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: Multimodal exercise programs incorporating traditional progressive resistance training ( PRT ) , weight-bearing impact training and /or balance training are recommended to reduce risk factors for falls and fracture . However , muscle power , or the ability to produce force rapidly , has emerged as a more crucial variable to functional decline than muscle strength or mass . The aim of this 12-month community-based r and omized controlled trial , termed Osteo-cise : Strong Bones for Life , was to evaluate the effectiveness and feasibility of a multimodal exercise program incorporating high-velocity (HV)-PRT , combined with an osteoporosis education and behavioral change program , on bone mineral density ( BMD ) , body composition , muscle strength and functional muscle performance in older adults . Falls incidence was evaluated as a secondary outcome . A total of 162 older adults ( mean ± SD ; 67 ± 6 years ) with risk factors for falls and /or low BMD were r and omized to the Osteo-cise program ( n = 81 ) or a control group ( n = 81 ) . Exercise consisted of fitness center-based HV-PRT , weight-bearing impact and challenging balance/mobility activities performed three times weekly . After 12 months , the Osteo-cise program led to modest but significant net gains in femoral neck and lumbar spine BMD ( 1.0 % to 1.1 % , p < 0.05 ) , muscle strength ( 10 % to 13 % , p < 0.05 ) , functional muscle power ( Timed Stair Climb , 5 % , p < 0.05 ) and dynamic balance ( Four Square Step Test 6 % , p < 0.01 ; Sit-to-St and , 16 % , p < 0.001 ) relative to controls . There was no effect on total body lean mass or mobility ( timed-up- and -go ) , and no difference in falls rate ( incidence rate ratio [ IRR ] , 1.22 ; 95 % confidence interval [ CI ] , 0.72 - 2.04 ) . In conclusion , this study demonstrates that the Osteo-cise : Strong Bones for Life community-based , multimodal exercise program represents an effective approach to improve multiple musculoskeletal and functional performance measures in older adults with risk factors for falls and /or low BMD . Although this did not translate into a reduction in the rate of falls , further large-scale trials are needed to evaluate the efficacy of this multimodal approach on reducing falls and fracture Background Gait and balance impairments may increase the risk of falls , the leading cause of accidental death in the elderly population . Fall-related injuries constitute a serious public health problem associated with high costs for society as well as human suffering . A rapid step is the most important protective postural strategy , acting to recover equilibrium and prevent a fall from initiating . It can arise from large perturbations , but also frequently as a consequence of volitional movements . We propose to use a novel water-based training program which includes specific perturbation exercises that will target the stepping responses that could potentially have a profound effect in reducing risk of falling . We describe the water-based balance training program and a study protocol to evaluate its efficacy ( Trial registration number # NCT00708136 ) . Methods / Design The proposed water-based training program involves use of unpredictable , multi-directional perturbations in a group setting to evoke compensatory and volitional stepping responses . Perturbations are made by pushing slightly the subjects and by water turbulence , in 24 training sessions conducted over 12 weeks . Concurrent cognitive tasks during movement tasks are included . Principles of physical training and exercise including awareness , continuity , motivation , overload , periodicity , progression and specificity were used in the development of this novel program . Specific goals are to increase the speed of stepping responses and improve the postural control mechanism and physical functioning . A prospect i ve , r and omized , cross-over trial with concealed allocation , assessor blinding and intention-to-treat analysis will be performed to evaluate the efficacy of the water-based training program . A total of 36 community-dwelling adults ( age 65–88 ) with no recent history of instability or falling will be assigned to either the perturbation-based training or a control group ( no training ) . Voluntary step reaction times and postural stability using stabiliogram diffusion analysis will be tested before and after the 12 weeks of training . Discussion This study will determine whether a water-based balance training program that includes perturbation exercises , in a group setting , can improve speed of voluntary stepping responses and improve balance control . Results will help