***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 
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    Input: Background Hydrotherapy is highly valued by people with rheumatoid arthritis yet few studies have compared the benefits of exercises in heated water against exercises on l and . In particular , data on quality of life is rarely reported . This is especially important because patients treated with hydrotherapy often report an enhanced sense of well-being . We report a r and omised controlled trial in which we compared the effects of hydrotherapy with exercises on l and on overall response to treatment , physical function and quality of life in patients with rheumatoid arthritis . Methods One hundred and fifteen patients with RA were r and omised to receive a weekly 30-minute session of hydrotherapy or similar exercises on l and for 6 weeks . Our primary outcome was a self-rated global impression of change – a measure of treatment effect on a 7-point scale ranging from 1(very much worse ) to 7 ( very much better ) assessed immediately on completion of treatment . Secondary outcomes including EuroQol health related quality of life , EuroQol health status valuation , HAQ , 10 metre walk time and pain scores were collected at baseline , after treatment and 3 months later . Binary outcomes were analysed by Fisher 's exact test and continuous variables by Wilcoxon or Mann-Whitney tests . Results Baseline characteristics of the two groups were comparable . Significantly more patients treated with hydrotherapy ( 40/46 , 87 % ) were much better or very much better than the patients treated with l and exercise ( 19/40 , 47.5 % ) , p < 0.001 Fisher 's exact test . Eleven patients allocated l and exercise failed to complete treatment compared with 4 patients allocated hydrotherapy ( p = 0.09 ) . Sensitivity analyses confirmed an advantage for hydrotherapy if we assumed non-completers would all not have responded ( response rates 70 % versus 38 % ; p < 0.001 ) or if we assumed that non-completers would have had the same response as completers ( response rates 82 % versus 55 % p = 0.002 ) . Ten metre walk time improved after treatment in both cases ( median pre-treatment time for both groups combined 10.9 seconds , post-treatment 9.1 s , and 3 months later 9.6 s ) . There was however no difference between treatment groups . Similarly there were no significant differences between groups in terms of changes to HAQ , EQ-5D utility score , EQ VAS and pain VAS . Conclusion Patients with RA treated with hydrotherapy are more likely to report feeling much better or very much better than those treated with l and exercises immediately on completion of the treatment programme . This perceived benefit was not reflected by differences between groups in 10-metre walk times , functional scores , quality of life measures and pain scores OBJECTIVES To describe the changes in functional ability ( FA ) taking place over 5 yr in patients with rheumatoid arthritis ( RA ) starting disease-modifying anti-rheumatic drug ( DMARD ) therapy  , to investigate the factors having most influence upon FA and to compare these factors at baseline and after 5 yr of treatment . METHODS Three hundred and sixty-six patients with active RA were studied as part of a 5-yr r and omized controlled study of DMARD therapy . FA was assessed by  Health Assessment Question naire  ( HAQ )  score every 6 months . Multiple linear regression was used to identify factors affecting FA at baseline and at 5 yr . The independent variables used were age , sex , visual analogue scale ( VAS ) pain , Ritchie articular index , C-reactive protein ( CRP ) , Larsen score and log-transformed morning stiffness ( EMS ) . RESULTS Mean HAQ score was 1.64 at baseline , improved by 21 % at 1 yr and gradually returned towards baseline levels by 5 yr . At baseline only 34 % of variance in HAQ score could be explained ; the most significant explanatory variables were the Ritchie articular index and CRP . At 5 yr the variance explained was 60 % . The Ritchie articular index remained the strongest factor followed by VAS pain , log(10 ) EMS and Larsen score . CONCLUSIONS Improvement in function did occur after commencement of the first DMARD therapy but was not maintained to 5 yr . The most consistent factor affecting function was joint tenderness . Global pain and duration of EMS were of lesser importance . Disease activity measures such as the CRP exerted an influence in the earlier , more active stages of disease : radiographic damage assumed greater importance as the arthritis progressed OBJECTIVES The aim of this study was to evaluate the effects of moderately intensive pool exercise therapy on patients with rheumatoid arthritis ( RA ) . METHODS Forty-six patients with chronic RA were r and omly assigned to a treatment group and a control group . The treatment group ( n = 20 ) exercised in a temperate pool twice a week for 12 weeks . The control group ( n = 23 ) continued with their previous activities .  