***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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    ***EXAMPLES*** 
    Input: BACKGROUND To assess the effects of comprehensive cardiac rehabilitation compared with usual care on physical activity and mental health for patients treated with catheter ablation for atrial fibrillation . METHODS The patients were r and omized 1:1 stratified by paroxysmal or persistent atrial fibrillation and sex to cardiac rehabilitation consisting of 12 weeks physical exercise and four psycho-educational consultations plus usual care ( cardiac rehabilitation group ) versus usual care . The primary outcome was Vo2 peak . The secondary outcome was self-rated mental health measured by the Short Form-36 question naire . Exploratory outcomes were collected . RESULTS 210 patients were included ( mean age : 59 years , 74 % men ) , 72 % had paroxysmal atrial fibrillation prior to ablation . Compared with usual care , the cardiac rehabilitation group had a beneficial effect on Vo2 peak at four months ( 24.3mL kg-1 min-1 versus 20.7mL kg-1 min-1 , p of main effect=0.003 , p of interaction between time and intervention=0.020 ) . No significant difference between groups on Short Form-36 was found ( 53.8 versus 51.9 points , P=.20 ) . Two serious adverse events ( atrial fibrillation in relation to physical exercise and death unrelated to rehabilitation ) occurred in the cardiac rehabilitation group versus one in the usual care group ( death unrelated to intervention ) ( P=.56 ) . In the cardiac rehabilitation group 16 patients versus 7 in the usual care group reported non-serious adverse events ( P=.047 ) . CONCLUSION Comprehensive cardiac rehabilitation had a positive effect on physical capacity compared with usual care , but not on mental health .  Cardiac rehabilitation caused more non-serious adverse events Major depression ( MD ) is associated with peripheral inflammation and increased cardiovascular risk . Regular physical exercise can have anti-inflammatory effects . The present study examined whether behavioral activation with exercise  affects inflammatory processes in MD . Ninety-eight patients with MD were r and omly assigned to cognitive-behavioral therapy ( CBT ) emphasizing exercise during behavioral activation ( CBT-E ) , CBT with pleasurable low-energy activities as an active control condition ( CBT-C ) or a passive waiting list control group ( WL )  . Plasma levels of C-reactive protein ( CRP ) , interleukin (IL)-6 , IL-10 , lipopolysaccharide (LPS)-stimulated IL-6 production , and blood immune cell counts were analyzed at baseline and weeks 8 ( post-behavioral activation ) and 16 ( post-treatment ) . Thirty non-depressed age- and sex-matched controls were included to examine potential immunological alterations  in MD at baseline . Patients with MD exhibited higher levels of CRP , higher neutrophil and monocyte counts , lower IL-10 levels and reduced LPS-stimulated IL-6 production compared to controls ( P<0.001−0.045 ) . Multilevel modeling indicated that CBT-E was associated with increased anti-inflammatory IL-10 at weeks 8 and 16 compared to CBT-C and WL ( P=0.004−0.018 ) . CBT-E did not significantly affect other immunological makers in the total sample . A subgroup analysis including patients with potentially higher cardiovascular risk ( CRP ⩾1 μg ml−1 ) indicated that CRP was reduced in CBT-E compared to CBT-C ( P<0.007 ) and marginally reduced compared to WL ( P<0.085 ) after week 16 . The present findings provide new insights into immunological effects of behavioral treatments against depression . Behavioral activation in conjunction with exercise may have the potential to reverse , in part , immunological alterations in MD BACKGROUND The safety and efficacy of aerobic exercise in heart failure ( HF ) patients with atrial fibrillation ( AF ) has not been well evaluated . OBJECTIVES This study examined whether outcomes with exercise training in HF vary according to AF status . METHODS HF-ACTION ( Heart Failure : A Controlled Trial Investigating Outcomes of Exercise Training ) r and omized 2,331 ambulatory HF patients with ejection fraction ≤35 % to exercise training or usual care .  