***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: R and omized controlled trials ( RCTs ) are conducted under idealized and rigorously controlled conditions that may compromise their external validity . A literature review was conducted of published English language articles that reported the findings of studies assessing external validity by a comparison of the patient sample included in RCTs reporting on pharmaceutical interventions with patients from everyday clinical practice . The review focused on publications in the fields of cardiology , mental health , and oncology . A range of data bases were interrogated ( MEDLINE ; EMBASE ; Science Citation Index ; Cochrane Methodology Register ) . Double- abstract review and data extraction were performed as per protocol specifications . Out of 5,456 de-duplicated abstract s , 52 studies met the inclusion criteria ( cardiology , n = 20 ; mental health , n = 17 ; oncology , n = 15 ) . Studies either performed an analysis of the baseline characteristics ( demographic , socioeconomic , and clinical parameters ) of RCT -enrolled patients compared with a real-world population , or assessed the proportion of real-world patients who would have been eligible for RCT inclusion following the application of RCT inclusion /exclusion criteria . Many of the included studies concluded that RCT sample s are highly selected and have a lower risk profile than real-world population s , with the frequent exclusion of elderly patients and patients with co-morbidities . Calculation of in eligibility rates in individual studies showed that a high proportion of the general disease population was often excluded from trials . The majority of studies ( n = 37 [ 71.2 % ] ) explicitly concluded that RCT sample s were not broadly representative of real-world patients and that this may limit the external validity of the RCT . Authors made a number of recommendations to improve external validity . Findings from this review indicate that there is a need to improve the external validity of RCTs such that physicians treating patients in real-world setting s have the appropriate evidence on which to base their clinical decisions . This goal could be achieved by trial design modification to include a more representative patient sample and by supplementing RCT evidence with data generated from observational studies . In general , a thoughtful approach to clinical evidence generation is required in which the trade-offs between internal and external validity are considered in a holistic and balanced manner Background Patients with schizophrenia have lower longevity than the general population as a consequence of a combination of risk factors connected to the disease , lifestyle and the use of medications , which are related to weight gain . Methods A multicentric , r and omized , controlled-trial was conducted to test the efficacy of a 12-week group Lifestyle Wellness Program ( LWP ) . The program consists of a one-hour weekly session to discuss topics like dietary choices , lifestyle , physical activity and self-esteem with patients and their relatives . Patients were r and omized into two groups : st and ard care ( SC ) and st and ard care plus intervention ( LWP ) . Primary outcome was defined as the weight and body mass index ( BMI ) . Results 160 patients participated in the study ( 81 in the intervention group and 79 in the SC group ) . On an intent to treat analysis , after three months the patients in the intervention group presented a decrease of 0.48 kg ( CI 95 % -0.65 to 1.13 ) while the st and ard care group showed an increase of 0.48 kg ( CI 95 % 0.13 to 0.83 ; p=0.055 ) . At six-month follow-up , there was a significant weight decrease of −1.15 kg , ( CI 95 % -2.11 to 0.19 ) in the intervention group compared to a weight increase in the st and ard care group ( + 0.5 kg , CI 95 % -0.42–1.42 , p=0.017 ) . Conclusion In conclusion , this was a multicentric r and omized clinical trial with a lifestyle intervention for individuals with schizophrenia , where the intervention group maintained weight and presented a tendency to decrease weight after 6 months . It is reasonable to suppose that lifestyle interventions may be important long-term strategies to avoid the tendency of these individuals to increase weight . Clinical trials.gov Background People with severe mental illnesses ( SMI ) are at increased risk of cardiovascular disease ( CVD ) . Clinical guidelines recommend regular screening for CVD risk factors . We evaluated a nurse led intervention to improve screening rates across the primary - secondary care interface . Methods Six community mental health teams ( CMHTs ) were r and omised to receive either the nurse led intervention plus education pack ( n = 3 ) or education pack only ( n = 3 ) . Intervention ( 6 months ) : The nurse promoted CVD screening in primary care and then in CMHTs . Patients who remained unscreened were offered screening by the nurse . After the intervention participants with SMI were recruited from each CMHT to collect outcome data . Main outcome : Numbers screened during the six months , confirmed in General Practice notes . Results All six CMHTs approached agreed to r and omisation . 