***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 The relationship between obesity and physical function is not well understood . Physical activity may be a key factor impacting on the relationship between obesity and physical function . METHODS Subjects included 171 community-dwelling women ( mean age = 74.3 , SD = 4.3 ) participating in a 14-year follow-up study to a walking intervention trial .  Measures of obesity [ body mass index ( BMI ) ] and physical activity ( Modified Paffenbarger Question naire ) were collected in 1982 , 1985 , 1995 , and 1999 . Physical function was assessed in 1999 using the Functional Status Question naire ( FSQ ) and gait speed . RESULTS Measures of obesity from 1982 to 1995 and measures of physical activity from 1982 to 1995 were related to physical function in 1999 . However , hierarchical regression analysis to predict physical function in 1999 controlling for the presence of chronic conditions indicated that physical activity from 1982 to 1995 , and not obesity from 1982 to 1995 , was an independent predictor of physical function ( FSQ : adjusted R2 = 0.09 , F = 4.68 , P < 0.001 ; gait speed : adjusted R2 = 18.0 , F = 9.41 , P < 0.0001 . CONCLUSION  Physical activity  appears to be as important if not more important than body weight in predicting future physical function CONTEXT Recent guidelines for treatment of overweight and obesity include recommendations for risk stratification by disease conditions and cardiovascular disease ( CVD ) risk factors , but the role of physical inactivity is not prominent in these recommendations . OBJECTIVE To quantify the influence of low cardiorespiratory fitness , an objective marker of physical inactivity , on CVD and all-cause mortality in normal-weight , overweight , and obese men and compare low fitness with other mortality predictors . DESIGN Prospect i ve observational data from the Aerobics Center Longitudinal Study . SETTING Preventive medicine clinic in Dallas , Tex . PARTICIPANTS A total of 25714 adult men ( average age , 43.8 years [ SD , 10.1 years ] ) who received a medical examination during 1970 to 1993 , with mortality follow-up to December 31 , 1994 . MAIN OUTCOME MEASURES Cardiovascular disease and all-cause mortality based on mortality predictors ( baseline CVD , type 2 diabetes mellitus , high serum cholesterol level , hypertension , current cigarette smoking , and low cardiorespiratory fitness ) stratified by body mass index . RESULTS During the study period , there were 1025 deaths ( 439 due to CVD ) during 258781 man-years of follow-up . Overweight and obese men with baseline CVD or CVD risk factors were at higher risk for all-cause and CVD mortality compared with normal-weight men without these predictors . Using normal-weight men without CVD as the referent , the strongest predictor of CVD death in obese men was baseline CVD ( age- and examination year-adjusted relative risk [ RR ] , 14.0 ; 95 % confidence interval [ CI ] , 9.4 - 20.8 ) ; RRs for obese men with diabetes mellitus , high cholesterol , hypertension , smoking , and low fitness were similar and ranged from 4.4 ( 95 % CI , 2.7 - 7.1 ) for smoking to 5.0 ( 95 % CI , 3.6 - 7.0 ) for low fitness . Relative risks for all-cause mortality in obese men ranged from 2.3 ( 95 % CI , 1.7 - 2.9 ) for men with hypertension to 4.7 ( 95 % CI , 3.6 - 6.1 ) for those with CVD at baseline . Relative risk for all-cause mortality in obese men with low fitness was 3.1 ( 95 % CI , 2.5 - 3.8 ) and in obese men with diabetes mellitus 3.1 ( 95 % CI , 2.3 - 4.2 ) and as slightly higher than the RRs for obese men who smoked or had high cholesterol levels . Low fitness was an independent predictor of mortality in all body mass index groups after adjustment for other mortality predictors . Approximately 50 % ( n = 1674 ) of obese men had low fitness , which led to a population -attributable risk of 39 % for CVD mortality and 44 % for all-cause mortality . Baseline CVD had population attributable risks of 51 % and 27 % for CVD and all-cause mortality , respectively . CONCLUSIONS In this analysis , low cardiorespiratory fitness was a strong and independent predictor of CVD and all-cause mortality and of comparable importance with that of diabetes mellitus and other CVD risk factors 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 BACKGROUND Obesity is associated with diverse health risks , but the role of body weight as a risk factor for death remains controversial . METHODS We examined the association between body weight and the risk of death in a 12-year prospect i ve cohort study of 1,213,829 Koreans between the ages of 30 and 95 years . We examined 82,372 deaths from any cause and 48,731 deaths from specific diseases ( including 29,123 from cancer , 16,426 from atherosclerotic cardiovascular disease , and 3362 from respiratory disease ) in relation to the body-mass index ( BMI ) ( the weight in kilograms divided by the square of the height in meters ) . RESULTS In both sexes , the average baseline BMI was 23.2 , and the rate of death from any cause had a J-shaped association with the BMI , regardless of cigarette-smoking history . The risk of death from any cause was lowest among patients with a BMI of 23.0 to 24.9 . In all groups , the risk of death from respiratory causes was higher among subjects with a lower BMI , and the risk of death from atherosclerotic cardiovascular disease or cancer was higher among subjects with a higher BMI . The relative risk of death associated with BMI declined with increasing age . CONCLUSIONS Underweight , overweight , and obese men and women had higher rates of death than men and women of normal weight . The association of BMI with death varied according to the cause of death and was modified by age , sex , and smoking history Aim The aim of this study was to investigate