***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: OBJECTIVES To determine whether obesity is associated with the frailty phenotype and , if so , whether comorbid conditions or inflammatory markers explain this association . DESIGN Cross-sectional analysis of baseline data from the Women 's Health and Aging Studies I ( 1992 ) and II ( 1994 ) , complementary population -based studies . SETTING Twelve contiguous ZIP code areas in Baltimore , Maryl and . PARTICIPANTS Five hundred ninety-nine community-dwelling women aged 70 to 79 with a body mass index ( BMI ) greater than 18.5 kg/m(2 ) . MEASUREMENTS The dependent variables were the frailty syndrome , including prefrailty , defined as presence of one or two of five frailty indicators ( weakness , slowness , weight loss , low physical activity , exhaustion ) , and frailty , defined as three or more indicators . Independent variables included BMI , categorized using World Health Organization criteria as normal ( 18.5 to < 25 kg/m(2 ) ) , overweight ( 25 to < 30 kg/m(2 ) ) , and obese ( > /=30 kg/m(2 ) ) ; chronic diseases ; C-reactive protein ; and serum carotenoids . RESULTS Being overweight was significantly associated with prefrailty , and obesity was associated with prefrailty and frailty . In all frail women , regardless of BMI group , a similar pattern of three defining frailty indicators was found : slowness , weakness , and low activity ( with the addition of weight loss in the normal weight group . ) In multinomial regression models , obesity was significantly associated with prefrailty ( odds ratio (OR)=2.23 , 95 % confidence interval (CI)=1.29 - 3.84 ) and frailty ( OR=3.52 , 95 % CI=1.34 - 9.13 ) , even when controlling for covariates . CONCLUSION Obesity is associated with the frailty syndrome in older women in cross-sectional data . This association remains significant even when multiple conditions associated with frailty are considered . Prospect i ve studies are needed to confirm this finding Body composition and the components of energy metabolism were examined in 12 men and women , aged 56 - 80 y , before and after 12 wk of resistance training .  Subjects were r and omly assigned to groups that consumed diets that providing either 0.8 or 1.6 g protein.kg-1.d-1 and adequate total energy to maintain baseline body weight . Fat mass decreased 1.8 + /- 0.4 kg ( P < 0.001 ) and fat-free mass ( FFM ) increased 1.4 + /- 0.4 kg ( P < 0.01 ) in these weight-stable subjects . The increase in FFM was associated with a 1.6 + /- 0.4 kg increase in total body water ( P < 0.01 ) but no significant change in either protein plus mineral mass or body cell mass . With resistance training , the mean energy intake required for body weight maintenance increased by approximately 15 % . Increased energy expenditure included increased resting metabolic rate ( P < 0.02 ) and the energy cost of resistance exercise . Dietary protein intake did not influence these results . Resistance training is an effective way to increase energy requirements , decrease body-fat mass , and maintain metabolically active tissue mass in healthy older people and may be useful as an adjunct to weight-control programs for older adults Background and aim Physical frailty has been regarded as a precursor state to disability and dependence on others for daily activities . Frail individuals are considered to be the group of patients that presents the most complex and challenging problems to health care professionals . The purpose of this study was to evaluate whether a 12-week functional circuit training program ( FCT ) could reduce self-reported fear of falling and improve health status in a group of physically frail community-dwelling older individuals . Methods Fifty-one individuals ( 31 F , 20 M ) , mean age ( SD ) 84 ( 2.9 ) years old , were considered frail and tested at week 0 and r and omly assigned into two groups ( intervention group , FCT = 26 ; control group , CG = 25 ) . FCT underwent a structured 12-week FCT program , which focused on a combination of functional balance and lower-body strength-based exercises . CG met once a week for health education meetings . Measures of self-reported fear of falling ( Activities-specific Balance Confidence scale ) and health status ( SF-12 ) were assessed at week 0 , 12 and 36 . All longitudinal analyses for continuous variables that were measured at the three time points ( week 0 , 12 and 36 ) were