***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 Following an extensive recruitment campaign , a 16-week lunchtime intervention to increase walking was implemented with insufficiently physically active University employees to examine programme feasibility and the effects of the programme in increasing walking behaviour , and in improving well-being and work performance . Methods / design A feasibility study in which participants were r and omised to an immediate treatment or a delayed treatment control ( to start at 10 weeks ) group . For the first ten weeks of the intervention , participants took part in three facilitator-led group walks per week each of thirty minutes duration and were challenged to accumulate another sixty minutes of walking during the weekends . In the second phase of the intervention , the organised group walks ceased to be offered and participants were encouraged to self-organise their walks . Motivational principles were employed using contemporary motivational theory . Outcome measures ( including self-reported walking , step counts , cardiovascular fitness , general and work-related well-being and work performance ) were assessed at baseline , at the end of the 16-week intervention and ( for some ) four months after the end of the intervention . Process and outcome assessment s were also taken throughout , and following , the intervention . Discussion The results of the intervention will determine the feasibility of implementing a lunchtime walking programme to increase walking behaviour , well-being and performance in sedentary employees . If successful , there is scope to implement definitive trials across a range of worksites with the aim of improving both employee and organisational health . Trial registration Current Controlled Trials IS RCT N81504663 Background The prevalence of both overweight and musculoskeletal disorders ( MSD ) in the construction industry is high . Many interventions in the occupational setting aim at the prevention and reduction of these health problems , but it is still unclear how these programmes should be design ed . To determine the effectiveness of interventions on these health outcomes r and omised controlled trials ( RCTs ) are needed . The aim of this study is to systematic ally develop a tailored intervention for prevention and reduction of overweight and MSD among construction workers and to describe the evaluation study regarding its (cost-)effectiveness . Methods / Design The Intervention Mapping ( IM ) protocol was applied to develop and implement a tailored programme aim ed at the prevention and reduction of overweight and MSD . The ( cost- ) effectiveness of the intervention programme will be evaluated using an RCT . Furthermore , a process evaluation will be conducted . The research population will consist of blue collar workers of a large construction company in the Netherl and s . InterventionThe intervention programme will be aim ed at improving ( vigorous ) physical activity levels and healthy dietary behaviour and will consist of tailored information , face-to-face and telephone counselling , training instruction ( a fitness " card " to be used for exercises ) , and material s design ed for the intervention ( overview of the company health promoting facilities , waist circumference measuring tape , pedometer , BMI card , calorie guide , recipes , and knowledge test).Main study parameters/endpointsThe intervention effect on body weight and waist circumference ( primary outcome measures ) , as well as on lifestyle behaviour , MSD , fitness , CVD risk indicators , and work-related outcomes ( i.e. productivity , sick leave ) ( secondary outcome measures ) will be assessed . Discussion The development of the VIP in construction intervention led to a health programme tailored to the needs of construction workers . This programme , if proven effective , can be directly implemented . Trial registration Netherl and s Trial Register ( NTR ) : OBJECTIVE To evaluate the effectiveness of a worksite health promotion program on improving cardiovascular disease risk factors . METHODS In St Louis , Missouri from 2005 to 2006 , 151 employees ( 134 F , 17 M , 81 % overweight/obese ) participated in a cohort-r and omized trial comparing assessment s + intervention ( worksite A ) with assessment s only ( worksite B ) for 1 year . All participants received personal health reports containing their assessment results . The intervention was design ed to promote physical activity and favorable dietary patterns using pedometers , healthy snack cart , WeightWatchers(R ) meetings , group exercise classes , seminars , team competitions , and participation rewards . Outcomes included BMI , body composition , blood pressure , fitness , lipids , and Framingham 10-year coronary heart disease risk . RESULTS 123 participants , aged 45+/-9 yr , with BMI 32.9+/-8.8 kg/m(2 ) completed 1 year . Improvements ( P < or = 0.05 ) were observed at both worksites for fitness , blood pressure , and total- , HDL- , and LDL-cholesterol . Additional improvements occurred at worksite A in BMI , fat mass , Framingham risk score , and prevalence of the metabolic syndrome ; only the changes in BMI and fat mass were different between worksites . CONCLUSION A multi-faceted worksite intervention