***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: OBJECTIVES This study evaluated the effectiveness ( changes in health behaviors , health status , and health service utilization ) of a self-management program for chronic disease design ed for use with a heterogeneous group of chronic disease patients . It also explored the differential effectiveness of the intervention for subjects with specific diseases and comorbidities . METHODS The study was a six-month r and omized , controlled trial at community-based sites comparing treatment subjects with wait-list control subjects .  Participants were 952 patients 40 years of age or older with a physician-confirmed diagnosis of heart disease , lung disease , stroke , or arthritis .  Health behaviors , health status , and health service utilization , as determined by mailed , self-administered question naires , were measured . RESULTS Treatment subjects , when compared with control subjects , demonstrated improvements at 6 months in weekly minutes of exercise , frequency of cognitive symptom management , communication with physicians , self-reported health , health distress , fatigue , disability , and social/role activities limitations . They also had fewer hospitalizations and days in the hospital . No differences were found in pain/physical discomfort , shortness of breath , or psychological well-being . CONCLUSIONS An intervention design ed specifically to meet the needs of a heterogeneous group of chronic disease patients , including those with comorbid conditions , was feasible and beneficial beyond usual care in terms of improved health behaviors and health status . It also result ed in fewer hospitalizations and days of hospitalization OBJECTIVE To assess the efficacy of physical activity promotion in primary care office setting s. DESIGN Systematic review of clinical trials in which the efficacy of physical activity promotion was investigated in a primary care office setting with at least one month of follow up . SUBJECTS A total of 13,981 adults , aged 17 - 85 + , were included from 203 practice s in eight trials assessing physical activity promotion in primary care office setting s. MAIN OUTCOME MEASURES Odds ratios and 95 % confidence intervals were calculated comparing the number of participants who increased their physical activity or were active at follow up in the intervention group with a control group for each study . RESULTS Five of eight trials where positive with statistically significant results ( range 0.91 - 6.56 ) , but significant biases or limited clinical relevance of the outcomes were found in all trials . Short term trials of less than one year ( four of four were positive ) , single-risk-factor trials ( three of three were positive ) , r and omised clinical trials ( two of three were positive ) , and those assessing moderate levels of physical activity ( three of four were positive ) were most likely to find benefit . Only one of four trials lasting longer than a year were positive . CONCLUSION There is limited evidence from well design ed trials that office based physical activity promotion in primary care setting s is efficacious in promoting changes in physical activity that could conceivably have lasting clinical benefits We performed a r and omized controlled trial to evaluate the effectiveness of a patient education and health promotion program in the treatment of Parkinson 's disease . The health promotion program ( PROPATH ) was design ed to improve health confidence , provide information and support , improve physical function through exercise , and work with the physician to optimize medical treatment and compliance . The intervention was delivered by mail , with disease assessment question naires completed by patient or caregiver at 0 , 2 , 4 , and 6 months , with computer-generated reports and individualized recommendation letters returned to patients and reports to physicians . Two hundred ninety patients completed the 6-month trial , 140 patients in the intervention group and 150 in a control group of patients who received only question naires . The intervention group had significantly increased exercise , decreased " time off " and percentage of time off , reduced side effects , and decreased summary Parkinson 's scores by approximately 10 % ( P > 0.05 ) . Twelve of 13 variables showed differences favoring the intervention group . The rate of progression of summary scores became essentially flat during the program for the intervention group and continued to rise sharply for controls ( P > 0.01 ) . Levodopa dose rose for controls and slightly decreased for the intervention group . Doctor visits , hospital days , and sick days were reduced in the intervention group . The quality -of-life assessment demonstrated improvement in patient global , self-efficacy scores , and spouse or caregiver assessment s. We conclude that a low-cost patient education program provides a useful adjunct to medical therapy of Parkinson 's disease , may reduce costs , and can improve intermediate term outcomes BACKGROUND The U.S. Congress m and ated evaluations , initiated in 1989 , to determine whether extending Medicare benefits to include preventive services would improve health status , reduce costs of care , and improve health risk behaviors of beneficiaries . METHODS The Johns Hopkins Medicare Preventive Services Demonstration was a r and omized trial in which Medicare beneficiaries were assigned either to an intervention group that was offered yearly preventive visits for 2 years and optional counseling visits to their primary care provider or to a control group that received usual care . This report describes the effect of the intervention over a period of 2 years on smoking , problem alcohol use , and sedentary lifestyle . RESULTS Differences were observed between the intervention and control groups in the extent to which changes occurred in smoking and problem alcohol use , but none of the differences was statistically significant . The proportion of smokers who quit was higher in the intervention group than in the control group ( 24.2 vs 17.9 % , P = 0.09 ) . However , a higher proportion of problem drinkers in the control group improved ( 67.1 vs 57.0 % , P = 0.183 ) . There was virtually no difference between the intervention and the control groups in the proportion with improvement in sedentary lifestyle . CONCLUSIONS This study demonstrates the difficulty of bringing about health behavior change in older patients in the course of a yearly preventive visit for 2 years with their primary care physician when the visit encompasses screening and immunizations , as well as health behavior counseling directed by the physician . Further study is required to determine whether a more intense program of counseling for health behavior change among older persons by their primary care providers would be effective Abstract Objectives : To establish the effect of an educational intervention for general practitioners on the health behaviours and wellbeing of elderly patients . Design : R and omised controlled trial with 1 year follow up . Setting : Metropolitan general practice s in Melbourne , Australia . Subjects : 42 general practitioners and 267 of their patients aged over 65 years . Intervention : Educational and clinical practice audit programme for general practitioners on health promotion for elderly people . Main outcome measures : Patients ' physical activity , functional status , self rated health , immunisation status , social contacts , psychological wellbeing , drug usage , and rate of influenza vaccination .  