***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: Regular physical exercise is broadly recommended by current European and American hypertension guidelines . It remains elusive , however , whether exercise leads to a reduction of blood pressure in resistant hypertension as well . The present r and omized controlled trial examines the cardiovascular effects of aerobic exercise on resistant hypertension . Resistant hypertension was defined as a blood pressure ≥140/90 mm Hg in spite of 3 antihypertensive agents or a blood pressure controlled by ≥4 antihypertensive agents . Fifty subjects with resistant hypertension were r and omly assigned to participate or not to participate in an 8- to 12-week treadmill exercise program ( target lactate , 2.0±0.5 mmol/L ) . Blood pressure was assessed by 24-hour monitoring . Arterial compliance and cardiac index were measured by pulse wave analysis . The training program was well tolerated by all of the patients . Exercise  significantly decreased systolic and diastolic daytime ambulatory blood pressure by 6±12 and 3±7 mm Hg , respectively ( P=0.03 each ) . Regular exercise  reduced blood pressure on exertion and increased physical performance as assessed by maximal oxygen uptake and lactate curves . Arterial compliance and cardiac index remained unchanged . Physical exercise is able to decrease blood pressure even in subjects with low responsiveness to medical treatment . It should be included in the therapeutic approach to resistant hypertension BACKGROUND Preliminary evidence suggests that meditative exercise may have benefits for patients with chronic systolic heart failure ( HF ) ; this has not been rigorously tested in a large clinical sample . We sought to investigate whether tai chi , as an adjunct to st and ard care , improves functional capacity and quality of life in patients with HF . METHODS A single-blind , multisite , parallel-group , r and omized controlled trial evaluated 100 out patients with systolic HF ( New York Heart Association class I-III , left ventricular ejection fraction ≤40 % ) who were recruited between May 1 , 2005 , and September 30 , 2008 . A group-based 12-week tai chi exercise program ( n = 50 ) or time-matched education ( n = 50 , control group ) was conducted . Outcome measures included exercise capacity ( 6- minute walk test and peak oxygen uptake ) and disease-specific quality of life ( Minnesota Living With Heart Failure Question naire ) . RESULTS Mean ( SD ) age of patients was 67 ( 11 ) years ; baseline values were left ventricular ejection fraction , 29 % ( 8 % ) and peak oxygen uptake , 13.5 mL/kg/min ; the median New York Heart Association class of HF was class II . At completion of the study , there were no significant differences in change in 6-minute walk distance and peak oxygen uptake ( median change [ first quartile , third quartile ] , 35 [ -2 , 51 ] vs 2 [ -7 , 54 ] meters , P = .95 ; and 1.1 [ -1.1 , 1.5 ] vs -0.5 [ -1.2 , 1.8 ] mL/kg/min , P = .81 ) when comparing tai chi and control groups ; however , patients in the tai chi group had greater improvements in quality of life ( Minnesota Living With Heart Failure Question naire , -19 [ -23 , -3 ] vs 1 [ -16 , 3 ] , P = .02 ) . Improvements with tai chi were also seen in exercise self-efficacy ( Cardiac Exercise Self-efficacy Instrument , 0.1 [ 0.1 , 0.6 ] vs -0.3 [ -0.5 , 0.2 ] , P < .001 ) and mood ( Profile of Mood States total mood disturbance , -6 [ -17 , 1 ] vs -1 [ -13 , 10 ] , P = .01 ) . CONCLUSION Tai chi exercise may improve quality of life , mood , and exercise self-efficacy in patients with HF . Trial Registration clinical trials.gov Identifier : NCT00110227 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 Objective : To examine the effects of a brief Tai Chi Chuan Qigong ( ` Qigong ' ) exercise intervention on individuals with traumatic brain injury . Design : A single-centre r and omized controlled trial pilot study . Setting : A registered charity day centre in the community . Subjects : Twenty individuals with traumatic brain injury . Intervention : Intervention participants attended a Qigong exercise session for one hour per week over eight weeks . Control participants engaged in non-exercise-based social and leisure activities for the same intervention