***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: BACKGROUND High-mobility group box-1 ( HMGB1 ) is a novel predictor of adverse postinfa rct ion clinical outcomes , playing a crucial role in the appropriate postinfa rct ion healing process . METHODS AND RESULTS Seventy-five postinfa rct ion patients were enrolled in a single-center r and omized study ( clinical trial.gov identifier : NCT00755131 ) . Group T patients ( training  , n = 37 ) underwent 6-month exercise-based cardiac rehabilitation ( CR ) program , whereas group C patients ( controls , n = 38 ) were discharged with generic instructions for maintaining physical activity and a correct lifestyle . After 6 months , HMGB1 levels were significantly reduced in the total population ( 26.1 ± 23.5 vs. 16.2 ± 12.9 ng/mL ; P = .0006 ) . After adjusting for several confounders , linear regression analysis showed that the inclusion in the training group ( β = -10.54 , P = .043 ) was associated with marked reduction of HMGB1 levels . After 6 months , HMGB1 levels were significantly lower in trained patients compared to controls ( 11.7 ± 7.0 vs. 20.5 ± 15.6 ng/mL , P = .0027 , respectively ) . In trained patients , decreased HMGB1 levels were significantly associated with the improvement in peak oxygen consumption ( β = -3.879 , P = .003 ) and heart rate recovery ( β = -2.492 , P = .002 ) , and with reduced left ventricular end-diastolic volume ( β = 1.412 , P = .001 ) and wall motion score index ( β = 1.138 , P = .002 ) . CONCLUSIONS The decrease in HMGB1 levels after anterior myocardial infa rct ion was associated with exercise training and with the improvement of cardiopulmonary and autonomic function , and with favorable cardiac remodeling Wu S-K , Lin Y-W , Chen C-L , Tsai S-W : Cardiac rehabilitation vs. home exercise after coronary artery bypass graft surgery : a comparison of heart rate recovery . Am J Phys Med Rehabil 2006;85:711–717 . Objective : The autonomic dysfunction is known to adversely affect clinical outcome in patients with cardiovascular disease , and exercise training has been shown to modify the sympathovagal control of heart rate . The purpose s of this study were to investigate the effect of cardiac rehabilitation on heart rate recovery in patients who received coronary artery bypass grafting ( CABG )  and compare the effect with that of a home-based exercise program . Design : Fifty-four male patients having undergone CABG were r and omly assigned to a cardiac rehabilitation exercise program ( n = 18 ) , a home-based exercise program ( n = 18 ) , and a control group ( n = 18 ) for 12 wks to evaluate the differences in heart rate recovery among groups . Results : Patients in the cardiac rehabilitation group had significant increases in heart rate recovery ( 19.1 ± 6.2 vs. 14.0 ± 5.4 beats/min , P = 0.022 ) compared with those in the control group . There were no significant differences in heart rate recovery between cardiac rehabilitation and home-based exercise groups ( 16.2 ± 4.8 beats/min ) or between home-based exercise and control groups . All three groups had significantly improved heart rate recovery compared with their baseline data ( P < 0.001 , < 0.001 , and 0.007 ) . Conclusion : Our results point out that a cardiac rehabilitation exercise program has a positive effect on heart rate recovery in patients having undergone CABG and is consistent with the autonomic improvement . Although the home-based exercise group did not reveal statistical significance s over those in the control group , it had comparable efficacy to that demonstrated in the cardiac rehabilitation group Heart rate variability ( HRV ) reflects the autonomic tone of the heart , and QT dispersion reflects the regional inhomogeneity of ventricular repolarization . The purpose of the present study was to determine the effects of early exercise training on HRV and QT dispersion in patients with acute myocardial infa rct ion ( AMI ) . Forty patients ( mean age : 59 years ) with AMI were r and omized to training rehabilitation  ( group Tr , n=20 ) or  conventional rehabilitation  ( group C , n=20 ) . Two weeks after AMI , group Tr underwent 10 min of exercise using a bicycle ergometer ( 80 % of anaerobic threshold ) twice a day . At the end of the second