***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: Abstract Objective : To evaluate the effectiveness of combinations of three methods to promote physical activity . Design : R and omised controlled trial . Baseline assessment with post-intervention follow up at 12 weeks and 1 year . Setting : One urban general practice , 1995 - 7 . Participants : 523 adults aged 40 to 64 years , r and omised to four intervention groups and a control group . Interventions : Brief ( one interview ) or intensive ( six interviews over 12 weeks ) motivational interviewing based on the stages of change model of behaviour change , with or without financial incentive ( 30 vouchers entitling free access to leisure facilities ) . Main outcome measures : Physical activity score ; sessions of moderate and vigorous activity in the preceding four weeks . Results : Response rate was 81 % at 12 weeks and 85 % at one year . More participants in the intervention group reported increased physical activity scores at 12 weeks than controls ( 38 % v 16 % , difference 22 % , 95 % confidence interval for difference 13 % to 32 % ) , with a 55 % increase observed in those offered six interviews plus vouchers . Vigorous activity increased in 29 % of intervention participants and 11 % of controls ( difference 18 % , 10 % to 26 % ) , but differences between the intervention groups were not significant . Short term increases in activity were not sustained , regardless of intensity of intervention . Conclusions : The most effective intervention for promoting adoption of exercise was the most intensive . Even this did not promote long term adherence to exercise . Brief interventions promoting physical activity that are used by many schemes in the United Kingdom are of question able effectiveness . Key messages Schemes promoting physical activity are currently popular in general practice in Britain , but few have been rigorously evaluated and their effectiveness is unknown . In this study , the most effective intervention for promoting adoption of physical activity was the most intensive , involving six motivational interviews and a financial incentive A comparatively brief intervention ( one interview ) was only effective in the short term in around a third of participants Short term increases in physical activity were not maintained at one year follow up and even the most intensive intervention was ineffective in promoting long term adherence to increased physical activity . National and local government , health authorities , and primary healthcare teams should be cautious about current and future expenditure on , and implementation of , exercise prescription or referral OBJECTIVES We examined the viability and efficacy of a known quantity of exercise in facilitating weight loss among previously sedentary or irregularly active overweight and obese adult women residing in a slum ( favela ) in Brazil . METHODS In this r and omized controlled trial , 156 women were r and omized to a  control or intervention group  ( 78 in each group ) . Exercise was supervised , consisting of three 50-minute aerobic sessions each week for 6 months . RESULTS Ninety-one percent ( 71 ) of the participants in the intervention group completed 6 months of the exercise program . At 6 months , women in the treatment group showed significant reduction in weight ( mean=-1.69 kg ; 95 % confidence interval [CI]=-2.36,-1.03 ) and body mass index ( mean=-0.63 kg/m2 ; 95 % CI=-0.97 , -0.30 ) compared with controls ( P for both<.001 ) . CONCLUSIONS A moderately intense , structured exercise program result ed in modest weight loss in women when sustained for 6 months Background In many countries exercise prescriptions are used in an attempt to initiate a physically active lifestyle in sedentary population s. Previous studies have primarily evaluated low intensive exercise prescription interventions and found moderately positive effects on physical activity and aerobic fitness . In a highly intensive Danish exercise prescription scheme called ' Exercise on Prescription ' ( EoP ) the general practitioners can prescribe EoP to sedentary patients with lifestyle diseases . The aim of this r and omized trial is to assess the short- and long-term effects of the EoP scheme . Thus , the aim of this paper is to describe the r and omized controlled trial design ed for evaluating effectiveness of EoP , and to present results from validations of outcome measures . Methods / Design EoP involves a 16-week supervised training intervention and five counselling sessions ( health profiles ) .  