121 people with SMI participated in outcome interviews during two waves of recruitment ( intervention arm n = 59 , control arm n = 62 ) . Participants from both arms of the trial had similar demographic profiles and rates of previous CVD screening in the previous year , with less than 20 % having been screened for each risk factor . After the trial , CVD screening had increased in both arms but participants from the intervention arm were significantly more likely to have received screening for blood pressure ( 96 % vs 68 % ; adjusted Odds Ratio ( OR ) 13.6 ; 95 % CI : 3.5 - 38.4 ) , cholesterol ( 66.7 % vs 26.9 % , OR 6.1 ; 3.2 - 11.5 ) , glucose ( 66.7 % vs 36.5 % OR 4.4 ; 2.7 - 7.1 ) , BMI ( 92.5 % vs 65.2 % OR 6.5 ; 2.1 - 19.6 ) , and smoking status ( 88.2 % vs 57.8 % OR 5.5 ; 3.2 - 9.5 ) and have a 10 year CVD risk score calculated ( 38.2 % vs 10.9 % ) OR 5.2 1.8 - 15.3 ) . Within the intervention arm approximately half the screening was performed in general practice and half by the trial nurse . Conclusions The nurse-led intervention was superior , result ing in an absolute increase of approximately 30 % more people with SMI receiving screening for each CVD risk factor . The feasibility of the trial was confirmed in terms of CMHT recruitment and the intervention , but the response rate for outcome collection was disappointing ; possibly a result of the cluster design . The trial was not large or long enough to detect changes in risk factors . Trial Registration International St and ard R and omised Controlled Trial Registration Number ( IS RCT RN ) 58625025 Physical activity is an important aspect of good health for everyone ; it is even more important for psychiatric patients who usually live an unhealthy lifestyle . In recent years , there has been growing focus on the use of soccer as a vehicle to improve the health of subjects with severe mental illness . The aim of this study was to investigate the effects of soccer practice on the self-reported health quality of life ( SRHQL ) and sports performance ( SP ) in psychotic subjects . Eighteen male patients with diagnosis of schizophrenia were r and omized into either a trained ( TG ) or a control group ( CG ) . The TG was trained for 12 weeks using two soccer training sessions per week . The CG did not perform any regular sports activity during the experimental period . Anthropometric measurements , SRHQL , personal time records in a 30 meter sprint test and slalom test running with a ball were evaluated before and after the experimental period . SRHQL was assessed using Short Form-12 question naire measuring physical and mental component summary scores . After the training period , the TG showed a relevant decrease by 4.6 % in bodyweight ( BW ) and body mass index compared to baseline . Conversely , the CG showed an increased BW and body mass index by 1.8 % from baseline to posttest . Moreover , after 12 weeks we found that control patients increased their BW significantly when compared to trained patients ( Δ = 5.4 % ; P < 0.05 ) . After the training period , comparing the baseline TG ’s Short Form-12-scores to posttest results , we found an improvement of 10.5 % and 10.8 % in physical component summary and mental component summary , respectively . In addition , performances on the 30 meter sprint test and slalom test running with a ball in the TG improved significantly ( P < 0.01 ) from baseline to posttest when compared to CG . Soccer practice appears able to improve psychophysical health in individuals with diagnosis of schizophrenia . Indeed , our study demonstrated that programmed soccer physical activity could reduce antipsychotic medication-related weight gain and improve SRHQL and sports performance in psychotic subjects OBJECTIVE Persons with chronic mental disorders are disproportionately burdened with physical health conditions . We determined whether Life Goals Collaborative Care compared to usual care improves