***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 Patients with chronic heart failure ( CHF ) have a continuing high mortality . Autonomic dysfunction may play an important role in the pathophysiology of cardiac death in CHF . UK-HEART examined the value of heart rate variability ( HRV ) measures as independent predictors of death in CHF . METHODS AND RESULTS In a prospect i ve study powered for mortality , we recruited 433 out patients 62+/-9.6 years old with CHF ( NYHA functional class I to III ; mean ejection fraction , 0.41+/-0.17 ) .  Time-domain HRV indices and conventional prognostic indicators were related to death by multivariate analysis . During 482+/-161 days of follow-up , cardiothoracic ratio , SDNN , left ventricular end-systolic diameter , and serum sodium were significant predictors of all-cause mortality . The risk ratio for a 41.2-ms decrease in SDNN was 1.62 ( 95 % CI , 1.16 to 2.44 ) . The annual mortality rate for the study population in SDNN subgroups was 5.5 % for > 100 ms , 12.7 % for 50 to 100 ms , and 51.4 % for < 50 ms . SDNN , creatinine , and serum sodium were related to progressive heart failure death . Cardiothoracic ratio , left ventricular end-diastolic diameter , the presence of nonsustained ventricular tachycardia , and serum potassium were related to sudden cardiac death . A reduction in SDNN was the most powerful predictor of the risk of death due to progressive heart failure . CONCLUSIONS CHF is associated with autonomic dysfunction , which can be quantified by measuring HRV . A reduction in SDNN identifies patients at high risk of death and is a better predictor of death due to progressive heart failure than other conventional clinical measurements . High-risk subgroups identified by this measurement are c and i date s for additional therapy after prescription of an ACE inhibitor Background Functional limitations , altered cardiac autonomic activity , and psychological distress are known disorders in chronic hemodialysis ( HD ) patients , relating to increased morbidity and mortality . The aim of this study was to examine the influence of an exercise training program on emotional parameters and heart rate variability ( HRV ) indices , as well as to determine whether emotional stress contributes to autonomic dysfunction in these patients . Methods Forty-four HD patients were r and omly assigned into group A ( 24 patients , aged 46.3 ± 11.2 years ) , who participated in a 1-year intradialytic exercise training program and group B ( 20 patients , aged 45.8 ± 10.8 years ) , who were used as controls . At baseline and a year after , measures of HRV were obtained for the estimation of st and ard deviation of RR intervals , the mean square successive differences , percentage of RR intervals differing by more than 50 ms from the preceding RR interval ( pNN50 ) , and low to high frequency components . Emotional parameters ( Beck Depression Inventory – BDI and Hospital Anxiety and Depression Scale – HADS ) were also assessed by vali date d question naires . Moreover , all patients performed a spiroergometric study for the estimation of VO2peak . Results At baseline , all measurements were similar in the two groups and remained almost unchanged after a year in group B. After a year of training , VO2peak increased from 16.79 ± 5.24 to 22.33 ± 4.90 ml/kg per min ( P > 0.001 ) in group A. Trained patients also showed an increase in st and ard deviation of RR intervals by 58.8 % ( P > 0.001 ) , the mean square successive differences by 68.1 % ( P > 0.001 ) , pNN50 by 23.5 % ( P > 0.001 ) , and a low to high frequency ratio by 17.3 % ( P > 0.001 ) . Finally , at the end of the study , group A showed a decrease in BDI score by 34.5 % ( P > 0.001 ) and HADS by 23.9 % ( P > 0.001 ) . Canonical correlation revealed significant inverse correlation among depression ( in BDI and HADS ) and HRV indices before and after exercise training . Conclusion Cardiac autonomic modulation seemed to be sensitive to the experience of persistent depression in HD patients .  