***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: Substantial progress has been made in the awareness , treatment , and prevention of  cardiovascular disease ( CVD ) in women since the first women-specific clinical recommendations for the prevention of CVD were published by the American Heart Association ( AHA ) in 1999.1 The myth that heart disease is a “ man 's disease ” has been debunked ; the rate of public awareness of CVD as the leading cause of death among US women has increased from 30 % in 1997 to 54 % in 2009.2 The age-adjusted death rate result ing from  coronary heart disease ( CHD ) in females , which accounts for about half of all CVD deaths in women , was 95.7 per 100 000 females in 2007 , a third of what it was in 1980.3,4 Approximately 50 % of this decline in CHD deaths has been attributed to reducing major risk factors and the other half to treatment of CHD including secondary preventive therapies.4 Major r and omized controlled clinical trials such as the Women 's Health Initiative have changed the practice of CVD prevention in women over the past decade.5 The investment in combating this major public health issue for women has been significant , as have the scientific and medical achievements . Despite the gains that have been made , considerable challenges remain . In 2007 , CVD still caused ≈1 death per minute among women in the United States.6 These represent 421 918 deaths , more women 's lives than were cl aim ed by cancer , chronic lower respiratory disease , Alzheimer disease , and accidents combined.6 Reversing a trend of the past 4 decades , CHD death rates in US women 35 to 54 years of age now actually appear to be increasing , likely because of the effects of the obesity epidemic.4 CVD rates in the United States are significantly higher for black females compared with their white counterparts ( 286.1/100 000 versus Introduction Isometric resistance training has repeatedly shown to be an effective exercise modality in lowering resting blood pressure ( BP ) , yet associated mechanisms and sex differences in the response to training remain unclear . Exploration into potential sex differences in the response to isometric resistance training is necessary , as it may allow for more optimal and sex-based exercise prescription , thereby maximizing the efficacy of the training intervention . Purpose Therefore , we investigated , in normotensives , whether sex differences exist in the response to isometric h and grip ( IHG ) training .  Methods Resting BP and endothelium-dependent vasodilation ( brachial artery flow-mediated dilation ; FMD ) were assessed in 11 women ( 23 ± 4 years ) and 9 men ( 21 ± 2 years ) prior to and following 8 weeks of IHG training  ( four , 2-min unilateral contractions at 30 % of maximal voluntary contraction ; 3 days per week ) . Results Main effects of time were observed ( all P < 0.05 ) , whereby IHG training reduced systolic BP ( Δ 8 ± 6 mmHg ) , diastolic BP ( Δ 2 ± 3 mmHg ) , mean arterial pressure ( Δ 4 ± 3 mmHg ) , and pulse pressure ( Δ 5 ± 7 mmHg ) , accompanied by increases in absolute ( Δ 0.09 ± 0.15 mm ) and relative ( Δ 2.4 ± 4.1 % ) brachial artery FMD ; however , no significant sex differences were observed in the magnitude of post-training change in any variable assessed ( all P > 0.05 ) . Conclusion IHG training  effectively lowers resting BP and improves endothelium-dependent vasodilation in men and women , without significant sex differences in the magnitude of response Isometric HG ( h and grip ) training lowers resting arterial BP ( blood pressure ) , yet the mechanisms are elusive . In the present study , we investigated improved systemic endothelial function as a mechanism of arterial BP modification following isometric HG training in normotensive individuals . This study employed a within-subject repeated measures design primarily to assess improvements in BA FMD ( brachial artery flow-mediated dilation ; an index of endothelium-dependent vasodilation ) , with the non-exercising limb acting as an internal control . Eleven subjects performed four 2-min unilateral isometric HG contractions at 30 % of maximal effort , three times per week for 8 weeks . Pre- , mid- and post-training resting ABP and BA FMD ( exercised arm and non-exercised arm ) were measured via automated brachial oscillometry and ultrasound respectively . BA FMD ( normalized to the peak shear rate experienced in response to the reactive hyperaemic stimulus ) remained unchanged [ exercised arm , 0.029+/-0.003 to 0.026+/-0.003 to 0.029+/-0.004%/s(-1 ) ( pre- to mid- to post-training respectively ) ; non-exercised arm , 0.023+/-0.003 to 0.023+/-0.003 to 0.024+/-0.003%/s(-1 ) ( pre- to mid- to post-training respectively ) ; P=0.22 ] . In conclusion , improved systemic endothelial function is unlikely to be responsible for lowering arterial BP in this population Aerobic and isometric training have been shown to reduce resting blood pressure , but simultaneous aerobic and isometric training have not been studied . The purpose of this study was to compare the changes in resting systolic ( SBP ) , diastolic ( DBP ) , and mean arterial blood pressure ( MAP ) after 6 weeks of either ( i ) simultaneous walking and isometric h and grip exercise ( WHG ) , ( ii ) walking ( WLK ) , ( iii ) isometric h and grip exercise ( IHG ) , or control ( CON ) . Forty-eight healthy sedentary participants ( age 20.7 ± 1.7 yrs , mass 67.2 ± 10.2 kg , height 176.7 ± 1.2 cm , male n = 26 , and female n = 22 ) were r and omly allocated , to one of four groups ( n = 12 in each ) . Training was performed 4 × week−1 and involved either treadmill walking for 30 minutes ( WLK ) , h and grip exercise 3 × 10 s at 20 % MVC ( IHG ) , or both performed simultaneously ( WHG ) . Resting SBP , DBP , and MAP were recorded at rest , before and after the 6-week study period . Reductions in resting blood pressure were significantly greater in the simultaneous walking and h and grip group than any other group . These results show that simultaneous walking and h and grip training may have summative effects on reductions in resting blood pressure Aerobic endurance exercise ( AEX ) is an effective treatment in the prevention and management of high blood pressure ( BP ) . Growing evidence suggests potential benefits from isometric h and grip ( IHG ) exercise , which may promote similar or even larger reductions in BP than AEX . We compared the effects of home-based AEX and home-based IHG on BP .  Sixty healthy individuals ( 31 men ; mean age , 33.1 years ; mean BP , 126.9 ± 1.6/84.7 ± 1.1 mm Hg ) were r and omized to IHG , AEX  , or a control group . Both exercise interventions were performed in the home environment . The IHG group performed daily 4 × 2 minutes sustained grips at 30 % of maximal volitional contraction . Participants in the AEX group were advised to perform at least 150 min/wk of aerobic exercise at moderate intensity . Outcome measurements were assessed at baseline and 8 weeks of follow-up . Compared with the control group , AEX result ed in a larger reduction in ambulatory BP ; both AEX and IHG exercise tended to induce larger reductions in office systolic BP , and office diastolic BP was significantly more reduced after AEX but not IHG exercise . Responses to training were not significantly different between both the exercise interventions . Eight weeks of home-based AEX results in significant reductions in both ambulatory BP and office BP in healthy adults , whereas IHG reduces only office BP Introduction : Several established tools are available to assess study quality and reporting of r and omized controlled trials ; however , these tools were design ed with clinical intervention trials in mind . In exercise training intervention trials some of the traditional study quality criteria , such as participant or research er blinding , are extremely difficult to implement . Methods : We developed the Tool for the assEssment of Study qualiTy and reporting in EXercise ( TESTEX ) – a study quality and reporting assessment tool , design ed specifically for use in exercise training studies . Our tool is a 15-point scale ( 5 points for study quality and 10 points for reporting ) and addresses previously unmentioned quality assessment criteria specific to exercise training studies . Results : There were no systematic differences between the summated TESTEX scores of each observer [ H(2 ) = 0.392 , P = 0.822 ] . There was a significant association between the summated TESTEX scores of the three observers , with almost perfect agreement between observers 1 and 2 [ intra-class correlation coefficient ( ICC ) = 0.93 , 95 % confidence interval ( CI ) 0.82–0.97 , P < 0.001 ] , observers 1 and 