***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 the effects of stopping and restarting two types of exercise programs in older adults . DESIGN A controlled , longitudinal study that utilized r and om assignment of volunteers . Treatments were exercise programs design ed to improve cardiovascular or neuromuscular fitness . MEASUREMENTS Dependent variables measured before and after implementation of treatments were : maximum oxygen consumption , oxygen pulse , treadmill and cycle training workloads , quadriceps isokinetic peak torque , quadriceps isokinetic total work , and quadriceps training workload . MAIN RESULTS Exercise training was highly effective in improving cardiovascular endurance or muscular strength . Ten weeks of exercise detraining result ed in small losses in newly gained cardiovascular capacity but more noticeable losses in muscular strength . Exercise retraining was accomplished easily using cardiovascular or resistive exercises . The functional benefits of restarting a cardiovascular exercise program appeared additive despite a 10-week intervening period of exercise detraining . In this age group , cardiovascular exercise produced limited improvements in muscular strength , and resistive exercise training positively influenced cardiovascular exercise performance . CONCLUSIONS Older adults are fairly resilient to 10 weeks of cardiovascular detraining and retain newly gained muscular strength for at least 5 weeks , despite an interruption of formal exercise . An occasional missed exercise session or temporary cessation of habitual exercise should not be a cause for distress in exercising older adults . Instead , they should realize the case with which they may restart their exercise program and also appreciate the generalized fitness benefits that can be ascribed to becoming more active BACKGROUND Intensive exercise training can lead to improvement in strength and functional performance in older people living at home and nursing home residents . There is little information whether intensive physical exercise may be applicable and effective in elderly patients suffering from the acute sequelae of injurious falls or hip surgery . OBJECTIVE To assess the feasibility , safety and efficacy of intensive , progressive physical training in rehabilitation after hip surgery . DESIGN Prospect i ve , r and omised , placebo-controlled intervention study of a 3-months training intervention and a 3-months ' follow-up . SETTING Physical training 6 - 8 weeks after hip surgery . SUBJECTS Twenty-eight ( 15 intervention , 13 control ) elderly patients with a history of injurious falls admitted to acute care or inpatient rehabilitation because of acute fall-related hip fracture or elective hip replacement . METHODS Progressive resistance and functional training to improve strength and functional performance . RESULTS No training-related medical problems occurred in the study group . Twenty-four patients ( 86 % ) completed all assessment s during the intervention and follow-up period . Adherence was excellent in both groups ( intervention : 93 , 0+/-13 , 5 % versus control : 96 , 7+/-6 , 2 % ) . Training significantly increased strength , functional motor performance and balance and reduced fall-related behavioural and emotional problems . Some improvements in strength persisted during 3-months follow-up while other strength variables and functional performances were lost after cessation of training . Patients in the control group showed no change in strength , functional performance and emotional state during intervention and follow-up . CONCLUSIONS Progressive resistance training and progressive functional training are safe and effective methods to increase strength and functional performance during rehabilitation in patients after hip surgery and a history of injurious falls . Because part of the training improvements were lost after stopping the training , a continuing training regime should be established OBJECTIVE To determine clinical effectiveness of strength training in children with spastic cerebral palsy . DESIGN Prospect i ve before and after trial in which subjects participated in a 6-week strength training program . All received before and after isometric strength evaluation of eight muscle groups in both lower extremities with a h and -held dynamometer , 3-D gait analysis at free and fast speeds , administration of the Gross Motor Function Measure ( GMFM ) , and assessment of energy expenditure during gait . SETTING Pediatric rehabilitation center at a tertiary care hospital . PATIENTS Eleven children met inclusion criteria for participation . Six had spastic diplegia , were limited community ambulators , and demonstrated less than 50 % of normal muscle strength . Five had spastic hemiplegia and demonstrated a 20 % strength asymmetry in at least two muscles across extremities . RESULTS Each group had significant strength gains in the muscles targeted . The entire cohort had higher gait velocity primarily as a result of increased cadence , with greater capacity to walk faster . GMFM Dimension 5 also improved , with no change in energy expenditure . Asymmetry in strength improved in hemiplegia , with no change in asymmetry in support times or joint motion across extremities . CONCLUSIONS This study reinforced the relationship of strength to motor function in cerebral palsy and further demonstrated the effectiveness of strengthening in this population Background and Purpose — To evaluate the efficacy of supervised high-intensity progressive resistance training ( PRT ) on lower extremity strength , function , and disability in older , long-term stroke survivors . Methods — Forty-two volunteers aged 50 years and above , 6 months to 6 years after a single mild to moderate stroke , were r and omized into either a control group of upper extremity stretching or a PRT group that received a 12-week supervised high-intensity resistance training program consisting of bilateral leg press ( LP ) , unilateral paretic and nonparetic knee extension ( KE ) , ankle dorsiflexion ( DF ) , and plantarflexion ( PF ) exercises .  Functional performance was assessed using the 6-minute walk , stair-climb time , repeated chair-rise time , and habitual and maximal gait velocities . Self-reported changes in function and disability were evaluated using the Late Life Function and Disability Instrument ( LLFDI ) . Results — Single-repetition maximum strength significantly improved in the PRT group for LP ( 16.2 % ) , paretic KE ( 31.4 % ) , and nonparetic KE ( 38.2 % ) with no change in the control group . Paretic ankle DF ( 66.7 % versus −24.0 % ) , paretic ankle PF ( 35.5 % versus −20.3 % ) , and nonparetic ankle PF ( 14.7 % versus −13.8 % ) significantly improved in the PRT group compared with the control . The PRT group showed significant improvement in self-reported function and disability with no change in the control . There was no significant difference between groups for any performance-based measure of function . Conclusions — High-intensity PRT improves both paretic and nonparetic lower extremity strength after stroke , and results in reductions in functional limitations and disability STUDY DESIGN A r and omized clinical trial . OBJECTIVES To examine the relative efficacy of three active therapies for chronic low back pain . SUMMARY OF BACKGROUND DATA There is much evidence documenting the efficacy of exercise in the conservative management of chronic low back pain , but many questions remain regarding its exact prescription and method of application . The most successful method must be identified to enable refinement of future rehabilitation programs to target the specific needs of the patient with chronic low back pain and the budget of the healthcare provider . METHODS One hundred forty-eight patients with chronic low back pain were r and omized to one of the following treatments , which they attended twice a week for 3 months : 1 ) modern active physiotherapy , 2 ) muscle reconditioning on training devices , or 3 ) low-impact aerobics . Pretherapy and posttherapy , objective measurements of lumbar mobility were performed , and question naires were administered inquiring about self-rated pain and disability , and psychosocial factors . Similar question naires were administered 6 months after therapy . The data were analyzed using the intention-to-treat principle . RESULTS Of the 148 patients , 16 ( 10.8 % ) dropped out of the therapy . One hundred thirty-seven question naires ( 93 % ) were available for analysis at all three time points . After therapy , significant reductions were observed in pain intensity , frequency , and disability ; Fear-Avoidance Beliefs about physical activity ( FABQactivity ) ; and " praying/hoping , " " catastrophizing , " and " pain behavior " coping strategies -- each with no group differences in the extent of the response . These effects were maintained over the subsequent 6 months , with the exception of disability and FABQactivity for the physiotherapy group . There were small but significant posttherapy increases in lumbar mobility , with aerobics and devices showing a greater response than physiotherapy . CONCLUSION The general lack of treatment specificity suggests that the main effects of the therapies were educed not through the reversal of physical weaknesses targeted by the corresponding exercise modality , but rather through some " central " effect , perhaps involving an adjustment of perception in relation to pain and disability . The direct costs associated with administering physiotherapy were three times as great , and devices four times as great , as those for aerobics . Administration of aerobics as an efficacious therapy for chronic low back pain has the potential to relieve some of the huge financial burden associated with the condition OBJECTIVE To test the effects of a high intensity home-based progressive strength training program on the clinical signs and symptoms of osteoarthritis ( OA ) of the knee . METHODS Forty-six community dwelling patients , aged 55 years or older with knee pain and radiographic evidence of knee OA , were r and omized to a 4 month home based progressive strength training program or a nutrition education program ( attention control ) .  