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: AIM This paper is a report of a study to assess the effect of an adapted arthritis self-management programme with an added focus on exercise practice among osteoarthritic knee sufferers . BACKGROUND Osteoarthritis of the knee is a major source of loss of function in older people . Previous studies have found self-management programmes to be effective in increasing arthritis self-efficacy and in mastery of self-management practice . METHOD A r and omized control trial was carried out from December 2002 to May 2003 and 120 participants ( 65.9 % , including 67 in intervention group and 53 in control group ) completed the 16-week postintervention assessment s. Outcome measures included arthritis self-efficacy , use of self-management techniques , pain intensity and daily activity . FINDINGS At 16 weeks , there was a ' statistically ' significant improvement in the arthritis self-efficacy level ( P < or= 0.001 ) , in most of the self-management skills , i.e. use of cold and hot compresses , in two of three joint protective practice s ( P < or= 0.001 ; P = 0.01 ) , an increase in the duration of light exercise practice ( P < or= 0.001 ) , reduction of current arthritis pain ( P < or= 0.001 ) and in the ability to perform daily activities ( P < or= 0.001 ) among the intervention group but not for the control group ( P-range from 0.04 to 0.95 ) . One joint protective practice showed a statistically significant increase in both groups ( P < or= 0.001 ) . CONCLUSION Our findings add to evidence showing short-term beneficial effects of self-efficacy theory in education programmes . Self-efficacy theory has great potential for empowering sufferers of chronic conditions to live with their illness PURPOSE S 1 ) To evaluate the effects of a 12-wk high-intensity knee extensor and flexor resistance training program on strength , pain , and adherence in patients with advanced knee osteoarthritis and varus malalignment and 2 ) to generate pilot data for change in dynamic knee joint load , patent-reported outcomes , and self-efficacy after training . METHODS Fourteen patients ( 48.35 + /- 6.51 yr ) with radiographically confirmed medial compartment knee osteoarthritis and varus malalignment of the lower limb were recruited from a surgical waiting list for high tibial osteotomy . Participants completed a high-intensity isokinetic resistance training program three times per week for 12 wk . Knee extensor and flexor strength  were assessed every third week , whereas  pain and adherence  were recorded at every training session . The external knee adduction moment during the gait , the 6-min-walk test , the Knee Injury and Osteoarthritis Outcome Score ( KOOS ) , and the Arthritis Self-Efficacy Scale ( ASES ) were also evaluated before and after training . RESULTS Significant improvements in knee extensor and flexor strength were observed without increases in pain during or after training . Adherence to the high-intensity program was high . No significant changes were observed for dynamic knee joint load or the KOOS . There was a significant increase in the function subscale of the ASES only . CONCLUSIONS These findings suggest that patients with advanced knee osteoarthritis and malalignment can experience substantial gains in strength after a high-intensity resistance training program without concomitant increases in pain , adverse events , or compromised adherence . These findings provide support for future clinical trials with longer-term outcomes OBJECTIVE Fit and Strong ! is an award winning , evidence -based , multiple-component physical activity/behavior change intervention . It is a group- and facility-based program that meets for 90 minutes 3 times per week for 8 weeks ( 24 sessions total ) . We originally tested Fit and Strong ! using physical therapists ( PTs )  as instructors but have transitioned to using nationally certified exercise instructors ( CEIs ) as part of an effort to translate Fit and Strong ! into community-based setting s , and have tested the impact of this shift in instruction type on participant outcomes . METHODS We used a 2-group design . The first 161 participants to sequentially enroll received instruction from PTs . The next 190 sequential enrollees received instruction from CEIs .  