***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: AIMS We examined the effects of physical activity with or without dietary restriction for 3 months on regional fat and insulin sensitivity and compared the effect of total energy expenditure from all levels of physical activity with that of physical activity energy expenditure from moderate-to-vigorous exercise in obese women with Type 2 diabetes . METHODS In this r and omized , controlled trial , we assessed change of body weight , abdominal visceral fat area , subcutaneous fat area and insulin sensitivity , expressed as K(ITT ) , and monitored total energy expenditure and physical activity energy expenditure using an accelerometer during a 12-week intervention in four groups : control , diet , exercise and diet plus exercise . RESULTS The mean body mass index was 28.0 + /- 2.7 kg/m(2 ) and the mean duration of diabetes was 8 + /- 6 years . Both the diet and diet plus exercise groups showed significant body weight loss compared with the control group ( P < 0.05 ) . However , the visceral fat area was reduced only in the diet and exercise group ( P = 0.017 ) and the subcutaneous fat area was reduced only in the diet group ( P = 0.009 ) . Mean energy intake was an independent determinant of the change in subcutaneous fat area ( P = 0.020 ) and mean total anergy expenditure was an independent determinant of visceral fat area ( P = 0.002 ) . Insulin sensitivity K(ITT ) was associated with physical activity energy expenditure ( P = 0.006 ) , energy intake ( P = 0.047 ) and the change in fructosamine level ( P = 0.016 ) but not with changes in body weight , subcutaneous fat area , visceral fat area or adipokine level . CONCLUSIONS Exercise had an additive effect to dietary restriction on visceral fat reduction . Visceral fat area was associated with total energy expenditure , but insulin sensitivity was associated with physical activity energy expenditure Background The prevalence of obesity in men is rising , but they are less likely than women to engage in existing weight management programmes . The potential of professional sports club setting s to engage men in health promotion activities is being increasingly recognised . This paper describes the development and optimization of the  Football Fans in Training ( FFIT ) programme , which aims to help overweight men ( many of them football supporters ) lose weight through becoming more active and adopting healthier eating habits . Methods The MRC Framework for the design and evaluation of complex interventions was used to guide programme development in two phases . In Phase 1 , a multidisciplinary working group developed the pilot programme ( p-FFIT ) and used a scoping review to summarize previous research and identify the target population . Phase 2 involved a process evaluation of p-FFIT  in 11 Scottish Premier League ( SPL ) clubs . Participant and coach feedback , focus group discussion s and interviews explored the utility/acceptability of programme components and suggestions for changes . Programme session observations identified examples of good practice and problems/issues with delivery . Together , these findings informed redevelopment of the optimized programme ( FFIT ) , whose components were mapped onto specific behaviour change techniques using an evidence -based taxonomy . Results p-FFIT comprised 12 , weekly , gender-sensitised , group-based weight management classroom and ‘ pitch-side ’ physical activity sessions . These in-stadia sessions were complemented by an incremental , pedometer-based walking programme . p-FFIT was targeted at men aged 35 - 65 years with body mass index ≥ 27 kg/m2 . Phase 2 demonstrated that participants in p-FFIT were enthusiastic about both the classroom and physical activity components , and valued the camaraderie and peer-support offered by the programme . Coaches appreciated the simplicity of the key healthy eating and physical activity messages . Suggestions for improvements that were incorporated into the optimized FFIT programme included : more varied in-stadia physical activity with football-related components ; post-programme weight management support ( emails and a reunion session ) ; and additional training for coaches in SMART goal setting and the pedometer-based walking programme . Conclusions The Football Fans in Training programme is highly acceptable to participants and SPL coaches , and is appropriate for evaluation in a r and omised controlled trial The goal of evidence -based medicine is ultimately to improve patient outcomes and quality of care .  