***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: Evidence -based practice involves the use of evidence from systematic review s and r and omised controlled trials , but the extent of this evidence in physiotherapy has not previously been surveyed . The aim of this survey is to describe the quantity and quality of r and omised controlled trials and the quantity of systematic review s relevant to physiotherapy . The Physiotherapy Evidence Data base ( PEDro ) was search ed . The quality of trials was assessed with the PEDro scale . The search identified a total of 2,376 r and omised controlled trials and 332 systematic review s. The first trial was published in 1955 and the first review was published in 1982 . Since that time , the number of trials and review s has grown exponentially . The mean PEDro quality score has increased from 2.8 in trials published between 1955 and 1959 to 5.0 for trials published between 1995 and 1999 . There is a substantial body of evidence about the effects of physiotherapy . However , there remains scope for improvements in the quality of the conduct and reporting of clinical trials This study aim ed to investigate the biological response to hypoxia as a stimulus , as well as exercise- and vibration-induced shear stress , which is known to induce angiogenesis . Twelve male cyclists ( 27.8 + /- 5.4 yr ) participated in this study . Each subject completed four cycle training sessions under normal conditions ( NC ) without vibration , NC with vibration , normobaric hypoxic conditions ( HC ) without vibration , and HC with vibration . Each session lasted 90 min , and sessions were held at weekly intervals in a r and omized order . Five blood sample s ( pretraining and 0 h post- , 0.5 h post- , 1 h post- , and 4 h posttraining ) were taken from each subject at each training session . Hypoxia was induced by a normobaric hypoxic chamber with an altitude of 2,500 m. The mechanical forces ( cycling with or without vibration ) were induced by a cycling ergometer . The parameters VEGF , endostatin , and matrix metalloproteinases ( MMPs ) were analyzed using the ELISA method . VEGF showed a significant increase immediately after the exercise only with exogenously induced vibrations , as calculated with separate ANOVA analysis . Endostatin increased after training under all conditions . Western blot analysis was performed for the determination of endostatin corresponding to the 22-kDa cleavage product of collagen XVIII . This demonstrated elevated protein content for endostatin at 0 h postexercise . MMP-2 increased in three of the four training conditions . The exception was NC with vibration . MMP-9 reached its maximum level at 4 h postexercise . In conclusion , the results support the contention that mechanical stimuli differentially influence factors involved in the induction of angiogenesis . These findings may contribute to a broader underst and ing of angiogenesis CONTEXT Although many studies suggest that physical activity may reduce risk of type 2 diabetes , the role of moderate-intensity activity such as walking is not well understood . OBJECTIVES To examine the relationship of total physical activity and incidence of type 2 diabetes in women and to compare the benefits of walking vs vigorous activity as predictors of subsequent risk of type 2 diabetes . DESIGN AND SETTING The Nurses ' Health Study , a prospect i ve cohort study that included detailed data for physical activity from women surveyed in 11 US states in 1986 , with up date s in 1988 and 1992 . PARTICIPANTS A total of 70,102 female nurses aged 40 to 65 years who did not have diabetes , cardiovascular disease , or cancer at baseline ( 1986 ) . MAIN OUTCOME MEASURE Risk of type 2 diabetes by quintile of metabolic equivalent task ( MET ) score , based on time spent per week on each of 8 common physical activities , including  walking .  