***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: Forty-eight community living women 66–87 years old volunteered to participate in a 12-month prospect i ve , r and omized , controlled , trial . The aim was to determine if a combined weight-bearing training program twice a week would be beneficial to bone mineral density and neuromuscular function . The participants were pairwise age-matched and r and omly assigned to either an exercise group ( n=24 ) or a control group ( n=24 ) . Twenty-one subjects in the intervention group and 19 in the control group completed the study . The exercise program lasted for 50 min and consisted of a combination of strengthening , aerobic , balance and coordination exercises . The mean percentage of scheduled sessions attended for the exercise group was 67 % . At the completion of the study , the intervention group showed significant increments in bone mineral density of the Ward ’s triangle ( 8.4 % , P<0.01 ) as well as improvement in maximum walking speed ( 11.4 % , P<0.001 ) and isometric grip strength ( 9.9 % , P<0.05 ) , as compared to the control group . The conclusion was that a combined weight-bearing training program might reduce fracture risk factors by improving bone density as well as muscle strength and walking ability . This program could be suitable for older community living women in general , and might , therefore , have important implication s for fracture prevention Reports on the efficacy of physical activity intervention trials usually only include discussion of the primary outcomes . However , assessing factors such as participant retention , adherence and compliance can assist in the accurate interpretation of the overall impact of a program in terms of reach and appeal . A quasi-r and omised trial was carried out to assess and compare retention and adherence rates , and compliance with , a twice weekly resistance training program provided either individually at home or in a group format . Retirement villages ( n=6 ) were assigned to either ' Have A Try ' ( HAT , home-based ) or ' Come Have A Try ' ( CHAT , group-based ) ; both programs included nine strength and two balance exercises . The program involved a 20-week Intervention Phase a 24-week Maintenance Phase and a 20-week On-going Maintenance Phase . One hundred and nineteen participants ( mean age 80+/-6 years ) were recruited ( HAT=38 , CHAT=81 ) . There was no difference in retention rates at the end of the Intervention Phase , but significantly more HAT than CHAT participants had dropped out of the study ( p<0.01 ) after the Maintenance Phase and the On-going Maintenance Phase . During the Intervention Phase , over half the HAT and CHAT participants completed > or = 75 % of the prescribed activity sessions , but adherence was significantly greater in CHAT than HAT during the Maintenance Phase ( p<0.01 ) . Participants in CHAT were significantly more compliant than HAT participants ( p<0.05 ) . Both home- and group-based formats were successful over the short-term , but , in retirement villages , the group program had better adherence and compliance in the longer-term OBJECTIVES We assessed the impact of existing best- practice physical activity programs for older adults on physical activity participation and health-related outcomes . METHODS We used a multisite , r and omized trial with 544 older adults ( mean age 66 years ) and measures at baseline , 5 , and 10 months to test the impact of a multiple-component physical activity program compared with results for a control group that did not participate in such a program . RESULTS For adults who participated in a multiple-component physical activity program , we found statistically significant benefits at 5 and 10 months with regard to self-efficacy for exercise adherence over time ( P < .001 ) , adherence in the face of barriers ( P = .01 ) , increased upper- and lower-body strength ( P = .02 , P = .01 ) , and exercise participation ( P = .01 ) . CONCLUSIONS Best- practice community-based physical activity programs can measurably improve aspects of functioning that are risk factors for disability among older adults . US public policy should encourage these inexpensive health promotion programs Objectives The effectiveness of community level interventions depends to a great extent on adherence . Currently , information on factors related to adherence in older adults from developing countries is scarce . Our aim was to identify factors associated to adherence to a physical activity intervention in older adults from a post-transitional middle income country . Design , setting and participants Using a combination of quantitative and qualitative methods we studied 996 older Chilean subjects ( 65–67.9 years at baseline ) with low to medium socioeconomic status from 10 health centers r and omized to receive a physical activity intervention as part of the CENEX cluster trial ( IS RCT N48153354 ) . Measurements Using a multilevel regression model , the relationship between adherence ( defined a priori as attendance at a minimum of 24 physical activity classes spread over at least 12 months ) and