***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: Of 22 r and omized trials of rehabilitation with exercise  after myocardial infa rct ion ( MI ) , one trial had results that achieved conventional statistical significance . To determine whether or not these studies , in the aggregate , show a significant benefit of rehabilitation after myocardial infa rct ion , we performed an overview of all r and omized trials , involving 4,554 patients ; we evaluated total and cardiovascular mortality , sudden death , and fatal and nonfatal reinfa rct ion . For each endpoint , we calculated an odds ratio ( OR ) and 95 % confidence interval ( 95 % CI ) for the trials combined . After an average of 3 years of follow-up , the ORs were significantly lower in the rehabilitation than in the comparison group : specifically , total mortality ( OR = 0.80 [ 0.66 , 0.96 ] ) , cardiovascular mortality ( OR = 0.78 [ 0.63 , 0.96 ] ) , and fatal reinfa rct ion ( OR = 0.75 [ 0.59 , 0.95 ] ) . The OR for sudden death was significantly lower in the rehabilitation than in the comparison group at 1 year ( OR = 0.63 [ 0.41 , 0.97 ] ) . The data were compatible with a benefit at 2 ( OR = 0.76 [ 0.54 , 1.06 ] ) and 3 years ( OR = 0.92 [ 0.69 , 1.23 ] ) , but these findings were not statistically significant . For nonfatal reinfa rct ion , there were no significant differences between the two groups after 1 ( OR = 1.09 [ 0.76 , 1.57 ] ) , 2 ( OR = 1.10 [ 0.82 , 1.47 ] ) , or 3 years ( OR = 1.09 [ 0.88 , 1.34 ] ) of follow-up . The observed 20 % reduction in overall mortality reflects a decreased risk of cardiovascular mortality and fatal reinfa rct ion throughout at least 3 years and a reduction in sudden death during the 1st year after infa rct ion and possibly for 2 - 3 years . With respect to the independent effects of the physical exercise component of cardiac rehabilitation , the relatively small number of " exercise only " trials , combined with the possibility that they may have had a formal or informal nonexercise component precludes the possibility of reaching any definitive conclusion . To do so would require a r and omized trial of sufficient size to distinguish between no effect and the most plausible effect based on the results of this overview We studied the relation between  self-reported physical activity and cancer  in the first National Health and Nutrition Examination Survey ( NHANES I ) cohort , originally examined between 1971 - 75 , and followed prospect ively through the Epidemiologic Follow-up Study ( NHEFS ) , conducted between 1982 - 84 . Among 5,138 men and 7,407 women 25 - 74 years old , for nonrecreational activity we observed increased risk of cancer among inactive individuals compared to very active persons ( for men , relative risk [ RR ] 1.8 , 95 % confidence interval [ CI ] = 1.4 , 2.4 ; for women RR 1.3 , 95 % CI = 1.0 , 1.8 ) . These findings were unchanged after adjustment for cigarette smoking , body mass index ( BMI ) , and other potential confounders . Sites which demonstrated stronger inactivity-cancer associations included colorectum ( RR 1.6 , 95 % CI = 0.7 , 3.5 ) and lung ( RR 1.6 ; 95 % CI = 1.2 , 3.5 ) among men , and breast ( post-menopausal ) ( RR 1.7 ; 95 % CI = 0.8 , 2.9 ) and cervix ( RR 5.2 ; 95 % CI = 1.4 , 14.5 ) among women , although these findings for women were based on relatively few cases . The association between inactivity and cancer was greater among persons of moderate ( or lower ) BMI , those cases occurring three or more years after baseline , and , in women , those more than 60 years old . In contrast , recreational exercise showed little relation to cancer , with the exception of prostate cancer . The results suggest that inactive individuals are at increased risk of cancer BACKGROUND The U.S. Congress m and ated evaluations , initiated in 1989 , to determine whether extending Medicare benefits to include preventive services would improve health status , reduce costs of care , and improve health risk behaviors of beneficiaries . METHODS The Johns Hopkins Medicare Preventive Services Demonstration was a r and omized trial in which Medicare beneficiaries were assigned either to an intervention group that was offered yearly preventive visits for 2 years and optional counseling visits to their primary care provider or to a control group that received usual care . This report describes the effect of the intervention over a period of 2 years on smoking , problem alcohol use , and sedentary lifestyle . RESULTS Differences were observed between the intervention and control groups in the extent to which changes occurred in smoking and problem alcohol use , but none of the differences was statistically significant . The proportion of smokers who quit was higher in the intervention group than in the control group ( 24.2 vs 17.9 % , P = 0.09 ) . However , a higher proportion of problem drinkers in the control group improved ( 67.1 vs 57.0 % , P = 0.183 ) . There was virtually no difference between the intervention and the control groups in the proportion with improvement in sedentary lifestyle . CONCLUSIONS This study demonstrates the difficulty of bringing about health behavior change in older patients in the course of a yearly preventive visit for 2 years with their primary care physician when the visit encompasses screening and immunizations , as well as health behavior counseling directed by the physician . Further study is required to determine whether a more intense program of counseling for health behavior change among older persons by their primary care providers would be effective OBJECTIVE To determine whether self-reported physical activity predicts a decreased rate of coronary heart disease ( CHD ) and all-cause mortalities in middle-aged men when rates are adjusted for known confounders . DESIGN Cohort Analytic Study of Israeli government employees in 1963 . SUBJECTS Eight thous and four hundred sixty-three Israeli male government employees , aged 40 years or older , representing six areas of birth , excluding those with known cardiovascular disease in either 1963 or 1965 , from an original cohort of 10,059 . MAIN OUTCOME MEASURE Comparison of rates of death due to CHD and all causes , determined from death certificates in 21 years of follow-up , for subjects with different baseline levels of self-reported leisure-time and work-related physical activities measured in 1965 . RESULTS Self-reported leisure-time but not work-related physical activity was inversely related to both CHD ( adjusted