***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: In a prospect i ve r and omized study the efficiacy of physical therapy in female stress incontinence could be verified . The greatest success rate was achieved by medical gymnastics , whereas the perineal electrical stimulation should be used as supporting measure like a biofeedback mechanism because of its low effective intensity . Despite of the good therapeutic success ( 51.5 % ) with lasting effects no objective criteria to the use of physical therapy in female stress incontinence were found OBJECTIVE To investigate associations between diet and non-dietary lifestyle factors and the onset of  overactive bladder ( OAB ) in men . SUBJECTS R and om sample of community-dwelling men aged 40 years plus . DESIGN AND METHODS Baseline data on  urinary symptoms and  diet  were collected from 5454 men using a postal question naire and a food-frequency question naire . Follow-up data on urinary symptoms were collected from 4887 men in a postal survey one year later .  Logistic regression analysis  was used to investigate diet and lifestyle factors associated with onset of OAB in the men without OAB at baseline . RESULTS There was a highly significant negative association between beer intake at baseline and subsequent OAB onset ( P=0.001 ) , with reduced risk at all levels of intake compared with those who seldom/never drank beer . Adjustment for total alcohol intake ( g ethanol day(-1 ) ) reduced the significance of the association ( P=0.02 ) . None of the food groups studied was associated with OAB onset , with the possible exception of potatoes ( P=0.05 ) , which showed an increased risk of onset at the highest level of consumption . Physical activity , smoking and obesity were not significantly associated . CONCLUSIONS While most diet and lifestyle factors were not associated with OAB onset , the evidence from this prospect i ve longitudinal study suggests that beer may have a protective role in the development of OAB . This could be due to a non-alcoholic ingredient as well as the alcohol content Abstract : The aim of this study was to evaluate the effect of weight reduction on  urinary incontinence in moderately obese women . This prospect i ve cohort study enrolled moderately obese women experiencing four or more incontinence episodes per week . BMI and a 7-day urinary diary were collected at baseline and on the completion of weight reduction . The study included 10 women with a mean ( þSD ) baseline BMI of 38.3 ( þ10.1 ) kg/m2 and 13 ( þ10 ) incontinent episodes per week . Participants had a mean BMI reduction of 5.3 ( þ6.2 ) kg/m2 ( P<0.03 ) . Among women achieving a weight loss of ≥5 % , 6/6 had ≥50 % reduction in incontinence frequency compared to 1 in 4 women with < 5 % weight loss ( P<0.03 ) . Incontinence episodes decreased to 8 ( þ10 ) per week following weight reduction ( P<0.07 ) . The study demonstrated an association between weight reduction and improved urinary incontinence . Weight reduction should be considered for moderately obese women as part of non-surgical therapy for incontinence Patients with symptoms of frequency and urgency often complain that their symptoms are exacerbated by tea or coffee . A series of 20 women with confirmed detrusor instability and 10 asymptomatic women were given 200 mg of caffeine citrate and urodynamic studies were performed . In the group with detrusor instability there was a statistically significant increase in detrusor pressure on bladder filling following administration of caffeine , but no difference in volume at first contraction , height of contraction or bladder capacity . Normal women had no abnormality on cystometry Background Both maternal pre-pregnancy obesity and excessive gestational weight gain are increasing in prevalence and associated with a number of adverse pregnancy outcomes for both mother and child . Observational studies regarding physical activity in pregnancy have found reduced weight gain in active mothers , as well as reduced risk of adverse pregnancy outcomes . There is however a lack of high quality , r and omized controlled trials on the effects of regular exercise training in pregnancy , especially those with a pre-pregnancy body mass index ( BMI ) at or above 30 kg/m2 . Methods We are conducting a r and omised , controlled trial in Norway with two parallel arms ; one intervention group and one control group . We will enroll 150 previously sedentary , pregnant women with a pre-pregnancy BMI at or above 30 kg/m2 . The intervention group will meet for organized exercise training three times per week , starting in gestation week 14 ( range 12 - 16 ) . The control group will get st and ard antenatal care . The main outcome measure will be weight gain from baseline to delivery . Among the secondary outcome measures are changes in exercise capacity , endothelial function , physical activity level , body composition , serum markers of cardiovascular risk , incontinence , lumbopelvic pain and cardiac function from baseline to gestation week 37 ( range 36 - 38 ) . Offspring outcome measures include anthropometric variables at birth , Apgar score , as well as serum markers of inflammation and metabolism in cord blood . Discussion The results of this trial will provide knowledge about effects of regular exercise training in previously sedentary , obese pregnant women . If the program proves effective in reducing gestational weight gain and adverse pregnancy outcomes , such programs should be considered as part of routine pregnancy care for obese women . Trial Registration Clinical Trials.gov : OBJECTIVE : To estimate the effect of a decrease in urinary incontinence ( UI ) frequency on UI management costs among women enrolled in a clinical trial of a weight loss intervention  and to identify factors that predict change in cost . METHODS : This is a secondary cohort analysis of 338 obese and overweight women with 10 or more weekly episodes of UI enrolled in an 18-month r and omized clinical trial of a weight loss intervention compared with a structured education program to treat UI . Quantities of re sources used for incontinence management , including pads , additional laundry , and dry cleaning , were reported by participants . Direct costs for UI management ( “ cost ” ) were calculated by multiplying re sources used by national re source costs ( in 2006 U.S. dollars ) . R and omized groups were combined to examine the effects of change in incontinence frequency on cost . Possible predictors of change in cost were examined using generalized estimating equations controlling for factors associated with change in cost in univariable analyses . RESULTS : Mean age±st and ard deviation was 53±10 years and baseline weight was 97±17 kg . Mean weekly UI frequency was 24±18 at baseline and decreased by 37 % at 6 months and 60 % at 18 months ' follow-up ( both P<.001 ) . At baseline , adjusted mean cost was $ 7.76±$14 per week , with costs increasing significantly with greater incontinence frequency . Mean cost decreased by 54 % at 6 months and 81 % at 18 months ( both P<.001 ) . In multivariable analyses , cost independently decreased by 23 % for each decrease of seven UI episodes per week and 21 % for each 5 kg of weight lost ( P<.001 for both ) . CONCLUSION : In obese and overweight women enrolled in a clinical trial of weight loss for UI  , incontinence management cost decreased by 81 % at 18 months ( $ 327 per woman per year ) and was strongly and independently associated with decreasing incontinence frequency . LEVEL OF EVIDENCE : Objective To evaluate the effectiveness of self management as a first line intervention for men with lower urinary tract symptoms . Design R and omised controlled trial . Setting A teaching hospital and a district general hospital in London . Participants 140 men ( mean age 63 ( SD 10.7 ) years ) , recruited between January 2003 and April 2004 , referred by general practitioners to urological outpatient departments with uncomplicated lower urinary tract symptoms . Interventions Self management and st and ard care ( n=73 ) or st and ard care alone ( n=67 ) . The self management group took part in three small group sessions comprising education , lifestyle advice , and training in problem solving and goal setting skills . Main outcome measures The primary outcome measure was treatment failure measured at 3 , 6 , and 12 months . Symptom severity ( international prostate symptom score ; higher scores represent a poorer outcome ) was used as a secondary outcome . Results At three months , treatment failure had occurred in 7 ( 10 % ) of the self management group and in 27 ( 42 % ) of the st and ard care group ( difference=32 % , 95 % confidence interval 18 % to 46 % ) . Corresponding differences in the frequency of treatment failure were 42 % ( 27 % to 57 % ) at six months and 48 % ( 32 % to 64 % ) at 12 months . At three months , the mean international prostate symptom score was 10.7 in the self management group and 16.4 in the st and ard care group ( difference=5.7 , 3.7 to 7.7 ) . Corresponding differences in score were 6.5 ( 4.3 to 8.7 ) at six months and 5.1 ( 2.7 to 7.6 ) at 12 months . Conclusions Self management significantly reduced the frequency of treatment failure and reduced urinary symptoms . Because of the large observed benefit of self management , the results of this study support the case for a large multicentre trial to confirm whether self management could be considered as first line treatment for men with lower urinary tract symptoms . Trial registration