***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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    Input: OBJECTIVE This study investigated the effect of commuter cycling on cardiorespiratory fitness in men and women . Secondary outcomes included body fat and blood pressure measurements . METHODS In February 2009 , 48 volunteers from the Isl and of Funen , Denmark were r and omly assigned to either " no change in lifestyle " or to " minimum 20 minutes of daily commuter cycling during 8 weeks " . Maximal oxygen uptake was assessed directly during a progressive cycle-ergometer-test , sum of skinfolds was used as an estimate of body fat , and  blood pressure was measured using a Dinamap monitor . Measurements were obtained at baseline and at the conclusion of the 8-week intervention program . RESULTS Six cyclists dropped out . After 8 weeks VO(2)max ( mL O(2 ) min(-1 ) ) and cardiorespiratory fitness ( mL O(2 ) kg(-1 ) min(-1 ) ) were significantly improved in the cycling group when compared to the control group . Delta change in VO(2)max between groups equaled 206 mL O(2 ) min(-1 ) ( p=0.005 ) and delta change in cardiorespiratory fitness equaled 2.6 mL O(2 ) kg(-1 ) min(-1 ) ( p=0.003 ) . Body fatness changed more noticeable ( p=0.026 ) in the cyclists ( -12.3±7.3 mm ) than in the controls ( -0.2±7.1 mm ) . CONCLUSIONS VO(2)max and cardiorespiratory fitness were significantly improved and body fat reduced as a result of people engaging in 8 weeks of commuter cycling Background The purpose of this study was to examine the impact of combined cardiorespiratory fitness and waist-to-height ratio in the form of a fit-fat index on incident diabetes risk . Additionally , the independent predictive performance of cardiorespiratory fitness , waist-to-height ratio , and body mass index also were estimated and compared . Methods This was a prospect i ve cohort study of 10,381 men who had a normal electrocardiogram and no history of major chronic disease at baseline from 1979 to 2005 .  R and om survival forest models and traditional Cox proportional hazards models were used to predict diabetes at 5- , 10- , and 15-year incidence horizons . Results Overall , 4.8 % of the participants developed diabetes . Receiver operating characteristic curve analyses for incidence risk demonstrated good discrimination using r and om survival forest models across fitness and fatness measures ; Cox models were poor to fair . The differences between fitness and fatness measures across horizons were clinical ly negligible . Smoothed r and om survival forest estimates demonstrated the impact of each fitness and fatness measure on incident diabetes was intuitive and grade d. Conclusions Although fitness and fatness measures showed a similar discriminative ability in predicting incident diabetes , unique to the study was the ability of the fit-fat index to demonstrate a better indication of incident risk when compared to fitness or fatness alone . A single index combining cardiorespiratory fitness and waist-to-height ratio may be more useful because it can indicate improvements in either or both of the measures AIMS We examined the association of grip strength with incident type 2 diabetes mellitus ( T2DM ) in healthy subjects initially aged 50 to 75years after a follow-up of 5.5years and 10.7years . METHODS This was a prospect i ve , population -based study derived from the CoLaus ( Cohorte Lausannoise ) study including 2318 participants ( aged 60.2y ; 1354 women ) free from T2DM at baseline .  Grip strength was assessed using a h and held dynamometer . The effect of grip strength on the incidence of T2DM was analyzed by logistic regression . RESULTS After a follow-up of 5.5years , 190 ( 8.2 % ) T2DM cases were identified . In bivariate analysis , participants who developed T2DM had a higher absolute grip strength ( 35.3±10.6 versus 33.2±10.7 kg , P=0.013 ) . Analysis between grip strength expressed in 5 kg increment and incident TD2 M showed a negative association when adjusted for age and sex [ ORs ( 95 % CI ) : 0.88 ( 0.79 , 0.98 ) ] , or for age , sex and body mass index ( BMI ) [ ORs ( 95 % CI ) : 0.87 ( 0.78 , 097 ) ] . After a follow-up of 10.7years , 131 supplemental ( 7.3 % ) T2DM cases