***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 Cycle ergometer training is an important component of pulmonary rehabilitation for patients with COPD . However , incremental cycle tests from which individualized cycle training intensity can be prescribed may not be readily available to clinicians . The aims of the study were to ( i ) investigate the physiological and psychophysical responses to the 6-min walk test ( 6MWT ) , incremental shuttle walk test ( ISWT ) and cycle ergometer test ( CET ) ; and ( ii ) determine whether the distance walked in either the 6MWT or the ISWT could be used to estimate peak work rate on a cycle ergometer . METHODS A repeated measures study was undertaken in COPD patients in a stable condition . The 6MWT , ISWT and CET were performed in r and om order , and physiological responses , rate of perceived exertion and dyspnoea were measured . RESULTS Twenty-two patients with COPD completed the study . There was no significant difference in peak oxygen uptake between the 6MWT , ISWT and CET . The significant correlation between the 6MWD and incremental shuttle walk distance with peak watts on the CET ( r = 0.63 , P = 0.002 and r = 0.75 , P < 0.001 , respectively ) was strengthened by the inclusion of weight , age and gender ( r = 0.89 P = 0.001 and r = 0.91 , P < 0.001 ) . Bl and -Altman analysis demonstrated a strong agreement between peak work rate measured on the CET and that estimated from either the 6MWT or the ISWT . CONCLUSIONS The significant relationships found between the three exercise tests , and the regression equations predicting peak work rate on the CET from the 6MWT or the ISWT , may allow for the estimation of intensity of cycle exercise training from walk tests in COPD patients OBJECTIVE To compare training and follow-up effects of combined aerobic and strength training versus aerobic-only training on cognitive and motor function in institutionalized patients with dementia and to explore whether improved motor function mediates improved cognitive function . METHODS Using a 9-week , parallel , three-group , single-blind , r and omized , controlled trial with a follow-up assessment at week 18 , we assessed 109 patients with dementia ( age 85.5 ± 5.1 years ) in a psycho-geriatric nursing home . Each 9-week intervention consisted of 36 , 30-minute sessions . A combined group ( N = 37 ) received and completed two strength and two walking sessions per week , an aerobic group ( N = 36 ) completed four walking sessions , and a social group ( N = 36 ) completed four social visits per  week . Cognitive and motor functions were assessed at baseline , after the 9-week intervention , and after a consecutive 9 weeks of usual care . RESULTS Baseline corrected post-test scores in the combined versus the social group were higher for global cognition , visual memory , verbal memory , executive function , walking endurance , leg muscle strength , and balance . Aerobic versus social group scores were higher for executive function . Follow-up effects reversed toward baseline values . Motor improvement did not significantly mediate cognitive improvement . CONCLUSION Compared with a nonexercise control group , a combination of aerobic and strength training is more effective than aerobic-only training in slowing cognitive and motor decline in patients with dementia . No mediating effects between improvements in cognitive function via improved motor function were found . Future research into the underlying mechanistic associations is needed BACKGROUND There is currently no disease-modifying treatment available to halt or delay the progression of the disease pathology in dementia . An agreed core set of the best-available and most appropriate outcomes for disease modification would facilitate the design of trials and ensure consistency across disease modification trials , as well as making results comparable and meta-analysable in future trials . OBJECTIVES To agree a set of core outcomes for disease modification trials for mild to moderate dementia with the UK dementia research community and patient and public involvement ( PPI ) . DATA SOURCES We included disease modification trials with quantitative outcomes of efficacy from ( 1 ) references from related systematic review s in workstream 1 ; ( 2 ) search es of the Cochrane Dementia and Cognitive Improvement Group study register , Cochrane Central Register of Controlled Trials , Cumulative Index to Nursing and Allied Health Literature , EMBASE , Latin American and Caribbean Health Sciences Literature and PsycINFO on 11 December 2015 , and clinical trial registries [ International St and ard R and omised Controlled Trial Number ( IS RCT N ) and clinical trials.gov ] on 22 and 29 January 2016 ; and ( 3 ) h and - search es of reference lists of relevant systematic review s from data base search es . REVIEW METHODS The project consisted of four workstreams . ( 1 ) We obtained related core outcome sets and work from co-applicants . ( 2 ) We systematic ally review ed published and ongoing disease modification trials to identify the outcomes used in different domains . We extracted outcomes used in each trial , recording how many used each outcome and with how many participants . We divided outcomes into the domains measured and search ed for validation data . ( 3 ) We consulted with PPI participants about recommended outcomes . ( 4 ) We presented all the synthesis ed information at a conference attended by the wider body of National Institute for Health Research ( NIHR ) dementia research ers to reach consensus on a core set of outcomes . RESULTS We included 149 papers from the 22,918 papers screened , referring to 125 individual trials . Eighty-one outcomes were used across trials , including 72 scales [ 31 cognitive , 12 activities of daily living ( ADLs ) , 10 global , 16 neuropsychiatric and three quality of life ] and nine biological techniques . We consulted with 18 people for PPI . The conference decided that only cognition and biological markers are core measures of disease modification . Cognition should be measured by the Mini Mental State Examination ( MMSE ) or the Alzheimer 's Disease Assessment Scale - Cognitive subscale ( ADAS-Cog ) , and brain changes through structural magnetic resonance imaging ( MRI ) in a subset of participants . All other domains are important but not core . We recommend using the Neuropsychiatric Inventory for neuropsychiatric symptoms : the Disability Assessment for Dementia for ADLs , the Dementia Quality of Life Measure for quality of life and the Clinical Dementia Rating scale to measure dementia globally . LIMITATIONS Most of the trials included participants with Alzheimer 's disease , so recommendations may not apply to other types of dementia . We did not conduct economic analyses . The PPI consultation was limited to members of the Alzheimer 's Society Research Network . CONCLUSIONS Cognitive outcomes and biological markers form the core outcome set for future disease modification trials , measured by the  MMSE or ADAS-Cog , and structural MRI in a subset of participants . FUTURE WORK We envisage that the core set may be superseded in the future , particularly for other types of dementia . There is a need to develop an algorithm to compare scores on the MMSE and ADAS-Cog . STUDY REGISTRATION The project was registered with Core Outcome Measures in Effectiveness Trials [ www.comet-initiative.org/ studies /details/819 ? result = true ( accessed 7 April 2016 ) ] . The systematic review protocol is registered as PROSPERO CRD42015027346 . FUNDING The National Institute for Health Research Health Technology Assessment programme Background Dementia is more common in older than in younger people , and as a result of the ageing of the population in developed countries , it is becoming more prevalent . Drug treatments for dementia are limited , and the main support offered to people with dementia and their families is generally services to mitigate against loss of function . Physical exercise is a c and i date non-pharmacological treatment for dementia . Methods / Design DAPA is a r and omised controlled trial funded by the National Institute for Health Research Health Technology Assessment programme to estimate the effect of a 4-month , moderate- to hard-intensity exercise training programme and subsequent advice to remain active , on cognition ( primary outcome ) at 12 months in people with mild to moderate dementia . Community-dwelling participants ( with their carers where possible ) , who are able to walk 3 metres without human assistance , able to undertake an exercise programme and do not have any unstable or terminal illness are recruited . Participants are then r and omised by an independent statistician using a computerised r and om number generator to usual care or exercise at a 2:1 ratio in favour of exercise . The exercise intervention comprises 29 , 1-hour-long exercise classes , run twice weekly at suitable venues such as leisure centres , which include aerobic exercise ( on static bikes ) and resistance exercise ( using weights ) . Goals for independent exercise are set while the classes are still running , and supported thereafter with phone calls . The primary outcome is measured using ADAS-cog . Secondary outcome measures include behavioural symptoms , functional ability , quality of life and carer burden . Primary and secondary outcomes will be measured at baseline and at 6 and 12 months after r and omisation , by research ers masked to participant r and omisation in the participants ’ own homes . An economic evaluation will be carried out in parallel to the RCT , as will a qualitative study capturing the experiences