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 Cardiovascular disease remains the leading killer of women in most developed areas of the world . Rates of physical inactivity and poor nutrition , which are two of the most important modifiable risk factors for cardiovascular disease in women , are substantial . This study sought to examine the effectiveness of a community-based lifestyle-modification program on increasing women 's physical activity in a r and omized trial guided by community-based participatory research ( CBPR ) methods . Methods A total of 335 healthy , 25–64 years old women who had been selected by a multiple-stage stratified cluster r and om sampling method in Bushehr Port/I.R. Iran , were r and omized into control and intervention groups . The intervention group completed an 8-week lifestyle modification program for increasing their physical activity , based on a revised form of Choose to Move program ; an American Heart Association Physical Activity Program for Women . Audio-taped activity instructions with music and practical usage of the educational package were given to the intervention group in weekly home-visits by 53 volunteers from local non-governmental and community-based organizations . Results Among the participants , the percentage who reported being active ( at lease 30 minutes of moderate intensity physical activity for at least 5 days a week , or at least 20 minutes of vigorous physical activity for at least three days a week ) increased from 3 % and 2.7 % at baseline to 13.4 % and 3 % ( p < 0.0001 ) at the ending of the program in the intervention and control groups , respectively . The participants in the intervention group reported more minutes of physical activity per week ( mean = 139.81 , SE = 23.35 ) than women in the control group ( mean = 40.14 , SE = 12.65 ) at week 8 ( p < 0.0001 ) . The intervention group subjects exhibited a significantly greater decrease in systolic blood pressure ( -10.0 mmHg ) than the control group women ( + 2.0 . mmHg ) . The mean ranks for posttest healthy heart knowledge in the intervention and control groups were 198.91 and 135.77 , respectively ( P < 0.0001 ) . Conclusion An intervention based on CBPR methods can be effective for the short-term adoption of physical activity behavior among women . The development of participatory process to support the adequate delivery of lifestyle-modification programs is feasible and an effective healthcare delivery strategy for cardiovascular community health promotion . Trial Registration Reduced-sodium , increased-potassium salt substitutes lower blood pressure but may also have direct effects on vascular structure and arterial function . This study aim ed to test the effects of long-term salt substitution on indices of these outcomes . The China Salt Substitute Study was a r and omized , controlled trial design ed to establish the effects of salt substitute ( 65 % sodium chloride , 25 % potassium chloride , 10 % magnesium sulfate ) compared with regular salt ( 100 % sodium chloride ) on blood pressure among 600 high-risk individuals living in six rural areas in northern China over a 12-month intervention period . Data on central aortic blood pressure , aortic pressure augmentation ( AUG ) , augmentation index ( AIx ) , the differences of the peak of first and baseline waves ( P1–P0 ) and pulse wave reflection time ( RT ) were collected at r and omization and at the completion of follow-up in 187 participants using the Sphygmocor pulse wave analysis system . Mean baseline blood pressure was 150.1/91.4 mm Hg , mean age was 58.4 years , 41 % were male and three quarters had a history of vascular disease . After 12 months of intervention , there were significant net reductions in peripheral ( 7.4 mm Hg , P=0.009 ) and central ( 6.9 mm Hg , P=0.011 ) systolic blood pressure levels and central pulse pressure ( 4.5 mm Hg , P=0.012 ) and correspondingly there was a significant net reduction in P1–P0 ( 3.0 mm Hg , P=0.007 ) , borderline significant net reduction in AUG ( 1.5 mm Hg , P=0.074 ) and significant net increase in RT ( 2.59 ms , P=0.001 ) . There were no detectable reductions in peripheral ( 2.8 mm Hg , P=0.14 ) or central ( 2.4 mm Hg , P=0.13 ) diastolic blood pressure levels or AIx ( 0.06 % , P=0.96 ) . In conclusion , over the 12-month study period the salt substitute