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: Tai Chi , a moving meditation , is examined for its efficacy in post-stressor recovery . Forty-eight male and 48 female Tai Chi practitioners were r and omly assigned to four treatment groups : Tai Chi , brisk walking , mediation and neutral reading . Mental arithmetic and other difficult tests were chosen as mental challenges , and a stressful film was used to produce emotional disturbance . Tai Chi and the other treatments were applied after these stressors . After all treatments , the salivary cortisol level dropped significantly , and the mood states were also improved . In general the stress-reduction effect of Tai Chi characterized moderate physical exercise . Heart rate , blood pressure , and urinary catecholamine changes for Tai Chi were found to be similar to those for walking at a speed of 6 km/hr . Although Tai Chi appeared to be superior to neutral reading in the reduction of state anxiety and the enhancement of vigour , this effect could be partially accounted for by the subjects ' high expectations about gains from Tai Chi . Approaches controlling for expectancy level are recommended for further assessment Background . The aim of this r and omized , controlled study was to investigate the effectiveness of a mindful walking program in patients with high levels of perceived psychological distress . Methods . Participants aged between 18 and 65 years with moderate to high levels of perceived psychological distress were r and omized to 8 sessions of mindful walking in 4 weeks ( each 40 minutes walking , 10 minutes mindful walking , 10 minutes discussion ) or to no study intervention ( waiting group ) . Primary outcome parameter was the difference to baseline on Cohen 's Perceived Stress Scale ( CPSS ) after 4 weeks between intervention and control . Results . Seventy-four participants were r and omized in the study ; 36 ( 32 female , 52.3 ± 8.6 years ) were allocated to the intervention and 38 ( 35 female , 49.5 ± 8.8 years ) to the control group . Adjusted CPSS differences after 4 weeks were −8.8 [ 95 % CI : −10.8 ; −6.8 ] ( mean 24.2 [ 22.2 ; 26.2 ] ) in the intervention group and −1.0 [ −2.9 ; 0.9 ] ( mean 32.0 [ 30.1 ; 33.9 ] ) in the control group , result ing in a highly significant group difference ( P < 0.001 ) . Conclusion . Patients participating in a mindful walking program  showed reduced psychological stress symptoms and improved quality of life compared to no study intervention . Further studies should include an active treatment group and a long-term follow-up Background Despite Internet-based interventions that incorporate pedometers with appropriate goal - setting processes and other theoretically-based behavior change strategies being proposed as a means of increasing walking behavior , few have incorporated all of these key features or assessed maintenance of behavior change . Objective The objective of our study was to investigate the effect of a 12-week pedometer step goal walking program individually tailored to baseline step counts , combined with an interactive support website for step counts , health parameters and motivation over 12 and 24 weeks . Methods Low active participants ( mean [ SD ] 46.2 [ 11.2 ] years ) were r and omly assigned to the  Stepwise ( SW ) intervention group ( n=49 ) or a  comparison ( CP ) group ( n=48 ) . SW received a pedometer , step goal walking program and access to the SW website ( containing interactive self-monitoring and goal feedback tools , motivational messages and action and coping planning strategies ) . CP received a pedometer and locally available physical activity information . Step counts , BMI , resting heart rate , blood pressure and glucose , cholesterol and triglyceride levels , psychological well-being , perceived health , self-efficacy and self-determined motivation were measured at baseline , 12 and 24 weeks . Results Linear mixed model analysis found that both groups ’ step counts increased from baseline to week 12 ( β = 11,002 , CI 5739 - 16,266 , P<.001 ) and 24 ( β = 6810 , CI 1190 - 12,431 ; P=.02 ) . Group step counts were significantly different at week 24 with SW taking 8939 ( CI 274 - 17604 , P=.04 ) more steps compared to CP . Compared to baseline , both groups had improved triglyceride levels ( 0.14 mmol/L , CI -0.25 to -0.02 , P=.02 ) at week 12 , decreased diastolic blood pressure ( 4.22 mmHg , CI -6.73 to -1.72 ) at weeks 12 and 24 ( 3.17 mmHg , CI -5.55 to -0.78 ) , improved positive ( β = .21 , CI 0.03 - 0.38 , P=.02 ) and negative affect ( β = -.15 , CI -0.28 to -0.03 , P=.02 ) at week 12 , and perceived health at week 12 ( β = 6.37 , CI 2.10 - 10.65 , P=.004 ) and 24 ( β = 8.52 , CI 3.98 - 13.06 , P<.001 ) . Total cholesterol increased at week 12 ( 0.26 mmol/L , CI 0.099 - 0.423 , P=.006 ) and week 24 ( 0.38 mmol/L , CI 0.20 - 0.56 , P<.001 ) . Repeated measures ANOVA found motivation for walking improved from baseline with higher task self-efficacy ( P<.001 , η2 = .13 ) and autonomous motivation ( P<.001 , η2=.14 ) at weeks 12 and 24 and decreased controlled motivation ( P=.004 , η2=.08 ) at week 24 . Conclusions Both groups had similar improvements in step counts and physical and psychological health after 12 weeks but only the SW group successfully maintained the increased step-counts 24 weeks post-intervention . This suggests the step- goal based walking program combined with Internet-based behavior change tools were important for sustained behavior change Introduction Affective responses during physical activity ( PA ) are important for engagement in PA programs and for adherence to a physically active lifestyle . Little is known about the affective responses to PA bouts lasting longer than 45 minutes . Therefore , the aims of the present study were to analyse acute effects on affective responses of a three-hour outdoor PA intervention ( mountain hiking ) compared to a sedentary control situation and to an indoor treadmill condition . Methods Using a r and omized crossover design , 42 healthy participants were r and omly exposed to three different conditions : outdoor mountain hiking , indoor treadmill walking , and sedentary control situation ( approximately three hours each ) . Measures included the Feeling Scale , Felt Arousal Scale and a Mood Survey Scale . Repeated measures ANOVAs were used to analyse differences between the conditions . Results Compared to the control situation , the participants showed a significant increase in affective valence ( d = 1.21 , p < .001 ) , activation ( d = 0.81 , p = .004 ) , elation ( d = 1.07 , p < .001 ) , and calmness ( d = 0.84 , p = .004 ) , and a significant decrease in fatigue ( d = -1.19 , p < .001 ) and anxiety ( d = -.79 , p < .001 ) after mountain hiking . Outdoor mountain hiking showed significantly greater positive effects on affective valence , activation , and fatigue compared to indoor treadmill walking . Discussion The results indicate that a three-hour PA intervention ( mountain hiking ) elicits higher positive and lower negative affective responses compared to a sedentary control situation and to an indoor PA condition . Outdoor mountain hiking can be recommended by health professionals as a form of PA with the potential to positively influence affective responses . Trial registration Clinical Trials.gov NCT02853760 . https:// clinical trials.gov/. Date of registration : 08/02/2016 ( retrospectively registered ) . Date of enrolment of the first participant to the trial : 05/01/2014 Physical activity has long been considered beneficial to health and regular exercise is purported to relieve stress . However empirical evidence demonstrating these effects is limited . In this study , we compared psychophysiological responses to an acute psychosocial stressor between individuals who did , or did not , report regular physical exercise . Healthy men and women ( N = 111 ) participated in two experimental sessions , one with the Trier Social Stress Test ( TSST ) and one with a non-stressful control task . We measured heart rate , blood pressure , cortisol , and self-reported mood before and at repeated times after the tasks . Individuals who reported physical exercise at least once per week exhibited lower heart rate at rest than non-exercisers , but the groups did not differ in their cardiovascular responses to the TSST . Level of habitual exercise did not influence self-reported mood before the tasks , but non-exercisers reported a greater decline in positive affect after the TSST in comparison to exercisers . These findings provide modest support for cl aims that regular exercise protects against the negative emotional consequences of stress , and suggest that exercise has beneficial effects in healthy individuals . These findings are limited by their correlational nature , and future prospect i ve controlled studies on the effects of regular exercise on response to acute stress are needed Purpose . To examine the effects of walking and yoga on multidimensional self-esteem and roles played by self-efficacy , body composition , and physical activity ( PA ) in changes in esteem . Design . Four-month r and omized controlled exercise trial with three