***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 Hydrotherapy , i.e. exercise in warm water , as a rehabilitation program has been considered potentially dangerous in patients with chronic heart failure ( CHF ) due to the increased venous return caused by the hydrostatic pressure . However , hydrotherapy has advantages compared to conventional training . We studied the applicability of an exercise programme in a temperature-controlled swimming pool , with specific reference to exercise capacity , muscle function , quality of life and safety . METHODS AND RESULTS Twenty-five patients with CHF ( NYHA II-III , age 72.1+/-6.1 ) were r and omised into either 8 weeks of hydrotherapy ( n=15 ) , or into a control group ( n=10 ) . The training program was well tolerated with no adverse events . Patients in the hydrotherapy group improved their maximal exercise capacity ( + 6.5 vs.-5.9 W , P=0.001 ) , isometric endurance in knee extension ( + 4 vs.-9 s , P=0.01 ) together with an improvement in the performance of heel-lift ( + 4 vs. -3 n.o . , P=<0.01 ) , shoulder abduction ( + 12 vs. -8 s , P=0.01 ) and shoulder flexion ( + 6 vs. + 4 , P=0.01 ) in comparison to patients in the control group . CONCLUSION Physical training in warm water was well tolerated and seems to improve exercise capacity as well as muscle function in small muscle groups in patients with CHF . This new approach broadens the variety of training regimes for older patients with CHF BACKGROUND Peak oxygen uptake ( pVO2 ) is used for risk stratification in chronic heart failure ( CHF ) , but little is known about the prognostic impact of pVO2-changes in patients on chronic beta-blocker ( BBL ) therapy .  We therefore prospect ively evaluated individual pVO2-changes at a 6-month interval in patients all receiving BBL . METHODS 194 patients with stable CHF on stable medication were included ( V1 ) and underwent clinical evaluation and exercise testing . Testing was repeated ( V2 ) at 5.7+/-1.5 months after V1 and patients were followed > 12 months after V2 . Death or hospitalisation due to cardiac reasons was the predefined EP ( EPP , end-point positive ; n=62 ; EPN , end-point negative ; n=113 ) . RESULTS Initial characteristics did not differ between EPP and EPN . Multivariate cox regression analysis revealed that change of pVO2 ( EPP : -0.6+/-2.6 ml/kg min ; EPN : + 2.5+/-3.3 ml/kg min ; p<0.001 ) was independent to pVO2 , LVEF , NTproBNP and NYHA at V2 for prediction of the combined end-point during follow-up . An increase of pVO2 by 10 % was identified as an adequate cut-off value for risk stratification and ROC- analysis showed the significant incremental prognostic value of the determination of pVO2 changes in combination with pVO2 . CONCLUSIONS Serial measurements of pVO2 yield additional information for risk stratification in clinical ly homogenous CHF patients receiving  BBL . This is the first study demonstrating this fact within a narrow predefined interval with all patients on BBL Background —There is evidence that aerobic exercise improves functional capacity in patients with New York Heart Association ( NYHA ) class II and III chronic heart failure . However , it is unknown whether dancing is safe and able to improve functional capacity in patients with chronic heart failure . Methods and Results —We prospect ively studied 130 patients with stable chronic heart failure ( 107 men ; mean age , 59±11 years ) in New York Heart Association class II and III and left ventricle ejection fraction < 40 % . Patients were r and omized to supervised aerobic exercise training at 70 % of peak & OV0312;o2 3 times a week for 8 weeks ( group E , n=44 ) or to a dance protocol of alternate slow ( 5 minutes ) and fast ( 3 minutes ) waltz lasting 21 minutes ( group D , n=44 ) . A group that did not undergo exercise training served as control ( group C , n=42 ) . On study entry and at 8 weeks , all patients underwent cardiopulmonary exercise testing on a cycle ergometer until volitional fatigue , 2D-echo with Doppler , and endothelium-dependent dilation of the brachial artery . Heart rate was 111±15 bpm during exercise training and 113±19 bpm during dancing ( P=0.59 ) . Peak & OV0312;o2 , anaerobic threshold , & OV0312;e/&OV0312;co2 slope , and & OV0312;o2/W slope were all similarly improved in both E and