***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 Fatigue or lack of interest can reduce the feasibility of intensive physical exercise in nursing home residents .  Low-volume exercise interventions with similar training effects might be an alternative . The aim of this r and omised controlled trial was to investigate the feasibility of Whole Body Vibration ( WBV ) in institutionalised elderly , and its impact on functional capacity and muscle performance . Methods Twenty-four nursing home residents ( 15 female , 9 male ; mean age 77.5 ± 11.0 years ) were r and omised ( stratification for age , gender and ADL-category ) to 6 weeks static WBV exercise ( WBV+ , N = 13 ) or control ( only static exercise ; N = 11 ) . Outcome measures were exercise compliance , timed up- and -go , Tinetti-test , back scratch , chair sit- and -reach , h and grip strength and linear isokinetic leg extension . Results At baseline , WBV+ and control groups were similar for all outcome variables . Twenty-one participants completed the program and attended respectively 96 % and 86 % of the exercise sessions for the WBV+ and control groups . Training-induced changes in timed up- and -go and Tinetti-test were better for WBV+ compared to control ( p = 0.029 for timed up- and -go , p = 0.001 and p = 0.002 for Tinetti body balance and total score respectively ) . In an alternative analysis ( Worst Rank Score & Last Observation Carried Forward ) the differences in change remained significant on the Tinetti body balance and total score . No other significant differences in change between both groups were observed . Conclusion In nursing home residents with limited functional dependency , six weeks static WBV exercise is feasible , and is beneficial for balance and mobility . The supplementary benefit of WBV on muscle performance compared to classic exercise remains to be explored further OBJECTIVE To use two different exercise programs over a 2-year period to reduce falls and their sequelae among residents of two long-term care facilities . DESIGN R and omized , controlled trial . SETTING The study took place at two long-term care facilities with services ranging from independent living to skilled nursing . PARTICIPANTS One hundred and ten participants whose average age was 84 and who were capable of ambulating with or without assistive devices and could follow simple directions . INTERVENTION Participants were r and omized to one of two exercise groups ( resistance/endurance plus basic enhanced programming or tai chi plus basic enhanced programming ) or to a control group ( basic enhanced programming only ) . Exercise classes were held three times per week throughout the study . MEASUREMENTS Participants were evaluated for cognitive and physical functioning at baseline and 6 , 12 , and 24 months . Falls were determined from incident reports filed by the nursing staffs at the facilities . RESULTS Time to first fall , time to death , number of days hospitalized , and incidence of falls did not differ among the treatment and control groups ( P>.05 ) . Among all participants , those who fell had significantly lower baseline Folstein Mini-Mental State Examination and instrumental activities of daily living scores and experienced significantly greater declines in these measures over the 2-year program . CONCLUSION There were no significant differences in falls among the two exercise groups and the control group . Lack of treatment differences and low adherence rates suggest that residents of long-term care facilities may require individualized exercise interventions that can be adapted to their changing needs This paper describes a quasi-experimental study of a musical exercise intervention to improve the physical , cognitive , behavioral status and life satisfaction of older residents in a long-term care facility in the United Kingdom . Twenty long-term care residents from three different units ( n=60 ) were recruited and assigned to one of three groups : a control ( C ) group ( no intervention ) , an occupational therapy ( OT ) group ( comparison group ) and a music exercise group ( intervention group ) . Assessment s of physical and cognitive status were made pre-intervention and repeated at the end of the 10-week exercise program and again 10 weeks after the completion of the program . The results show that both OT and exercise participation is associated with improvement in physical and cognitive function . However , the exercise group showed significant improvement in more areas than the OT group . The functional benefits from OT and exercise were not sustainable after these activities ceased and showed significant decline 10 weeks after the end of the programs OBJECTIVES To establish the effectiveness of a fall-prevention program in reducing falls and injurious falls in older residential care residents . DESIGN Cluster , r and omized , controlled trial . SETTING Fourteen r and omly selected residential care homes in Auckl and , New Zeal and . PARTICIPANTS All older residents ( n=628 , 95 % participation rate ) . INTERVENTION Residential care staff , using existing re sources , implemented systematic individualized fall-risk management for all residents using a fall-risk assessment tool , high-risk logo , and strategies to address identified risks . MEASUREMENTS Number of residents sustaining a fall , falls , and injurious-falls incidence rates . RESULTS During 12 months of follow-up , 103 ( 43 % ) residents in the control group and 173 ( 56 % ) residents in the intervention group fell ( P<.018 ) . There was a significantly higher incidence rate of falls in intervention homes than in control homes ( incident rate ratio=1.34 , 95 % confidence interval=1.06 - 1.72 ) during the intervention period after adjusting for dependency level ( type of home ) , baseline fall rate , and clustering . There was no difference in the injurious fall incidence rate or incidence of serious injuries . CONCLUSION This fall-prevention intervention did not reduce falls or injury from falls . Low-intensity intervention may be worse than usual care OBJECTIVE to determine the effect of risk factor modification and balance exercise on falls rates in residential care homes . DESIGN cluster r and omised controlled trial . PARTICIPANTS 196 residents ( aged 60 years or over ) in 20 residential care homes were enrolled ( 38 % response rate ) . Homes were r and omly allocated to intervention and control arms . A total of 102 residents were consigned to the intervention arm and 94 to the control arm . INTERVENTION a multifactorial falls prevention programme including 3 months gait and balance training , medication review , podiatry and optometry . MAIN OUTCOME MEASURES number of falls/recurrent falls per person , number of medications per person , and change in Tinetti gait and balance measure . RESULTS in the intervention group there was a mean of 2.2 falls per resident per year compared with 4.0 in the control group ; this failed to reach statistical significance ( P = 0.2 ) once the intra-cluster correlation ( ICC , 0.10 ) had been accounted for . Several risk factors were reduced in the intervention arm . CONCLUSIONS falls risk factor reduction is possible in residents of care homes . A modest reduction in falls rates was demonstrated but this failed to reach statistical significance Many studies have documented the effectiveness of verbally elicited imagery in the enhancement of motor skills in young , nondisabled population s. The present study examined the effects of verbally elicited imagery in the encouragement of two exercises ( i.e. , reaching up to pick apples and reaching down to pick up coins ) in elderly women . The subjects were 27 women between 62 and 96 years of age who were selected from a nursing home , a residential retirement home , and a foster care home . All of the subjects received imagery as well as control conditions , but in a counterbalanced fashion . The Wilcoxon matched-pairs signed rank tests indicated that the imagery condition elicited significantly more repetitions of the reaching-up exercise than did the control condition ( z = 2.25 , p [ one-tailed ] = .012 ) . The results in the reaching-down exercise were generally in the same direction but difficult to interpret statistically . The results are discussed in terms of other recent research investigating ways to add purpose to therapeutic exercise through occupation . Clinicians are urged to explore the advantages and disadvantages of imagery-based occupations in treatment Background Regular physical activity may improve different aspects of wellbeing in older people , such as quality of life , vitality and depression . However , there is little experimental evidence to support this assumption . Therefore , we examined the effect of different training protocol s on quality of life , vitality and depression of older adults living in long-term care facilities . Methods Subjects ( n = 173 , aged 64 to 94 years , living in long-term care facilities ) , were r and omized to six months of three different moderate-intensity group exercise training protocol s , or to an ' educational ' control condition . Exercise consisted of two 45–60-minute training sessions per week of 1 ) resistance training ; 2 ) all-round , functional training ; or 3 ) a combination of both . Perceived health , the Geriatric Depression Scale ( GDS ) , the Vitality Plus Scale ( VPS ) and the Dementia Quality of Life question naire ( DQoL ) were administered at baseline and after six months . Results In the combined training group a small but significant decline was seen in perceived health , DQoL and VPS score compared to the control group . Conclusions We conclude that neither strength training nor all-round , functional training of moderate intensity is effective in improving quality of life , vitality or depression of older people living in long-term care facilities The aims of this r and omised controlled trial were to determine if a high-intensity functional exercise program improves balance , gait ability , and lower-limb strength in older persons dependent in activities of daily living and if an intake of protein-enriched energy supplement immediately after the exercises increases the effects of the training . One hundred and ninety-one older persons dependent in activities of daily living , living in residential care facilities , and with a Mini-Mental State Examination ( MMSE ) score of ? 