guide the development of more cost-effective interventions that can prevent the occurrence of falls in the elderly BACKGROUND Water-based resistance training ( WRT ) has been indicated to promote strength gains in elderly population . However , no study has compared different training strategies to identify the most efficient one . The aim of this study was to compare the effects of 3 WRT strategies on the strength and functional capacity of older women . METHODS In total , 36 women were r and omly allocated to training groups : simple set of 30 seconds [ 1 × 30s ; 66.41 ( 1.36 ) y ; n = 12 ] , multiple sets of 10 seconds [ 3 × 10s ; 66.50 ( 1.43 ) y ; n = 11 ] , and simple set of 10 seconds [ 1 × 10s ; 65.23 ( 1.09 ) y ; n = 13 ] . Training lasted for 12 weeks . The maximal dynamic strength ( in kilograms ) and muscular endurance ( number of repetitions ) of knee extension , knee flexion , elbow flexion , and bench press , as well as functional capacity ( number of repetitions ) , were evaluated . RESULTS All types of training promoted similar gains in maximal dynamic strength of knee extension and flexion as well as elbow flexion . Only the 1 × 30s and 1 × 10s groups presented increments in bench press maximal strength . All 3 groups showed increases in muscular endurance in all exercises and functional capacity . CONCLUSIONS WRT using long- or short- duration simple sets promotes the same gains in strength and functional capacity in older women as does WRT using multiple sets To examine effects of 21-week twice/week strength training ( ST ) period followed by an additional 21-week twice or once/week ST period on force production , walking and balance in aging people . Seventy-two women ( 58 ± 7 years ; W ) and 63 ( 58 ± 6 years ) men ( M ) were r and omized for the first 21-week ST period : STW and STM , control ( C ) CW and CM . Training participants were r and omized for the second 21-week ST period : once/week STWx1 and STMx1 , twice/week STWx2 and STMx2 . LegPress , isometric leg extension rate of force development ( RFD ) , walking time , and balance . First 21-week ST period : leg press , RFD , balance , and walking improved significantly in STW and STM . Second 21-week ST period : leg press first increased in STMx1 and STMx2 , and then decreased to the level of 21 weeks in STMx2 and remained unchanged in STWx2 and decreased in STWx1 and STMx1 . Walking and balance improved significantly in STWx1 and STWx2 . A progressive 21-week ST period twice/week in aging people can lead to large improvements in maximal strength , walking time , and balance in both genders . A further strength training period with the same amount of training may maintain the strength gains , whereas balance and walking may be maintained with less training The aim of the present study was to evaluate the effects of an AAG on BMD , osteocalcin and functional autonomy in older women . The sample consisted of eighty-two post-menopausal women with low BMD , r and omly divided into two groups : the Aquatic Aerobics Group [ AAG ; n=42 ; age : 66.8±4.2years ] , su bmi tted to two weekly sessions over eight months , and the  Control Group ( GC ; n=42 ; age : 66.9±3.2years ) , which did not participate in regular exercise . BMD was measured by  Dual Energy X-ray Absorptiometry [ DXA ] of the lumbar and femur , and serum osteocalcin was measured using electrochemiluminescence . A functional autonomy assessment protocol ( GDLAM , 2004 ) was also applied . Statistical analyses used were repeated measures ANOVA and Tukey 's post hoc tests . The results showed a significant improvement in tests following the GDLAM protocol : 10 meters walk ( 10mw ) -p=0.003 ; rising from a ventral decubitus position ( RVDP ) - Δ%=0.78 , p<0.001 ; rising from a chair and moving around the house ( RCMH ) -p<0.001 and autonomy index ( AI ) -p=0.007 , with more favorable results observed in the AAG when compared to the CG . The AAG achieved the best results for BMD ; however , no inter or intragroup statistical differences were recorded for total femur -p=0.975 and lumbar L(2)-L(4)p=0.597 . For serum osteocalcin , intra and intergroup statistical differences of p=0.042 and p=0.027 were observed in the AAG , respectively . This demonstrates that an eight-month aquatic aerobic exercise program can improve functional autonomy and osteocalcin levels , although training did not improve lumbar and total femur BMD in the older women [ Purpose ] The purpose of the present study was to examine the effects of an aqua aerobic therapy exercise for older adults on biomechanical and physiological factors affecting gait . [ Subjects ] A total of 15 subjects participated in this study and they were r and omly