***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: BACKGROUND Our objective was to test the effect of physicians providing brief health lifestyle counseling to patients with type 2 diabetes mellitus during usual care visits . METHODS We conducted a r and omized controlled trial of a 12-month intervention at 2 large community health centers , enrolling 310 patients with a body mass index ( calculated as weight in kilograms divided by height in meters squared ) of 25 or greater . In the intervention group , self-management goals for nutrition and physical activity were set using a tailored computer program . Goals were then review ed at each clinic visit by physicians . The control group received only printed health education material s. The main outcome measures included change in physical activity and body weight . RESULTS In the intervention group , recommended levels of physical activity increased from 26 % at baseline to 53 % at 12 months ( P < .001 ) compared with controls ( 30 % to 37 % ; P= .27 ) , and 32 % of patients in the intervention group lost 6 or more pounds at 12 months compared with 18.9 % of controls ( odds ratio , 2.2 ; P= .006 ) . CONCLUSION A brief intervention to increase the dialogue between patients and health care providers about behavioral goals can lead to increased physical activity and weight loss Purpose The purpose of this study was to evaluate the effectiveness of a  self-help physical activity program  for persons with type 2 diabetes . Effectiveness was measured by cardiovascular indicators , hemoglobin A1C , anthropometric indicators , and activity levels . Methods This intervention study included 53 individuals with type 2 diabetes . Participants were r and omly assigned . Participants in the intervention group attended the usual Diabetes Self-Management Education Program ( DSMEP ) and received a copy of the book , Manpo-kei ; a concise h and out summarizing the key points of Manpo-kei ; and a pedometer . Participants not assigned to the intervention attended the usual DSMEP only . Data collection was completed at the beginning of the study and 3 months later using a lifestyle and diabetes question naire , a physical activity question naire , and cardiovascular and anthropometric measures . Results Those who participated in the intervention demonstrated a significant decrease in hemoglobin A1C , weight , and body fat . In addition , they increased their number of daily steps as measured by the pedometer . The control group also demonstrated a significant decrease in hemoglobin A1C and weight . Both groups demonstrated increases in their regular weekly activity . At the end of the study period , the intervention group had a significantly lower diastolic blood pressure than the control group . Conclusions Pedometers can be a helpful strategy to motivate persons with diabetes to increase physical activity . However , it appears that attendance at DSMEP alone may be enough to increase physical activity for persons with type 2 diabetes The objective of this study was to determine the impact of an aerobic physical exercise program in the treatment of a group of elderly patients with type 2 diabetes mellitus ( DM ) in relation to metabolic control , physical capacity , quality of life ( QOL ) and attitudes toward diabetes . Patients were r and omly assigned to either an experimental ( n=19 ) or a control ( n=20 ) group . The following measurements were conducted at baseline and after week 16 : glycosylated hemoglobin ( hbA1c ) , fructosamine , 3 h oral glucose tolerance test , treadmill test ( Balke-Naughton ) , and a question naire on QOL and attitudes toward DM . After the intervention , the experimental group showed a significant decrease of glucose excursion during the oral glucose tolerance test ( OGTT ) ( area under the curve ) ( 16.6+/-3.8 vs. 15.3+/-3.1 , P<0.05 ) and an increase in total time on the treadmill ( s ) ( 423+/-207 vs. 471+/-230 , P<0.05 ) . An improvement in the attitudes toward DM was observed in the experimental group ( P=0.01 ) but not in the control group . Female gender , higher body mass index and hbA1c were factors associated with a response to the intervention . This study suggests that physical