***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: Objective : To determine whether falls can be prevented with minimally supervised exercise targeting potentially remediable fall risk factors , i.e. , poor balance , reduced leg muscle strength , and freezing of gait , in people with Parkinson disease . Methods : Two hundred thirty-one people with Parkinson disease were r and omized into exercise or usual-care control groups . Exercises were practice d for 40 to 60 minutes , 3 times weekly for 6 months . Primary outcomes were fall rates and proportion of fallers during the intervention period . Secondary outcomes were physical ( balance , mobility , freezing of gait , habitual physical activity ) , psychological ( fear of falling , affect ) , and quality -of-life measures . Results : There was no significant difference between groups in the rate of falls ( incidence rate ratio [ IRR ] = 0.73 , 95 % confidence interval [ CI ] 0.45–1.17 , p = 0.18 ) or proportion of fallers ( p = 0.45 ) . Preplanned subgroup analysis revealed a significant interaction for disease severity ( p < 0.001 ) . In the lower disease severity subgroup , there were fewer falls in the exercise group compared with controls ( IRR = 0.31 , 95 % CI 0.15–0.62 , p < 0.001 ) , while in the higher disease severity subgroup , there was a trend toward more falls in the exercise group ( IRR = 1.61 , 95 % CI 0.86–3.03 , p = 0.13 ) . Postintervention , the exercise group scored significantly ( p < 0.05 ) better than controls on the Short Physical Performance Battery , sit-to-st and , fear of falling , affect , and quality of life , after adjusting for baseline performance . Conclusions : An exercise program targeting balance , leg strength , and freezing of gait did not reduce falls but improved physical and psychological health . Falls were reduced in people with milder disease but not in those with more severe Parkinson disease . Classification of evidence : This study provides Class III evidence that for patients with Parkinson disease , a minimally supervised exercise program does not reduce fall risk . This study lacked the precision to exclude a moderate reduction or modest increase in fall risk from exercise . Trial registration : Australian New Zeal and Clinical Trials Registry ( ACTRN12608000303347 ) PURPOSE The purpose of this r and omized trial was to evaluate the efficacy of the Mindfulness-Based Stress Reduction for Breast Cancer ( MBSR[BC ] ) program in improving psychological and physical symptoms and quality of life among breast cancer survivors ( BCSs ) who completed treatment . Outcomes were assessed immediately after 6 weeks of MBSR(BC ) training and 6 weeks later to test efficacy over an extended timeframe . PATIENTS AND METHODS A total of 322 BCSs were r and omly assigned to either a 6-week  MBSR(BC ) program ( n = 155 ) or a usual care group ( n = 167 ) . Psychological ( depression , anxiety , stress , and fear of recurrence ) and physical symptoms ( fatigue and pain ) and quality of life ( as related to health ) were assessed at baseline and at 6 and 12 weeks . Linear mixed models were used to assess MBSR(BC ) effects over time , and participant characteristics at baseline were also tested as moderators of MBSR(BC ) effects . RESULTS Results demonstrated extended improvement for the MBSR(BC ) group compared with usual care in both psychological symptoms of anxiety , fear of recurrence overall , and fear of recurrence problems and physical symptoms of fatigue severity and fatigue interference ( P < .01 ) . Overall effect sizes were largest for fear of recurrence problems ( d = 0.35 ) and fatigue severity ( d = 0.27 ) . Moderation effects showed BCSs with the highest levels of stress at baseline experienced the greatest benefit from MBSR(BC ) . CONCLUSION The MBSR(BC ) program significantly improved a broad range of symptoms among BCSs up to 6 weeks after MBSR(BC ) training , with generally small to moderate overall effect sizes Objective : To detect the effectiveness of incremental speed-dependent treadmill training on postural instability , dynamic balance and fear of falling in patients with idiopathic Parkinson 's disease . Design : R and omized controlled trial . Setting : Ankara Education and Research Hospital , 2nd PM&R Clinic , Cardiopulmonary Rehabilitation Unit . Subjects : Fifty-four patients with idiopathic Parkinson 's disease in stage 2 or 3 of the Hoehn Yahr staging entered , and 31 patients ( 21 training , 10 control ) had outcome data . Interventions : Postural instability of patients with Parkinson 's disease was assessed using the motor component of the Unified Parkinson 's Disease Rating Scale ( UPDRS ) , Berg Balance Test , Dynamic Gait Index and Falls Efficacy Scale .  