***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 This study examined whether the combination of alternate day fasting ( ADF ) plus exercise produces superior changes in body composition and plasma lipid levels when compared to each intervention alone . DESIGN AND METHODS Obese subjects ( n = 64 ) were r and omized to 1 of 4 groups for 12 weeks : 1 ) combination ( ADF plus endurance exercise ) , 2 ) ADF , 3 ) exercise , or 4 ) control .  RESULTS Body weight was reduced ( P < 0.05 ) by 6 ± 4 kg , 3 ± 1 kg , and 1 ± 0 kg in the combination , ADF , and exercise groups , respectively . Fat mass and waist circumference decreased ( P < 0.001 ) , while lean mass was retained in the combination group . Low-density lipoprotein ( LDL ) cholesterol decreased ( 12 ± 5 % , P < 0.05 ) and high-density lipoprotein ( HDL ) cholesterol increased ( 18 ± 9 % , P < 0.05 ) in the combination group only . LDL particle size increased ( P < 0.001 ) by 4 ± 1 Å and 5 ± 1 Å in the combination and ADF groups , respectively . The proportion of small HDL particles decreased ( P < 0.01 ) in the combination group only . CONCLUSIONS These findings suggest that the combination produces superior changes in body weight , body composition , and lipid indicators of heart disease risk , when compared to individual treatments Background : Elevated circulating levels of soluble lectin-like oxidized low-density lipoprotein receptor-1 ( sLOX-1 ) have been observed in obese persons and are reduced by weight loss . However , it is not known whether combining caloric restriction ( CR ) with exercise training is better in reducing sLOX-1 levels than CR alone . Objective : We examined whether the addition of aerobic exercise to a weight loss intervention differentially affects sLOX-1 levels in 61 abdominally obese post-menopausal women r and omly assigned to a CR only ( n=22 ) , CR+moderate-intensity exercise ( n=22 ) or CR+vigorous-intensity exercise ( n=17 ) intervention for 20 weeks . The caloric deficit was ∼2800 kcal per week for all groups . Results : The intervention groups were similar at baseline with respect to body weight , body composition , lipids and blood pressure . However , plasma sLOX-1 levels were higher in the CR-only group ( 99.90±8.23 pg ml−1 ) compared with both the CR+moderate-intensity exercise ( 69.39±8.23 pg ml−1 , P=0.01 ) and the CR+vigorous-intensity exercise ( 72.83±9.36 pg ml−1 , P=0.03 ) groups . All three interventions significantly reduced body weight ( ∼14 % ) , body fat and waist and hip circumferences to a similar degree . These changes were accompanied by a 23 % reduction in sLOX-1 levels overall ( −19.00±30.08 pg ml−1 , P<0.0001 ) , which did not differ among intervention groups ( P=0.13 ) . Changes in body weight , body fat and maximal oxygen consumption ( VO2 max ) were not correlated with changes in sLOX-1 levels . In multiple regression analyses in all women combined , baseline sLOX-1 levels ( β=−0.70±0.06 , P<0.0001 ) , age ( β=0.92±0.43 , P=0.03 ) and baseline body mass index ( BMI ) ( β=1.88±0.66 , P=0.006 ) were independent predictors of the change in sLOX-1 with weight loss . Conclusions : Weight loss interventions of equal energy deficit have similar effects on sLOX-1 levels in overweight and obese post-menopausal women , with the addition of aerobic exercise having no added benefit when performed in conjunction with CR Background : Bariatric surgery is effective for the treatment of stage II and III obesity and its related diseases , although increasing evidence is showing weight regain ~12–24 months postsurgery . Weight regain increases the risk of physical function decline , which negatively affects an individual 's ability to undertake activities of daily living . The study assessed the effects of a 12-week supervised exercise intervention on physical function and body composition in patients between 12 and 24 months post bariatric surgery . Methods : Twenty-four inactive adult bariatric surgery patients whose body mass index remained ⩾30 kg m2 12 to 24 months post surgery were r and omised to an exercise intervention ( n=12 ) or control group ( n=12 ) . Supervised exercise consisted of three 60-min gym sessions per week of moderate intensity aerobic and resistance training for 12 weeks . Control participants received usual care .  