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: Background Pedometer-based programs have elicited increased walking behaviors associated with improvements in blood pressure in sedentary/low active postmenopausal women , a population at increased risk of cardiovascular disease . Such programs typically encourage increasing the volume of physical activity with little regard for its intensity . Recent advances in commercially available pedometer technology now permit tracking of both steps/day and time in moderate ( or greater ) intensity physical activity on a daily basis . It is not known whether the dual message to increase steps/day while also increasing time spent at higher intensity walking will elicit additional improvements in blood pressure relative to a message to only focus on increasing steps/day . The purpose of this paper is to present the rationale , study design , and protocol s employed in WalkMore , a 3-arm 3-month blinded and r and omized controlled trial ( RCT ) design ed to compare the effects of two community pedometer-based walking interventions ( reflecting these separate and combined messages ) relative to a control group on blood pressure in sedentary/low active post-menopausal women , a population at increased risk of cardiovascular disease . Methods / Design 120 sedentary/low active post-menopausal women ( 45 - 74 years of age ) will be r and omly assigned ( computer-generated ) to 1 of 3 groups : A ) 10,000 steps/day ( with no guidance on walking intensity/speed/cadence ; BASIC intervention , n = 50 ) ; B ) 10,000 steps/day and at least 30 minutes in moderate intensity ( i.e. , a cadence of at least 100 steps/min ; ENHANCED intervention , n = 50 ) ; or a Control group ( n = 20 ) . An important strength of the study is the strict control and quantification of the pedometer-based physical activity interventions . The primary outcome is systolic blood pressure . Secondary outcomes include diastolic blood pressure , anthropometric measurements , fasting blood glucose and insulin , flow mediated dilation , gait speed , and accelerometer-determined physical activity and sedentary behavior . Discussion This study can make important contributions to our underst and ing of the relative benefits that walking volume and /or intensity may have on blood pressure in a population at risk of cardiovascular disease . Trial registration Clinical Trials.gov Record NCT01519583 , January 18 , PURPOSE ( a ) To establish pedometer steps/min intensity categories ( i.e. , light , moderate , hard , very hard ) for adults under controlled conditions , and ( b ) use these cut-points to ascertain the number of steps expected in 30 minutes of moderate intensity activity . METHODS 25 men and 25 women , ages 18 - 39 years , performed 6-min exercise bouts at 3 treadmill speeds ( 4.8 , 6.4 , and  9.7 km/hr ) . Yamax SW-200 pedometers indicated steps  , and steady-state VO2 was recorded . METs were calculated by dividing steady-state VO2 by 3.5 ml x kg(-1 ) x min(-1 ) . Linear regression was used to quantify the relationships between steps/min and METs across all speeds . Ten participants ( 5 M , 5 F ) were r and omly selected from the original 50 and constituted a holdout sample for cross-validation purpose s ( i.e , comparing actual and predicted METs ; paired t-test ) . RESULTS The regression equation for males was : METs = -7.065 + ( 0.105 x steps/min ) r2 = 0.803 . For females it was : METs = -8.805 + ( 0.110 x steps/min ) r2 = 0.830 . Cross-validation was confirmed . CONCLUSIONS Pedometer cut-points corresponding to minimal moderate intensity walking were 96 steps/min in men and 107 steps/min in women , or roughly 100 steps/min for both . This translates to approximately 3,000 steps in 30 min of moderate-intensity ambulatory activity for both genders BACKGROUND Increasing moderate-to-vigorous-intensity physical activity ( MVPA ) is an important public health goal . Pedometers are evidence -based devices for increasing daily activity , but studies have not evaluated the comparative efficacy of step cadence goals for increasing MVPA . PURPOSE This study aim ed to evaluate the efficacy of three pedometer-based step goals for increasing MVPA . METHODS Latina women ( n = 180 ; 18 - 55 yr , mean body mass index = 31.1 , SD = 6.5 ) were recruited to 12 community centers , which were r and omly assigned to one of three conditions . Each group received an identical 12-wk theory-based