significantly reduced not only peripheral and central systolic blood pressure but also reduced arterial stiffness OBJECTIVE The prevalence of type 2 diabetes , especially in developing countries , has grown over the past decades . We performed a controlled clinical study to determine whether a community-based , group-centered public health intervention addressing nutrition and exercise can ameliorate glycemic control and associated cardiovascular risk factors in type 2 diabetic patients in rural Costa Rica . RESEARCH DESIGN AND METHODS A total of 75 adults with type 2 diabetes , mean age 59 years , were r and omly assigned to the intervention group or the control group . All participants received basic diabetes education . The subjects in the intervention group participated in 11 weekly nutrition classes ( 90 min each session ) . Subjects for whom exercise was deemed safe also participated in triweekly walking groups ( 60 min each session ) . Glycosylated hemoglobin , fasting plasma glucose , total cholesterol , triglycerides , HDL and LDL cholesterol , height , weight , BMI , and blood pressure were measured at baseline and the end of the study ( after 12 weeks ) . RESULTS The intervention group lost 1.0 + /- 2.2 kg compared with a weight gain in the control group of 0.4 + /- 2.3 kg ( P = 0.028 ) . Fasting plasma glucose decreased 19 + /- 55 mg/dl in the intervention group and increased 16 + /- 78 mg/dl in the control group ( P = 0.048 ) . Glycosylated hemoglobin decreased 1.8 + /- 2.3 % in the intervention group and 0.4 + /- 2.3 % in the control group ( P = 0.028 ) . CONCLUSIONS Glycemic control of type 2 diabetic patients can be improved through community-based , group-centered public health interventions addressing nutrition and exercise . This pilot study provides an economically feasible model for programs that aim to improve the health status of people with type 2 diabetes In a r and omized , single-blind , controlled trial , 621 patients were assigned either intervention diet A ( group A , 310 patients ) or control diet B  ( group B , 311 patients ) for a period of 24 weeks . After 24 weeks as revealed by dietary question naires , group A patients received : ( 1 ) a diet with a higher percentage of calories from fruits and vegetables and complex carbohydrates ; ( 2 ) a higher polyunsaturated/saturated fat ratio diet ; and ( 3 ) a larger amount of soluble dietary fiber , antioxidant vitamins and minerals and low saturated fat and cholesterol than group B. Group A patients also did more physical and yogic exercises than group B. Adherence to diet and exercise was obtained through question naires and information obtained was quantified into a formula . After 24 weeks , the overall score of diet and exercises  was significantly higher in group A than in group B. There was a significant decrease in serum total cholesterol ( 13.3 % ) , low-density lipoprotein cholesterol ( 16.9 % ) , triglycerides ( 19.2 % ) , fasting blood glucose ( 19.5 % ) and blood pressures ( 11.5/6.2 mm Hg ) in the intervention group compared with initial levels and changes in group B. The effect of  exercise  on the decrease in risk factors was additive . Within group A , overall score for diet and exercise  was greater in 1 subset of 116 patients in the intervention group which had maximal lifestyle changes . A separate analysis of data in this subgroup revealed a greater decrease in risk factors compared with risk factor changes in the remaining 194 patients with less higher overall score ; this indicated that the relation of lifestyle changes with reduction in risk factors may be of causal nature . ( ABSTRACT TRUNCATED AT 250 WORDS A total of 3,318 men and women from a region in rural China were r and omized to receive daily either a multiple vitamin/mineral supplement or a placebo . Deaths that occurred in the participants were ascertained and classified according to cause over the 6-year period from 1985 to 1991 . At the end of supplementation , blood pressure readings were taken , and the prevalence of hypertension was determined . There was a slight reduction in overall mortality in the supplement group ( relative risk ( RR ) = 0.93 , 95 percent confidence interval ( CI ) 0.75 - 1.16 ) , with the decreased relative risk most pronounced for cerebrovascular disease deaths ( RR = 0.63 , 95 percent CI 