D groups ( + 16 % and 18 % , 20 % and 21 % , 14 % and 15 % , 18 % and 19 % , respectively ; P not significant for all comparisons ; P<0.001 versus controls ) . Endothelium-dependent relaxation was also similarly improved ( group E , from 2.6±1.3 % to 5.2±1.5 % , P<0.001 versus control ; group D , from 2.2±1.4 % to 5.0±1.5 % , P<0.001 versus control for both E and D ) . The change in peak & OV0312;o2 in E and D groups was correlated with changes in peak velocity of early filling wave/peak velocity of late filling ratio ( r=−0.58 , P<0.001 ) and endothelium-dependent dilation ( r=0.64 , P<0.001 ) . Untoward events were rare in both E and D groups . Conclusions —In patients with stable chronic heart failure , waltz dancing is safe and able to improve functional capacity and endothelium-dependent dilation similar to traditional aerobic exercise training . Waltz dancing may be considered in clinical practice in combination with aerobic exercise training or as an alternative to it Most systematic review s rely substantially on the assessment of the method ological quality of the individual trials . The aim of this study was to obtain consensus among experts about a set of generic core items for quality assessment of r and omized clinical trials ( RCTs ) . The invited participants were experts in the field of quality assessment of RCTs . The initial item pool contained all items from existing criteria lists . Subsequently , we reduced the number of items by using the Delphi consensus technique . Each Delphi round comprised a question naire , an analysis , and a feedback report . The feedback report included staff team decisions made on the basis of the analysis and their justification . A total of 33 international experts agreed to participate , of whom 21 completed all question naires . The initial item pool of 206 items was reduced to 9 items in three Delphi rounds . The final criteria list ( the Delphi list ) was satisfactory to all participants . It is a starting point on the way to a minimum reference st and ard for RCTs on many different research topics . This list is not intended to replace , but rather to be used alongside , existing criteria lists This study documented the feasibility and immediate effects of a dance intervention two times per week for 12 weeks on depression , physical function , and disability in older , underserved adults . The one-group , pretest-posttest study had a convenience sample of 40 participants recruited from a federally subsidized apartment complex located in an economically depressed , inner-city neighborhood .  Depression , physical function , and disability were measured at baseline and 12 weeks . Average age was 63 years ( SD = 7.9 ) , 92 % were female , and 75 % were African American . At baseline , participants reported increased depression ( M = 20.0 , SD = 12.4 ) , decreased physical function ( M = 56.6 , SD = 10.9 ) , and increased disability limitations ( M = 65.7 , SD = 14.9 ) . At posttest , paired t tests showed that the dance intervention significantly decreased depression , t = 6.11 , p < .001 , and disability , t = -2.70 , p = .014 , and significantly increased physical function , t = -2.74 , p = .013 . The results indicate that the 12-week dance intervention may be an effective adjunct therapy to improve depression , disability , and physical function in underserved adults BACKGROUND AND PURPOSE Assessment of the quality of r and omized controlled trials ( RCTs ) is common practice in systematic review s. However , the reliability of data obtained with most quality assessment scales has not been established . This report describes 2 studies design ed to investigate the reliability of data obtained with the Physiotherapy Evidence Data base ( PEDro ) scale developed to rate the quality of RCTs evaluating physical therapist interventions . METHOD In the first study , 11 raters independently rated 25 RCTs r and omly selected from the PEDro data base . In the second study , 2 raters rated 120 RCTs r and omly selected from the PEDro data base , and disagreements were resolved by a third rater ; this generated a set of individual rater and consensus ratings . The process was repeated by independent raters to create a second set of individual and consensus ratings . Reliability of ratings of PEDro scale items was calculated