***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 
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    Input: 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 OBJECTIVE To assess whether pedometers and text messaging increase physical activity in adolescents with type 1 diabetes . RESEARCH DESIGN AND METHODS A 12-week r and omized controlled trial was conducted . A total of 78 subjects participated in the trial ( mean ± SD age 14.4 ± 2.37 years , 36 [ 47 % ] male ) . Intervention participants wore an open pedometer and received regular motivational text messages . Control participants received usual care . Primary outcomes were daily step count ( 4-day closed pedometer ) and physical activity question naire . RESULTS Baseline median step count was 11,063 steps/day ( range 1,541–20,158 ) . At 12 weeks , mean daily step count reduced by 840 ( 95 % CI −1,947 to 266 ) in the control group and by 22 ( −1,407 to 1,364 ) in the intervention group ( P = 0.4 ) . Mean self-reported moderate or vigorous physical activity increased by 38.5 min/week in the control group and by 48.4 in the intervention group ( P = 0.9 ) . CONCLUSIONS A 12-week intervention using pedometers and text messaging as motivational tools in adolescents with type 1 diabetes  did not increase physical activity Sixteen postmenarcheal Type 1 diabetic adolescent girls were r and omized into training ( involving aerobic and strength exercises ) and nontraining groups .  Body composition ( skinfold thickness ) , aerobic fitness ( PWC170 ) , plasma lipids , serum apolipoproteins , lipoprotein(a ) , leptin , and adiponectin were assessed before and after the 6-month period . After the 6-month period , fat mass and leptin increased significantly in the nontraining group but not in the training group . Conversely , in the latter group , fat-free mass increased ( P < .01 ) . Moreover , PWC170 improved and apolipoproteinB : apolipoproteinA-1 ratio decreased with physical training ( P < .05 ) . Thus , physical training reduces cardiovascular risks and the increase of insulin resistance risk factors in diabetic adolescent girls AIM To evaluate the effects of the design ed regime encompassing high volume-low intensity physical activity programme on glycemic control in  diabetic children , 20 subjects ( age 12.81 + /- 2.14 ) spent 2 weeks in a controlled environment of a summer camp . METHODS An exercise physiologist and a kinesiology specialist programme and conducted the three exercise sessions a day . Total daily caloric intake was controlled and the blood glucose was monitored four times a day with special concern for hypoglycaemia episodes . Short and long-term effects ( HbA1c ) of the summer camp were evaluated 10 days and 2 months following programme completion . The insulin dosage was not lowered at the beginning of the camp for everyone , but it was individually modified according to the blood glucose monitoring . RESULTS Initial HbA1c was 8.28 + /- 1.3 % and decreased to 7.92 + /- 1.42 % measured 10 days after the camp ( P = 0.023 ) while the number of children with the satisfactory HbA1c level lower than 7.5 % doubled . HbA1c increased again 2 months following the camp . The average blood glucose concentrations decreased in the last days of the camp when compared with the first day in three out of four daily measurements ( P < 0.05 ) . There were only two clinical ly manifested hypoglycaemia episodes recorded . CONCLUSION With a low rate of hypoglycaemia crisis and better glycemic control the proposed programme was found to be satisfactory but the downside was that the duration of the effects was too short . With no participation in organised exercise programmes and with absence of controlled nutrition , the beneficial effects of the camp disappeared within 2 months after the camp OBJECTIVES To test the safety and effects of exercise conditioning on cardiorespiratory fitness , body composition , muscle strength , glucose regulation , and lipid/cholesterol levels . SUBJECTS Ten male adolescents with insulin-dependent diabetes mellitus ( IDDM ) and 10 adolescent nondiabetic ( ND ) subjects . DESIGN Pretest , posttest intervention trial with control group . SETTING University-based human performance laboratory . INTERVENTION Mixed endurance and calisthenic/strength activities performed at a rapid pace three times weekly for 12 weeks . RESULTS Only one subject with IDDM experienced hypoglycemia after a single exercise session . Both subject groups improved their cardiorespiratory endurance ( p < .05 ) . Lean body mass of IDDM subjects increased by 3.5 % ( p < .05 ) . Subjects with and without IDDM lowered their percent body fat ( p < .05 and .001 , respectively ) . Strength improvement of IDDM subjects ranged from 13.7 % ( p < .001 ) to 44.4 % ( p < .01 ) , depending upon the maneuver . Fasting blood plasma glucose for all subjects was unchanged by training , but glycosylated hemoglobin A1c of IDDM subjects was reduced by .96 percentage point ( p < .05 ) . Reductions of HbA1c benefitted subjects exhibiting poor preconditioning glycemic control . Low-density lipoprotein cholesterol was decreased in subjects with IDDM ( p < .05 ) , but not total cholesterol or triglycerides . CONCLUSION Adolescents with IDDM undergoing aerobic circuit training improve their cardiorespiratory endurance , muscle strength , lipid profile , and glucose regulation .  