were identified , but there was no association between grip strength and incident T2DM in bivariate and multivariable analysis , potentially due to a lack of statistical power . CONCLUSIONS In non elderly healthy adults , the risk of incident T2DM is overall not associated with grip strength over a maximum follow-up of 10.7years . Future studies are warranted to better assess the association between grip strength and incident T2DM in bigger and even younger cohorts A major problem in review ing the published results of different epidemiologic studies of the relation between a quantitative variable and the risk of disease is that the results are presented in many different ways . The purpose of this paper is to exemplify methods by which results expressed either as risks ( or rates ) according to quantlle groups of the quantitative variable or as results derived from a  logistic regression analysis can be reexpressed in a uniform manner , as a mean difference in the quantitative variable between the cases of disease and the other subjects in the study . An important assumption of the methods is that the quantitative variable has an approximately normal distribution , and a way of investigating the appropriateness of this assumption is given . The methods can be applied to both prospect i ve and case-control studies and are exemplified by a number of studies of serum albumin concentrations and mortality . In some applications , these methods can be used as a precursor to formal meta- analysis , for example , when differential control of potential confounding factors is not a problem . At the least , the methods can be useful either in quantitatively review ing published studies before undertaking new research or in putting the results of a new study into the context of previously published ones Background : Aerobic exercise is recommended for weight management but energy balance is often less negative than predicted from exercise energy expenditure ( ExEE ) . Objective : To examine effects of active commuting and leisure-time exercise on  fat loss in women and men with overweight and obesity . Methods : We r and omized 130 younger , physically inactive women and men with overweight and obesity ( body mass index : 25–35 kg m−2 ) to 6 months of habitual lifestyle ( control ; CON , n=18 ) , active commuting ( BIKE  , n=35 ) or leisure-time exercise of moderate ( MOD , 50 % VO2peak reserve , n=39 ) or vigorous intensity ( VIG , 70 % VO2peak reserve , n=38 ) . The primary outcome was change in fat mass measured by dual-energy X-ray absorptiometry , which was analyzed intention-to-treat . Accumulated energy balance was calculated based on changes in body composition , and ExEE was calculated based on heart rate monitoring during exercise . Results : Testing at 3 and 6 months was completed by 95 and 90 participants , respectively . Fat mass was reduced after 3 and 6 months in BIKE ( 3 months : −3.6 ( −5.5 ; −1.7 ) kg ( mean ( 95 % CI ) ) ; 6 months : −4.2 ( −6.6 ; −1.9 ) kg ; both : P<0.001 ) , MOD ( 3 months : −2.2 ( −3.9 ; −0.4 ) kg ; 6 months : −2.6 ( −4.8 ; −0.5 ) kg , both : P<0.02 ) and VIG ( 3 months : −3.4 ( −5.2 ; −1.7 ) kg ; 6 months : −4.5 ( −6.6 ; −2.3 ) kg ; both : P<0.001 ) compared with CON . Furthermore , fat loss was greater in VIG compared with MOD ( 6 months : −1.8 ( −3.6 ; −0.1 ) kg , P=0.043 ) . Based on the ExEE and the accumulated energy balance MOD compensated for the ExEE ( 77 ( 48 ; 106 ) % ) but not BIKE ( 38 ( −18 ; 95 ) % ) and VIG ( 21 ( −14 ; 55 ) % ) . Conclusions : A meaningful fat loss was obtained by 6 months of active commuting and leisure-time exercise , but fat loss was greater with vigorous compared with moderate intensity exercise . Active commuting is an alternative to leisure-time exercise in the management of overweight and obesity .  