We examined clinical characteristics and outcomes ( mortality/hospitalization ) by baseline AF status ( past history of AF or AF on baseline electrocardiogram vs. no AF ) using adjusted Cox models and explored an interaction with exercise training . We assessed post-r and omization AF events diagnosed via hospitalizations for AF and reports of serious arrhythmia caused by AF . RESULTS Of 2,292 patients with baseline rhythm data , 382 ( 17 % ) had AF , 1,602 ( 70 % ) had sinus rhythm , and 308 ( 13 % ) had " other " rhythm . Patients with AF were older and had lower peak Vo2 . Over a median follow-up of 2.6 years , AF was associated with a 24 % per year higher rate of mortality/hospitalization ( hazard ratio [ HR ] : 1.53 ; 95 % confidence interval [ CI ] : 1.34 to 1.74 ; p < 0.001 ) in unadjusted analysis ; this did not remain significant after adjustment ( HR : 1.15 ; 95 % CI : 0.98 to 1.35 ; p = 0.09 ) . There was no significant difference in AF event rates by r and omized treatment assignment in the overall population or by baseline AF status ( all p > 0.10 ) . There was no interaction between AF and exercise training on measures of functional status or clinical outcomes ( all p > 0.10 ) . CONCLUSIONS AF in patients with chronic HF was associated with older age , reduced exercise capacity at baseline , and a higher overall rate of clinical events , but not a differential response to exercise training for clinical outcomes or changes in exercise capacity . ( Heart Failure : A Controlled Trial Investigating Outcomes of Exercise Training [ HF-ACTION ] ; NCT00047437 ) Introduction : Several established tools are available to assess study quality and reporting of r and omized controlled trials ; however , these tools were design ed with clinical intervention trials in mind . In exercise training intervention trials some of the traditional study quality criteria , such as participant or research er blinding , are extremely difficult to implement . Methods : We developed the Tool for the assEssment of Study qualiTy and reporting in EXercise ( TESTEX ) – a study quality and reporting assessment tool , design ed specifically for use in exercise training studies . Our tool is a 15-point scale ( 5 points for study quality and 10 points for reporting ) and addresses previously unmentioned quality assessment criteria specific to exercise training studies . Results : There were no systematic differences between the summated TESTEX scores of each observer [ H(2 ) = 0.392 , P = 0.822 ] . There was a significant association between the summated TESTEX scores of the three observers , with almost perfect agreement between observers 1 and 2 [ intra-class correlation coefficient ( ICC ) = 0.93 , 95 % confidence interval ( CI ) 0.82–0.97 , P < 0.001 ] , observers 1 and 3 ( ICC = 0.96 , 95 % CI 0.89–0.98 , P < 0.001 ) and observers 2 and 3 ( ICC = 0.91 , 95 % CI 0.75–0.96 , P < 0.001 ) . Conclusions : The TESTEX scale is a new , reliable tool , specific to exercise scientists , that facilitates a comprehensive review of exercise training trials PURPOSE A r and omized study was conducted to determine whether short-term exercise training in patients with chronic atrial fibrillation ( AF ) might improve exercise capacity and quality of life ( QOL ) , and influence atrioventricular conduction . METHODS Atrial fibrillation patients ( age 64 + /- 7 years ) were r and omized to exercise training  ( n = 15 ) or a 2-month control period ( n = 15 ) followed by the training program . Twenty-four training sessions consisted of aerobic exercise and muscle strengthening . A cycle ergometer test and a 15-minute resting high-frequency spectral electrocardiogram analysis were performed and a QOL question naire ( SF-36 ) was completed before and after training . Because there were no changes after 2 months in the control group , pooled data for all patients are presented before and after training . RESULTS Cumulated work at Borg scale 17 increased by 41 % + /- 36 % . Heart rate at rest and after 10 minutes of exercise decreased from 75 + /- 14 to 68 + /- 14 bpm and 145 + /- 19 to 137 + /- 21 bpm , respectively . HF increased from 81 + /- 17 to 91 + /- 22 milliseconds . Four of the 8 scales and 1 of the 2 summary scales of the Short-Form-36 improved . P < .05 for all results . CONCLUSIONS Exercise capacity , heart rate variability , and QOL improved after 2 months of exercise training  in patients with chronic AF .  