0.37 - 1.07 ) . This benefit was greater for men ( RR = 0.42 , 95 percent CI 0.19 - 0.93 ) than for women ( RR = 0.93 , 95 percent CI 0.44 - 1.98 ) . Among the survivors , the presence of elevations in both systolic and diastolic blood pressures was less common in those who received the supplement ( RR for men = 0.43 , 95 % CI 0.28 - 0.65 ; RR for women = 0.92 , 95 percent CI 0.68 - 1.24 ) . This study indicates that supplementation with a multivitamin/mineral combination may have reduced mortality from cerebrovascular disease and the prevalence of hypertension in this rural population with a micronutrient-poor diet Resistance training increases muscle strength in older adults , decreasing the effort necessary for executing physical tasks , and reducing cardiovascular load during exercise . This hypothesis has been confirmed during strength-based activities , but not during aerobic-based activities . This study determined whether different resistance training regimens , strength training ( ST , constant movement velocity ) or power training ( PT , concentric phase performed as fast as possible ) can blunt the increase in cardiovascular load during an aerobic stimulus . Older adults ( 63.9 ± 0.7 years ) were r and omly allocated to : control ( N = 11 ) , ST ( N = 13 , twice a week , 70 - 90 % 1-RM ) and PT ( N = 15 , twice a week , 30 - 50 % 1-RM ) groups . Before and after 16 weeks , oxygen uptake ( VO(2 ) ) , systolic blood pressure ( SBP ) , heart rate ( HR ) , and rate pressure product ( RPP ) were measured during a maximal treadmill test . Resting SBP and RPP were similarly reduced in all groups ( combined data = -5.7 ± 1.2 and -5.0 ± 1.7 % , respectively , P < 0.05 ) . Maximal SBP , HR and RPP did not change . The increase in measured VO(2 ) , HR and RPP for the increment in estimated VO(2 ) ( absolute load ) decreased similarly in all groups ( combined data = -9.1 ± 2.6 , -14.1 ± 3.9 , -14.2 ± 3.0 % , respectively , P < 0.05 ) , while the increments in the cardiovascular variables for the increase in measured VO(2 ) did not change . In elderly subjects , ST and PT did not blunt submaximal or maximal HR , SBP and RPP increases during the maximal exercise test , showing that they did not reduce cardiovascular stress during aerobic tasks This study was conducted in three stages in a semi-rural region of Eskisehir , Turkey . In the first stage , individuals selected by r and om sampling  were evaluated for cardiovascular disease risk factors . In the second stage , Group I and Group II training material s were r and omly distributed . In the third stage , the subjects were screened one year later to assess and determine if there had been any changes in their attitudes towards the dangers of cardiovascular diseases . The number of active smokers significantly decreased after the training in the both groups . The percentage of people with regulated blood pressure exhibited an increase in Group II more than Group Objective Dietary sodium and potassium consumption is associated with  blood pressure levels . The objective of this study was to define a practical and low-cost method for the control of blood pressure by modification of these dietary cations in rural Chinese . Methods This study was a double-blind , r and omized , controlled trial design ed to establish the long-term effects of a reduced-sodium , high-potassium salt substitute ( 65 % sodium chloride , 25 % potassium chloride , 10 % magnesium sulphate ) compared to normal salt ( 100 % sodium chloride ) on blood pressure among high-risk individuals . Following a 4-week run-in period on salt substitute , participants were r and omly assigned to replace their household salt with either the study salt substitute or normal salt for a 12-month period . Results The mean age of the 608 r and omized participants was 60 years and 56 % of them were female . Sixty-four percent had a history of vascular disease and 61 % were taking one or more blood pressure-lowering drugs at entry .  Mean baseline blood pressure was 159/93 mmHg ( 
    Output:
    
agent
Subgroup analyses showed smaller sample s reporting larger effect sizes ; intervention lasting less than 6 months showed larger effect sizes and intention-to-treat analysis showed smaller effect sizes Lifestyle interventions may be of value in preventing and reducing blood pressure in LMICs .