using multirater kappas , and reliability of the total ( summed ) score was calculated using intraclass correlation coefficients ( ICC [ 1,1 ] ) . RESULTS The kappa value for each of the 11 items ranged from.36 to.80 for individual assessors and from.50 to.79 for consensus ratings generated by groups of 2 or 3 raters . The ICC for the total score was.56 ( 95 % confidence interval=.47-.65 ) for ratings by individuals , and the ICC for consensus ratings was.68 ( 95 % confidence interval=.57-.76 ) . DISCUSSION AND CONCLUSION The reliability of ratings of PEDro scale items varied from " fair " to " substantial , " and the reliability of the total PEDro score was " fair " to " good . PURPOSE The purpose was to examine , for a subset of a large r and om survey of men and women , the age-related changes in the parameters of aerobic function , maximal oxygen consumption ( VO2max ) , and ventilatory threshold ( T(VE ) ) . METHODS A " ramp-like " treadmill protocol was design ed to measure  VO2max and T(VE ) on a total of 298 subjects ( 152 men and 146 women ) , aged 55 - 86 yr . RESULTS Data for VO2max ( and HRmax ) and T(VE ) by 5-yr age groups provide " normative " results . Age-related declines in VO2max and T(VE ) were fit by a linear model ; however , age explained at most 37 % of the variance across ages 55 - 86 yr . In this restricted age range , the rate of decline in VO2max , in both men ( -0.034 L x min(-1 ) x yr(-1 ) ) and women ( -0.019 L x min(-1 ) x yr(-1 ) ) , was similar to that of previous reports for linear regression with age . Men , but not women , showed a decrease in body mass across age . Thus , the decline in VO2max expressed relative to body mass was similar in men ( 0.31 mL x kg(-1 ) x min(-1 ) x yr(-1 ) ) and women ( 0.25 ) ; however , across this older age the decline is slower than noted for younger groups . The minimum level of aerobic power compatible with an independent life at age 85 yr was approximately 18 mL x kg(-1 ) x min(-1 ) in men and 15 mL x kg(-1 ) x min(-1 ) in women . Regression analysis showed HRmax across this age span is not well predicted by age . T(VE ) across age declined at about one-half the rate of the VO2max , and in older age was approximately 85 % of the VO2max . CONCLUSION The study provides " normative " cardiorespiratory function data of a r and om sample of independently living men and women aged 55 - 86 yr Objective : To compare the effects of traditional dancing with formal exercise training in terms of functional and cardiovascular benefits and motivation in patients with chronic heart failure . Design : R and omized controlled trial . Setting : Sports Medicine Laboratory . Subjects : Fifty-one Greek male patients aged 67.1±5.5 years with chronic heart failure of New York Heart Association ( NYHA ) class II – III , participated in an eight-month study . Interventions : They were r and omly assigned to either training with Greek traditional dances ( group A , n=18 ) , formal exercise training ( group B , n=16 ) or a sedentary control group ( group C , n=17 ) . Main measures : At entry and the end of the study all patients underwent  cardiopulmonary exercise testing , functional ability assessment and quality of life evaluations . The Intrinsic Motivation Inventory was also used to assess participants ’ subjective experience . Results : After training group A showed increased peak oxygen consumption by 33.8 % ( 19.5 vs. 26.1 ml/kg/min , p<0.05 ) and B by 32.3 % ( 19.5 vs. 25.8 ml/kg/min , p<0.05 ) , maximal treadmill tolerance by 48.5 % ( p<0.05 ) and by 46.4 % ( p<0.05 ) , and a decreased Slope of expired minute ventilation for carbon dioxide output ( VE/VCO2 ) slope by 18 % ( p<0.05 ) and 19.5 % ( p<0.05 ) , respectively . Trained patients revealed significant improvement in the quality of life indices . Intrinsic Motivation Inventory was increased only in group A by 26.2 % ( 3.08 vs.  
    Output:
    
The results suggested that dance therapy compared with control had a positive impact on peak VO2 and HRQOL .
Non-significant difference in VO2 peak and HRQOL for participants in the exercise group compared with dance therapy .
Conclusions : Dance therapy may improve peak VO2 and HRQOL in patients with chronic heart failure ( CHF ) and could be considered for inclusion in cardiac rehabilitation programmes