***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: This paper reports on the cost-effectiveness of pedometer-based versus time-based Green Prescriptions in improving physical activity and health-related quality of life ( EQ-5D ) in a r and omised controlled trial of 330 low-active , community-based adults aged 65 years and over . Costs , measured in $ NZ ( NZ$1=A$0.83 , December 2008 ) , comprised public and private health care costs plus exercise-related personal expenditure . Based on intention-to-treat data at 12-month follow up , the pedometer group showed a greater increase in weekly leisure walking ( 50.6 versus 28.1min for the time-based group , adjusted means , P=0.03 ) . There were no significant between-group differences in costs . The incremental cost-effectiveness ratios , for the pedometer-based versus time-based Green Prescription , per 30min of weekly leisure walking and per quality -adjusted life year were , ( i ) when including only community care costs , $ 115 and $ 3105 , ( ii ) when including only exercise and community care costs , $ 130 and $ 3500 , and ( iii ) for all costs , -$185 and -$4999 , respectively . The cost-effectiveness acceptability curves showed that the pedometer-based compared with the time-based Green Prescription was statistically cost-effective , for the above cost categories , at the following quality -adjusted life year thresholds : ( i ) $ 30000 ; ( ii ) $ 30500 ; and ( iii ) $ 16500 . The additional program cost of converting one sedentary adult to an active state over a 12-month period was $ 667 . The outcomes suggest the pedometer-based Green Prescription may be cost-effective in increasing physical activity and health-related quality of life over 12 months in previously low-active older adults Background The aim of the present study was to evaluate the cost-effectiveness of tailored print communication ( TPC ) , telephone motivational interviewing ( TMI ) , a combination of the two , and no intervention on two outcomes in adults aged 45 to 70 , half of them having hypertension : increasing the number of public health guidelines met for three behaviors ( physical activity and fruit and vegetable consumption ) , and impact on quality adjusted life years ( QALYs ) . Methods Participants ( n = 1,629 ) from 23 Dutch general practice s were r and omized into one of four groups , which received 4 TPCs , 4 TMIs , 2 of each ( combined ) , or no intervention ( control ) , respectively . The self-reported outcomes , measured at baseline and 73 weeks follow-up ( 7 months after the last intervention component ) , were difference in total number of guidelines met at follow-up compared to baseline , and number of QALYs experienced over 73 weeks . The costs of implementing the intervention were estimated using a bottom-up approach . Results At 73 weeks follow-up participants showed increased adherence with 0.62 ( TPC ) , 0.40 ( TMI ) , 0.50 ( combined ) , and 0.26 ( control ) guidelines compared to baseline , and experienced 1.09 , 1.08 , 1.08 , and 1.07 QALYs , respectively . The costs for the control group were considered to be zero . TMI was more expensive ( € 107 per person ) than both the combined intervention ( € 80 ) and TPC ( € 57 ) . The control condition was most cost-effective for lower ceiling ratios , while TPC had the highest probability of being most cost-effective for higher ceiling ratios ( more than € 160 per additional guideline met , and € 2,851 for each individual QALY ) . Conclusions For low society 's willingness to pay , the control group was most cost-effective for the number of QALYs experienced over 73 weeks . This also applied to the increase in the number of guidelines met at lower ceiling ratios , whereas at higher ceiling ratios , TPC had a higher probability of being more cost-effective than the TMI , combined or control conditions . This also seemed to apply for QALYs experienced over 73 weeks . More research is needed on the long-term efficacy of both TPC and TMI , as well as on how to increase their cost-effectiveness . Trial registration Dutch Trial Register This study aims to evaluate the cost-effectiveness of a long-term workplace health promotion programme on physical activity ( PA ) and nutrition . In total , 924 participants enrolled in a 2-year cluster r and omized controlled trial , with departments ( n = 74 ) within companies ( n = 6 ) as the unit of r and omization . The intervention was compared with a st and ard programme consisting of a physical health check with face-to-face advice and personal feedback on a website . The intervention consisted of several additional website functionalities : action-oriented feedback , self-monitoring , possibility to ask questions and monthly e-mail messages . Primary outcomes were meeting the guidelines for PA and fruit and vegetable intake . Secondary outcomes were self-perceived health , obesity , elevated blood