***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 frail older people have a high risk of  falling . OBJECTIVE assess the effect of a frailty intervention on risk factors for falls and fall rates  in frail older people . DESIGN r and omised controlled trial . PARTICIPANTS 241 community-dwelling people aged 70 + without severe cognitive impairment who met the Cardiovascular Health Study frailty definition . INTERVENTION multifactorial , interdisciplinary intervention targeting frailty characteristics with an individualised home exercise programme prescribed in 10 home visits from a physiotherapist and interdisciplinary management of medical , psychological and social problems . MEASUREMENTS risk factors for falls were measured using the Physiological Profile Assessment ( PPA ) and mobility measures at 12 months by a blinded assessor . Falls were monitored with calendars . RESULTS participants had a mean ( SD ) age of 83.3 ( 5.9 ) years , 68 % were women and 216 ( 90 % ) completed the study . After 12 months the intervention group had significantly better performance than the control group , after controlling for baseline values , in the PPA components of quadriceps strength ( between-group difference 1.84 kg , 95 % CI 0.17 - 3.51 , P = 0.03 ) and body sway ( -90.63 mm , 95 % CI -168.6 to -12.6 , P = 0.02 ) , short physical performance battery ( 1.58 , 95 % CI 1.02 - 2.14 , P ≤ 0.001 ) and 4 m walk ( 0.06 m/s 95 % CI 0.01 - 0.10 , P = 0.02 ) with a trend toward a better total PPA score ( -0.40 , 95 % CI -0.83 - 0.04 , P = 0.07 ) but no difference in fall rates ( incidence rate ratio 1.12 , 95 % CI 0.78 - 1.63 , P = 0.53 ) . CONCLUSION the intervention improved performance on risk factors for falls but did not reduce the rate of falls . TRIAL REGISTRATION ACTRN12608000250336 Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more OBJECTIVES To estimate the magnitude of small meaningful and substantial individual change in physical performance measures and evaluate their responsiveness . DESIGN Secondary data analyses using distribution- and anchor-based methods to determine meaningful change . SETTING Secondary analysis of data from an observational study and clinical trials of community-dwelling older people and subacute stroke survivors . PARTICIPANTS Older adults with mobility disabilities in a strength training trial ( n=100 ) , subacute stroke survivors in an intervention trial ( n=100 ) , and a prospect i ve cohort of community-dwelling older people ( n=492 ) . MEASUREMENTS  Gait speed , Short Physical Performance Battery ( SPPB ) , 6-minute-walk distance ( 6MWD ) , and self-reported mobility . RESULTS Most small meaningful change estimates ranged from 0.04 to 0.06 m/s for gait speed , 0.27 to 0.55 points for SPPB , and 19 to 22 m for 6MWD . Most substantial change estimates ranged from 0.08 to 0.14 m/s for gait speed , 0.99 to 1.34 points for SPPB , and 47 to 49 m for 6MWD . Based on responsiveness indices , per-group sample sizes for clinical trials ranged from 13 to 42 for substantial change and 71 to 161 for small meaningful change . CONCLUSION Best initial estimates of small meaningful change are near 0.05 m/s for gait speed , 0.5 points for SPPB , and 20 m for 6MWD and of substantial change are near 0.10 m/s for gait speed , 1.0 point for SPPB , and 50 m for 6MWD . For clinical use , substantial change in these measures and small change in gait speed and 6MWD , but not SPPB , are detectable . For research use , these measures yield feasible sample sizes for detecting meaningful change OBJECTIVES Protein supplementation has been proposed as an effective dietary strategy to increase skeletal muscle mass and improve physical performance in frail elderly people . Our objective was to assess the impact of 24 weeks of dietary protein supplementation on muscle mass , strength , and physical performance in frail elderly people . DESIGN / SETTING / PARTICIPANTS A total of 65 frail elderly subjects were included and r and omly allocated to either daily protein or placebo supplementation ( 15 g protein at breakfast and lunch ) . MEASUREMENTS Skeletal muscle mass ( DXA ) , muscle fiber size ( muscle biopsy ) , strength ( 1-RM ) , and physical performance ( SPPB ) were assessed at baseline , and after 12 and 24 weeks of dietary intervention . RESULTS Skeletal muscle mass did not change in the protein- ( from 45.8 ± 1.7 to 45.8 ± 1.7 kg ) or placebo-supplemented group ( from 46.7 ± 1.7 to 46.6 ± 1.7 kg ) following 24 weeks of intervention ( P > .05 ) . In accordance , type I and II muscle fiber size did not change over time ( P > .05 ) . Muscle strength increased significantly in both groups ( P < .01 ) , with leg extension strength tending to increase to a greater extent in the protein ( 57 ± 5 to 68 ± 5 kg ) compared with the placebo group ( 57 ± 5 to 63 ± 5 kg ) ( treatment × time interaction effect : P = .059 ) . Physical performance improved significantly from 8.9 ± 0.6 to 10.0 ± 0.6 points in the protein group and did not change in the placebo group ( from 7.8 ± 0.6 to 7.9 ± 0.6 points ) ( treatment × time interaction effect : P = .02 ) . CONCLUSION Dietary protein supplementation improves physical performance , but does not increase skeletal muscle mass in frail elderly people Background Frailty is a well known and accepted term to clinicians working with older people . The study aim was to determine whether an intervention could reduce frailty and improve mobility . Methods We conducted a single center , r and omized , controlled trial among older people who were frail in Sydney , Australia . One group received an intervention targeting the identified characteristics of frailty , whereas the comparison group received the usual health care and support services . Outcomes were assessed by raters masked to treatment allocation at 3 and 12 months after study entry . The primary outcomes were frailty as assessed by the Cardiovascular Health Study criteria , and mobility as assessed by the Short Physical Performance Battery . Secondary outcome measures included disability , depressive symptoms and health-related quality of life . Results A total of 216 participants ( 90 % ) completed the study . Overall , 68 % of participants were women and the mean age was 83.3 years ( st and ard deviation , 5.9 ) . In the intention-to-treat analysis , the between-group difference in frailty was 14.7 % at 12 months ( 95 % confidence interval : 2.4 % , 27.0 % ; P = 0.02 ) . The score on the Short Physical Performance Battery , in which higher scores indicate better physical status , was stable in the intervention group and had declined in the control group ; with the mean difference between groups being 1.44 ( 95 % confidence interval , 0.80 , 2.07 ; P < 0.001 ) at 12 months . There were no major differences between the groups with respect to secondary outcomes . The few adverse events that occurred were exercise-associated musculoskeletal symptoms . Conclusions Frailty and mobility disability can be successfully treated using an interdisciplinary multifaceted treatment program . Trial registration Australia and New Zeal and Clinical Trials Register ( ANZCTR ) : OBJECTIVE The aim of the Intervention by Nutrition and Exercise ( INE ) study was to investigate the effects of a mail-based intervention for sarcopenia prevention on muscle mass and anabolic hormones in community-dwelling older adults . DESIGN A cluster-r and omized controlled trial . SETTING AND PARTICIPANTS This trial recruited community-dwelling adults aged 65 years and older in Japan . The 227 participants were cluster r and omized into a  walking and nutrition ( W/N ) group ( n = 79 ) , a  walking ( W ) group ( n = 71 ) , and a  control ( C ) group ( n = 77 ) . We analyzed the physical and biochemical measurements in this sub study . INTERVENTION Six months of mail-based intervention ( a pedometer-based walking program and nutritional supplementation ) . MEASUREMENTS The skeletal muscle mass index ( SMI ) using the bioelectrical impedance data acquisition system , biochemical measurements , such as those of insulinlike growth factor ( IGF-1 ) , dehydroepi and rosterone sulfate ( DHEA-S ) , and 25-hydroxy vitamin D ( 25[OH]D ) , as well as frailty , were assessed by the Cardiovascular Health Study criteria . RESULTS Participants in the W/N and W groups had significantly greater improvements in SMI , IGF-1 , and 25(OH)D ( P < .05 ) than those in the C group . Participants in the W/N group had significantly greater improvements in DHEA-S ( P < .05 ) than in the other groups . These effects were more pronounced in frail , older adults . CONCLUSION These results suggest that the mail-based walking intervention of the remote monitoring type for sarcopenia prevention can increase anabolic hormone levels and SMI in community-dwelling older adults , particularly in those who are frail BACKGROUND This study is a part of the r and omized controlled trial , the Trondheim Hip Fracture Trial , and it compared physical behavior and function during the first postoperative days for hip fracture patients managed with comprehensive geriatric care ( CGC ) with those managed with orthopedic care ( OC ) .  