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: This study examined balance ability , lower-extremity muscle strength , fear of falling and their inter-relationships in 40 community-dwelling older adults ( > 65 years ) . Subjects who self-identified either as being fearful offalling or not ( no concern ) were screened to exclude those with known risk factors for falling .  Limits of stability , maximal isometric strength , gait speed , and fear of falling were contrasted between groups ( 27 control subjects , 13 fearful subjects ) . Those fearful of falling demonstrated smaller center of pressure ( COP ) excursions in anterior , left , and right directions ( p < .0001 ) and used a smaller percentage of their base of support during maximal weight shifting in combined anterior-posterior and right-left directions ( p < .001 ) compared to the control group . Strength did not differ between groups , but was associated with the ability to shift the COP in the anterior-posterior direction ( p < .05 ) . Fear of falling also related to weight shifting ability ( p < .017 ) . Seniors fearful of falling demonstrated limitations in balance ability and balance confidence that could not be explained by muscle weakness The aims of this r and omised controlled trial were to determine if a high-intensity functional exercise program improves balance , gait ability , and lower-limb strength in older persons dependent in activities of daily living and if an intake of protein-enriched energy supplement immediately after the exercises increases the effects of the training . One hundred and ninety-one older persons dependent in activities of daily living , living in residential care facilities , and with a Mini-Mental State Examination ( MMSE ) score of ? 10 participated . They were r and omised to a high-intensity functional exercise program or a control activity , which included 29 sessions over 3 months , as well as to protein-enriched energy supplement or placebo .  Berg Balance Scale , self-paced and maximum gait speed , and one-repetition maximum in lower-limb strength were followed-up at three and six months and analysed by 2 x 2 factorial ANCOVA , using the intention-to-treat principle . At three months , the exercise group had improved significantly in self-paced gait speed compared with the control group ( mean difference 0.04 m/s , p = 0.02 ) . At six months , there were significant improvements favouring the exercise group for Berg Balance Scale ( 1.9 points , p = 0.05 ) , self-paced gait speed ( 0.05 m/s , p = 0.009 ) , and lower-limb strength ( 10.8 kg , p = 0.03 ) . No interaction effects were seen between the exercise and nutrition interventions . In conclusion , a high-intensity functional exercise program has positive long-term effects in balance , gait ability , and lower-limb strength for older persons dependent in activities of daily living . An intake of protein-enriched energy supplement immediately after the exercises does not appear to increase the effects of the training Studies of test-retest reliability for health-related quality of life instruments have used varying intervals between test administrations . There is no evidence available to aid in the selection of the time interval between question naire administrations for a study of test-retest reliability for health status instruments . We compared the test-retest reliability at 2 days and 2 weeks for four knee-rating scales and the eight domains of the SF-36 . Seventy patients with disorders of the knee who were in a stable state were r and omly allocated to repeat the question naires at either 2 days or 2 weeks . There were no statistically significant differences in the test-retest reliability ( intraclass correlation coefficient and limits of agreement statistics ) for the two time intervals BACKGROUND AND PURPOSE The interpretation of patient scores on clinical tests of physical mobility is limited by a lack of data describing the range of performance among people without disabilities . The purpose of this study was to provide data for 4 common clinical tests in a sample of community-dwelling older adults . SUBJECTS Ninety-six community-dwelling elderly people ( 61 - 89 years of age ) with independent functioning performed 4 clinical tests . METHODS Data were collected on the  Six-Minute Walk Test ( 6MW ) , Berg Balance Scale ( BBS ) , and Timed Up & Go Test ( TUG ) and during comfortable- and fast-speed walking ( CGS and FGS ) . Intraclass correlation coefficients ( ICCs ) were used to determine the test-retest reliability for the 6MW , TUG , CGS , and FGS measurements . Data were analyzed by gender and age ( 60 - 69 , 70 - 79 , and 80 - 89 years ) cohorts , similar to previous studies . Means , st and ard deviations , and 95 % confidence intervals for each measurement were calculated for each cohort . RESULTS The 6MW , TUG , CGS , and FGS measurements showed high test-retest reliability ( ICC [2,1]=.95-.97 ) . Mean test scores showed a trend of age-related declines for the 6MW , BBS , TUG , CGS , and FGS for both male and female subjects . DISCUSSION AND CONCLUSION Preliminary descriptive data suggest that physical therapists should use age-related data when interpreting patient data obtained for the 6MW , BBS , TUG , CGS and FGS . Further data on these clinical tests with larger sample sizes are needed to serve as a reference for patient comparisons Work Package 3 of the Prevention of Falls Network Europe has evaluated measurement properties of clinical balance measures to be used to : ( 1 ) select participants for interventions with the goal to prevent falls in older people , and ( 2 ) assess the results of such intervention on balance function . Inclusion in a fall prevention study may be based on measures identifying subjects who have impaired balance or increased risk of future falls . We propose that an appropriate statistical method to analyse discriminative ability of a balance measure is discriminant analysis or logistic regression analysis . The optimal cut-off score is best determined by plotting a receiver-operating-characteristic curve for different cut-off values . The evaluation of predictors for risk of future falls should be based on a study design with a prospect i ve data collection of falls . Sensitivity to change is a measurement property needed to evaluate the outcome of an intervention . The st and ardized response mean is frequently encountered in the literature and is recommended as a statistical measure of sensitivity to change in the context of an intervention study . Adequate reliability is a prerequisite for consistent measurement . Relative reliability may be reported as an intraclass correlation coefficient and absolute reliability as the within-subject st and ard deviation ( s(w ) ) , also called st and ard error of measurement . When measurement error is proportional to the score , calculation of a coefficient of variation can be considered . In a second paper , the authors will evaluate  clinical balance measures  for use in fall prevention studies based upon criteria recommended in this report BACKGROUND The reproducibility of a performance-based and a self-reported measure of functional status was investigated , as well as the impact of age and cognitive function on the reproducibility . METHODS Of a r and om sample of 114 men of the 1995 survey of the Zutphen Elderly Study , 105 men ( aged 79.9 + /- 4.5 years ) participated in a test-retest study . They filled out a question naire on disabilities and carried out performance tests twice , in a 2-week interval . Four performance tests were administered ( st and ing balance , walking speed , chair st and , and external shoulder rotation ) , and a summary performance score was constructed . The number of self-reported disabilities in basic activities of daily living , mobility , and instrumental activities of daily living were assessed . Kappa statistics and Pearson correlation coefficients between test and retest measurements were computed for the total group and stratified by age and cognitive function . RESULTS Three performance tests and the summary performance score had fair to good reproducibility ( walking speed : Pearsons r = .90 , chair st and : r = .82 , shoulder rotation : kappa = .49 , summary score : kappa = .52 ) . Only the test for st and ing balance was poorly reproducible ( kappa = .29 ) . The self-reported functional status was fairly to good reproducible ( kappa = .63 , r = .87 ) . Self-reported functional status was significantly less reproducible in very old and cognitively impaired than in younger and nonimpaired individuals . CONCLUSIONS In the elderly male subjects , performance tests and self-reported disabilities had moderate to good reproducibility , with the exception of the test for st and ing balance . In very old or cognitively impaired population s , self-reported functional status may have a lower reproducibility Study objective : To compare health walks , a community based lay-led walking scheme versus advice only on physical activity  and cardiovascular health status in middle aged adults . Design : R and omised controlled trial with one year follow up . Physical activity was measured by question naire . Other measures included attitudes to exercise , body mass index , cholesterol , aerobic capacity , and blood pressure . Setting : Primary care and community . Participants : 260 men and women aged 40–70 years , taking less than 120 minutes of moderate intensity activity per week . Main results : Seventy three