Twenty-one patients with Parkinson 's disease participated in an eight-week exercise programme using incremental speed-dependent treadmill training . Before and after the training programme , balance , gait , fear of falling and walking distance and speed on treadmill were assessed in both Parkinson 's disease groups . Main measures : Walking distance and speed on treadmill , UPDRS , Berg Balance Test , Dynamic Gait Index and Falls Efficacy Scale . Results : Initial total walking distance of the training group on treadmill was 266.45 ± 82.14 m and this was progressively increased to 726.36 ± 93.1 m after 16 training session ( P < 0.001 ) . Tolerated maximum speed of the training group on treadmill at baseline was 1.9 ± 0.75 km/h and improved to 2.61 ± 0.77 km/h ( P < 0.001 ) . Berg Balance Test , Dynamic Gait Index and Falls Efficacy Scale scores of the training group were improved significantly after the training programme ( P < 0.01 ) . There was no significant improvement in any of the outcome measurements in the control group ( P > 0.05 ) . Conclusions : Specific exercise programmes using incremental speed-dependent treadmill training may improve mobility , reduce postural instability and fear of falling in patients with Parkinson 's disease BACKGROUND AND AIMS Degludec is an ultralong-acting insulin analogue with a flat and reproducible pharmacodynamic profile . As some patients with type 1 diabetes ( T1D ) fail to achieve 24-h coverage with glargine or detemir despite twice-daily injections , we studied the effect of switching T1D patients from twice-daily glargine or detemir to degludec . METHODS AND RESULTS In this prospect i ve observational study , T1D patients on twice-daily glargine or detemir were enrolled . At baseline and 12 weeks after switching to degludec , we recorded HbA1c , insulin dose , 30-day blood glucose self monitoring ( SMBG ) or 14-day continuous glucose monitoring ( CGM ) , treatment satisfaction ( DTSQ ) , fear of hypoglycemia ( FHS ) . We included 29 patients ( mean age 34 ± 11 years ; diabetes duration 18 ± 10 years ) . After switching to degludec  , HbA1c decreased from 7.9 ± 0.6 % ( 63 ± 6 mmol/mol ) to 7.7 ± 0.6 % ( 61 ± 6 mmol/mol ; p = 0.028 ) . SMBG showed significant reductions in the percent and number of blood glucose values < 70 mg/dl and in the low blood glucose index ( LBGI ) during nighttime . CGM showed a significant reduction of time spent in hypoglycemia , an increase in daytime spent in target 70 - 180 mg/dl , and a reduction in glucose variability . Total insulin dose declined by 17 % ( p < 0.001 ) , with 24 % reduction in basal and 10 % reduction in pr and ial insulin . DTSQ and FHS significantly improved . CONCLUSION Switching from twice-daily glargine or detemir to once daily degludec  improved HbA1c , glucose profile , hypoglycemia risk and treatment satisfaction , while insulin doses decreased . Clinical Trials.govNCT02360254 Background Recovery from myocardial infa rct ion has been associated with patients ’ perceptions of damage to their heart . New technologies offer a way to show patients animations that may foster more accurate perceptions and encourage medication adherence , increased exercise and faster return to activities . Purpose The purpose of this study was to investigate the effects of a brief animated intervention delivered at the patients ’ bedside on perceptions and recovery in acute coronary syndrome patients . Methods Seventy acute coronary syndrome patients were r and omly assigned to the intervention or st and ard care alone .  Illness perceptions , medication beliefs and recovery outcomes were measured . Results Post-intervention , the intervention group had significantly increased treatment control perceptions and decreased medication harm beliefs and concerns . Seven weeks later , intervention participants had significantly increased treatment control and timeline beliefs , decreased symptoms , lower cardiac avoidance , greater exercise and faster return to normal activities compared to control patients . Conclusions A brief animated intervention may be clinical ly effective for acute coronary syndrome patients ( Trial-ID : ACTRN12614000440628 ) OBJECTIVE To compare in a multicenter r and omized controlled trial the benefits in terms of anxiety regulation of a 15-session single-component group intervention ( SGI ) based on support with those of a 15-session multiple-component structured manualized group intervention ( MGI ) combining support with cognitive-behavioral and hypnosis components . METHODS Patients with nonmetastatic breast cancer were r and omly assigned at the beginning of the survivorship period to the SGI ( n = 83 ) or MGI ( n = 87 ) .  