relative risk , 0.79 ; 95 % confidence interval , 0.66 to 0.95 ) and all-cause mortalities ( adjusted relative risk , 0.91 ; 95 % confidence interval , 0.83 to 0.99 ) . Most of the apparent benefit accrued was from light physical activity on less than a daily basis . These inverse relationships persisted after adjustment for age , systolic blood pressure , cigarette smoking , total and high-density lipoprotein cholesterol levels , body mass index , psychosocial factors , and other potential confounders . CONCLUSION Baseline levels of self-reported leisure-time physical activity predicted a decreased rate of CHD and all-cause mortalities in employed middle-aged Israeli men followed up prospect ively for 21 years Integrating health promotion into daily clinical practice is a challenging undertaking . This project was a prospect i ve trial of a brief physician intervention program , performed as part of routine patient care , that addressed six areas of patients ' lifestyle risks ( nutrition , exercise , alcohol use , smoking , stress , and seat belt use ) . The components of the program were lifestyle assessment , physician prescription of lifestyle change , and educational material s.  Patients visiting a family practice residency model office for any reason were selected to receive all program components  ,  parts of the program , or no program components .  Lifestyle behavior changes over the ensuing four-week period were measured for all groups by a structured phone interview . Patients who received one or more components of the program reported significantly more change at follow-up than those who received no program components ( P = .001 ) ; the greatest change was seen in the group that received all of the program components . Demographic variables that were significantly related to a higher degree of change were female sex , previous contact with the physician , and being married . In this sample age , income , and education were not related to behavior change . Motivation to change -- an expressed desire to work on a given lifestyle area -- was a stronger predictor of change than any demographic variable BACKGROUND In accordance with the U.S. Preventive Services Task Force recommendations , the current pilot study tests the feasibility and efficacy of a physician-delivered physical activity counseling intervention . METHODS A sequential comparison group design was used to examine change in self-reported physical activity between experimental ( counseling and self-help material s ) and control ( usual care ) patients at base-line and 6 weeks after the initial office visit . Patients in both groups were contacted by telephone 2 weeks after their office visit and asked about the physical activity counseling at their most recent physician visit . Experimental patients also received a follow-up appointment to discuss physical activity with their physician 4 weeks after their initial visit . RESULTS Counseling was feasible for physicians to do and produced short-term increases in physical activity levels . Both groups increased their physical activity , but the increase in physical activity was greater for patients who reported receiving a greater number of counseling messages . CONCLUSIONS Physician-delivered physical activity interventions may be an effective way to achieve wide-spread improvements in the physical activity of middle-aged and older adults BACKGROUND In accordance with one of the Year 2000 Health Objectives , the current study tests the efficacy of brief physician-based counseling to increase physical activity in sedentary patients in a nonr and omized controlled trial . METHODS Control and intervention physicians were matched on medical practice variables . Two hundred fifty-five apparently healthy , sedentary , adult patients were recruited from 17 physician offices ( mean age = 39 years , 84 % female , 28 % ethnic minority ) . Intervention physicians delivered 3 to 5 min of structured physical activity counseling during a well visit or follow-up for a chronic condition . A health educator made a brief booster phone call to patients 2 weeks after receiving physician counseling .  Self-reported physical activity and stage of change ( i.e. , behavioral readiness to adopt or maintain activity ) were collected at baseline and at 4- to 6-week follow-up . Objective activity monitoring was conducted on a sub sample . RESULTS Intervention patients reported increased walking more than control patients ( + 37 min/week vs. + 7 min/week ) . There was a significant intervention effect on the activity monitor . Intervention participants also demonstrated a greater increase in readiness to adopt activity than control subjects . CONCLUSIONS Physician-based counseling for physical activity is efficacious in producing short-term increases in moderate physical activity among previously sedentary patients This prospect i ve study evaluated changes in patients ' health-risk behavior  one year after  preventive intervention  by primary care physicians . The trial used a quasiexperimental design with 2,218 adults ( 1,409 study subjects and 809 controls ) at five multispecialty , group practice sites in three regions of the United States . Pre- and postintervention surveys showed that the treated study patients with behavioral risks were more likely to report positive changes than were controls in regard to beginning regular exercise ( P = .02 ) , using auto seat belts , ( P less than .001 ) , losing weight ( P = .05 ) , decreasing alcohol intake ( P = .01 ) , and to performance of monthly breast self-examination by women ( P less than .001 ) . The smoking cessation rate was greater among the treated study group compared with the controls , although the change was not significantly different . Greater behavioral risk changes also occurred among the total study group ( treated and untreated ) in comparison with the control group . An additive index of these behavioral risks showed greater reduction among the treated and the total group of study patients compared with controls . These initial results suggest that clinical preventive services , which include risk factor education and counseling by primary care physicians , can improve short-term health-related behavior of patients 
    Output:
    
There is limited evidence from well design ed trials that office based physical activity promotion in primary care setting s is efficacious in promoting changes in physical activity that could conceivably have lasting clinical benefits