All participants were assessed at baseline , at the conclusion of the 8-week Fit and Strong ! program , and at the 6-month followup . RESULTS We saw no significant differences by group on outcomes at 8 weeks or 6 months . Participants in both groups improved significantly with respect to lower-extremity strength , aerobic capacity , pain , stiffness , and physical function . Significant differences favoring the PT-led classes were seen on 2 of 5 mediators , self-efficacy for exercise and barriers adherence efficacy . Participant evaluations rated both types of instruction equally highly , attendance was identical , and no untoward health events were observed or reported under either instruction mode . CONCLUSION Outcomes under the 2 types of instruction are remarkably stable . These findings justify the use of CEIs in the future to extend the reach of the Fit and Strong ! program Background Osteoarthritis ( OA ) is a degenerative disease , considered to be one of the major public health problems . Research suggests that patient education is feasible and valuable for achieving improvements in quality of life , in function , well-being and improved coping . Since 1994 , Primary Health Care in Malmö has used a patient education programme directed towards OA . The aim of this study was to evaluate the effects of this education programme for patients with OA in primary health care in terms of self-efficacy , function and self-perceived health . Method The study was a single-blind , r and omized controlled trial ( RCT ) in which the  EuroQol-5D and Arthritis self-efficacy scale were used to measure self-perceived health and self-efficacy and function was measured with Grip Ability Test for the upper extremity and five different functional tests for the lower extremity . Results We found differences between the intervention group and the control group , comparing the results at baseline and after 6 months in EuroQol-5D ( p < 0.001 ) and in st and ing one leg eyes closed ( p = 0.02 ) in favour of the intervention group . No other differences between the groups were found . Conclusion This study has shown that patient education for patients with osteoarthritis is feasible in a primary health care setting and can improve self-perceived health as well as function in some degree , but not self-efficacy . Further research to investigate the effect of exercise performance on function , as well as self-efficacy is warranted . Trial registration The trial is registered with Clinical Trials.gov . Registration number : OBJECTIVE To examine effects of activity strategy training ( AST ) , a structured rehabilitation program taught by occupational therapists and design ed to teach adaptive strategies for symptom control and engagement in physical activity ( PA ) . METHODS A r and omized controlled pilot trial was conducted at 4 sites ( 3 senior housing facilities and 1 senior center ) in southeastern , lower Michigan . Fifty-four older adults with hip or knee osteoarthritis ( mean + /- SD age 75.3+/-7.1 years ) participated . At each site , older adults were r and omly assigned to 1 of 2 programs : exercise plus AST ( Ex + AST ) or exercise plus health education ( Ex + Ed ) . The programs involved 8 sessions over 4 weeks with 2 followup sessions over a 6-month period , and were conducted concurrently within each site . Pain , total PA and PA intensity ( measured objective ly by actigraphy and subjectively by the Community Healthy Activities Model Program for Seniors question naire ) , arthritis self-efficacy , and physical function were assessed at baseline and posttest . RESULTS At posttest , participants who received Ex + AST had significantly higher levels of objective peak PA ( P=0.02 ) compared with participants who received Ex + Ed . Although not statistically significant , participants in Ex + AST tended to have larger pain decreases , increased total objective and subjective PA , and increased physical function . No effects were found for arthritis self-efficacy . CONCLUSION Although participants were involved in identical exercise programs , participants who received AST tended to have larger increases in PA at posttest compared with participants who received health education . Future studies will be needed to examine larger sample s and long-term effects of AST Background COMP ( Cartilage oligomeric matrix protein ) is a matrix protein , which is currently studied as a potential serum marker for cartilage processes in osteoarthritis ( OA ) . The influence of physical exercise on serum COMP is not fully eluci date d . The objective of the present study was to monitor serum levels of COMP during a r and omised controlled trial of physical exercise vs. st and ardised rest in individuals with symptomatic and radiographic knee OA . Methods Blood sample s were collected from 58 individuals at predefined time points before and after exercise or rest , one training group and one control group . The physical exercise consisted of a one-hour supervised session twice a week and daily home exercises . In a second supplementary study 7 individuals were subjected to the same exercise program and sampling of blood was performed at fixed intervals before , immediately after , 30 and 60 minutes after the exercise session and then with 60 minutes interval for another five hours after exercise to monitor the