Significantly , exercise training  reduced emotional distress and concomitantly improved HRV AIM To evaluate the effects of a yoga-based exercise program on pain , fatigue , sleep disturbance , and biochemical markers in hemodialysis patients . MATERIAL S AND METHODS In 2004 a r and omized controlled trial was carried out in the outpatient hemodialysis unit of the Nephrology Department , Uludag University Faculty of Medicine . Clinical ly stable hemodialysis patients ( n=37 ) were included and followed in two groups : the modified yoga-based exercise group ( n=19 ) and the control group ( n=18 ) . Yoga-based exercises were done in groups for 30 min/day twice a week for 3 months . All of the patients in the yoga and control groups were given an active range of motion exercises to do for 10 min at home . The main outcome measures were pain intensity ( measured by the visual analogue scale , VAS ) , fatigue ( VAS ) , sleep disturbance ( VAS ) , and grip strength ( mmHg ) ; biochemical variables-- urea , creatinine , calcium , alkaline phosphatase , phosphorus , cholesterol , HDL-cholesterol , triglyceride , erythrocyte , hematocrit -- were evaluated . RESULTS After a 12-week intervention , significant improvements were seen in the variables : pain -37 % , fatigue -55 % , sleep disturbance -25 % , grip strength + 15 % , urea -29 % , creatinine -14 % , alkaline phosphatase -15 % , cholesterol -15 % , erythrocyte + 11 % , and hematocrit count + 13 % ; no side-effects were seen . Improvement of the variables in the yoga-based exercise program was found to be superior to that in the control group for all the variables except calcium , phosphorus , HDL-cholesterol and triglyceride levels . CONCLUSION A simplified yoga-based rehabilitation program is a complementary , safe and effective clinical treatment modality in patients with end-stage renal disease BACKGROUND The prevalence of obesity has markedly increased in patients with chronic kidney disease ( CKD ) . Studies on the impact of exercise focusing on obese CKD patients are scarce . Therefore , we aim ed to investigate the effect of aerobic exercise performed either in an exercise centre or at home on visceral fat in overweight non-dialysed CKD patients . METHODS Twenty-seven sedentary men ( 52.1 ± 9.5 years , body mass index 30.4 ± 3.8 kg/m(2 ) , estimated glomerular filtration rate ( eGFR ) 27.5 ± 11.6 mL/min ) were r and omly assigned to a centre-based exercise group ( n = 10 ) , home-based exercise group ( n = 8) or control group ( n = 9 ) . The aerobic training was prescribed according to ventilatory threshold and performed three times per week during 12 weeks . Body composition was assessed by dual energy X-ray absorptiometry ( DEXA ) and the distribution of abdominal fat by computed tomography . RESULTS In the centre-based group , visceral fat and waist circumference decreased 6.4 ± 6.4 mm ( P < 0.01 ) and 2.0 ± 2.3 cm ( P = 0.03 ) and leg lean mass increased 0.5 ± 0.4 kg ( P < 0.01 ) . No significant changes were observed in the home-based group . Visceral fat increased 5.0 ± 4.4 mm in the control group ( P = 0.01 ) . In relation to the control , a group-by-time interaction was significant for visceral fat and waist circumference for both exercise groups and for leg lean mass for the centre-based group . Mean blood pressure decreased in both exercise groups ( centre-based 13 % , P < 0.01 and home-based 10 % , P = 0.03 ) and eGFR increased 3.6 ± 4.6 mL/min ( P = 0.03 ) in the centre-based group . These parameters remained unchanged in the control group . CONCLUSIONS Centre-based aerobic exercise is an effective approach to reduce visceral fat besides promoting relevant clinical benefits in male overweight CKD patients BACKGROUND AND OBJECTIVES CKD is associated with poor  cardiorespiratory fitness ( CRF ) . This predefined sub study determined the effect of exercise training and lifestyle intervention on CRF and explored the effect on cardiovascular risk factors and cardiac and vascular function . DESIGN , SETTING , PARTICIPANTS , & MEASUREMENTS Between February 2008 and March 2010 , 90 patients with stage 3 - 4 CKD were screened with an exercise stress echocardiogram before enrollment . Patients ( n=83 ) were r and omized to st and ard care ( control ) or lifestyle intervention .  