***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: OBJECTIVES We sought to determine whether structured exercise training ( ET ) improves maximal exercise capacity , left ventricular diastolic function , and quality of life ( QoL ) in patients with heart failure with preserved ejection fraction ( HFpEF ) . BACKGROUND Nearly one-half of patients with heart failure experience HFpEF , but effective therapeutic strategies are sparse . METHODS A total of 64 patients ( age 65 ± 7 years , 56 % female ) with HFpEF were prospect ively r and omized ( 2:1 ) to supervised endurance/resistance training in addition to usual care ( ET , n = 44 ) or to usual care alone ( UC ) ( n = 20 ) . The primary endpoint was the change in peak Vo(2 ) after 3 months . Secondary endpoints included effects on cardiac structure , diastolic function , and QoL. RESULTS Peak Vo(2 ) increased ( 16.1 ± 4.9 ml/min/kg to 18.7 ± 5.4 ml/min/kg ; p < 0.001 ) with ET and remained unchanged ( 16.7 ± 4.7 ml/min/kg to 16.0 ± 6.0 ml/min/kg ; p = NS ) with UC . The mean benefit of ET was 3.3 ml/min/kg ( 95 % confidence interval [ CI ] : 1.8 to 4.8 , p < 0.001 ) . E/e ' ( mean difference of changes : -3.2 , 95 % CI : -4.3 to -2.1 , p < 0.001 ) and left atrial volume index ( milliliters per square meter ) decreased with ET and remained unchanged with UC ( -4.0 , 95 % CI : -5.9 to -2.2 , p < 0.001 ) . The physical functioning score ( 36-Item Short-Form Health Survey ) improved with ET and remained unchanged with UC ( 15 , 95 % CI : 7 to 24 , p < 0.001 ) . The ET-induced decrease of E/e ' was associated with 38 % gain in peak Vo(2 ) and 50 % of the improvement in physical functioning score . CONCLUSIONS Exercise training improves exercise capacity and physical dimensions of QoL in HFpEF . This benefit is associated with atrial reverse remodeling and improved left ventricular diastolic function . ( Exercise Training in Diastolic Heart Failure-Pilot Study : A Prospect i ve , R and omised , Controlled Study to Determine the Effects of Physical Training on Exercise Capacity and Quality of Life [ Ex-DHF-P ] ; IS RCT N42524037 ) Background —Heart failure ( HF ) with preserved left ventricular ejection fraction ( HFPEF ) is the most common form of HF in the older population . Exercise intolerance is the primary chronic symptom in patients with HFPEF and is a strong determinant of their reduced quality of life ( QOL )  . Exercise training ( ET ) improves exercise intolerance and QOL in patients with HF with reduced ejection fraction ( EF ) . However , the effect of ET in HFPEF has not been examined in a r and omized controlled trial . Methods and Results —This 16-week investigation was a r and omized , attention-controlled , single-blind study of medically supervised ET ( 3 days per week ) on exercise intolerance and QOL in 53 elderly patients ( mean age , 70±6 years ; range , 60 to 82 years ; women , 46 ) with isolated HFPEF ( EF ≥50 % and no significant coronary , valvular , or pulmonary disease ) . Attention controls received biweekly follow-up telephone calls . Forty-six patients completed the study ( 24 ET , 22 controls )  . Attendance at exercise sessions in the ET group was excellent ( 88 % ; range , 64 % to 100 % ) . There were no trial-related adverse events . The primary outcome of peak exercise oxygen uptake increased significantly in the ET group compared to the control group ( 13.8±2.5 to 16.1±2.6 mL/kg per minute [ change , 2.3±2.2 mL/kg per minute ] versus 12.8±2.6 to 12.5±3.4 mL/kg per minute [ change , −0.3±2.1 mL/kg per minute ] ; P=0.0002 ) . There were significant improvements in peak power output , exercise time , 6-minute walk distance , and ventilatory anaerobic threshold ( all P<0.002 ) . There was improvement in the physical QOL score ( P=0.03 ) but not in the total score ( P=0.11 ) . Conclusions —ET improves peak and submaximal exercise capacity in older patients with HFPEF . Clinical Trial Registration —URL : http://www . clinical trials.gov . Unique identifier : NCT01113840 BACKGROUND The health benefits of leisure-time