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: Study design : Follow-up study of seven individuals with spinal cord injury ( SCI ) who completed a 9-month r and omized control trial ( RCT ) of exercise training .  Objective : In a 9-month RCT conducted in our lab , individuals with SCI who participated in a twice-weekly supervised exercise training reported greater perceived quality of life ( PQOL ) , and less stress and pain than a nonexercising control cohort . The present follow-up study examined the voluntary continuation of exercise training after the study ended and the persistence of the accrued psychosocial benefits . Setting : Centre for Health Promotion and Rehabilitation , McMaster University , Hamilton , Ontario , Canada . Methods : Five men and two women ( age 42.3±3.6 years ) with SCI ( C5–T12 ; ASIA A – D 12.7±8.2 years postinjury ) were invited to continue supervised exercise training twice weekly at the completion of the 9-month RCT . Exercise adherence , PQOL , stress and bodily pain were measured at a 3-month follow-up and were compared to values obtained at baseline , and at 3 , 6 and 9 months during the intervention . Results : There was a significant decrease in adherence at the 3-month follow-up compared to the overall 9-month adherence rate ( 42.7 versus 80.6 % , respectively ; P<0.01 ) . There was also a significant decrease in PQOL ( P<0.05 ) and a trend for increased pain ( P=0.07 ) and stress ( P=0.12 ) , at follow-up compared to the end of the 9-month trial . Finally , there was a significant negative correlation between pain at the conclusion of the RCT and exercise adherence over the 3-month follow-up period ( r=−0.91 ; P<0.01 ) . Conclusions : These findings emphasize the importance of continued exercise adherence to the maintenance of exercise-related increases in psychological well-being among individuals with SCI The purpose of this study is to assess satisfaction with life domains in people with spinal cord injuries ( SCI ) and investigate whether participation in sports and physical recreation is associated with life satisfaction in SCI . 1,748 r and omly selected participants with SCI who fulfilled the criteria : SCI at level C5 or below , wheelchair dependent ; aged 18 - 50 at the time of injury ; at least 1 year post-injury , were approached to take part in this study . Completed replies were received from 985 individuals with SCI ( 198 women , 798 men ) . The measures used included the  Sports Participation Question naire , the Life Satisfaction Question naire and the Hospital Anxiety and Depression Scale . The numbers of hours participating in sports decreased significantly after injury . There was a greater decrease in numbers participating in team sports in comparison to the decrease seen in numbers participating in individual sports . The highest level of satisfaction existed within social domains such as : family life and contacts with friends . The lowest level of satisfaction was found in regard to the participant 's sexual life and vocational situation . Higher satisfaction with life in general was demonstrated in respondents with SCI involved in sports or physical recreation compared to those not participating in physical activities Study design : R and omized controlled trial of exercise training in persons with spinal cord injury . Objective : The purpose of this study was to examine the effects of 9 months of twice-weekly exercise training on strength , arm ergometry performance , and indices of psychological well-being and quality of life . Setting : Centre for Health Promotion and Rehabilitation , McMaster University , Hamilton , Ontario , Canada . Methods : Thirty-four men and women ( aged 19–65 years ) with traumatic spinal cord injury ( C4–L1 ; ASIA A – D ) of 1–24 years duration volunteered to participate , and were r and omized into exercise ( EX ; n=21 ) and control ( CON ; n=13 ) groups . Twenty-three subjects ( 11 EX ; 12 CON ) successfully completed the 9-month study . Subjects were assessed for one repetition maximum ( 1RM ) strength , arm ergometry performance , and several indices of quality of life and psychological well-being at baseline , 3 , 6 , and 9 months . Results : At baseline , there were no significant differences between groups in age , submaximal arm ergometry performance , muscle strength , or psychological well-being . Following training , the EX group had significant increases in submaximal arm ergometry power output ( 81 % ; P<0.05 ) , and significant increases in upper body muscle strength ( 19–34 % ; P<0.05 ) ; no significant changes occurred in CON . Participants in EX reported significantly less pain , stress and depression after training , and scored higher than CON in indices of satisfaction with physical function , level of perceived health and overall quality of life ( P<0.05 ) . Exercise adherence ( per cent of prescribed sessions attended ) in those subjects who completed the 9 months of training was 82.5 % . Conclusions : These results demonstrate that long-term twice-weekly exercise training in this population is feasible , and results in significant gains in both physical and psychological