***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 AND OBJECTIVE To develop a checklist of items measuring the quality of reports of r and omized clinical trials ( RCTs ) assessing nonpharmacological treatments ( NPTs ) . STUDY DESIGN AND SETTING The Delphi consensus method was used to select and reduce the number of items in the checklist . A total of 154 individuals were invited to participate : epidemiologists and statisticians involved in the field of methodology of RCTs ( n = 55 ) , members of the Cochrane Collaboration ( n = 41 ) , and clinicians involved in planning NPT clinical trials ( n = 58 ) . Participants ranked on a 10-point Likert scale whether an item should be included in the checklist . RESULTS Fifty-five experts ( 36 % ) participated in the survey . They were experienced in systematic review s ( 68 % were involved in the Cochrane Collaboration ) and in planning RCTs ( 76 % ) . Three rounds of the Delphi method were conducted to achieve consensus . The final checklist contains 10 items and 5 subitems , with items related to the st and ardization of the intervention , care provider influence , and additional measures to minimize the potential bias from lack of blinding of participants , care providers , and outcome assessors . CONCLUSIONS This tool can be used to critically appraise the medical literature , design NPT studies , and assess the quality of trial reports included in systematic review The purpose of the study was to evaluate the impact of step aerobic ( StA ) and cycle ergometer training ( CET ) on physical performance , coordination , and pleasure , during workout . Forty untrained persons ( 40 - 70 years ) were r and omly assigned to either of the two regimens . Prior to and after three months of training , we investigated the participants ' physical performance with a cycle ergometer test and by testing coordinative tasks ( upper extremities : tapping test ; lower extremities : one-leg stance ) . After the training period , visual analog scales were used to evaluate personal assessment ( pleasure , wellbeing , team spirit , interest in prolongation of training ) . StA increased the relative oxygen uptake at the anaerobic threshold ( RVO2AT ) while CET increased the relative maximal oxygen uptake ( RVO2max ) to a statistically significant extent . However , intergroup comparison failed to show group-specific differences . Concerning coordinative tasks , the members of the StA group achieved a significant time reduction for both h and s ' tapping test . However , only the improvement in left-h and ed tapping was significantly higher than that achieved by members of the CET group . Despite the absence of group-specific differences , CET members showed a statistically significant change when comparing the duration of pre- with post-training time for one-leg stance under proprioceptive conditions . Team spirit was significantly higher in the StA group than in the CET group . Except for the time reduction in left-h and ed tapping , the present study found no group-specific differences in physical performance and coordination . Participating in a StA class has a more cohesive effect on the individual members than attending a CET group OBJECTIVE We evaluated the effects of exercise on neurobehavioral function in healthy older people more than 75 years of age . DESIGN A r and omized controlled trial with 6-month follow-up was conducted . SETTING The study was performed in the rural town of Kahoku , Japan , the population of which is considered representative of the older population of Japan . PARTICIPANTS We studied 42 healthy volunteers ( 18 men and 24 women ; mean age , 79 years ( range 75 to 87 years ) ) who were r and omly assigned to one of two groups , exercise or control . INTERVENTION Subjects assigned to the exercise group were instructed to exercise for 60 minutes twice a week for 6 months . Subjects in the control group were not instructed to engage in an specific exercise regimen . MEASUREMENTS The following measurements were recorded for both groups at baseline and at 6-month follow-up : ( 1 ) Neurobehavioral function as determined by the following tests : Mini-Mental State Exam ( MMSE ) , Hasegawa Dementia Scale Revised ( HDSR ) , Visuospatial Cognitive Performance Test ( VCP-test ) , Button score , Up & Go test , and Functional Reach ; and ( 2 ) Body mass index and blood pressure . RESULTS The effects of exercise were shown in the Up & Go test , and Functional Reach ( ANOVA with repeated measures ) . CONCLUSION This study demonstrates the acceptability and effectiveness of exercise on neurobehavioral function , even in older people more than 75 years of age The goal was to determine the existence of differential effects of long-term moderate- or low-intensity exercise on selected bio-behavioral variables in 72 community-dwelling persons over 60 years of age . After screening , subjects were r and omly assigned to a moderate ( n = 39 , 60 - 70 % heart rate reserve [ HRR ] ) or low ( n = 33 , 30 - 40 % HRR ) intensity exercise protocol . Both groups exercised three times per week for 9 months and dependent measures were taken at baseline , 4.5 months and after 9 months . Repeated measures ANOVA with Tukey post hoc comparisons constituted the analysis approach . Moderate exercise showed no superiority over low-intensity exercise ; both groups improved about equally . Variables that significantly improved included : self-reported sleep ( sleep quantity and dream recall ) , mental status ( attention/concentration , short-term memory and higher cognitive functioning ) , health perceptions ( health outlook , health worry , rejection of the sick role ) , and cardiovascular fitness indicators ( submaximum stress test heart rate , maximum oxygen consumption ( VO2max ) , maximum work capacity and maximum exercise time ) . Similarity of outcomes in both groups may mean that the moderate exercise protocol was too conservative . Conversely , the findings may indicate that lower levels of exercise , which may be safer and more feasible over time , do improve fitness levels , prolong independent functioning , and promote positive perceptions of well-being in older adults PURPOSE Research supports an association between aerobic fitness and cognitive functioning in chronic obstructive pulmonary disease ( COPD ) patients . However , the impact of exercise intervention duration has not been satisfactorily examined . Therefore , the purpose of this study was to examine the effects of a 3-month and an 18-month exercise intervention on the cognitive functioning of an older COPD sample . METHODS COPD patients ( 56 - 80 yr ) were given a 3-month exercise program and then were r and omly assigned to continue for an additional 15 months ( long-term group ) or to leave the exercise program ( short-term group ) . Age and education were assessed before involvement in the exercise intervention ( baseline ) . Fluid intelligence , pulmonary function , aerobic fitness , and depression were assessed at baseline , at 3 months , and at 18 months . RESULTS After 3 months of exercise , results indicated that cognitive function and walk distance improved significantly . Results also indicated that the gain in cognitive function was reliably predicted by the decrease in VE at VO2peak . At 18 months , results indicated that cognitive performance did not differ between the short- and long-term exercise groups , but that walk distance improved significantly for the long-term group , but not for the short-term group . Results of a regression analysis showed that the cognitive performance improvement from 3 months to 18 months was predicted by the gain in walk distance and by the decrease in VE at VO2peak . CONCLUSION It is concluded that improvements in aerobic fitness are associated with gains in fluid intelligence after 3 and 18 months of exercise training in COPD patients . However , at 18 months , exercise group was not predictive of the gains in cognitive performance . Therefore , a 3-month exercise program may be a sufficient impetus to foster these cognitive gains in COPD patients Objective : To determine the effect of yoga and of aerobic exercise on cognitive function , fatigue , mood , and quality of life in multiple sclerosis ( MS ) . Methods : Subjects with clinical ly definite MS and Exp and ed Disability Status Score less than or equal to 6.0 were r and omly assigned to one of three groups lasting 6 months : weekly Iyengar yoga class along with home practice , weekly exercise class using a stationary bicycle along with home exercise , or a waiting-list control group . Outcome assessment s performed at baseline and at the end of the 6-month period included a battery of cognitive measures focused on attention , physiologic measures of alertness , Profile of Mood States , State-Trait Anxiety Inventory , Multi-Dimensional Fatigue Inventory ( MFI ) , and Short Form (SF)-36 health-related quality of life . Results : Sixty-nine subjects were recruited and r and omized . Twelve subjects did not finish the 6-month intervention . There were no adverse events related to the intervention . There were no effects from either of the active interventions on either of the primary outcome measures of attention or alertness . Both active interventions produced improvement in secondary measures of fatigue compared to the control group : Energy and Fatigue ( Vitality ) on the SF-36 and general fatigue on the MFI . There were no clear changes in mood related to yoga or exercise . Conclusion : Subjects with MS participating in either a 6-month yoga class or exercise class showed significant improvement in measures of fatigue compared to a waiting-list control group . There was no relative improvement of cognitive function in either of the intervention groups Abstract : A r and omised controlled trial was conducted to determine whether a 12–month program of group exercise had beneficial effects on physiological and cognitive functioning and mood in 187 older community – dwelling women . The  exercisers ( n= 