified . The publication status of each scale was determined and cl aims of a significant treatment effect were recorded . RESULTS Trials were more likely to report that a treatment was superior to control when an unpublished scale was used to make the comparison ( relative risk 1.37 ( 95 % CI 1.12 - 1.68 ) ) . This effect increased when a ' gold-st and ard ' definition of treatment superiority was applied ( RR 1.94 ( 95 % CI 1.35 - 2.79 ) ) . In non-pharmacological trials , one-third of ' gold-st and ard ' cl aims of treatment superiority would not have been made if published scales had been used . CONCLUSIONS Unpublished scales are a source of bias in schizophrenia trials The purpose of this study was to determine the effects a health education and exercise program would have in limiting weight gain and in improving fitness and psychological parameters in adults with mood or psychotic disorders . Thirty volunteers were r and omly assigned to the healthy lifestyle group ( HL ) or a control group . The HL group engaged in exercise for 12 weeks . Pre- and post-exercise testing was conducted to assess body fat , lipid profile , and cardiovascular fitness . Educational seminars were held weekly . The intervention group evidence d greater weight loss than the control group , although not statistically significant . Significant differences were observed in ratings of general health ( p < .05 ) and empowerment ( p < .01 ) . Trends suggest that exercise interventions may encourage weight loss , particularly if barriers to full participation can be addressed . Additionally , such interventions may contribute to " perceived " well-being even among those with sub clinical participation CONTEXT Weight gain , a common adverse effect of antipsychotic medications , is associated with medical comorbidities in psychiatric patients . OBJECTIVE To test the efficacy of lifestyle intervention and metformin alone and in combination for antipsychotic-induced weight gain and abnormalities in insulin sensitivity . DESIGN , SETTING , AND PATIENTS A r and omized controlled trial ( October 2004-December 2006 ) involving 128 adult patients with schizophrenia in the Mental Health Institute of the Second Xiangya Hospital , Central South University , China . Participants who gained more than 10 % of their predrug weight were assigned to 1 of 4 treatment groups . INTERVENTIONS Patients continued their antipsychotic medication and were r and omly assigned to 12 weeks of placebo , 750 mg/d of metformin alone , 750 mg/d of metformin and lifestyle intervention , or lifestyle intervention only . MAIN OUTCOME MEASURES Body mass index , waist circumference , insulin levels , and insulin resistance index . RESULTS All 128 first-episode schizophrenia patients maintained relatively stable psychiatric improvement . The lifestyle-plus-metformin group had mean decreases in body mass index ( BMI ) of 1.8 ( 95 % confidence interval [ CI ] , 1.3 - 2.3 ) , insulin resistance index of 3.6 ( 95 % CI , 2.7 - 4.5 ) , and waist circumference of 2.0 cm ( 95 % CI , 1.5 - 2.4 cm ) . The metformin-alone group had mean decreases in BMI of 1.2 ( 95 % CI , 0.9 - 1.5 ) , insulin resistance index of 3.5 ( 95 % CI , 2.7 - 4.4 ) , and waist circumference of 1.3 cm ( 95 % CI , 1.1 - 1.5 cm ) . The lifestyle-plus-placebo group had mean decreases in BMI of 0.5 ( 95 % CI , 0.3 - 0.8 ) and insulin resistance index of 1.0 ( 95 % CI , 0.5 - 1.5 ) . However , the placebo group had mean increases in BMI of 1.2 ( 95 % CI , 0.9 - 1.5 ) , insulin resistance index of 0.4 ( 95 % CI , 0.1 - 0.7 ) , and waist circumference of 2.2 cm ( 95 % CI , 1.7 - 2.8 cm ) . The lifestyle-plus-metformin treatment was significantly superior to metformin alone and to lifestyle plus placebo for weight , BMI , and waist circumference reduction . CONCLUSIONS Lifestyle intervention and metformin alone and in combination demonstrated efficacy for antipsychotic-induced weight gain . Lifestyle intervention plus metformin showed the best effect on weight loss . Metformin alone was more effective in weight loss and improving insulin sensitivity than lifestyle intervention alone . Trial Registration clinical trials.gov Identifier : NCT00451399 The purpose of this study was to examine the effects of 10 weeks of physical exercises programme on mental states and quality of life ( QOL ) of individuals with 
    Output:
    
Results of this Cochrane review are similar to existing review s that have examined the health benefits of exercise in this population ( Faulkner 2005 ) .
Although studies included in this review are small and used various measures of physical and mental health , results indicated that regular exercise programmes are possible in this population , and that they can have healthful effects on both the physical and mental health and well-being of individuals with schizophrenia .