arms : walking , yoga , and control . Subjects . Previously low-active middle-aged women ( n = 164 ; M age = 49.9 ; SD = 3.6 ) . Intervention . Structured and supervised walking program meeting three times per week for 1 hour and supervised yoga program meeting twice per week for 90 minutes . Measures . Body composition , fitness assessment , and battery of psychologic measures . Analysis . Panel analysis within a structural equation modeling framework using Mplus 3.0 . Results . The walking and yoga interventions failed to enhance global or physical self-esteem but improved subdomain esteem relative to physical condition and strength ( for walking ) and body attractiveness ( for both walking and yoga ) . Over time the effects of PA , self-efficacy , and body fat on changes in physical self-esteem and global esteem were mediated by changes in physical condition and body attractiveness subdomain esteem . Women reporting greater levels of self-efficacy and PA with lower body fat also reported greater enhancements in subdomain esteem . Conclusion . These results provide support for the hierarchic and multidimensional nature of self-esteem and indicate that middle-aged women may enhance certain aspects of physical self-esteem by participating in PA A r and omized controlled trial examined the growth and form of multidimensional self-esteem over a 12-month period ( 6-month exercise intervention and 6-month follow-up ) in 174 older adults engaged in either a walking or stretching/toning program .  The extent to which changes in physical fitness parameters and physical self-efficacy were related to changes in perceptions of attractive body , strength , physical conditioning , and physical self-worth was also determined . Latent growth curve analyses showed a curvilinear pattern of growth in esteem with significant increases at all levels of self-esteem upon completion of the intervention followed by significant declines at 6 months poistintervention in both groups . Frequency of activity and changes in physical fitness , body fat , and self-efficacy were related to improvements in esteem perceptions relative to attractive body , strength , and physical condition . Model fitting procedures suggested that the best fit of the data was to a model in which the influence of changes in efficacy and physical parameters on physical self-worth were mediated by perceptions of attractive body and physical conditions OBJECTIVES Yoga and exercise have beneficial effects on  mood and anxiety .  γ-Aminobutyric acid (GABA)-ergic activity is reduced in mood and anxiety disorders . The practice of yoga postures is associated with increased brain GABA levels . This study addresses the question of whether changes in mood , anxiety , and GABA levels are specific to yoga or related to physical activity . METHODS Healthy subjects with no significant medical/psychiatric disorders were r and omized to yoga or a metabolically matched walking intervention for 60 minutes 3 times a week for 12 weeks . Mood and anxiety scales were taken at weeks 0 , 4 , 8 , 12 , and before each magnetic resonance spectroscopy scan . Scan 1 was at baseline . Scan 2 , obtained after the 12-week intervention , was followed by a 60-minute yoga or walking intervention , which was immediately followed by Scan 3 . RESULTS The  yoga subjects ( n = 19 ) reported greater improvement in mood and greater decreases in anxiety than the walking group ( n = 15 ) . There were positive correlations between improved mood and decreased anxiety and thalamic GABA levels . The yoga group had positive correlations between changes in mood scales and changes in GABA levels . CONCLUSIONS The 12-week yoga intervention was associated with greater improvements in mood and anxiety than a metabolically matched walking exercise . This is the first study to demonstrate that increased thalamic GABA levels are associated with improved mood and decreased anxiety . It is also the first time that a behavioral intervention ( i.e. , yoga postures ) has been associated with a positive correlation between acute increases in thalamic GABA levels and improvements in mood and anxiety scales . Given that pharmacologic agents that increase the activity of the GABA system are prescribed to improve mood and decrease anxiety , the reported correlations are in the expected direction . The possible role of GAB 
    Output:
    
agent
Evidence for anxiety , psychological stress , psychological well-being , subjective well-being and social isolation and loneliness varied in volume and effectiveness , but no harmful effects were identified .
