***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: Loss of function and postural instability occur in Parkinson disease ( PD ) .  Dynamic exercise interventions are successful in improving motor control and physical function . However , most programs are based in a health facility or physical therapy setting and involve travel . With the limitations associated with PD ( e.g. health care and medication cost as well as travel limitations ) these therapies may be inaccessible and exclude some individuals from maintaining or increasing their function . The purpose of this study was to evaluate the effectiveness of a home-based exercise intervention on postural control in individuals with PD . Multivariate analysis of covariance was performed on individuals with PD ( N = 10 ) and healthy aged-matched controls ( N = 10 ) . Participants were assessed utilizing  computerized dynamic posturography ( CDP )  before and after a 10-week exercise intervention . Participants were instructed on proper technique prior to the intervention , were given an illustrated home program , and were monitored weekly concerning their progress . Pre-intervention assessment demonstrated that individuals with PD had statically lower scores on a Sensory Organization Test ( p < .05 ) . Following the intervention , results indicated no statistical difference between individuals with PD and aged match controls ( p > .05 ) . This initial study indicates that a home exercise intervention is an effective method of improving postural control in individuals with PD . Results from this investigation support further study to determine the extent to which both preventative and restorative home-based programs can improve postural control OBJECTIVE During hospitalization older people often experience functional decline which impacts on their future independence . The objective of this study was to evaluate a multifaceted transitional care intervention including home-based exercise strategies for at-risk older people on functional status , independence in activities of daily living ( ADLs ) and walking ability . METHODS A r and omized controlled trial was undertaken in a metropolitan hospital in Australia with 128 patients ( 64 intervention , 64 control ) aged over 65 years with an acute medical admission and at least one risk factor for hospital readmission . The intervention group received an individually tailored programme for exercise and follow-up care which was commenced in hospital and included regular visits in hospital by a physiotherapist and a registered nurse , a home visit following discharge and regular telephone follow-up for 24 weeks following discharge . The programme was design ed to improve health-promoting behaviours , strength , stability , endurance and mobility . Data were collected at baseline , then 4 , 12 and 24 weeks following discharge using the Index of ADL , Instrumental Activities of Daily Living ( IADL ) and the Walking Impairment Question naire ( WIQ ; modified ) . RESULTS Significant improvements were found in the intervention group in IADL scores ( P < 0.001 ) , ADL scores ( P < 0.001 ) and WIQ scale scores ( P < 0.001 ) in comparison to the control group . The greatest improvements were found in the first 4 weeks following discharge . CONCLUSIONS Early introduction of a transitional model of care incorporating a tailored exercise programme and regular telephone follow-up for hospitalized at-risk older adults can improve independence and functional ability & NA ; Physical therapists seeking to use evidence to guide their practice may have limited time to read research reports . One way to reduce the time required to identify and read about the research that is relevant to a particular clinical question is to read a systematic review that summarizes multiple studies . This paper explains the process that is used to conduct systematic review s , which includes the establishment of a protocol , comprehensive search ing , appraisal of the quality of the included studies , data extraction and meta analysis , and consideration of the clinical and research implication s of the findings . We also consider how the reader of a systematic review can determine whether the review is likely to provide an unbiased ( believable ) estimate of the treatment effect . A systematic review of r and omized trials of a  cardiopulmonary physical therapy intervention is used as an example . The issue of appraisal of quality is then discussed further , with a demonstration of how one vali date d tool for quality appraisal ‐‐the PEDro scale‐‐can be used to evaluate a r and omized trial in cardiopulmonary physical therapy Supervised , hospital-based exercise rehabilitation programs are effective for improving functional status for patients with claudication due to peripheral arterial occlusive disease . However , it has been suggested that unsupervised , home-based exercise programs , which have been relatively little evaluated , would be equally efficacious as compared with hospital-based programs . The authors tested the hypothesis that a hospital-based exercise rehabilitation program would improve treadmill exercise perfor mance more than a home-based program . Of 20 consecutively enrolled patients with claudication , 10 were r and omly placed into a supervised , hospital-based program and 10 into an unsupervised , home-based program for a three-month period .  