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 The aim of this study was to determine whether the Comprehensive Reminder System based on the Health Belief Model improves health belief , health behaviours , medication adherence and blood pressure control as a means of decreasing the rate of stroke recurrence among hypertensive ischaemic stroke . BACKGROUND Hypertensive patients having experienced recent ischaemic strokes are at high risk for stroke recurrence . Several trials attempted to improve secondary stroke prevention via patient education , however , patient outcomes remained poor . Long-term follow-up studies regarding secondary stroke prevention are limited . DESIGN A multi-centre , 12-month , assessor-blinded , parallel-group , r and omized controlled longitudinal trial . METHODS Hypertensive patients having experienced an ischaemic stroke are the target population . The intervention consists of health belief education , a calendar h and book , a weekly automated short-message service and four telephone follow-up interviews . Outcomes will be assessed at baseline and at 3 , 6 and 12 months following discharge . The primary outcome is blood pressure control . The secondary outcomes include health belief , health behaviours and medication adherence . The clinical endpoint is the rate of stroke recurrence . DISCUSSION Although many efforts to improve secondary stroke prevention have been undertaken , research indicates that improvements remain possible and warranted . This research protocol based on the Health Belief Model will improve our underst and ing of stroke education and transitional care needed in China and with the world-wide target population Objective To assess , in a sample of systematic review s of non-pharmacological interventions , the completeness of intervention reporting , identify the most frequently missing elements , and assess review authors ’ use of and beliefs about providing intervention information . Design Analysis of a r and om sample of systematic review s of non-pharmacological stroke interventions ; online survey of review authors . Data sources and study selection The Cochrane Library and PubMed were search ed for potentially eligible systematic review s and a r and om sample of these assessed for eligibility until 60 ( 30 Cochrane , 30 non-Cochrane ) eligible review s were identified . Data collection In each review , the completeness of the intervention description in each eligible trial ( n=568 ) was assessed by 2 independent raters using the Template for Intervention Description and Replication ( TIDieR ) checklist . All review authors ( n=46 ) were invited to complete a survey . Results Most review s were missing intervention information for the majority of items . The most incompletely described items were : modifications , fidelity , material s , procedure and tailoring ( missing from all interventions in 97 % , 90 % , 88 % , 83 % and 83 % of review s , respectively ) . Items that scored better , but were still incomplete for the majority of review s , were : ‘ when and how much ’ ( in 31 % of review s , adequate for all trials ; in 57 % of review s , adequate for some trials ) ; intervention mode ( in 22 % of review s , adequate for all trials ; in 38 % , adequate for some trials ) ; and location ( in 19 % of review s , adequate for all trials ) . Of the 33 ( 71 % ) authors who responded , 58 % reported having further intervention information but not including it , and 70 % tried to obtain information . Conclusions Most focus on intervention reporting has been directed at trials . Poor intervention reporting in stroke systematic review s is prevalent , compounded by poor trial reporting . Without adequate intervention descriptions , the conduct , usability and interpretation of review s are restricted and therefore , require action by trialists , systematic review ers , peer review ers and editors Background and Purpose — Longitudinal conducted studies show that neurologic and functional recovery show faster recovery in the first weeks poststroke . The aim of the present study was to study the effects of progress of time on observed improvements in motor strength , synergisms , and activities during the first 16 weeks poststroke . Methods — Based on data from a previous study , 101 patients with first-ever ischemic middle cerebral artery strokes were prospect ively investigated during the first 16 weeks after stroke . Progress of time was categorized into 8 biweekly time intervals and was used as the independent covariate in a first-order longitudinal regression model . The biweekly time change ( progress of time ) was related to improvement in upper and lower limb motor recovery assessed with Fugl-Meyer score and Motricity Index , reduction in visuospatial inattention based on the letter cancellation task , and improvement in walking ability , dexterity , and activities of daily living measured with the Functional Ambulation Categories , Action Research Arm test , and Barthel Index . Results — Time explained a significant change of 8.4 ( 42 % ) measurement units on the