per cent of people completed the trial . Of these , the proportion increasing their activity above 120 minutes of moderate intensity activity per week was 22.6 % in the advice only and 35.7 % in the health walks group at 12 months ( between group difference = 13 % ( 95 % CI 0.003 % to 25.9 % ) p=0.05 ) . Intention to treat analysis , using the last known value for missing cases , demonstrated smaller differences between the groups ( between group difference = 6 % ( 95 % CI −5 % to 16.4 % ) ) with the trend in favour of health walks . There were improvements in the total time spent and number of occasions of moderate intensity activity , and aerobic capacity , but no statistically significant differences between the groups . Other cardiovascular risk factors remained unchanged . Conclusions : There were no significant between group differences in self reported physical activity at 12 month follow up when the analysis was by intention to treat . In people who completed the trial , health walks was more effective than giving advice only in increasing moderate intensity activity above 120 minutes per week OBJECTIVES To estimate the magnitude of small meaningful and substantial individual change in physical performance measures and evaluate their responsiveness . DESIGN Secondary data analyses using distribution- and anchor-based methods to determine meaningful change . SETTING Secondary analysis of data from an observational study and clinical trials of community-dwelling older people and subacute stroke survivors . PARTICIPANTS Older adults with mobility disabilities in a strength training trial ( n=100 ) , subacute stroke survivors in an intervention trial ( n=100 ) , and a prospect i ve cohort of community-dwelling older people ( n=492 ) . MEASUREMENTS  Gait speed , Short Physical Performance Battery ( SPPB ) , 6-minute-walk distance ( 6MWD ) , and self-reported mobility . RESULTS Most small meaningful change estimates ranged from 0.04 to 0.06 m/s for gait speed , 0.27 to 0.55 points for SPPB , and 19 to 22 m for 6MWD . Most substantial change estimates ranged from 0.08 to 0.14 m/s for gait speed , 0.99 to 1.34 points for SPPB , and 47 to 49 m for 6MWD . Based on responsiveness indices , per-group sample sizes for clinical trials ranged from 13 to 42 for substantial change and 71 to 161 for small meaningful change . CONCLUSION Best initial estimates of small meaningful change are near 0.05 m/s for gait speed , 0.5 points for SPPB , and 20 m for 6MWD and of substantial change are near 0.10 m/s for gait speed , 1.0 point for SPPB , and 50 m for 6MWD . For clinical use , substantial change in these measures and small change in gait speed and 6MWD , but not SPPB , are detectable . For research use , these measures yield feasible sample sizes for detecting meaningful change OBJECTIVE To identify reasons for dropout and factors that may predict dropout from an exercise intervention aim ed at improving physical function in frail older persons . DESIGN / SETTING An 18-month r and omized controlled intervention in a community setting . The intervention comprised 2 groups : class-based and self-paced exercise . PARTICIPANTS 155 community-dwelling older persons , mean age 77.4 , with mildly to moderately compromised mobility . MEASUREMENTS The primary outcome measure was dropout . Dropouts were grouped as : D0 , dropout between baseline and 3-month assessment , and D3 , dropout after 3-month assessment . MEASUREMENTS Measurements of demographics , health , and physical performance included self-rated health , SF-36 , disease burden , adverse events , PPT-8 , MacArthur battery , 6-minute walk , and gait velocity . RESULTS There were 56 dropouts ( 36 % ) , 31 in first 3 months . Compared with retained subjects ( R ) , the D0 group had greater disease burden ( P = .011 ) , worse self-perceived physical health ( P = .014 ) , slower usual gait speed ( P = .001 ) , and walked a shorter distance over 6 minutes ( P<.001 ) . No differences were found between R and D3 . Multinomial logistic regression showed 6-minute walk ( P<.001 ) and usual gait velocity ( P<.001 ) were the strongest independent predictors of dropout . Controlling for all other variables , adverse events after r and omization and 6-minute walk distance were the strongest independent predictors of dropout , and self-paced exercise assignment increased the risk of dropout . CONCLUSIONS We observed baseline differences between early dropouts and retained subjects in disease burden , physical function , and endurance , suggesting that these factors at baseline may predict dropout . Improved underst and ing of factors that lead to and predict dropout could 
    Output:
    
agent
Walking speed is a highly valid test , both at habitual and maximum speed .