The setting and context of walking seems to be important variables .
***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: Tai Chi , a moving meditation , is examined for its efficacy in post-stressor recovery . Forty-eight male and 48 female Tai Chi practitioners were r and omly assigned to four treatment groups : Tai Chi , brisk walking , mediation and neutral reading . Mental arithmetic and other difficult tests were chosen as mental challenges , and a stressful film was used to produce emotional disturbance . Tai Chi and the other treatments were applied after these stressors . After all treatments , the salivary cortisol level dropped significantly , and the mood states were also improved . In general the stress-reduction effect of Tai Chi characterized moderate physical exercise . Heart rate , blood pressure , and urinary catecholamine changes for Tai Chi were found to be similar to those for walking at a speed of 6 km/hr . Although Tai Chi appeared to be superior to neutral reading in the reduction of state anxiety and the enhancement of vigour , this effect could be partially accounted for by the subjects ' high expectations about gains from Tai Chi . Approaches controlling for expectancy level are recommended for further assessment Background . The aim of this r and omized , controlled study was to investigate the effectiveness of a mindful walking program in patients with high levels of perceived psychological distress . Methods . Participants aged between 18 and 65 years with moderate to high levels of perceived psychological distress were r and omized to 8 sessions of mindful walking in 4 weeks ( each 40 minutes walking , 10 minutes mindful walking , 10 minutes discussion ) or to no study intervention ( waiting group ) . Primary outcome parameter was the difference to baseline on Cohen 's Perceived Stress Scale ( CPSS ) after 4 weeks between intervention and control . Results . Seventy-four participants were r and omized in the study ; 36 ( 32 female , 52.3 ± 8.6 years ) were allocated to the intervention and 38 ( 35 female , 49.5 ± 8.8 years ) to the control group . Adjusted CPSS differences after 4 weeks were −8.8 [ 95 % CI : −10.8 ; −6.8 ] ( mean 24.2 [ 22.2 ; 26.2 ] ) in the intervention group and −1.0 [ −2.9 ; 0.9 ] ( mean 32.0 [ 30.1 ; 33.9 ] ) in the control group , result ing in a highly significant group difference ( P < 0.001 ) . Conclusion . Patients participating in a mindful walking program  showed reduced psychological stress symptoms and improved quality of life compared to no study intervention . Further studies should include an active treatment group and a long-term follow-up Background Despite Internet-based interventions that incorporate pedometers with appropriate goal - setting processes and other theoretically-based behavior change strategies being proposed as a means of increasing walking behavior , few have incorporated all of these key features or assessed maintenance of behavior change . Objective The objective of our study was to investigate the effect of a 12-week pedometer step goal walking program individually tailored to baseline step counts , combined with an interactive support website for step counts , health parameters and motivation over 12 and 24 weeks . Methods Low active participants ( mean [ SD ] 46.2 [ 11.2 ] years ) were r and omly assigned to the  Stepwise ( SW ) intervention group ( n=49 ) or a  comparison ( CP ) group ( n=48 ) . SW received a pedometer , step goal walking program and access to the SW website ( containing interactive self-monitoring and goal feedback tools , motivational messages and action and coping planning strategies ) . CP received a pedometer and locally available physical activity information . Step counts , BMI , resting heart rate , blood pressure and glucose , cholesterol and triglyceride levels , psychological well-being , perceived health , self-efficacy and self-determined motivation were measured at baseline , 12 and 24 weeks . Results Linear mixed model analysis found that both groups ’ step counts increased from baseline to week 12 ( β = 11,002 , CI 5739 - 16,266 , P<.001 ) and 24 ( β = 6810 , CI 1190 - 12,431 ; P=.02 ) . Group step counts were significantly different at week 24 with SW taking 8939 ( CI 274 - 17604 , P=.04 ) more steps compared to CP . Compared to baseline , both groups had improved triglyceride levels ( 0.14 mmol/L , CI -0.25 to -0.02 , P=.02 ) at week 12 , decreased diastolic blood pressure ( 4.22 mmHg , CI -6.73 to -1.72 ) at weeks 12 and 24 ( 3.17 mmHg , CI -5.55 to -0.78 ) , improved positive ( β = .21 , CI 0.03 - 0.38 , P=.02 ) and negative affect ( β = -.15 , CI -0.28 to -0.03 , P=.02 ) at week 12 , and perceived health at week 12 ( β = 6.37 , CI 2.10 - 10.65 , P=.004 ) and 24 ( β = 8.52 , CI 3.98 - 13.06 , P<.001 ) . Total cholesterol increased at week 12 ( 0.26 mmol/L , CI 0.099 - 0.423 , P=.006 ) and week 24 ( 0.38 mmol/L , CI 0.20 - 0.56 , P<.001 ) . Repeated measures ANOVA found motivation for walking improved from baseline with higher task self-efficacy ( P<.001 , η2 = .13 ) and autonomous motivation ( P<.001 , η2=.14 ) at weeks 12 and 24 and decreased controlled motivation ( P=.004 , η2=.08 ) at week 24 . Conclusions Both groups had similar improvements in step counts and physical and psychological health after 12 weeks but only the SW group successfully maintained the increased step-counts 24 weeks post-intervention . This suggests the step- goal based walking program combined with Internet-based behavior change tools were important for sustained behavior change Introduction Affective responses during physical activity ( PA ) are important for engagement in PA programs and for adherence to a physically active lifestyle . Little is known about the affective responses to PA bouts lasting longer than 45 minutes . Therefore , the aims of the present study were to analyse acute effects on affective responses of a three-hour outdoor PA intervention ( mountain hiking ) compared to a sedentary control situation and to an indoor treadmill condition . Methods Using a r and omized crossover design , 42 healthy participants were r and omly exposed to three different conditions : outdoor mountain hiking , indoor treadmill walking , and sedentary control situation ( approximately three hours each ) . Measures included the Feeling Scale , Felt Arousal Scale and a Mood Survey Scale . Repeated measures ANOVAs were used to analyse differences between the conditions . Results Compared to the control situation , the participants showed a significant increase in affective valence ( d = 1.21 , p < .001 ) , activation ( d = 0.81 , p = .004 ) , elation ( d = 1.07 , p < .001 ) , and calmness ( d = 0.84 , p = .004 ) , and a significant decrease in fatigue ( d = -1.19 , p < .001 ) and anxiety ( d = -.79 , p < .001 ) after mountain hiking . Outdoor mountain hiking showed significantly greater positive effects on affective valence , activation , and fatigue compared to indoor treadmill walking . Discussion The results indicate that a three-hour PA intervention ( mountain hiking ) elicits higher positive and lower negative affective responses compared to a sedentary control situation and to an indoor PA condition . Outdoor mountain hiking can be recommended by health professionals as a form of PA with the potential to positively influence affective responses . Trial registration Clinical Trials.gov NCT02853760 . https:// clinical trials.gov/. Date of registration : 08/02/2016 ( retrospectively registered ) . Date of enrolment of the first participant to the trial : 05/01/2014 Physical activity has long been considered beneficial to health and regular exercise is purported to relieve stress . However empirical evidence demonstrating these effects is limited . In this study , we compared psychophysiological responses to an acute psychosocial stressor between individuals who did , or did not , report regular physical exercise . Healthy men and women ( N = 111 ) participated in two experimental sessions , one with the Trier Social Stress Test ( TSST ) and one with a non-stressful control task . We measured heart rate , blood pressure , cortisol , and self-reported mood before and at repeated times after the tasks . Individuals who reported physical exercise at least once per week exhibited lower heart rate at rest than non-exercisers , but the groups did not differ in their cardiovascular responses to the TSST . Level of habitual exercise did not influence self-reported mood before the tasks , but non-exercisers reported a greater decline in positive affect after the TSST in comparison to exercisers . These findings provide modest support for cl aims that regular exercise protects against the negative emotional consequences of stress , and suggest that exercise has beneficial effects in healthy individuals . These findings are limited by their correlational nature , and future prospect i ve controlled studies on the effects of regular exercise on response to acute stress are needed Purpose . To examine the effects of walking and yoga on multidimensional self-esteem and roles