physical activity ( PA ) intervention that differed only on the type of daily step goal : 1 ) a self-selected goal ( SELF ) ; 2 ) a goal of 10,000 steps per day ( FREQUENCY ) ; or 3 ) a goal of 3000 steps in 30 min ( CADENCE ) . Accelerometer-based PA  was measured at baseline and after 12 wk . RESULTS Adjusted multilevel pattern-mixture models using generalized estimating equations revealed that participants in the CADENCE condition engaged in similar levels of postintervention MVPA to those in the SELF and FREQUENCY goal conditions . However , MVPA of participants in the CADENCE condition was more likely to occur in bouts lasting greater than 10 consecutive minutes compared with the MVPA of participants in the SELF ( P = 0.01 ) or FREQUENCY ( P = 0001 ) conditions . CONCLUSIONS PA interventions should consider including a step cadence goal to help individuals accumulate bout-based MVPA and meet national PA guidelines Self-efficacy has a well-established , beneficial effect on health behavior and health status in young and middle-aged adults , but little is known about these relationships in older population s. We examined this issue as part of a r and omized trial to determine the cost savings and changes in health-related quality of life associated with the provision and reimbursement of a preventive services package to 2,524 Medicare beneficiaries enrolled in Group Health Cooperative of Puget Sound .  Baseline self-efficacy data  were collected for all participants in five behavioral areas : exercise , dietary fat intake , weight control , alcohol intake , and smoking . Results reveal that efficacy and outcome expectations for these health behaviors are not independent . Correlational and factor analyses indicate two dimensions of efficacy expectations , one consisting of exercise , dietary fat , and weight control , and another consisting of smoking and alcohol consumption . Outcome expectations of the five behaviors form a single dimension . Older adults with high self-efficacy had lower health risk in all behaviors and better health . Regression analyses detected a positive association between socioeconomic status and health-related quality of life ( p < .02 ) , but the strength of the association declined ( p < .11 ) after the self-efficacy measures entered the model , indicating that self-efficacy explains part of the association between socioeconomic status and health status . Interventions aim ed at improving self-efficacy also may improve health status Recent public health recommendations for step frequency over a given timeframe ( steps min(-1 ) ) associated with moderate-intensity physical activity ( MPA ) have been developed . The recommendation suggests 100 steps min(-1 ) . This estimate overlooks the impact of anthropometric differences between individuals , notably leg length , which is related to step frequency . Therefore this study examined the impact of leg length on steps min(-1 ) associated with MPA . Twenty adults age 20 - 40 years ( age 26.4+/-4.6 years , 9 males ) walked  over-ground  at five walking speeds ( 0.5 m s(-1 ) , 0.75 m s(-1 ) , 1.0 m s(-1 ) , 1.25 m s(-1 ) , and 1.5 m s(-1 ) ) , lasting 6 min each , while wearing a portable gas analyser . Participants ' step frequency ( steps min(-1 ) ) for each walking speed was determined using a h and -tally counter . R and om effects models were used to predict steps min(-1 ) from METs and participant anthropometric measures ( body mass index and leg length [ cm ] ) . Model estimates were used to predict steps min(-1 ) corresponding to heights ranging from 5 ft . to 6 ft . 6 in . ( 6 in increments ) . Overall , 100 steps min(-1 ) corresponded to expending 3 METs ( SEE 3.49 steps min(-1 ) , R(2)=0.68 ) . As leg length increased estimated steps min(-1 ) decreased by -1.15 steps min(-1 ) ( 95CI -2.19 to -0.10 steps min(-1 ) ) . Based on leg length for individuals 5 ft to 6 ft 6 in . , steps min(-1 ) ranged from 111 to 85 , respectively . Established steps min(-1 ) cutpoints associated with MPA are general public health guidelines and anthropometric differences in leg length should be accounted for when developing step frequency recommendations for physical activity or weight loss studies that include individuals of varying height Purpose . Determine the proportion of adults aware of Canada 's Physical Activity Guide to Healthy Active Living ( Guide ) and its specific recommendations ( objective 1 ) ; whether key