***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 Lifestyle modification is recommended for management of prehypertension , yet finding effective interventions to reach rural women is a public health challenge . This community-based clinical trial compared the effectiveness of st and ard advice to two multi-component theory-based tailored interventions , using web-based or print-mailed delivery , in reducing blood pressure among rural women , ages 40–69 , with prehypertension . Methods 289 women with prehypertension enrolled in the Wellness for Women : DASHing towards Health trial , a 12-month intervention with 12-month follow-up . Women were r and omly assigned to groups using a 1:2:2 ratio , comparing st and ard advice ( 30-minute counseling session ) to two interventions ( two 2-hour counseling sessions , 5 phone goal - setting sessions , strength-training video , and 16 tailored newsletters , web-based or print-mailed ) . Linear mixed model methods were used to test planned pairwise comparisons of marginal mean change in blood pressure , healthy eating and activity , adjusted for age and baseline level . General estimating equations were used to examine the proportion of women achieving normotensive status and meeting health outcome criteria for eating and activity . Results Mean blood pressure reduction ranged from 3.8 ( SD = 9.8 ) mm Hg to 8.1 ( SD = 10.4 ) mm Hg . The 24-month estimated marginal proportions of women achieving normotensive status were 47 % for web-based , and 39 % for both print-mailed and st and ard advice groups , with no group differences ( p = .11 and p = .09 , respectively ) . Web-based and print-mailed groups improved more than st and ard advice group for waist circumference ( p = .017 and p = .016 , respectively ) ; % daily calories from fat ( p = .018 and p = .030 ) and saturated fat ( p = .049 and p = .013 ) ; daily servings of fruit and vegetables ( p = .008 and p < .005 ) ; and low fat dairy ( p < .001 and p = .002 ) . Greater improvements were observed in web-based versus st and ard advice groups in systolic blood pressure ( p = .048 ) and estimated VO2max ( p = .037 ) . Dropout rates were 6 % by 6-months , 11.4 % by 24 months , with no differences across groups . Conclusions Rural women with prehypertension receiving  distance-delivery theory-based lifestyle modifications can achieve a reduction of blood pressure and attainment of normotensive status . Trial registration Clinical Trials.gov Introduction Collaborative and multilevel interventions to effectively address obesity-related behaviors among rural communities with health disparities can be challenging , and traditional research approaches may be unsuitable . The primary objective of our 15-week r and omized controlled pilot study , which was guided by community-based participatory research ( CBPR ) principles , was to determine the effectiveness of providing twice-weekly access to group fitness classes , with and without weekly nutrition and physical activity education sessions , in Caswell County , North Carolina , a rural region devoid of medical and physical activity re sources . Methods Participants were r and omly divided into 2 groups : group 1 was offered fitness sessions and education in healthful eating and physical activity ; group 2 was offered fitness sessions only . Outcome measures were assessed at baseline and immediately after the intervention . St and ardized assessment procedures , vali date d measures , and tests for analysis of variance were used . Results Of 91 enrolled participants , most were African American ( 62 % ) or female ( 91 % ) . Groups were not significantly different at baseline . Group 1 experienced significantly greater improvements in body mass index ( F = 15.0 , P < .001 ) and waist circumference ( F = 7.0 , P = .01 ) , compared with group 2 . Both groups significantly increased weekly minutes of moderate physical activity ( F = 9.4 , P < .003 ) . Participants in group 1 also had significantly greater weight loss with higher attendance at the education ( F = 14.7 , P < .001 ) and fitness sessions ( F = 18.5 , P < .001 ) . Conclusion This study offers effective programmatic strategies that can reduce weight and increase physical activity and demonstrates feasibility for a larger scale CBPR obesity trial targeting underserved residents affected by health disparities . This study also signifies successful collaboration among community and academic partners engaged in a CBPR coalition OBJECTIVES We tested a community-based intervention design ed to reduce cardiovascular disease risk in sedentary midlife and older women who were overweight or obese . METHODS In a r and omized controlled trial conducted in 8 counties in Arkansas and Kansas , counties were assigned to the intervention ( a 12-week twice-weekly heart health program ) group or to the delayed-intervention control group .  