***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 Cardiovascular disease remains the leading killer of women in most developed areas of the world . Rates of physical inactivity and poor nutrition , which are two of the most important modifiable risk factors for cardiovascular disease in women , are substantial . This study sought to examine the effectiveness of a community-based lifestyle-modification program on increasing women 's physical activity in a r and omized trial guided by community-based participatory research ( CBPR ) methods . Methods A total of 335 healthy , 25–64 years old women who had been selected by a multiple-stage stratified cluster r and om sampling method in Bushehr Port/I.R. Iran , were r and omized into control and intervention groups . The intervention group completed an 8-week lifestyle modification program for increasing their physical activity , based on a revised form of Choose to Move program ; an American Heart Association Physical Activity Program for Women . Audio-taped activity instructions with music and practical usage of the educational package were given to the intervention group in weekly home-visits by 53 volunteers from local non-governmental and community-based organizations . Results Among the participants , the percentage who reported being active ( at lease 30 minutes of moderate intensity physical activity for at least 5 days a week , or at least 20 minutes of vigorous physical activity for at least three days a week ) increased from 3 % and 2.7 % at baseline to 13.4 % and 3 % ( p < 0.0001 ) at the ending of the program in the intervention and control groups , respectively . The participants in the intervention group reported more minutes of physical activity per week ( mean = 139.81 , SE = 23.35 ) than women in the control group ( mean = 40.14 , SE = 12.65 ) at week 8 ( p < 0.0001 ) . The intervention group subjects exhibited a significantly greater decrease in systolic blood pressure ( -10.0 mmHg ) than the control group women ( + 2.0 . mmHg ) . The mean ranks for posttest healthy heart knowledge in the intervention and control groups were 198.91 and 135.77 , respectively ( P < 0.0001 ) . Conclusion An intervention based on CBPR methods can be effective for the short-term adoption of physical activity behavior among women . The development of participatory process to support the adequate delivery of lifestyle-modification programs is feasible and an effective healthcare delivery strategy for cardiovascular community health promotion . Trial Registration Reduced-sodium , increased-potassium salt substitutes lower blood pressure but may also have direct effects on vascular structure and arterial function . This study aim ed to test the effects of long-term salt substitution on indices of these outcomes . The China Salt Substitute Study was a r and omized , controlled trial design ed to establish the effects of salt substitute ( 65 % sodium chloride , 25 % potassium chloride , 10 % magnesium sulfate ) compared with regular salt ( 100 % sodium chloride ) on blood pressure among 600 high-risk individuals living in six rural areas in northern China over a 12-month intervention period . Data on central aortic blood pressure , aortic pressure augmentation ( AUG ) , augmentation index ( AIx ) , the differences of the peak of first and baseline waves ( P1–P0 ) and pulse wave reflection time ( RT ) were collected at r and omization and at the completion of follow-up in 187 participants using the Sphygmocor pulse wave analysis system . Mean baseline blood pressure was 150.1/91.4 mm Hg , mean age was 58.4 years , 41 % were male and three quarters had a history of vascular disease . After 12 months of intervention , there were significant net reductions in peripheral ( 7.4 mm Hg , P=0.009 ) and central ( 6.9 mm Hg , P=0.011 ) systolic blood pressure levels and central pulse pressure ( 4.5 mm Hg , P=0.012 ) and correspondingly there was a significant net reduction in P1–P0 ( 3.0 mm Hg , P=0.007 ) , borderline significant net reduction in AUG ( 1.5 mm Hg , P=0.074 ) and significant net increase in RT ( 2.59 ms , P=0.001 ) . There were no detectable reductions in peripheral ( 2.8 mm Hg , P=0.14 ) or central ( 2.4 mm Hg , P=0.13 ) diastolic blood pressure