The incremental shuttle walk test ( ISWT ) was used to assess functional walking performance after the 12-week exercise intervention , and at 24 weeks follow-up . Measures of anthropometric , physical activity , cardiovascular and psychological outcomes were also examined . Using an intention-to-treat protocol , independent t-tests were used to compare outcome measures between groups . Results : Significant improvements in the exercise group were observed for the ISWT , body composition , physical function , cardiovascular and self-efficacy measures from baseline to 12 weeks . A large baseline to 12-week change was observed for the ISWT ( exercise : 325.00±117.28 m ; control : 355.00±80.62 m , P<0.001 ) . The exercise group at 24 weeks recorded an overall mean improvement of 143.3±86.6 m and the control group recorded a reduction of −32.50±75.93 m. Findings show a 5.6 kg difference between groups in body mass change from baseline to 24 weeks favouring the exercise group . Conclusions : A 12-week supervised exercise intervention led to significant improvements in body mass and functional walking ability post intervention , with further improvements at the 24-week follow-up Evidence -based practice involves the use of evidence from systematic review s and r and omised controlled trials , but the extent of this evidence in physiotherapy has not previously been surveyed . The aim of this survey is to describe the quantity and quality of r and omised controlled trials and the quantity of systematic review s relevant to physiotherapy . The Physiotherapy Evidence Data base ( PEDro ) was search ed . The quality of trials was assessed with the PEDro scale . The search identified a total of 2,376 r and omised controlled trials and 332 systematic review s. The first trial was published in 1955 and the first review was published in 1982 . Since that time , the number of trials and review s has grown exponentially . The mean PEDro quality score has increased from 2.8 in trials published between 1955 and 1959 to 5.0 for trials published between 1995 and 1999 . There is a substantial body of evidence about the effects of physiotherapy . However , there remains scope for improvements in the quality of the conduct and reporting of clinical trials INTRODUCTION Unfavorable lipid profile is associated with developed cardiovascular diseases . It is necessary to know the beneficial effects of different mode exercises to improve lipid profile . OBJECTIVE To investigate , in obese men and women , the effect on lipid profile of hypocaloric diet combined with structured exercise programs or recommendations of physical activity . METHODS Ninety six obese subjects ( 59 women and 61 men ; 18 - 50 years ; BMI > 30 and < 34.9 kg/m(2 ) ) were r and omised into four supervised treatment groups : strength training ( S ; n = 24 ) , endurance training ( E ; n = 26 ) , combined S + E ( SE ; n = 24 ) , and and received recommendations of physical activity ( PA ; n = 22 ) . Energy intake , body composition , training variables ( VO(2peak ) , strength index , dynamometric strength index ) and blood lipid profile were recorded at baseline and after 24 weeks of treatment . RESULTS Blood lipid profile improved in all groups . No statistically significant differences in baseline and posttraining values were observed between groups . HDLCholesterol showed no changes . A decrease in LDLCholesterol values was observed in all groups after the intervention ( S : 11.2 % , E : 10.8 % , SE : 7.9 % , PA : 10.8 % ; p < 0.01 ) . S , E and PA subjects showed decrease in triglycerides ( S : 14.9 % , E : 15.8 % , PA : 15.7 % ; p < 0.01 ) . Total cholesterol decreased in all groups ( S : 8.4 % , p < 0.01 ; E : 8.8 % , p < 0.01 ; SE : 4.9 % , p < 0.01 ; PA : 8.3 % , p < 0.05 ) . CONCLUSION All protocol s proposed in our study improved blood lipid profile  in obese people . There were no significant differences about the effect on the lipid profile between the implementation of a structured training protocol with physical activity professional supervision and follow recommendations of physical activity Objectives The aim of this study was to examine the effect of three different doses of aerobic exercise training ( corresponding to approximately 50 % , 100 % and 150 % of the National Institutes of Health consensus guidelines ) on endothelial function in sedentary obese postmenopausal women with elevated blood pressure .  