and fourth weeks , 12-lead and 24-h Holter ECGs  were recorded . QT intervals were measured and corrected using Bazett 's formula ( QTc ) , and QTc dispersion ( QTcd ) was defined as the difference between maximum and minimum QTc . HRV was accessed by the high-frequency component ( HF : 0.15 - 0.40 Hz ) of the HRV power spectrum ( parasympathetic activity ) and the ratio of low frequency ( 0.04 - 0.15 Hz ) to HF ( L/H ratio : sympathetic activity ) . In group Tr , HF increased ( 82.5 to 131.1 ms2 ) , the L/H ratio decreased ( 3.9 to 2.6 ) , and QTcd decreased ( 77.2 to 57.2 ms ) . In group C , none of the indices changed . It was concluded that early exercise training improves sympathovagal balance and decreases QTcd , and may reduce the arrhythmogenic substrate following AMI INTRODUCTION Heart rate recovery , defined as the fall in heart rate during the first minute after exercise , is an indicator of autonomic function , and has been found to be an independent predictor of mortality after acute myocardial infa rct ion . Exercise training has several well-known benefits in terms of cardiorespiratory fitness , modifiable cardiovascular risk factors and prognosis after acute coronary events . However , there are no r and omized controlled studies in the literature evaluating the effects of exercise training per se , controlling for changes in medication and diet , on heart rate recovery . Thus , this study aims to assess the effects of exercise training on autonomic function in coronary artery disease patients recovering from acute myocardial infa rct ion . METHODS Thirty-eight patients following a first acute myocardial infa rct ion participated in this prospect i ve r and omized clinical trial . Patients were r and omized into two groups : exercise training or control . The exercise group participated in an 8-week aerobic exercise program , while the control received st and ard medical care and follow-up . Changes in hemodynamics at rest and at peak exercise ( heart rate , systolic and diastolic blood pressure , and rate pressure product ) , dietary intake , cardiorespiratory fitness , and heart rate recovery were assessed . RESULTS Medication and diet remained unchanged in both groups during the study period . The exercise-training group improved resting hemodynamics , particularly resting heart rate ( from 68.0 ± 9.2 to 62.6 ± 8.7 bpm , p=0.030 ) and systolic blood pressure ( from 135 ± 7.1 to 125.6 ± 11.3 mm Hg , p=0.012 ) , cardiorespiratory fitness ( from 30.8 ± 7.8 to 33.9 ± 8.3 ml/min/kg , p=0.016 ) , and heart rate recovery ( from 20 ± 6 to 24 ± 5 bpm , p=0.007 ) . No significant changes were observed in the control group . CONCLUSIONS Exercise training improved autonomic function , assessed by heart rate recovery , resting heart rate and systolic blood pressure , in the absence of changes in diet or medication OBJECTIVES The aim of this study was to assess the efficacy of exercise and antidepressant medication in reducing depressive symptoms and improving cardiovascular biomarkers in depressed patients with coronary heart disease . BACKGROUND Although there is good evidence that clinical depression is associated with poor prognosis , optimal therapeutic strategies are currently not well defined . METHODS One hundred one out patients with coronary heart disease and elevated depressive symptoms underwent assessment of depression , including a psychiatric interview and the Hamilton Rating Scale for Depression . Participants were r and omized to 4 months of aerobic exercise ( 3 times/week ) , sertraline ( 50 - 200 mg/day ) , or placebo . Additional assessment s of cardiovascular biomarkers included measures of heart rate variability , endothelial function , baroreflex sensitivity , inflammation , and platelet function . RESULTS After 16 weeks , all groups showed improvement on Hamilton Rating Scale for Depression scores . Participants in both the aerobic exercise ( mean -7.5 ; 95 % confidence interval : -9.8 to -5.0 ) and sertraline ( mean -6.1 ; 95 % confidence interval : -8.4 to -3.9 ) groups achieved larger reductions in depressive symptoms compared with those receiving placebo ( mean -4.5 ; 95 % confidence interval : -7.6 to -1.5 ; p = 0.034 ) ; exercise and sertraline were equally effective at