***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: The effect of 8 wk of progressive bicycle training on the immune system was evaluated in a controlled study on 18 patients with rheumatoid arthritis and moderate disease activity .  Maximal O2 uptake increased significantly , whereas heart rate at stage 2 and rate of perceived exertion decreased significantly , in the training group compared with the controls . Resting levels of a number of immune parameters were measured before and after 4 and 8 wk of training . Training did not induce changes in blood mononuclear cell sub population s , proliferative response , or natural killer cell activity . Furthermore the plasma concentrations of interleukin-1 alpha , interleukin-1 beta , and interleukin-6 did not change in response to training . It is concluded that 8 wk of bicycle training does not influence the immune system of patients with rheumatoid arthritis OBJECTIVE To investigate physical fitness and work capacity in women with rheumatoid arthritis ( RA ) . METHODS The 42 subjects were a subset of a prospect i ve trial of conditioning exercise in rheumatic disease . Assignment to an exercise or nonexercise group was determined by proximity to the intervention , a 3-month supervised group exercise program . Physical fitness and work capacity were assessed at baseline , 3 months , and 12 months . RESULTS At baseline , subjects were deconditioned and limited in h and function , lifting ability , and lower extremity mobility . Only the exercise group improved their aerobic capacity and exercise tolerance . There were no significant changes in measured work capacity in either group . Moderate to strong correlations were found between aerobic capacity , mobility , h and function , and work capacity . Grip strength was a strong and consistent correlate of work capacity . CONCLUSION Our findings suggest that physical capacity , particularly h and function , may be important in the complex phenomenon of work disability in RA The objective was to study the long-term effect ( 2 years ) of different training programs in patients with rheumatoid arthritis . The method was a r and omized trial with 75 patients participating . The measured variables included morning stiffness , a pain score , number of swollen joints , a health assessment score , a functional score , ESR , Hb , the cost of medicine , and progression using X-rays of h and s and feet . The results showed no effect of training on the disease activity or on the progression of the disease . The conclusion is that although most patients are in favour of training , the present study does not support that training lessons per se affect the disease activity or the progression of the disease Twenty-six patients with rheumatoid arthritis ( RA ) participated either in a 21 day , community sponsored , in-patient multidisciplinary rehabilitation program ( N = 20 ) or ; received traditional , out-patient physiotherapy design ed by the patient 's rheumatologist ( N = 6 ) . Clinical assessment s were made ( prior to , immediately after , and 6 months after rehabilitation ) to evaluate the response to these two quite different rehabilitative measures that included : functional classification , joint score index , subjective VAS of pain , HAQ , pain disability index , Comprehensible psychopathological rating scale , hemoglobin , and CRP measurements . Economic assessment s included salary , direct and community sponsored costs , for rehabilitation and costs for sick days and production losses . No clear-cut differences between the two rehabilitation modes were detected . Both modes showed improvement in different assessment parameters ; patients with higher education and , therefore , with a less joint-disturbing work profile appeared to profit more from an extensive in-patient rehabilitation program . Patients with less education and a more manually-oriented working profile , did worse and had a higher tendency to seek medical pensioning , in spite of rehabilitative measures . As the total costs for out-patient rehabilitation only add up to 15.8 % of the total costs for in-patient rehabilitation , this study setting cautiously suggests that out-patient rehabilitation might be an acceptable alternative to individualized patient groups that might not compromise clinical and vocational outcome . Larger patient groups are needed , however , to confirm these findings The aim of the study was to evaluate the effects of a dynamic training program versus a muscle relaxation training program as home exercise in patients with inflammatory rheumatic diseases . Fifty-four patients ( mean age 54 years , mean symptom duration 14 years ) were r and omized to one of the two programs . After personal instructions every patient exercised at home for half an hour , 5 days a week during 3 months . Before and after the interventions , all patients were assessed for health-related quality of life , joint tenderness