***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 Background Declines in cognitive functioning are a normal part of aging that can affect daily functioning and quality of life . This study will examine the impact of an exercise training program , and a combined exercise and cognitive training program , on the cognitive and physical functioning of older adults . Methods / Design Fit Bodies , Fine Minds is a r and omized , controlled trial . Community-dwelling adults , aged between 65 and 75 years , are r and omly allocated to one of three groups for 16 weeks . The exercise-only group do three 60-minute exercise sessions per week . The exercise and cognitive training group do two 60-minute exercise sessions and one 60-minute cognitive training session per week . A no-training control group is contacted every 4 weeks . Measures of cognitive functioning , physical fitness and psychological well-being are taken at baseline ( 0 weeks ) , post-test ( 16 weeks ) and 6-month follop ( 40 weeks ) . Qualitative responses to the program are taken at post-test . Discussion With an increasingly aged population , interventions to improve the functioning and quality of life of older adults are particularly important . Exercise training , either alone or in combination with cognitive training , may be an effective means of optimizing cognitive functioning in older adults . This study will add to the growing evidence base on the effectiveness of these interventions .Trial Registration Australian Clinical Trials Register : 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 In the current work we asked whether executive function , as measured by tests of working memory capacity , might benefit from an acute bout of exercise and , more specifically , whether individuals who are lower or higher in working memory to begin with would be more or less affected by an exercise manipulation . Healthy adults completed working memory measures in a nonexercise ( baseline ) session and immediately following a 30-min self-paced bout of exercise on a treadmill ( exercise session ) . Sessions were conducted 1 week apart and session order was counterbalanced across participants . A significant Session x Working Memory interaction was obtained such that only those individuals lowest in working memory benefited from the exercise manipulation . This work suggests that acute bouts of exercise may be most beneficial for healthy adults whose cognitive performance is generally the lowest , and it demonstrates that the impact of exercise on cognition is not uniform across all individuals 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 Physical exercise has been shown to increase brain volume and improve cognition in r and omized trials of non-demented elderly . Although greater social engagement was found to reduce dementia risk in observational studies , r and omized trials of social interventions have not been reported . A representative sample of 120 elderly from Shanghai , China was r and omized to four groups ( Tai Chi , Walking , Social Interaction , No Intervention ) for 40 weeks . Two MRIs were obtained , one before the intervention period , the other after . A neuropsychological battery was administered at baseline , 20 weeks , and 40 weeks . Comparison of changes in brain volumes in intervention groups with the No Intervention group were assessed by t-tests . Time-intervention group interactions for neuropsychological measures were evaluated with repeated- measures mixed models . Compared to the No Intervention group , significant increases in brain volume were seen in the Tai Chi and Social Intervention groups ( p < 0.05 ) . Improvements also were observed in several neuropsychological measures in the Tai Chi group , including the Mattis Dementia Rating Scale score ( p = 0.004 ) , the Trailmaking Test A ( p = 0.002 ) and B ( p = 0.0002 ) , the Auditory Verbal Learning Test ( p = 0.009 ) , and verbal fluency for animals ( p = 0.01 ) . The Social Interaction group showed improvement on some , but fewer neuropsychological indices . No differences were observed between the Walking and No Intervention groups . The findings differ from previous clinical trials in showing increases in brain volume and improvements in cognition with a largely non-aerobic exercise ( Tai Chi ) . In addition , intellectual stimulation through social interaction was associated with increases in brain volume as well as with some cognitive improvements CONTEXT Many observational studies have shown that physical activity reduces the risk of cognitive decline ; however , evidence from r and omized trials is lacking . OBJECTIVE To determine whether physical activity reduces the rate of cognitive decline among older adults at risk . DESIGN AND SETTING R and omized controlled trial of a 24-week physical activity intervention conducted between 2004 and 2007 in metropolitan Perth , Western Australia . Assessors of cognitive function were blinded to group membership . PARTICIPANTS We recruited volunteers who reported memory problems but did not meet criteria for dementia . Three hundred eleven individuals aged 50 years or older were screened for eligibility , 89 were not eligible , and 52 refused to participate . A total of 170 participants were r and omized and 138 participants completed the 18-month assessment . INTERVENTION Participants were r and omly allocated to an education and usual care group or to a 24-week home-based program of physical activity . MAIN OUTCOME MEASURE Change in Alzheimer Disease Assessment Scale-Cognitive Subscale ( ADAS-Cog ) scores ( possible range , 0 - 70 ) over 18 months . RESULTS In an intent-to-treat analysis , participants in the intervention group improved 0.26 points ( 95 % confidence interval , -0.89 to 0.54 ) and those in the usual care group deteriorated 1.04 points ( 95 % confidence interval , 0.32 to 1.82 ) on the ADAS-Cog at the end of the intervention . The absolute difference of the outcome measure between the intervention and control groups was -1.3 points ( 95 % confidence interval,-2.38 to -0.22 ) at the end of the intervention . At 18 months , participants in the intervention group improved 0.73 points ( 95 % confidence interval , -1.27 to 0.03 ) on the ADAS-Cog , and those in the usual care group improved 0.04 points ( 95 % confidence interval , -0.46 to 0.88 ) . Word list delayed recall and Clinical Dementia Rating sum of boxes improved modestly as well , whereas word list total immediate recall , digit symbol coding , verbal fluency , Beck depression score , and Medical Outcomes 36-Item Short-Form physical and mental component summaries did not change significantly . CONCLUSIONS In this study of adults with subjective memory impairment , a 6-month program of physical activity provided a modest improvement in cognition over an 18-month follow-up period . TRIAL REGISTRATION anzctr.org.au Identifier : ACTRN12605000136606 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 Objective : To study the influence of leisure activity participation on risk of development of  amnestic mild cognitive impairment ( aMCI ) .  Methods : The authors examined the relationship between baseline level of participation in leisure activities and risk of aMCI in a prospect i ve cohort of 437 community-residing subjects older than 75 years , initially free of dementia or aMCI , using Cox analysis adjusted for age , sex , education , and chronic illnesses . The authors derived  Cognitive and Physical Activity Scales based on frequency of participation in individual activities . Results : Over a median follow-up of 5.6 years , 58 subjects had development of aMCI . A one-point increase on the Cognitive ( hazard ratio [ HR ] 0.95 , 95 % CI 0.91 to 0.99 ) but not Physical Activities Scale ( HR 0.97 , 95 % CI 0.93 to 1.01 ) was associated with lower risk of aMCI . Subjects with Cognitive Activity scores in the highest ( HR 0.46 , 95 % CI 0.2 
    Output:
    
Our analyses comparing aerobic exercise to any active intervention showed no evidence of benefit from  aerobic exercise  in any cognitive domain .
This was also true of our analyses comparing aerobic exercise to no intervention .
Our subgroup analyses of aerobic exercise versus flexibility or balance interventions also showed no benefit of aerobic exercise in any cognitive domain .
Overall none of our analyses showed a cognitive benefit from aerobic exercise even when the intervention was shown to lead to improved cardiorespiratory fitness .
We found no evidence in the available data from RCTs that aerobic physical activities , including those which successfully improve cardiorespiratory fitness , have any cognitive benefit in cognitively healthy older adults .