***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 : Both Nordic walking and Exercise on Prescription have potential as elements in the management of type 2 diabetes mellitus .  These programs are recommended , but their effectiveness has not yet been established . The aim was to evaluate the efficacy of these 2 interventions compared with st and ard information on physical activity . Design : Single-blinded , r and omized , controlled intervention study . Setting : Sixty-eight patients ( 37 men and 31 women ) were r and omized into 3 groups :  Nordic walking ( NW ; n = 22 ) , Exercise on Prescription ( EP ; n = 24 ) , and control ( CG ; n = 22 ) . Patients : Patients were recruited from a diabetes outpatient clinic and via newspaper advertisement . Interventions : Consisted of a 4-month intervention period followed by an 8-month follow-up , during which the participants were recommended to train on their own . Main Outcome Measures : HbA1c . Results : There was no difference in HbA1c when comparing the intervention groups relative to the control group : ΔNW = −0.4 % [ 95 % confidence intervals ( CI ) , −0.9 % to 0.1 % ] and ΔEP = −0.2 % ( 95 % CI , −0.6 % to 0.2 % ) after 4 months ; ΔNW = 0.0 % ( 95 % CI , −0.6 % to 0.5 % ) and ΔEP = 0.3 % ( 95 % CI , −0.3 % to 0.9 % ) after 12 months . However , fat mass assessed by dual energy X-ray absorptiometry ( DXA ) decreased significantly in the NW group after 4 months [ −1.0 kg ( 95 % CI , −1.7 to 0.1 ) ] and after 12 months in both NW [ −1.8 kg ( 95 % CI , −3.2 to −0.4 ) ] and EP [ −1.5 kg ( 95 % CI , −2.9 to −0.05 ) ] groups . No significant changes in other variables . Conclusions : Four-month exercise programs at moderate intensity of either Nordic walking or Exercise on Prescription did not significantly improve HbA1c  in patients with type 2 diabetes either at the end of the program or at the follow-up Background —The Dietary Approaches to Stop Hypertension ( DASH ) diet is recommended in the 2005 US Dietary Guidelines . To underst and the potential benefits of DASH on coronary heart disease ( CHD ) , we applied the Framingham risk equations to calculate 10-year risk of developing CHD using data from the DASH trial . Methods and Results —In the DASH trial , 459 individuals with prehypertension or stage-1 hypertension not taking antihypertensive medication were r and omly assigned to 1 of 3 diets : control , fruits and vegetables ( F/V ) , or DASH ( rich in fruits , vegetables , low-fat dairy , and reduced in fats and cholesterol ) . Weight was held constant . Estimated 10-year CHD risk was the primary outcome of this secondary analysis . Among 436 participants with complete data , mean ( SD ) age was 44.7 ( 10.7 ) years , 51 % were male , and 60 % were African-American .  Median 10-year CHD risk was 0.98 % at baseline and decreased in all groups . Compared with control , the relative risk ratio comparing 8-week with baseline 10-year CHD risk was 0.93 ( 95 % confidence interval , 0.85 to 1.02 ; P=0.12 ) for F/V and 0.82 ( 95 % confidence interval , 0.75 to 0.90 ; P<0.001 ) for DASH . Comparing DASH with F/V , the relative risk ratio was 0.89 ( 95 % confidence interval , 0.81 to 0.97 ; P=0.012 ) . With the exception of an interaction between dietary pattern and race suggesting a greater risk reduction in blacks than whites ( P for interaction=0.038 ) , results were similar across subgroups . Conclusions —Compared with control and F/V , the DASH diet reduced estimated 10-year CHD risk by 18 % and 11 % , respectively . In addition to reducing blood pressure , the DASH diet should substantially reduce the risk of CHD . Clinical Trial Registration —URL : http:// clinical trials.gov . Unique identifier : NCT00000544 Thirty insulin-treated adult diabetic out patients , within normal weight for at least 5 years , were instructed either on an unmeasured diet with the single restriction of simple sugars , or on a weight maintenance , caloric defined , exchange type American Diabetes Association diet . During the next 2 years , both groups reported similar caloric intakes , food composition , and distribution , which were remarkably close to the calculated ideals . Both groups kept body weights within normal limits . There was no difference in insulin doses or serum cholesterol . Fasting glycemia was higher , triglycerides lower , and hypoglycemic reactions less frequent in the group on the unmeasured diet . These differences were not significant . It is suggested that normal weight diabetics spontaneously regulate their intake to maintain a constant weight regardless of precise degree of glycemia control or insulin dosage OBJECTIVE —The effectiveness of intentional weight loss in reducing cardiovascular disease ( CVD ) events in type 2 diabetes is unknown . This report describes 1-year changes in CVD risk factors in a trial design ed to examine the long-term effects of an intensive lifestyle intervention on the incidence of major CVD events . RESEARCH DESIGN AND METHODS —This study consisted of a multicentered , r and omized , controlled trial of 5,145 individuals with type 2 diabetes , aged 45–74 years , with BMI > 25 kg/m2 ( > 27 kg/m2 if taking insulin ) . An intensive lifestyle intervention ( ILI ) involving group and individual meetings to achieve and maintain weight loss through decreased caloric intake and increased physical activity was compared with a diabetes support and education ( DSE ) condition . RESULTS — Participants assigned to ILI lost an average 8.6 % of their initial weight vs. 0.7 % in DSE group ( P < 0.001 ) . Mean fitness increased in ILI by 20.9 vs. 5.8 % in DSE ( P < 0.001 ) . A greater proportion of ILI participants had reductions in diabetes , hypertension , and lipid-lowering medicines . Mean A1C dropped from 7.3 to 6.6 % in ILI ( P < 0.001 ) vs. from 7.3 to 7.2 % in DSE . Systolic and diastolic pressure , triglycerides , HDL cholesterol , and urine albumin-to-creatinine ratio improved significantly more in ILI than DSE participants ( all P < 0.01 ) . CONCLUSIONS —At 1 year , ILI result ed in clinical ly significant weight loss in people with type 2 diabetes . This was associated with improved diabetes control and CVD risk factors and reduced medicine use in ILI versus DSE . Continued intervention and follow-up will determine whether these changes are maintained and will reduce CVD risk OBJECTIVES The aim of the present study was to develop , implement and evaluate a brief intervention to improve adherence to the recommended lifestyle changes for patients with Type 2 diabetes , in particular to help patients to reduce the total amount of fat consumed and to increase lifestyle physical activity levels . DESIGN AND METHOD A brief , tailored lifestyle self-management intervention for patients with Type 2 diabetes was evaluated in a r and omized controlled trial . One hundred participants ( aged 40 - 70 yrs ) completed assessment s at three time points- baseline , three months and one year . Participants were allocated to either an intervention group who received the brief tailored intervention including follow-up telephone calls , or a usual care control group . RESULTS Results indicate that the intervention was successful in helping patients to reduce fat intake and , to a lesser extent , increase lifestyle physical activity levels . These self-reported changes in behaviour were reflected in the objective data with weight maintenance in the intervention group compared to the control group , together with a significant reduction ( 2 cm ) in waist circumference . CONCLUSIONS These results provide further evidence of the effectiveness of tailored interventions for lifestyle change BACKGROUND Physical activity ( PA ) is a cornerstone in the management of type 2 diabetes ( T2DM ) . This pilot investigation explores the effects of a st and ard diabetes education program compared with a supplemental PA intervention on diabetes-related health outcomes . METHODS Using a prospect i ve 2-armed design , 96 adults with T2DM were r and omly assigned to either st and ard care ( diabetes education program ; n = 49 ) or st and ard care supplemented with an 8-week , individualized-counseling and community-based PA component ( n = 47 ) . Measurements were taken at baseline , 3 , 6 , and 12 months . Primary outcomes were changes in PA ( self-report ) and HbA1c . Between group changes were compared using analysis of covariance ( ANCOVA ) and changes over time using repeated- measures ANOVA . RESULTS In comparison with st and ard care , the supplemental group demonstrated an increase in PA ( Ps < 0.01 ) and cardiorespiratory fitness ( Ps < 0.05 ) from baseline to all follow-up time-points . HbA1c levels declined ( P < .05 ) from baseline to all time points in the st and ard care group . Reduction in cholesterol-ratio ( P < .01 ) , increase in HDL ( P < .05 ) , and reductions in blood pressure , resting heart rate and BMI ( approaching statistical significance Ps < 0.10 ) were also reported for both groups . CONCLUSIONS PA counseling in addition to st and ard care is effective for promoting PA behavior change and positive health-related outcomes among individuals with T2DM Background — Although trials of lifestyle interventions generally focus on cardiovascular disease risk factors rather than hard clinical outcomes , 10-year coronary heart disease ( CHD ) risk can be estimated from the Framingham risk equations . Our objectives were to study the effect of 2 multicomponent lifestyle interventions on estimated CHD risk relative to advice alone and to evaluate whether differences can be observed in the effects of the lifestyle interventions among subgroups defined by baseline variables . Methods and Results — A total of 810 healthy adults with untreated prehypertension or stage I hypertension were r and omized to 1 of 3 intervention groups : An “ advice-only ” group , an “ established ” group that used established lifestyle recommendations for blood pressure control ( sodium reduction , weight loss , and increased physical activity ) , or an “ established-plus-DASH ” group that combined established lifestyle recommendations with the DASH ( Dietary Approaches to Stop Hypertension ) diet . The primary outcome was 10-year CHD risk , estimated from follow-up data collected at 6 months . A secondary outcome was 10-year CHD risk at 18 months . Of the 810 participants , 62 % were women and 34 % were black . Mean age was 50 years , mean systolic/diastolic blood pressure was 135/85 mm Hg , and median baseline Framingham risk was 1.9 % . The relative risk ratio comparing 6-month to baseline Framingham risk was 0.86 ( 95 % confidence interval 0.81 to 0.91 , P<0.001 ) in the established group and 0.88 ( 95 % confidence interval 0.83 to 0.94 , P<0.001 ) in the established-plus-DASH group relative to advice alone . Results were virtually identical in sensitivity analyses , in each major subgroup , and at 18 months . Conclusions — The observed reductions of 12 % to 14 % in estimated CHD risk are substantial and , if achieved , should have important public health benefits Background Given the recognized health effects of visceral fat , the underst and ing of how diet can modulate changes in the phenotype “ waist circumference for a given body mass index ( WC BMI ) ” , a proxy measure of visceral adiposity , is deemed necessary . Hence , the objective of the present study was to assess the association between dietary factors and prospect i ve changes in visceral adiposity as measured by changes in the phenotype WC BMI . Methods and Findings We analyzed data from 48,631 men and women from 5 countries participating in the European Prospect i ve Investigation into Cancer and Nutrition ( EPIC ) study .  Anthropometric measurements were obtained at baseline and after a median follow-up time of 5.5 years . WC BMI was defined as the residuals of waist circumference regressed on body mass index , and annual change in WC BMI ( ΔWC BMI , cm/y ) was defined as the difference between residuals at follow-up and baseline , divided by follow-up time . The association between energy , energy density ( ED ) , macronutrients , alcohol , glycemic index ( GI ) , glycemic load ( GL ) , fibre and ΔWC BMI was modelled using centre-specific adjusted linear regression , and r and om-effects meta-analyses to obtain pooled estimates . Men and women with higher ED and GI diets showed significant increases in their WC BMI , compared to those with lower ED and GI [ 1 kcal/g greater ED predicted a ΔWC BMI of 0.09 cm ( 95 % CI 0.05 to 0.13 ) in men and 0.15 cm ( 95 % CI 0.09 to 0.21 ) in women ; 10 units greater GI predicted a  
    Output:
    
In patients with cardiometabolic disease , self-management plus exercise may prevent weight and BMI increases and self-management and /or exercise may prevent waist circumference increases versus minimal/no intervention .