***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: Substantial progress has been made in the awareness , treatment , and prevention of  cardiovascular disease ( CVD ) in women since the first women-specific clinical recommendations for the prevention of CVD were published by the American Heart Association ( AHA ) in 1999.1 The myth that heart disease is a “ man 's disease ” has been debunked ; the rate of public awareness of CVD as the leading cause of death among US women has increased from 30 % in 1997 to 54 % in 2009.2 The age-adjusted death rate result ing from  coronary heart disease ( CHD ) in females , which accounts for about half of all CVD deaths in women , was 95.7 per 100 000 females in 2007 , a third of what it was in 1980.3,4 Approximately 50 % of this decline in CHD deaths has been attributed to reducing major risk factors and the other half to treatment of CHD including secondary preventive therapies.4 Major r and omized controlled clinical trials such as the Women 's Health Initiative have changed the practice of CVD prevention in women over the past decade.5 The investment in combating this major public health issue for women has been significant , as have the scientific and medical achievements . Despite the gains that have been made , considerable challenges remain . In 2007 , CVD still caused ≈1 death per minute among women in the United States.6 These represent 421 918 deaths , more women 's lives than were cl aim ed by cancer , chronic lower respiratory disease , Alzheimer disease , and accidents combined.6 Reversing a trend of the past 4 decades , CHD death rates in US women 35 to 54 years of age now actually appear to be increasing , likely because of the effects of the obesity epidemic.4 CVD rates in the United States are significantly higher for black females compared with their white counterparts ( 286.1/100 000 versus Isometric HG ( h and grip ) training lowers resting arterial BP ( blood pressure ) , yet the mechanisms are elusive . In the present study , we investigated improved systemic endothelial function as a mechanism of arterial BP modification following isometric HG training in normotensive individuals . This study employed a within-subject repeated measures design primarily to assess improvements in BA FMD ( brachial artery flow-mediated dilation ; an index of endothelium-dependent vasodilation ) , with the non-exercising limb acting as an internal control . Eleven subjects performed four 2-min unilateral isometric HG contractions at 30 % of maximal effort , three times per week for 8 weeks . Pre- , mid- and post-training resting ABP and BA FMD ( exercised arm and non-exercised arm ) were measured via automated brachial oscillometry and ultrasound respectively . BA FMD ( normalized to the peak shear rate experienced in response to the reactive hyperaemic stimulus ) remained unchanged [ exercised arm , 0.029+/-0.003 to 0.026+/-0.003 to 0.029+/-0.004%/s(-1 ) ( pre- to mid- to post-training respectively ) ; non-exercised arm , 0.023+/-0.003 to 0.023+/-0.003 to 0.024+/-0.003%/s(-1 ) ( pre- to mid- to post-training respectively ) ; P=0.22 ] . In conclusion , improved systemic endothelial function is unlikely to be responsible for lowering arterial BP in this population OBJECTIVE A short-term isometric exercise protocol was tested in ten hypertensive individuals to determine its efficacy as a high blood pressure-reducing intervention . DESIGN The study was a prospect i ve case study of 10 hypertensive individuals ( 8 men , 2 woman , mean age = 52 + 5 years ) who underwent six weeks of isometric exercise training ( three sessions/week ) . METHODS Blood pressure , blood lipids and markers of oxidative stress were monitored before , during and following the isometric intervention . Electron spin resonance spectroscopy was used to directly measure radicals in the blood sample s. RESULTS After six weeks , systolic blood pressure decreased an average 13 mm Hg ( p < 0.05 ) from a mean blood pressure of 146 to 133 mm Hg , a level that is below the usual 140 mm Hg hypertension threshold . Blood lipids were unchanged , but markers of oxidative stress were affected , with a dramatic decrease in exercise-induced oxygen centered radicals ( -266 % ) , ( p < 0.05 ) and an increased resting whole blood glutathione : oxidized glutathione ( + 61 % ) in hypertensive adults following six