and physical capacities . The dynamic training group had improved in perceived exertion at the walking test ( p < or = 0.05 ) , while the relaxation training group had improved their total Nottingham Health Profile ( p < or = 0.01 ) , its subscale for lack of energy ( p < or = 0.05 ) , Ritchie 's articular index ( p < or = 0.05 ) , muscle function of the lower extremities ( p < or = 0.01 ) , and arm endurance ( p < or = 0.01 ) . Regarding changes in muscle function of the lower extremities during the intervention period , there was a significant difference ( p < or = 0.05 ) between the groups in favour of the relaxation training group . The results of the study thus indicated that progressive muscle relaxation training might improve health related quality of life , reduce joint tenderness and be superior to dynamic muscle training in improving the muscle function of the lower extremities in patients with inflammatory rheumatic diseases . The clinical effects were small and the results have to be interpreted with caution Thirty-nine consecutive patients with recent-onset rheumatoid or psoriatic arthritis were r and omly allotted for six months period either to the experimental progressive dynamic strength training group ( EG , 10 women and 11 men ; 41 + /- 10 yrs ) , or to the control group ( CG , 10 women and 8 men ; 45 + /- 11 yrs ) who just maintained their habitual physical activities . All patients received antirheumatic medication throughout the experimental period . During the study period significant improvements took place in the EG in maximal muscle strength of all examined muscle groups ( 31.5 % for the knee extensors , p < 0.001 ; 14.8 % and 10.7 % for the trunk flexors and extensors , p < 0.01 ; 27.8 % and 20.4 % for grip strength , p < 0.001 ) as well as in erytrocyte sedimentation rate ( p < 0.05 ) . Ritchie 's articular index ( RI ) ( p < 0.001 ) and HAQ ( p < 0.01 ) . In the CG only the decrease in RI was statistically significant ( p < 0.05 ) . Erosive changes in joints increased only slightly and less in the EG than in the CG . The present results suggest that dynamic strength training in early arthritis increases the neuromuscular performance without detrimental effects on disease activity or joint damage The effectiveness of an exercise prescription and unsupervised home exercise programme was tested on 37 subjects with rheumatoid arthritis and 34 with systemic lupus erythematosus . Subjects were r and omly assigned to control or stationary bicycling at home , using loaned bicycles . Exercise subjects ( with bicycles ) did better than controls , but not significantly , on all outcome d measures ( exercise tolerance test , fatigue , depression and helplessness ) at 3 months . Bicycles were recl aim ed at 3 months and all subjects in both groups given instructions for home exercise . Exercise in the second 3 months was predicted primarily by baseline exercise habits and fatigue . It is concluded that although safe , unsupervised home exercise programmes may benefit few patients . Future research should address methods of stimulating and maintaining unsupervised exercise programmes in patients with systemic rheumatic disease OBJECTIVE The aim of this study was to evaluate the therapeutic effects of hydrotherapy which combines elements of warm water immersion and exercise . It was predicted that hydrotherapy would result in a greater therapeutic benefit than either of these components separately . METHODS One hundred thirty-nine patients with chronic rheumatoid arthritis were r and omly assigned to hydrotherapy , seated immersion , l and exercise , or progressive relaxation . Patients attended 30-minute sessions twice weekly for 4 weeks . Physical and psychological measures were completed before and after intervention , and at a 3-month followup . RESULTS All patients improved physically and emotionally , as assessed by the Arthritis Impact Measurement Scales 2 question naire . Belief that pain was controlled by chance happenings decreased , signifying improvement . In addition , hydrotherapy patients showed significantly greater improvement in joint tenderness and in knee range of movement ( women only ) . At followup , hydrotherapy patients maintained the improvement in emotional and psychological state . CONCLUSIONS Although all patients experienced some benefit , hydrotherapy produced the greatest improvements . This study , therefore , provides some justification for the continued use of hydrotherapy OBJECTIVE To determine whether hydrotherapy in a thermomineral institution is superior to the same hydrotherapy in an ordinary hospital exercise-bath . DESIGN Controlled therapeutic trial . SETTING The thermomineral institution at Arcen and the exercise bath at the Maasl and Hospital in Sittard , the Netherl and s. PATIENTS AND METHODS 46 patients with rheumatoid arthritis were treated in a by a skilled physiotherapist , according to a st and ardized exercise-scheme : 27 were treated in the thermomineral institution  and 19 ( control-group ) in the hospital exercise-bath .  