***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 Hypertension is the leading risk factor responsible for premature death worldwide , but its burden has shifted to low- and middle-income countries . Therefore , we studied hypertension and cardiovascular risk in the population of Suriname , a middle-income country with a predominantly urban population of African and Asian ancestry . METHODS A r and om sample of 1,800 noninstitutionalized men and women aged 18 - 70 years was selected to be interviewed at home and examined at the local hospital for cardiovascular risk factors , asymptomatic organ damage , and cardiovascular disease . RESULTS The 1,157 participants examined ( 37 % men ) were mainly of self-defined Asian ( 43 % ) or African ( 39 % ) ancestry , mean age 43 years ( SD 14 ) . The majority of the population ( 71 % ) had  hypertension or prehypertension  , respectively , 40 % and 31 % . Furthermore , 72 % was obese or overweight , while 63 % had diabetes or prediabetes . Only 1 % of the adult population had an optimal cardiovascular risk profile . Hypertension awareness , treatment , and control were respectively 68 % , 56 % , and 20 % . In line with this , 22 % of the adult population had asymptomatic organ damage , including increased arterial stiffness , left ventricular hypertrophy , microalbuminuria , or asymptomatic chronic kidney disease . CONCLUSIONS In this first extensive cardiovascular assessment in the general population of this middle-income Caribbean country , high prevalence of hypertension with inadequate levels of treatment and control was predominant . The findings emphasize the need for collaborative effort from national and international bodies to prioritize the implementation of affordable and sustainable public health programs that combat the escalating hypertension and cardiovascular risk factor burden 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 Background Both exercise training and diet are recommended to prevent and control hypertension and overweight/obesity . Purpose The purpose of this study was to determine the effectiveness of different 16-week aerobic exercise programmes with hypocaloric diet on blood pressure , body composition , cardiorespiratory fitness and pharmacological treatment . Methods Overweight/obese , sedentary participants ( n = 175 , aged 54.0 ± 8.2 years ) with hypertension were r and omly assigned into an attention control group ( physical activity recommendations ) or one of three supervised exercise groups ( 2 days/week : high-volume with 45 minutes of moderate-intensity continuous training ( MICT ) , high-volume and high-intensity interval training ( HIIT ) , alternating high and moderate intensities , and low-volume HIIT ( 20 minutes ) ) . All variables were assessed pre- and post-intervention . All participants received the same hypocaloric diet . Results Following the intervention , there was a significant reduction in blood pressure and body mass in all groups with no between-group differences for blood pressure . However , body mass was significantly less reduced in the attention control group compared with all exercise groups ( attention control –6.6 % , high-volume MICT –8.3 % , high-volume HIIT –9.7 % , low-volume HIIT –6.9 % ) . HIIT groups had significantly higher cardiorespiratory fitness than high-volume MICT , but there were no significant between-HIIT differences ( attention control 16.4 % , high-volume MICT 23.6 % , high-volume HIIT 36.7 % , low-volume HIIT 30.5 % ) . Medication was removed in 7.6 % and reduced in 37.7 % of the participants . Conclusions The combination of hypocaloric diet with supervised aerobic exercise 2 days/week offers an optimal non-pharmacological tool in the management of blood pressure , cardiorespiratory fitness and body composition in overweight/obese and sedentary individuals with hypertension . High-volume HIIT seems to be better for reducing body mass compared with low-volume HIIT . The exercise-induced improvement in cardiorespiratory fitness is intensity dependent with low-volume HIIT as a time-efficient method in this population . Clinical Trials.gov Registration : NCT02283047 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 The effects of long-term aerobic exercise on endothelial function in patients with essential hypertension remain unclear . To determine whether endothelial function relating to forearm hemodynamics in these patients differs from normotensive subjects and whether endothelial function can be modified by continued physical exercise , we r and omized patients with essential hypertension into a group that engaged in 30 minutes of brisk walking 5 to 7 times weekly for 12 weeks ( n=20 ) or a group that underwent no activity modifications  ( control group , n=7 ) . Forearm blood flow was measured using strain-gauge plethysmography during reactive hyperemia to test for endothelium-dependent vasodilation and after sublingual nitroglycerin administration to test endothelium-independent vasodilation . Forearm blood flow in hypertensive patients during reactive hyperemia was significantly less than that in normotensive subjects ( n=17 ) . Increases in forearm blood flow after nitroglycerin were similar between hypertensive and normotensive subjects . Exercise lowered mean blood pressure from 115.7+/-5.3 to 110.2+/-5.1 mm Hg ( P<0.01 ) and forearm vascular resistance from 25.6+/-3.2 to 23 . 