period . Measures : Outcome was assessed at baseline and post intervention using the General Health Question naire-12 , the Physical Self-Description Question naire and the Social Support for Exercise Habits Scale , to measure perceived mood , self-esteem , flexibility , coordination , physical activity and social support . Results : Groups were comparable at baseline . After the intervention , mood was improved in the exercise group when compared with controls ( U = 22.0 , P = 0.02 ) . Improvements in self-esteem ( Z = 2.397 , P = 0.01 ) and mood ( Z = —2.032 , P = 0.04 ) across the study period were also evident in the exercise group only . There were no significant differences in physical functioning between groups . In view of the sample size , these findings are inconclusive . Conclusions : This study provides preliminary evidence that a brief Qigong exercise intervention programme may improve mood and self-esteem for individuals with traumatic brain injury . This needs to be tested in a large-scale r and omized trial Objectives . To evaluate the effectiveness of Baduanjin Qigong exercise on  sleep , fatigue , anxiety , and depressive symptoms in chronic fatigue syndrome- ( CFS- ) like illness and to determine the dose-response relationship . Methods . One hundred fifty participants with CFS-like illness ( mean age = 39.0 , SD = 7.9 ) were r and omly assigned to Qigong and waitlist . Sixteen 1.5-hour Qigong lessons were arranged over 9 consecutive weeks . Pittsburgh Sleep Quality Index ( PSQI ) , Chalder Fatigue Scale ( ChFS ) , and Hospital Anxiety and Depression Scale ( HADS ) were assessed at baseline , immediate posttreatment , and 3-month posttreatment . The amount of Qigong self- practice was assessed by self-report . Results . Repeated measures analyses of covariance showed a marginally nonsignificant ( P = 0.064 ) group by time interaction in the PSQI total score , but it was significant for the " subjective sleep quality " and " sleep latency " items , favoring Qigong exercise . Improvement in " subjective sleep quality " was maintained at 3-month posttreatment . Significant group by time interaction was also detected for the ChFS and HADS anxiety and depression scores . The number of Qigong  lessons attended and the amount of Qigong self- practice were significantly associated with sleep , fatigue , anxiety , and depressive symptom improvement . Conclusion . Baduanjin Qigong was an efficacious and acceptable treatment for  sleep disturbance in CFS-like illness . This trial is registered with Hong Kong Clinical Trial Register : HKCTR-1380 OBJECTIVE To assess the effects of a 12-week Tai Chi exercise program on sleep using the sleep spectrogram , a method based on a single channel electrocardiogram (ECG)-derived estimation of cardiopulmonary coupling , previously shown to identify stable and unstable sleep states . METHODS We retrospectively analyzed 24-h continuous ECG data obtained in a clinical trial of Tai Chi exercise in patients with heart failure . Eighteen patients with chronic stable heart failure , left ventricular ejection fraction < or= 40 % ( mean [ + /-st and ard deviation ] age , 59+/-14 years , mean baseline ejection fraction 24%+/-8 % , mean ) were r and omly assigned to receive usual care ( N=10 ) , which included pharmacological therapy and dietary and exercise counseling , or 12 weeks of Tai Chi training ( N=8 ) in addition to usual care . Using the ECG-based sleep spectrogram , we compared intervention and control groups by evaluating baseline and 12-week high ( stable ) and low ( unstable ) frequency coupling ( HFC & LFC , respectively ) as a percentage of estimated total sleep time ( ETST ) . RESULTS At 12 weeks , those who participated in Tai Chi showed a significant increase in HFC ( + 0.05+/-0.10 vs. -0.06+/-0.09 % ETST , p=0.04 ) and significant reduction in LFC ( -0.09+/-0.09 vs. + 0.13+/-0.13 % ETST , p<0.01 ) , compared to patients in the control group . Correlations were seen between improved sleep stability and better disease-specific quality of life . CONCLUSIONS Tai Chi exercise may enhance sleep stability in patients with chronic heart failure . This sleep effect may have a beneficial impact on blood pressure , arrhythmogenesis and quality of life Purpose . To assess