***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: The hypothesis that the adaptive capacity is higher in human upper- than lower-body skeletal muscle was tested . Furthermore , the hypothesis that more pronounced adaptations in upper-body musculature can be achieved by " low-volume high-intensity " compared with " high-volume low-intensity " exercise training was evaluated . A group of sedentary premenopausal women aged 45 ± 6 yr ( ± SD ) with expected high adaptive potential in both upper- and lower-extremity muscle groups participated . After r and om allocation to high-intensity swimming ( HIS , n = 21 ) , moderate-intensity swimming ( MOS , n = 21 ) , soccer ( SOC , n = 21 ) or a nontraining control group ( CON , n = 20 ) , the training groups completed three workouts per week for 15 wk . Resting muscle biopsies were obtained from the vastus lateralis muscle and deltoideus muscle before and after the intervention . After the training intervention , a larger ( P < 0.05 ) increase existed in deltoideus muscle of the HIS group compared with vastus lateralis muscle of the SOC group for citrate synthase maximal activity ( 95 ± 89 vs. 27 ± 34 % ) , citrate synthase protein expression ( 100 ± 29 vs. 31 ± 44 % ) , 3-hydroxyacyl-CoA dehydrogenase maximal activity ( 35 ± 43 vs. 3 ± 25 % ) , muscle glycogen content ( 63 ± 76 vs. 20 ± 51 % ) , and expression of mitochondrial complex II , III , and IV . Additionally , HIS caused higher ( P < 0.05 ) increases than MOS in deltoideus muscle citrate synthase maximal activity , citrate synthase protein expression , and muscle glycogen content . In conclusion , the deltoideus muscle has a higher adaptive potential than the vastus lateralis muscle in sedentary women , and " high-intensity low-volume " training is a more efficient regime than " low-intensity high-volume " training for increasing the aerobic capacity of the deltoideus muscle AIM It has been suggested , that water exercise is less effective than weight-bearing exercise on l and for body fat reduction . METHODS To test this hypothesis 38 middle-aged obese women ( 25 - 47 % body fat ) participated in a 13 week exercise-diet program to compare the effects of aerobic exercise in water versus walking on l and on indices of fat reduction and weight loss changes . Subjects were r and omly assigned to 1 of 3 exercise groups : 1 ) walking on l and ( WL ) , 2 ) swimming ( SW ) at 27 degrees C water temperature and 3 ) walking in 29 degrees C water ( WW ) at the shallow end of a declining pool with the water at navel height . Subjects in the SW group alternated breast- , side- , and backstroke swimming without face immersion . Exercise parameters were kept constant for all three groups . Subjects participated in supervised exercise sessions for 40 min , 4 times a week at 70 % of age-predicted maximum heart rate . Subjects were tested before and after the 13-week experimental period . RESULTS Significant reductions in body weight , ( 5.9 kg ) , percent body fat , ( 3.7 % ) , and skinfold and girth measurements , occurred in all groups . There where no significant differences between groups . CONCLUSIONS The results of this study indicate that there are no differences in the effect of aerobic activities in the water versus weight-bearing aerobic exercise on l and on body composition components as long as similar intensity , duration and frequency are used Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more Objective Swimming is often recommended in the prevention and treatment of  hypertension . Few studies have investigated the effect of swimming training on blood pressure ( BP ) . Our objective was to evaluate 6 months of supervised moderate swimming or walking on BP in previously sedentary , normotensive , older women . Design Women aged 50–70 years ( n = 116 ) were r and omly assigned to a supervised 6-month swimming or walking programme . They were further r and omized to receive usual care or a behavioural intervention package . Methods Exercise comprised 3 sessions/week with a warm-up , cool down , and 30-min of moderate intensity walking or swimming . BP was recorded for 20 min supine , and 5 min st and ing . Assessment s were made at 0 and 6 months . Results At baseline , mean supine BP ( ± SD ) was 115.7 ± 1.3/66.8 ± 0.7 mmHg . Swimming  improved swim distance by 78.1 m ( 29.3 % ) [ 95 % confidence interval ( CI ) ; 66.7 , 89.4 ] and walk time by 0.58 min ( 3.8 % ) ( 0.41 , 0.74 ) . Walking decreased walk time by 1.0 min ( 6.5 % ) ( 0.81 , 1.19 ) . After adjustment for initial BP , age , hypertension treatment status and change in weight , swimming increased supine and st and ing systolic BP relative to walking by 4.4 mmHg ( 1.2 , 7.5 ) ( P = 0.008 ) and 6.0 mmHg ( 2.6 , 9.5 ) ( P = 0.001 ) , respectively . Supine and st and ing diastolic BP increased by 1.4 mmHg ( −0.14 , 3.0 ) ( P = 0.07 ) and 1.8 mmHg ( −0.02 , 3.5 ) ( P = 0.05 ) , respectively . Conclusion Relative to moderately paced walking , regular swimming significantly elevates BP in previously sedentary , normotensive , older women . This finding may have important implication s for exercise prescription in older subjects OBJECTIVE To investigate the medium-term benefits of a swimming program in schoolchildren and adolescents with moderate persistent atopic asthma ( MPAA ) . METHODS A r and omized , prospect i ve study of children and adolescents ( age 7 - 18 years ) with MPAA was carried out at the Hospital de Clínicas of Universidade Estadual de Campinas ( UNICAMP ) , Campinas , Brazil . After a 1-month run-in period , 61 patients ( 34 female ) were r and omized into two groups , a swimming group ( n = 30 ) and a control