***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 
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    ***EXAMPLES*** 
    Input: CONTEXT Although many studies suggest that physical activity may reduce risk of type 2 diabetes , the role of moderate-intensity activity such as walking is not well understood . OBJECTIVES To examine the relationship of total physical activity and incidence of type 2 diabetes in women and to compare the benefits of walking vs vigorous activity as predictors of subsequent risk of type 2 diabetes . DESIGN AND SETTING The Nurses ' Health Study , a prospect i ve cohort study that included detailed data for physical activity from women surveyed in 11 US states in 1986 , with up date s in 1988 and 1992 . PARTICIPANTS A total of 70,102 female nurses aged 40 to 65 years who did not have diabetes , cardiovascular disease , or cancer at baseline ( 1986 ) . MAIN OUTCOME MEASURE Risk of type 2 diabetes by quintile of metabolic equivalent task ( MET ) score , based on time spent per week on each of 8 common physical activities , including  walking .  RESULTS During 8 years of follow-up ( 534 , 928 person-years ) , we documented 1419 incident cases of type 2 diabetes . After adjusting for age , smoking , alcohol use , history of hypertension , history of high cholesterol level , and other covariates , the relative risks ( RRs ) of developing type 2 diabetes across quintiles of physical activity ( least to most ) were 1.0 , 0.77 , 0.75 , 0.62 , and 0.54 ( P for trend < .001 ) ; after adjusting for body mass index ( BMI ) , RRs were 1.0 , 0.84 , 0.87 , 0.77 , and 0.74 ( P for trend = .002 ) . Among women who did not perform vigorous activity , multivariate RRs of type 2 diabetes across quintiles of MET score for walking were 1.0 , 0.91,0.73 , 0.69 , and 0.58 ( P for trend < .001 ) . After adjusting for BMI , the trend remained statistically significant ( RRs were 1.0 , 0.95 , 0.80 , 0.81 , 0.74 ; P for trend = .01 ) . Faster usual walking pace was independently associated with decreased risk . Equivalent energy expenditures from walking and vigorous activity result ed in comparable magnitudes of risk reduction . CONCLUSIONS Our data suggest that greater physical activity level is associated with substantial reduction in risk of type 2 diabetes , including physical activity of moderate intensity and duration Prevention of type 2 diabetes by intensive lifestyle intervention design ed to achieve and maintain ideal body weight was assessed in subjects with impaired glucose tolerance ( IGT ) . Male subjects with IGT recruited from health-screening examinees were r and omly assigned in a 4:1 ratio to a st and ard intervention group ( control group ) and intensive intervention group ( intervention group ) . The final numbers of subjects were 356 and 102 , respectively . The subjects in the control group and in the intervention group were advised to maintain body mass index ( BMI ) of < 24.0 kg/m2 and of < 22.0 kg/m2 , respectively , by diet and exercise . In the intervention group , detailed instructions on lifestyle were repeated every 3 - 4 months during hospital visits . Diabetes was judged to have developed when two or more consecutive fasting plasma glucose ( FPG ) values exceeded 140 mg/dl . A 100 g oral glucose tolerance test was performed every 6 months to detect improvement of glucose tolerance . The subjects were seen in an ordinary outpatient clinic . The cumulative 4-year incidence of diabetes was 9.3 % in the control group , versus 3.0 % in the intervention group , and the reduction in risk of diabetes was 67.4 % ( P < 0.001 ) . Body weight decreased by 0.39 kg in the control group and by 2.18 kg in the intervention group ( P < 0.001 ) . The control group was subclassified according to increase and decrease in body weight . The incidence of diabetes was positively correlated with the changes in body weight , and the improvement in glucose tolerance was negatively correlated . Subjects with higher FPG at baseline developed diabetes at a higher rate than those with lower FPG . Higher 2h plasma glucose values and higher BMI values at baseline were also associated with a higher incidence of diabetes , but the differences were not significant . Subjects with a low insulinogenic index ( DeltaIRI/DeltaPG 30 min after an oral glucose load ) developed diabetes at a significantly higher rate than those with a normal insulinogenic index . Comparison of the BMI data and incidence of diabetes in five diabetes