Systematic review s of the available published evidence are required to identify interventions that lead to improvements in behavior , health , and well-being . Authoritative literature review s depend on the quality of published research and research reports . The Consoli date d St and ards for Reporting Trials ( CONSORT ) Statement ( www.consort-statement.org ) was developed to improve the design and reporting of interventions involving r and omized clinical trials ( RCTs ) in medical journals . We describe the 22 CONSORT guidelines and explain their application to behavioral medicine research and to evidence -based practice . Additional behavioral medicine-specific guidelines ( e.g. , treatment adherence ) are also presented . Use of these guidelines by clinicians , educators , policymakers , and research ers who design , report , and evaluate or review RCTs will strengthen the research itself and accelerate efforts to apply behavioral medicine research to improve the processes and outcomes of behavioral medicine practice Background Exposure to smoking-related cues leads to increased urge to smoke in regular cigarette smokers and resisting these urges requires considerable self-control . Purpose Adopting a re source depletion model , two studies tested the hypothesis that resisting smoking urges depletes self-control re sources . Methods Adopting a within- participants r and omized cross-over design , participants ( study 1 , N = 19 ; study 2 , N = 32 ) were exposed to smoking-related ( study 1 : smoking images ; study 2 : cigarette cue-exposure task ) and neutral ( study 1 : neutral images ; study 2 : drinking-straw task ) cues with presentation order r and omized . After each cue set , participants completed self-control tasks ( study 1 : h and grip task ; study 2 : h and grip and Stroop tasks ) , performance on which constituted dependent measures of self-control . Results Self-control task performance was significantly impaired when exposed to smoking-related cues compared to neutral cues . No significant presentation-order effects , or interaction effects between stimulus and presentation order , were found . Conclusions Findings corroborate our hypothesis that resisting smoking urges depletes cigarette smokers ’ self-control re sources and suggests that self-control capacity is governed by a limited re source Background Few studies have evaluated how to combine dietary and physical activity ( PA ) interventions to enhance adherence . Purpose We tested how sequential versus simultaneous diet plus PA interventions affected behavior changes . Methods Two hundred participants over age 44 years not meeting national PA and dietary recommendations ( daily fruit and vegetable servings and percent of calories from saturated fat ) were r and omized to one of four 12-month telephone interventions : sequential ( exercise first or diet first ) , simultaneous , or attention control . At 4 months , the other health behavior was added in the sequential arms . Results Ninety-three percent of participants were retained through 12 months . At 4 months , only exercise first improved PA , and only the simultaneous and diet-first interventions  improved dietary variables . At 12 months , mean levels of all behaviors in the simultaneous arm met recommendations , though not in the exercise- and diet-first arms . Conclusions We observed a possible behavioral suppression effect of early dietary intervention on PA that merits investigation PURPOSE A hypertensive response to exercise ( HRE ) is common in patients with type 2 diabetes and is associated with increased left ventricular ( LV ) mass and mortality . This study aim ed to determine whether lifestyle modification would improve exercise blood pressure ( BP ) and reduce LV mass in patients with type 2 diabetes . METHODS One hundred and eighty-five patients with type 2 diabetes were r and omized to 1 yr of  lifestyle intervention ( n=97 , mean ± SD age=54.7 ± 11.3 yr , 51 % men ) or  usual care ( control ; n=88 , age=53.8 ± 8.1 yr , 61 % men ) . Brachial BP was measured at rest and during a grade d maximal exercise test at baseline and 1 yr . Patients also underwent two-dimensional echocardiography to determine LV dimensions . A subgroup of 61 patients had resting and exercise central BP estimated from radial tonometry . An HRE was defined as a maximal exercise systolic BP of ≥210 mm Hg for men and ≥190 mm Hg for women . RESULTS At study entry , there were 101 patients ( 55 % ) with an HRE ( n=51 controls ) . Compared with controls , lifestyle intervention significantly reduced the propensity to develop an HRE in those participants who did not have HRE at baseline ( 29.8 % vs 59.5 % , P=0.006 ) . However , absolute values of exercise and resting ( brachial and central ) BP and LV mass were not significantly changed ( all P values > 0.05 ) . There were significant ( all P values < 0.05 ) improvements in V˙O2max , body mass index , plasma glucose , insulin resistance , and HDL cholesterol after lifestyle intervention compared with control . CONCLUSIONS Lifestyle intervention significantly attenuates the development of an HRE but does not reduce cardiac size after 1 yr in patients with type 2 diabetes This study compared treatment outcomes for a new weight loss program that emphasized reducing unhealthy relationships with food , body image dissatisfaction , and internalized weight bias ( New Perspectives ) to a weight loss program that emphasizes environmental modification and habit formation and disruption ( Transforming Your Life ) . Fifty-nine overweight and obese adults ( body mass index ≥ 27 kg/m2 ) were r and omly assigned to either a 12-week New Perspectives or Transforming Your Life intervention . Despite equivalent outcomes at the end of treatment , the Transforming Your Life participants were significantly more effective at maintaining their weight loss than New Perspectives participants during the 6-month no-treatment follow-up period OBJECTIVE R and omized treatment comparing an intensive glycemic treatment strategy with a st and ard strategy in the Action to Control Cardiovascular Risk in Diabetes ( ACCORD ) trial was ended early because of an unexpected excess of mortality in the intensive arm . As part of ongoing post hoc analyses of potential mechanisms for this finding , we explored whether on-treatment A1C itself had an independent relationship with mortality . RESEARCH DESIGN AND METHODS Participants with type 2 diabetes ( n = 10,251 with mean age 62 years , median duration of diabetes 10 years , and median A1C 8.1 % ) were r and omly assigned to treatment strategies targeting either A1C < 6.0 % ( intensive ) or A1C 7.0–7.9 % ( st and ard ) . Data obtained during 3.4 ( median ) years of follow-up before cessation of intensive treatment were analyzed using several multivariable models . RESULTS Various characteristics of the participants and the study sites at baseline had significant associations with the risk of mortality . Before and after adjustment for these covariates , a higher average on-treatment A1C was a stronger predictor of mortality than the A1C for the last interval of follow-up or the decrease of A1C in the first year . Higher average A1C was associated with greater risk of death . The risk of death with the intensive strategy increased approximately linearly from 6–9 % A1C and appeared to be greater with the intensive than with the st and ard strategy only when average A1C was > 7 % . CONCLUSIONS These analyses implicate factors associated with persisting higher A1C levels , rather than low A1C per se , as likely contributors to the increased mortality risk associated with the intensive glycemic treatment strategy in ACCORD BACKGROUND Lifestyle changes soon after diagnosis might improve outcomes in patients with type 2 diabetes mellitus , but no large trials have compared interventions . We investigated the effects of diet and physical activity on blood pressure and glucose concentrations . METHODS We did a r and omised , controlled trial in southwest Engl and in adults aged 30 - 80 years in whom type 2 diabetes had been diagnosed 5 - 8 months previously . Participants were assigned usual care ( initial dietary consultation and follow-up every 6 months ; control group ) , an intensive diet intervention ( dietary consultation every 3 months with monthly nurse support ) , or the latter plus a pedometer-based activity programme , in a 2:5:5 ratio . The primary endpoint was improvement in glycated haemoglobin A(1c)(HbA(1c ) ) concentration and blood pressure at 6 months . Analysis was done by intention to treat . This study is registered , number IS RCT N92162869 . FINDINGS Of 593 eligible individuals , 99 were assigned usual care , 248 the diet regimen , and 246 diet plus activity . Outcome data were available for 587 ( 99 % ) and 579 ( 98 % ) participants at 6 and 12 months , respectively . At 6 months , glycaemic control had worsened in the control group ( mean baseline HbA(1c ) percentage 6·72 , SD 1·02 , and at 6 months 6·86 , 1·02 ) but improved in the diet group ( baseline-adjusted difference in percentage of HbA(1c ) -0·28 % , 95 % CI -0·46 to -0·10 ; p=0·005 ) and diet plus activity group ( -0·33 % , -0·51 to -0·14 ; p<0·001 ) . These differences persisted to 12 months , despite less use of diabetes drugs . Improvements were also seen in bodyweight and insulin resistance between the intervention and control 
    Output:
    
Conclusions Diet and physical activity interventions achieved clinical ly significant reductions in HbA1c at three and six months , but not at 12 and 24 months .