well-being The purpose of the present investigation was to study the effects of an arm ergometer training programme on several physiological variables of recreational wheelchair subjects . Ten paraplegics ( 5 experimental , 5 control ) were tested prior to and immediately after a 2 month exercise regimen at 80 % of peak heart rate ( 30 min per day , 5 days per week , for 8 consecutive weeks at 50 rev/min ) . The results demonstrated significant increases ( P<0.05 ) in VO2max ( 1 min-1 & ml kg-1 min-1 ) and workload but only mild improvements in maximal heart rate and post exercise blood lactates . Body fat , vital capacity and forced expiratory volume did not change with training . Triceps lateralis fibre distribution and fast twitch ( FT ) fibre area were unaffected by the endurance training programme . However , slow twitch ( ST ) fibre area increased ( P < 0·05 ) with training . The results indicate that physiological variables of paraplegic subjects  following an arm ergometer endurance training programme react similarly to changes previously observed in non-h and icapped subjects . The values when compared with normals are low as a result of the relative inactivity of the subjects due to the lack of available exercise programmes for wheelchair people Although considered the gold-st and ard research design , r and omized controlled trials ( RCT ) create a series of method ological , ethical , and practical challenges when applied to exercise training studies of people with spinal cord injury ( SCI ) . These challenges are discussed , and some pragmatic alternatives are suggested to advance SCI research while maintaining scientific integrity Objectives : To assess pain relieving effects of an intensive exercise programme on a seated double-poling ergometer in individuals with spinal cord injury ( SCI ) . Setting : Stockholm , Sweden . Methods : A total of 13 wheelchair-dependent individuals with a thoracic or lumbar SCI were recruited to a 10-week training period ( three times weekly ) assessing the effects of regular training on upper-body strength , aerobic and mechanical power , and crossover effects on functional performance , as well as cardiovascular risk factors . Eight of the participants reported pain and were included in this exploratory pain protocol and assessed using the International SCI Basic Pain Data set , the Wheelchair Users ’ Shoulder Pain Index and International SCI Quality of Life Basic Data set . Results : For those with neuropathic pain , median pain intensity ratings decreased from 5 on a 0–10 numerical rating scale at base-line to 3 at the end of study , and four of seven participants reported an improvement on the Patient Global Impression of Change scale . For those with musculoskeletal pain ( n=5 ) , median pain intensity ratings improved from 4 at baseline to 0 at the end of study . All but one rated no musculoskeletal pain at all at the end of study and number of days with pain per week decreased from 5.5 to 0.7 . None of the participants developed pain , because of overuse during the training period and few reported unwanted side effects . Conclusion : Considering its promising effects and safety , an intensive exercise programme can be tried for treating musculoskeletal pain and also neuropathic pain following SCI BACKGROUND AND PURPOSE Assessment of the quality of r and omized controlled trials ( RCTs ) is common practice in systematic review s. However , the reliability of data obtained with most quality assessment scales has not been established . This report describes 2 studies design ed to investigate the reliability of data obtained with the Physiotherapy Evidence Data base ( PEDro ) scale developed to rate the quality of RCTs evaluating physical therapist interventions . METHOD In the first study , 11 raters independently rated 25 RCTs r and omly selected from the PEDro data base . In the second study , 2 raters rated 120 RCTs r and omly selected from the PEDro data base , and disagreements were resolved by a third rater ; this generated a set of individual rater and consensus ratings . The process was repeated by independent raters to create a second set of individual and consensus ratings . Reliability of ratings of PEDro scale items was calculated using multirater kappas , and reliability of the total ( summed ) score was calculated using intraclass correlation coefficients ( ICC [ 1,1 ] ) . RESULTS The kappa value for each of the 11 items ranged from.36 to.80 for individual assessors and from.50 to.79 for consensus ratings generated by groups of 2 or 3 raters . The ICC for the total score was.56 ( 95 % confidence interval=.47-.65 ) for ratings by individuals , and the ICC for consensus ratings was.68 ( 95 % confidence interval=.57-.76 ) . DISCUSSION AND CONCLUSION The reliability of ratings of PEDro scale items varied from " fair " to " substantial , " and the reliability of the total PEDro score was " fair " to " good . 
    Output:
    
agent
Although there was a lack of consensus among the selected studies , the majority of them presented a strong correlation between physical activity and variables of quality of life and /or functional independence .