Barthel Index for the first 10 weeks poststroke , 1.1 ( 22 % ) measurement units on Functional Ambulation Categories , and 19 % on the Action Research Arm test for the first 6 and 8 weeks poststroke . Approximately 25 % ( for Fugl-Meyer – arm ) to 26 % ( for Motricity Index – arm ) of the significant change in measurements units was explained by time alone for the upper limb compared with 33 % for Fugl-Meyer – leg and 39 % for Motricity Index – leg of the lower limb . Time accounted for a reduction of 16 % in the letter cancellation task . Observed associations did not change after controlling for covariates such as age , gender , hemisphere of stroke , type of stroke , or intervention . Conclusion — Progress of time is an independent covariate that reflects spontaneous recovery of body functions and activities explaining ≈16 % to 42 % of the observed improvements in the first 6 to 10 weeks after stroke onset Background and Purpose — Insulin resistance and glucose intolerance are highly prevalent after stroke , contributing to worsening cardiovascular disease risk and a predisposition to recurrent stroke . Treadmill exercise training ( T-AEX ) increases aerobic capacity ( Vo2 peak ) in chronic stroke patients , suggesting intensity levels that may be adequate to improve glucose metabolism . We compared the effects of a progressive T-AEX intervention to an attention-matched stretching intervention ( CONTROL ) on glucose tolerance and indices of insulin sensitivity in stroke survivors . Methods — Participants had hemiparetic gait after remote ( > 6 months ) ischemic stroke . They were r and omized to 6-month T-AEX or a duration matched reference CONTROL program of supervised stretching exercises . Main outcome measures were glucose and insulin responses during a 3-hour oral glucose tolerance test ( OGTT ) . Results — Forty-six subjects ( T-AEX=26 , CONTROL=20 ) completed OGTT testing before and after the interventions . T-AEX  increased Vo2 peak ( + 15 % versus −3 % & Dgr ; , P<0.01 ) compared with CONTROL . There were significant reductions in fasting insulin ( −23 % versus + 9 % & Dgr ; , P<0.05 ) and the total integrated 3-hour insulin response ( −24 % versus + 3 % & Dgr ; , P<0.01 ) in T-AEX compared with CONTROL . In patients with abnormal glucose tolerance at baseline , T-AEX result ed in a significant 14 % decrease in 3-hour glucose response ( n=12 , P<0.05 ) . Fifty-eight percent of T-AEX participants with abnormal baseline OGTT ( 7 of 12 ) improved glucose tolerance status at 2 hours compared with < 10 % ( 1 of 11 ) of impaired CONTROLS ( P<0.05 ) . Conclusions — These preliminary findings suggest that progressive aerobic exercise can reduce insulin resistance and prevent diabetes in hemiparetic stroke survivors . Larger clinical trials are needed to definitively establish the use of structured exercise training for stimulating metabolic improvement poststroke Even when adults meet physical activity guidelines , sitting for prolonged periods can compromise metabolic health .  Television ( TV ) time and objective measurement studies show deleterious associations , and breaking up sedentary time is beneficial .  Sitting time , TV time , and time sitting in automobiles increase premature mortality risk . Further evidence from prospect i ve studies , intervention trials , and population -based behavioral studies is required BACKGROUND AND PURPOSE Little is known about the relative efficacy of supervised versus unsupervised community exercise programs for stroke survivors . This study compared the effectiveness of a 10-week supervised strengthening and conditioning program ( supervised ) with a 1-week supervised instruction program followed by a 9-week unsupervised home program ( unsupervised ) and evaluated retention of changes at 6 months and 1 year after program completion . METHODS Seventy-two subjects retained at baseline ( 27 women , 45 men ; mean+/-SD age , 64.6+/-11.8 years ) were r and omly allocated to receive the supervised or unsupervised program . The primary outcome was walking speed over 6 minutes , and secondary outcome measures were Human Activity Profile , Medical Outcome Study 36-Item Short-Form survey ( SF-36 ) , Physiological Cost Index , and lower extremity muscle strength . RESULTS The 6-minute walking speed increased significantly in both groups and remained significantly improved by 1 year . The Human Activity Profile demonstrated an increasing trend only in the supervised group that was significant by 1 year . The SF-36 Physical Component summary score increased significantly in the supervised group and remained improved by 1 year ; the unsupervised group showed significant improvement at 1 year . Women made greater gains in supervised programs , but men made greater gains in unsupervised programs . CONCLUSIONS Supervised exercise programs and unsupervised programs after initial supervised instruction were both associated with physical benefits that were retained for 1 year , although supervised programs showed trends to greater improvements in self-reported gains . Gender differences require further