prevention studies by lifestyle intervention revealed a linear correlation between the incidence of diabetes and the BMI values , with the exception of the DaQing Study . However , the slope of the reduction in incidence of diabetes in the intensive intervention groups was steeper than expected simply on the basis of the reduction of BMI , suggesting that the effect of lifestyle intervention can not be solely ascribed to the body weight reduction . We conclude that lifestyle intervention aim ed at achieving ideal body weight in men with IGT  is effective and can be conducted in an outpatient clinic setting A survey was conducted to assess the potential for an  exercise and weight control program  for persons with Type II diabetes . Question naires were sent to 1,000 individuals with diabetes , who were r and omly selected from the provincial health records office .  Physicians and dietitians were the primary sources of information about both exercise and diet . Although few respondents participated in organized ( 7.7 % ) or informal ( 36.8 % ) exercise programs , or expressed an interest in participating ( 36.8 % ) , the majority ( 84.0 % ) believed that they should get more exercise . This points to a gap between attitude and behaviour . Activity preferences were similar to those reported previously for all Canadians , however , barriers to participation differed in the present group . It was concluded that barriers must be assessed , and behaviour modification included , if diet and exercise programs are to be successful in this population Clinical trials have demonstrated that lifestyle changes can prevent type 2 diabetes , but the importance of leisure-time physical activity ( LTPA ) is still unclear . We carried out post hoc analyses on the role of LTPA in preventing type 2 diabetes in 487 men and women with impaired glucose tolerance who had completed 12-month LTPA question naires . The subjects were participants in the Finnish Diabetes Prevention Study , a r and omized controlled trial of lifestyle changes including diet , weight loss , and LTPA .  There were 107 new cases of diabetes during the 4.1-year follow-up period . Individuals who increased moderate-to-vigorous LTPA or strenuous , structured LTPA the most were 63 - 65 % less likely to develop diabetes . Adjustment for changes in diet and body weight during the study attenuated the association somewhat ( upper versus lower third : moderate-to-vigorous LTPA , relative risk 0.51 , 95 % CI 0.26 - 0.97 ; strenuous , structured LTPA , 0.63 , 0.35 - 1.13 ) . Low-intensity and lifestyle LTPA  and walking also conferred benefits , consistent with the finding that the change in total LTPA ( upper versus lower third : 0.34 , 0.19 - 0.62 ) was the most strongly associated with incident diabetes . Thus increasing physical activity may substantially reduce the incidence of type 2 diabetes in high-risk individuals BACKGROUND Type 2 diabetes mellitus is increasingly common , primarily because of increases in the prevalence of a sedentary lifestyle and obesity . Whether type 2 diabetes can be prevented by interventions that affect the lifestyles of subjects at high risk for the disease is not known . METHODS We r and omly assigned 522 middle-aged , overweight subjects ( 172 men and 350 women ; mean age , 55 years ; mean body-mass index [ weight in kilograms divided by the square of the height in meters ] , 31 ) with impaired glucose tolerance to either the intervention group or the control group . Each subject in the intervention group received individualized counseling aim ed at reducing weight , total intake of fat , and intake of saturated fat and increasing intake of fiber and physical activity . An oral glucose-tolerance test was performed annually ; the diagnosis of diabetes was confirmed by a second test . The mean duration of follow-up was 3.2 years . RESULTS The mean ( + /-SD ) amount of weight lost between base line and the end of year 1 was 4.2+/-5.1 kg in the intervention group and 0.8+/-3.7 kg in the control group ; the net loss by the end of year 2 was 3.5+/-5.5 kg in the intervention group and 0.8+/-4.4 kg in the control group ( P<0.001 for both comparisons between the groups ) . The cumulative incidence of diabetes after four years was 11 percent ( 95 percent confidence interval , 6 to 15 percent ) in the intervention group and 23 percent ( 95 percent confidence interval , 17 to 29 percent ) in the control group . During the trial , the risk of diabetes was reduced by 58 