The lifestyle intervention included multidisciplinary care ( CKD clinic ) , a lifestyle program , and aerobic and resistance exercise training for 12 months . CRF ( peak Vo2 ) , left ventricular function , arterial stiffness , anthropometric , and biochemical data were collected at baseline and 12 months . RESULTS Ten percent of r and omized patients had sub clinical myocardial ischemia at screening and completed the study without incident . There was no baseline difference among 72 patients who completed follow-up ( 36 in the lifestyle intervention group and 36 in the control group ) . The intervention increased peak Vo2 ( 2.8±0.7 ml/kg per minute versus -0.3±0.9 ml/kg per minute ; P=0.004 ) . There was small weight loss ( -1.8±4.2 kg versus 0.7±3.7 kg ; P=0.02 ) but no change in BP or lipids . Diastolic function improved ( increased e ' of 0.75±1.16 cm/s versus -0.47±1.0 cm/s ; P=0.001 ) but systolic function was well preserved and did not change . The change in arterial elastance was attenuated ( 0.11±0.76 mmHg/ml versus 0.76±0.96 mmHg/ml ; P=0.01 ) . Δ peak Vo2 was associated with group allocation and improved body composition . CONCLUSIONS Exercise training and lifestyle intervention in patients with CKD  produces improvements in CRF , body composition , and diastolic function Background : Dyslipidemia has been established as a well-known traditional risk factor for cardiovascular disease in chronic kidney disease patients . Aim : This study investigated the impact of Hatha yoga exercise on lipid parameters in patients with end-stage renal disease ( ESRD ) on hemodialysis . Material s and Methods : This prospect i ve r and omized study consisted of 33 ESRD patients in the Hatha yoga exercise group  that was matched with 35 ESRD patients in the control group .  Serum total cholesterol , triglycerides , low-density lipoprotein (LDL)-cholesterol , and high-density lipoprotein (HDL)-cholesterol were determined at baseline ( 0 month ) and after 4 months . Results : Comparing values after 4 months versus baseline in the prehemodialysis Hatha yoga exercise group , there was found a significant decrease in total cholesterol from 5.126 ± 0.092 mmol/l to 4.891 ± 0.072 mmol/l ( -4.58 % ; P = 0.0001 ) , triglycerides from 2.699 ± 0.078 mmol/l to 2.530 ± 0.063 mmol/l ( -6.26 % ; P = 0.0001 ) , LDL-cholesterol from 2.729 ± 0.083 mmol/l to 2.420 ± 0.066 mmol/l ( -11.32 % ; P = 0.0001 ) , and total cholesterol/HDL-cholesterol ratio from 5.593 ± 0.119 mmol/l to 4.907 ± 0.116 mmol/l ( -12.26 % ; P = 0.047 ) . For patients in the Hatha yoga exercise group , 51.5 % had normal total cholesterol at 0 month while 70.0 % had normal total cholesterol ( P < 0.05 ) after 4 four months and 54.5 % of patients had normal LDL-cholesterol at 0 month while 84.9 % had normal LDL-cholesterol after 4 months ( P < 0.05 ) . Conclusion : These findings suggest that Hatha yoga exercise has preventive and beneficial effects and may be a safe therapeutic modality in ESRD patients BACKGROUND Cardiovascular disease ( CVD ) mortality rates are greatly elevated in chronic kidney disease patients receiving maintenance haemodialysis therapy . The purpose of this study was to evaluate the efficacy of intradialytic endurance exercise training on novel risk 
    Output:
    
The strongest evidence is for the effects of  aerobic exercise on improving physical fitness , muscular strength and quality of life in dialysis patients .
The benefits of exercise in dialysis patients are well established , supporting the prescription of physical activity in their regular treatment .