***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: AIM This paper is a report of a study to assess the effect of an adapted arthritis self-management programme with an added focus on exercise practice among osteoarthritic knee sufferers . BACKGROUND Osteoarthritis of the knee is a major source of loss of function in older people . Previous studies have found self-management programmes to be effective in increasing arthritis self-efficacy and in mastery of self-management practice . METHOD A r and omized control trial was carried out from December 2002 to May 2003 and 120 participants ( 65.9 % , including 67 in intervention group and 53 in control group ) completed the 16-week postintervention assessment s. Outcome measures included arthritis self-efficacy , use of self-management techniques , pain intensity and daily activity . FINDINGS At 16 weeks , there was a ' statistically ' significant improvement in the arthritis self-efficacy level ( P < or= 0.001 ) , in most of the self-management skills , i.e. use of cold and hot compresses , in two of three joint protective practice s ( P < or= 0.001 ; P = 0.01 ) , an increase in the duration of light exercise practice ( P < or= 0.001 ) , reduction of current arthritis pain ( P < or= 0.001 ) and in the ability to perform daily activities ( P < or= 0.001 ) among the intervention group but not for the control group ( P-range from 0.04 to 0.95 ) . One joint protective practice showed a statistically significant increase in both groups ( P < or= 0.001 ) . CONCLUSION Our findings add to evidence showing short-term beneficial effects of self-efficacy theory in education programmes . Self-efficacy theory has great potential for empowering sufferers of chronic conditions to live with their illness 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 To test the effects of a high intensity home-based progressive strength training program on the clinical signs and symptoms of osteoarthritis ( OA ) of the knee . METHODS Forty-six community dwelling patients , aged 55 years or older with knee pain and radiographic evidence of knee OA , were r and omized to a 4 month home based progressive strength training program or a nutrition education program ( attention control ) .  Thirty-eight patients completed the trial with an adherence of 84 % to the intervention and 65 % to the attention control . The primary outcome was the Western Ontario and McMaster Universities Osteoarthritis ( WOMAC ) index pain and physical function subscales . Secondary outcomes included clinical knee examination , muscle strength , physical performance measures , and question naires to measure quality of life variables . RESULTS Patients in the strength training group who completed the trial had a 71 % improvement in knee extension strength in the leg reported as most painful versus a 3 % improvement in the control group ( p < 0.01 ) . In a modified intent to treat analysis , self-reported pain improved by 36 % and physical function by 38 % in the strength training group versus 11 and 21 % , respectively , in the control group ( p = 0.01 for between group comparison ) . In addition , those patients in the strength training group who completed the trial had a 43 % mean reduction in pain ( p = 0.01 vs controls ) , a 44 % mean improvement in self-reported physical function ( p < 0.01 vs controls ) , and improvements in physical performance , quality of life , and self-efficacy when compared to the control group . CONCLUSION High intensity , home based strength training can produce substantial improvements in strength , pain , physical function and quality of life in patients with knee OA BACKGROUND People with osteoarthritis ( OA ) of the knee experience pain and deconditioning that lead to disability . This study challenged the clinical belief that repetitive lower extremity exercise is not indicated in persons with knee OA . The effects of high-intensity and low-intensity stationary cycling on functional status , gait , overall and acute pain , and aerobic capacity were examined . METHODS Thirty-nine adults ( 71+/-6.9 years old ) with complaints of knee pain and diagnosis of OA were r and omized to either a high-intensity ( 70 % heart rate reserve [ HRR ] ) or low-intensity ( 40 % HRR ) exercise group for 10 weeks of stationary cycling . Participants cycled for 25 minutes , 3 times per week . Before and after the exercise intervention they completed the Arthritis Impact Measurement Scale 2 for overall pain assessment , underwent timed chair rise , 6-minute walk test , gait , and  grade d exercise treadmill tests . Acute pain was reported daily with a visual analog scale and the Western Ontario and McMaster Universities Osteoarthritis Index scale . RESULTS Analysis of variance revealed that participants in both groups significantly improved in the timed chair rise , in the 6-minute walk test , in the range of walking speeds , in the amount of overall pain relief , and in aerobic capacity . No differences between groups were found . Daily pain reports suggested that cycling did not increase acute pain in either group . CONCLUSIONS Cycling may be considered as an alternative exercise modality for patients with knee OA .  