physical activity are well known , but whether less exercise than the recommended 150 min a week can have life expectancy benefits is unclear . We assessed the health benefits of a range of volumes of physical activity in a Taiwanese population . METHODS In this prospect i ve cohort study , 416,175 individuals ( 199,265 men and 216,910 women ) participated in a st and ard medical screening programme in Taiwan between 1996 and 2008 , with an average follow-up of 8·05 years ( SD 4·21 ) . On the basis of the amount of weekly exercise indicated in a self-administered question naire , participants were placed into one of five categories of exercise volumes : inactive , or low , medium , high , or very high activity . We calculated hazard ratios ( HR ) for mortality risks for every group compared with the inactive group , and calculated life expectancy for every group . FINDINGS Compared with individuals in the inactive group , those in the low-volume activity group , who exercised for an average of 92 min per week ( 95 % CI 71 - 112 ) or 15 min a day ( SD 1·8 ) , had a 14 % reduced risk of all-cause mortality ( 0·86 , 0·81 - 0·91 ) , and had a 3 year longer life expectancy . Every additional 15 min of daily exercise beyond the minimum amount of 15 min a day further reduced all-cause mortality by 4 % ( 95 % CI 2·5 - 7·0 ) and all-cancer mortality by 1 % ( 0·3 - 4·5 ) . These benefits were applicable to all age groups and both sexes , and to those with cardiovascular disease risks . Individuals who were inactive had a 17 % ( HR 1·17 , 95 % CI 1·10 - 1·24 ) increased risk of mortality compared with individuals in the low-volume group . INTERPRETATION 15 min a day or 90 min a week of moderate-intensity exercise might be of benefit , even for individuals at risk of cardiovascular disease . FUNDING Taiwan Department of Health Clinical Trial and Research Center of Excellence and National Health Research Institutes Exercise training improves functional capacity in patients with exercise limitation attributed to systolic dysfunction ( SD ) , but exercise training effects in patients with diastolic dysfunction is unclear . The authors determined the functional capacity , quality of life , and echocardiography responses of heart failure with preserved ejection fraction ( HFpEF ) patients to 16 weeks exercise training .  Thirty patients with HFpEF were r and omized to an  exercise training or non-exercising control group . The patients had a baseline mean age of 64 ± 8 years , left ventricular ejection fraction 57 % ± 10 % , and peak oxygen consumption ( peak VO(2 ) ) of 13.3 ± 3.8 mL O(2 ) /kg/min . Minnesota Living With Heart Failure and Hare-Davis scores and echocardiographic measures ( ejection fraction , systolic and diastolic tissue velocity and filling pressure [ E/E ' ] ) were performed at baseline and after 16 weeks of exercise training . The exercise training and non-exercising control groups showed similar baseline VO(2 ) ( 12.2 ± 3.6 mL/kg/min vs 14.1 ± 4.1 mL/kg/min ) , ejection fraction ( 58 % ± 13 % vs 57 % ± 8 % ) , and systolic and diastolic function . After exercise training the increment in peak VO(2 ) in the exercise training group was ( 24.6 % , P=.02 ) , and the non-exercising control group ( 5.1 % , P=.19 ) . V(E ) /VCO(2 ) slope was reduced by 12.7 % in the exercise training group ( P=.02 ) but was unchanged in the non-exercising control group ( P=.03 ) . No significant changes in diastolic or systolic function were noted in either group . Quality -of-life and depression scores were unchanged with exercise training . Changes in peak VO(2 ) and V(E ) /VCO(2 ) slope were unrelated to measures of diastolic and systolic function . In patients with exercise limitation attributed to HFpEF , the improvement in peak VO(2 ) with exercise training was not clearly related to changes in cardiac function OBJECTIVE : To test the feasibility of creating a valid and reliable checklist with the following features : appropriate for assessing both r and omised and non-r and omised studies ; provision of