RESULTS During 8 years of follow-up ( 534 , 928 person-years ) , we documented 1419 incident cases of type 2 diabetes . After adjusting for age , smoking , alcohol use , history of hypertension , history of high cholesterol level , and other covariates , the relative risks ( RRs ) of developing type 2 diabetes across quintiles of physical activity ( least to most ) were 1.0 , 0.77 , 0.75 , 0.62 , and 0.54 ( P for trend < .001 ) ; after adjusting for body mass index ( BMI ) , RRs were 1.0 , 0.84 , 0.87 , 0.77 , and 0.74 ( P for trend = .002 ) . Among women who did not perform vigorous activity , multivariate RRs of type 2 diabetes across quintiles of MET score for walking were 1.0 , 0.91,0.73 , 0.69 , and 0.58 ( P for trend < .001 ) . After adjusting for BMI , the trend remained statistically significant ( RRs were 1.0 , 0.95 , 0.80 , 0.81 , 0.74 ; P for trend = .01 ) . Faster usual walking pace was independently associated with decreased risk . Equivalent energy expenditures from walking and vigorous activity result ed in comparable magnitudes of risk reduction . CONCLUSIONS Our data suggest that greater physical activity level is associated with substantial reduction in risk of type 2 diabetes , including physical activity of moderate intensity and duration Early stages of atherosclerosis are commonly noted in youth . The present study was design ed to examine the effects of lifestyle modification in 19 overweight children ( age 8 - 17 ) who were placed on a high-fiber , low-fat diet in a 2-week residential program where food was provided ad libitum and daily exercise ( 2 - 2.5h ) was performed . In each subject , pre- and post-intervention fasting blood was drawn to measure serum lipids , oxidative stress marker 8-isoprostagl and in F2alpha ( 8-iso-PGF2alpha ) and generating enzyme myeloperoxidase ( MPO ) , soluble intracellular adhesion molecule (sICAM)-1 and sE-selectin as indicators of endothelial activation , the inflammatory protein C-reactive protein ( CRP ) and total matrix metalloproteinase-9 ( MMP-9 ) . Using subject sera and human aortic endothelial cell ( HAEC ) culture systems , monocyte chemotactic protein-1 ( MCP-1 ) production , as well as nitric oxide ( NO ) , superoxide and hydrogen peroxide production were measured in vitro by fluorometric detection . After 2 weeks , significant reductions ( p<0.05 ) in all serum lipids ( except HDL cholesterol ) , 8-iso-PGF2alpha , MPO , sICAM-1 , sE-selectin , CRP , MMP-9 , and cellular MCP-1 production were noted . Additionally , there was a significant decrease in cultured , serum-stimulated HAEC production of superoxide and hydrogen peroxide , and a concomitant increase in NO production ( all p<0.01 ) , These results indicate amelioration of several traditional as well as novel factors associated with atherosclerosis after lifestyle modification , even in youth without documented disease The purpose of this study was to investigate the effects of high-force eccentric muscle contractions on collagen remodeling and on circulating levels of matrix metalloproteinases ( MMP ) and tissue inhibitors of metalloproteinases ( TIMP ) in humans . Nine volunteers [ 5 men and 4 women , mean age 23 ( SD 4 ) yr ] each performed a bout of  100 maximum voluntary eccentric contractions of the knee extensors . Muscle biopsies were taken before exercise and on days 4 and 22 afterward . Image analysis of stained tissue sections was used to quantify endomysial collagen staining intensity . Maximum voluntary contractile isometric force was recorded preexercise and on days 1 , 2 , 3 , 4 , 8 , 11 , and 14 postexercise . Venipuncture blood sample s were also drawn on these days for measurement of serum creatine kinase activity and concentrations of MMP-9 , TIMP-1 , TIMP-2 , and the MMP-2/TIMP-2 complex . Maximum voluntary contractile force declined by 39 + /- 23 % ( mean + /- SD ) on day 2 postexercise and recovered thereafter . Serum creatine kinase activity peaked on day 4 postexercise ( P < 0.01 ) . Collagen type IV staining intensity increased significantly on day 22 postexercise to 126 + /- 29 % ( mean + /- SD ) of preexercise values ( P < 0.05 ) . Serum MMP-9 levels increased on day 8 postexercise ( P < 0.01 ) , and serum TIMP-1 was also significantly elevated on days 1 , 2 , 3 , 4 , and 14 postexercise ( P < 0.05 ) . These results suggest that a single bout of eccentric muscle contractions results in remodeling of endomysial type IV collagen , possibly via the MMP pathway This study examined the effect of acute exercise and 4 weeks of aerobic training on skeletal