***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 : Regular aerobic exercise in patients with cystic fibrosis ( CF ) improves aerobic conditioning and delays disease progression , result ing in better quality of life . The purpose of this study was to evaluate the effect of an aerobic exercise program based on verbal and written guidelines on maximum exercise capacity using a cardiopulmonary exercise test , quality of life , and the self-reported aerobic exercise practice of children and adolescents with CF . METHODS : This r and omized controlled trial followed guidelines for physical exercise in a CF center . Subjects were assigned to 2 groups : intervention ( group 1 ) , with 17 subjects ; and control ( group 2 ) , also with 17 subjects . Data were collected from October 2010 to October 2011 , and the study population comprised 7–20-y-old children and adolescents with CF . The intervention consisted of h and ing out a manual with guidelines for aerobic physical exercises and reinforcing recommendations in telephone calls every 2 weeks . RESULTS : Thirty-four subjects were included in the study , 20 of whom were boys ( 58.5 % ) . The groups were similar at baseline . In group 1 , 6 subjects ( 35.2 % ) reported practicing physical exercises regularly . The mean age was 13.4 ± 2.8 y , the  mean percent-of-predicted FEV1 was 95.5 ± 17.9 % , and the mean peak oxygen uptake ( V̇O2 ) relative to body mass was 34.9 ± 9.0 mL/kg/min . In group 2 , 4 subjects ( 23.5 % ) reported practicing physical exercises regularly . The mean age was 12.7 ± 3.3 y , the mean percent-of-predicted FEV1 was 100.1 ± 21.2 % , and the mean peak V̇O2 was 33.2 ± 8.2 mL/kg/min . In group 1 , there was a significant increase in physical exercise practice as reported by subjects after 3 months of intervention compared with group 2 ( P = .01 ) . No statistically significant differences were found for the other variables . CONCLUSIONS : Verbal and written guidelines for aerobic exercise , together with supervision over the telephone , had a positive impact on the self-reported regular physical exercise practice of children and adolescents . However , no improvement was found in lung function and maximum exercise capacity or domains of the quality of life question naire AIMS To assess the sensitivity of selected outcome measures to any change result ing from treatment of adults with cystic fibrosis with physiotherapy musculoskeletal techniques , use the data for sample size calculations for future studies and assess the acceptability of the methods to potential participants . DESIGN Preliminary , prospect i ve , single-blind , r and omised controlled trial . SETTING Specialist cystic fibrosis centre . PARTICIPANTS Adults recruited from a cystic fibrosis outpatient clinic . INTERVENTIONS The control group received normal optimal physiotherapy care and the intervention group received weekly musculoskeletal treatment for 6 weeks in addition to normal optimal physiotherapy care . OUTCOME MEASURES Recorded at baseline , 3 , 6 and 12 weeks . The outcome measures were posture ( thoracic index ) , chest wall excursion , forced expiratory volume in 1 second ( FEV₁ ) , visual analogue scale for pain , modified shuttle test and Cystic Fibrosis Quality of Life Question naire -- Section One ( physical functioning ) . STATISTICAL ANALYSIS Descriptive statistics [ using medians and interquartile ranges ( IQRs ) ] and linear regression mixed model . RESULTS From a total of 20 subjects , 10 were r and omised to each group . Fifty percent of subjects were male , with a median age of 27 years ( IQR 25 to 34 ) , median FEV(1 ) of 1.75 l ( IQR 1.4 to 2.4 ) and median body mass index of 20.8 ( IQR 20.0 to 23.5 ) . Baseline differences between groups in thoracic index and modified shuttle test made any differences difficult to interpret , but the results for thoracic index and chest wall excursion at the third rib in the treatment group showed a trend towards improvement . The usefulness of FEV₁ , the visual analogue scale for pain and the Cystic Fibrosis Quality of Life Question naire as measures is unclear . CONCLUSION Further musculoskeletal studies in people with cystic fibrosis should consider using thoracic index and a measure of lung function in addition to FEV₁. The musculoskeletal techniques appear to be acceptable to people with cystic fibrosis , and do not seem to have associated adverse effects Objective . Comparing global postural reeducation ( GPR ) to a st and ard physiotherapy treatment ( PT ) based on active exercises , stretching , and massaging for improving pain and function in chronic low back pain ( CLBP ) patients . Design . Prospect i ve controlled study . Setting . Outpatient rehabilitation facility . Participants . Adult patients with diagnosis of nonspecific , chronic ( > 6 months ) low back pain . Interventions . Both treatments consisted of 15 sessions of one hour each , twice a week including patient education . Measures . Rol and Morris Disability Question naire to evaluate disability , and Numeric Analog Scale for pain . A score change > 30 % was considered clinical ly significant . Past treatments , use of medications , smoking habits , height , weight , profession , and physical activity were also recorded on baseline , on discharge , and 1 year after discharge ( resp . , T0 , T1 , and T2 ) . Results . At T0 103 patients with cLBP ( 51 cases and 52 controls ) were recruited . The treatment ( T1 ) has been completed by 79 ( T1 ) of which 60 then carried out the 1-year follow-up ( T2 ) . Both GPR and PT at T1 were associated with a significant statistical and clinical improvement in pain and function , compared to T0 . At T2 , only pain in GPR still registered a statistically significant improvement DESIGN R and omized controlled study . SETTING Laboratory . PARTICIPANTS 26 healthy swimmers r and omly assigned to