weeks of isometric exercise . CONCLUSION Six weeks of isometric exercise training was effective in lowering systolic but not diastolic blood pressure in pre-hypertensive and hypertensive individuals , and enhanced antioxidant protection is a likely underlying mechanism 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 No previous studies have examined the effects of isometric training intensity upon resting blood pressure ( BP ) . The aims of this study were ( a ) to compare the effects of leg isometric training , performed at two intensities , upon resting systolic-SBP , diastolic-DBP and mean arterial-MAP BP ; and ( b ) to examine selected cardiovascular variables , in an attempt to explain any changes in resting BP following training . Thirty-three participants were r and omly allocated  to either control , high- ( HI ) or low-intensity ( LI ) training for 8 weeks . Participants performed 4 × 2 min exercise bouts 3 × weekly . Resting BP was measured at baseline , 4-weeks and post-training . SBP , DBP and MAP fell significantly in both groups after training . Changes were –5.2 ± 4.0 , –2.6 ± 2.9 and –2.5 ± 2.2 mmHg [ HI ] ; –3.7 ± 3.7 , –2.5 ± 4.8 and –2.6 ± 2.5 mmHg [ LI ] for SBP , DBP and MAP , respectively . There were no significant changes in BP at 4 weeks . No significant changes were observed in any of the other cardiovascular variables examined . These findings suggest that isometric training causes reductions in SBP , DBP and MAP at a range of exercise intensities , when it is performed over 8 weeks . Furthermore , it is possible to reduce resting BP using a much lower isometric exercise intensity than has previously been shown Objectives Isometric h and grip ( IHG ) training ( four , 2-min sustained contractions at 30 % of maximal voluntary contraction , three times per week for 8–10 weeks ) lowers resting arterial blood pressure ( BP ) in hypertensive patients , including those receiving pharmacotherapy , although the mechanisms remain elusive . Ambulatory BP measurements are more efficacious in predicting cardiovascular disease-related events , yet the effects of IHG training on ambulatory BP are unknown . The objective of the current investigation was to test the hypotheses that 8 weeks of IHG training lowers resting and 24 h ambulatory BP concomitantly in medicated hypertensive patients , and may be the result of improved vagal modulation . Methods BP was assessed using brachial artery oscillometry , and coarse-graining spectral analysis was used to determine spectral power . Resting and 24 h ambulatory BP and heart rate variability ( HRV ) were measured pretraining , midtraining , and post-training in 11 medicated hypertensive patients ( mean±SD , resting BP : 113.9±12.7/60.7±11.6 mmHg ) , and in nine medicated hypertensive controls ( resting BP : 117.8±14.3/67.5±4.2 mmHg ) . Results Indices of BP and HRV were not significantly altered with IHG training ( all P>0.05 ) . Conclusion IHG training does not lower resting or ambulatory BP  in hypertensive patients successfully treated with pharmacotherapy to within the normal range ( ⩽120/80 mmHg ) , nor does it improve HRV . Future studies should examine alternative IHG training protocol s in well-managed hypertensive patients and /or target poorly controlled medicated hypertensive patients PURPOSE Research has demonstrated the efficacy of isometric h and grip ( IHG ) training to attenuate resting blood pressure . These studies have relied on the use of programmable digital h and grips for training . This study aim ed to determine the effectiveness of simple , inexpensive spring-loaded h and grip devices in producing hypotensive effects . METHODS The study was a r and omized controlled trial of 49 normotensive participants ( 66.4 ± 0.9 years ; 57 % women ) . Participants in the exercise group ( n = 25 ) trained and had blood pressure measured twice weekly for 8 weeks .  