human
***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: OBJECTIVE To investigate the effects of an 8-week , 24-session weight-bearing physical conditioning program on disease signs and symptoms in children with chronic arthritis . METHODS In a within-subjects , repeated measures design , 25 subjects , ages 8 - 17 years , with chronic polyarticular juvenile rheumatoid arthritis ( JRA ) , were assessed at study entry , after an 8-week control period , and after an 8-week exercise period , for 1 ) disease status , based on joint count ( JC ) and articular severity index ( ASI ) ( sum of scores for joint swelling , pain on motion , tenderness , and limitations of motion ) ; 2 ) worst pain during the past week , using a 10-cm visual analog scale ( VAS ) , and 3 ) aerobic endurance , using the 9-minute run-walk test of the Health Related Physical Fitness Test battery . The 60-minute conditioning program included warm-up ( 10 minutes ) , low-impact aerobics ( 25 minutes ) , strengthening ( 15 minutes ) , and cool-down and flexibility exercises ( 10 minutes ) . Subjects exercised twice a week at their rheumatology center and once a week at home , using a commercial exercise video-tape supplied by the investigator . RESULTS Significant improvement was found in the ASI ( Friedman analysis of variance [ ANOVA ] ) , JC , and 9-minute run-walk test ( repeated measures ANOVA ) from the pre- to post-exercise tests . Mean VAS pain scores decreased 16 % from study entry to the post-exercise test . Statistically significant improvement ( reliable change index > 1.96 ) occurred in 80 % of subjects on the ASI and 72 % on the JC . CONCLUSION Children and adolescents with chronic polyarticular JRA can improve their aerobic endurance through participation in weight-bearing physical conditioning programs without disease exacerbation or increased pain , and may achieve decreased joint signs and symptoms through increased physical activity OBJECTIVE To examine the effectiveness of high-intensity aerobic training compared with low-intensity training in terms of energy cost of locomotion , peak oxygen uptake , peak power , and self-reported physical function in children with juvenile idiopathic arthritis ( JIA ) . METHODS Eighty children with JIA , ages 8 - 16 years , were enrolled in a r and omized , single-blind controlled trial . Both groups participated in a 12-week , 3-times-weekly training program consisting of high-intensity aerobics in the experimental group and qigong in the control group . Subjects underwent exercise testing measuring submaximal oxygen uptake at 3 km/hour ( VO(2submax ) ) as the primary outcome , maximal oxygen uptake , and peak power at the beginning and end of the program . Physical function was measured using the Child Health Assessment Question naire ( C-HAQ ) . RESULTS The exercise program was well tolerated in both groups . There was no difference in VO(2submax ) or any other exercise testing measures between the groups through the study period and no indication of improvement . Both groups showed significant improvements in C-HAQ with no difference between the groups . Adherence was higher in the control group than the experimental group . CONCLUSION Our findings suggest that activity programs with or without an aerobic training component are safe and may result in an important improvement in physical function . The intensity of aerobic training did not seem to provide any additional benefits , but higher adherence in the qigong program may suggest that less intensive regimens are easier for children with JIA to comply with , and provide a degree of benefit equivalent to more intensive programs BACKGROUND AND OBJECTIVE Search ing for nonr and omized studies in electronic data bases is complicated because there is a variety of study design s and lack of st and ardization in the terminology . The purpose of this study was to develop and evaluate a method to limit search strategies according to study design of comparative nonr and omized studies ( cNRSs ) . METHODS Four up date d Cochrane systematic review s that included nonr and omized studies ( cohort , case-control , and cross-sectional studies ) of the effects of health care interventions were selected . Search strategies limited to study design were devised for each one of these topic areas in two electronic data bases ( MEDLINE and EMBASE ) . A progressive method ( PM ) and a fixed method for selecting the most appropriate search terms associated with study design of nonr and omized studies are suggested . RESULTS The results showed that the sensitivity of search strategies ( in two data bases combined ) limited to study design were between 90 % and 100 % for the PM using both controlled vocabulary ( CV ) and textwords ( TWs ) and between 95 % and 100 % for a fixed set of controlled vocabulary and TWs . CONCLUSIONS It is possible and acceptable to use search strategies limited to study design of cNRSs of health care interventions OBJECTIVE To 1 ) assess the safety and feasibility of laboratory-based exercise testing in juvenile idiopathic arthritis ( JIA ) , 2 ) test the safety and feasibility of a 3-month exercise program in JIA , 3 ) assess pain during exercise in JIA , 4 ) compare ratings of perceived effort ( RPE ) with heart rate ( HR ) achieved , and 5 ) estimate the training effect on metabolic efficiency of gait as measured by submaximal exercise testing . METHODS Nine children with JIA were enrolled in a 12-week circuit training program involving pool , stationary bicycle , treadmill , and Fitball . They underwent formal exercise testing before and after the program , underwent a full joint assessment , were administered the Childhood Health Assessment Question naire and Juvenile Arthritis Functional Status Index , and were assessed for overall quality of life and health-related quality of life . A visual analog scale was used to assess pain during testing and training , and the Borg scale was used to measure RPE . RESULTS Children with JIA were able to participate in exercise testing without any significant problems . Children with severe hip disease dropped out of the exercise program due to  pain  during the exercise sessions and worsened arthritis symptoms . Target HR was achieved and correlated with RPE in the bicycle and treadmill sessions . Submaximal exercise testing showed an improvement with a small to moderate effect size . CONCLUSION This study suggests that it is safe , feasible , and acceptable for children with arthritis , in the absence of severe hip involvement , to participate in formal exercise testing and structured fitness programs OBJECTIVE To explore early changes and predictors of bone mass in children with juvenile idiopathic arthritis ( JIA ) in order to identify patients who will develop bone mass reductions . METHODS We conducted a prospect i ve cohort study of 108 children with early JIA ( ages 6 - 18 years ; mean disease duration 19.3 months ) who were individually matched with 108 healthy children for age , sex , race , and county of residence .  Bone mass and changes in total body , spine , femur , and forearm bone mineral density and bone mineral content ( BMC ) , body composition , growth , and biochemical parameters of bone turnover were examined at baseline and at followup a mean of 24 months later . Low bone mass was defined as a Z score > 1 SD below the reference population . RESULTS Of the 200 children evaluated at followup , the 100 healthy children had greater gains in total body BMC ( P = 0.035 ) , distal radius BMC ( P < 0.001 ) , and total body lean mass ( P < 0.001 ) than did the 100 JIA patients . Low or very low total body BMC was observed in 24 % of the patients and 12 % of the healthy children . Bone formation , bone resorption , and weight-bearing activities were reduced in the patients compared with the healthy children . Multiple regression analysis showed that in patients with JIA , serum bone-specific alkaline phosphatase , serum C-telopeptide of type I collagen , and weight-bearing activities were independent predictors of changes in total body BMC . Total body BMC was lower in patients with polyarticular onset than in those with oligoarticular disease onset . CONCLUSION Patients with JIA have moderate reductions in bone mass gains , bone turnover , and total body lean mass early in the disease course OBJECTIVE To evaluate the effects of an aquatic training programme for JIA patients . METHODS Fifty-four patients with JIA ( age range 5 to 13 yr ) participated in this study and were r and omized into an experimental ( n = 27 ) and a control ( n = 27 ) group . The children in the experimental group received a training programme consisting of a 1 h per week supervised training programme in a local pool of approximately 20 sessions . Effects were analysed on the following domains : functional ability , health-related quality of life , joint status and physical fitness . RESULTS Although all measures improved more in the experimental group than the control group , none of the differences was statistically significant . CONCLUSIONS The current research found no significant effect of an aquatic fitness training programme in children with JIA . Since there were no signs of worsening in health status , one can conclude that this was a safe exercise programme OBJECTIVE To analyze patterns of daily pain , stiffness , and fatigue related to juvenile arthritis ; to examine the relationships of demographics , disease severity , and psychological adjustment to daily disease symptoms ; and to examine daily disease symptoms as predictors of reduced participation in school and social activity . METHODS For a 2-month period , 41 children with polyarticular juvenile arthritis completed daily diaries that included measures of symptoms and function . Children also underwent an initial evaluation and 4 followup evaluations that included a joint count , laboratory testing , and completion of question naires assessing physical and psychosocial functioning . RESULTS Children reported having pain an average of 73 % of days , with the majority of children ( 76 % ) reporting pain on > 60 % of all days . On average , children described the intensity of their daily pain as being in the mild to moderate range ; however , a significant subgroup ( 31 % ) reported pain in the severe range . Higher physician global assessment ratings , increased functional disability , and increased anxiety were significantly associated with increased daily pain and other daily symptoms . Multilevel r and om-effects analyses indicated that increased daily symptoms of pain , stiffness , and fatigue were significant predictors of reduced participation in school and social activities . CONCLUSION Physicians should consider treating pain more aggressively in children with arthritis , in order to preserve function in school and social domains , as well as physical function . Moreover , optimal pain management in children with arthritis should include therapeutic regimens addressing anxiety as well as st and ard pharmacologic interventions 
    Output:
    
agent
Results suggest that youth with JIA participated less in both  social and physical leisure activities  as compared to healthy peers , and those with JIA did not meet national recommendations for physical activity .