individual , intervention-related and context ual factors was evaluated . We also conducted 40 semi-structured interviews with older adults ( n=36 ) and instructors ( n=4 ) . Transcripts of the interviews were analyzed using content analysis to identify barriers and facilitators to adherence . Results Adherence to physical activity intervention was 42.6 % ( CI 95 % 39.5 to 45.6 ) . Depression , diabetes mellitus , percentage of impoverished households and rate of arrests for violent crimes in the neighborhood predicted less adherence ( p<0.05 ) while being retired , participation in physical activity prior to the intervention , and green areas per habitant were positively associated with adherence ( p<0.05 ) . The qualitative interviews identified three primary barriers to adherence : current health problems , lack of time due to commitments for caring for family members , and being employed , and two primary facilitators to adherence : the health benefits attributed to the intervention and the opportunity the classes provided for social interaction with others . Conclusion In order to enhance effectiveness of community exercise interventions , strategies to improve participation should be targeted to older adults from deprived areas and those with psychological and medical conditions BACKGROUND Although inactivity is an important contributor to impaired functioning and disability with age , little is known concerning how improvements in physical functioning and well-being in older adults vary with the type of physical activity undertaken . METHODS One hundred three adults age 65 years and older , recruited via population -based methods , were r and omized to 12 months of community-based , moderate-intensity endurance and strengthening exercises ( Fit & Firm ) or stretching and flexibility exercises ( Stretch & Flex ) . A combination of class- and home-based exercise formats was used . Measured and self-rated physical performance along with perceived functioning and well-being were assessed pre- and postintervention . RESULTS Fit & Firm subjects showed greater 12-month improvements in both measured and self-rated endurance and strength compared to Stretch & Flex subjects . Stretch & Flex subjects reported greater improvements in bodily pain , and Stretch & Flex men evidence d greater improvements in flexibility relative to Fit & Firm subjects . Although overall exercise adherence was high in both exercise conditions ( approximately 80 % ) , subjects in both conditions showed better adherence to the home- versus class-based portions of their exercise prescriptions . CONCLUSIONS Community-based programs focusing on moderate-intensity endurance and strengthening exercises or flexibility exercises can be delivered through a combination of formats that result in improvement in important functional and well-being outcomes . This represents one of the first studies to report significant improvements in an important quality of life outcome -bodily pain-with a regular regimen of stretching and flexibility exercises in a community-based sample of older adults After a r and omized controlled trial showing that improvement on some aspects of cognitive function was related to adherence to an exercise program , determinants of adherence and maintenance were further studied . Older adults with mild cognitive impairment were contacted 6 mo after the end of exercise programs for a telephone interview addressing patterns of adherence and determinants of maintenance . Mean adherence during the trial was 53 % . About one third of participants had lapses during the trial but completed , one third had no lapses , and one third dropped out or never started . Practical barriers ( time , location ) were related to not starting and functional limitations to dropout . After the trial 25 % of participants continued the programs , 14 % reported intention to continue , and 61 % quit . Maintenance was determined by fewer health complaints , higher satisfaction with the programs , and better adherence during the programs . Although maintenance was low , this study identified several reasons and barriers to adherence and maintenance that could be addressed PURPOSE We present final outcomes from the multiple-component Fit and Strong ! intervention for older adults with lower extremity osteoarthritis . DESIGN AND METHODS A r and omized controlled trial compared the effects of this exercise and behavior-change program followed by home-based reinforcement  ( n=115 ) with a wait list control  ( n=100 ) at 2 , 6 , and 12 months . Fit and Strong ! combined flexibility , aerobic walking , and resistance training with education and group problem solving to enhance self-efficacy for exercise and maintenance of physical activity . All participants developed individualized plans for long-term maintenance . RESULTS Relative to controls , treatment participants experienced statistically significant improvements in self-efficacy for exercise  ( p=.001 ) , minutes of exercise per week ( p=.000 ) , and lower extremity stiffness ( p=.018 ) at 2 months . These benefits were maintained at 6 months and were