Each patient received 12 treatments in 12 weeks . ENDPOINTS PARAMETERS : Morning stiffness , erythrocyte sedimentation rate , Ritchie index , amount of pain , answers to 11 questions concerning the activities of daily life , and psychosocial aspects of the disease . The various subjective and objective parameters were scored by the same physician . RESULTS Statistically significant improvement was observed in both groups concerning morning stiffness . Other subjective parameters improved , but did not reach significance . Objective parameters did not change significantly . Between-group differences were not found . CONCLUSION Hydrotherapy has a positive effect on some subjective but not on objective parameters in patients with rheumatoid arthritis , whether it is applied in a thermomineral institution or an ordinary hospital exercise bath The importance of pain in the health status and health behavior of patients with chronic rheumatic disease was evaluated . The Arthritis Impact Measurement Scales were used to estimate physical disability , psychological status , and pain in a large set of rheumatic disease patients .  Explanatory regression models were built to explore the contribution of pain in physician and patient assessment s of overall health , medication usage , and changes in health status over time . Results confirm that pain makes a highly significant contribution to explaining both physician and patient overall health assessment s ( P less than 0.001 ) . Pain is also the most important of the 3 health status components in explaining medication usage ( P less than 0.001 ) . Finally , using prospect i ve data , it is shown that current pain , rather than current physical or psychological disability , is the best predictor of subsequent pain ( P less than 0.001 ) . Current pain also is most associated with subsequent physical disability ( P less than 0.05 ) . These findings confirm the importance of pain in determining the health status and health behavior of individuals with chronic rheumatic disease , and suggest that doctors and other health professionals should continue to solicit and address the patient 's complaints of pain This study aim ed at evaluating the effects of a dynamic physical training programme on circulating levels of corticotropin-releasing hormone ( CRH ) , beta-lipotropin ( beta-LPH ) , and beta-endorphin ( beta-EP ) after high-intensity training for 6 weeks ( 60 min twice a week ) and after low-intensity training ( home-training ) for another 6 months in patients with rheumatoid arthritis ( RA ) and in healthy subjects . Additionally , differences in neuropeptide levels between the two groups were studied . A total of 30 patients with RA were r and omly allocated to the study , 15 in the training group ( TG ) and 15 in the control group ( CG ) . In addition , 20 healthy subjects ( 10 in TG ; 10 in CG ) participated . In addition to the biochemical analyses , the following variables were assessed for the RA group : pain and disability ( Stanford health assessment question naire ) , joint tenderness ( Ritchie articular index ) , disease activity , muscle function , aerobic capacity , sociodemographic data and attitudes . The results obtained at the start revealed significant differences ( p < 0.05 ) between RA patients and healthy subjects concerning CRH levels , RA patients showing the lower levels ( RA-group Md = 24 pmol/L , healthy group Md = 29 pmol/L ) . No significant differences concerning beta-LPH and beta-EP were found here . After the high-intensity training period , a significant increase of the CRH levels were found for the RA-TG ( pretest Md = 24 pmol/L , after 6 weeks Md = 27 pmol/L , p < 0.05 ) . No such results were found for the healthy-TG or the control groups . Concerning beta-EP , significant differences between the RA-TG and healthy-TG were found after the training . RA patients generally showing higher levels as compared with the healthy ( RA-group Md = 42 pmol/L , healthy group Md = 36 pmol/L , p < 0.05 ) . The same pattern was found for the beta-LPH levels . In conclusion , the effects of physical training on circulating neuropeptides remain still incompletely examined , and there is no definite answer to the question whether increased beta-EP levels are good or bad A group of 120 patients with rheumatoid arthritis or osteoarthritis volunteered to be subjects for this study of aerobic versus nonaerobic exercise . Patients were strat 
    Output:
    
The results suggest that dynamic exercise therapy is effective in increasing aerobic capacity and muscle strength .
No detrimental effects on disease activity and pain were observed .
The effects of dynamic exercise therapy on functional ability and radiological progression are unclear .
It is concluded that dynamic exercise therapy has a positive effect on physical capacity .