Both habitual and maximum walking speeds are valid instruments , and they predict death , hospitalization/institutionalization , and decline in mobility
***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: This study examined balance ability , lower-extremity muscle strength , fear of falling and their inter-relationships in 40 community-dwelling older adults ( > 65 years ) . Subjects who self-identified either as being fearful offalling or not ( no concern ) were screened to exclude those with known risk factors for falling .  Limits of stability , maximal isometric strength , gait speed , and fear of falling were contrasted between groups ( 27 control subjects , 13 fearful subjects ) . Those fearful of falling demonstrated smaller center of pressure ( COP ) excursions in anterior , left , and right directions ( p < .0001 ) and used a smaller percentage of their base of support during maximal weight shifting in combined anterior-posterior and right-left directions ( p < .001 ) compared to the control group . Strength did not differ between groups , but was associated with the ability to shift the COP in the anterior-posterior direction ( p < .05 ) . Fear of falling also related to weight shifting ability ( p < .017 ) . Seniors fearful of falling demonstrated limitations in balance ability and balance confidence that could not be explained by muscle weakness The aims of this r and omised controlled trial were to determine if a high-intensity functional exercise program improves balance , gait ability , and lower-limb strength in older persons dependent in activities of daily living and if an intake of protein-enriched energy supplement immediately after the exercises increases the effects of the training . One hundred and ninety-one older persons dependent in activities of daily living , living in residential care facilities , and with a Mini-Mental State Examination ( MMSE ) score of ? 10 participated . They were r and omised to a high-intensity functional exercise program or a control activity , which included 29 sessions over 3 months , as well as to protein-enriched energy supplement or placebo .  Berg Balance Scale , self-paced and maximum gait speed , and one-repetition maximum in lower-limb strength were followed-up at three and six months and analysed by 2 x 2 factorial ANCOVA , using the intention-to-treat principle . At three months , the exercise group had improved significantly in self-paced gait speed compared with the control group ( mean difference 0.04 m/s , p = 0.02 ) . At six months , there were significant improvements favouring the exercise group for Berg Balance Scale ( 1.9 points , p = 0.05 ) , self-paced gait speed ( 0.05 m/s , p = 0.009 ) , and lower-limb strength ( 10.8 kg , p = 0.03 ) . No interaction effects were seen between the exercise and nutrition interventions . In conclusion , a high-intensity functional exercise program has positive long-term effects in balance , gait ability , and lower-limb strength for older persons dependent in activities of daily living . An intake of protein-enriched energy supplement immediately after the exercises does not appear to increase the effects of the training Studies of test-retest reliability for health-related quality of life instruments have used varying intervals between test administrations . There is no evidence available to aid in the selection of the time interval between question naire administrations for a study of test-retest reliability for health status instruments . We compared the test-retest reliability at 2 days and 2 weeks for four knee-rating scales and the eight domains of the SF-36 . Seventy patients with disorders of the knee who were in a stable state were r and omly allocated to repeat the question naires at either 2 days or 2 weeks . There were no statistically significant differences in the test-retest reliability ( intraclass correlation coefficient and limits of agreement statistics ) for the two time intervals BACKGROUND AND PURPOSE The interpretation of patient scores on clinical tests of physical mobility is limited by a lack of data describing the range of performance among people without disabilities . The purpose of this study was to provide data for 4 common clinical tests in a sample of community-dwelling older adults . SUBJECTS Ninety-six community-dwelling elderly people ( 61 - 89 years of age ) with independent functioning performed 4 clinical tests . METHODS Data were collected on the  Six-Minute Walk Test ( 6MW ) , Berg Balance Scale ( BBS ) , and Timed Up & Go Test ( TUG ) and during comfortable- and fast-speed walking ( CGS and FGS ) . Intraclass correlation coefficients ( ICCs ) were used to determine the test-retest reliability for the 6MW , TUG , CGS , and FGS measurements . Data were analyzed by gender