promoted favorable changes in cardiovascular disease risk factors , but many of the improvements were achieved with worksite health assessment s and personalized health reports in the absence of an intervention Background  Physical activity ( PA )  has been identified as a central component in the promotion of health . PA programs can provide a low cost intervention opportunity , encouraging PA behavioral change while worksites have been shown to be an appropriate setting for implementing such health promotion programs . Along with these trends , there has been an emergence of the use of pedometers as a self-monitoring and motivational aid for PA.This study determines the effectiveness of a worksite health promotion program comprising of a 10-week , pedometer-based intervention ( “ Steps that Count ! ” ) , and individualized email-based feedback to effect PA behavioral change . Methods The study is a r and omized controlled trial in a worksite setting , using pedometers and individualized email-based feedback to increase steps per day ( steps/d ) .  Participant selection will be based on attendance at a corporate wellness event and information obtained , following the completion of a Health Risk Appraisal ( HRA ) , in keeping with inclusion criteria for the study . All participants will , at week 1 ( pre-intervention ) , be provided with a blinded pedometer to assess baseline levels of PA . Participants will be provided with feedback on pedometer data and identify strategies to improve daily PA towards current PA recommendations . Participants will thereafter be r and omly assigned to the intervention group ( INT ) or control group ( CTL ) . The INT will subsequently wear an un-blinded pedometer for 10 consecutive weeks . Individualized feedback messages based on average steps per day , derived from pedometer data ( INT ) and general supportive/motivational messages ( INT+CTL ) , will be provided via bi-weekly e-mails ; blinded pedometer-wear will be conducted at week 12 ( post-intervention : INT+CTL ) . Discussion The purpose of this paper is to outline the rationale behind , and the development of , an intervention aim ed at improving ambulatory PA through pedometer use , combined with regular , individualized , email-based feedback . Pedometer-measured PA and individualized feedback may be a practical and easily applied intervention . Trial registration Number : DOH-27 - 0112 - Summary This paper describes a controlled study of the effects of an unsupervised walking-programme in 108 volunteers from among 580 middle-aged employees in a Nottingham light industrial company . Objective measurements of physical condition and of customary activity were made on four occasions at 12-week intervals . The subjects were r and omly allocated to three groups and encouraged to follow a walking-programme in the first , second or third periods of the study : no activity was prescribed in the other periods .  Compliance with the programme was estimated from log-cards and from a week 's pedometer record . Although there were no significant differences between the changes seen in subjects following the walking-programme and those in control subjects , there were significant small improvements in physical condition and modest increases in customary activity in a ) those subjects actually completing the programme , and b ) the subjects measured before and after their programme , pooled without regard to the period of measurement . At least some of the increased activity is maintained for 12 weeks after the programme . The marginal changes suggest that the intensity of the training-programme as experienced by the subjects was close to the threshold for maintenance of physical condition in this age-group of workers BACKGROUND This study explored the experiences of university employees recruited to a 10-week r and omized controlled trial ( n = 64 ) . The trial compared " walking routes " with " walking-while-working " on daily step totals , showing that , compared with controls , interventions result ed in around 1000 extra steps per day . METHODS A sub sample of 15 academic and administrative employees from intervention groups completed interviews at the end of intervention . Interviews were transcribed verbatim and subject to inductive coding within the major themes of benefits /positives and problems/barriers . FINDINGS Both interventions benefited employee health and work productivity but were difficult to implement in the workplace . Involvement in walking routes was challenged by the difficulties of managing time pressures , and individuals assigned to walking-while-working had to deal with local management subcultures favoring physical presence and inactivity . CONCLUSIONS Findings highlight the need for further research , advocate the value of walking at work , and provide insights into the challenges that face staff in workplace interventions Background Statistical mediation analysis can be used to improve the design of obesity prevention and treatment programs by identifying the possible mechanisms through which an intervention achieved its effects . The aim of this study was to identify mediators of weight loss in an Internet-based weight-loss program specifically design ed for overweight men . Methods The Self-Help , Exercise and Diet