Primary efficacy variables were changes in outcome measures over 1 year period . Results : Patients in the intervention group had increased ( a ) walking by an average of 88 minutes per fortnight , ( b ) frequency of pleasurable activities , and ( c ) self rated health compared with the control group . No change was seen in drug usage , rate of influenza vaccination , functional status , or psychological wellbeing as a result of the intervention . Extrapolations of the known effect of these changes in behaviour suggest mortality could be reduced by 22 % if activity was sustained for 5 years . Conclusions : Education of the general practitioners had a positive effect on health outcomes of their elderly patients . General practitioners may have considerable public health impact in promotion of health for elderly patients . Key messages Few educational interventions for doctors have shown benefit to the health of patients Elderly people were identified in the UK health initiatives as in need of additional attention , and levels of health protective behaviours were low in community surveys A multifaceted educational intervention for general practitioners was effective in improving walking behaviour , self rated health status , and the frequency of social contacts in elderly patients General practitioners are effective in improving health and health behaviours in their elderly The medical care system is not very effective in modifying health behavior of individuals , in particular , ensuring patient compliance with medication regimens , healthy diets , regular physical activity , and regular health screening , and in the avoidance of substance abuse . Telephone-Linked Care ( TLC ) is a telecommunications technology that enables computer-controlled telephone counseling with patients in their homes . It has been applied to the task of improving a number of different health behaviors . R and omized controlled studies suggest that use of the system for as little as 3 months is associated with improvement in adherence to medication regimens , dietary change in hypercholesterolemia , and increased physical activity among sedentary individuals . Future work involves applying the technology to other important health behaviors , optimally using health behavior theory in the system design , targeting use of TLC to the most appropriate patient groups , incorporating new computer and telecommunications technology into the system , and interfacing TLC into the health care delivery system This study investigated the aerobic fitness , body composition , spirometric variables , Human Activity Profile , and level of adherence to physical activity subsequent to completion of a progressive walking program of six month 's duration ( T1 ) . Sixty-six women previously r and omized to training ( TG ) and control ( CG ) groups were reassessed six months after finishing the six month walking program ( T2 ) . During the follow-up period , 77.8 % of the TG subjects continued with exercise and maintained lower ( p < 0.005 ) exercise heart rates compared to the CG . A Mann-Whitney U test on the difference scores ( T2-T1 ) revealed no difference ( p > 0.05 ) between the TG and CG for changes in Maximum Current Activity and Normative Impairment Index , which are both components of the Human Activity Profile , with the earlier increases ( p < 0.05 ) in these parameters by the TG having been maintained . Participation in a previous low frequency training regimen therefore result ed in elderly women adopting and sustaining a higher level of habitual physical activity . This is important because a favorable modification of lifestyle factors is likely to be indicative of an enhanced outlook for independence This study examines the longitudinal ( 48 months ) effects of a preventive services intervention trial with Medicare beneficiaries . The health promotion intervention incorporated a series of workshops and targeted individualized counseling dealing primarily with nutrition and exercise . All subjects completed a health risk appraisal ( HRA ) question naire , which served as a dependent measure . Results show significant , positive changes in intervention subjects in two activity outcomes ,  aerobic activity and stretching exercises .  Although previous research on this cohort found significant positive changes in nutrition behaviors at 12-month follow-up , these differences were not sustained over the three-year follow-up period . The results offer encouragement that continued research on health promotion will eventually produce protocol s for select activities that will improve the status of seniors ' health 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 OBJECTIVE To determine whether gains in functioning observed immediately following participation in an 8-week program of supervised fitness walking for patients with knee osteoarthritis were sustained at 1-year followup . METHODS Twenty-nine ( 61.1 % ) of 47 original intervention program patients and 23 ( 51.1 % ) of 45 original control patients were interviewed by telephone at 1-year followup . Patients completed the Arthritis Impact Measurement Scales physical activity , arthritis impact , pain , medication use , and general health perceptions subscales , as well as a separate visual analog pain scale and measures of perceived self-efficacy to cope with arthritis pain and other symptoms . RESULTS Adherence to walking was low , and there were no statistically significant differences between intervention and control patients at one year . CONCLUSIONS The failure of intervention patients to maintain regular walking result ed in loss of functional benefits that were observed at 8 weeks in the original study . Long-term adherence to walking is critical to maintenance of initial gains in functional outcomes Higher levels of physical activity are associated with lower risk of cardiovascular disease . There is growing evidence that the development of the atherosclerotic plaque is associated with inflammation . In this study , the authors investigated the cross-sectional association between physical activity and markers of inflammation in a healthy elderly population . Data obtained in 1989 - 1990 and 1992 - 1993 from the Cardiovascular Health Study , a cohort of 5,888 men and women aged > /=65 years , were analyzed . Concentrations of the inflammation markers-C-reactive protein , fibrinogen , Factor VIII activity , white blood cells , and albumin-were compared cross-sectionally by quartile of self-reported physical activity . Compared with persons in the lowest quartile , those in the highest quart 
    Output:
    
A wide variety of intervention strategies were reported .
The most common interventions were self-monitoring , general health education , goal setting , supervised center-based exercise , problem solving , feedback , reinforcement , and relapse prevention education .
Common method ological weaknesses included small sample s , untested outcome measures , and time-limited longitudinal design s. Significant numbers of aging adults increased their physical activity in response to experimental interventions .
The amount of increased activity rarely equaled accepted behavior st and ards to achieve positive health outcomes .