Thus , physical activity appears to have an important influence on social relationships , functional independence , psychological factors , and physical aspects , which can enhance quality of life and independence in the performance of daily activities
***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: Study design : Follow-up study of seven individuals with spinal cord injury ( SCI ) who completed a 9-month r and omized control trial ( RCT ) of exercise training .  Objective : In a 9-month RCT conducted in our lab , individuals with SCI who participated in a twice-weekly supervised exercise training reported greater perceived quality of life ( PQOL ) , and less stress and pain than a nonexercising control cohort . The present follow-up study examined the voluntary continuation of exercise training after the study ended and the persistence of the accrued psychosocial benefits . Setting : Centre for Health Promotion and Rehabilitation , McMaster University , Hamilton , Ontario , Canada . Methods : Five men and two women ( age 42.3±3.6 years ) with SCI ( C5–T12 ; ASIA A – D 12.7±8.2 years postinjury ) were invited to continue supervised exercise training twice weekly at the completion of the 9-month RCT . Exercise adherence , PQOL , stress and bodily pain were measured at a 3-month follow-up and were compared to values obtained at baseline , and at 3 , 6 and 9 months during the intervention . Results : There was a significant decrease in adherence at the 3-month follow-up compared to the overall 9-month adherence rate ( 42.7 versus 80.6 % , respectively ; P<0.01 ) . There was also a significant decrease in PQOL ( P<0.05 ) and a trend for increased pain ( P=0.07 ) and stress ( P=0.12 ) , at follow-up compared to the end of the 9-month trial . Finally , there was a significant negative correlation between pain at the conclusion of the RCT and exercise adherence over the 3-month follow-up period ( r=−0.91 ; P<0.01 ) . Conclusions : These findings emphasize the importance of continued exercise adherence to the maintenance of exercise-related increases in psychological well-being among individuals with SCI The purpose of this study is to assess satisfaction with life domains in people with spinal cord injuries ( SCI ) and investigate whether participation in sports and physical recreation is associated with life satisfaction in SCI . 1,748 r and omly selected participants with SCI who fulfilled the criteria : SCI at level C5 or below , wheelchair dependent ; aged 18 - 50 at the time of injury ; at least 1 year post-injury , were approached to take part in this study . Completed replies were received from 985 individuals with SCI ( 198 women , 798 men ) . The measures used included the  Sports Participation Question naire , the Life Satisfaction Question naire and the Hospital Anxiety and Depression Scale . The numbers of hours participating in sports decreased significantly after injury . There was a greater decrease in numbers participating in team sports in comparison to the decrease seen in numbers participating in individual sports . The highest level of satisfaction existed within social domains such as : family life and contacts with friends . The lowest level of satisfaction was found in regard to the participant 's sexual life and vocational situation . Higher satisfaction with life in general was demonstrated in respondents with SCI involved in sports or physical recreation compared to those not participating in physical activities Study design : R and omized controlled trial of exercise training in persons with spinal cord injury . Objective : The purpose of this study was to examine the effects of 9 months of twice-weekly exercise training on strength , arm ergometry performance , and indices of psychological well-being and quality of life . Setting : Centre for Health Promotion and Rehabilitation , McMaster University , Hamilton , Ontario , Canada . Methods : Thirty-four men and women ( aged 19–65 years ) with traumatic spinal cord injury ( C4–L1 ; ASIA A – D ) of 1–24 years duration volunteered to participate , and were r and omized into exercise ( EX ; n=21 ) and control ( CON ; n=13 ) groups . Twenty-three subjects ( 11 EX ; 12 CON ) successfully completed the 9-month study . Subjects were assessed for one repetition maximum ( 1RM ) strength , arm ergometry performance , and several indices of quality of life and psychological well-being at baseline , 3 , 6 , and 9 months . Results : At baseline , there were no significant differences between groups in age , submaximal arm ergometry performance , muscle strength , or psychological well-being . Following training , the EX group had significant increases in submaximal arm ergometry power output ( 81 % ; P<0.05 ) , and significant increases in upper body muscle strength ( 19–34 % ; P<0.05 ) ; no significant changes occurred in CON . Participants in EX reported significantly less pain , stress and depression after training , and scored higher than CON in indices of satisfaction with physical function , level of perceived health and overall quality of life ( P<0.05 ) . Exercise adherence ( per cent of prescribed sessions attended ) in those subjects who