demographic factors ( objective 2a ) and physical activity behavior ( objective 2b ) are associated with awareness and specific familiarity with the Guide ; and if changes in awareness and specific recommendations with the Guide occurred over a 1-year period ( objective 3a and 3b ) . Design . R and om selection with computer-assisted telephone interviewing . Setting . Edmonton , Alberta , Canada . Subjects . A total of 2803 adults 18 years or older completed interviews from 4831 telephone contacts ( response rate , 58.0 % ) , and after 1 year , 1423 individuals ( 55 % ) completed interviews . Measures . Demographic , physical activity , Guide awareness . Analysis . Chi-square , analysis of variance . Results . At baseline , 27.3 % were aware of the Guide , and 15.6 % were familiar with the Guide 's specific recommendations . Younger individuals ( p = .01 ) , women ( p < .001 ) , and those with a higher education ( p < .001 ) were more likely to be generally aware of the Guide , and women were also more specifically aware ( p = .01 ) . Physical activity levels were positively associated with the general ( p < .001 ) and specific ( p < .001 ) awareness of the Guide . Changes in general familiarity and specific recommendations over 1 year were observed . Conclusions . The majority of those surveyed were not familiar with the Guide . Men , individuals with a lower education , and older individuals may need to be specifically targeted . ( Am J Health Promot 2011;25[5]:294 - 297 . PURPOSE The study investigated ( a ) walking intensity ( stride rate and energy expenditure ) under three speed instructions ; ( b ) associations between stride rate , age , height , and walking intensity ; and ( c ) synchronization between stride rate and music tempo during overground walking in a population of healthy older adults . METHODS Twenty-nine participants completed 3 treadmill-walking trials and 3 overground-walking trials at 3 self-selected speeds . Treadmill VO2  was measured using indirect calorimetry .  Stride rate and music tempo were recorded during overground-walking trials . RESULTS Mean stride rate exceeded minimum thresholds for moderate to vigorous physical activity ( MVPA ) under slow ( 111.41 ± 11.93 ) , medium ( 118.17 ± 11.43 ) , and fast ( 123.79 ± 11.61 ) instructions . A multilevel model showed that stride rate , age , and height have a significant effect ( p < .01 ) on walking intensity . CONCLUSIONS Healthy older adults achieve MVPA with stride rates that fall below published minima for MVPA . Stride rate , age , and height are significant predictors of energy expenditure in this population . Music can be a useful way to guide walking cadence OBJECTIVES The purpose was to determine if a 12-week weight loss intervention with a physical activity ( PA ) component would lead to changes in steps/day , step count accumulation patterns , and peak cadence . DESIGN R and omized clinical trial . METHODS Overall , 121 overweight/obese White and African-American adults ( ages 35 - 64yrs ) were r and omized to a diet education plus PA education and behavior change intervention group ( DE+PA ) or diet education and behavior change group ( DE ) . The DE+PA intervention was design ed to increase steps/day , and steps at moderate-to-vigorous intensity . The Actigraph GT3X+ accelerometer was used to measure steps accumulated in different cadence b and s ( 1 - 19 , 20 - 39 , 40 - 59 , 60 - 79 , 80 - 99 , 100 - 119 , 120 + steps/min ) , and peak 1-min , 30-min and 60-min cadence . Pre- to post-intervention changes in steps/day , step count within each cadence b and , and peak cadences were compared within groups using paired sample t-test and between groups after adjustment for baseline values of the same variable using ANCOVA . RESULTS Ninety participants had valid data ( 44 in the DE+PA  group ) . Change in steps/day was not significantly different between the groups . However , participants in the DE+PA group accumulated significantly more steps at post-intervention in the 80 - 99 , 100 - 119 , and 120 + cadence b and s , all p<0.02 . The DE+PA group increased step counts accumulated within the 100 - 119 ( 463±109 
    Output:
    
agent
In general , 100 steps/minute is prescribed for adults to achieve moderate intensity , but older adults may require a higher cadence .
Currently , few studies have explored using walking cadence prescription as an intervention to increase physical activity levels .