the impact of circuit-based exercise on the body composition in obese older women by focusing on physical exercise and body weight ( BW ) gain control in older people . Methods Seventy older women ( > 60 years old ) voluntarily took part in the study . Participants were r and omized into six different groups according to body mass index ( BMI ):  appropriate weight ( AW ) control ( AWC ) and trained ( AWT ) groups , overweight ( OW ) control ( OWC ) and trained ( OWT ) groups , and obesity ( O ) control ( OC ) and trained ( OT ) groups . The exercise program consisted of 50 minutes of exercise three times per week for 12 weeks . The exercises were alternated between upper and lower body using rest between sets for 40 seconds with intensity controlled by heart rate ( 70 % of work ) . The contraction time established was 5 seconds to eccentric and concentric muscular action phase . The following anthropometric parameters were evaluated : height ( m ) , body weight ( BW , kg ) , body fat ( BF , % ) , fat mass ( FM , kg ) , lean mass ( LM , kg ) , and BMI ( kg/m2 ) . Results The values ( mean ± st and ard deviation [ SD ] ) of relative changes to BW ( −8.0 % ± 0.8 % ) , BF ( −21.4 % ± 2.1 % ) , LM ( 3.0 % ± 0.3 % ) , and FM ( −31.2 % ± 3.0 % ) to the OT group were higher ( P < 0.05 ) than in the AWT ( BW : −2.0 % ± 1.1 % ; BF : −4.6 % ± 1.8 % ; FM : −7.0 % ± 2.8 % ; LM : 0.2 % ± 1.1 % ) and OWT ( BW : −4.5 % ± 1.0 % ; BF : −11.0 % ± 2.2 % ; FM : −16.1 % ± 3.2 % ; LM : −0.2 % ± 1.0 % ) groups ; additionally , no differences were found for C groups . While reduction ( P < 0.03 ) in BMI according to absolute values was observed for all trained groups ( AWT : 22 ± 1 versus 21 ± 1 ; OWT : 27 ± 1 versus 25 ± 1 , OT : 34 ± 1 versus 30 ± 1 ) after training , no differences were found for C groups . Conclusion In summary , circuit-based exercise is an effective method for promoting reduction in anthropometrics parameters in obese older women Few studies have compared the relative benefits of moderate- vs. higher intensity exercise training on improving insulin sensitivity in older people while holding exercise volume constant . Healthy older ( 73 + /- 10 yr ) women ( N = 25 ) who were inactive , but not obese , were r and omized into one of three training programs ( 9-mo duration ): 1 ) high-intensity [ 80 % peak aerobic capacity ( V(O2)peak ) ; T(H ) ] aerobic training ; 2 ) moderate-intensity ( 65 % V(O2)peak ; T(M ) ) aerobic training ; or 3 ) low-intensity ( stretching ) placebo control ( 50 % V(O2)peak ) ; C(TB ) ) . Importantly , exercise volume ( 300 kcal/session ) was held constant for subjects in both the T(H ) and the T(M ) groups . V(O2)peak was determined by using a grade d exercise challenge on a treadmill . Total body fat and lean mass were determined with dual-energy X-ray absorptiometry . The rate of insulin-stimulated glucose utilization as well as the suppression of lipolysis were determined approximately 72 h after the final exercise bout by using a two-step euglycemic-hyperinsulinemic clamp . We observed improved glucose utilization at the higher insulin dose with training , but these improvements were statistically significant only in the T(H ) ( 21 % ; P = 0.02 ) compared with the T(M ) ( 16 % ; P = 0.17 ) and C(TB ) ( 8 % ; P = 0.37 ) groups and were observed without changes in either body composition or V(O2)peak . Likewise in the T(H ) group , we detected a significant improvement in insulin-stimulated suppression ( % ) of adipose tissue lipolysis at the low-insulin dose ( 38 - 55 % , P < 0.05 ) . Our findings suggest that long-term higher intensity exercise training provides more enduring benefits to insulin action compared with moderate- or low-intensity exercise , likely due to greater transient effects PURPOSE The effects of exercise in subjects with multiple cardiovascular risk factors ( RF ) have never been tested in a large-scale r and omized controlled trial . The favorable results from our observational study led to this r and omized controlled trial . METHODS The participants , recruited from a community , were overweight , with two of the following three risk factors : hypertension , hyperlipidemia , or glucose intolerance ( N=561 ; 44 % male ; mean age ( SD ) 67 ( 6 ) ; mean BMI 26.4 ( 2.0 ) ) . All participants received a st and ard health exam with counseling , followed by r and omization . The intervention group ( INT ) was to exercise two to four times per week for 6 months at a fitness club . RESULTS Dropout rate was 11 % for INT and 10 % for the controls . INT exercised an average of 2.6 times per week . Among primary outcome measures , there was a marginally significant between-group difference in changes in systolic blood pressure ( intervention minus control , -2.46 mm Hg ) . Reductions in LDL cholesterol ( -1.9 mg.dL ) and hemoglobin A1c ( -0.042 % ) were not significant . Among secondary outcomes , between-group differences were significantly greater ( P<0.05 ) for INT in mean body weight ( -1.60 kg ) , waist circumference ( -1.8 cm ) , triglyceride ( -7 mg.dL ) , hsCRP ( -0.063 mg . L ) , and estimated VO2peak ( 2.0 mL.kg.min ) . All directional mean RF changes consistently favored INT . A cardiovascular risk reduction estimated from the changes in RF was about 24 % . A greater improvement was also found in health-related quality -of-life measures ( SF-36 ) in INT . No difference was found in the adverse event rate . CONCLUSIONS Exercising an average of 2.6 times per week for 6 months produced a significant improvement in cardiovascular risk profile in subjects with multiple cardiovascular risk factors through cumulative results of mod 
    Output:
    
Exercise in overweight and obese older individuals  improves anthropometric measures such as BMI and WC .
The effect of exercise on serum lipids is unclear