short-term changes of serum COMP . COMP was quantified with a s and wich-ELISA ( AnaMar Medical , Lund , Sweden ) . Results Before exercise or rest no significant differences in COMP levels were seen between the groups . After 60 minutes exercise serum COMP levels increased ( p < 0.001 ) . After 60 minutes of rest the serum levels decreased ( p = 0.003 ) . Median serum COMP values in sample s obtained prior to exercise or rest at baseline and after 24 weeks did not change between start and end of the study . In the second study serum COMP was increased immediately after exercise ( p = 0.018 ) and had decreased to baseline levels after 30 minutes . ConclusionS erum COMP levels increased during exercise in individuals with knee OA , whereas levels decreased during rest . The increased serum COMP levels were normalized 30 minutes after exercise session , therefore we suggest that sample s of blood for analysis of serum COMP should be drawn after at least 30 minutes rest in a seated position . No increase was seen after a six-week exercise program indicating that any effect of individualized supervised exercise on cartilage turnover is transient Background Studies on exercise in knee osteoarthritis ( OA ) have focused on elderly subjects . Subjects in this study were middle-aged with symptomatic and definite radiographic knee osteoarthritis . The aim was to test the effects of a short-term , high-intensity exercise program on self-reported pain , function and quality of life . Methods Patients aged 36–65 , with OA grade III ( Kellgren & Lawrence ) were recruited . They had been referred for radiographic examination due to knee pain and had no history of major knee injury . They were r and omized to a twice weekly supervised one hour exercise intervention for six weeks , or to a non-intervention control group . Exercise was performed at ≥ 60 % of maximum heart rate ( HR max ) . The primary outcome measure was the Knee injury and Osteoarthritis Outcome Score ( KOOS ) . Follow-up occurred at 6 weeks and 6 months . Results Sixty-one subjects ( mean age 56 ( SD 6 ) , 51 % women , mean BMI 29.5 ( SD 4.8 ) ) were r and omly assigned to intervention ( n = 30 ) or control group ( n = 31 ) . No significant differences in the KOOS subscales assessing pain , other symptoms , or function in daily life or in sport and recreation were seen at any time point between exercisers and controls . In the exercise group , an improvement was seen at 6 weeks in the KOOS subscale quality of life compared to the control group ( mean change 4.0 vs. -0.7 , p = 0.05 ) . The difference between groups was still persistent at 6 months ( p = 0.02 ) . Conclusion A six-week high-intensive exercise program had no effect on pain or function in middle-aged patients with moderate to severe radiographic knee OA . Some effect was seen on quality of life in the exercise group compared to the control group PURPOSE This study assessed the impact of a low cost , multicomponent physical activity intervention for older adults with lower extremity osteoarthritis . DESIGN AND METHODS A r and omized controlled trial compared the effects of a facility-based multiple-component training program followed by home-based adherence  ( n = 80 ) to a  wait list control group ( n = 70 ) . Assessment s were conducted at baseline and at 2 and 6 months following r and omization . The training program consisted of range of motion , resistance training , aerobic walking , and education-group problem solving regarding self-efficacy for exercise and exercise adherence . All training group participants developed individualized plans for posttraining adherence . RESULTS Relative to the persons in the control group , individuals who participated in the exercise program experienced a statistically significant improvement in exercise efficacy , a 48.5 % increase in exercise adherence , and a 13.3 % increase in 6-min distance walk that were accompanied by significant decreases in lower extremity stiffness at 2 and 6 months . Program participants also experienced a significant decrease in lower extremity pain and a borderline significant improvement in efficacy to adhere to exercise over time at 6 months ( p = .052 ) . In contrast , persons in the control group deteriorated over time on the efficacy and adherence measures and showed no change on the other measures . No adverse health effects were encountered . IMPLICATION S These benefits indicate that this low-cost intervention may hold great promise as one of a growing number of public health intervention strategies for older adults in the United States with osteoarthritis The purpose of this study was to assess the relative effects of coping self-efficacy and  catast 
    Output:
    
agent
Small to moderate effect sizes were observed regardless of whether the intervention included exercise .