94 ) and controls ( n= 93 ) were well matched in terms of the test measures and a number of health and life – style assessment s. The mean number of classes attended by the 71 exercise subjects who completed the program was 59.0 ( range 26 to 82 ) . At the end of the trial , the exercisers showed significant improvements in reaction time , strength , memory span and measures of wellbeing when compared with the controls . There was also an indication that anxiety had been reduced in the exercisers . Within the exercise group , improvements in memory span were associated with concomitant improvements in both reaction time and muscle strength . Also , within this group , initial mood measures were significantly inversely associated with improvements at retest , which suggests that the program may have normalised mood states in subjects who had high initial depression , anxiety and stress levels , rather than inducing improvements in all subjects . These findings suggest that group exercise has beneficial effects on physiological and cognitive functioning and wellbeing in older people CONTEXT Dementia is common , costly , and highly age related . Little attention has been paid to the identification of modifiable lifestyle habits for its prevention . OBJECTIVE To explore the association between physical activity and the risk of cognitive impairment and dementia .  DESIGN , SETTING , AND SUBJECTS Data come from a community sample of 9008 r and omly selected men and women 65 years or older , who were evaluated in the 1991 - 1992 Canadian Study of Health and Aging , a prospect i ve cohort study of dementia . Of the 6434 eligible subjects who were cognitively normal at baseline , 4615 completed a 5-year follow-up .  Screening and clinical evaluations were done at both waves of the study . In 1996 - 1997 , 3894 remained without cognitive impairment , 436 were diagnosed as having cognitive impairment-no dementia , and 285 were diagnosed as having dementia . MAIN OUTCOME MEASURE Incident cognitive impairment and dementia by levels of physical activity at baseline . RESULTS Compared with no exercise , physical activity was associated with lower risks of cognitive impairment , Alzheimer disease , and dementia of any type . Significant trends for increased protection with greater physical activity were observed . High levels of physical activity were associated with reduced risks of cognitive impairment ( age- , sex- , and education-adjusted odds ratio , 0.58 ; 95 % confidence interval , 0.41 - 0.83 ) , Alzheimer disease ( odds ratio , 0.50 ; 95 % confidence interval , 0.28 - 0.90 ) , and dementia of any type ( odds ratio , 0.63 ; 95 % confidence interval , 0.40 - 0.98 ) . CONCLUSION Regular physical activity could represent an important and potent protective factor for cognitive decline and dementia in elderly persons Physical activity may help preserve cognitive function and decrease dementia risk , but epidemiologic findings are inconsistent . The authors conducted a prospect i ve study to determine the association between physical activity and risk of  dementia , Alzheimer 's disease , and vascular dementia . The US study population comprised 3,375 men and women aged 65 years or older , free of dementia at baseline , who participated in the Cardiovascular Health Cognition Study in 1992 - 2000 .  Leisure-time energy expenditure and an activity index reflecting number of different physical activities were calculated . Analyses were based on Cox proportional hazards models . There were 480 incident cases of dementia over an average of 5.4 years of follow-up . After multivariate adjustment , participants in the highest quartile of physical energy expenditure had a relative risk of dementia of 0.85 ( 95 % confidence interval : 0.61 , 1.19 ) compared with those in the lowest quartile , and participants engaging in > or=4 activities had a relative risk of dementia of 0.51 ( 95 % confidence interval : 0.33 , 0.79 ) compared with those engaging in 0 - 1 activity . These associations were more marked in apolipoprotein E genotype ( APOE ) epsilon4 allele noncarriers but were absent in carriers . A similar pattern was observed for Alzheimer 's disease and vascular dementia . Mechanisms to explain the observed relations deserve further study Cardiovascular fitness is 
    Output:
    
There is evidence that aerobic physical activities which improve cardiorespiratory fitness are beneficial for cognitive function in healthy older adults , with effects observed for motor function , cognitive speed , auditory and visual attention .
The data are insufficient to show that the improvements in cognitive function which can be attributed to physical exercise are due to improvements in cardiovascular fitness , although the temporal association suggests that this might be the case .
At the same time , it would be informative to underst and why some cognitive functions seem to improve with ( aerobic ) physical exercise while other functions seem to be insensitive to physical exercise .