pressure , elevated cholesterol level and maximum oxygen uptake . Direct and indirect costs were calculated from a societal perspective , and a process evaluation was performed . Of the 924 participants , 72 % participated in the first and 60 % in the second follow-up . No statistically significant differences were found on primary and secondary outcomes , nor on costs . Average direct costs per participant over the 2-year period were € 376 , and average indirect costs were € 9476 . In conclusion , no additional benefits were found in effects or cost savings . Therefore , the programme in its current form can not be recommended for implementation BACKGROUND More evidence is needed on the potential role of ' booster ' interventions in the maintenance of increases in physical activity levels after a brief intervention in relatively sedentary population s. OBJECTIVES To determine whether objective ly measured physical activity , 6 months after a brief intervention , is increased in those receiving physical activity ' booster ' consultations  delivered in a motivational interviewing ( MI ) style , either face to face or by telephone . DESIGN Three-arm , parallel-group , pragmatic , superiority r and omised controlled trial with nested qualitative research fidelity and geographical information systems and health economic sub studies . Treatment allocation was carried out using a web-based simple r and omisation procedure with equal allocation probabilities . Principal investigators and study statisticians were blinded to treatment allocation until after the final analysis only . SETTING Deprived areas of Sheffield , UK . PARTICIPANTS Previously sedentary people , aged 40 - 64 years , living in deprived areas of Sheffield , UK , who had increased their physical activity levels after receiving a brief intervention . INTERVENTIONS Participants were r and omised to the control group ( no further intervention ) or to two sessions of MI , either face to face ( ' full booster ' ) or by telephone ( ' mini booster ' ) . Sessions were delivered 1 and 2 months post-r and omisation . MAIN OUTCOME MEASURES The primary outcome was total energy expenditure ( TEE ) per day in kcal from 7-day accelerometry , measured using an Actiheart device ( CamNtech Ltd , Cambridge , UK ) . Independent evaluation of practitioner competence was carried out using the Motivational Interviewing Treatment Integrity assessment . An estimate of the per-participant intervention costs , re source use data collected by question naire and health-related quality of life data were analysed to produce a range of economic models from a short-term NHS perspective . An additional series of models were developed that used TEE values to estimate the long-term cost-effectiveness . RESULTS In total , 282 people were r and omised ( control = 96 ; mini booster = 92 , full booster = 94 ) of whom 160 had a minimum of 4 out of 7 days ' accelerometry data at 3 months ( control = 61 , mini booster = 47 , full booster = 52 ) . The mean difference in TEE per day between baseline and 3 months favoured the control arm over the combined booster arm but this was not statistically significant ( -39 kcal , 95 % confidence interval -173 to 95 , p = 0.57 ) . The autonomy-enabled MI communication style was generally acceptable , although some participants wanted a more paternalistic approach and most expressed enthusiasm for monitoring and feedback components of the intervention and research . Full boosters were more popular than mini boosters . Practitioners achieved and maintained a consistent level of MI competence . Walking distance to the nearest municipal green space or leisure facilities was not associated with physical activity levels . Two alternative modelling approaches both suggested that neither intervention was likely to be cost-effective . CONCLUSIONS Although some individuals do find a community-based , brief MI ' booster ' intervention supportive , the low levels of recruitment and retention and the lack of impact on objective ly measured physical activity levels in those with adequate outcome data suggest that it is unlikely to represent a clinical ly effective or cost-effective intervention for the maintenance of recently acquired physical activity increases in deprived middle-aged urban population s. Future research with middle-aged and relatively deprived population s should explore interventions to promote physical activity that require less proactive engagement from individuals , including environmental interventions . STUDY REGISTRATION Current Controlled Trials IS RCT N56495859 , Clinical Trials.gov NCT00836459 . FUNDING This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment ; Vol . 