muscle gene and protein expression of pro- and anti-angiogenic factors in 14 young male subjects . Training consisted of 60 min of cycling ( ∼60 % of ) , 3 times/week . Biopsies were obtained from vastus lateralis muscle before and after training . Muscle interstitial fluid was collected during cycling at weeks 0 and 4 . Training increased ( P < 0.05 ) the capillary : fibre ratio and capillary density by 23 % and 12 % , respectively . The concentration of interstitial vascular endothelial growth factor ( VEGF ) in response to acute exercise increased similarly ( > 6-fold ; P < 0.05 ) before and after training . Resting protein levels of soluble VEGF receptor-1 in interstitial fluid , and of VEGF , thrombospondin-1 ( TSP-1 ) and tissue inhibitor of matrix metalloproteinase-1 ( TIMP1 ) in muscle were unaffected by training , whereas endothelial nitric oxide synthase protein levels in muscle increased by 50 % ( P < 0.05 ) . Before and after training , acute exercise induced a similar increase ( P < 0.05 ) in the mRNA level of angiopoietin 2 , matrix metalloproteinase 9 and TSP-1 . After training , TIMP1 mRNA content increased with exercise ( P < 0.05 ) . In conclusion , acute exercise induced a similar increase in the gene-expression of both pro- and anti-angiogenic factors in untrained and trained muscle . We propose that the increase in anti-angiogenic factors  with exercise is important for modulation of angiogenesis . The lack of effect of training on basal muscle VEGF protein levels and VEGF secretion during exercise suggests that increased VEGF levels are not a prerequisite for exercise-induced capillary growth in healthy muscle AIM This study assessed the impact of regular exercise on inflammatory markers ( high-sensitivity C-reactive protein [ hsCRP ] , fibrinogen ) , and matrix metalloproteinases ( MMPs ) and their inhibitors ( TIMPs ) , in patients with type 2 diabetes mellitus ( T2DM ) . PATIENTS Fifty overweight patients with T2DM were r and omly assigned to two groups : ( A ) an exercise group ( EXG , n=25 ) , with self-controlled exercise for at least 150 min/week and one additional supervised exercise session/week ; and ( B ) a control group ( COG , n=25 ) , with no exercise instructions .  All participants were taking oral antidiabetic drugs , and none had diabetic complications .  Clinical parameters , exercise capacity ( VO(2 peak ) ) , ventilatory threshold ( VT ) , insulin resistance indices ( fasting insulin , HOMA-IR , HOMA%S ) , hsCRP , fibrinogen , MMP-2 , MMP-9 , TIMP-1 and TIMP-2 were assessed at baseline and after 16 weeks . RESULTS No significant changes were found in body mass index , waist/hip ratio , insulin-resistance indices , MMP-2 and TIMP-1 throughout the study in either group ( P>0.05 ) . Compared with controls , the EXG showed a significant decrease in systolic and mean blood pressure , total and LDL cholesterol , and HbA(1c ) ( P<0.05 ) . Also , exercise significantly suppressed levels of fibrinogen ( P=0.047 ) , hsCRP ( P=0.041 ) and MMP-9 ( P=0.028 ) , and the MMP-9-to-TIMP-1 ratio ( P=0.038 ) , whereas VO(2 peak ) ( P=0.011 ) , VT ( P=0.008 ) and plasma TIMP-2 levels ( P=0.022 ) were considerably upregulated in the EXG vs. COG . St and ard multiple-regression analyses revealed that MMP-9 changes were independently associated with fibrinogen and HbA(1c ) changes , while fibrinogen changes independently predicted TIMP-2 alterations with exercise . CONCLUSION Mostly self-controlled exercise of moderate intensity ameliorated serum levels of pro- and anti-atherogenic markers in patients with T2DM , with no effects on body weight . These data offer further insight into the cardioprotective mechanisms of exercise in patients with T2DM AIMS The study was design ed to compare a combined aerobic and resistance training ( ART ) with an aerobic training ( AT ) 
    Output:
    
Results revealed that chronic aerobic training induces a decrease in MMP-9 and MMP-2 levels , possibly indicating a cardioprotective effect , while resistance exercise training displayed conflicting results .
Conclusion Alterations in MMP-9 and MMP-2 plasma concentrations may be valuable biomarkers to reflect the influence of exercise on the inflammatory state .