if Tai Chi added to endurance training ( ET ) is more effective than ET alone in improving exercise tolerance and quality of life ( QOL ) of elderly patients with chronic heart failure ( CHF ) . Design . Sixty CHF patients , age 73.8 ± 6 years , M/F 51/9 , were enlisted . Thirty pts were r and omized to combined training ( CT ) performing Tai Chi + ET and 30 patients  to ET ( ET only ) . Methods . At baseline and after 12 weeks all patients underwent 6-minute walking test  ( 6MWT ) , assessment of amino terminal probrain natriuretic peptide ( NT-pro BNP ) , quadriceps maximal voluntary contraction ( MVC ) and peak torque ( PT ) , QOL question naire ( MacNewQLMI ) , blood pressure ( BP ) , and heart rate ( HR ) . All patients performed 4 sessions of exercise/week . Results . Distance at 6mwt improved in both groups with significant between-groups differences ( P = .031 ) . Systolic BP and NT-proBNP decreased significant in the CT group compared to ET ( P = .025 ) and P = .015 ) , resp . ) . CT group had a greater significant improvement in physical perception ( P = .026 ) and a significant increase of PT compared to ET group . Conclusions . The association of Tai Chi and ET  improves exercise tolerance and QOL of patients with CHF more efficiently than ET Exercise and relaxation decrease blood pressure .  Qigong is a traditional Chinese exercise consisting of breathing and gentle movements . We conducted a r and omised controlled trial to study the effect of Guolin qigong on blood pressure . In all , 88 patients with mild essential hypertension were recruited from the community and r and omised to Goulin qigong or conventional exercise for 16 weeks . The main outcome measurements were blood pressure , health status ( SF-36 scores ) , Beck Anxiety and Depression Inventory scores . In the qigong group , blood pressure decreased significantly from 146.3±7.8/93.0±4.1 mmHg at baseline to 135.5±10.0/87.1±7.7 mmHg at week 16 . In the exercise group , blood pressure also decreased significantly from 140.9±10.9/93.1±3.5 mmHg to 129.7±11.1/86.0±7.0 mmHg . Heart rate , weight , BMI , waist circumference , total cholesterol , renin and 24 h urinary albumin excretion significantly decreased in both groups after 16 weeks . General health , bodily pain , social functioning and depression also improved in both groups . No significant differences between qigong and conventional exercise were found . In conclusion , Guolin qigong and conventional exercise have similar effects on blood pressure in patients with mild hypertension . While no additional benefits were identified , it is nevertheless an alternative to conventional exercise in the nondrug treatment of hypertension In this study , 126 patients ( 90 males , average age 56 years , range 39 - 80 ) were r and omised to Wu Chian-Ch'uan style Tai Chi ( 38 ) , aerobic exercise ( 41 ) or a non-exercise support group ( 47 ) following acute myocardial infa rct ion . Patients attended twice weekly for three weeks then weekly for a further five weeks . Heart rate and blood pressure were recorded before and after each session . Over the 11 sessions of exercise there was a negative trend in diastolic blood pressure only in the Tai Chi group ( Rs = 0.79 , p < 0.01 ) . Significant trends in systolic blood pressure occurred in both exercise groups ( Rs = 0.64 and 0.63 , both p < 0.05 ) . Only four ( 8 % ) patients completed the support group eight-week programme which was less than the number completing Tai Chi ( 82 % ; p < 0.001 ) and aerobic exercise groups ( 73 % ; p < 0.001 ) OBJECTIVES To evaluate the effects on blood pressure , lipid profile , and anxiety status on subjects received a 12-week Tai Chi Chuan exercise program . DESIGN R and omized controlled study of a Tai Chi Chuan group and a group of sedentary life controls . SETTING Taipei Medical University Hospitals and University campus in the Taipei , Taiwan , area . SUBJECTS Two ( 2 ) selected groups of 76 healthy subjects with blood pressure at high-normal or stage I hypertension . INTERVENTION A 12-week 
    Output:
    
Conclusions This study demonstrated that TCE can effectively improve physiological outcomes , biochemical outcomes , physical function , quality of life , and depression among patients with cardiovascular disease .