Anxiety regulation was assessed , before and after group interventions , through an anxiety regulation task design ed to assess their ability to regulate anxiety psychologically ( anxiety levels ) and physiologically ( heart rates ) . Question naires were used to assess psychological distress , everyday anxiety regulation , and fear of recurrence . Group allocation was computer generated and concealed till baseline completion . RESULTS Compared with patients in the SGI group ( n = 77 ) , patients attending the MGI group ( n = 82 ) showed significantly reduced anxiety after a self-relaxation exercise ( P = .006 ) and after exposure to anxiety triggers ( P = .013 ) and reduced heart rates at different time points throughout the task ( P = .001 to P = .047 ) . The MGI participants also reported better everyday anxiety regulation ( P = .005 ) , greater use of fear of recurrence-related coping strategies ( P = .022 ) , and greater reduction in fear of recurrence-related psychological distress ( P = .017 ) compared with the SGI group . CONCLUSIONS This study shows that an MGI combining support with cognitive-behavioral techniques and hypnosis is more effective than an SGI based only on support in improving anxiety regulation in patients with breast cancer OBJECTIVE Among the most prevalent and distressing concerns endorsed by breast cancer survivors is fear of cancer recurrence ( FOR ) , and one of the most salient facets is the worry that a recurrence of cancer could cause one 's death . The primary goal of the present study was to test the effects of a brief , low-cost gratitude intervention on overall FOR and death-related FOR , positing pursuit of meaningful goals as a theoretically driven putative mediator . To replicate published tests of similar gratitude-eliciting interventions , positive affect ( PA ) was also considered as an outcome . METHOD Sixty-seven women with early stage breast cancer were r and omly assigned to either a 6-week online gratitude intervention or a 6-week online control condition . Outcomes were assessed at pre- and posttreatment , as well as 1 month and 3 months after the end of treatment . The mediator , meaningful goal pursuit , was measured via assessment s over the 6-week intervention period . RESULTS Results revealed that patients in the gratitude intervention experienced a significant decrease in death-related FOR compared to the control condition . Moreover , this effect was significantly mediated by meaningful goal pursuit ( and not by PA ) . The gratitude intervention was also found to prevent declines in PA observed in the control condition . CONCLUSIONS Overall , findings support the notion that a brief gratitude intervention can promote well-being and psychological adaptation to cancer by stimulating the pursuit of meaningful goals and subsequently reducing death-related FOR . ( PsycINFO Data base Background Depressive symptoms , and the associated coexistence of symptoms of anxiety and decreased quality of life ( QoL ) , are common in patients with heart failure ( HF ) . However , treatment strategies for depressive symptoms in patients with HF still remain to be established . Internet-based cognitive behavioral therapy ( ICBT ) , as guided self-help CBT programs , has shown good effects in the treatment of depression . Until now , ICBT has not been evaluated in patients with HF with depressive symptoms . Objective The aims of this study were to ( 1 ) evaluate the effect of a 9-week guided ICBT program on depressive symptoms in patients with HF ; ( 2 ) investigate the effect of the ICBT program on cardiac anxiety and QoL ; and ( 3 ) assess factors associated with the change in depressive symptoms . Methods Fifty participants were r and omized into 2 treatment arms : ICBT or a Web-based moderated discussion forum ( DF ) . The Patient Health Question naire-9 was used to measure depressive symptoms , the Cardiac Anxiety Question naire ( CAQ ) was used to measure cardiac-related anxiety , and the Minnesota Living with Heart Failure question naire was 
    Output:
    
Results The data on psychotherapy ( CBT , third-wave CBT , and mindfulness ) , patient education , and rehabilitation programs demonstrated effectiveness in cancer and cardiac patients .
Exercise interventions demonstrated effectiveness in patients with Parkinson ’s disease , and medical interventions showed limited effectiveness in reducing HA in diabetes and epilepsy .
Conclusions The literature supports that a variety of interventions may be effective in reducing HA in individuals with chronic illness .