Conclusion .
Prescribing walking cadence as a way to increase physical activity levels has potential as a practical and useful strategy , but more evidence is required to assess its ability to increase physical activity levels at moderate intensity
***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: Background Pedometer-based programs have elicited increased walking behaviors associated with improvements in blood pressure in sedentary/low active postmenopausal women , a population at increased risk of cardiovascular disease . Such programs typically encourage increasing the volume of physical activity with little regard for its intensity . Recent advances in commercially available pedometer technology now permit tracking of both steps/day and time in moderate ( or greater ) intensity physical activity on a daily basis . It is not known whether the dual message to increase steps/day while also increasing time spent at higher intensity walking will elicit additional improvements in blood pressure relative to a message to only focus on increasing steps/day . The purpose of this paper is to present the rationale , study design , and protocol s employed in WalkMore , a 3-arm 3-month blinded and r and omized controlled trial ( RCT ) design ed to compare the effects of two community pedometer-based walking interventions ( reflecting these separate and combined messages ) relative to a control group on blood pressure in sedentary/low active post-menopausal women , a population at increased risk of cardiovascular disease . Methods / Design 120 sedentary/low active post-menopausal women ( 45 - 74 years of age ) will be r and omly assigned ( computer-generated ) to 1 of 3 groups : A ) 10,000 steps/day ( with no guidance on walking intensity/speed/cadence ; BASIC intervention , n = 50 ) ; B ) 10,000 steps/day and at least 30 minutes in moderate intensity ( i.e. , a cadence of at least 100 steps/min ; ENHANCED intervention , n = 50 ) ; or a Control group ( n = 20 ) . An important strength of the study is the strict control and quantification of the pedometer-based physical activity interventions . The primary outcome is systolic blood pressure . Secondary outcomes include diastolic blood pressure , anthropometric measurements , fasting blood glucose and insulin , flow mediated dilation , gait speed , and accelerometer-determined physical activity and sedentary behavior . Discussion This study can make important contributions to our underst and ing of the relative benefits that walking volume and /or intensity may have on blood pressure in a population at risk of cardiovascular disease . Trial registration Clinical Trials.gov Record NCT01519583 , January 18 , PURPOSE ( a ) To establish pedometer steps/min intensity categories ( i.e. , light , moderate , hard , very hard ) for adults under controlled conditions , and ( b ) use these cut-points to ascertain the number of steps expected in 30 minutes of moderate intensity activity . METHODS 25 men and 25 women , ages 18 - 39 years , performed 6-min exercise bouts at 3 treadmill speeds ( 4.8 , 6.4 , and  9.7 km/hr ) . Yamax SW-200 pedometers indicated steps  , and steady-state VO2 was recorded . METs were calculated by dividing steady-state VO2 by 3.5 ml x kg(-1 ) x min(-1 ) . Linear regression was used to quantify the relationships between steps/min and METs across all speeds . Ten participants ( 5 M , 5 F ) were r and omly selected from the original 50 and constituted a holdout sample for cross-validation purpose s ( i.e , comparing actual and predicted METs ; paired t-test ) . RESULTS The regression equation for males was : METs = -7.065 + ( 0.105 x steps/min ) r2 = 0.803 . For females it was : METs = -8.805 + ( 0.110 x steps/min ) r2 = 0.830 . Cross-validation was confirmed . CONCLUSIONS Pedometer cut-points corresponding to minimal moderate intensity walking were 96 steps/min in men and 107 steps/min in women , or roughly 100 steps/min for both . This translates to approximately 3,000 steps in 30 min of moderate-intensity ambulatory activity for both genders BACKGROUND Increasing moderate-to-vigorous-intensity physical activity ( MVPA ) is an important public health goal . Pedometers are evidence -based devices for increasing daily activity , but studies have not evaluated the comparative efficacy of step cadence goals for increasing MVPA . PURPOSE This study aim ed to evaluate the efficacy of three pedometer-based step goals for