of participants , carers and staff delivering the intervention . Discussion The DAPA study will be the first large , r and omised trial of the cognitive effects of exercise on people with dementia . The intervention is design ed to be capable of being delivered within the constraints of NHS service provision , and the economic evaluation will allow assessment of its cost-effectiveness . Trial registration DAPA was registered with the IS RCT N data base on 29 July 2011 , registration number IS RCT N32612072 More than 800000 people in the UK have dementia , and it is a government priority to improve dementia care . Drug treatment options are relatively limited . The Dementia And Physical Activity ( DAPA ) study is a r and omised trial which targets cognition in people with dementia , using an exercise programme . There is evidence to suggest that both aerobic and resistance exercise may be useful in improving cognition . Hence the intervention comprises a supervised part of twice-weekly exercise classes of one hour duration for 4 months , including aerobic exercise at moderate intensity on static bicycles , and resistance ( weight training ) exercise using weight vests , weight belts and dumbbells . Thereafter participants progress to unsupervised , independent exercise . Aids to behaviour modification have been incorporated into the intervention . The DAPA intervention has been design ed to maximise likelihood of effectiveness and cost-effectiveness , and for delivery in the UK National Health Service BACKGROUND Data regarding the relationship between physical activity and  cognitive impairment  are limited and controversial . We examined whether physical activity is associated with incident cognitive impairment during follow-up . METHODS As part of a community-based prospect i ve cohort study in southern Bavaria , Germany , 3903 participants older than 55 years were enrolled between 2001 and 2003 and followed up for 2 years .  Physical activity ( classified as no activity , moderate activity [ <3 times/wk ] , and high activity [ > or =3 times/wk ] ) , cognitive function ( assessed by the 6-Item Cognitive Impairment Test )  , and potential confounders were evaluated . The main outcome measure was incident cognitive impairment after 2 years of follow-up . RESULTS At baseline , 418 participants ( 10.7 % ) had cognitive impairment . After a 2-year follow-up , 207 of 3485 initially unimpaired subjects ( 5.9 % ) developed incident cognitive impairment . Compared with participants without physical activity , fully adjusted multiple logistic regression analysis showed a significantly reduced risk of incident cognitive impairment after 2 years for participants with moderate or high physical activity at baseline ( odds ratio [ OR ] , 0.57 ; 95 % confidence interval [ CI ] , 0.37 - 0.87 [ P = .01 ] ; and OR , 0.54 ; 95 % CI , 0.35 - 0.83 [ P = .005 ] ; respectively ) . Further sub analysis including participants ( n = 2029 ) without functional impairment and without prodromal phase of dementia result ed in an even higher reduction of risk of incident cognitive impairment for participants with moderate or high physical activity ( OR , 0.44 ; 95 % CI , 0.24 - 0.83 [ P = .01 ] ; and OR , 0.46 ; 95 % CI , 0.25 - 0.85 [ P = .01 ] ; respectively ) compared with no activity . CONCLUSION Moderate or high physical activity is associated with a reduced incidence of cognitive impairment after 2 years in a large population -based cohort of elderly subjects BACKGROUND AND PURPOSE Knowledge concerning the applicability and the effect of high-intensity exercise programs is very limited for older people with severe cognitive and physical impairments . The primary aim of this study was to evaluate the applicability of a high-intensity functional weight-bearing exercise program among older people who are dependent in activities of daily living and living in residential care facilities . A second aim was to analyze whether cognitive function was associated with the applicability of the program . SUBJECTS The subjects were 91 older people ( mean age=85.3 years , SD=6.1 , range=68 - 100 ) who were dependent in personal activities of daily living and r and omly assigned to participate in an exercise intervention .  Their mean score for the Mini-Mental State Examination ( MMSE ) was 17.5 ( SD=5.0 , range=10 - 29 ) . METHODS A high-intensity functional weight-bearing exercise program was performed in groups of 3 to 7 participants who were supervised by physical therapists . There were  
    Output:
    
The exercise intervention was dominated in health economic terms .
This is a large well-conducted RCT , with good compliance to exercise and research procedures .
A structured exercise programme did not produce any clinical ly meaningful benefit in function or HRQoL in people with dementia or on carer burden .