Low-intensity cycling was as effective as high-intensity cycling in improving function and gait , decreasing pain , and increasing aerobic capacity Background Osteoarthritis ( OA ) is a common problem in older women that is associated with pain and disabilities . Although yoga is recommended as an exercise intervention to manage arthritis , there is limited evidence documenting its effectiveness , with little known about its long term benefits . This study ’s aims were to assess the feasibility and potential efficacy of a Hatha yoga exercise program in managing OA-related symptoms in older women with knee OA . Methods Eligible participants ( N = 36 ; mean age 72 years ) were r and omly assigned to 8-week yoga program involving group and home-based sessions or wait-list control . The yoga intervention program was developed by a group of yoga experts ( N = 5 ) . The primary outcome was the Western Ontario and McMaster Universities Osteoarthritis Index ( WOMAC ) total score that measures knee OA pain , stiffness , and function at 8 weeks . The secondary outcomes , physical function of the lower extremities , body mass index ( BMI ) , quality of sleep ( QOS ) , and quality of life ( QOL ) , were measured using weight , height , the short physical performance battery ( SPPB ) , the Pittsburgh Sleep Quality Index ( PSQI ) , the Cantril Self-Anchoring Ladder , and the SF12v2 Health Survey . Data were collected at baseline , 4 weeks and 8 weeks , and 20 weeks . Results The recruitment target was met , with study retention at 95 % . Based on ANCOVAs , participants in the treatment group exhibited significantly greater improvement in WOMAC pain ( adjusted means [ SE ] ) ( 8.3 [ .67 ] , 5.8 [ .67 ] ; p = .01 ) , stiffness ( 4.7 [ .28 ] , 3.4 [ .28 ] ; p = .002 ) and SPPB ( repeated chair st and s ) ( 2.0 [ .23 ] , 2.8 [ .23 ] ; p = .03 ) at 8 weeks . Significant treatment and time effects were seen in WOMAC pain ( 7.0 [ .46 ] , 5.4 [ .54 ] ; p = .03 ) , function ( 24.5 [ 1.8 ] , 19.9 [ 1.6 ] ; p = .01 ) and total scores ( 35.4 [ 2.3 ] , 28.6 [ 2.1 ] ; p = .01 ) from 4 to 20 weeks . Sleep disturbance was improved but the PSQI total score declined significantly at 20 weeks . Changes in BMI and QOL were not significant . No yoga related adverse events were observed . Conclusions A weekly yoga program with home practice is feasible , acceptable , and safe for older women with knee OA , and shows therapeutic benefits .Trial registration Clinical Trials.gov : Background Strengthening exercises of the quadriceps femoris muscle ( QFM ) are beneficial for patients with knee osteoarthritis ( OA ) . Studies reporting short-term effects of neuromuscular electrical stimulation ( NMES ) of the QFM in this population support the use of this modality as an adjunct treatment . The objectives of this follow-up study are to compare the effects of an exercise program with and without NMES of the QFM on pain , functional performance , and muscle strength immediately posttreatment and 12 weeks after completion of the intervention . Methods Sixty-three participants with knee OA were r and omly assigned into two groups receiving 12 biweekly treatments : An exercise-only program or an exercise program combined with NMES . Results A significantly greater reduction in knee pain was observed immediately after treatment in the NMES group , which was maintained 12 weeks postintervention in both groups . Although at this stage NMES had no additive effect , both groups demonstrated an immediate increase in muscle strength and in functional abilities , with no differences between groups . Although the improvements in gait velocity and in self-report functional ability were maintained at the follow-up session , the noted improvements in muscle strength , time to up and go , and stair negotiation were not maintained . Conclusion Supplementing an exercise program with NMES to the QFM increased pain modulation immediately after treatment in patients with knee OA . Maintenance