levels or AIx ( 0.06 % , P=0.96 ) . In conclusion , over the 12-month study period the salt substitute significantly reduced not only peripheral and central systolic blood pressure but also reduced arterial stiffness OBJECTIVE The prevalence of type 2 diabetes , especially in developing countries , has grown over the past decades . We performed a controlled clinical study to determine whether a community-based , group-centered public health intervention addressing nutrition and exercise can ameliorate glycemic control and associated cardiovascular risk factors in type 2 diabetic patients in rural Costa Rica . RESEARCH DESIGN AND METHODS A total of 75 adults with type 2 diabetes , mean age 59 years , were r and omly assigned to the intervention group or the control group . All participants received basic diabetes education . The subjects in the intervention group participated in 11 weekly nutrition classes ( 90 min each session ) . Subjects for whom exercise was deemed safe also participated in triweekly walking groups ( 60 min each session ) . Glycosylated hemoglobin , fasting plasma glucose , total cholesterol , triglycerides , HDL and LDL cholesterol , height , weight , BMI , and blood pressure were measured at baseline and the end of the study ( after 12 weeks ) . RESULTS The intervention group lost 1.0 + /- 2.2 kg compared with a weight gain in the control group of 0.4 + /- 2.3 kg ( P = 0.028 ) . Fasting plasma glucose decreased 19 + /- 55 mg/dl in the intervention group and increased 16 + /- 78 mg/dl in the control group ( P = 0.048 ) . Glycosylated hemoglobin decreased 1.8 + /- 2.3 % in the intervention group and 0.4 + /- 2.3 % in the control group ( P = 0.028 ) . CONCLUSIONS Glycemic control of type 2 diabetic patients can be improved through community-based , group-centered public health interventions addressing nutrition and exercise . This pilot study provides an economically feasible model for programs that aim to improve the health status of people with type 2 diabetes In a r and omized , single-blind , controlled trial , 621 patients were assigned either intervention diet A ( group A , 310 patients ) or control diet B  ( group B , 311 patients ) for a period of 24 weeks . After 24 weeks as revealed by dietary question naires , group A patients received : ( 1 ) a diet with a higher percentage of calories from fruits and vegetables and complex carbohydrates ; ( 2 ) a higher polyunsaturated/saturated fat ratio diet ; and ( 3 ) a larger amount of soluble dietary fiber , antioxidant vitamins and minerals and low saturated fat and cholesterol than group B. Group A patients also did more physical and yogic exercises than group B. Adherence to diet and exercise was obtained through question naires and information obtained was quantified into a formula . After 24 weeks , the overall score of diet and exercises  was significantly higher in group A than in group B. There was a significant decrease in serum total cholesterol ( 13.3 % ) , low-density lipoprotein cholesterol ( 16.9 % ) , triglycerides ( 19.2 % ) , fasting blood glucose ( 19.5 % ) and blood pressures ( 11.5/6.2 mm Hg ) in the intervention group compared with initial levels and changes in group B. The effect of  exercise  on the decrease in risk factors was additive . Within group A , overall score for diet and exercise  was greater in 1 subset of 116 patients in the intervention group which had maximal lifestyle changes . A separate analysis of data in this subgroup revealed a greater decrease in risk factors compared with risk factor changes in the remaining 194 patients with less higher overall score ; this indicated that the relation of lifestyle changes with reduction in risk factors may be of causal nature . ( ABSTRACT TRUNCATED AT 250 WORDS A total of 3,318 men and women from a region in rural China were r and omized to receive daily either a multiple vitamin/mineral supplement or a placebo . Deaths that occurred in the participants were ascertained and classified according to cause over the 6-year period from 1985 to 1991 . At the end of supplementation , blood pressure readings were taken , and the prevalence of hypertension was determined . There was a slight reduction in overall mortality in the supplement group ( relative risk ( RR ) = 0.93 , 95 percent confidence interval ( CI ) 0.75 - 1.16 ) , with the decreased relative risk most pronounced for cerebrovascular disease deaths ( RR = 0.63 , 95 percent CI 0.37 - 1.07 ) . This benefit was greater for men ( RR = 0.42 , 95 percent CI 0.19 - 0.93 ) than for women ( RR = 0.93 , 95 percent CI 0.44 - 1.98 ) . Among the survivors , the presence of elevations in both systolic and diastolic blood pressures was less common in those who received the supplement ( RR for men = 0.43 , 95 % CI 0.28 - 0.65 ; RR for women = 0.92 , 95 percent CI 0.68 - 1.24 ) . This study indicates that supplementation with a multivitamin/mineral combination may have reduced mortality from cerebrovascular disease and the prevalence of hypertension in this rural population with a micronutrient-poor diet Resistance training increases muscle strength in older adults , decreasing the effort necessary for executing physical tasks , and reducing cardiovascular load during exercise . This hypothesis has been confirmed during strength-based activities , but not during aerobic-based activities . This study determined whether different resistance training regimens , strength training ( ST , constant movement velocity ) or power training ( PT , concentric phase performed as fast as possible ) can blunt the increase in cardiovascular load during an aerobic stimulus . Older adults ( 63.9 ± 0.7 years ) were r and omly allocated to : control ( N = 11 ) , ST ( N = 13 , twice a week , 70 - 90 % 1-RM ) and PT ( N = 15 , twice a week , 30 - 50 % 1-RM ) groups . Before and after 16 weeks , oxygen uptake ( VO(2 ) ) , systolic blood pressure ( SBP ) , heart rate ( HR ) , and rate pressure product ( RPP ) were measured during a maximal treadmill test . Resting SBP and RPP were similarly reduced in all groups ( combined data = -5.7 ± 1.2 and -5.0 ± 1.7 % , respectively , P < 0.05 ) . Maximal SBP , HR and RPP did not change . The increase in measured VO(2 ) , HR and RPP for the increment in estimated VO(2 ) ( absolute load ) decreased similarly in all groups ( combined data = -9.1 ± 2.6 , -14.1 ± 3.9 , -14.2 ± 3.0 % , respectively , P < 0.05 ) , while the increments in the cardiovascular variables for the increase in measured VO(2 ) did not change . In elderly subjects , ST and PT did not blunt submaximal or maximal HR , SBP and RPP increases during the maximal exercise test , showing that they did not reduce cardiovascular stress during aerobic tasks This study was conducted in three stages in a semi-rural region of Eskisehir , Turkey . In the first stage , individuals selected by r and om sampling  were evaluated for cardiovascular disease risk factors . In the second stage , Group I and Group II training material s were r and omly distributed . In the third stage , the subjects were screened one year later to assess and determine if there had been any changes in their attitudes towards the dangers of cardiovascular diseases . The number of active smokers significantly decreased after the training in the both groups . The percentage of people with regulated blood pressure exhibited an increase in Group II more than Group Objective Dietary sodium and potassium consumption is associated with  blood pressure levels . The objective of this study was to define a practical and low-cost method for the control of blood pressure by modification of these dietary cations in rural Chinese . Methods This study was a double-blind , r and omized , controlled trial design ed to establish the long-term effects of a reduced-sodium , high-potassium salt substitute ( 65 % sodium chloride , 25 % potassium chloride , 10 % magnesium sulphate ) compared to normal salt ( 100 % sodium chloride ) on blood pressure among high-risk individuals . Following a 4-week run-in period on salt substitute , participants were r and omly assigned to replace their household salt with either the study salt substitute or normal salt for a 12-month period . Results The mean age of the 608 r and omized participants was 60 years and 56 % of them were female . Sixty-four percent had a history of vascular disease and 61 % were taking one or more blood pressure-lowering drugs at entry .  Mean baseline blood pressure was 159/93 mmHg ( 
    Output:
    