***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: OBJECTIVE To pilot , among women with gestational diabetes mellitus ( GDM ) , the feasibility of a prenatal/postpartum intervention to modify diet and physical activity similar to the Diabetes Prevention Program . The intervention was delivered by telephone , and support for breastfeeding was addressed . RESEARCH DESIGN AND METHODS The goal was to help women return to their prepregnancy weight , if it was normal , or achieve a 5 % reduction from prepregnancy weight if overweight . Eligible participants were identified shortly after a GDM diagnosis ; 83.8 % consented to be r and omly assigned to intervention or usual medical care ( 96 and 101 women , respectively ) . The retention was 85.2 % at 12 months postpartum . RESULTS The proportion of women who reached the postpartum weight goal was higher , although not statistically significant , in the intervention condition than among usual care ( 37.5 vs. 21.4 % , absolute difference 16.1 % , P = 0.07 ) . The intervention was more effective among women who did not exceed the recommended gestational weight gain ( difference in the proportion of women meeting the weight goals : 22.5 % , P = 0.04 ) . The intervention condition decreased dietary fat intake more than the usual care ( condition difference in the mean change in percent of calories from fat : −3.6 % , P = 0.002 ) and increased breastfeeding , although not significantly ( condition difference in proportion : 15.0 % , P = 0.09 ) . No differences in postpartum physical activity were observed between conditions . CONCLUSIONS This study suggests that a lifestyle intervention that starts during pregnancy and continues postpartum is feasible and may prevent pregnancy weight retention and help overweight women lose weight . Strategies to help postpartum women overcome barriers to increasing physical activity are needed Background Colorectal cancer ( CRC ) is the third most commonly diagnosed cancer and the second highest cause of cancer death in the UK . Most cases occur in people over 50 years and CRC often co-exists with other lifestyle related disorders including obesity , type 2 diabetes mellitus ( T2DM ) and cardiovascular disease ( CVD ) . These diseases share risk factors related to the metabolic syndrome including large body size , abnormal lipids and markers of insulin resistance indicating common aetiological pathways . Methods / Design This 3 year study will be a two-arm , multicentre , r and omised controlled trial comparing the BeWEL lifestyle ( diet , physical activity and behaviour change ) programme against usual care . The pre-trial development will take 6 months and participants will be recruited over a 12 month period and undertake the intervention and follow up for 12 months ( total 24 months recruitment and intervention implementation ) with a further 6 months for data collection , analysis and interpretation . Four hundred and fifty two participants who have had a colorectal adenoma detected and removed ( through the national colorectal screening programme ) will provide 80 % power to detect a weight loss of 7 % over 12 months . Primary outcomes are changes in body weight and waist circumference . Secondary outcomes will include cardiovascular risk factors , psycho-social measures and intervention costs . Discussion The results from this study will enhance the evidence base for lifestyle change in patients at higher risk of chronic disease including obesity related cancers . International St and ard R and omised Controlled Trials No : IS RCT Background : Obesity and a sedentary lifestyle are associated with physical impairments and biologic changes in older adults . Weight loss combined with exercise may reduce inflammation and improve physical functioning in overweight , sedentary , older adults . This study tested whether a weight loss program combined with moderate exercise could improve physical function in obese , older adult women . Methods : Participants ( N = 34 ) were generally healthy , obese , older adult women ( age range 55–79 years ) with mild to moderate physical impairments ( ie , functional limitations ) . Participants were r and omly assigned to one of two groups for 24 weeks : ( i ) weight loss plus exercise ( WL+E ; n = 17 ; mean age = 63.7 years [ 4.5 ] ) or ( ii ) educational control ( n = 17 ; mean age = 63.7 [ 6.7 ] ) . In the WL+E group , participants attended a group-based weight management session plus three supervised exercise sessions within their community each week . During exercise sessions , participants engaged in brisk walking and lower-body resistance training of moderate intensity . Participants in the educational control group attended monthly health education lectures on topics relevant to older adults . Outcomes were : ( i ) body weight , ( ii ) walking speed ( assessed by 400-meter walk test ) , ( iii ) the Short Physical Performance Battery ( SPPB ) , and ( iv ) knee extension isokinetic strength . Results : Participants r and omized to the WL+E group lost significantly more weight than participants in the educational control group ( 5.95 [ 0.992 ] vs 0.23 [ 0.99 ] kg ; P < 0.01 ) . Additionally , the walking speed of participants in the WL+E