performed using linear mixed modeling . Results FCT participants had greater improvements than those in the CG in fear of falling and self-reported physical function , physical composite score and mental composite score ; these improvements were maintained in the week 36 follow-up , with significant group-by-time interactions by the end of the study . Conclusions These data indicate that a FCT program is effective in improving self-reported measures of fear of falling and health status in a group of physically frail individuals BACKGROUND AND PURPOSE Systematic review s and meta-analyses often include an evaluation of the method ological quality of the individual studies that have been included , and are usually conducted by at least 2 individuals . The objective of this study was to assess the method ological quality and reliability of a series of r and omized controlled trials ( RCTs ) of both pharmacological and nonpharmacological interventions by use of the 10-item Physiotherapy Evidence -Based Data base ( PEDro ) Scale . METHODS Two abstract ors independently review ed 81 RCTs assessing a variety of interventions . The Cohen kappa statistic and the intraclass correlation coefficient ( ICC ) were used to assess agreement between abstract ors . RESULTS The average total PEDro scores were 5.94 ( SD=1.43 ) for all studies combined , 6.88 ( SD=1.2 ) for pharmacological studies , and 5.29 ( SD=1.26 ) for nonpharmacological studies . The median score for pharmacological studies was significantly higher than that for nonpharmacological studies ( 7 versus 5 ) . Pair-wise kappa scores ranged from a low of .452 for concealed allocation among drug trials to perfect agreement ( 1.00 ) for r and omization and reporting of results from between-group comparisons . The ICCs associated with the cumulative PEDro score were .91 ( 95 % confidence interval [CI]=.83-.94 ) for all studies , .89 ( 95 % CI=.78-.95 ) for pharmacological studies , and .91 ( 95 % CI=.84-.952 ) for nonpharmacological studies . DISCUSSION AND CONCLUSION The method ological quality for pharmacological interventions was significantly higher than that for nonpharmacological interventions . There was good agreement between raters at an individual item level and in total PEDro scores . A lack of reporting clarity , poor organization of the report , or the failure to include salient details contributed to less-than-perfect agreement between raters BACKGROUND frail older people have a high risk of  falling . OBJECTIVE assess the effect of a frailty intervention on risk factors for falls and fall rates  in frail older people . DESIGN r and omised controlled trial . PARTICIPANTS 241 community-dwelling people aged 70 + without severe cognitive impairment who met the Cardiovascular Health Study frailty definition . INTERVENTION multifactorial , interdisciplinary intervention targeting frailty characteristics with an individualised home exercise programme prescribed in 10 home visits from a physiotherapist and interdisciplinary management of medical , psychological and social problems . MEASUREMENTS risk factors for falls were measured using the Physiological Profile Assessment ( PPA ) and mobility measures at 12 months by a blinded assessor . Falls were monitored with calendars . RESULTS participants had a mean ( SD ) age of 83.3 ( 5.9 ) years , 68 % were women and 216 ( 90 % ) completed the study . After 12 months the intervention group had significantly better performance than the control group , after controlling for baseline values , in the PPA components of quadriceps strength ( between-group difference 1.84 kg , 95 % CI 0.17 - 3.51 , P = 0.03 ) and body sway ( -90.63 mm , 95 % CI -168.6 to -12.6 , P = 0.02 ) , short physical performance battery ( 1.58 , 95 % CI 1.02 - 2.14 , P ≤ 0.001 ) and 4 m walk ( 0.06 m/s 95 % CI 0.01 - 0.10 , P = 0.02 ) with a trend toward a better total PPA score ( -0.40 , 95 % CI -0.83 - 0.04 , P = 0.07 ) but no difference in fall rates ( incidence rate ratio 1.12 , 95 % CI 0.78 - 1.63 , P = 0.53 ) . CONCLUSION the intervention improved performance on risk factors for falls but did not reduce the rate of falls . TRIAL REGISTRATION ACTRN12608000250336 OBJECTIVES To determine the effects of moderate intensity group-exercise programs on falls , functional performance , and disability in older adults ; and to investigate the influence of frailty on these effects . DESIGN A 20-week , multicenter