research Introduction Many studies have now demonstrated the efficacy of text messaging in positively changing behaviours . We aim ed to identify features and factors that explain the effectiveness of a successful text messaging program in terms of user engagement , perceived usefulness , behavior change and program delivery preferences . Methods Mixed methods qualitative design combining four data sources ; ( i ) analytic data extracted directly from the software system , ( ii ) participant survey , ( iii ) focus groups to identify barriers and enablers to implementation and mechanisms of effect and ( iv ) recruitment screening logs and text message responses to examine engagement . This evaluation was conducted within the TEXT ME trial — a parallel design , single-blind r and omized controlled trial ( RCT ) of 710 patients with coronary heart disease ( CHD ) . Qualitative data were interpreted using inductive thematic analysis . Results 307/352 ( 87 % response rate ) of recruited patients with CHD completed the program evaluation survey at six months and 25 participated in a focus group . Factors increasing engagement included ( i ) ability to save and share messages , ( ii ) having the support of providers and family , ( iii ) a feeling of support through participation in the program , ( iv ) the program being initiated close to the time of a cardiovascular event , ( v ) personalization of the messages , ( vi ) opportunity for initial face-to-face contact with a provider and ( vii ) that program and content was perceived to be from a credible source . Clear themes relating to program delivery were that diet and physical activity messages were most valued , four messages per week was ideal and most participants felt program duration should be provided for at least for six months or longer . Conclusions This study provides context and insight into the factors influencing consumer engagement with a text message program aim ed at improving health-related behavior . The study suggests program components that may enhance potential success but will require integration at the development stage to optimize up-scaling . Trial Registration Australia and New Zeal and Clinical Trials Registry , ACTRN12611000161921 Background Physical activity ( PA ) and nutrition are the cornerstones of diabetes management . Several review s and meta-analyses report that PA independently produces clinical ly important improvements in glucose control in people with Type 2 diabetes . However , it remains unclear what the optimal strategies are to increase PA behaviour in people with Type 2 diabetes in routine primary care . Methods This study will determine whether an evidence -informed multifaceted behaviour change intervention ( Movement as Medicine for Type 2 Diabetes ) targeting both consultation behaviour of primary healthcare professionals and PA behaviour in adults with Type 2 diabetes is both acceptable and feasible in the primary care setting . An open pilot study conducted in two primary care practice s ( phase one ) will assess acceptability , feasibility and fidelity . Ongoing feedback from participating primary healthcare professionals and patients will provide opportunities for systematic adaptation and refinement of the intervention and study procedures . A two-arm parallel group clustered pilot r and omised controlled trial with patients from participating primary care practice s in North East Engl and will assess acceptability , feasibility , and fidelity of the intervention ( versus usual clinical care ) and trial processes over a 12-month period . Consultation behaviour involving fidelity of intervention delivery , diabetes and PA related knowledge , attitudes/beliefs , intentions and self-efficacy for delivering a behaviour change intervention targeting PA behaviour will be assessed in primary healthcare professionals . We will rehearse the collection of outcome data ( with the focus on data yield and quality ) for a future definitive trial , through outcome assessment at baseline , one , six and twelve months . An embedded qualitative process evaluation and treatment fidelity assessment will explore issues around intervention implementation and assess whether intervention components can be reliably and faithfully delivered in routine primary care . Discussion Movement as Medicine for Type 2 Diabetes will address an important gap in the evidence -base , that is , the need for interventions to increase free-living PA behaviour in adults with Type 2 diabetes . The multifaceted intervention incorporates an online accredited training programme for primary healthcare professionals and represents , to the best of our knowledge , the first of its kind in the United Kingdom . This study will establish whether the multifaceted behavioural intervention is acceptable and feasible in routine primary care . Trial registration Movement as Medicine for Type 2 Diabetes ( MaMT2D 
    Output:
    
agent
Face to face and telephone-based self-management programmes were identified as having promise to engage stroke survivors in PA behaviour change .