exercise has significant effects on glucose excursion during an OGTT and exercise tolerance in elderly patients with type 2 DM This study examined the independent and combined effects of diet and exercise on adipocytokine and inflammatory cytokines in postmenopausal women with type 2 diabetes . Using a r and omized , controlled design , 33 women ( age , 50 - 70 years ) were assigned to diet alone ( D ) , exercise alone ( EX ) , or diet + exercise ( D + E ) for 14 weeks . Before and after the interventions , blood sample s for adipocytokines and inflammatory markers were drawn , a meal test was performed , and abdominal fat distribution was measured by magnetic resonance imaging ( MRI ) . Body weight decreased approximately 4.5 + /- 0.6 kg ( P < .05 ) after the D and D + E interventions , whereas only small changes in body weight were found with the exercise-alone intervention . Plasma C-reactive protein levels were decreased by approximately 15 % with all 3 interventions , whereas leptin levels were reduced with the D and D + E intervention ( D : pre = 48.7 + /- 6.0 , post = 38.9 + /- 5.0 ng/mL ; D + E : pre = 38.5 + /- 6.0 , post = 22.9 + /- 5.0 ng/mL ; P < .05 ) with no differences between groups . There was a trend for leptin levels to decrease in the EX group ( P = .06 ) . Plasma resistin levels were not altered by the 3 interventions from pre- to posttreatment ( D : pre = 6.9 + /- 0.6 , post = 6.2 + /- 0.4 ng/mL ; D + E : pre = 5.6 + /- 0.6 , post = 5.7 + /- 0.4 ng/mL ; E : pre = 6.2 + /- 0.6 , post = 5.9 + /- 0.6 ng/mL , P > .05 ) , and no differences in adiponectin and tumor necrosis factor alpha ( TNF- alpha ) levels were found . Visceral adipose tissue and tumor necrosis factor alpha were the only predictors of calculated insulin resistance ( P < .05 ) , explaining 43 % of the variability . A typically prescribed weight loss program with lifestyle changes result ed in few changes in adipocytokines and inflammatory cytokines in older women with type 2 diabetes , suggesting that dramatic weight loss or clinical interventions are needed Aims /hypothesisAdults with type 2 diabetes mellitus have impaired microvascular function . It has been hypothesised that microvascular function may be restored through regular exercise . The aim of this study was to investigate whether 6 months of regular aerobic exercise would improve microvascular function in adults with type 2 diabetes . Material s and methods Fifty-nine patients with type 2 diabetes ( 32 males , age 62.9±7.6 years , HbA1c 6.8±0.9 % ) were r and omised to either a 6-month aerobic exercise programme ( 30 min , three times a week , 70–80 % of maximal heart rate ) or a ‘ st and ard care ’ control group . Before and after the intervention period , microvascular function was assessed as the maximum skin hyperaemia to local heating and endothelial and non-endothelial responsiveness following the iontophoretic application of acetylcholine and sodium nitroprusside . Maximal oxygen uptake , as an index of aerobic fitness , was assessed using a maximal exercise test . Results No significant improvement was seen in the exercise group compared with the control group for any of the variables measured : maximal oxygen uptake ( control pre : 1.73±0.53 [ means±SD ] vs post : 1.67±0.40 ; exercise pre : 1.75±0.56 vs post : 1.87±0.62 l/min , p=0.10 ) ; insulin sensitivity ( insulin tolerance test ) ( control pre : −0.17±0.06 vs post : −0.17±0.06 ; exercise pre : −0.16±0.1 vs post : −0.17±0.07 mmol l−1 min−1 , p=0.97 ) ; maximal hyperaemia ( control pre : 1.49±0.43 vs post : 1.52±0.57 ; exercise pre : 1.42±0.36 vs post : 1.47±0.33 V , p=0.85 ) ; peak response to acetylcholine ( control pre : 1.37±0.47 vs post : 1.28±0.37 ; exercise pre : 1.27±0.44 vs post : 1.44±0.23 V , p=0.19 ) or to sodium nitroprusside ( control pre : 1.09±0.50 vs post : 1.10±0.39 ; exercise pre : 1.12±0.28 vs post : 1.13±0.40 V , p=0.98 ) . Conclusions /interpretationIn this group of type 2 diabetic patients with good glycaemic control a 6-month aerobic exercise programme did not improve microvascular function or aerobic fitness Background : National guidelines for managing diabetes set st and ards for care . We sought to determine whether a 