increasing MVPA . METHODS Latina women ( n = 180 ; 18 - 55 yr , mean body mass index = 31.1 , SD = 6.5 ) were recruited to 12 community centers , which were r and omly assigned to one of three conditions . Each group received an identical 12-wk theory-based physical activity ( PA ) intervention that differed only on the type of daily step goal : 1 ) a self-selected goal ( SELF ) ; 2 ) a goal of 10,000 steps per day ( FREQUENCY ) ; or 3 ) a goal of 3000 steps in 30 min ( CADENCE ) . Accelerometer-based PA  was measured at baseline and after 12 wk . RESULTS Adjusted multilevel pattern-mixture models using generalized estimating equations revealed that participants in the CADENCE condition engaged in similar levels of postintervention MVPA to those in the SELF and FREQUENCY goal conditions . However , MVPA of participants in the CADENCE condition was more likely to occur in bouts lasting greater than 10 consecutive minutes compared with the MVPA of participants in the SELF ( P = 0.01 ) or FREQUENCY ( P = 0001 ) conditions . CONCLUSIONS PA interventions should consider including a step cadence goal to help individuals accumulate bout-based MVPA and meet national PA guidelines Self-efficacy has a well-established , beneficial effect on health behavior and health status in young and middle-aged adults , but little is known about these relationships in older population s. We examined this issue as part of a r and omized trial to determine the cost savings and changes in health-related quality of life associated with the provision and reimbursement of a preventive services package to 2,524 Medicare beneficiaries enrolled in Group Health Cooperative of Puget Sound .  Baseline self-efficacy data  were collected for all participants in five behavioral areas : exercise , dietary fat intake , weight control , alcohol intake , and smoking . Results reveal that efficacy and outcome expectations for these health behaviors are not independent . Correlational and factor analyses indicate two dimensions of efficacy expectations , one consisting of exercise , dietary fat , and weight control , and another consisting of smoking and alcohol consumption . Outcome expectations of the five behaviors form a single dimension . Older adults with high self-efficacy had lower health risk in all behaviors and better health . Regression analyses detected a positive association between socioeconomic status and health-related quality of life ( p < .02 ) , but the strength of the association declined ( p < .11 ) after the self-efficacy measures entered the model , indicating that self-efficacy explains part of the association between socioeconomic status and health status . Interventions aim ed at improving self-efficacy also may improve health status Recent public health recommendations for step frequency over a given timeframe ( steps min(-1 ) ) associated with moderate-intensity physical activity ( MPA ) have been developed . The recommendation suggests 100 steps min(-1 ) . This estimate overlooks the impact of anthropometric differences between individuals , notably leg length , which is related to step frequency . Therefore this study examined the impact of leg length on steps min(-1 ) associated with MPA . Twenty adults age 20 - 40 years ( age 26.4+/-4.6 years , 9 males ) walked  over-ground  at five walking speeds ( 0.5 m s(-1 ) , 0.75 m s(-1 ) , 1.0 m s(-1 ) , 1.25 m s(-1 ) , and 1.5 m s(-1 ) ) , lasting 6 min each , while wearing a portable gas analyser . Participants ' step frequency ( steps min(-1 ) ) for each walking speed was determined using a h and -tally counter . R and om effects models were used to predict steps min(-1 ) from METs and participant anthropometric measures ( body mass index and leg length [ cm ] ) . Model estimates were used to predict steps min(-1 ) corresponding to heights ranging from 5 ft . to 6 ft . 