completed the 9 months of training was 82.5 % . Conclusions : These results demonstrate that long-term twice-weekly exercise training in this population is feasible , and results in significant gains in both physical and psychological well-being The purpose of the present investigation was to study the effects of an arm ergometer training programme on several physiological variables of recreational wheelchair subjects . Ten paraplegics ( 5 experimental , 5 control ) were tested prior to and immediately after a 2 month exercise regimen at 80 % of peak heart rate ( 30 min per day , 5 days per week , for 8 consecutive weeks at 50 rev/min ) . The results demonstrated significant increases ( P<0.05 ) in VO2max ( 1 min-1 & ml kg-1 min-1 ) and workload but only mild improvements in maximal heart rate and post exercise blood lactates . Body fat , vital capacity and forced expiratory volume did not change with training . Triceps lateralis fibre distribution and fast twitch ( FT ) fibre area were unaffected by the endurance training programme . However , slow twitch ( ST ) fibre area increased ( P < 0·05 ) with training . The results indicate that physiological variables of paraplegic subjects  following an arm ergometer endurance training programme react similarly to changes previously observed in non-h and icapped subjects . The values when compared with normals are low as a result of the relative inactivity of the subjects due to the lack of available exercise programmes for wheelchair people Although considered the gold-st and ard research design , r and omized controlled trials ( RCT ) create a series of method ological , ethical , and practical challenges when applied to exercise training studies of people with spinal cord injury ( SCI ) . These challenges are discussed , and some pragmatic alternatives are suggested to advance SCI research while maintaining scientific integrity Objectives : To assess pain relieving effects of an intensive exercise programme on a seated double-poling ergometer in individuals with spinal cord injury ( SCI ) . Setting : Stockholm , Sweden . Methods : A total of 13 wheelchair-dependent individuals with a thoracic or lumbar SCI were recruited to a 10-week training period ( three times weekly ) assessing the effects of regular training on upper-body strength , aerobic and mechanical power , and crossover effects on functional performance , as well as cardiovascular risk factors . Eight of the participants reported pain and were included in this exploratory pain protocol and assessed using the International SCI Basic Pain Data set , the Wheelchair Users ’ Shoulder Pain Index and International SCI Quality of Life Basic Data set . Results : For those with neuropathic pain , median pain intensity ratings decreased from 5 on a 0–10 numerical rating scale at base-line to 3 at the end of study , and four of seven participants reported an improvement on the Patient Global Impression of Change scale . For those with musculoskeletal pain ( n=5 ) , median pain intensity ratings improved from 4 at baseline to 0 at the end of study . All but one rated no musculoskeletal pain at all at the end of study and number of days with pain per week decreased from 5.5 to 0.7 . None of the participants developed pain , because of overuse during the training period and few reported unwanted side effects . Conclusion : Considering its promising effects and safety , an intensive exercise programme can be tried for treating musculoskeletal pain and also neuropathic pain following SCI BACKGROUND AND PURPOSE Assessment of the quality of r and omized controlled trials ( RCTs ) is common practice in systematic review s. However , the reliability of data obtained with most quality assessment scales has not been established . This report describes 2 studies design ed to investigate the reliability of data obtained with the Physiotherapy Evidence Data base ( PEDro ) scale developed to rate the quality of RCTs evaluating physical therapist interventions . METHOD In the first study , 11 raters independently rated 25 RCTs r and omly selected from the PEDro data base . In the second study , 2 raters rated 120 RCTs r and omly selected from the PEDro data base , and disagreements were resolved by a third rater ; this generated a set of individual rater and consensus ratings . The process was repeated by independent raters to create a second set of individual and consensus ratings . Reliability of ratings of PEDro scale items was calculated using multirater kappas , and reliability of the total ( summed ) score was calculated using intraclass correlation coefficients ( ICC [ 1,1 ] ) . RESULTS The kappa value for each of the 11 items ranged from.36 to.80 for individual assessors and from.50 to.79 for consensus ratings generated by groups of 2 or 3 raters . The ICC for the total score was.56 ( 95 % confidence interval=.47-.65 ) for ratings by individuals , and the ICC for consensus ratings was.68 ( 95 % confidence interval=.57-.76 ) . DISCUSSION AND CONCLUSION The reliability of ratings of PEDro scale items varied from " fair " to " substantial , " and the reliability of the total PEDro score was " fair " to " good . 
    Output:
    