reducing depressive symptoms ( p = 0.607 ) . Exercise and medication tended to result in greater improvements in heart rate variability compared with placebo ( p = 0.052 ) ; exercise tended to result in greater improvements in heart rate variability compared with sertraline ( p = 0.093 ) . CONCLUSIONS Both exercise and sertraline result ed in greater reductions in depressive symptoms compared to placebo in patients with coronary heart disease . Evidence that active treatments may also improve cardiovascular biomarkers suggests that they may have a beneficial effect on clinical outcomes as well as on quality of life . ( Exercise to Treat Depression in Individuals With Coronary Heart Disease ; NCT00302068 ) The aim of this study was to evaluate the influence of cardiac rehabilitation ( CR ) on heart rate variability ( HRV ) indices in men with coronary artery disease ( CAD ) treated with percutaneous coronary intervention ( PCI ) or coronary artery bypass graft surgery ( CABG ) .  The study population consisted of 131 male patients with CAD prospect ively and consecutively admitted to CR after PCI n = 72 , or CABG n = 59 . Participants performed cycle ergometer interval training for 45 min three times a week for 8 weeks . At baseline and after 8 weeks , all patients underwent the  HRV assessment . HRV indices in CAGB survivals were significantly lower in comparison to PCI patients at baseline . Significant increases were seen for SDNN , rMSSD , and HF in the CABG group and only in HF component in PCI group after 8 weeks of CR . Eight weeks of CR seems to be more effective in CABG patients than patients after PCI CONTEXT Observational studies have shown that psychosocial factors are associated with increased risk for cardiovascular morbidity and mortality , but the effects of behavioral interventions on psychosocial and medical end points remain uncertain . OBJECTIVE To determine the effect of 2 behavioral programs , aerobic exercise training and stress management training , with routine medical care on psychosocial functioning and markers of cardiovascular risk . DESIGN , SETTING , AND PATIENTS R and omized controlled trial of 134 patients ( 92 male and 42 female ; aged 40 - 84 years ) with stable ischemic heart disease ( IHD ) and exercise-induced myocardial ischemia . Conducted from January 1999 to February 2003 . INTERVENTIONS Routine medical care ( usual care ) ; usual care plus supervised aerobic exercise training for 35 minutes 3 times per week for 16 weeks ; usual care plus weekly 1.5-hour stress management training for 16 weeks . MAIN OUTCOME MEASURES Self-reported measures of general distress ( General Health Question naire [ GHQ ] ) and depression ( Beck Depression Inventory [ BDI ] ) ; left ventricular ejection fraction ( LVEF ) and wall motion abnormalities ( WMA ) ; flow-mediated dilation ; and cardiac autonomic control ( heart rate variability during deep breathing and baroreflex sensitivity ) . RESULTS Patients in the exercise and stress management groups had lower mean ( SE ) BDI scores ( exercise : 8.2 [ 0.6 ] ; stress management : 8.2 [ 0.6 ] ) vs usual care ( 10.1 [ 0.6 ] ; P = .02 ) ; reduced distress by GHQ scores ( exercise : 56.3 [ 0.9 ] ; stress management : 56.8 [ 0.9 ] ) vs usual care ( 53.6 [ 0.9 ] ; P = .02 ) ; and smaller reductions in LVEF during mental stress testing ( exercise : -0.54 % [ 0.44 % ] ; stress management : -0.34 % [ 0.45 % ] ) vs usual care ( -1.69 % [ 0.46 % ] ; P = .03 ) . Exercise and stress management were associated with lower mean ( SE ) WMA rating scores ( exercise : 0.20 [ 0.07 ] ; stress management : 0.10 [ 0.07 ] ) in a subset of patients with significant stress-induced WMA at baseline vs usual care ( 0.36 [ 0.07 ] ; P = .02 ) . Patients in the exercise and stress management groups had greater mean ( SE ) improvements in flow-mediated d 
    Output:
    
Exercise-based CR  improves the post-exercise parasympathetic function , with greater effects in younger CAD patients and in those who were revascularised with percutaneous intervention .
The effects on resting parasympathetic function are more controversial due to method ological inconsistencies in measuring HRV , with the use of RMSSD recommended instead of HF because its results show higher consistency .