***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 The aim of this study was to determine whether the Comprehensive Reminder System based on the Health Belief Model improves health belief , health behaviours , medication adherence and blood pressure control as a means of decreasing the rate of stroke recurrence among hypertensive ischaemic stroke . BACKGROUND Hypertensive patients having experienced recent ischaemic strokes are at high risk for stroke recurrence . Several trials attempted to improve secondary stroke prevention via patient education , however , patient outcomes remained poor . Long-term follow-up studies regarding secondary stroke prevention are limited . DESIGN A multi-centre , 12-month , assessor-blinded , parallel-group , r and omized controlled longitudinal trial . METHODS Hypertensive patients having experienced an ischaemic stroke are the target population . The intervention consists of health belief education , a calendar h and book , a weekly automated short-message service and four telephone follow-up interviews . Outcomes will be assessed at baseline and at 3 , 6 and 12 months following discharge . The primary outcome is blood pressure control . The secondary outcomes include health belief , health behaviours and medication adherence . The clinical endpoint is the rate of stroke recurrence . DISCUSSION Although many efforts to improve secondary stroke prevention have been undertaken , research indicates that improvements remain possible and warranted . This research protocol based on the Health Belief Model will improve our underst and ing of stroke education and transitional care needed in China and with the world-wide target population Objective To assess , in a sample of systematic review s of non-pharmacological interventions , the completeness of intervention reporting , identify the most frequently missing elements , and assess review authors ’ use of and beliefs about providing intervention information . Design Analysis of a r and om sample of systematic review s of non-pharmacological stroke interventions ; online survey of review authors . Data sources and study selection The Cochrane Library and PubMed were search ed for potentially eligible systematic review s and a r and om sample of these assessed for eligibility until 60 ( 30 Cochrane , 30 non-Cochrane ) eligible review s were identified . Data collection In each review , the completeness of the intervention description in each eligible trial ( n=568 ) was assessed by 2 independent raters using the Template for Intervention Description and Replication ( TIDieR ) checklist . All review authors ( n=46 ) were invited to complete a survey . Results Most review s were missing intervention information for the majority of items . The most incompletely described items were : modifications , fidelity , material s , procedure and tailoring ( missing from all interventions in 97 % , 90 % , 88 % , 83 % and 83 % of review s , respectively ) . Items that scored better , but were still incomplete for the majority of review s , were : ‘ when and how much ’ ( in 31 % of review s , adequate for all trials ; in 57 % of review s , adequate for some trials ) ; intervention mode ( in 22 % of review s , adequate for all trials ; in 38 % , adequate for some trials ) ; and location ( in 19 % of review s , adequate for all trials ) . Of the 33 ( 71 % ) authors who responded , 58 % reported having further intervention information but not including it , and 70 % tried to obtain information . Conclusions Most focus on intervention reporting has been directed at trials . Poor intervention reporting in stroke systematic review s is prevalent , compounded by poor trial reporting . Without adequate intervention descriptions , the conduct , usability and interpretation of review s are restricted and therefore , require action by trialists , systematic review ers , peer review ers and editors Background and Purpose — Longitudinal conducted studies show that neurologic and functional recovery show faster recovery in the first weeks poststroke . The aim of the present study was to study the effects of progress of time on observed improvements in motor strength , synergisms , and activities during the first 16 weeks poststroke . Methods — Based on data from a previous study , 101 patients with first-ever ischemic middle cerebral artery strokes were prospect ively investigated during the first 16 weeks after stroke . Progress of time was categorized into 8 biweekly time intervals and was used as the independent covariate in a first-order longitudinal regression model . The biweekly time change ( progress of time ) was related to improvement in upper and lower limb motor recovery assessed with Fugl-Meyer score and Motricity Index , reduction in visuospatial inattention based on the letter cancellation task , and improvement in walking ability , dexterity , and activities of daily living measured with the Functional Ambulation Categories , Action Research Arm test , and Barthel Index . Results — Time explained a significant