group significantly increased compared with that of the control group ( reduction in time on the 400-meter walk test = 44 seconds ; P < 0.05 ) . Scores on the SPPB improved in both the intervention and educational control groups from pre- to post-test ( P < 0.05 ) , with significant differences between groups ( P = 0.02 ) . Knee extension strength was maintained in both groups . Conclusion : Our findings suggest that a lifestyle-based weight loss program consisting of moderate caloric restriction plus moderate exercise can produce significant weight loss and improve physical function while maintaining muscle strength in obese , older adult women with mild to moderate physical impairments OBJECTIVE To assess the process variables involved in a weight loss program for African-American adolescent girls . Several process variables have been identified as affecting success in in vivo weight loss programs for adults and children , including program adherence , self-efficacy , and social support . The current study sought to broaden the underst and ing of these process variables as they pertain to an intervention program that is presented using the Internet . It was hypothesized that variables such as program adherence , dietary self-efficacy , psychological factors , and family environment factors would mediate the effect of the experimental condition on weight loss . RESEARCH METHODS AND PROCEDURES Participants were 57 adolescent African-American girls who joined the program with one obese parent ; family pairs were r and omized to either a behavioral or control condition in an Internet-based weight loss program .  Outcome data ( weight loss ) are reported for the first 6 months of the intervention . RESULTS Results partially supported the hypotheses . For weight loss among adolescents , parent variables pertaining to life and family satisfaction were the strongest mediating variables . For parental weight loss , changes in dietary practice s over the course of 6 months were the strongest mediators . DISCUSSION The identification of factors that enhance or impede weight loss for adolescents is an important step in improving weight loss programs for this group . The current findings suggest that family/parental variables exert a strong influence on weight loss efforts for adolescents and should be considered in developing future programs Background Tailored nutrition interventions have been shown to be more effective than non-tailored material s in changing dietary behaviours , particularly fat intake and fruit and vegetable intake . But further research examining efficacy of tailored nutrition education in comparison to other nutrition education methods and across a wider range of dietary behaviours is needed . The Stages to Healthy Eating Patterns Study ( STEPs ) was an intervention study , in middle-aged adults with cardiovascular risk factors , to examine the effectiveness of printed , tailored , iterative dietary feedback delivered by mail in improving short-term dietary behaviour in the areas of saturated fat , fruit , vegetable and grain and cereal intake . Methods STEPs was a 3-month r and omised controlled trial with a pre and post-test design . There were three experimental conditions : 1 ) tailored , iterative , printed dietary feedback ( TF ) with three instalments mail-delivered over a 3-month period that were re-tailored to most recent assessment of dietary intake , intention to change and assessment of self-adequacy of dietary intake . Tailoring for dietary intake was performed on data from a vali date d 63-item combination FFQ design ed for the purpose 2 ) small group nutrition education sessions ( GE ) : consisting of two 90-minute dietitian-led small group nutrition education sessions and 3 ) and a wait-listed control ( C ) group who completed the dietary measures and socio-demographic question naires at baseline and 3-months later . Dietary outcome measures in the areas of saturated fat intake ( g ) , and the intake of fruit ( serves ) , vegetables ( serves ) , grain and cereals as total and wholegrain ( serves ) were collected using 7-day estimated dietary records . Descriptive statistics , paired t-tests and general linear models adjusted for baseline dietary intake , age and gender were used to examine the effectiveness of different nutrition interventions . Results The TF group reported a significantly greater increase in fruit intake ( 0.3 serves/d P = 0.031 ) in comparison to GE and the C group . All three intervention groups showed a reduction in total saturated fat intake . GE also had a within-group increase in mean vegetable intake after 3 months , but this increase was not different from changes in the other groups . Conclusions In this study , printed , tailored , iterative dietary feedback was more effective than small group nutrition education in improving the short-term fruit intake behaviour , and as effective in improving saturated fat intake of middle-aged adults with cardiovascular risk factors . This showed that a low-level dietary intervention could achieve modest dietary behaviour changes that are of public health significance Introduction Latinas are more likely to be inactive than non-Hispanic white women . Although 74 % of