***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: AIM This paper is a report of a study to assess the effect of an adapted arthritis self-management programme with an added focus on exercise practice among osteoarthritic knee sufferers . BACKGROUND Osteoarthritis of the knee is a major source of loss of function in older people . Previous studies have found self-management programmes to be effective in increasing arthritis self-efficacy and in mastery of self-management practice . METHOD A r and omized control trial was carried out from December 2002 to May 2003 and 120 participants ( 65.9 % , including 67 in intervention group and 53 in control group ) completed the 16-week postintervention assessment s. Outcome measures included arthritis self-efficacy , use of self-management techniques , pain intensity and daily activity . FINDINGS At 16 weeks , there was a ' statistically ' significant improvement in the arthritis self-efficacy level ( P < or= 0.001 ) , in most of the self-management skills , i.e. use of cold and hot compresses , in two of three joint protective practice s ( P < or= 0.001 ; P = 0.01 ) , an increase in the duration of light exercise practice ( P < or= 0.001 ) , reduction of current arthritis pain ( P < or= 0.001 ) and in the ability to perform daily activities ( P < or= 0.001 ) among the intervention group but not for the control group ( P-range from 0.04 to 0.95 ) . One joint protective practice showed a statistically significant increase in both groups ( P < or= 0.001 ) . CONCLUSION Our findings add to evidence showing short-term beneficial effects of self-efficacy theory in education programmes . Self-efficacy theory has great potential for empowering sufferers of chronic conditions to live with their illness PURPOSE S 1 ) To evaluate the effects of a 12-wk high-intensity knee extensor and flexor resistance training program on strength , pain , and adherence in patients with advanced knee osteoarthritis and varus malalignment and 2 ) to generate pilot data for change in dynamic knee joint load , patent-reported outcomes , and self-efficacy after training . METHODS Fourteen patients ( 48.35 + /- 6.51 yr ) with radiographically confirmed medial compartment knee osteoarthritis and varus malalignment of the lower limb were recruited from a surgical waiting list for high tibial osteotomy . Participants completed a high-intensity isokinetic resistance training program three times per week for 12 wk . Knee extensor and flexor strength  were assessed every third week , whereas  pain and adherence  were recorded at every training session . The external knee adduction moment during the gait , the 6-min-walk test , the Knee Injury and Osteoarthritis Outcome Score ( KOOS ) , and the Arthritis Self-Efficacy Scale ( ASES ) were also evaluated before and after training . RESULTS Significant improvements in knee extensor and flexor strength were observed without increases in pain during or after training . Adherence to the high-intensity program was high . No significant changes were observed for dynamic knee joint load or the KOOS . There was a significant increase in the function subscale of the ASES only . CONCLUSIONS These findings suggest that patients with advanced knee osteoarthritis and malalignment can experience substantial gains in strength after a high-intensity resistance training program without concomitant increases in pain , adverse events , or compromised adherence . These findings provide support for future clinical trials with longer-term outcomes OBJECTIVE Fit and Strong ! is an award winning , evidence -based , multiple-component physical activity/behavior change intervention . It is a group- and facility-based program that meets for 90 minutes 3 times per week for 8 weeks ( 24 sessions total ) . We originally tested Fit and Strong ! using physical therapists ( PTs )  as instructors but have transitioned to using nationally certified exercise instructors ( CEIs ) as part of an effort to translate Fit and Strong ! into community-based setting s , and have tested the impact of this shift in instruction type on participant outcomes . METHODS We used a 2-group design . The first 161 participants to sequentially enroll received instruction from PTs . The next 190 sequential enrollees received instruction from CEIs .  