3 ( ICC = 0.96 , 95 % CI 0.89–0.98 , P < 0.001 ) and observers 2 and 3 ( ICC = 0.91 , 95 % CI 0.75–0.96 , P < 0.001 ) . Conclusions : The TESTEX scale is a new , reliable tool , specific to exercise scientists , that facilitates a comprehensive review of exercise training trials OBJECTIVE A short-term isometric exercise protocol was tested in ten hypertensive individuals to determine its efficacy as a high blood pressure-reducing intervention . DESIGN The study was a prospect i ve case study of 10 hypertensive individuals ( 8 men , 2 woman , mean age = 52 + 5 years ) who underwent six weeks of isometric exercise training ( three sessions/week ) . METHODS Blood pressure , blood lipids and markers of oxidative stress were monitored before , during and following the isometric intervention . Electron spin resonance spectroscopy was used to directly measure radicals in the blood sample s. RESULTS After six weeks , systolic blood pressure decreased an average 13 mm Hg ( p < 0.05 ) from a mean blood pressure of 146 to 133 mm Hg , a level that is below the usual 140 mm Hg hypertension threshold . Blood lipids were unchanged , but markers of oxidative stress were affected , with a dramatic decrease in exercise-induced oxygen centered radicals ( -266 % ) , ( p < 0.05 ) and an increased resting whole blood glutathione : oxidized glutathione ( + 61 % ) in hypertensive adults following six weeks of isometric exercise . CONCLUSION Six weeks of isometric exercise training was effective in lowering systolic but not diastolic blood pressure in pre-hypertensive and hypertensive individuals , and enhanced antioxidant protection is a likely underlying mechanism Introduction : Hypertension is a major risk factor contributing to cardiovascular disease , which is the number one cause of deaths worldwide . Although antihypertensive medications are effective at controlling blood pressure , current first-line treatment for hypertension is nonpharmacological lifestyle modifications . Recent studies indicate that isometric resistance training ( IRT ) may also be effective for assisting with blood pressure management . The aim of this study was to determine the efficacy of IRT for blood pressure management and the suitability of a low-intensity working control group . Methods : Forty hypertensive individuals , aged between 36 and 65 years , conducted IRT for 8 weeks . Participants were r and omized into 2 groups , working at an intensity of either 5 % or 30 % of their maximum voluntary contraction . Participants performed 4 × 2 minute isometric h and grip exercises with their nondominant h and , each separated by a 3-minute rest period , 3 days a week . Results : Blood pressure measurements were conducted at baseline and at the end of the protocol using a Finometer . Eight weeks of isometric resistance training result ed in a 7-mmHg reduction of resting systolic blood pressure ( SBP ) ( 136 ± 12 to 129 ± 15 ; P = 0.04 ) in the 30 % group . Reductions of 4 mmHg were also seen in mean arterial pressure ( MAP ) ( 100 ± 8 to 96 ± 11 ; P = 0.04 ) in the 30 % group . There were no statistically significant reductions in diastolic blood pressure for the 30 % group , or any of the data for the 5 % group . Conclusion : Isometric resistance training conducted using h and grip exercise at 30 % of maximum voluntary contraction significantly reduced SBP and MAP . A lack of reduction in blood pressure in the 5 % group indicates that a low-intensity group may be suitable as a working control for future studies Objectives : Aerobic dynamic exercise reduces  blood pressure ( BP )  and is broadly recommended by current American and European hypertension guidelines . Isometric exercise is currently not recommended , since data from only a few studies are available . We compare for the first time the effects of isometric h and grip training and aerobic exercise in a r and omized controlled trial . Methods : A total of 75 hypertensive patients were r and omized to one of the following 12-week programmes : Isometric h and grip training five times weekly ( two contractions of 2 min at 30 % of maximal power with each arm ) ; ‘ Sham-h and grip training ’ five times weekly 
    Output:
    
Conclusions H and grip exercise is an effective modality for resting BP reduction result ing in clinical ly significant reductions for men and women of all ages .