***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: CONTEXT There is a paucity of data regarding the association between glycosylated hemoglobin ( HbA1c ) variability and risk of microvascular complications in adolescents with type 1 diabetes ( T1D ) . OBJECTIVE To investigate the association between HbA1c variability and risk of microvascular complications in adolescents with T1D . DESIGN Prospect i ve cohort study from 1990 to 2014 ( median follow-up , 8.1 y ) . SETTING Tertiary pediatric hospital . PARTICIPANTS A total of 1706 adolescents ( aged 12 - 20 minimum diabetes duration 5 y ) with median age of 15.9 years ( interquartile range , 14.3 - 17.5 ) and diabetes duration of 8.1 years ( 6.3 - 10.8 ) . MAIN OUTCOME MEASURES Glycemic variability was computed as the SD of all HbA1c measurements ( SD-HbA1c ) after diagnosis . Retinopathy was detected using 7-field fundal photography , renal function assessed using albumin excretion rate , peripheral neuropathy detected using thermal and vibration threshold testing , and cardiac autonomic neuropathy ( CAN ) detected using time- and frequency-domain analyses of electrocardiogram recordings . Generalized estimating equations were used to examine the relationship between complications outcomes and HbA1c variability , after adjusting for known risk factors , including HbA1c , diabetes duration , blood pressure , and lipids . RESULTS In multivariable analysis , SD-HbA1c was associated with early retinopathy ( odds ratio [ OR ] 1.32 ; 95 % confidence interval , 1.00 - 1.73 ) , albuminuria ( OR 1.81 ; 1.04 - 3.14 ) , increased log10 albumin excretion rate ( OR 1.10 ; 1.05 - 1.15 ) and CAN ( OR 2.28 ; 1.23 - 4.21 ) but not peripheral neuropathy . CONCLUSIONS Greater HbA1c variability predicts retinopathy , early nephropathy , and CAN , in addition to established risk factors , in adolescents with T1D . Minimizing long term fluctuations in glycemia may provide additional protection against the development of microvascular complications INTRODUCTION Osteoporosis is a growing health problem in patients with type 1 diabetes mellitus ( T1DM ) . The aim of this study was to determine the effects of a 9-month weight-bearing physical activity program on bone mineral density ( BMD ) and bone biomarkers in T1DM compared with healthy children . METHODS This was a r and omized controlled trial including 27 diabetic and 32 healthy children ( mean age = 10.5 ± 2.5 yr ) . Both T1DM and healthy participants were r and omized to either an exercise or a control group ( i.e. , four groups ) . At baseline and 9 months , total body ( TB ) , lumbar spine ( LS2-LS4 ) , femoral neck , and greater trochanter areal BMD ( aBMD ) and serum bone biomarkers ( osteocalcin , type 1 collagen cross-linking ) were measured . The intervention consisted of two 90-min sessions per week of weight-bearing physical activity ( ball games , jumping , rope skipping , and gymnastics ) . RESULTS Baseline variables were similar among groups . At 9 months , changes in TB ( T1DM = 0.035 ± 0.022 g·cm(-2 ) , healthy = 0.031 ± 0.017 g·cm(-2 ) ) and LS2-LS4 ( T1DM = 0.046 ± 0.038 g·cm(-2 ) , healthy = 0.063 ± 0.034 g·cm(-2 ) ) aBMD were statistically significant in the intervention groups and of similar magnitude between T1DM and healthy subjects . The level of type 1 collagen cross-linking ( T1DM = -0.12 ± 0.32 ng·mL(-1 ) , healthy = -0.36 ± 0.11 ng·mL(-1 ) ) decreased in the intervention groups but was not associated with TB aBMD changes . CONCLUSIONS Regular weight-bearing physical activity ( 180 min·wk(-1 ) , including ball games , jumping activities , and gymnastics )  improves total and LS2-LS4 bone mineral accretion in children with T1DM , in a similar magnitude to healthy subjects . We conclude that children with T1DM should be encouraged to practice regular physical activity to enhance peak bone mass and prevent osteoporosis later in life OBJECTIVES To evaluate the evolution of subcutaneous glucose ( SG ) after a st and ardized aerobic exercise in children and adolescents treated with continuous subcutaneous insulin infusion ( CSII ) or multiple daily injection ( MDI ) regimen before and after adaptation of insulin doses . RESEARCH DESIGN AND METHODS Eleven CSII- and 13 MDI-treated patients performed 2 30-minute sessions of moderate to vigorous ( 70 % of age-based maximal heart rate ) exercise on a treadmill under continuous glucose monitoring ( CGM ) . First sessions were scheduled without insulin modification ( TT#1 ) while patients performed second sessions ( TT#2 ) after preemptive algorithm-based insulin dose modifications . RESULTS While insulin adaptations did not modify immediate postexercise drops in blood glucose during TT#2 in either group , CSII-treated patients had their glucose control improved during TT#2 ( mean of 141 ± 56 mg/dL vs 144 ± 80 mg/dL in TT#1 ; P < .05 ) with up to 86 % of SG levels within targets during 16 hours postexercise . Contrarily , SG levels did not normalize during TT#2 in MDI-treated patients who experienced higher rates of hyperglycemia during the afternoon snack . As compared with TT#1 , CSII-treated patients had reduced rates of hypoglycemia during 4 hours post-TT#2 ( from 19.5 % to 2.1 % ; P < .01 ) and had shorter duration of nocturnal hypoglycemia ( 35.5 ± 12.8 vs 204.7 ± 165 minutes ; P = .04 ) whereas in the MDI group no changes in percentages of hypoglycemia were observed during TT#2 . CONCLUSION In our pediatric cohort , algorithmic adaptations of insulin doses were associated with better outcomes in terms of postexercise glucose control in patients with CSII therapy but not with MDI treatment This paper describes PEDro , the Physiotherapy Evidence Data base . PEDro is a web-based data base of r and omized controlled trials and systematic review s in physiotherapy . It can be accessed free of charge at http://ptwww.cchs.usyd.edu.au/pedro . The data base contains bibliographic details and abstract s of most English- language r and omized trials and systematic review s in physiotherapy , and of many trials and review s in other language s. Trials on the data base are rated on the basis of their method ological quality so that users of the data base can quickly identify trials of high quality . Trials and systematic review s are extensively indexed to facilitate search ing . PEDro provides an important information re source to support evidence -based clinical practice BACKGROUND Patients with type 1 diabetes mellitus ( T1DM ) may experience poor muscle health as a result of chronic hyperglycemia . Despite this , muscle function in children with T1DM with good or poor glycemic control has yet to be examined in detail . OBJECTIVE To assess differences in muscle-related fitness variables in children with T1DM with good glycemic control ( T1DM-G ) , as well as those with poor glycemic control ( T1DM-P ) , and non-diabetic , healthy controls . SUBJECTS Eight children with T1DM-G [ glycosylated hemoglobin ( HbA1c ) ≤ 7.5 % for 9 months ] , eight children with T1DM-P ( HbA1c ≥ 9.0 % for 9 months ) , and eight healthy controls completed one exercise session .  METHODS Anaerobic and aerobic muscle functions were assessed with a maximal isometric grip strength test , a Wingate test , and an incremental continuous cycling test until exhaustion . Blood sample s were collected at rest to determine HbA1c at the time of testing . Physical activity  was monitored over 7 d using accelerometry . RESULTS Children with T1DM-P displayed lower peak oxygen consumption ( VO2peak ) values ( mL/kg/min ) compared to healthy controls ( T1DM-P : 33.2 ± 5.6 , controls : 43.5 ± 6.3 , p < 0.01 ) , while T1DM-G ( 43.5 ± 6.3 ) had values similar to controls and T1DM-P. There was a negative relationship between VO2peak and HbA1c% ( r = -0.54 , p < 0.01 ) . All groups were similar in all other fitness variables . There were no group differences in physical activity variables . CONCLUSION Children with T1DM-G did not display signs of impaired muscle function , while children with T1DM-P have signs of altered aerobic muscle capacity 
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FINDINGS Both observational and interventional studies showed considerable agreement that supervised regular moderate to vigorous physical activity ( MVPA ) is more effective on adiposity and cardiorespiratory fitness than habitual PA .
Further , it was reported that PA of different intensities improves insulin sensitivity and decreases daily insulin dosage .
Results of glycemic control were equivocal .
A consistent agreement among the studies revealed a considerable benefit of regular habitual PA of light to moderate intensity on blood glucose regulation and lipid profile .