and age ( 60 - 69 , 70 - 79 , and 80 - 89 years ) cohorts , similar to previous studies . Means , st and ard deviations , and 95 % confidence intervals for each measurement were calculated for each cohort . RESULTS The 6MW , TUG , CGS , and FGS measurements showed high test-retest reliability ( ICC [2,1]=.95-.97 ) . Mean test scores showed a trend of age-related declines for the 6MW , BBS , TUG , CGS , and FGS for both male and female subjects . DISCUSSION AND CONCLUSION Preliminary descriptive data suggest that physical therapists should use age-related data when interpreting patient data obtained for the 6MW , BBS , TUG , CGS and FGS . Further data on these clinical tests with larger sample sizes are needed to serve as a reference for patient comparisons Work Package 3 of the Prevention of Falls Network Europe has evaluated measurement properties of clinical balance measures to be used to : ( 1 ) select participants for interventions with the goal to prevent falls in older people , and ( 2 ) assess the results of such intervention on balance function . Inclusion in a fall prevention study may be based on measures identifying subjects who have impaired balance or increased risk of future falls . We propose that an appropriate statistical method to analyse discriminative ability of a balance measure is discriminant analysis or logistic regression analysis . The optimal cut-off score is best determined by plotting a receiver-operating-characteristic curve for different cut-off values . The evaluation of predictors for risk of future falls should be based on a study design with a prospect i ve data collection of falls . Sensitivity to change is a measurement property needed to evaluate the outcome of an intervention . The st and ardized response mean is frequently encountered in the literature and is recommended as a statistical measure of sensitivity to change in the context of an intervention study . Adequate reliability is a prerequisite for consistent measurement . Relative reliability may be reported as an intraclass correlation coefficient and absolute reliability as the within-subject st and ard deviation ( s(w ) ) , also called st and ard error of measurement . When measurement error is proportional to the score , calculation of a coefficient of variation can be considered . In a second paper , the authors will evaluate  clinical balance measures  for use in fall prevention studies based upon criteria recommended in this report BACKGROUND The reproducibility of a performance-based and a self-reported measure of functional status was investigated , as well as the impact of age and cognitive function on the reproducibility . METHODS Of a r and om sample of 114 men of the 1995 survey of the Zutphen Elderly Study , 105 men ( aged 79.9 + /- 4.5 years ) participated in a test-retest study . They filled out a question naire on disabilities and carried out performance tests twice , in a 2-week interval . Four performance tests were administered ( st and ing balance , walking speed , chair st and , and external shoulder rotation ) , and a summary performance score was constructed . The number of self-reported disabilities in basic activities of daily living , mobility , and instrumental activities of daily living were assessed . Kappa statistics and Pearson correlation coefficients between test and retest measurements were computed for the total group and stratified by age and cognitive function . RESULTS Three performance tests and the summary performance score had fair to good reproducibility ( walking speed : Pearsons r = .90 , chair st and : r = .82 , shoulder rotation : kappa = .49 , summary score : kappa = .52 ) . Only the test for st and ing balance was poorly reproducible ( kappa = .29 ) . The self-reported functional status was fairly to good reproducible ( kappa = .63 , r = .87 ) . Self-reported functional status was significantly less reproducible in very old and cognitively impaired than in younger and nonimpaired individuals . CONCLUSIONS In the elderly male subjects , performance tests and self-reported disabilities had moderate to good reproducibility , with the exception of the test for st and ing balance . In very old or cognitively impaired population s , self-reported functional status may have a lower reproducibility Study objective : To compare health walks , a community based lay-led walking scheme versus advice only on physical activity  and cardiovascular health status in middle aged adults . Design : R and omised controlled trial with one year follow up . Physical activity was measured by question naire . Other measures included attitudes to exercise , body mass index , cholesterol , aerobic capacity , and blood pressure . Setting : Primary care and community . Participants : 260 men and women aged 40–70 