divided into the experimental and the control group . [ Methods ] Physiological variables , leg strength , power and flexibility , and biomechanical variables , both kinematic and kinetic , were measured before and after the aqua aerobic therapy exercise . Each subject was instructed to walk along an elevated walkway and during the trials a trapdoor opened at r and om to create a 10 cm falling perturbation . Full body motion and kinetics was gathered during the gait . [ Results ] There were significant reductions in body weight , and body fat mass , and stride time after the perturbation . Significant increases in leg strength corresponded to the maximum joint moment of the l and ing leg showing that the subjects ' ability for recovery of balance after the perturbation improved . [ Conclusion ] As the results showed significant improvements in gait pattern and recovery time after perturbed gait , we conclude that aqua aerobic therapy is an effective exercise method for training older adults to reduce their risk of falling This study evaluated the effects of a water exercise training program that includes perturbation exercises ( WEP ) to improve the speed of voluntary stepping reaction in older adults .  Speed of voluntary stepping considered as an important skill to prevent a fall when balance is lost . In a single-blinded r and omized controlled trial with a crossover design thirty-six independent old adults ( 64 - 88 years old ) were divided into two groups . Group A received WEP for the first 12 weeks , followed by no intervention for the second 12 weeks . Group B did not receive intervention for the first 12 weeks and received WEP for the second 12 weeks . Voluntary Step Execution Test and postural stability in upright st and ing ( eyes open and closed conditions ) were measured at baseline , 12 weeks , and 24 weeks . A significant interaction effect between group and time was found for the step execution , due to improvement in initiation phase and swing phase duration s in the WEP group . Also significant improvement in postural stability parameters in eyes open and closed conditions is noted . The present results indicate that the primary benefit of WEP that include perturbations to induce stepping , was a reduction in voluntary stepping times . The WEP generalized to a better control of balance in up-right st and ing OBJECTIVE To analyze the effects of a water-based exercise program on peak torque ( PT ) and rate of torque development ( RTD ) during maximal voluntary ballistic isometric contractions of the lower limb muscles and the performance of a number of functional tests in the elderly . METHOD Thirty-seven elderly were r and omly assigned to water-based training ( 3 d/wk for 12 wk ) or a control group .  Extensor and flexor PT and RTD of the ankle , knee , and hip joints and functional tests were evaluated before and after training . RESULTS PT increased after training for the hip flexors ( 18 % ) and extensors ( 40 % ) and the plantar-flexor ( 42 % ) muscles in the water-based group . RTD increased after training for the hip-extensor ( 10 % ) , knee-extensor ( 11 % ) , and ankle plantar-flexor ( 27 % ) muscles in the water-based group . Functional tests also improved after training in the water-based group ( p < .05 ) . CONCLUSION The water-based program improved PT and RTD and functional performance in the elderly Background Hip muscle weakness in older people seems to be an influencing factor of falls . Currently , it is unclear which muscles out of the hip muscle group play an important role in older people . A validating process in the measurement regarding muscle strength related to falls is necessary before answering that question . Objective Firstly , we aim ed to investigate which hip muscle group strength shows an acceptable level of distinction between older adult fallers and non-fallers compared to a predefined external criterion regarding falling . Secondly , we aim ed to compare the same outcomes and questions for h and -grip strength in relation to the same external criterion . Design This study was a cross-sectional validity study . Methods The  maximum voluntary isometric strength ( MVIS ) and the rate of force generation of hip abductors ( ABD ) , adductors , internal and external rotators , extensors , and flexors were measured with a dynamometer fixed to a custom-made frame as well as h and -grip strength with a Martin Vigorimeter in 60 older people aged over 65 years ( 38 females and 22 males ) . Results The area under the curve ( AUC ) and the 
    Output:
    
agent
However , aquatic exercise improved key predisposing physical fitness components that are modifiable and internal risk factors for falling .