Aerobic capacity , measured by means of a submaximum bicycle test , and the physical component of the SF-36 were chosen as the primary outcome measures . Two tests of muscle endurance were chosen as the secondary outcome measure . Additional functional tests and instruments were included . RESULTS No significant differences between the groups were found for the primary outcome measures . Significant improvements in the following aspects of muscular function ( P < 0.05 ) were found in the treatment group when their performance was compared with that of the control group : isometric shoulder endurance , grip force , dynamic endurance of lower extremities ( chair test ) and muscle function of lower extremities . Significant improvements were also found for vitality ( SF-36 ) compared with the control group . The improvements in the training group were maintained for 3 months . CONCLUSIONS Pool exercise therapy of moderate intensity significantly improved muscle endurance in the upper and lower extremities in patients with RA , while no impact on aerobic capacity was found . However , the study population was small and there is a need for further studies with larger population OBJECTIVES To compare quadriceps sensorimotor function , lower limb functional performance and disability in patients with rheumatoid arthritis ( RA ) and healthy subjects , and to investigate the efficacy and safety of a brief rehabilitation regime . METHODS Quadriceps strength , voluntary activation , proprioceptive acuity and the aggregate time [ aggregate functional performance time ( AFPT ) ] taken to perform four common activities [ aggregate functional performance time ( AFPT ) ] were compared between 103 RA patients who had lower limb involvement and 25 healthy subjects . In addition , disability ( Health Assessment Question naire ) , clinical disease activity and the plasma concentration of proinflammatory cytokines were measured in the RA patients . In a follow-on r and omized controlled trial of rehabilitation , these variables were used as baseline data for 93 of the RA patients , who were r and omized to a rehabilitation or a control group . Changes in the variables were analysed within and between groups . RESULTS Compared with healthy subjects , RA patients had weaker quadriceps [ mean difference 157 N ; 95 % confidence interval ( CI ) 125 - 189 ] , poorer activation ( 8 % , 95 % CI 4.5 - 15 ) and proprioceptive acuity ( 0.8 degrees , 95 % CI 0.4 - 1.3 ) and took longer to perform the AFPT ( 34 s , CI 23.5 - 44.8 ) . Rehabilitation increased quadriceps strength ( mean increase 61 N , 95 % CI 28 - 95 ) and voluntary activation ( 8 % , 95 % CI 3 - 12.4 ) and decreased the AFPT ( 12.3 s , 95 % CI -2 to 27.7 ) and subjective disability ( 0.21 HAQ points , 95 % CI 0 - 0.35 ) without exacerbating disease activity . All the improvements were maintained at the 6-month follow-up . There was no change during the control period . CONCLUSIONS Patients with RA that affected their lower limb had quadriceps sensorimotor deficits that were associated with lower limb disability . A clinical ly applicable rehabilitation regime increased quadriceps sensorimotor function and decreased lower limb disability without exacerbating pain or disease activity . For patients with well-controlled RA that causes lower limb involvement , the regime is effective and safe Summary This study aims to evaluate the effect of 18-week progressive muscular strength and proprioception training program on the muscle strength of the quadriceps , in prevention of falls in postmenopausal women with osteoporosis . The incidence of falls in the intervention group was significantly lower than in the control group ( incidence rate ratio ( IRR ) = 0.263 , 95 % CI 0.10–0.68 ) . Introduction This study aims to evaluate the effect of a progressive muscular strength and proprioception training program on the muscle strength of the quadriceps , balance , quality of life , and reduction in the risk of falls in postmenopausal women with osteoporosis . Methods One hundred sedentary postmenopausal women with osteoporosis , ages ranging from 55 to 75 , were selected and r and omized into two groups : the intervention group comprised of 50 patients who underwent a 18-week of progressive load training for the quadriceps muscle ( 50 % up to 80 % of 1-RM — one maximum repetition ) and proprioception training associated to a drug treatment of osteoporosis and the  control group that included 50 patients who only underwent a drug treatment of osteoporosis .  