Aerobic exercise training improves endothelial function in individuals with cardiovascular risk ; however , it is unknown whether these adaptations occur in a dose-dependent manner . Methods Obese postmenopausal women ( n=155 ) with elevated blood pressure ( systolic blood pressure between 120 and 159.0 mm Hg ) were r and omly assigned to one of four groups : 4 , 8 or 12 kilocalories per kilogram of energy expenditure per week ( kcal/kg/week ) or a non-exercise control group for 6 months . Endothelial function was assessed via flow-mediated dilation ( FMD ) at baseline and post-intervention . Results After exercise training , there was a similar improvement ( 1.02–1.5 % ) in FMD in all three exercise groups ( p<0.05 ) compared with control ( –0.5 % ) . Change in FMD  after exercise training was significantly correlated with FMD at baseline ( r= –0.35 , p<0.001 ) . Post hoc analyses found a significant improvement in FMD in exercisers ( all exercise groups combined ) with endothelial dysfunction ( FMD < 5.5 % ) at baseline ( 1.8 % , 95 % CI : 1.17 to 2.38 ; p<0.001 ) compared with exercisers with normal endothelial function ( FMD ≥ 5.5 % ) ( –1.2 % ; 95 % CI : –1.17 to 0.69 ; p=0.60 ) . Conclusions Aerobic exercise training was associated with improved FMD  in postmenopausal women with elevated blood pressure . In addition , exercise training may be more efficacious in improving endothelial function in postmenopausal women with endothelial dysfunction than individuals with normal endothelial function at baseline Editors ' Notes Context Whether there is added benefit from performing the same amount of exercise at a higher intensity is unclear . Contribution In this 24-week study , participants r and omly assigned to complete the same total amount of exercise at higher or lower intensities had similar reductions in waist circumference and weight .  High-intensity exercise alone improved 2-hour glucose tolerance and led to the greatest increase in cardiorespiratory fitness . Caution The importance of improved 2-hour glucose tolerance in participants without diabetes is unclear . Implication For the same amount of exercise , higher-intensity exercise may not result in greater reduction in waist circumference or weight but may provide benefits in glucose tolerance and cardiorespiratory fitness . The high prevalence of obesity and associated type 2 diabetes mellitus among adults presents a major public health challenge ( 1 ) . Physical inactivity is a significant determinant of obesity , and most adults in the United States are inactive ( 2 ) . Although progress has been made to eluci date the effects of exercise as a strategy for reducing obesity and related glucose tolerance , the specific exercise exposures required to achieve optimal benefit continue to be the source of considerable uncertainty and debate . Implicit within current guidelines for physical activity and health is the observation that 75 minutes of weekly high-intensity exercise is equivalent to 150 minutes of weekly lower-intensity exercise ( 3 , 4 ) . Therefore , guidelines suggest that there are no added health benefits of high-intensity exercise other than the shorter time frame needed to expend the appropriate amount of energy . Thus , the benefits of engaging in high-intensity exercise are attributed to the greater amount of energy expenditure per unit of time and do not relate to intensity per se ( 3 ) . The scientific committee report from which current guidelines were developed recognized that many unanswered issues exist in response to the question of how much of what type of activity is appropriate for a given health outcome , and acknowledged that future investigations need to evaluate the effects of exercise intensity at fixed amounts of energy expenditure . We therefore performed a r and omized clinical trial to investigate the separate effects of habitual exercise differing in amount and intensity on abdominal obesity and glucose tolerance . We studied abdominally obese adults because they are at substantially increased risk for morbidity ( 5 ) and mortality ( 6 ) and because it is estimated that 60 % of men and 45 % of women between the ages of 35 and 65 years in the United 
    Output:
    
Exercise duration ( weeks of exercise ) and intensity correlate better than exercise time ( minutes per week ) with a large and consistent improvement in adult obesity .
Conclusion We suggest that individuals with obesity  should exercise consistently to achieve significant improvements in their health