Control  participants ( n = 24 ) completed weekly  blood pressure measurements  . Pre- and posttraining measurements were each assessed over 3 visits . Statistical analysis of the pre-post data involved analyses of variance and hierarchical linear modeling was used to examine changes over time . RESULTS Following 8 weeks , IHG participants demonstrated significant reductions in resting blood pressure . Systolic and diastolic blood pressures were reduced from 122 ± 3 mm Hg to 112 ± 3 mm Hg ( P < .001 ) and from 70 ± 1 mm Hg to 67 ± 1 mm Hg ( P < .05 ) , respectively . Hierarchical linear modeling analysis also revealed a significant cross-level ( ie , group ÷ time ) interaction , with an estimated reduction in systolic blood pressure of 5.4 mm Hg ( P < .001 ) over the training period in the IHG group . CONCLUSIONS In agreement with previous studies , IHG training reduced resting arterial pressure following 8 weeks of training . Hypotensive effects linked to IHG training may be achieved using simple , inexpensive spring h and grip training devices and may provide a convenient and affordable therapeutic alternative or adjunctive therapy for lowering blood pressure BACKGROUND AND PURPOSE Assessment of the quality of r and omized controlled trials ( RCTs ) is common practice in systematic review s. However , the reliability of data obtained with most quality assessment scales has not been established . This report describes 2 studies design ed to investigate the reliability of data obtained with the Physiotherapy Evidence Data base ( PEDro ) scale developed to rate the quality of RCTs evaluating physical therapist interventions . METHOD In the first study , 11 raters independently rated 25 RCTs r and omly selected from the PEDro data base . In the second study , 2 raters rated 120 RCTs r and omly selected from the PEDro data base , and disagreements were resolved by a third rater ; this generated a set of individual rater and consensus ratings . The process was repeated by independent raters to create a second set of individual and consensus ratings . Reliability of ratings of PEDro scale items was calculated using multirater kappas , and reliability of the total ( summed ) score was calculated using intraclass correlation coefficients ( ICC [ 1,1 ] ) . RESULTS The kappa value for each of the 11 items ranged from.36 to.80 for individual assessors and from.50 to.79 for consensus ratings generated by groups of 2 or 3 raters . The ICC for the total score was.56 ( 95 % confidence interval=.47-.65 ) for ratings by individuals , and the ICC for consensus ratings was.68 ( 95 % confidence interval=.57-.76 ) . DISCUSSION AND CONCLUSION The reliability of ratings of PEDro scale items varied from " fair " to " substantial , " and the reliability of the total PEDro score was " fair " to " good . ST-segment depression was measured during submaximal dynamic ( treadmill ) and combined isometric-dynamic ( isodynamic ) exercise at comparable rate-pressure products in 11 patients ( mean age 63 years ) with stable coronary artery disease who were participating in an exercise training program .  Each patient completed 3 separate trials . Trial 1 ( baseline ) was a submaximal treadmill exercise test to determine the threshold heart rate-systolic blood pressure ( rate-pressure product ) for ST-segment depression ( greater than or equal to 1.0 mm ) . During trials 2 and 3 , patients performed ( in r and om order ) dynamic treadmill exercise and isodynamic exercise ( treadmill walking 1.5 to 2.0 mph carrying 15 to 25 kg ) until threshold rate-pressure product was achieved . During trial 1 , each patient showed significant ST depression ( mean 1.7 mm ) at target rate-pressure product ( mean 18,200 ) . Subsequent dynamic exercise trials 2 and 3 showed similar mean ST depression ( 1.5 mm ) and rate-pressure product ( 18,000 ) . During isodynamic exercise trials 2 and 3 , subjects showed only minimal ST depression ( mean 0.4 mm ) at a rate-pressure product similar to dynamic exercise ( mean 18,590 ) . Heart rates were significantly lower ( -10/min ) and systolic ( + 20 mm Hg ) and diastolic ( + 25 mm Hg ) pressure was higher during isodynamic exercise ( p less than 0.05 ) . The rate-pressure product is not a valid index of ST response during isodynamic exercise in stable exercise-trained cardiac patients . Attenuation of ST depression during isodynamic exercise may be attributed to a combination of increased diastol 
    Output:
    
CONCLUSION Isometric resistance training lowers SBP , DBP , and mean arterial pressure .
The magnitude of effect is larger than that previously reported in dynamic aerobic or resistance training .
Our data suggest that this form of training has the potential to produce significant and clinical ly meaningful blood pressure reductions and could serve as an adjunctive exercise modality