All participants were assessed at baseline , at the conclusion of the 8-week Fit and Strong ! program , and at the 6-month followup . RESULTS We saw no significant differences by group on outcomes at 8 weeks or 6 months . Participants in both groups improved significantly with respect to lower-extremity strength , aerobic capacity , pain , stiffness , and physical function . Significant differences favoring the PT-led classes were seen on 2 of 5 mediators , self-efficacy for exercise and barriers adherence efficacy . Participant evaluations rated both types of instruction equally highly , attendance was identical , and no untoward health events were observed or reported under either instruction mode . CONCLUSION Outcomes under the 2 types of instruction are remarkably stable . These findings justify the use of CEIs in the future to extend the reach of the Fit and Strong ! program Background Osteoarthritis ( OA ) is a degenerative disease , considered to be one of the major public health problems . Research suggests that patient education is feasible and valuable for achieving improvements in quality of life , in function , well-being and improved coping . Since 1994 , Primary Health Care in Malmö has used a patient education programme directed towards OA . The aim of this study was to evaluate the effects of this education programme for patients with OA in primary health care in terms of self-efficacy , function and self-perceived health . Method The study was a single-blind , r and omized controlled trial ( RCT ) in which the  EuroQol-5D and Arthritis self-efficacy scale were used to measure self-perceived health and self-efficacy and function was measured with Grip Ability Test for the upper extremity and five different functional tests for the lower extremity . Results We found differences between the intervention group and the control group , comparing the results at baseline and after 6 months in EuroQol-5D ( p < 0.001 ) and in st and ing one leg eyes closed ( p = 0.02 ) in favour of the intervention group . No other differences between the groups were found . Conclusion This study has shown that patient education for patients with osteoarthritis is feasible in a primary health care setting and can improve self-perceived health as well as function in some degree , but not self-efficacy . Further research to investigate the effect of exercise performance on function , as well as self-efficacy is warranted . Trial registration The trial is registered with Clinical Trials.gov . Registration number : OBJECTIVE To examine effects of activity strategy training ( AST ) , a structured rehabilitation program taught by occupational therapists and design ed to teach adaptive strategies for symptom control and engagement in physical activity ( PA ) . METHODS A r and omized controlled pilot trial was conducted at 4 sites ( 3 senior housing facilities and 1 senior center ) in southeastern , lower Michigan . Fifty-four older adults with hip or knee osteoarthritis ( mean + /- SD age 75.3+/-7.1 years ) participated . At each site , older adults were r and omly assigned to 1 of 2 programs : exercise plus AST ( Ex + AST ) or exercise plus health education ( Ex + Ed ) . The programs involved 8 sessions over 4 weeks with 2 followup sessions over a 6-month period , and were conducted concurrently within each site . Pain , total PA and PA intensity ( measured objective ly by actigraphy and subjectively by the Community Healthy Activities Model Program for Seniors question naire ) , arthritis self-efficacy , and physical function were assessed at baseline and posttest . RESULTS At posttest , participants who received Ex + AST had significantly higher levels of objective peak PA ( P=0.02 ) compared with participants who received Ex + Ed . Although not statistically significant , participants in Ex + AST tended to have larger pain decreases , increased total objective and subjective PA , and increased physical function . No effects were found for arthritis self-efficacy . CONCLUSION Although participants were involved in identical exercise programs , participants who received AST tended to have larger increases in PA at posttest compared with participants who received health education . Future studies will be needed to examine larger sample s and long-term effects of AST Background COMP ( Cartilage oligomeric matrix protein ) is a matrix protein , which is currently studied as a potential serum marker for cartilage processes in osteoarthritis ( OA ) . The influence of physical exercise on serum COMP is not fully eluci date d . The objective of the present study was to monitor serum levels of COMP during a r and omised controlled trial of physical exercise vs. st and ardised rest in individuals with symptomatic and radiographic knee OA . Methods Blood sample s were collected from 58 individuals at predefined time points before and after exercise or rest , one training group and one control group . The physical exercise consisted of a one-hour supervised session twice a week and daily home exercises . In a second supplementary study 7 individuals were subjected to the same exercise program and sampling of blood was performed at fixed intervals before , immediately after , 30 and 60 minutes after the exercise session and then with 