of the positive posttreatment effects during a 12-week period was observed only for pain , self-reported functional ability , and walk velocity , with no difference between groups . Clinical rehabilitation effect The effects of a comprehensive group exercise program with or without NMES are partially maintained 12 weeks after completion of the intervention . The addition of NMES is recommended primarily for its immediate effect on pain . Further studies are necessary to determine the effects of repeated bouts of exercise with and without NMES in this population This observer-blinded , r and omized controlled trial compared the short- and long-term effects of 4 months of supervised strength training ( ST ) in a local fitness center , supervised Nordic Walking ( NW ) in a local park , and unsupervised home-based exercise ( HBE , control ) on functional performance in 60 + -year-old persons ( n = 152 ) with hip osteoarthritis ( OA ) not awaiting hip replacement .  Functional performance [ i.e. , 30-s chair st and test ( primary outcome ) , timed stair climbing , and 6-min walk test ] and self-reported outcomes ( i.e. , physical function , pain , physical activity level , self-efficacy , and health-related quality of life ) were measured at baseline and at 2 , 4 , and 12 months . Based on intention-to-treat-analyses improvements [ mean ( 95 % CI ) ] after intervention in number of chair st and s were equal in all three groups at 4 months [ ST : 0.9 ( 0.2 - 1.6 ) , NW : 1.9 ( 0.8 - 3.0 ) , HBE : 1.1 ( 0.1 - 2.0 ) ] but greater in the NW group [ 1.4 ( 0.02 - 2.8 ) ] than in the ST group at 12 months . Generally , improvements in functional performance were greater ( P < 0.001-P < 0.03 ) after NW compared with HBE and ST at all follow-up time points . Furthermore , NW was superior ( P < 0.01 ) to HBE for improving vigorous physical activity and to both ST and HBE for improving ( P < 0.01 ) mental health . These data suggest that NW is the recommended exercise modality compared with ST and HBE Objective : To evaluate the effects of tai chi consisting of group and home-based sessions in elderly subjects with knee osteoarthritis . Design : A r and omized , controlled , single-blinded 12-week trial with stratification by age and sex , and six weeks of follow-up . Setting : General community . Participants : Forty-one adults ( 709 / 9.2 years ) with knee osteoarthritis . Interventions : The tai chi programme featured six weeks of group tai chi sessions , 40 min/session , three times a week , followed by another six weeks ( weeks 7 -12 ) of home-based tai chi training . Subjects were requested to discontinue tai chi training during a six-week follow-up detraining period ( weeks 13 - 18 ) . Subjects in the attention control group attended six weeks of health lectures following the same schedule as the group-based tai chi intervention ( weeks 0 -6 ) , followed by 12 weeks of no activity ( weeks 7 - 18 ) . Main outcome measures : Knee pain measured by visual analogue scale , knee range of motion and physical function measured by Western Ontario and McMaster Universities Osteoarthritis Index ( WOMAC ) were recorded at baseline and every three weeks throughout the 18-week study period . Data were analysed using a mixed model ANOVA . Results : The six weeks of group tai chi followed by another six weeks of home tai chi training showed significant improvements in mean overall knee pain ( P = 0.0078 ) , maximum knee pain ( P = 0.0035 ) and the WOMAC subscales of physical function ( P = 0.0075 ) and stiffness ( P = 0.0206 ) compared to the baseline . No significant change of any outcome measure was noted in the attention control group throughout the study . The tai chi group reported lower overall pain and better WOMAC physical function than the attention control group at weeks 9 and 12 . All improvements disappeared after detraining OBJECTIVE To determine the effects of structured exercise programs 
    Output:
    
In subgroup analyses , resistance training still ranked the most effective pain reduction intervention , followed by strengthening exercise and yoga .
Among female subjects with intervention adherence rate more than 90 % , the most effective intervention was yoga .
Strengthening exercise was superior to all other forms of interventions when comparing long-term effect of selected interventions .
Among older adults with osteoarthritis , resistance training can be considered a treatment option for pain relief .
Yoga is an effective intervention strategy for female elderly , and strengthening exercise has a better long-term beneficial effect