both an overall score for study quality and a profile of scores not only for the quality of reporting , internal validity ( bias and confounding ) and power , but also for external validity . DESIGN : A pilot version was first developed , based on epidemiological principles , review s , and existing checklists for r and omised studies . Face and content validity were assessed by three experienced review ers and reliability was determined using two raters assessing 10 r and omised and 10 non-r and omised studies . Using different raters , the checklist was revised and tested for internal consistency ( Kuder-Richardson 20 ) , test-retest and inter-rater reliability ( Spearman correlation coefficient and sign rank test ; kappa statistics ) , criterion validity , and respondent burden . MAIN RESULTS : The performance of the checklist improved considerably after revision of a pilot version . The Quality Index had high internal consistency ( KR-20 : 0.89 ) as did the subscales apart from external validity ( KR-20 : 0.54 ) . Test-retest ( r 0.88 ) and inter-rater ( r 0.75 ) reliability of the Quality Index were good . Reliability of the subscales varied from good ( bias ) to poor ( external validity ) . The Quality Index correlated highly with an existing , established instrument for assessing r and omised studies ( r 0.90 ) . There was little difference between its performance with non-r and omised and with r and omised studies . Raters took about 20 minutes to assess each paper ( range 10 to 45 minutes ) . CONCLUSIONS : This study has shown that it is feasible to develop a checklist that can be used to assess the method ological quality not only of r and omised controlled trials but also non-r and omised studies . It has also shown that it is possible to produce a checklist that provides a profile of the paper , alerting review ers to its particular method ological strengths and weaknesses . Further work is required to improve the checklist and the training of raters in the assessment of external validity Heart failure with preserved ejection fraction ( HFpEF ) is a major cause of morbidity and mortality . Exercise training is an established adjuvant therapy in heart failure ; however , the effects of high-intensity interval training ( HIIT ) in HFpEF are unknown . We compared the effects of HIIT vs. moderate-intensity aerobic continuous training ( MI-ACT ) on peak oxygen uptake ( V̇o₂peak ) , left ventricular diastolic dysfunction , and endothelial function in patients with HFpEF . Nineteen patients with HFpEF ( age 70 ± 8.3 yr ) were r and omized to either HIIT ( 4 × 4 min at 85 - 90 % peak heart rate , with 3 min active recovery ) or MI-ACT ( 30 min at 70 % peak heart rate ) . Fifteen patients completed exercise training ( HIIT : n = 9 ; MI-ACT : n = 6 ) . Patients trained 3 days/wk for 4 wk . Before and after training patients underwent a treadmill test for V̇o₂peak determination , 2D-echocardiography for assessment of left ventricular diastolic dysfunction , and brachial artery flow-mediated dilation ( FMD ) for assessment of endothelial function . HIIT improved V̇o₂peak ( pre = 19.2 ± 5.2 ml·kg(-1)·min(-1 ) ; post = 21.0 ± 5.2 ml·kg(-1)·min(-1 ) ; P = 0.04 ) and left ventricular diastolic dysfunction grade ( pre = 2.1 ± 0.3 ; post = 1.3 ± 0.7 ; P = 0.02 ) , but FMD was unchanged ( pre = 6.9 ± 3.7 % ; post = 7.0 ± 4.2 % ) . No changes were observed following MI-ACT . A trend for reduced left atrial volume index was observed following HIIT compared with MI-ACT ( -3.3 ± 6.6 vs. + 5.8 ± 10.7 ml/m(2 
    Output:
    
There were significant improvements in peak oxygen uptake , 6-min walking test distance , and ventilatory threshold , whereas quality of life and echocardiographic parameters improved only in some studies .
Endothelial function/arterial stiffness remained unchanged .
No adverse events were reported .
Appropriate exercise programs are able to get a favorable cardiovascular outcome in patients with HFpEF .
This could also benefit in terms of quality of life , even if more controversial .