1-year intensive multitherapy program result ed in greater goal attainment than usual care among patients with poorly controlled type 2 diabetes mellitus . Methods : We identified patients with poorly controlled type 2 diabetes receiving outpatient care in the community or at our hospital . Patients 30–70 years of age with a hemoglobin A1c concentration of 8 % or greater were r and omly assigned to receive intensive multitherapy  ( n = 36 ) or usual care ( n = 36 ) . Results : The average hemoglobin A1c concentration at entry was 9.1 % ( st and ard deviation [ SD ] 1 % ) in the intensive therapy group and 9.3 % ( SD 1 % ) in the usual therapy group . By 12 months , a higher proportion of patients in the intensive therapy group than in the control group had achieved Canadian Diabetes Association ( CDA ) goals for hemoglobin A1c concentrations ( goal ≤ 7.0 % : 35 % v. 8 % ) , diastolic blood pressure ( goal < 80 mm Hg : 64 % v. 37 % ) , low-density lipoprotein cholesterol ( LDL-C ) levels ( goal < 2.5 mmol/L : 53 % v. 20 % ) and triglyceride levels ( goal < 1.5 mmol/L : 44 % v. 14 % ) . There were no significant differences between the 2 groups in attaining the targets for fasting plasma glucose levels , systolic blood pressure or total cholesterol : high-density lipoprotein cholesterol ratio . None of the patients reached all CDA treatment goals . By 18 months , differences in goal attainment were no longer evident between the 2 groups , except for LDL-C levels . Quality of life , as measured by a specific question naire , increased in both groups , with a greater increase in the intensive therapy group ( 13 % [ SD 10 % ] v. 6 % [ SD 13 % ] , p < 0.003 ) . Interpretation : Intensive multitherapy for patients with poorly controlled type 2 diabetes is successful in helping patients meet most of the goals set by a national diabetes association . However , 6 months after intensive therapy stopped and patients returned to usual care , the benefits had vanished OBJECTIVE The prevalence of type 2 diabetes , especially in developing countries , has grown over the past decades . We performed a controlled clinical study to determine whether a community-based , group-centered public health intervention addressing nutrition and exercise can ameliorate glycemic control and associated cardiovascular risk factors in type 2 diabetic patients in rural Costa Rica . RESEARCH DESIGN AND METHODS A total of 75 adults with type 2 diabetes , mean age 59 years , were r and omly assigned to the intervention group or the control group . All participants received basic diabetes education . The subjects in the intervention group participated in 11 weekly nutrition classes ( 90 min each session ) . Subjects for whom exercise was deemed safe also participated in triweekly walking groups ( 60 min each session ) . Glycosylated hemoglobin , fasting plasma glucose , total cholesterol , triglycerides , HDL and LDL cholesterol , height , weight , BMI , and blood pressure were measured at baseline and the end of the study ( after 12 weeks ) . RESULTS The intervention group lost 1.0 + /- 2.2 kg compared with a weight gain in the control group of 0.4 + /- 2.3 kg ( P = 0.028 ) . Fasting plasma glucose decreased 19 + /- 55 mg/dl in the intervention group and increased 16 + /- 78 mg/dl in the control group ( P = 0.048 ) . Glycosylated hemoglobin decreased 1.8 + /- 2.3 % in the intervention group and 0.4 + /- 2.3 % in the control group ( P = 0.028 ) . CONCLUSIONS Glycemic control of type 2 diabetic patients can be improved through community-based , group-centered public health interventions addressing nutrition and exercise . This pilot study provides an economically feasible 
    Output:
    
Physical activity advice alone was not associated with HbA(1c ) changes .
CONCLUSIONS Structured exercise training that consists of aerobic exercise , resistance training , or both combined is associated with HbA(1c ) reduction in patients with type 2 diabetes .
Structured exercise training of more than 150 minutes per week is associated with greater HbA(1c ) declines than that of 150 minutes or less per week .
Physical activity advice is associated with lower HbA(1c ) , but only when combined with dietary advice