using Information Technology ( SHED-IT ) program was a 3-month r and omized controlled trial ( Internet-based intervention group vs information only control group ) that was implemented in 2007 with baseline and 6-month follow-up assessment of weight , physical activity and dietary behaviors . Intention-to-treat and per- protocol mediation analyses were conducted using a product-of-coefficients test . Results Participants ( N = 65 ) were overweight and obese male academic ( n = 10 ) and non-academic ( n = 27 ) staff and students ( n = 28 ) from the University of Newcastle , Australia . Mean ( SD ) age = 35.9 ( 11.1 ) years and mean ( SD ) BMI = 30.6 ( 2.8 ) . In the intention-to-treat analysis , both groups lost weight , but relative to the control group , the intervention did not have a statistically significant ' total effect ' on weight , τ = -.507 , p = .716 ( 95 % CI = -3.277 to 2.263 ) . In the per- protocol analysis , the intervention had a statistically significant ' total effect ' on weight , τ = -4.487 , p < .05 ( 95 % CI = -8.208 to -.765 ) . The intervention did not have a statistically significant effect on any of the hypothesized mediators and none of the behavioral variables mediated weight loss in the SHED-IT program . Although participants in the intervention group reduced their fat intake over the study period , the changes did not satisfy the criteria for mediation . Conclusion Few studies have examined the mediators of weight loss in obesity treatment interventions . While none of the hypothesized mediators satisfied the criteria for mediation in the current study , there was some evidence to suggest that overweight men in the SHED-IT intervention reduced their fat intake over the study period . Future obesity treatment and prevention programs should explore behavioral mediators of weight loss using appropriate statistical methods .Trial Registration Australian New Zeal and Clinical Trials Registry No : ANZCTRN12607000481471 We examined the effects of two physical activity modes on depressive symptoms over a 5-year period among older adults and change in physical self-esteem as a mediator of changes in depressive symptoms . Formerly sedentary , older adults ( N = 174 ) were r and omly assigned into 6-month conditions of either walking or low-intensity resistance/flexibility training .  Depressive symptoms and physical self-esteem were measured before and after the 6-month intervention , and 12 and 60 months after intervention initiation . Depressive symptoms scores were decreased immediately after the intervention , followed by a sustained reduction for 12 and 60 months after intervention initiation ; there was no differential pattern of change between the physical activity modes . Change in physical self-esteem predicted change in depressive symptoms . This study supports the effectiveness of an exercise intervention for the sustained reduction of depressive symptoms among sedentary older adults and physical self-esteem as a potential mediator of this effect Background . Worksite wellness programs vary considerably in their design . This study tested four models to compare effectiveness at controlling  high blood pressure , obesity , and cigarette smoking .  Methods . Baseline screening was conducted in four manufacturing plants . Site 1 offered screening only , with referral recommendations for those found to have CVD risks . Site 2 also provided health education information and classes . Site 3 added routine follow-up counseling and a menu of intervention types , and Site 4 added social organization within the plant . R and om sample s of 400 to 500 employees were rescreened at the end of three years . Results . Major improvements in risk levels were found with the addition of routine follow-up counseling and a menu of interventions ( Sites 3 and 4 , compared with Sites 1 and 2 ) . More hypertensives entered treatment and showed greater reductions in blood pressure . Participation in worksite weight loss and smoking cessation programs was significantly increased , and those who participated showed significantly better maintenance of improvements where follow-up was provided . Discussion . The program models that offered short-term interventions promoted through local media suffered in comparison with models that included personal outreach to people at risk , a variety of health improvement intervention modalities , and ongoing follow-up counseling to help people make decisions and sustain health improvements Study objective : To determine if a self help intervention , delivered via written interactive material s ( the “ Walk in to Work Out ” pack ) , could increase  active commuting behaviour ( walking and cycling ) . Design : R and omised controlled trial . The intervention group received the “ Walk in to Work Out ” pack , which contained written interactive material s based on the transtheoret 
    Output:
    
There were no differences between the pedometer programme and the control group for blood pressure , a number of biochemical outcomes and the quality of life physical component .
There was limited and low quality data providing insufficient evidence to assess the effectiveness of pedometer interventions in the workplace for increasing physical activity and improving subsequent health outcomes