group ( n = 31 ) , and followed for 3 months . Both patient groups received inhaled fluticasone ( dry powder , 250 mcg twice a day ) and salbutamol as needed . The swim training program consisted of two weekly classes over a 3-month period for a total of 24 sessions . Both groups underwent  spirometric assessment  and methacholine challenge test -- provocative concentration of methacholine causing a 20 % fall in FEV1 (PC₂₀)--before and after the study period . Maximal inspiratory pressure ( MIP ) and maximal expiratory pressure ( MEP ) were measured only in the swimming group . RESULTS Significant increases in PC₂₀ ( pre-training , 0.31±0.25 ; post-training , 0.63±0.78 ; p = 0.008 ) , MIP ( pre-training , 67.08±17.13 cm H₂O ; post-training 79.46±18.66 ; p < 0.001 ) , and MEP ( pre-training , 71.69±20.01 cm H₂O ; post-training , 78.92±21.45 cm H₂O ; p < 0.001 ) were found in the swimming group . CONCLUSION Children and adolescents with MPAA subjected to a swim training program experienced a significant decrease in bronchial hyperresponsiveness , as determined by increased PC₂₀ values , when compared with asthmatic controls who did not undergo swim training . Participants in the swimming group also showed improvement in elastic recoil of the chest wall Reduced respiratory muscle strength in individuals with Down syndrome ( DS ) may affect speech respiratory variables such as maximum phonation duration ( MPD ) , initiation volume , and expired mean airflow . Research ers r and omly assigned adolescents with DS ( N = 28 ) to either 12 weeks of swim training ( DS-ST ) or a control group ( DS-NT ) . Repeated measures MANOVA demonstrated a significant increase in MPD for DS-ST participants from pretest to posttest , t(11 ) = -3.44 , p = 0.006 , that was not maintained at follow-up , t(11 ) = 6.680 , p < .001 . No significant change was observed for DS-NT participants across time , F(2 , 11 ) = 4.20 , p = 0.044 . The lack of long-term change in DS-ST participants may be related to the relatively short training period Purpose The present study examined the effects of 15 weeks of soccer training and two different swimming training protocol s on bone turnover in sedentary middle-aged women . Methods Eighty-three premenopausal mildly hypertensive women [ age : 45 ± 6 ( ±SD ) years , height : 165 ± 6 cm , weight : 80.0 ± 14.1 kg , body fat : 42.6 ± 5.7 % , systolic blood pressure/diastolic blood pressure : 138 ± 6/85 ± 3 mmHg ] were r and omized into soccer training ( SOC , n = 21 ) , high-intensity intermittent swimming ( HS , n = 21 ) , moderate-intensity swimming ( MS , n = 21 ) intervention groups , and a control group ( C , n = 20 ) . The training groups completed three sessions per week for 15 weeks . DXA scans were performed and resting blood sample s were drawn pre- and post-intervention . Results In SOC , plasma osteocalcin , procollagen type I N propeptide and C-terminal telopeptide increased ( P < 0.05 ) by 37 ± 15 , 52 ± 23 and 42 ± 18 % , respectively , with no changes in MS , HS and C. The intervention-induced increase in SOC was larger ( P < 0.05 ) than in MS , HS and C. In SOC , leg BMC increased ( P < 0.05 ) by 3.1 ± 4.5 % , with a larger increase in SOC than in C. Femoral shaft and trochanter bone mineral density ( BMD ) increased ( P < 0.05 ) by 1.7 ± 1.9 and 2.4 ± 2.9 % , respectively , in SOC , with a greater ( P < 0.05 ) change in SOC than in MS and C , whereas total body and total leg BMD did not change in any of the groups . Conclusion In conclusion , 15 weeks of soccer training with sedentary middle-aged women caused marked increases in bone turnover markers , with concomitant increases in leg bone mass . No changes in bone formation and resorption markers were seen after prolonged submaximal or high-intensity intermittent swimming training . Thus , soccer training appears to provide a powerful osteogenic stimulus in middle-aged women Purpose We tested the hypothesis that low-volume high-intensity swimming has a larger impact on insulin sensitivity and glucose control than high-volume low-intensity swimming in inactive premenopausal women with mild hypertension . Methods Sixty-two untrained premenopausal women were r and omised to an inactive control ( n = 20 ; CON ) , a high-intensity low-volume ( n = 21 ; HIT ) or a low-intensity high-volume ( n = 21 ; LIT ) training group . During the 15-week intervention period , HIT performed 3 weekly 6–10 × 30-s all-out swimming intervals ( average heart rate ( HR ) = 86 ± 3 % HRmax ) interspersed by 2-min recovery periods and LIT swam continuously for 1 h at low intensity ( average HR = 73 ± 3 % HRmax ) . Fasting blood sample s were taken and an oral glucose tolerance test ( OGTT ) was conducted pre- and post-intervention . Results After HIT , resting plasma [ insulin ] was lowered ( 17 ± 34 % ; P < 0.05 ) but remained similar after LIT and CON . Following HIT , 60-min OGTT plasma [ insulin ] and [ glucose ] was lowered ( 24 ± 30 % and 10 ± 16 % ; P < 0.05 ) but remained similar after LIT and CON . Total area under the curve for plasma [ glucose ] was lower ( P < 0.05 ) after HIT than LIT ( 660 ± 141 vs. 860 ± 325 mmol min L−1 ) . Insulin sensitivity ( HOMA-IR ) had increased ( P < 0.05 ) by 22 ± 34 % after HIT , with no significant change after LIT or CON , respectively . Plasma soluble intracellular cell adhesion molecule 1 was lowered ( P < 0.05 ) by 4 ± 8 and 3 ± 9 % after HIT and CON , respectively , while plasma soluble vascular 
    Output:
    
Conclusions Swimming may offer robust beneficial effects on cardiorespiratory fitness and body composition across multiple population s and effects may be comparable to other exercise modes .