Characterization of leisure activity remains limited and mostly focused on physical activity in JIA .
***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: OBJECTIVE To investigate the effects of an 8-week , 24-session weight-bearing physical conditioning program on disease signs and symptoms in children with chronic arthritis . METHODS In a within-subjects , repeated measures design , 25 subjects , ages 8 - 17 years , with chronic polyarticular juvenile rheumatoid arthritis ( JRA ) , were assessed at study entry , after an 8-week control period , and after an 8-week exercise period , for 1 ) disease status , based on joint count ( JC ) and articular severity index ( ASI ) ( sum of scores for joint swelling , pain on motion , tenderness , and limitations of motion ) ; 2 ) worst pain during the past week , using a 10-cm visual analog scale ( VAS ) , and 3 ) aerobic endurance , using the 9-minute run-walk test of the Health Related Physical Fitness Test battery . The 60-minute conditioning program included warm-up ( 10 minutes ) , low-impact aerobics ( 25 minutes ) , strengthening ( 15 minutes ) , and cool-down and flexibility exercises ( 10 minutes ) . Subjects exercised twice a week at their rheumatology center and once a week at home , using a commercial exercise video-tape supplied by the investigator . RESULTS Significant improvement was found in the ASI ( Friedman analysis of variance [ ANOVA ] ) , JC , and 9-minute run-walk test ( repeated measures ANOVA ) from the pre- to post-exercise tests . Mean VAS pain scores decreased 16 % from study entry to the post-exercise test . Statistically significant improvement ( reliable change index > 1.96 ) occurred in 80 % of subjects on the ASI and 72 % on the JC . CONCLUSION Children and adolescents with chronic polyarticular JRA can improve their aerobic endurance through participation in weight-bearing physical conditioning programs without disease exacerbation or increased pain , and may achieve decreased joint signs and symptoms through increased physical activity OBJECTIVE To examine the effectiveness of high-intensity aerobic training compared with low-intensity training in terms of energy cost of locomotion , peak oxygen uptake , peak power , and self-reported physical function in children with juvenile idiopathic arthritis ( JIA ) . METHODS Eighty children with JIA , ages 8 - 16 years , were enrolled in a r and omized , single-blind controlled trial . Both groups participated in a 12-week , 3-times-weekly training program consisting of high-intensity aerobics in the experimental group and qigong in the control group . Subjects underwent exercise testing measuring submaximal oxygen uptake at 3 km/hour ( VO(2submax ) ) as the primary outcome , maximal oxygen uptake , and peak power at the beginning and end of the program . Physical function was measured using the Child Health Assessment Question naire ( C-HAQ ) . RESULTS The exercise program was well tolerated in both groups . There was no difference in VO(2submax ) or any other exercise testing measures between the groups through the study period and no indication of improvement . Both groups showed significant improvements in C-HAQ with no difference between the groups . Adherence was higher in the control group than the experimental group . CONCLUSION Our findings suggest that activity programs with or without an aerobic training component are safe and may result in an important improvement in physical function . The intensity of aerobic training did not seem to provide any additional benefits , but higher adherence in the qigong program may suggest that less intensive regimens are easier for children with JIA to comply with , and provide a degree of benefit equivalent to more intensive programs BACKGROUND AND OBJECTIVE Search ing for nonr and omized studies in electronic data bases is complicated because there is a variety of study design s and lack of st and ardization in the terminology . The purpose of this study was to develop and evaluate a method to limit search strategies according to study design of comparative nonr and omized studies ( cNRSs ) . METHODS Four up date d Cochrane systematic review s that included nonr and omized studies ( cohort , case-control , and cross-sectional studies ) of the effects of health care interventions were selected . Search strategies limited to study design were devised for each one of these topic areas in two electronic data bases ( MEDLINE and EMBASE ) . A progressive method ( PM ) and a fixed method for selecting the most appropriate search terms associated with study design of nonr and omized studies are suggested . RESULTS The results showed that the sensitivity of search strategies ( in two data bases combined ) limited to study design were between 90 % and 100 % for the PM using both controlled vocabulary ( CV ) and textwords ( TWs ) and between 95 % and 100 % for a fixed set of controlled vocabulary and TWs . CONCLUSIONS It is possible and acceptable to use search strategies limited to study design of cNRSs of health care interventions OBJECTIVE To 1 ) assess the safety and feasibility of laboratory-based exercise testing in juvenile idiopathic arthritis ( JIA ) , 2 ) test the safety and feasibility of a 3-month exercise program in JIA , 3 ) assess pain during exercise in JIA , 4 ) compare ratings of perceived effort ( RPE ) with heart rate ( HR ) achieved , and 5 ) estimate the training effect on metabolic efficiency of gait as measured by submaximal exercise testing . METHODS Nine children with JIA were enrolled in a 12-week circuit training program involving