Conclusions There is limited , low- quality evidence to support the use of aquatic exercise for improving physiological components that are risk factors for falling .
***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: Multimodal exercise programs incorporating traditional progressive resistance training ( PRT ) , weight-bearing impact training and /or balance training are recommended to reduce risk factors for falls and fracture . However , muscle power , or the ability to produce force rapidly , has emerged as a more crucial variable to functional decline than muscle strength or mass . The aim of this 12-month community-based r and omized controlled trial , termed Osteo-cise : Strong Bones for Life , was to evaluate the effectiveness and feasibility of a multimodal exercise program incorporating high-velocity (HV)-PRT , combined with an osteoporosis education and behavioral change program , on bone mineral density ( BMD ) , body composition , muscle strength and functional muscle performance in older adults . Falls incidence was evaluated as a secondary outcome . A total of 162 older adults ( mean ± SD ; 67 ± 6 years ) with risk factors for falls and /or low BMD were r and omized to the Osteo-cise program ( n = 81 ) or a control group ( n = 81 ) . Exercise consisted of fitness center-based HV-PRT , weight-bearing impact and challenging balance/mobility activities performed three times weekly . After 12 months , the Osteo-cise program led to modest but significant net gains in femoral neck and lumbar spine BMD ( 1.0 % to 1.1 % , p < 0.05 ) , muscle strength ( 10 % to 13 % , p < 0.05 ) , functional muscle power ( Timed Stair Climb , 5 % , p < 0.05 ) and dynamic balance ( Four Square Step Test 6 % , p < 0.01 ; Sit-to-St and , 16 % , p < 0.001 ) relative to controls . There was no effect on total body lean mass or mobility ( timed-up- and -go ) , and no difference in falls rate ( incidence rate ratio [ IRR ] , 1.22 ; 95 % confidence interval [ CI ] , 0.72 - 2.04 ) . In conclusion , this study demonstrates that the Osteo-cise : Strong Bones for Life community-based , multimodal exercise program represents an effective approach to improve multiple musculoskeletal and functional performance measures in older adults with risk factors for falls and /or low BMD . Although this did not translate into a reduction in the rate of falls , further large-scale trials are needed to evaluate the efficacy of this multimodal approach on reducing falls and fracture Background Gait and balance impairments may increase the risk of falls , the leading cause of accidental death in the elderly population . Fall-related injuries constitute a serious public health problem associated with high costs for society as well as human suffering . A rapid step is the most important protective postural strategy , acting to recover equilibrium and prevent a fall from initiating . It can arise from large perturbations , but also frequently as a consequence of volitional movements . We propose to use a novel water-based training program which includes specific perturbation exercises that will target the stepping responses that could potentially have a profound effect in reducing risk of falling . We describe the water-based balance training program and a study protocol to evaluate its efficacy ( Trial registration number # NCT00708136 ) . Methods / Design The proposed water-based training program involves use of unpredictable , multi-directional perturbations in a group setting to evoke compensatory and volitional stepping responses . Perturbations are made by pushing slightly the subjects and by water turbulence , in 24 training sessions conducted over 12 weeks . Concurrent cognitive tasks during movement tasks are included . Principles of physical training and exercise including awareness , continuity , motivation , overload , periodicity , progression and specificity were used in the development of this novel program . Specific goals are to increase the speed of stepping responses and improve the postural control mechanism and physical functioning . A prospect i ve , r and omized , cross-over trial with concealed allocation , assessor blinding and intention-to-treat analysis will be performed to evaluate the efficacy of the water-based training program . A total of 36 community-dwelling adults ( age 65–88 ) with no recent history of instability or falling will be assigned to either the perturbation-based training or a control group ( no training ) . Voluntary step reaction times and postural stability using stabiliogram diffusion analysis will be tested before and after the 12 weeks of training . Discussion This study will determine whether a water-based balance training program