All patients referred to EoP were eligible for the trial and were offered participation during the baseline health profile . Comparisons between the EoP group and the control group were made at baseline , and after four and ten months . Physiological measures used were maximal oxygen uptake ( VO2max ) , glycosylated haemoglobin ( HbA1c ) , bodyweight , and BMI . Patient-reported measures used were physical activity , health-related quality of life , amount and intensity of exercise , compliance with national guidelines for physical activity , and physical fitness . The validation of the cycle ergometer test found a strong correlation between maximal work capacity and VO2max , and acceptable test-retest reliability at group level . Calibration of the HbA1c apparatus was stable over ten weeks with minimal use , and test-retest reliability was good . High agreement percents were found for test-retest reliability for the self-administered question naire . Discussion The trial is design ed to provide information about the effectiveness of the EoP scheme . The trial is part of a health technology assessment of EoP , which besides the effectiveness covers the patient perspective , the organization , and the health economy . All three methods vali date d were found useful for the EoP trial Study objective : To compare health walks , a community based lay-led walking scheme versus advice only on physical activity  and cardiovascular health status in middle aged adults . Design : R and omised controlled trial with one year follow up . Physical activity was measured by question naire . Other measures included attitudes to exercise , body mass index , cholesterol , aerobic capacity , and blood pressure . Setting : Primary care and community . Participants : 260 men and women aged 40–70 years , taking less than 120 minutes of moderate intensity activity per week . Main results : Seventy three per cent of people completed the trial . Of these , the proportion increasing their activity above 120 minutes of moderate intensity activity per week was 22.6 % in the advice only and 35.7 % in the health walks group at 12 months ( between group difference = 13 % ( 95 % CI 0.003 % to 25.9 % ) p=0.05 ) . Intention to treat analysis , using the last known value for missing cases , demonstrated smaller differences between the groups ( between group difference = 6 % ( 95 % CI −5 % to 16.4 % ) ) with the trend in favour of health walks . There were improvements in the total time spent and number of occasions of moderate intensity activity , and aerobic capacity , but no statistically significant differences between the groups . Other cardiovascular risk factors remained unchanged . Conclusions : There were no significant between group differences in self reported physical activity at 12 month follow up when the analysis was by intention to treat . In people who completed the trial , health walks was more effective than giving advice only in increasing moderate intensity activity above 120 minutes per week OBJECTIVE To evaluate three strategies for promoting physical activity ( PA ) in a primary care setting . METHOD Data were collected between 2002 and 2004 from 136 patients attending two general practice s in Brisbane , Australia . Inactive patients ( 50 - 70 years ) were r and omly allocated to one of three hierarchical intervention groups : the general practitioner ( GP ) group received ' brief ' advice ; the GP+ES group also received behavior change advice from an exercise scientist ( ES ) ; and the GP+ES+P group also received a pedometer .  Self-reported PA and its determinants were measured at baseline and weeks 12 and 24 . Cardio-respiratory variables were measured at baseline and week 12 . RESULTS Overall , mean PA time increased by 84 and 128 min/week at weeks 12 and 24 ( p<.01 ) with no significant group differences . Small improvements in blood pressure and post-exercise heart rate were observed . At week 24 , the GP+ES+P group were more likely to report meeting PA guidelines than the GP group ( OR=2.39 95 % CI : 1.01 , 5.64 ) . CONCLUSION PA levels can be increased in mid- to older-age adults , either by brief advice from motivated GPs alone , or from collaboration between GPs and ESs . The most intense intervention ( GP+ES+P ) showed the most promising results OBJECTIVES To evaluate and compare the effectiveness and cost-effectiveness of a leisure centre-based exercise programme , an instructor-led walking programme and advice-only in patients referred for exercise by their GPs . DESIGN A single-centre , parallel-group , r and omised controlled trial , consisting of three arms , with the primary comparison at 6 months . SETTING Assessment s were carried out at Copthall Leisure Centre in Barnet , an outer London borough , and exercise programmes conducted there and at three other leisure centres and a variety of locations suitable for supervised walking throughout the borough . PARTICIPANTS Participants were aged between 40 and 74 years , not currently physically active and with at least one cardiovascular risk factor . INTERVENTIONS The 943 patients who agreed to participate in the trial were assessed in cohorts and r and omised to one of the following three arms : a 10-week programme of supervised exercise classes , two to three times a week in a local leisure centre ; a 10-week instructor-led walking programme , two to three times a week ; an advice-only control group who received tailored advice and information on physical activity including information on local exercise facilities . After 6 months the control group were rer and omised to one of the other trial arms . Assessment s took place before r and omisation , at 10 weeks ( in a r and om 50 % sub sample of participants ) , 6 months