pool , stationary bicycle , treadmill , and Fitball . They underwent formal exercise testing before and after the program , underwent a full joint assessment , were administered the Childhood Health Assessment Question naire and Juvenile Arthritis Functional Status Index , and were assessed for overall quality of life and health-related quality of life . A visual analog scale was used to assess pain during testing and training , and the Borg scale was used to measure RPE . RESULTS Children with JIA were able to participate in exercise testing without any significant problems . Children with severe hip disease dropped out of the exercise program due to  pain  during the exercise sessions and worsened arthritis symptoms . Target HR was achieved and correlated with RPE in the bicycle and treadmill sessions . Submaximal exercise testing showed an improvement with a small to moderate effect size . CONCLUSION This study suggests that it is safe , feasible , and acceptable for children with arthritis , in the absence of severe hip involvement , to participate in formal exercise testing and structured fitness programs OBJECTIVE To explore early changes and predictors of bone mass in children with juvenile idiopathic arthritis ( JIA ) in order to identify patients who will develop bone mass reductions . METHODS We conducted a prospect i ve cohort study of 108 children with early JIA ( ages 6 - 18 years ; mean disease duration 19.3 months ) who were individually matched with 108 healthy children for age , sex , race , and county of residence .  Bone mass and changes in total body , spine , femur , and forearm bone mineral density and bone mineral content ( BMC ) , body composition , growth , and biochemical parameters of bone turnover were examined at baseline and at followup a mean of 24 months later . Low bone mass was defined as a Z score > 1 SD below the reference population . RESULTS Of the 200 children evaluated at followup , the 100 healthy children had greater gains in total body BMC ( P = 0.035 ) , distal radius BMC ( P < 0.001 ) , and total body lean mass ( P < 0.001 ) than did the 100 JIA patients . Low or very low total body BMC was observed in 24 % of the patients and 12 % of the healthy children . Bone formation , bone resorption , and weight-bearing activities were reduced in the patients compared with the healthy children . Multiple regression analysis showed that in patients with JIA , serum bone-specific alkaline phosphatase , serum C-telopeptide of type I collagen , and weight-bearing activities were independent predictors of changes in total body BMC . Total body BMC was lower in patients with polyarticular onset than in those with oligoarticular disease onset . CONCLUSION Patients with JIA have moderate reductions in bone mass gains , bone turnover , and total body lean mass early in the disease course OBJECTIVE To evaluate the effects of an aquatic training programme for JIA patients . METHODS Fifty-four patients with JIA ( age range 5 to 13 yr ) participated in this study and were r and omized into an experimental ( n = 27 ) and a control ( n = 27 ) group . The children in the experimental group received a training programme consisting of a 1 h per week supervised training programme in a local pool of approximately 20 sessions . Effects were analysed on the following domains : functional ability , health-related quality of life , joint status and physical fitness . RESULTS Although all measures improved more in the experimental group than the control group , none of the differences was statistically significant . CONCLUSIONS The current research found no significant effect of an aquatic fitness training programme in children with JIA . Since there were no signs of worsening in health status , one can conclude that this was a safe exercise programme OBJECTIVE To analyze patterns of daily pain , stiffness , and fatigue related to juvenile arthritis ; to examine the relationships of demographics , disease severity , and psychological adjustment to daily disease symptoms ; and to examine daily disease symptoms as predictors of reduced participation in school and social activity . METHODS For a 2-month period , 41 children with polyarticular juvenile arthritis completed daily diaries that included measures of symptoms and function . Children also underwent an initial evaluation and 4 followup evaluations that included a joint count , laboratory testing , and completion of question naires assessing physical and psychosocial functioning . RESULTS Children reported having pain an average of 73 % of days , with the majority of children ( 76 % ) reporting pain on > 60 % of all days . On average , children described the intensity of their daily pain as being in the mild to moderate range ; however , a significant subgroup ( 31 % ) reported pain in the severe range . Higher physician global assessment ratings , increased functional disability , and increased anxiety were significantly associated with increased daily pain and other daily symptoms . Multilevel r and om-effects analyses indicated that increased daily symptoms of pain , stiffness , and fatigue were significant predictors of reduced participation in school and social activities . CONCLUSION Physicians should consider treating pain more aggressively in children with arthritis , in order to preserve function in school and social domains , as well as physical function . Moreover , optimal pain management in children with arthritis should include therapeutic regimens addressing anxiety as well as st and ard pharmacologic interventions 
    Output:
    