Exercise perfor mance was evaluated by treadmill testing using a grade d protocol . In addition , func tional status was evaluated by the Walking Impairment Question naire ( WIQ ) and the Medical Outcomes Study SF-20 question naire ( MOS ) . Patients in the hospital-based program were treated with treadmill walking three times a week for one hour/visit . Patients in the home-based program were instructed to walk at least three times a week and were contacted weekly to provide encouragement and to record compliance with ( continued on next page ) the program . Patients in the hospital-based group improved peak walking time by 137 % , pain-free walking time by 150 % , and peak oxygen consumption by 19 % ( all P<0.05 ) . Patients reported an improved walking distance and speed according to WIQ data ( both P<0.05 ) . In addition , the MOS physical functioning score in the hospital-based group improved by 20 percentage points ( P<0.05 ) . In contrast , patients in the home-based program did not improve exercise performance measured on the treadmill . Improvement in the ability to walk on the treadmill was greater in the hospital-based than the home- based program ( P<0.05 ) . The ability to walk distances was the only question naire measure that improved in persons who received the home-based program ( P<0.05 ) . Preliminary results suggest that a supervised , hospital-based program is more effective for improving treadmill exercise performance than an unsupervised , home-based program Advice to rest and take things easy if patients become fatigued during radiotherapy may be detrimental . Aerobic walking improves physical functioning and has been an intervention for chemotherapy‐related fatigue . A prospect i ve , r and omized , controlled trial was performed to determine whether aerobic exercise would reduce the incidence of fatigue and prevent deterioration in physical functioning during radiotherapy for localized prostate carcinoma Background : Self-efficacy is a person 's confidence in being able to successfully perform a specific activity or behavior . Self-efficacy has been shown to influence exercise capacity in patients post myocardial infa rct ion , but has not been fully explored in patients with heart failure ( HF ) . This study examined the impact of performance of a single treadmill exercise test and participation in a 3-month program of walking and resistance exercise on self-efficacy in HF patients . Methods : 24 patients were r and omized to either a home-based walking and resistance exercise program or usual care for 3 months . Prior to enrollment into the exercise program all participants performed a single treadmill exercise test with respiratory gas analysis .  Self-efficacy question naires were completed at 3 time points , 1 ) prior to performance of an exercise treadmill test ; 2 ) immediately after completing an exercise test ; and 3 ) at the end of a 3-month exercise program . Results : Self-efficacy for walking ( p = 0.07 ) , climbing ( p = 0.17 ) , lifting ( p = 0.73 ) and general activity ( p = 0.15 ) did not improve after performance of a single treadmill exercise test and usual care . However , self-efficacy for walking increased after 3 months of a walking and resistance exercise program . ( p = 0.04 ) . Conclusions : The findings from this study suggest that in patients with stable mild to moderate heart failure , self-efficacy is improved with participation in a home-based walking and endurance exercise program .  Self-efficacy is not enhanced by performance of a single treadmill exercise test and usual care BACKGROUND AND PURPOSE The effects of a home exercise program for persons with chronic peripheral neuropathies ( CPN ) have not been documented . We compared changes in impairment and health-related quality of life ( HRQL ) between exercise and control groups , investigated the relationship between HRQL and measures of impairment , and contrasted the HRQL of individuals with CPN to that previously described for the general population . SUBJECTS Twenty-eight subjects with CPN , aged 23 to 84 years ( mean = 56.2 , SD = 14.9 ) , completed the study . METHODS Impairment measures included average muscle score ( AMS ) , h and grip force , walking time , and forced vital capacity . The HRQL instrument measured the eight scales of the Medical Outcomes Study 36-Item Short-Form Health Survey ( SF-36 ) and the component