change of 8.4 ( 42 % ) measurement units on the Barthel Index for the first 10 weeks poststroke , 1.1 ( 22 % ) measurement units on Functional Ambulation Categories , and 19 % on the Action Research Arm test for the first 6 and 8 weeks poststroke . Approximately 25 % ( for Fugl-Meyer – arm ) to 26 % ( for Motricity Index – arm ) of the significant change in measurements units was explained by time alone for the upper limb compared with 33 % for Fugl-Meyer – leg and 39 % for Motricity Index – leg of the lower limb . Time accounted for a reduction of 16 % in the letter cancellation task . Observed associations did not change after controlling for covariates such as age , gender , hemisphere of stroke , type of stroke , or intervention . Conclusion — Progress of time is an independent covariate that reflects spontaneous recovery of body functions and activities explaining ≈16 % to 42 % of the observed improvements in the first 6 to 10 weeks after stroke onset Background and Purpose — Insulin resistance and glucose intolerance are highly prevalent after stroke , contributing to worsening cardiovascular disease risk and a predisposition to recurrent stroke . Treadmill exercise training ( T-AEX ) increases aerobic capacity ( Vo2 peak ) in chronic stroke patients , suggesting intensity levels that may be adequate to improve glucose metabolism . We compared the effects of a progressive T-AEX intervention to an attention-matched stretching intervention ( CONTROL ) on glucose tolerance and indices of insulin sensitivity in stroke survivors . Methods — Participants had hemiparetic gait after remote ( > 6 months ) ischemic stroke . They were r and omized to 6-month T-AEX or a duration matched reference CONTROL program of supervised stretching exercises . Main outcome measures were glucose and insulin responses during a 3-hour oral glucose tolerance test ( OGTT ) . Results — Forty-six subjects ( T-AEX=26 , CONTROL=20 ) completed OGTT testing before and after the interventions . T-AEX  increased Vo2 peak ( + 15 % versus −3 % & Dgr ; , P<0.01 ) compared with CONTROL . There were significant reductions in fasting insulin ( −23 % versus + 9 % & Dgr ; , P<0.05 ) and the total integrated 3-hour insulin response ( −24 % versus + 3 % & Dgr ; , P<0.01 ) in T-AEX compared with CONTROL . In patients with abnormal glucose tolerance at baseline , T-AEX result ed in a significant 14 % decrease in 3-hour glucose response ( n=12 , P<0.05 ) . Fifty-eight percent of T-AEX participants with abnormal baseline OGTT ( 7 of 12 ) improved glucose tolerance status at 2 hours compared with < 10 % ( 1 of 11 ) of impaired CONTROLS ( P<0.05 ) . Conclusions — These preliminary findings suggest that progressive aerobic exercise can reduce insulin resistance and prevent diabetes in hemiparetic stroke survivors . Larger clinical trials are needed to definitively establish the use of structured exercise training for stimulating metabolic improvement poststroke Even when adults meet physical activity guidelines , sitting for prolonged periods can compromise metabolic health .  Television ( TV ) time and objective measurement studies show deleterious associations , and breaking up sedentary time is beneficial .  Sitting time , TV time , and time sitting in automobiles increase premature mortality risk . Further evidence from prospect i ve studies , intervention trials , and population -based behavioral studies is required BACKGROUND AND PURPOSE Little is known about the relative efficacy of supervised versus unsupervised community exercise programs for stroke survivors . This study compared the effectiveness of a 10-week supervised strengthening and conditioning program ( supervised ) with a 1-week supervised instruction program followed by a 9-week unsupervised home program ( unsupervised ) and evaluated retention of changes at 6 months and 1 year after program completion . METHODS Seventy-two subjects retained at baseline ( 27 women , 45 men ; mean+/-SD age , 64.6+/-11.8 years ) were r and omly allocated to receive the supervised or unsupervised program . The primary outcome was walking speed over 6 minutes , and secondary outcome measures were Human Activity Profile , Medical Outcome Study 36-Item Short-Form survey ( SF-36 ) , Physiological Cost Index , and lower extremity muscle strength . RESULTS The 6-minute walking speed increased significantly in both groups and remained significantly improved by 1 year . The Human Activity Profile demonstrated an increasing trend only in the supervised group that was significant by 1 year . The SF-36 Physical Component summary score increased significantly in the supervised group and remained improved by 1 year ; the unsupervised group showed significant improvement at 1 year . Women made greater gains in supervised programs , but men made greater gains in unsupervised programs . CONCLUSIONS Supervised exercise programs and unsupervised programs after initial supervised instruction were both associated with physical benefits that were retained for 1 year , although supervised