The trial was registered at clinical trials.gov as NCT01962259 ( main trial ) and NCT01973686 ( energy metabolism sub- study ) Observational studies have reported an association of h and grip strength with risk of cardiovascular disease . However , residual confounding and reverse causation may have influenced these findings . A Mendelian r and omization ( MR ) study was conducted to examine whether h and grip is causally associated with cardiovascular disease . Two single nucleotide polymorphisms ( SNPs ) , rs3121278 and rs752045 , were used as the genetic instruments for h and grip . The effect of each SNP on coronary artery disease/myocardial infa rct ion ( CAD/MI ) was weighted by its effect on h and grip strength , and estimates were pooled to provide a summary measure for the effect of increased h and grip on risk of CAD/MI . MR analysis showed that higher grip strength reduces risk for CAD/MI , with 1-kilogram increase in genetically determined h and grip reduced odds of CAD by 6 % ( odds ratio ( OR ) = 0.94 , 95 % confidence interval ( CI ) 0.91–0.99 , P = 0.01 ) , and reduced odds of MI by 7 % ( OR = 0.93 , 95 % CI 0.89–0.98 , P = 0.003 ) . No association of grip strength with type 2 diabetes , body mass index , LDL- and HDL-cholesterol , triglycerides and fasting glucose was found . The inverse causal relationship between h and grip and the risk of CAD or MI suggests that promoting physical activity and resistance training to improve muscle strength may be important for cardiovascular health BACKGROUND Limited data are available on the relationship between muscular and performance fitness ( MPF ) and the incidence of  type 2 diabetes . METHODS A cohort of 3792 Japanese men completed a medical examination that included MPF and cardiorespiratory fitness tests .  MPF index composite score was calculated using Z-scores from vertical jump , sit-ups , side step , and functional reach tests . RESULTS The mean follow-up period was 187 months ( 15.6 years ) . There were 240 patients who developed  type 2 diabetes  during follow-up . Relative risks and 95 % confidence intervals ( CI ) for incidence of diabetes across baseline quartiles of MPF index composite score were obtained using the Cox proportional hazards model while adjusting for age , BMI , diastolic blood pressure , cigarette smoking , alcohol intake , and family history of diabetes . The relative risks for developing diabetes across quartiles of MPF index composite scores ( lowest to highest ) were 1.0 ( referent ) , 1.15 ( 95 % CI 0.83 - 1.60 ) , 1.10 ( 0.78 - 1.55 ) , and 0.57 ( 0.37 - 0.90 ) ( P for trend = .061 ) . These results were attenuated after adjustment for cardiorespiratory fitness ( P for trend = .125 ) . CONCLUSIONS This prospect i ve study suggests that MPF is a predictor of type 2 diabetes , although its predictive ability was attenuated after adjusting for cardiorespiratory fitness CONTEXT Exercise guidelines for individuals with diabetes include both aerobic and resistance training although few studies have directly examined this exercise combination . OBJECTIVE To examine the benefits of aerobic training alone , resistance training alone , and a combination of both on hemoglobin A(1c ) ( HbA(1c ) ) in individuals with type 2 diabetes . DESIGN , SETTING , AND PARTICIPANTS A r and omized controlled trial in which 262 sedentary men and women in Louisiana with type 2 diabetes and HbA(1c ) levels of 6.5 % or higher were enrolled in the 9-month exercise program between April 2007 and August 2009 . INTERVENTION Forty-one participants were assigned to the nonexercise control group , 73 to resistance training 3 days a week , 72 to aerobic exercise in which they expended 12 kcal/kg per week ; and 76 to combined aerobic and resistance training in which they expended 10 kcal/kg per week and engaged in resistance training twice a week . Main Outcome Change in HbA(1c ) level . Secondary outcomes included measures of anthropometry and fitness . RESULTS The study included 63.0 % women and 47.3 % nonwhite participants who were a mean ( SD ) age of 55.8 years ( 8.7 years ) with a baseline HbA(1c ) level of 7.7 % ( 1.0 % ) . Compared with the control group , the absolute mean change in HbA(1c ) in the combination training exercise group was -0.34 % ( 95 % confidence interval [ CI ] , -0.64 % to -0.03 % ; P = .03 ) . The mean changes in HbA(1 
    Output:
    
Conclusions /interpretationRelatively small increments in cardiorespiratory fitness and muscle strength were associated with clinical ly meaningful reductions in type 2 diabetes risk with indication of a linear dose – response relationship for cardiorespiratory fitness .