Ten to fifteen women were selected from each site , and participants ' weight , waist circumference , diet , physical activity , and self-efficacy were measured before and after the intervention . Data were analyzed with multiple regressions . RESULTS Compared with the control group , participants in the intervention group had a significant decrease in body weight ( -2.1 kg ; 95 % confidence interval [ CI ] = -3.2 , -1.0 ) , waist circumference ( -2.3 in ; 95 % CI = -4.2 , -0.5 ) , and energy intake ( -390 kcal/day ; 95 % CI = -598 , -183 ) ; an increase in activity ( + 1637 steps/day ; 95 % CI = 712 , 2562 ) ; and an increase in self-efficacy for dietary and physical activity behaviors . CONCLUSIONS Our results suggest that a community-based program can improve self-efficacy , increase physical activity , and decrease energy intake , result ing in decreased waist circumference and body weight among at-risk women Background : Unhealthy diet and lack of physical activity increase rural midlife and older women 's risk of chronic diseases and premature death , and they are behind urban residents in meeting Healthy People 2010 objectives . Objectives : The objective of this study was to compare a tailored intervention based on the Health Promotion Model with a generic intervention to increase physical activity  and  healthy eating  among rural women . Methods : In a r and omized-by-site , community-based , controlled , clinical trial , Wellness for Women , 225 women aged 50 to 69 years were recruited in two similar rural areas . Over 12 months , women received by mail either 18 generic newsletters or 18 newsletters computer tailored on Health Promotion Model behavior-specific cognitions ( benefits , barriers , self-efficacy , and interpersonal support ) , activity , and eating . Outcomes at 6 and 12 months included behavioral markers and biomarkers of physical activity and eating . Data were analyzed by repeated- measures analysis of variance and chi-square tests ( & agr ; < .05 ) . Results : Both groups significantly increased stretching and strengthening exercise and fruit and vegetable servings and decreased percentage of calories from fat , whereas only the tailored group increased moderate or greater intensity activity and decreased percentage of calories from saturated fat from baseline to 6 months . Both groups increased stretching and strengthening exercise , whereas only the tailored group increased moderate or greater intensity activity and fruit and vegetable servings and decreased percentage of calories from fat from baseline to 12 months . Both groups had several changes in biomarkers over the study . A higher proportion of women receiving tailored newsletters met Healthy People 2010 criteria for moderate or greater intensity activity , fruit and vegetable servings , and percentage of calories from fat at 12 months . Discussion : Mailed computer-tailored and generic print newsletters facilitated the adoption of change in both activity and eating over 6 months . Tailored newsletters were more efficacious in facilitating change over 12 months Physical activity is associated with health and reduced mortality risk , yet only15 % ofU.S. adults achieve adequate activity . This study is an experimental repeated measures nested design r and omizing two similar rural communities to investigate the effectiveness of the Heart and Soul Physical Activity Program ( HSPAP ) ( Peterson , 2002 ) in promoting physical activity in midlife women ( n = 42 ) aged 35 to 65 years . The HSPAP , an innovative church-based health promotion intervention , is conceptualized in social support and design ed to increase physical activity , energy expenditure ( EE ) , and cardiorespiratory fitness ( VO2 max ) , measured over time . A significant interaction ( p < .001 ) was found for EE in one HSPAP group increasing their EE by 1,010 kcals/week . HSPAP participants increased their VO2 max level by 75 % ( p < .001 ) and 10 % ; comparison groups stayed the same or declined 16 % . Study results provide preliminary support for the HSPAP intervention as an effective treatment to improve physical activity levels in sedentary , rural , midlife women CONTEXT Obesity is a chronic disease of epidemic proportions in the United States . Primary care providers are critical to timely diagnosis and treatment of obesity , and need better tools to deliver effective obesity care . PURPOSE To conduct a pilot r and omized trial of a chronic care model ( CCM ) program for obesity care in rural Kansas primary care . METHODS We enrolled 107 participants to a 6-month , 2-armed , r and omized trial comparing a CCM for obesity with usual care . The primary outcome was weight change at 90 days . The usual care arm received educational weight loss material s and outcome assessment s at day 0 , 90 , and 180 . The active arm received the same elements as the usual care arm plus a multicomponent obesity CCM . FINDINGS The Day 90 mean + /- SD weight change for the active arm ( n = 34 ) and control arm ( n = 33 ) , respectively , was -4.5 + /- 7.7 pounds and -2.4 + /- 8.1 pounds ( P = .27 for difference ) . The Day 180 mean + /- SD weight change for the active ( n = 27 ) and control ( n = 27 ) arms , respectively , was -9.4 + /- 10.3 pounds and -2.1 + /- 10.7 pounds ( P = .01 for difference ) . There was no significant change in physical activity , or fruit and vegetable intake at day 90 or day 180 . CONCLUSIONS Improving the recognition and treatment of obesity in primary care setting s is a critical initiative . Rural population s suffer disproportionately with obesity , and better methods of delivering obesity care are needed for this population . Further research is needed to establish the effectiveness of a CCM approach for obesity care The WATCH ( Wellness for African Americans Through Churches ) Project was a r and omized trial comparing the effectiveness of 2 strategies to promote colorectal cancer preventive behaviors among 587 African American members of 12 rural North Carolina churches . Using a 2 X 2 factorial research design , the authors compared a tailored print and video ( TPV ) intervention , consisting of 4 individually tailored newsletters and targeted videotapes , with a lay health advisor ( LHA ) intervention . Results showed that the TPV intervention significantly improved ( p < .05 ) fruit and vegetable consumption ( 0.6 servings ) and recreational physical activity ( 2.5 metabolic task equivalents per hour ) and , among those 50 and older ( n = 287 ) , achieved a 15 % increase in fecal occult blood testing screening ( p = .08 ) . The LHA intervention did not prove effective , possibly because of suboptimal reach and diffusion Background : In the Wellness for Women Project , a r and omized-by-site 1-year controlled clinical trial , the efficacy of generic newsletters and newsletters tailored on Health Promotion Model behavior-specific cognitions , eating behavior , and activity behavior were compared among 225 women aged 50 to 69 years . Objectives : The purpose of this study was to compare the maintenance of change in healthy eating and physical activity over the 12 months following the tailored versus generic mailed newsletter intervention . Methods : Outcomes at 18 and 24 months included behavioral markers and biomarkers of physical activity and eating . Data were analyzed using the multivariate approach to repeated measures analysis of variance and generalized estimating equations ( α < .05 ) . Results : At 18 months , the tailored group maintained levels of all eating and activity behaviors , whereas the generic group maintained levels of fruit and vegetable servings , a moderate or greater activity , stretching exercise , lower body strength and flexibility but increased saturated fat intake and declined in weekly strength exercise and cardiorespiratory fitness . At 24 months , both groups maintained or returned to 12-month levels of all eating behaviors , moderate or greater activity , stretching exercise , and flexibility but declined in cardiorespiratory fitness ; the tailored group maintained levels of strength exercise and lower body strength , whereas the generic group decreased in both . A greater proportion of women who received tailored newsletters continued to achieve most Healthy People 2010 criteria for eating and activity . Discussion : Mailed tailored print newsletters were more efficacious than generic newsletters in facilitating maintenance of change in eating and activity for 6 months postintervention . Both tailored and generic newsletters facilitated the maintenance of change in eating behaviors and in moderate or greater physical activity and stretching exercise , whereas tailored newsletters were more efficacious in maintaining change in strength exercise for 12 months postintervention 
    Output:
    
Interventions which are very personalized or tailored and /or include many intervention contacts appear to be most effective .