Thirty-eight patients completed the trial with an adherence of 84 % to the intervention and 65 % to the attention control . The primary outcome was the Western Ontario and McMaster Universities Osteoarthritis ( WOMAC ) index pain and physical function subscales . Secondary outcomes included clinical knee examination , muscle strength , physical performance measures , and question naires to measure quality of life variables . RESULTS Patients in the strength training group who completed the trial had a 71 % improvement in knee extension strength in the leg reported as most painful versus a 3 % improvement in the control group ( p < 0.01 ) . In a modified intent to treat analysis , self-reported pain improved by 36 % and physical function by 38 % in the strength training group versus 11 and 21 % , respectively , in the control group ( p = 0.01 for between group comparison ) . In addition , those patients in the strength training group who completed the trial had a 43 % mean reduction in pain ( p = 0.01 vs controls ) , a 44 % mean improvement in self-reported physical function ( p < 0.01 vs controls ) , and improvements in physical performance , quality of life , and self-efficacy when compared to the control group . CONCLUSION High intensity , home based strength training can produce substantial improvements in strength , pain , physical function and quality of life in patients with knee OA Bourbonnais D , Bilodeau S , Lepage Y , Beaudoin N , Gravel D , Forget R : Effect of force-feedback treatments in patients with chronic motor deficits after a stroke . Am J Phys Med Rehabil 2002;81:890–897 . Objective To assess the effects a motor reeducation approach based on static dynamometers used to provide feedback on the force produced . Design The study design was a single-blind , r and omized , controlled trial . Chronic stroke subjects participated in a 6-wk , thrice-weekly , force-feedback program of either the upper paretic limb ( n = 13 ) or the  lower paretic limb ( n = 12 ) . Baseline and postintervention assessment s of the performance of both the upper and the lower limb were measured for each subject , the untreated paretic limb  of each group serving as a control for the other group . Results With the exception of the h and grip force , strength measurements of the treated limb increased after completion of the treatment . The outcome measurements of the upper limb of the subjects included in the upper paretic limb were not significantly different after treatment from those measured in the lower paretic limb . In contrast , gait velocity and the distance walked in 2 min increased after treatment in the lower paretic limb as compared with the upper paretic limb , whereas the scores in the Fugl-Meyer test for the lower limb and the timed up- and -go test did not increase for either group after treatment . Conclusion The results indicate that treatment of the lower limb based on force feedback produces an improvement of gait velocity PURPOSE Pulmonary rehabilitation programs are effective in patients with severe chronic obstructive pulmonary disease ( COPD ) in the short term , but their long-term effects are not known . We investigated the short- and long-term effects of a 6-month outpatient rehabilitation program in patients with severe COPD . SUBJECTS AND METHODS One hundred patients were r and omly assigned to receive either an exercise training program that included cycling , walking , and strength training ( n = 50 ) or usual medical care ( n = 50 ) . Thirty-four patients in the training group were evaluated after 6 months ( end of training ) , and 26 were evaluated after 18 months of follow-up . In the control group , 28 patients were evaluated at 6 months and 23 after 18 months . We measured pulmonary function , 6-minute walking distance , maximal exercise capacity , peripheral and respiratory muscle strength , and quality of life ( on a 20 to 140-point scale ) , and estimated the cost-effectiveness of the program . RESULTS At 6 months , the training group showed improvement in 6-minute walking distance [ mean difference ( training - control ) of 52 m ; 95 % confidence interval ( CI ) , 15 to 89 m ] , maximal work load ( 12 W ; 95 % CI , 6 to 19 W ) , maximal oxygen uptake ( 0.26 liters/min ; 95 % CI , 0.07 to 0.45 liters/min ) , quadriceps force ( 18 Nm ; 95 % CI , 7 
    Output:
    
Across conditions , PRE was shown to improve the ability to generate force , with moderate to large effect sizes that may carry over into an improved ability to perform daily activities .