years , taking less than 120 minutes of moderate intensity activity per week . Main results : Seventy three per cent of people completed the trial . Of these , the proportion increasing their activity above 120 minutes of moderate intensity activity per week was 22.6 % in the advice only and 35.7 % in the health walks group at 12 months ( between group difference = 13 % ( 95 % CI 0.003 % to 25.9 % ) p=0.05 ) . Intention to treat analysis , using the last known value for missing cases , demonstrated smaller differences between the groups ( between group difference = 6 % ( 95 % CI −5 % to 16.4 % ) ) with the trend in favour of health walks . There were improvements in the total time spent and number of occasions of moderate intensity activity , and aerobic capacity , but no statistically significant differences between the groups . Other cardiovascular risk factors remained unchanged . Conclusions : There were no significant between group differences in self reported physical activity at 12 month follow up when the analysis was by intention to treat . In people who completed the trial , health walks was more effective than giving advice only in increasing moderate intensity activity above 120 minutes per week OBJECTIVES To estimate the magnitude of small meaningful and substantial individual change in physical performance measures and evaluate their responsiveness . DESIGN Secondary data analyses using distribution- and anchor-based methods to determine meaningful change . SETTING Secondary analysis of data from an observational study and clinical trials of community-dwelling older people and subacute stroke survivors . PARTICIPANTS Older adults with mobility disabilities in a strength training trial ( n=100 ) , subacute stroke survivors in an intervention trial ( n=100 ) , and a prospect i ve cohort of community-dwelling older people ( n=492 ) . MEASUREMENTS  Gait speed , Short Physical Performance Battery ( SPPB ) , 6-minute-walk distance ( 6MWD ) , and self-reported mobility . RESULTS Most small meaningful change estimates ranged from 0.04 to 0.06 m/s for gait speed , 0.27 to 0.55 points for SPPB , and 19 to 22 m for 6MWD . Most substantial change estimates ranged from 0.08 to 0.14 m/s for gait speed , 0.99 to 1.34 points for SPPB , and 47 to 49 m for 6MWD . Based on responsiveness indices , per-group sample sizes for clinical trials ranged from 13 to 42 for substantial change and 71 to 161 for small meaningful change . CONCLUSION Best initial estimates of small meaningful change are near 0.05 m/s for gait speed , 0.5 points for SPPB , and 20 m for 6MWD and of substantial change are near 0.10 m/s for gait speed , 1.0 point for SPPB , and 50 m for 6MWD . For clinical use , substantial change in these measures and small change in gait speed and 6MWD , but not SPPB , are detectable . For research use , these measures yield feasible sample sizes for detecting meaningful change OBJECTIVE To identify reasons for dropout and factors that may predict dropout from an exercise intervention aim ed at improving physical function in frail older persons . DESIGN / SETTING An 18-month r and omized controlled intervention in a community setting . The intervention comprised 2 groups : class-based and self-paced exercise . PARTICIPANTS 155 community-dwelling older persons , mean age 77.4 , with mildly to moderately compromised mobility . MEASUREMENTS The primary outcome measure was dropout . Dropouts were grouped as : D0 , dropout between baseline and 3-month assessment , and D3 , dropout after 3-month assessment . MEASUREMENTS Measurements of demographics , health , and physical performance included self-rated health , SF-36 , disease burden , adverse events , PPT-8 , MacArthur battery , 6-minute walk , and gait velocity . RESULTS There were 56 dropouts ( 36 % ) , 31 in first 3 months . Compared with retained subjects ( R ) , the D0 group had greater disease burden ( P = .011 ) , worse self-perceived physical health ( P = .014 ) , slower usual gait speed ( P = .001 ) , and walked a shorter distance over 6 minutes ( P<.001 ) . No differences were found between R and D3 . Multinomial logistic regression showed 6-minute walk ( P<.001 ) and usual gait velocity ( P<.001 ) were the strongest independent predictors of dropout . Controlling for all other variables , adverse events after r and omization and 6-minute walk distance were the strongest independent predictors of dropout , and self-paced exercise assignment increased the risk of dropout . CONCLUSIONS We observed baseline differences between early dropouts and retained subjects in disease burden , physical function , and endurance , suggesting that these factors at baseline may predict dropout . Improved underst and ing of factors that lead to and predict dropout could 
    Output:
    