Aerobic circuit training is safe for properly trained and monitored adolescent diabetics INTRODUCTION Osteoporosis is a growing health problem in patients with type 1 diabetes mellitus ( T1DM ) . The aim of this study was to determine the effects of a 9-month weight-bearing physical activity program on bone mineral density ( BMD ) and bone biomarkers in T1DM compared with healthy children . METHODS This was a r and omized controlled trial including 27 diabetic and 32 healthy children ( mean age = 10.5 ± 2.5 yr ) . Both T1DM and healthy participants were r and omized to either an exercise or a control group ( i.e. , four groups ) . At baseline and 9 months , total body ( TB ) , lumbar spine ( LS2-LS4 ) , femoral neck , and greater trochanter areal BMD ( aBMD ) and serum bone biomarkers ( osteocalcin , type 1 collagen cross-linking ) were measured . The intervention consisted of two 90-min sessions per week of weight-bearing physical activity ( ball games , jumping , rope skipping , and gymnastics ) . RESULTS Baseline variables were similar among groups . At 9 months , changes in TB ( T1DM = 0.035 ± 0.022 g·cm(-2 ) , healthy = 0.031 ± 0.017 g·cm(-2 ) ) and LS2-LS4 ( T1DM = 0.046 ± 0.038 g·cm(-2 ) , healthy = 0.063 ± 0.034 g·cm(-2 ) ) aBMD were statistically significant in the intervention groups and of similar magnitude between T1DM and healthy subjects . The level of type 1 collagen cross-linking ( T1DM = -0.12 ± 0.32 ng·mL(-1 ) , healthy = -0.36 ± 0.11 ng·mL(-1 ) ) decreased in the intervention groups but was not associated with TB aBMD changes . CONCLUSIONS Regular weight-bearing physical activity ( 180 min·wk(-1 ) , including ball games , jumping activities , and gymnastics )  improves total and LS2-LS4 bone mineral accretion in children with T1DM , in a similar magnitude to healthy subjects . We conclude that children with T1DM should be encouraged to practice regular physical activity to enhance peak bone mass and prevent osteoporosis later in life PURPOSE This pilot study compares the effectiveness of home- and community-based physical activity interventions that target mothers and daughters to increase physical activity and improve health-related fitness . METHODS Mothers ( 45.18 + /- 7.49 yr ) and daughters ( 15.41 + /- 1.33 yr ) were r and omly assigned to a community-based ( CB ) ( N = 20 participants ) or home-based ( HB ) ( N = 14 participants ) program . CB participants attended three instructor-led sessions per week for 12 wk . HB participants were asked to participate in 3 sessions per week for 12 wk in a program similar to the CB program . The main difference between the programs was that CB activities were completed at a fitness facility within a university and HB activities were completed in or near the home . Before and after the intervention , changes in health-related fitness and physical activity were assessed . A series of 2 ( group assignment ) x 2 ( time ) ANOVAs were conducted to assess changes separately for mothers and daughters . RESULTS CB participants attended 77 % of the sessions , and none of the pairs dropped out . HB participants completed 70 % of the recommended sessions , and three pairs dropped out . Mothers and daughters in both groups significantly increased their participation in aerobic , muscular strength , and flexibility activities ( P = 0.02 to 0.000 ) . Daughters in both groups significantly improved their muscular endurance ( sit-ups , P = 0.000 ) . Mothers in both groups improved their muscular strength ( push-ups , P = 0.003 ) , muscular endurance ( sit-ups , P = 0.000 ) , flexibility ( sit- and -reach , P = 0.008 ) , and aerobic capacity ( 1-mile walk , P = 0.002 ) . Positive changes in diastolic blood pressure also occurred ( P = 0.008 ) . CONCLUSION Mothers and daughters responded positively to CB and HB physical activity programs . Home-based physical activity programming is a cost-effective means to increase physical activity and improve health-related fitness in these groups PURPOSE This exploratory study tested the feasibility of conducting a novel , personalized exercise intervention based upon the current fitness levels of adolescents with type 1 diabetes ( T1DM ) . The relationships of perceptions of benefits and barriers to exercise , exercise self-efficacy and family support to exercise adherence and changes in cardiovascular ( CV ) fitness , quality of life ( QOL ) , and glycemic control were studied . METHODS Adolescents who were sedentary received a grade d exercise test to determine their current fitness level ( VO(2peak ) ) . A 16-wk personalized exercise program was developed for each adolescent based upon individual fitness level and exercise preferences . Pretest and posttest measures of exercise self-efficacy , benefits and barriers to exercise , family support , and diabetes QOL were completed . A1c levels were obtained using the DCA2000 . Adherence to exercise  was measured using the Actigraph Accelerometer . RESULTS Twelve adolescents completed the study . Accelerometry data revealed adherence to 60 min of moderate-to-vigorous physical activity ( MVPA ) per day for a mean of 45.5 ( SD = 23.9)% of the days the accelerometer was worn . Adolescents ' perceptions of family support for exercise improved following the intervention ( p = 0.03 ) . Adolescents who had more daily bouts of exercise lasting 60 min increased their CV fitness ( r = 0.59 , p = 0.04 ) . A1c remained unchanged . CONCLUSIONS Encouraging 60 min of accumulated exercise bouts/d can improve fitness levels in adolescents with T1DM , minimizing future CV risks . Although physical activity increased in adolescents , family based strategies are required to promote current physical activity recommendations 
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CONCLUSIONS Physical activity is important for diabetes management and has the potential to delay cardiovascular disease , but there is a lack of studies that are underpinned by psychological behaviour change theory , promoting sustained physical activity and exploring psychological outcomes .
There remains a lack of knowledge of how to promote physical activity in people with Type 1 diabetes