programs showed trends to greater improvements in self-reported gains . Gender differences require further research Introduction Many studies have now demonstrated the efficacy of text messaging in positively changing behaviours . We aim ed to identify features and factors that explain the effectiveness of a successful text messaging program in terms of user engagement , perceived usefulness , behavior change and program delivery preferences . Methods Mixed methods qualitative design combining four data sources ; ( i ) analytic data extracted directly from the software system , ( ii ) participant survey , ( iii ) focus groups to identify barriers and enablers to implementation and mechanisms of effect and ( iv ) recruitment screening logs and text message responses to examine engagement . This evaluation was conducted within the TEXT ME trial — a parallel design , single-blind r and omized controlled trial ( RCT ) of 710 patients with coronary heart disease ( CHD ) . Qualitative data were interpreted using inductive thematic analysis . Results 307/352 ( 87 % response rate ) of recruited patients with CHD completed the program evaluation survey at six months and 25 participated in a focus group . Factors increasing engagement included ( i ) ability to save and share messages , ( ii ) having the support of providers and family , ( iii ) a feeling of support through participation in the program , ( iv ) the program being initiated close to the time of a cardiovascular event , ( v ) personalization of the messages , ( vi ) opportunity for initial face-to-face contact with a provider and ( vii ) that program and content was perceived to be from a credible source . Clear themes relating to program delivery were that diet and physical activity messages were most valued , four messages per week was ideal and most participants felt program duration should be provided for at least for six months or longer . Conclusions This study provides context and insight into the factors influencing consumer engagement with a text message program aim ed at improving health-related behavior . The study suggests program components that may enhance potential success but will require integration at the development stage to optimize up-scaling . Trial Registration Australia and New Zeal and Clinical Trials Registry , ACTRN12611000161921 Background Physical activity ( PA ) and nutrition are the cornerstones of diabetes management . Several review s and meta-analyses report that PA independently produces clinical ly important improvements in glucose control in people with Type 2 diabetes . However , it remains unclear what the optimal strategies are to increase PA behaviour in people with Type 2 diabetes in routine primary care . Methods This study will determine whether an evidence -informed multifaceted behaviour change intervention ( Movement as Medicine for Type 2 Diabetes ) targeting both consultation behaviour of primary healthcare professionals and PA behaviour in adults with Type 2 diabetes is both acceptable and feasible in the primary care setting . An open pilot study conducted in two primary care practice s ( phase one ) will assess acceptability , feasibility and fidelity . Ongoing feedback from participating primary healthcare professionals and patients will provide opportunities for systematic adaptation and refinement of the intervention and study procedures . A two-arm parallel group clustered pilot r and omised controlled trial with patients from participating primary care practice s in North East Engl and will assess acceptability , feasibility , and fidelity of the intervention ( versus usual clinical care ) and trial processes over a 12-month period . Consultation behaviour involving fidelity of intervention delivery , diabetes and PA related knowledge , attitudes/beliefs , intentions and self-efficacy for delivering a behaviour change intervention targeting PA behaviour will be assessed in primary healthcare professionals . We will rehearse the collection of outcome data ( with the focus on data yield and quality ) for a future definitive trial , through outcome assessment at baseline , one , six and twelve months . An embedded qualitative process evaluation and treatment fidelity assessment will explore issues around intervention implementation and assess whether intervention components can be reliably and faithfully delivered in routine primary care . Discussion Movement as Medicine for Type 2 Diabetes will address an important gap in the evidence -base , that is , the need for interventions to increase free-living PA behaviour in adults with Type 2 diabetes . The multifaceted intervention incorporates an online accredited training programme for primary healthcare professionals and represents , to the best of our knowledge , the first of its kind in the United Kingdom . This study will establish whether the multifaceted behavioural intervention is acceptable and feasible in routine primary care . Trial registration Movement as Medicine for Type 2 Diabetes ( MaMT2D 
    Output:
    