percent ( P<0.001 ) in the intervention group . The reduction in the incidence of diabetes was directly associated with changes in lifestyle . CONCLUSIONS Type 2 diabetes can be prevented by changes in the lifestyles of high-risk subjects BACKGROUND Lifestyle interventions can prevent the deterioration of impaired glucose tolerance to manifest type 2 diabetes , at least as long as the intervention continues . In the extended follow-up of the Finnish Diabetes Prevention Study , we assessed the extent to which the originally-achieved lifestyle changes and risk reduction remain after discontinuation of active counselling . METHODS Overweight , middle-aged men ( n=172 ) and women ( n=350 ) with impaired glucose tolerance were r and omly assigned to intensive lifestyle intervention or control group . After a median of 4 years of active intervention period , participants who were still free of diabetes were further followed up for a median of 3 years , with median total follow-up of 7 years . Diabetes incidence , bodyweight , physical activity , and dietary intakes of fat , saturated fat , and fibre were measured . FINDINGS During the total follow-up , the incidence of type 2 diabetes was 4.3 and 7.4 per 100 person-years in the intervention and control group , respectively ( log-rank test p=0.0001 ) , indicating 43 % reduction in relative risk . The risk reduction was related to the success in achieving the intervention goals of weight loss , reduced intake of total and saturated fat and increased intake of dietary fibre , and increased physical activity . Beneficial lifestyle changes achieved by participants in the intervention group were maintained after the discontinuation of the intervention , and the corresponding incidence rates during the post-intervention follow-up were 4.6 and 7.2 ( p=0.0401 ) , indicating 36 % reduction in relative risk . INTERPRETATION Lifestyle intervention in people at high risk for type 2 diabetes result ed in sustained lifestyle changes and a reduction in diabetes incidence , which remained after the individual lifestyle counselling was stopped BACKGROUND Physical activity ( PA ) has been shown to benefit glucose tolerance . Walking is a convenient low-impact mode of PA and is reported to be the most commonly performed activity for those with diabetes . The purpose of this study was to determine whether a recommendation to accumulate 10,000 steps/day for 8 weeks was effective at improving glucose tolerance in overweight , inactive women . METHODS Eighteen women ( 53.3 + /- 7.0 years old , 35.0 + /- 5.1 kg/m(2 ) ) with a family history of type 2 diabetes completed a 4-week control period followed by an 8-week walking program with no changes in diet . The walking program provided a goal of accumulating at least 10,000 steps/day , monitored by a pedometer . RESULTS During the control period , participants walked 4972 steps/day . During the intervention period , the participants increased their accumulated steps/day by 85 % to 9213 , which result ed in beneficial changes in 2-h postload glucose levels ( P < 0.001 ) , AUC(glucose ) ( P = 0.025 ) , systolic blood pressure ( P < 0.001 ) , and diastolic blood pressure ( P = 0.002 ) . There were no changes in body mass , body fat percentage , and waist circumference during the walking intervention . CONCLUSIONS The 10,000 steps/day recommendation result ed in improved glucose tolerance and a reduction in systolic and diastolic blood pressure in overweight women at risk for type 2 diabetes . This demonstrates that activity can be accumulated throughout the day and does not have to result in weight loss to benefit this population BACKGROUND Major questions remain unanswered about how best to accomplish multiple behavior change . The purpose of this study was to evaluate whether there are differences in successfully changing multiple behaviors in computer-tailored sequential and simultaneous interventions for physical activity ( PA ) promotion and fat intake ( FI ) reduction . METHODS Participants ( N=567 ) were r and omly assigned to receive an intervention for PA and FI simultaneously ; PA at baseline and FI at 3 months ; or FI at baseline and 
    Output:
    
Internal and external barriers to exercise  were identified among adults either at high risk of T2D or already diagnosed .
Internal barriers were factors which were influenced by the individual 's own decision-making , and external barriers included factors which were outside of the individual 's own control .