played by self-efficacy , body composition , and physical activity ( PA ) in changes in esteem . Design . Four-month r and omized controlled exercise trial with three arms : walking , yoga , and control . Subjects . Previously low-active middle-aged women ( n = 164 ; M age = 49.9 ; SD = 3.6 ) . Intervention . Structured and supervised walking program meeting three times per week for 1 hour and supervised yoga program meeting twice per week for 90 minutes . Measures . Body composition , fitness assessment , and battery of psychologic measures . Analysis . Panel analysis within a structural equation modeling framework using Mplus 3.0 . Results . The walking and yoga interventions failed to enhance global or physical self-esteem but improved subdomain esteem relative to physical condition and strength ( for walking ) and body attractiveness ( for both walking and yoga ) . Over time the effects of PA , self-efficacy , and body fat on changes in physical self-esteem and global esteem were mediated by changes in physical condition and body attractiveness subdomain esteem . Women reporting greater levels of self-efficacy and PA with lower body fat also reported greater enhancements in subdomain esteem . Conclusion . These results provide support for the hierarchic and multidimensional nature of self-esteem and indicate that middle-aged women may enhance certain aspects of physical self-esteem by participating in PA A r and omized controlled trial examined the growth and form of multidimensional self-esteem over a 12-month period ( 6-month exercise intervention and 6-month follow-up ) in 174 older adults engaged in either a walking or stretching/toning program .  The extent to which changes in physical fitness parameters and physical self-efficacy were related to changes in perceptions of attractive body , strength , physical conditioning , and physical self-worth was also determined . Latent growth curve analyses showed a curvilinear pattern of growth in esteem with significant increases at all levels of self-esteem upon completion of the intervention followed by significant declines at 6 months poistintervention in both groups . Frequency of activity and changes in physical fitness , body fat , and self-efficacy were related to improvements in esteem perceptions relative to attractive body , strength , and physical condition . Model fitting procedures suggested that the best fit of the data was to a model in which the influence of changes in efficacy and physical parameters on physical self-worth were mediated by perceptions of attractive body and physical conditions OBJECTIVES Yoga and exercise have beneficial effects on  mood and anxiety .  γ-Aminobutyric acid (GABA)-ergic activity is reduced in mood and anxiety disorders . The practice of yoga postures is associated with increased brain GABA levels . This study addresses the question of whether changes in mood , anxiety , and GABA levels are specific to yoga or related to physical activity . METHODS Healthy subjects with no significant medical/psychiatric disorders were r and omized to yoga or a metabolically matched walking intervention for 60 minutes 3 times a week for 12 weeks . Mood and anxiety scales were taken at weeks 0 , 4 , 8 , 12 , and before each magnetic resonance spectroscopy scan . Scan 1 was at baseline . Scan 2 , obtained after the 12-week intervention , was followed by a 60-minute yoga or walking intervention , which was immediately followed by Scan 3 . RESULTS The  yoga subjects ( n = 19 ) reported greater improvement in mood and greater decreases in anxiety than the walking group ( n = 15 ) . There were positive correlations between improved mood and decreased anxiety and thalamic GABA levels . The yoga group had positive correlations between changes in mood scales and changes in GABA levels . CONCLUSIONS The 12-week yoga intervention was associated with greater improvements in mood and anxiety than a metabolically matched walking exercise . This is the first study to demonstrate that increased thalamic GABA levels are associated with improved mood and decreased anxiety . It is also the first time that a behavioral intervention ( i.e. , yoga postures ) has been associated with a positive correlation between acute increases in thalamic GABA levels and improvements in mood and anxiety scales . Given that pharmacologic agents that increase the activity of the GABA system are prescribed to improve mood and decrease anxiety , the reported correlations are in the expected direction . The possible role of GAB 
    Output:
    