6 in . ( 6 in increments ) . Overall , 100 steps min(-1 ) corresponded to expending 3 METs ( SEE 3.49 steps min(-1 ) , R(2)=0.68 ) . As leg length increased estimated steps min(-1 ) decreased by -1.15 steps min(-1 ) ( 95CI -2.19 to -0.10 steps min(-1 ) ) . Based on leg length for individuals 5 ft to 6 ft 6 in . , steps min(-1 ) ranged from 111 to 85 , respectively . Established steps min(-1 ) cutpoints associated with MPA are general public health guidelines and anthropometric differences in leg length should be accounted for when developing step frequency recommendations for physical activity or weight loss studies that include individuals of varying height Purpose . Determine the proportion of adults aware of Canada 's Physical Activity Guide to Healthy Active Living ( Guide ) and its specific recommendations ( objective 1 ) ; whether key demographic factors ( objective 2a ) and physical activity behavior ( objective 2b ) are associated with awareness and specific familiarity with the Guide ; and if changes in awareness and specific recommendations with the Guide occurred over a 1-year period ( objective 3a and 3b ) . Design . R and om selection with computer-assisted telephone interviewing . Setting . Edmonton , Alberta , Canada . Subjects . A total of 2803 adults 18 years or older completed interviews from 4831 telephone contacts ( response rate , 58.0 % ) , and after 1 year , 1423 individuals ( 55 % ) completed interviews . Measures . Demographic , physical activity , Guide awareness . Analysis . Chi-square , analysis of variance . Results . At baseline , 27.3 % were aware of the Guide , and 15.6 % were familiar with the Guide 's specific recommendations . Younger individuals ( p = .01 ) , women ( p < .001 ) , and those with a higher education ( p < .001 ) were more likely to be generally aware of the Guide , and women were also more specifically aware ( p = .01 ) . Physical activity levels were positively associated with the general ( p < .001 ) and specific ( p < .001 ) awareness of the Guide . Changes in general familiarity and specific recommendations over 1 year were observed . Conclusions . The majority of those surveyed were not familiar with the Guide . Men , individuals with a lower education , and older individuals may need to be specifically targeted . ( Am J Health Promot 2011;25[5]:294 - 297 . PURPOSE The study investigated ( a ) walking intensity ( stride rate and energy expenditure ) under three speed instructions ; ( b ) associations between stride rate , age , height , and walking intensity ; and ( c ) synchronization between stride rate and music tempo during overground walking in a population of healthy older adults . METHODS Twenty-nine participants completed 3 treadmill-walking trials and 3 overground-walking trials at 3 self-selected speeds . Treadmill VO2  was measured using indirect calorimetry .  Stride rate and music tempo were recorded during overground-walking trials . RESULTS Mean stride rate exceeded minimum thresholds for moderate to vigorous physical activity ( MVPA ) under slow ( 111.41 ± 11.93 ) , medium ( 118.17 ± 11.43 ) , and fast ( 123.79 ± 11.61 ) instructions . A multilevel model showed that stride rate , age , and height have a significant effect ( p < .01 ) on walking intensity . CONCLUSIONS Healthy older adults achieve MVPA with stride rates that fall below published minima for MVPA . Stride rate , age , and height are significant predictors of energy expenditure in this population . Music can be a useful way to guide walking cadence OBJECTIVES The purpose was to determine if a 12-week weight loss intervention with a physical activity ( PA ) component would lead to changes in steps/day , step count accumulation patterns , and peak cadence . DESIGN R and omized clinical trial . METHODS Overall , 121 overweight/obese White and African-American adults ( ages 35 - 64yrs ) were r and omized to a diet education plus PA education and behavior change intervention group ( DE+PA ) or diet education and behavior change group ( DE ) . The DE+PA intervention was design ed to increase steps/day , and steps at moderate-to-vigorous intensity . The Actigraph GT3X+ accelerometer was used to measure steps accumulated in different cadence b and s ( 1 - 19 , 20 - 39 , 40 - 59 , 60 - 79 , 80 - 99 , 100 - 119 , 120 + steps/min ) , and peak 1-min , 30-min and 60-min cadence . Pre- to post-intervention changes in steps/day , step count within each cadence b and , and peak cadences were compared within groups using paired sample t-test and between groups after adjustment for baseline values of the same variable using ANCOVA . RESULTS Ninety participants had valid data ( 44 in the DE+PA  group ) . Change in steps/day was not significantly different between the groups . However , participants in the DE+PA group accumulated significantly more steps at post-intervention in the 80 - 99 , 100 - 119 , and 120 + cadence b and s , all p<0.02 . The DE+PA group increased step counts accumulated within the 100 - 119 ( 463±109 
    Output:
    