The muscular strength , balance , functional mobility , and quality of life were evaluated in the beginning and end of the research . The number of falls was evaluated 24 weeks post-treatment . Results Eighty-five patients concluded the research . The program promoted a significant difference among the groups for SF-36 in the eight sub-scales ( p ≤ 0.0018 ) , Timed Up & Go Test ( p < 0.0001 ) , 1-RM test ( p < 0.0001 ) , Berg Balance Scale ( p < 0.0001 ) and also a decrease in the number of falls in the intervention group compared to control ( IRR = 0.263 , 95 % CI 0.10–0.68 , p = 0.0064 ) . Conclusion The association of progressive strength training for the quadriceps and the proprioceptive training is effective for the prevention of falls , increasing the muscle power , the static and dynamic balance and increasing the speed of the motor responses , therefore improving the performance of daily activities OBJECTIVE To determine the effect on balance and strength of 3 months of intensive balance and /or weight training followed by 6 months of low intensity Tai Chi training for maintenance of gains . DESIGN R and omized control intervention . Four groups in 2 x 2 design : Control , Balance , Strength , Balance + Strength , using blinded testers . SETTING Exercise and balance laboratory at University of Connecticut Health Center . PARTICIPANTS Subjects were 110 healthy community dwellers ( mean age 80 ) who were free of dementia , neurological disease , and serious cardiovascular or musculoskeletal conditions . INTERVENTIONS Short-term training ( 3 months ) occurred 3 times/week ( 45 minutes Balance and Strength , 90 minutes Balance + Strength ) . Balance training included equilibrium control exercises of firm and foam surfaces and center-of-pressure biofeedback . Strengthening consisted of lower extremity weight-lifting . All subjects than received long-term group Tai Chi instruction ( 6 months , 1 hour , 1 time/week ) . MEASUREMENTS Losses of balance during Sensory Organization Testing ( LOB ) , single stance time ( SST ) , voluntary limits of stability ( FBOS ) , summed isokinetic torque of eight lower extremity movements ( ISOK ) , and usual gait velocity ( GVU ) . RESULTS AND CONCLUSIONS Balance training meaningfully improved all balance measures by restoring performance to a level analogous to an individual 3 to 10 years younger : LOB = -2.0 + /- 0.3 ( adjusted paired differences , P < .005 ANOVA ) ; SST = 7.0 + /- 1.2 sec ; and FBOS = 9.0 + /- 2.0 % of foot length ( P < .05 ) . Strengthening increased ISOK by 1.1 + /- 0.1 Nm kg-1 ( P < .005 ) . There was no interaction between balance and strength training . Significant gains persisted after 6 months of Tai Chi , although there was some decrement OBJECTIVE We previously demonstrated the efficacy of a 6 week home based physical therapy ( PT ) intervention for people with moderate to severe rheumatoid arthritis ( RA ) . This followup study determined if short term improvements were maintained to one year . METHODS Participants in the short term study were r and omly assigned to receive a PT intervention ( education , exercise , and pain relief modalities ) delivered by physiotherapists with advanced rheumatology training ( Weeks 0 to 6 ) or to a wait list control group . The control group received the intervention between Weeks 6 to 12 . Outcome measures included the Stanford Arthritis Self-Efficacy Scale ( SES ) , the Arthritis Community Research and Evaluation Unit Rheumatoid Arthritis Knowledge Question naire ( KQ ) , and a visual analog scale for pain . Disease activity measures ( tender joints , grip strength , and morning stiffness ) were also included . MANOVA was used to compare within-subject scores at baseline and at 12 and 52 weeks . Paired t tests were used to determine if 12 week changes were maintained at 52 weeks . RESULTS Of the 127 protocol completers , 117 ( 92.1 % ) were available for the one year followup . For those measures that showed significant improvement in the r and omized controlled trial ( SES , KQ , morning stiffness ) , improvements at 12 weeks were maintained at 5 
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After analysing them , we observed that the main interventions were exercises to improve muscle strength , endurance , and dynamic exercises ( swimming , walking , etc ) .