accompanied by increased self-efficacy for adherence to exercise over time ( p=.001 ) , reduced pain ( p=.040 ) , and a marginally significant increase in self-efficacy for arthritis pain management ( p=.052 ) . Despite a substantially smaller sample size at 12 months , significant treatment-group effects were maintained on self-efficacy for exercise ( p=.006 ) and minutes of exercise per week ( p=.001 ) , accompanied by marginally significant reductions in lower extremity stiffness ( p=.056 ) and pain ( p=.066 ) . No adverse health effects were seen . Effect sizes for self-efficacy for exercise and for maintenance of physical activity were 0.798 and 0.713 , and 0.905 and 0.669 , respectively , in the treatment group at 6 and 12 months . IMPLICATION S This consistent pattern of benefits indicates that this low-cost intervention is efficacious for older adults with lower extremity osteoarthritis Background and Purpose : Physical activity has many benefits for older adults , but adherence is often low . The purpose s of this study were to ( 1 ) identify motivators and barriers for participation in EnhanceFitness ( EF ) , a group-based exercise program ; and ( 2 ) quantitatively examine the association between motivators , barriers and individual characteristics , and ongoing participation in the program . Methods : This was a prospect i ve , cross-sectional study . We mailed a pilot , investigator-developed survey to assess motivators and barriers to exercising to 340 adults who started a new EF class , regardless of their attendance rate . We precoded surveys on the basis of class attendance , with former participants defined as having no attendance a month or more before a 4-month fitness check . Results : Of the 241 respondents ( 71 % response rate ) , 61 ( 25 % ) were precoded as former participants and 180 ( 75 % ) as current participants . The mean age of respondents was 71 years and they were predominately female ( 89 % ) . More than half of respondents were whites ( 58 % ) , and almost half were married ( 46 % ) . Former participants reported lower total motivation scores than current participants ( P < .01 ) and had a significantly higher mean total barrier score ( P < .001 ) . The effects of 5 barriers ( “ Class was too hard , ” “ Class was too easy , ” “ I do n't like to exercise , ” “ Personal illness , ” and “ Exercise caused pain ” ) and 2 motivators ( “ I want to exercise ” and “ I plan exercise as part of my day ” ) were significantly different between current and former participants . Discrete event history models show that dropout was related positively to ethnicity ( whites were more likely to drop out ) and health-related barriers . Discussion : In newly formed EF classes , participants who drop out report more program , psychosocial , and health barriers , and fewer program and psychosocial motivators . Total barrier score and health barriers significantly predict a participant 's dropping out , and white ethnicity is associated with a higher likelihood of dropping out . Conclusions : Employing strategies that address health barriers to participation could improve attendance rates for group-based exercise programs Increasing evidence suggests that physical activity can prevent some aspects of mental illness in older people such as depression , dementia and Alzheimer ’s disease . Additionally , limited research has shown that engagement in structured exercise can improve aspects of psychological well-being such as mood and self-perceptions in older adults . However , the relationship between incidental daily activity such as walking or time spent sedentary , with psychological well-being has not been investigated . The Better Ageing Project provided an opportunity to assess well-being and quality of life using st and ardised question naires with 176 adults aged 70 and over .  Accelerometry was used to objective ly assess daily energy expended in physical activity at different levels of intensity . In addition , an assessment of the impact of the 12-month Better Ageing structured group exercise programme was assessed through question naires and interviews . Total daily physical activity energy expenditure ( joules/day ) and amount of time spent in activity of at least moderate intensity were weakly related ( r = 0.20–0.28 ) to quality of life , subjective well-being and physical self-perceptions . Time spent sedentary ( min/day ) was weakly and negatively related to several mental health indicators . The quantitative data showed only minor psychological benefits of the exercise intervention . In contrast , interviews with 27 research participants and 4 exercise leaders suggested that important improvements 
    Output:
    
Evidence surrounding these programmes is limited both in terms of long-term adherence measures and the views of participants .
However , based on limited findings there is some indication that community based group exercise programmes  have long-term adherence rates of almost 70 % .
Incorporating the views of older people into programme design s may provide guidance for innovative interventions leading to sustained adherence