METHODS Treatment comprised CGC with particular focus on mobilization , or OC .  A total of 397 hip fracture patients , age 70 years or older , home dwelling , and able to walk 10 m before the fracture , were included . Primary outcome was measurement of upright time ( st and ing and walking ) recorded for 24 hours the fourth day postsurgery by a body-worn accelerometer-based activity monitor . Secondary outcomes were number of upright events on Day 4 , need for assistance in ambulation measured by the Cumulated Ambulation score on Days 1 - 3 , and lower limb function measured by the Short Physical Performance Battery on Day 5 postsurgery . RESULTS A total of 317 ( CGC n = 175 , OC n = 142 ) participants wore the activity monitor for a 24-hour period . CGC participants had significantly more upright time ( mean 57.6 vs 45.1 min , p = .016 ) , higher number of upright events ( p = .005 ) and better Short Physical Performance Battery scores ( p = .002 ) , than the OC participants . Cumulated Ambulation score did not differ between groups ( p = .234 ) . CONCLUSIONS When treated with CGC , compared with OC , older persons suffering a hip fracture spent more time in upright , had more upright events , and had better lower limb function early after surgery despite no difference in their need for assistance during ambulation Purpose : To assess some fall-related clinical variables ( balance , gait , fear of falling , functional autonomy , self-actualization and self-efficacy ) that might explain the fact that supervised Tai Chi has a better impact on preventing falls compared to a conventional physiotherapy program . Methods : The participants ( 152 older adults over 65 who were admitted to a geriatric day hospital program ) were r and omly assigned to either a supervised Tai Chi group or the usual physiotherapy . The presence of the clinical variables related to falls was evaluated before the intervention ( T1 ) , immediately after ( T2 ) , and 12 months after the end of the intervention ( T3 ) . Results : Both exercise programs significantly improved fall-related outcomes but only the Tai Chi intervention group decreased the incidence of falls . For both groups , most variables followed the same pattern , i.e. showed significant improvement with the intervention between T1 and T2 , and followed by a statistically significant decrease at the T3 evaluation . However , self-efficacy was the only variable that improved solely with the Tai Chi intervention ( p = 0.001 ) . Conclusions : The impact of supervised Tai Chi on fall prevention can not be explained by a differential effect on balance , gait and fear of falling . It appeared to be related to an increase of general self-efficacy , a phenomenon which is not seen in the conventional physiotherapy program . Implication s for Rehabilitation Each participant received a multidisciplinary intervention with either Tai Chi or physical therapy . Both interventions were associated with improved balance , gait , less fear of falling , improved functional autonomy and greater self actualisation . Only Tai Chi decreased the incidence of falls which appeared to be related to self-efficacy .  Tai Chi seems to be a good alternative to physical therapy exercises to prevent falls in frail older people Summary At present , most hip fracture patients are 
    Output:
    
Interventions that incorporated one or more physical activity components significantly improved physical outcomes in pre-frail and /or frail older adults .
Conclusions Physical activity interventions are key to maintaining independence in pre-frail and frail older adults .
This absence may ultimately impact on the ability of older and frail adults to live well and for longer in the community