physical health in patients with mental disorders within 12 months . METHODS This single-blind r and omized controlled effectiveness study of a collaborative care model was conducted at a midwestern Veterans Affairs urban outpatient mental health clinic . Patients ( N = 293 out of 474 eligible approached ) with an ICD-9-CM diagnosis of schizophrenia , bipolar disorder , or major depressive disorder and at least 1 cardiovascular disease risk factor provided informed consent and were r and omized ( February 24 , 2010 , to April 29 , 2015 ) to Life Goals ( n = 146 ) or usual care ( n = 147 ) . A total of 287 completed baseline assessment s , and 245 completed 12-month follow-up assessment s. Life Goals included 5 weekly sessions that provided semistructured guidance on managing physical and mental health symptoms through healthy behavior changes , augmented by ongoing care coordination . The primary outcome was change in physical health-related quality of life score ( Veterans R AND 12-item Short Form Health Survey [ VR-12 ] physical health component score ) . Secondary outcomes included control of cardiovascular risk factors from baseline to 12 months ( blood pressure , lipids , weight ) , mental health-related quality of life , and mental health symptoms . RESULTS Among patients completing baseline and 12-month outcomes assessment s ( N = 245 ) , the mean age was 55.3 years ( SD = 10.8 ; range , 25 - 78 years ) , and 15.4 % were female . Intent-to-treat analysis revealed that compared to those in usual care , patients r and omized to Life Goals had slightly increased VR-12 physical health scores ( coefficient = 3.21 ; P = .01 ) . CONCLUSIONS Patients with chronic mental disorders and cardiovascular disease risk who received Life Goals had improved physical health-related quality of life . TRIAL REGISTRATION Clinical Trials.gov identifiers : NCT01487668 and NCT01244854 Objective : Weight gain is common for individuals with serious mental illness ( SMI ) receiving antipsychotic drug therapy .  Contingency management ( CM ) is a behavioral intervention that rewards positive performance and has demonstrated effectiveness in reducing drug use in SMI population s. This study evaluated the feasibility of using CM to promote weight loss in individuals with SMI over 8 weeks . Method : 30 individuals ( BMI ≥ 28 kg/m2 ) were r and omized to one of three conditions : i ) The combination of a st and ardized lifestyle modification ( LM ) program for individuals with SMI and payment for group attendance ( CMattendance ) , ii ) The combination of LM and payment for weight loss ( CMweight ) , and iii ) waitlist control ( CON ) . After the waitlist period , those participants joined a LM group and received payment for behavioral change ( CMbehavior ) . Results : Subjects in the CMattendance and in the CMweight group lost a mean of 1.16 kg and 1.23 kg , respectively , while subjects in the CON gained a mean of 0.68 kg . Subjects receiving CMbehavior , lost a mean of 2.54 kg , which was a significant weight loss compared to the control period . Conclusion : LM supplemented with CM may facilitate weight loss in patients taking antipsychotic medications ; financial reimbursement for behavioral change may be particularly effective in this population Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more Life expectancy in patients with schizophrenia is reduced by 20 years for men and 15 years for women compared to the general population . About 60 % of the excess mortality is due to physical illnesses , with cardiovascular disease being dominant . CHANGE was a r and omized , parallel-group , superiority , multi-centre trial with blinded outcome assessment , testing the efficacy of an intervention aim ed to improve cardiovascular risk profile and hereby potentially reduce mortality . A total of 428 patients with schizophrenia spectrum disorders and abdominal obesity were recruited and central ly r and omized 1:1:1 to 12 months of lifestyle coaching plus care coordination plus treatment as usual ( N=138 ) , or care coordination plus treatment as usual ( N=142 ) , or treatment as usual alone ( N=148 ) . The primary outcome was 10-year risk of cardiovascular disease assessed post-treatment and st and ardized to age 60 . At follow-up , the mean 10-year risk of cardiovascular disease was 8.4 ± 6.7 % in the group receiving lifestyle coaching , 8.5 ± 
    Output:
    
Conclusion : There is a statistically significant , but clinical ly insignificant , mean effect of individualized lifestyle interventions for weight reduction in people with SMI