scales . The exercise group ( n = 14 ) completed a 6-week home exercise program . The control group ( n = 14 ) did not participate in a home exercise program . RESULTS There was an increase in the AMS in the exercise group compared with the control group . No other between-group differences were found . The exercise group improved in scores on the role limitation scales of the SF-36 . The AMS and walking time were moderately correlated with the physical function scale of the SF-36 ( r = .55 and -.62 , respectively ) . The SF-36 scores of individuals with CPN were lower than scores previously described for the general population . CONCLUSION AND DISCUSSION The home exercise program appears to be an important component of the treatment of persons with CPN . Compared with the general population , patients with CPN appear to have a lower HRQL , but some areas appear to improve following a home exercise program OBJECTIVE to examine the effects of the Informatics for Diabetes Education and Telemedicine ( IDEATel ) telemedicine intervention and pedometer use on physical activity ( PA ) and impairment in older adults with diabetes . DESIGN r and omised clinical trial . Subjects ethnically diverse medically underserved Medicare beneficiaries with diabetes ( n= 1,650 ) . METHODS participants received home videovisits with a diabetes educator every 4 - 6 weeks or usual care . All received a pedometer . Annual measurements included hemoglobin A1c , Comprehensive Assessment and Referral Evaluation Activities of Daily Living , Diabetes Self-Care Activities , Charlson Comorbidity Index , Luben Social Support and pedometer use . Mixed model analyses were performed using r and om effects to adjust for clustering within primary care physicians . RESULTS in the telemedicine group compared with the usual care group , the rate of decline in PA ( P= 0.0128 ) and physical impairment ( PI ) ( P= 0.0370 ) was significantly less over time . Significant mean endpoint differences were observed for PA ( P= 0.003 ) . Pedometer use was significantly associated with PA ( P= 0.0006 ) and PI ( P < 0.0001 ) . Baseline characteristics associated with greater PA included having fewer comorbid conditions ( P= 0.0054 ) , less depression ( P < 0.0001 ) , more social networking ( P < 0.0001 ) , lower BMI ( P < 0.0001 ) , male gender ( P < 0.0001 ) and lower hemoglobin A1c level ( P= 0.0045 ) . Similar predictors were observed for PI , except duration of diabetes also predicted increased impairment ( P < 0.0001 ) . Significant indirect effects were observed through use of the pedometer on reduced decline in PA ( P= 0.0024 , 0.0013 ) and PI ( P= 0.0024 , P < 0.0001 ) . CONCLUSIONS this telemedicine intervention reduced rates of decline in PA and impairment in older adults with diabetes . Pedometers may be a helpful inexpensive adjunct to diabetes initiatives delivered remotely with emerging technologies . Clinical Trials.gov identifier NCT 00271739 OBJECTIVE To compare the adherence to and effectiveness of Tai Chi exercise program through a live , interactive , telecommunication-based exercise ( Tele-ex ) with that of a similar program through a community center-based exercise ( Comm-ex ) and a home video-based exercise ( Home-ex ) among community-dwelling elders who are at risk for falls . DESIGN Three groups r and omized controlled trial with pretests and posttests . SETTING Exercise programs were community-based , and the outcome measures were laboratory-based . PARTICIPANTS Adults ( N=64 ) age 65 + years with positive fall history in the previous year and /or significant fear of falling . INTERVENTION A 24-form , Yang-style Tai Chi for 15 weeks , 3 hours a week . MAIN OUTCOME MEASURES Exercise compliance , number of falls , fear of falling ( Activities-specific Balance Confidence [ ABC ] score ) , self-perceived health ( Medical Outcomes Study 36-Item Short Form Health Survey [ SF-36 ] ) , Timed Up & Go ( TUG ) , single leg stance ( SLS ) , and body sway during quiet stance ( medial-lateral foot center of pressure [ ML-COP ] ) . RESULTS Tele-ex and Comm-ex groups demonstrated significantly higher exercise attendance and in-class practice time than the Home-ex group ( P<.01 ) and significant reductions in the mean number of falls and injurious falls ( P<.01 ) . There were significant improvements posttraining in SLS , ABC , ML-COP , and Physical Health subscore of the SF-36 ( P<.05 ) . Both Tele-ex and Comm-ex groups demonstrated larger improvements than the Home-ex group in TUG , ML-COP , and the Social Function , Mental Health , and Physical Health subsc 
    Output:
    
Results imply with varying strength that interventions using frequent , non-frequent or direct remote feedback seem more effective than treatment as usual and equally effective as supervised exercise interventions .
Direct remote contact seems a particularly good alternative to supervised onsite exercising .