National Research Register N0263115137 ; Clinical trials NCT00270309 PURPOSE We determined the effect of caffeine restriction and fluid manipulation in the treatment of patients with urodynamic stress incontinence and detrusor overactivity . MATERIAL S AND METHODS This was a 4-week r and omized , prospect i ve , observational crossover study in 110 women with urodynamic stress incontinence ( USI ) or idiopathic detrusor overactivity ( IDO ) to determine the effect of caffeine restriction , and of increasing and decreasing fluid intake on urinary symptoms . Data were recorded in a urinary diary for the entire study period on urgency episodes , frequency , pad weight increase , wetting episodes and quality of life . RESULTS A total of 69 women with a mean age of 54.8 years completed the study , including 39 with USI and 30 with IDO . In the IDO group decreasing fluid intake significantly decreased voiding frequency , urgency and wetting episodes with improved quality of life . In the USI group there was a significant decrease in wetting episodes when fluid intake was decreased . Changing from caffeine containing to decaffeinated drinks produced no improvement in symptoms . CONCLUSIONS Conservative and life-style interventions are first line treatments in the management of incontinence and storage lower urinary tract symptoms . This study shows that a decrease in fluid intake improves some of these symptoms in patients with USI and IDO and , therefore , it should be considered when treating such patients This study was design ed to determine whether a 6-month Tai Chi exercise program can improve self-reported physical functioning limitations among healthy , physically inactive older individuals . Ninety-four community residents ages 65 to 96 ( M age = 72.8 years , SD = 5.1 ) volunteered to participate in the study . Participants were r and omly assigned to either a 6-month experimental ( Tai Chi ) group ( n = 49 ) , which exercised twice per week for 60 min , or a wait-list control group ( n = 45 ) . A 6-item self-report physical functioning scale , assessing the extent of behavioral dysfunction caused by health problems , was used to evaluate change in physical functioning limitations as a result of Tai Chi intervention . Results indicated that compared to the control group , participants in the Tai Chi group experienced significant improvements in all aspects of physical functioning over the course of the 6-month intervention . Overall , the experimental group had 65 % improvement across all 6 functional status measures ranging from daily activities such as walking and lifting to moderate-vigorous activities such as running . It was concluded that the 6-month Tai Chi exercise program was effective for improving functional status in healthy , physically inactive older adults . A self-paced and self-controlled activity such as Tai Chi has the potential to be an effective , low-cost means of improving functional status in older persons Objective : Maintaining weight loss is a major challenge in obesity treatment . Individuals often indicate that waning motivation prompts cessation of effective weight management behaviors . Therefore , a novel weight loss maintenance program that specifically targets motivational factors was evaluated . Design : Overweight women ( N=338 ; 19 % African American ) with urinary incontinence were r and omized to lifestyle obesity treatment or control and followed for 18 months . All participants in lifestyle ( N=226 ) received the same initial 6-month group behavioral obesity treatment and were then r and omized to ( 1 ) a novel motivation-focused maintenance program ( N=113 ) or ( 2 ) a st and ard skill-based maintenance approach (N=113).Main Outcome Measure : Weight assessed at baseline , 6 and 18 months . Results : Both treatment groups ( motivation-focused and skill-based ) achieved comparable 18-month weight losses ( −5.48 % for motivation-focused vs −5.55 % in skill-based , P=0.98 ) , and both groups lost significantly more than controls ( −1.51 % ; P=0.0012 in motivation-focused and P=0.0021 in skill-based ) . Conclusions : A motivation-focused maintenance program offers an alternative , effective approach to weight maintenance exp and ing available evidence -based interventions beyond traditional skill-based programs . Trial Registration : clinical trials. 
    Output:
    
However , it was not possible to reach any conclusions about the effects of these changes , due to method ological limitations , that result ed in very low quality evidence .Adverse effects appeared relatively uncommon for all interventions studied .
Generally , there was insufficient evidence to inform practice reliably about whether lifestyle interventions are helpful in the treatment of urinary incontinence