r and omized controlled trial , with 52-week follow-up . SETTING Fifteen homes for the elderly . PARTICIPANTS Two hundred seventy-eight men and women ( mean age + /- st and ard deviation , 85+/-6y ) . INTERVENTIONS Two exercise programs were r and omly distributed across 15 homes . The first program , functional walking ( FW ) , consisted of exercises related to daily mobility activities . In the second program , in balance ( IB ) , exercises were inspired by the principles of Tai Chi . Within each home participants were r and omly assigned to an intervention or a control group . Participants in the control groups were asked not to change their usual pattern of activities . The intervention groups followed a 20-week exercise program with 1 meeting a week during the first 4 weeks and 2 meetings a week during the remaining weeks . MAIN OUTCOME MEASURES Falls , Performance Oriented Mobility Assessment ( POMA ) , physical performance score , and the Groningen Activity Restriction Scale ( GARS ) ( measuring self-reported disability ) . RESULTS Fall incidence rate was higher in the FW group ( 3.3 falls/y ) compared with the IB ( 2.4 falls/y ) and control ( 2.5 falls/y ) groups , but this difference was not statistically significant . The risk of becoming a faller in the exercise groups increased significantly in the subgroup of participants who were classified as being frail ( hazard ratio [ HR ] = 2.95 ; 95 % confidence interval [ CI ] , 1.64 - 5.32 ) . For participants who were classified as being pre-frail , the risk of becoming a faller decreased ; this effect became significant after 11 weeks of training ( HR = .39 ; 95 % CI , .18-.88 ) . Participants in both exercise groups showed a small , but significant improvement in their POMA and physical performance scores . In the FW group , this held true for the GARS score as well . Post hoc analyses revealed that only the pre-frail participants improved their POMA and physical performance scores . CONCLUSIONS Fall-preventive moderate intensity group-exercise programs have positive effects on falling and physical performance in pre-frail , but not in frail elderly BACKGROUND Little is known about the natural course of frailty . We performed a prospect i ve study to determine the transition rates between frailty states and to evaluate the effect of the preceding frailty state on subsequent frailty transitions . METHODS We studied 754 community-living persons , aged 70 years or older , who were nondisabled in 4 essential activities of daily living . Frailty , assessed every 18 months for 54 months , was defined on the basis of weight loss , exhaustion , low physical activity , muscle weakness , and slow walking speed .  Participants were classified as frail if they met 3 or more of these criteria , as prefrail if they met 1 or 2 of the criteria , and as nonfrail if they met none of the criteria . RESULTS Of the 754 participants , 434 ( 57.6 % ) had at least 1 transition between any 2 of the 3 frailty states during 54 months . The rates were 36.8 % , 21.5 % , and 9.2 % for 1 , 2 , and 3 transitions , respectively . During the 18-month intervals , transitions to states of greater frailty were more common ( rates up to 43.3 % ) than transitions to states of lesser frailty ( rates up to 23.0 % ) , and the probability of transitioning from being frail to nonfrail was very low ( rates , 0%-0.9 % ) , even during an extended period . The likelihood of transitioning between frailty states was highly dependent on one 's preceding frailty state . CONCLUSIONS Frailty among older persons is a dynamic process , characterized by frequent transitions between frailty states over time . Our findings suggest ample opportunity for the prevention and remediation of frailty Low-intensity ( ~50 % of a single repetition maximum—1 RM ) resistance training combined with vascular occlusion results in increases in muscle strength and cross-sectional area [ Takarada et al. ( 2002 ) Eur J Appl Physiol 86:308–331 ] . The mechanisms responsible for this hypertrophy and strength gain remain elusive and no study has assessed the contribution of neuromuscular adaptations to these strength gains . We examined the effect of low-intensity training ( 8 
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Conclusions This systematic review suggested that frail older adults seemed to benefit from exercise interventions , although the optimal program remains unclear .