and 1 year in the leisure centre and walking arms . The control participants were similarly assessed up to 6 months and then reassessed at the same intervals as those initially r and omised to the leisure centre and walking groups . MAIN OUTCOME MEASURES The primary outcome measures were changes in self-reported exercise behaviour , blood pressure , total cholesterol and lipid subfractions . Secondary outcomes included changes in anthropometry , cardiorespiratory fitness , flexibility , strength and power , self-reported lifestyle behaviour , general and psychological health status , quality of life and health service usage . The costs of providing and making use of the service were quantified for economic evaluation . RESULTS There was a net increase in the proportion of participants achieving at least 150 minutes per week of at least moderate activity in the sport/leisure and walking categories in all three study groups : at 6 months , the net increases were 13.8 % in the leisure centre group , 11.1 % in the walking group and 7.5 % in the advice-only group . There were significant reductions in systolic and diastolic blood pressure in all groups at each assessment point compared with baseline . There were also significant and sustained improvements in cardiorespiratory fitness and leg extensor power , and small reductions in total and low-density lipoprotein cholesterol in all groups , but there were no consistent differences between the groups for any parameter over time . All three groups showed improvement in anxiety and mental well-being scores 6 months after the beginning of the trial . Leisure centre and walking groups maintained this improvement at 1 year . There were no differences between groups . Costs to the participants amounted to pound 100 for the leisure centre scheme and pound 84 for the walking scheme , while provider costs were pound 186 and pound 92 , respectively . Changes in overall Short Form 36 scores were small and advice only appeared the most cost-effective intervention . CONCLUSIONS The results of this trial suggest that referral for tailored advice , supported by written material s , including details of locally available facilities , supplemented by detailed assessment s may be effective in increasing physical activity . The inclusion of supervised exercise classes or walks as a formal component of the scheme may not be more effective than the provision of information about their availability . On cost-effectiveness grounds , assessment and advice alone from an exercise specialist may be appropriate to initiate action in the first instance . Subsidised schemes may be best concentrated on patients at higher absolute risk , or with specific conditions for which particular programmes may be beneficial . Walking appears to be as effective as leisure centre classes and is cheaper . Efforts should be directed towards maintenance of increased activity , with proven measures such as telephone support . Further research should include an up date d meta- analysis of published exercise interventions using the st and ardised mean difference approach Objective : To assess the effectiveness of domiciliary physical fitness programmes in obese individuals . Design : Nine-month r and omized controlled trial . Setting : Home-based intervention with outpatient visits . Subjects : Morbidly obese subjects ( body mass index ( BMI ) ≥30 ) aged 25—65 years suitable for physical activities at home . Intervention : At the end of a preliminary one-month in-hospital rehabilitation programme ( baseline ) , 52 patients were r and omly assigned either to a structured educational programme ( intervention group ) of daily incremental physical activity at home ( walking and skeletal muscle resistance training , with booklets and written instructions ) or to a programme of general advice ( control group ) regarding exercise and long-term fitness . Main measures : Both groups were evaluated at baseline and every three months for : ( 1 ) time , metabolic equivalents ( METs ) , and heart rate reserve ( HRR ) during a st and ardized 2-km walking test ( 2kmWT ) ; ( 2 ) anthropometric measures ( body weight , BMI , abdominal and neck circumference ) ; ( 3 ) the Polar Fitness Test index ( PFTI ) , and ( 4 ) time to exhaustion while sustaining consecutive isoload extensions in the dominant leg ( isoload LE ) . Time during 2kmWT was the study primary outcome . Results : Body weight , BMI and abdominal circumference improved significantly ( P<0.05 ) over time in the intervention group . The cardiopulmonary fitness variables changed significantly ( P<0.0 
    Output:
    
Evidence of a between group difference in physical activity of moderate or vigorous intensity or in other health outcomes was inconsistent at follow-up .
We did not find any difference in outcomes between exercise referral schemes and the other two comparator groups .
Conclusions Considerable uncertainty remains as to the effectiveness of exercise referral schemes for increasing physical activity , fitness , or health indicators , or whether they are an efficient use of re sources for sedentary people with or without a medical diagnosis