Latinas report no leisure-time activity , few interventions have been design ed to promote physical activity among these women . The objective of this study was to assess the effect of the California WISEWOMAN program on low-income Latinas 's readiness to change physical activity and on self-reported physical activity behaviors . Methods We screened 1,332 women for cardiovascular disease risk factors and r and omly assigned 1,093 women to 2 groups : an enhanced intervention ( n = 552 ) or usual care ( n = 541 ) . The enhanced intervention was delivered by community health workers in one-on-one counseling sessions . We examined self-reported readiness to change and physical activity at baseline and 12-month follow-up among participants who completed both assessment s ( n = 868 ) . Results Mean age of participants was 52 years ( st and ard deviation , 6 y ) ; most ( 65 % ) were Mexican or Mexican American , and most ( 81 % ) were not high school graduates . A higher percentage ( 67 % ) of the enhanced intervention group was in the action/maintenance stage for vigorous physical activity at follow-up compared with baseline ( 47 % ) . We found no such change among women in usual care ( 52 % , baseline ; 58 % , follow-up ) . A higher percentage of the enhanced intervention group also reported significant increases in moderate ( 71 % , baseline ; 84 % , follow-up ) and vigorous ( 13 % to 33 % ) physical activity at follow-up than at baseline . Women in usual care reported no changes . Conclusion A culturally tailored adaptation of the WISEWOMAN program that used community health workers significantly improved both self-reported readiness to engage in physical activity and vigorous physical activity among low-income Latinas OBJECTIVE To study the overall effect of the Active Prevention in High-Risk Individuals of Diabetes Type 2 in and Around Eindhoven ( APHRODITE ) lifestyle intervention on type 2 diabetes risk reduction in Dutch primary care after 0.5 and 1.5 years and to evaluate the variability between general practice s. RESEARCH DESIGN AND METHODS Individuals at high risk for type 2 diabetes ( Finnish Diabetes Risk Score ≥13 ) were r and omly assigned into an intervention group ( n = 479 ) or a usual-care group ( n = 446 ) . Comparisons were made between study groups and between general practice s regarding changes in clinical and lifestyle measures over 1.5 years . Participant , general practitioner , and nurse practitioner characteristics were compared between individuals who lost weight or maintained a stable weight and individuals who gained weight . RESULTS Both groups showed modest changes in glucose values , weight measures , physical activity , energy intake , and fiber intake . Differences between groups were significant only for total physical activity , saturated fat intake , and fiber intake . Differences between general practice s were significant for BMI and 2-h glucose but not for energy intake and physical activity . In the intervention group , the nurse practitioners ’ mean years of work experience was significantly longer in individuals who were successful at losing weight or maintaining a stable weight compared with unsuccessful individuals . Furthermore , successful individuals more often had a partner . CONCLUSIONS Risk factors for type 2 diabetes could be significantly reduced by lifestyle counseling in Dutch primary care . The small differences in changes over time between the two study groups suggest that additional intervention effects are modest . In particular , the level of experience of the nurse practitioner and the availability of partner support seem to facilitate intervention success Background Although lifestyle interventions targeting multiple lifestyle behaviors are more effective in preventing unhealthy weight gain and chronic diseases than intervening on a single behavior , few studies have compared individual and combined effects of diet and /or exercise interventions on health-related quality of life ( HRQOL ) . In addition , the mechanisms of how these lifestyle interventions affect HRQOL are unknown . The primary aim of this study was to examine the individual and combined effects of dietary weight loss and /or 
    Output:
    
The main limitations include inadequate reporting of outcomes and the methods for allocation , r and omisation and blinding ; extensive use of self-reported measures to estimate the effects of interventions on a number of outcomes , including weight loss , dietary consumption and physical activity levels ; and insufficient assessment of sustainability due to lack of post-intervention assessment s. AUTHORS ' CONCLUSIONS The evidence to support the use of TTM SOC in weight loss interventions is limited by risk of bias and imprecision , not allowing firm conclusions to be drawn .
When combined with diet or physical activity , or both , and other interventions we found very low quality evidence that it might lead to better dietary and physical activity habits .
This systematic review highlights the need for well- design ed RCTs that apply the principles of the TTM SOC appropriately to produce conclusive evidence about the effect of TTM SOC lifestyle interventions on weight loss and other health outcomes