60 minutes interval for another five hours after exercise to monitor the short-term changes of serum COMP . COMP was quantified with a s and wich-ELISA ( AnaMar Medical , Lund , Sweden ) . Results Before exercise or rest no significant differences in COMP levels were seen between the groups . After 60 minutes exercise serum COMP levels increased ( p < 0.001 ) . After 60 minutes of rest the serum levels decreased ( p = 0.003 ) . Median serum COMP values in sample s obtained prior to exercise or rest at baseline and after 24 weeks did not change between start and end of the study . In the second study serum COMP was increased immediately after exercise ( p = 0.018 ) and had decreased to baseline levels after 30 minutes . ConclusionS erum COMP levels increased during exercise in individuals with knee OA , whereas levels decreased during rest . The increased serum COMP levels were normalized 30 minutes after exercise session , therefore we suggest that sample s of blood for analysis of serum COMP should be drawn after at least 30 minutes rest in a seated position . No increase was seen after a six-week exercise program indicating that any effect of individualized supervised exercise on cartilage turnover is transient Background Studies on exercise in knee osteoarthritis ( OA ) have focused on elderly subjects . Subjects in this study were middle-aged with symptomatic and definite radiographic knee osteoarthritis . The aim was to test the effects of a short-term , high-intensity exercise program on self-reported pain , function and quality of life . Methods Patients aged 36–65 , with OA grade III ( Kellgren & Lawrence ) were recruited . They had been referred for radiographic examination due to knee pain and had no history of major knee injury . They were r and omized to a twice weekly supervised one hour exercise intervention for six weeks , or to a non-intervention control group . Exercise was performed at ≥ 60 % of maximum heart rate ( HR max ) . The primary outcome measure was the Knee injury and Osteoarthritis Outcome Score ( KOOS ) . Follow-up occurred at 6 weeks and 6 months . Results Sixty-one subjects ( mean age 56 ( SD 6 ) , 51 % women , mean BMI 29.5 ( SD 4.8 ) ) were r and omly assigned to intervention ( n = 30 ) or control group ( n = 31 ) . No significant differences in the KOOS subscales assessing pain , other symptoms , or function in daily life or in sport and recreation were seen at any time point between exercisers and controls . In the exercise group , an improvement was seen at 6 weeks in the KOOS subscale quality of life compared to the control group ( mean change 4.0 vs. -0.7 , p = 0.05 ) . The difference between groups was still persistent at 6 months ( p = 0.02 ) . Conclusion A six-week high-intensive exercise program had no effect on pain or function in middle-aged patients with moderate to severe radiographic knee OA . Some effect was seen on quality of life in the exercise group compared to the control group PURPOSE This study assessed the impact of a low cost , multicomponent physical activity intervention for older adults with lower extremity osteoarthritis . DESIGN AND METHODS A r and omized controlled trial compared the effects of a facility-based multiple-component training program followed by home-based adherence  ( n = 80 ) to a  wait list control group ( n = 70 ) . Assessment s were conducted at baseline and at 2 and 6 months following r and omization . The training program consisted of range of motion , resistance training , aerobic walking , and education-group problem solving regarding self-efficacy for exercise and exercise adherence . All training group participants developed individualized plans for posttraining adherence . RESULTS Relative to the persons in the control group , individuals who participated in the exercise program experienced a statistically significant improvement in exercise efficacy , a 48.5 % increase in exercise adherence , and a 13.3 % increase in 6-min distance walk that were accompanied by significant decreases in lower extremity stiffness at 2 and 6 months . Program participants also experienced a significant decrease in lower extremity pain and a borderline significant improvement in efficacy to adhere to exercise over time at 6 months ( p = .052 ) . In contrast , persons in the control group deteriorated over time on the efficacy and adherence measures and showed no change on the other measures . No adverse health effects were encountered . IMPLICATION S These benefits indicate that this low-cost intervention may hold great promise as one of a growing number of public health intervention strategies for older adults in the United States with osteoarthritis The purpose of this study was to assess the relative effects of coping self-efficacy and  catast 
    Output:
    