an  exercise ( n = 13 ; Ex ) or control group ( n = 13 ; Cont ) . INTERVENTION The Ex group performed respiratory-muscle exercises for 10 min thrice a week for 4 wk . CONTEXT Respiratory-muscle exercises are used not only in the rehabilitation of patients with respiratory disease but also in endurance training for athletes . Respiration involves the back and abdominal muscles . These muscles are 1 of the elements responsible for posture control , which is integral to injury prevention and physical performance . However , the effects of respiratory-muscle exercise on posture remain unclear . OBJECTIVE To examine the potential of respiratory-muscle exercise for improving posture . MAIN OUTCOME MEASURES Spinal curvature , pulmonary function , and trunk-muscle strength were measured for both the groups at baseline and after 4 wk . The data were compared between the Ex and Cont groups with Mann-Whitney U test and preintervention and postintervention within groups with a Wilcoxon signed rank-sum test . RESULTS AND CONCLUSION The spinal curvature was significantly different in the Ex group , indicating a decrease in the thoracic ( -13.1 % , P < .01 ) and lumbar ( -17.7 % , P < .05 ) angles . The Ex group presented with lower thoracic ( -8.6 % ) and lumbar ( -20.9 % ) angles at postexercise than the Cont group ( P < .05 ) . With respect to trunk-muscle strength , only trunk-flexion strength significantly increased from pretest to posttest in the Ex group ( P < .05 ) . For pulmonary function , forced vital capacity and forced expiratory volume in 1.0 s were significantly increased after 4 wk in the Ex group ( P < .05 ) . The results suggest that respiratory-muscle exercise straightened the spine , leading to good posture control , possibly because of contraction of abdominal muscles OBJECTIVE To evaluate postural changes and the distribution of plantar pressures in patients with cystic fibrosis ( CF ) . We also sought to evaluate the effects of an educational guideline for physical activity on body posture in children and adolescents with CF . STUDY DESIGN This was a 2-phase study of individuals between age 7 and 20 years . Phase I was a cross-sectional study in which healthy subjects were selected for postural evaluation and baropodometry , aim ing to perform a later comparison with patients with CF . In phase II , we performed a r and omized controlled clinical trial to assess the influence of the exercise guideline on the postural changes . Patients were assigned to 2 groups : control and intervention . The intervention consisted of a h and book with instructions for aerobic exercise and stretching . Main outcomes were postural abnormalities , plantar pressure distribution , and lung function . RESULTS In phase I , 34 patients with CF and 34 healthy matched individuals were included . No significant baseline differences were identified . Children with CF presented more postural deviations compared with healthy subjects ( P < .05 ) , as to alignment of the head , shoulder girdle , and pelvis , increased cervical lordosis , and lateral chest distance . In phase II ( n = 34 ) , there were no baseline differences between groups . The intervention caused ( P < .05 ) a decrease in cervical lordosis , thoracic kyphosis , lumbar lordosis , lateral chest distance , and abdominal protrusion , as well as in the baropodometric mean pressure and contact area . CONCLUSIONS Children and adolescents with CF present postural changes when compared with healthy individuals . The educational guideline for exercise practice helped to improve posture , preventing the progression of some postural disorders Virtual healthcare is fast entering medical practice . Research into the feasibility of using it to teach treatment regimens such as exercise has not been explored . Maintaining an exercise regime can be difficult in cystic fibrosis : group classes risk potential infection , yet motivation is hard to maintain when alone . Tai Chi is a low-impact exercise and involves gentle , dem and ing movements . This study aim ed to assess the feasibility , safety and acceptability of learning Tai Chi via an internet-based approach and compared patient-reported outcomes . Children and adults with cystic fibrosis were recruited to a r and omised , comparative effectiveness trial . Participants learnt eight Tai Chi movements ; teaching was delivered in eight lessons over 3 months : delivered either via the internet or face-to-face . Assessment s were at 3-monthly intervals over 9 months . Outcomes included health status , quality of life , sleep , mindfulness and instructor-led questions . 40 adults and children completed the eight sets of Tai Chi  lessons . The median age was 22.8 years ( range 6.1–51.5 years ) ; 27 patients were female . The cohort comprised 26 adults ( aged > 16 years ) , six teenagers and eight children ( aged < 12 years ) . The groups were well matched . Feasibility and safety were demonstrated . Participants showed significant improvements in self-reported sleep , cough ( both daytime and night-time ) , stomach ache and breathing . No differences in lung function , health status , quality of life , sleep or mindfulness was shown before or after completing the lessons . Tai Chi was safe and well tolerated ; it was feasible to deliver individual lessons via the internet , reducing concerns regarding cross-infection , and appeared to improve self-reported symptoms . R and omised controlled trial of Tai Chi in cystic fibrosis 
    Output:
    
Manual therapy may make little or no difference to the change in trunk deformity compared to usual care ( low- quality evidence ) .
Due to method ological limitations in the included trials , and in addition to the very low to low quality of the current evidence , there is limited evidence about the benefits of physical therapies on postural abnormalities in people with CF .