that includes perturbation exercises , in a group setting , can improve speed of voluntary stepping responses and improve balance control . Results will help guide the development of more cost-effective interventions that can prevent the occurrence of falls in the elderly BACKGROUND Water-based resistance training ( WRT ) has been indicated to promote strength gains in elderly population . However , no study has compared different training strategies to identify the most efficient one . The aim of this study was to compare the effects of 3 WRT strategies on the strength and functional capacity of older women . METHODS In total , 36 women were r and omly allocated to training groups : simple set of 30 seconds [ 1 × 30s ; 66.41 ( 1.36 ) y ; n = 12 ] , multiple sets of 10 seconds [ 3 × 10s ; 66.50 ( 1.43 ) y ; n = 11 ] , and simple set of 10 seconds [ 1 × 10s ; 65.23 ( 1.09 ) y ; n = 13 ] . Training lasted for 12 weeks . The maximal dynamic strength ( in kilograms ) and muscular endurance ( number of repetitions ) of knee extension , knee flexion , elbow flexion , and bench press , as well as functional capacity ( number of repetitions ) , were evaluated . RESULTS All types of training promoted similar gains in maximal dynamic strength of knee extension and flexion as well as elbow flexion . Only the 1 × 30s and 1 × 10s groups presented increments in bench press maximal strength . All 3 groups showed increases in muscular endurance in all exercises and functional capacity . CONCLUSIONS WRT using long- or short- duration simple sets promotes the same gains in strength and functional capacity in older women as does WRT using multiple sets To examine effects of 21-week twice/week strength training ( ST ) period followed by an additional 21-week twice or once/week ST period on force production , walking and balance in aging people . Seventy-two women ( 58 ± 7 years ; W ) and 63 ( 58 ± 6 years ) men ( M ) were r and omized for the first 21-week ST period : STW and STM , control ( C ) CW and CM . Training participants were r and omized for the second 21-week ST period : once/week STWx1 and STMx1 , twice/week STWx2 and STMx2 . LegPress , isometric leg extension rate of force development ( RFD ) , walking time , and balance . First 21-week ST period : leg press , RFD , balance , and walking improved significantly in STW and STM . Second 21-week ST period : leg press first increased in STMx1 and STMx2 , and then decreased to the level of 21 weeks in STMx2 and remained unchanged in STWx2 and decreased in STWx1 and STMx1 . Walking and balance improved significantly in STWx1 and STWx2 . A progressive 21-week ST period twice/week in aging people can lead to large improvements in maximal strength , walking time , and balance in both genders . A further strength training period with the same amount of training may maintain the strength gains , whereas balance and walking may be maintained with less training The aim of the present study was to evaluate the effects of an AAG on BMD , osteocalcin and functional autonomy in older women . The sample consisted of eighty-two post-menopausal women with low BMD , r and omly divided into two groups : the Aquatic Aerobics Group [ AAG ; n=42 ; age : 66.8±4.2years ] , su bmi tted to two weekly sessions over eight months , and the  Control Group ( GC ; n=42 ; age : 66.9±3.2years ) , which did not participate in regular exercise . BMD was measured by  Dual Energy X-ray Absorptiometry [ DXA ] of the lumbar and femur , and serum osteocalcin was measured using electrochemiluminescence . A functional autonomy assessment protocol ( GDLAM , 2004 ) was also applied . Statistical analyses used were repeated measures ANOVA and Tukey 's post hoc tests . The results showed a significant improvement in tests following the GDLAM protocol : 10 meters walk ( 10mw ) -p=0.003 ; rising from a ventral decubitus position ( RVDP ) - Δ%=0.78 , p<0.001 ; rising from a chair and moving around the house ( RCMH ) -p<0.001 and autonomy index ( AI ) -p=0.007 , with more favorable results observed in the AAG when compared to the CG . The AAG achieved the best results for BMD ; however , no inter or intragroup statistical differences were recorded for total femur -p=0.975 and lumbar L(2)-L(4)p=0.597 . For serum osteocalcin , intra and intergroup statistical differences of p=0.042 and p=0.027 were observed in the AAG , respectively . This demonstrates that an eight-month aquatic aerobic exercise program can improve functional autonomy and osteocalcin levels , although training did not improve lumbar and total femur BMD in the older women [ Purpose ] The purpose of the present study was to examine the effects of an aqua aerobic therapy exercise for older