2+/-2.8 mm Hg/mL per minute per 100 mL tissue ( P<0.01 ) ; no change occurred in controls . Basal forearm blood flow , body weight , and heart rate did not differ with exercise . After 12 weeks of exercise , maximal forearm blood flow response during reactive hyperemia increased significantly , from 38.4+/-4.6 to 47.1+/-4.9 mL/min per 100 mL tissue ( P<0.05 ) ; this increase was not seen in controls . Changes in forearm blood flow after sublingual nitroglycerin administration were similar before and after 12 weeks of exercise . Intra-arterial infusion of the nitric oxide synthase inhibitor NG-monomethyl-L-arginine abolished the enhancement of reactive hyperemia induced by 12 weeks of exercise . These findings suggest that through increased release of nitric oxide , continued physical exercise alleviates impairment of reactive hyperemia in patients with essential hypertension Background —Reductions in the compliance of central arteries exert a number of adverse effects on cardiovascular function and disease risk . Endurance training is efficacious in increasing arterial compliance in healthy adults . We determined the effects of resistance training on carotid arterial compliance using the intervention study design . Methods and Results —Twenty-eight healthy men 20 to 38 years old were r and omly assigned to the intervention group ( n=14 ) and the control group ( n=14 ) . Control subjects were instructed not to alter their normal activity levels throughout the study period . Intervention subjects underwent 3 supervised resistance training sessions per week for 4 months and detraining for a subsequent 4 months . The resistance training increased maximal strength in all muscle groups tested ( P<0.001 ) . There were no significant differences in baseline arterial compliance and & bgr;-stiffness index between the intervention and control groups . In the intervention group , carotid arterial compliance decreased 19 % ( P<0.05 ) , and & bgr;-stiffness index increased 21 % ( P<0.01 ) after resistance training . These values returned completely to the baseline levels during the detraining period . Arterial compliance did not change in the control group . In both groups , there were no significant changes in brachial and carotid blood pressure , carotid intima-media thickness , lumen diameter , and femoral arterial compliance . Changes in carotid artery compliance were significantly and negatively related to corresponding changes in left ventricular mass index ( r=−0.56 , P<0.001 ) and left ventricular hypertrophy index ( r=−0.68 , P<0.001 ) . Conclusions —In marked contrast to the beneficial effect of regular aerobic exercise , several months of resistance training “ reduces ” central arterial compliance in healthy men BACKGROUND Lifestyle modification ( i.e. , regular physical activity and diet ) is effective in preventing the age-related increase in cardiovascular disease risks . Potential therapeutic effects of curcumin ( diferuloylmethane ) have been confirmed on various diseases , including cancer and Alzheimer 's disease , but the effects of curcumin have not been tested on central arterial hemodynamics . The aim of this pilot study was to test the hypothesis that the regular endurance exercise combined with daily curcumin ingestion lowers the age-related increase in left ventricular ( LV ) afterload to a greater extent than monotherapy with either intervention alone in postmenopausal women using a r and omized , double-blind , placebo-controlled , parallel manner . METHODS Forty-five women were r and omly assigned to four interventions : " placebo ingestion " ( n = 11 ) , " curcumin ingestion " ( n = 11 ) , " exercise training with placebo ingestion " ( n = 11 ) , or " exercise training with curcumin ingestion " ( n = 12 ) . Curcumin or placebo pills ( 150 mg/day ) were administered for 8 weeks . Aortic blood pressure ( BP ) and augmentation index ( AIx ) , an index of LV afterload , were evaluated by pulse wave analysis from tonometrically measured radial arterial pressure waveforms . RESULTS There were no significant differences in baseline hemodynamic variables among four groups . After the interventions , brachial systolic BP ( SBP ) significantly decreased in both exercise-trained groups ( P < 0.05 for both ) , whereas aortic SBP significantly decreased only in the combined-treatment ( e.g. , exercise and curcumin ) group ( P < 0.05 ) . Heart rate ( HR ) corrected aortic AIx significantly decreases only in the combined-treatment group . CONCLUSIONS These findings suggest that regular endurance exercise combined with daily curcumin ingestion may reduce LV afterload to a greater extent than monotherapy with either intervention alone in postmenopausal women Purpose Regular physical exercise is recommended for the prevention and treatment of cardiovascular disease . However , it is unclear whether the effects of exercise training on arterial stiffness are the same in older hypertensive individuals as those observed in older healthy subjects . The aim of this study was to compare the effects of exercise training on arterial stiffness between older hypertensive and healthy females . Methods Ninety-two females with untreated hypertension and 108 healthy females were r and omly 
    Output:
    
Aerobic exercise training significantly ( p < 0.001 ) reduced systolic and diastolic BP in each ethnic group .
Sub-analyses suggested somewhat larger reductions in systolic BP  following aerobic training in hypertensive Africans compared with hypertensive Asians .