18 , No. 13 . See the NIHR Journals Library website for further project information OBJECTIVE To evaluate the cost-effectiveness of non-face-to-face interventions for increasing physical activity in sedentary adults . The study took place in Providence , Rhode Isl and between the years 2000 and 2004 . METHODS Two hundred and thirty-nine participants were r and omized to Phone , Print or a contact control . Phone and Print groups were mailed regular surveys regarding their level of physical activity , motivational readiness and self-efficacy . Surveys were scanned by a computer expert system to generate feedback reports . Phone group participants received feedback by telephone . Print group participants received feedback by mail . The contact control group received mailings unrelated to physical activity . Intervention costs were assessed prospect ively , from a payer perspective . Physical activity was measured using the 7-day Physical Activity Recall . Ambulatory health service use was assessed via monthly surveys . RESULTS The Print intervention was more economically efficient than the Phone intervention in engaging participants in a more active lifestyle . CONCLUSION The Print intervention provides an efficient approach to increasing physical activity . Research is needed to determine the cost-effectiveness of the intervention in a more diverse population , within the context of the health service delivery system and over a longer period of time Objective : To assess the cost effectiveness of a community based exercise programme as a population wide public health intervention for older adults . Design : Pragmatic , cluster r and omised community intervention trial . Setting : 12 general practice s in Sheffield ; four r and omly selected as intervention population s , and eight as control population s. Participants : All those aged 65 and over in the least active four fifths of the population responding to a baseline survey . There were 2283 eligible participants from intervention practice s and 4137 from control practice s. Intervention : Eligible subjects were invited to free locally held exercise classes , made available for two years . Main outcome measures : All cause and exercise related cause specific mortality and hospital service use at two years , and health status assessed at baseline , one , and two years using the SF-36 . A cost utility analysis was also undertaken . Results : Twenty six per cent of the eligible intervention practice population attended one or more  exercise sessions  . There were no significant differences in mortality rates , survival times , or admissions . After adjusting for baseline characteristics , patients in intervention practice s had a lower decline in health status , although this reached significance only for the energy dimension and two composite scores ( p<0.05 ) . The incremental average QALY gain of 0.011 per person in the intervention population result ed in an incremental cost per QALY ratio of € 17 174 ( 95 % CI = € 8300 to € 87 120 ) . Conclusions : Despite a low level of adherence to the exercise programme , there were significant gains in health related quality of life . The programme was more cost effective than many existing medical interventions , and would be practical for primary care commissioning agencies to implement Abstract Objective : To assess the long term effectiveness of the “ green prescription ” programme , a clinician based initiative in general practice that provides counselling on physical activity . Design : Cluster r and omised controlled trial . Practice s were r and omised before systematic screening and recruitment of patients . Setting : 42 rural and urban general practice s in one region of New Zeal and . Subjects : All sedentary 40–79 year old patients visiting their general practitioner during the study 's recruitment period . Intervention : General practitioners were prompted by the patient to give oral and written advice on physical activity during usual consultations . Exercise specialists continued support by telephone and post . Control patients received usual care . Main outcome measures : Change in physical activity , quality of life ( as measured by the “ short form 36 ” ( SF-36 ) question naire ) , cardiovascular risk ( Framingham and D'Agostino equations ) , and blood pressure over a 12 month period . Results : 74 % ( 117/159 ) of general practitioners and 66 % ( 878/1322 ) of screened eligible patients participated in the study . The follow up rate was 85 % ( 750/878 ) . Mean total energy expenditure increased by 9.4 kcal/kg/week ( P=0.001 ) and leisure exercise by 2.7 kcal/kg/week ( P=0.02 ) or 34 minutes/week more in the intervention group than in the control group ( P=0.04 ) . The proportion of the intervention group undertaking 2.5 hours/ 
    Output:
    
CONCLUSIONS Brief interventions promoting physical activity in primary care and the community are likely to be inexpensive compared with usual care .
Given the commonly accepted thresholds , they appear to be cost-effective on the whole , although there is notable variation between studies