Heart rates at rest and during exercise decreased Background — Exercise training is an effective treatment for important atrial fibrillation ( AF ) comorbidities . However , a high level of endurance exercise is associated with an increased AF prevalence . We assessed the effects of aerobic interval training ( AIT ) on time in AF , AF symptoms , cardiovascular health , and quality of life in AF patients . Methods and Results — Fifty-one patients with nonpermanent AF were r and omized to AIT ( n=26 ) consisting of four 4-minute intervals at 85 % to 95 % of peak heart rate 3 times a week for 12 weeks or to a control group ( n=25 ) continuing their regular exercise habits . An implanted loop recorder measured time in AF continuously from 4 weeks before to 4 weeks after the intervention period . Cardiac function , peak oxygen uptake ( O2peak ) , lipid status , quality of life , and AF symptoms were evaluated before and after the 12-week intervention period . Mean time in AF increased from 10.4 % to 14.6 % in the control group and was reduced from 8.1 % to 4.8 % in the exercise group ( P=0.001 between groups ) . AF symptom frequency ( P=0.006 ) and AF symptom severity ( P=0.009 ) were reduced after AIT . AIT improved O2peak , left atrial and ventricular ejection fraction , quality -of-life measures of general health and vitality , and lipid values compared with the control group . There was a trend toward fewer cardioversions and hospital admissions after AIT . Conclusions — AIT for 12 weeks reduces the time in AF in patients with nonpermanent AF . This is followed by a significant improvement in AF symptoms , O2peak , left atrial and ventricular function , lipid levels , and QoL. Clinical Trial Registration — URL : http://www . clinical trials.gov . Unique identifier : NCT01325675 Background Physical activity at moderate-high intensity is recommended to prevent lifestyle diseases . Patients with atrial fibrillation are at risk of a sedentary lifestyle due to fear of exercise-induced episodes of atrial fibrillation . The burden of arrhythmia can be reduced by physical exercise . The effect of exercise intensity on burden of atrial fibrillation needs to be studied further . Methods and results In a 12-week r and omized controlled trial , 76 patients with paroxysmal/persistent atrial fibrillation were allocated to perform exercise at either low intensity or high intensity ( 50 % and 80 % of maximal perceived exertion , respectively ) . Primary outcome was burden of AF measured by daily electrocardiography-reporting during 12 weeks . Secondarily , change in maximal oxygen uptake ( peak VO2 ) and 1-year hospitalization was compared between low and high intensity exercise . Sixty-three patients completed the follow-up . In the intention-to-treat analysis , we found no statistical difference in burden of atrial fibrillation between low and high intensity exercise ( incidence rate ratio 0.742 , 95 % CI 0.29–1.91 , P = 0.538 ) . No serious adverse events were reported and there was no difference in hospitalization between the two exercise groups . Both exercise groups improved significantly in peak VO2 ( low intensity : 3.62 mL O2/kg/min , SD 3.77 ; high intensity : 2.87 mL O2/kg/min , SD 4.98 ) , with no statistical difference between-groups ( mean difference : 0.76 mL O2/kg/min , 95 % CI -3.22–1.7 ) . Conclusions High intensity physical exercise was not superior to low intensity physical exercise in reducing burden of atrial fibrillation . HI exercise was well tolerated ; no evidence of an increased risk was found for HI compared to LI exercise . Larger studies are required to further prove our findings . Trial registration Clinical Trials.gov Background : Little is known about ivabradine in cardiac rehabilitation in patients with coronary artery bypass graft ( CABG ) . Methods : In this prospect i ve , r and omized study , suitable patients admitted for cardiac rehabilitation after recent CABG were r and omized to ivabradine 5 mg twice a day + st and ard medical therapy including bisoprolol 1.25 mg once daily ( group I-BB , n = 38 ) or st and ard medical therapy including bisoprolol 2.5 to 3.75 mg once daily ( group BB , n = 43 ) . 
    Output:
    
Improvements were also seen in AF symptom burden and markers of cardiac function .
Conclusions Exercise capacity , cardiac function , symptom burden and health-related quality of life were improved with exercise-based CR in the short term ( up to 6 months ) targeted at patients with AF .