10 participated . They were r and omised to a high-intensity functional exercise program or a control activity , which included 29 sessions over 3 months , as well as to protein-enriched energy supplement or placebo .  Berg Balance Scale , self-paced and maximum gait speed , and one-repetition maximum in lower-limb strength were followed-up at three and six months and analysed by 2 x 2 factorial ANCOVA , using the intention-to-treat principle . At three months , the exercise group had improved significantly in self-paced gait speed compared with the control group ( mean difference 0.04 m/s , p = 0.02 ) . At six months , there were significant improvements favouring the exercise group for Berg Balance Scale ( 1.9 points , p = 0.05 ) , self-paced gait speed ( 0.05 m/s , p = 0.009 ) , and lower-limb strength ( 10.8 kg , p = 0.03 ) . No interaction effects were seen between the exercise and nutrition interventions . In conclusion , a high-intensity functional exercise program has positive long-term effects in balance , gait ability , and lower-limb strength for older persons dependent in activities of daily living . An intake of protein-enriched energy supplement immediately after the exercises does not appear to increase the effects of the training Background The Health Enhancing Strength Training in Nonagenarians ( STRONG ) is a r and omised control trial to assess the effectiveness of an aerobic and strength training program for improving muscle strength , functional capacity and quality of life in nonagenarians . Methods Sixty ( 51 women ) nonagenarians ( age range : 90–102 years ) who live in a geriatric nursing home will be r and omly assigned to either a usual care ( control ) group ( n = 30 ) or an intervention ( training ) group ( n = 30 ) . Participants allocated in the usual care group will receive general physical activity guidelines and participants allocated in the intervention group will also enrol in three weekly non-consecutive individualized training sessions ( ~45–50 min each ) during 8 weeks . The exercise program will consist of muscular strength [ with a special focus on leg press at 30 % ( start of the program ) to 70 % 1 repetition maximum ( end ) ] and aerobic exercises ( cycle-ergometry during 3–5 to 15 minutes at 12–14 points in the rate of perceived exertion scale ) . Results Results from STRONG will help to better underst and the potential of regular physical activity for improving the well-being of the oldest population groups . Conclusion The increase in life expectancy together with the dramatic decrease in birth rates in industrialized countries calls the attention to health care systems and public health policymakers to focus attention on promoting healthy lifestyle in the highest sector of the population pyramid . Our study attempts to improve functional capacity and QOL of nonagenarians by implementing an individualised aerobic and strength training program in a geriatric residential care . Results from STRONG will help to better underst and the potential of regular physical activity for improving the well being even in persons aged 90 years or over . Trail Registration Clinical Trials.gov ID : Stretching has been widely used to increase the range of motion . We assessed the effects of a stretching program on muscle-tendon length , flexibility , torque , and activities of daily living of institutionalized older women . Inclusion /exclusion criteria were according to Mini-Mental State Examination ( MMSE ) ( > 13 ) , Barthel Index ( > 13 ) and Lysholm Scoring Scale ( > 84 ) . Seventeen 67 ± 9 year-old elderly women from a nursing home were divided into 2 groups at r and om : the control group ( CG , N = 9 ) participated in enjoyable cultural activities ; the stretching group ( SG , N = 8) performed active stretching of hamstrings , 4 bouts of 1 min each . Both groups were supervised three times per week over a period of 8 weeks . Peak torque was assessed by an isokinetic method . Both groups were evaluated by a photogrammetric method to assess muscle-tendon length of uni- and biarticular hip flexors and hamstring flexibility . All measurements were analyzed before and after 8 weeks by two-way ANOVA with the level of significance set at 5 % . Hamstring flexibility increased by 30 % 
    Output:
    
Synthesis of secondary outcomes suggested there is a beneficial effect on strength , flexibility , and balance , and possibly on mood , although the size of any such effect is unknown .
AUTHORS ' CONCLUSIONS Physical rehabilitation for long-term care residents may be effective , reducing disability with few adverse events , but effects appear quite small and may not be applicable to all residents .
There is insufficient evidence to reach conclusions about improvement sustainability , cost-effectiveness , or which interventions are most appropriate .