adults on biomechanical and physiological factors affecting gait . [ Subjects ] A total of 15 subjects participated in this study and they were r and omly divided into the experimental and the control group . [ Methods ] Physiological variables , leg strength , power and flexibility , and biomechanical variables , both kinematic and kinetic , were measured before and after the aqua aerobic therapy exercise . Each subject was instructed to walk along an elevated walkway and during the trials a trapdoor opened at r and om to create a 10 cm falling perturbation . Full body motion and kinetics was gathered during the gait . [ Results ] There were significant reductions in body weight , and body fat mass , and stride time after the perturbation . Significant increases in leg strength corresponded to the maximum joint moment of the l and ing leg showing that the subjects ' ability for recovery of balance after the perturbation improved . [ Conclusion ] As the results showed significant improvements in gait pattern and recovery time after perturbed gait , we conclude that aqua aerobic therapy is an effective exercise method for training older adults to reduce their risk of falling This study evaluated the effects of a water exercise training program that includes perturbation exercises ( WEP ) to improve the speed of voluntary stepping reaction in older adults .  Speed of voluntary stepping considered as an important skill to prevent a fall when balance is lost . In a single-blinded r and omized controlled trial with a crossover design thirty-six independent old adults ( 64 - 88 years old ) were divided into two groups . Group A received WEP for the first 12 weeks , followed by no intervention for the second 12 weeks . Group B did not receive intervention for the first 12 weeks and received WEP for the second 12 weeks . Voluntary Step Execution Test and postural stability in upright st and ing ( eyes open and closed conditions ) were measured at baseline , 12 weeks , and 24 weeks . A significant interaction effect between group and time was found for the step execution , due to improvement in initiation phase and swing phase duration s in the WEP group . Also significant improvement in postural stability parameters in eyes open and closed conditions is noted . The present results indicate that the primary benefit of WEP that include perturbations to induce stepping , was a reduction in voluntary stepping times . The WEP generalized to a better control of balance in up-right st and ing OBJECTIVE To analyze the effects of a water-based exercise program on peak torque ( PT ) and rate of torque development ( RTD ) during maximal voluntary ballistic isometric contractions of the lower limb muscles and the performance of a number of functional tests in the elderly . METHOD Thirty-seven elderly were r and omly assigned to water-based training ( 3 d/wk for 12 wk ) or a control group .  Extensor and flexor PT and RTD of the ankle , knee , and hip joints and functional tests were evaluated before and after training . RESULTS PT increased after training for the hip flexors ( 18 % ) and extensors ( 40 % ) and the plantar-flexor ( 42 % ) muscles in the water-based group . RTD increased after training for the hip-extensor ( 10 % ) , knee-extensor ( 11 % ) , and ankle plantar-flexor ( 27 % ) muscles in the water-based group . Functional tests also improved after training in the water-based group ( p < .05 ) . CONCLUSION The water-based program improved PT and RTD and functional performance in the elderly Background Hip muscle weakness in older people seems to be an influencing factor of falls . Currently , it is unclear which muscles out of the hip muscle group play an important role in older people . A validating process in the measurement regarding muscle strength related to falls is necessary before answering that question . Objective Firstly , we aim ed to investigate which hip muscle group strength shows an acceptable level of distinction between older adult fallers and non-fallers compared to a predefined external criterion regarding falling . Secondly , we aim ed to compare the same outcomes and questions for h and -grip strength in relation to the same external criterion . Design This study was a cross-sectional validity study . Methods The  maximum voluntary isometric strength ( MVIS ) and the rate of force generation of hip abductors ( ABD ) , adductors , internal and external rotators , extensors , and flexors were measured with a dynamometer fixed to a custom-made frame as well as h and -grip strength with a Martin Vigorimeter in 60 older people aged over 65 years ( 38 females and 22 males ) . Results The area under the curve ( AUC ) and the 
    Output:
    