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: CONTEXT Testosterone in Older Men with Mobility Limitations Trial determined the effects of testosterone on muscle performance and physical function in older men with mobility limitation . Trial 's Data and Safety Monitoring Board recommended enrollment cessation due to increased frequency of adverse events in testosterone arm . The changes in muscle performance and physical function were evaluated in relation to participant 's perception of change . METHODS Men aged 65 years and older , with mobility limitation , total testosterone 100 - 350 ng/dL , or free testosterone less than 50 pg/mL , were r and omized to placebo or 10 g testosterone gel daily for 6 months . Primary outcome was leg-press strength . Secondary outcomes included chest-press strength , stair-climb , 40-m walk , muscle mass , physical activity , self-reported function , and fatigue . Proportions of participants exceeding minimally important difference in study arms were compared . RESULTS Of 209 r and omized participants , 165 had follow-up efficacy measures . Mean ( SD ) age was 74 ( 5.4 ) years and short physical performance battery score 7.7 ( 1.4 ) .  Testosterone arm exhibited greater improvements in leg-press strength , chest-press strength and power , and loaded stair-climb than placebo . Compared with placebo , significantly greater proportion of men receiving testosterone improved their leg-press and chest-press strengths ( 43 % vs 18 % , p = .01 ) and stair-climbing power ( 28 % vs 10 % , p = .03 ) more than minimally important difference . Increases in leg-press strength and stair-climbing power were associated with changes in testosterone levels and muscle mass . Physical activity , walking speed , self-reported function , and fatigue did not change . CONCLUSIONS Testosterone administration in older men with mobility limitation was associated with patient-important improvements in muscle strength and stair-climbing power . Improvements in muscle strength and only some physical function measures should be weighed against the risk of adverse events in this population OBJECTIVES To determine the effects of primary care-based , multicomponent physical activity counseling ( PAC ) promoting physical activity ( PA ) guidelines on gait speed and related measures of PA and function in older veterans . DESIGN R and omized controlled trial . SETTING Veterans Affairs Medical Center of Durham , North Carolina . PARTICIPANTS Three hundred ninety-eight male veterans aged 70 and older . INTERVENTION Twelve months of usual care ( UC ) or multicomponent PAC consisting of baseline in-person and every other week and then monthly telephone counseling by a lifestyle counselor , one-time clinical endorsement of PA , monthly automated telephone messaging from the primary care provider , and quarterly tailored mailings of progress in PA . MEASUREMENTS Gait speed ( usual and rapid ) , self-reported PA , function , and disability at baseline and 3 , 6 , and 12 months . RESULTS Although no between-group differences were noted for usual gait speed , rapid gait speed improved significantly more for the PAC group ( 1.56 + /- 0.41 m/s to 1.68 + /- 0.44 m/s ) than with UC ( 1.57 + /- 0.40 m/sec to 1.59 + /- 0.42 m/sec , P=.04 ) . Minutes of moderate/vigorous PA increased significantly in the PAC group ( from 57.1 + /- 99.3 to 126.6 + /- 142.9 min/wk ) but not in the UC group ( from 60.2 + /- 116.1 to 69.6 + /- 116.1 min/wk , P<.001 ) . Changes in other functional/disability outcomes were small . CONCLUSION In this group of older male veterans , multicomponent PA significantly improved rapid gait and PA . Translation from increased PA to overall functioning was not observed . Integration with primary care was successful Background and Purpose — To determine the effect of a multifaceted stroke telerehabilitation ( STeleR ) intervention on physical function , and secondarily on disability , in veterans poststroke . Methods — We conducted a prospect i ve , r and omized , multisite , single-blinded trial in 52 veterans with stroke from 3 Veterans Affairs medical centers . Veterans with a stroke in the preceding 24 months were r and omized to the STeleR intervention or usual care .  The STeleR intervention consisted of 3 home visits , 5 telephone calls , and an in-home messaging device provided over 3 months to instruct patients in functionally based exercises and adaptive strategies . Usual care participants received routine rehabilitation care as prescribed by their physicians . The primary outcome measures were improvement in function at 6 months , measured by both the motor subscale of the Telephone Version of Functional Independence Measure and by the function scales of the Late-Life Function and Disability Instrument . Results — The 2 complementary primary outcomes ( Late-Life Function and Disability Instrument Function and Telephone Version of Functional Independence Measure ) improved at 6 months for the STeleR group and declined for the usual care group , but the differences were not statistically significant ( P=0.25 , Late-Life Function and Disability Instrument ; P=0.316 ) . Several of secondary outcomes were statistically significant . At 6 months , compared with the usual care group , the STeleR group showed statistically significant improvements in 4 of the 5 Late-Life Function and Disability Instrument disability component subscales ( P<0.05 ) , and approached significance in 1 of the 3 Function component subscales ( P=0.06 ) . Conclusions — The STeleR intervention significantly improved physical function , with improvements persisting up to 3 months after completing the intervention . STeleR could be a useful supplement to traditional poststroke rehabilitation given the limited re sources available for in-home rehabilitation for stroke survivors . Clinical Trial Registration — URL : http://www . clinical trials.gov . Unique identifier : NCT00384748 Background Self-rated health ( SRH ) is a widely used indicator of general health and multiple studies have supported the predictive validity of SRH in older population s concerning future health , functional decline , disability , and mortality . The aim of this study was to use the theoretical framework of the International Classification of Functioning , Disability and Health ( ICF ) to create a better underst and ing of factors associated with SRH among community-dwelling older people in urban and rural areas . Methods The study design was population -based and cross-sectional . Participants were 185 Icel and ers , r and omly selected from a national registry , community-dwelling , 65 - 88 years old , 63 % urban residents , and 52 % men . Participants were asked : " In general , would you say your health is excellent , very good , good , fair , or poor ? " Associations with SRH were analyzed with ordinal logistic regression . Explanatory variables represented aspects of body functions , activities , participation , environmental factors and personal factors components of the ICF . Results Univariate analysis revealed that SRH was significantly associated with all analyzed ICF components through 16 out of 18 explanatory variables . Multivariate analysis , however , demonstrated that SRH had an independent association with five variables representing ICF body functions , activities , and personal factors components : The likelihood of a better SRH increased with advanced lower extremity capacity ( adjusted odds ratio [ adjOR ] = 1.05 , p < 0.001 ) , upper extremity capacity ( adjOR = 1.13 , p = 0.040 ) , household physical activity ( adjOR = 1.01 , p = 0.016 ) , and older age ( adjOR = 1.09 , p = 0.006 ) ; but decreased with more depressive symptoms ( adjOR = 0.79 , p < 0.001 ) . Conclusions The results highlight a collection of ICF body functions , activities and personal factors associated with higher SRH among community-dwelling older people . Some of these , such as physical capacity , depressive symptoms , and habitual physical activity are of particular interest due to their potential for change through public health interventions . The use of ICF conceptual framework and widely accepted st and ardized assessment s should make these results comparable and relevant in an international context Introduction Older breast cancer survivors ( BCS ) report more falls and functional limitations than women with no cancer history .  Exercise training could reduce risk factors for future falls and disability . Methods We conducted a r and omized , controlled trial in 106 early-stage , postmenopausal BCS who were ≥50 years old at diagnosis and post-treatment . Women were r and omly assigned to a 1-year resistance + impact exercise program or a stretching placebo program . Endpoints were one repetition maximum bench press and leg press strength , timed five chair st and s , 4 m usual walk speed , timed stance tests , h and grip strength , self-report physical function , and fatigue . We also examined the influence of age , adjuvant hormone therapy use , and exercise adherence on study outcomes . Results Women in the resistance + impact training program significantly improved maximal leg ( p < 0 .02 ) and bench ( p < 0 .02 ) press strength compared to the stretching group . Women who attended 50 % or more of prescribed resistance training sessions had significantly better changes in maximal strength measures compared to less adherent women . Conclusions Resistance + impact exercise is superior to stretching at improving maximal muscle strength and exercise adherence contributes to the degree of improvement . Implication s for cancer survivorsOlder BCS can safely engage in resistance exercise that improves lower and upper body strength , thereby reducing a risk factor for falls and future disability . However , the ability of resistance training to shift other indices of fall and disability risk , i.e. , balance and function , is unclear . Strategies to promote adherence to resistance training could lead to greater improvements in strength PURPOSE Diet and exercise interventions have been tested in cancer survivors as a means to reduce late effects and comorbidity , but few have assessed adherence and health outcomes long term . METHODS Between July 2005 and May 2007 , the Reach Out to Enhance Wellness ( RENEW ) trial accrued 641 locoregionally staged , long-term ( ≥ 5 years from diagnosis ) colorectal , breast , and prostate cancer survivors in the United States ( 21 states ) , Canada , and the United Kingdom . All participants were sedentary ( < 150 minutes of physical activity [ PA ] a week ) , overweight or obese ( body mass index , 25 to 40 kg/m(2 ) ) , and over age 65 years . The trial tested a diet-exercise intervention delivered via mailed print material s and telephone counseling . RENEW used a wait-list control , cross-over design ( ie , participants received the year-long intervention immediately or after a 1-year delay ) , which allowed the opportunity to assess program efficacy ( previously reported primary outcome ) , durability , and reproducibility ( reported herein ) . Measures included diet quality ( DQ ) , PA , BMI , and physical function ( PF ) . RESULTS No significant relapse was observed in the immediate-intervention arm for DQ , PA , and BMI ; however , rates of functional decline increased when the intervention ceased . From year 1 to year 2 , significant improvements were observed in the delayed-intervention arm ; mean change scores in behaviors and BMI and PF slopes were as follows : DQ score , 5.2 ( 95 % CI , 3.4 to 7.0 ) ; PA , 45.8 min/wk ( 95 % CI , 26.9 to 64.6 min/wk ) ; BMI , -0.56 ( 95 % CI , -0.75 to -0.36 ) ; and Short Form-36 PF , -1.02 versus -5.52 ( P < .001 for all measures ) . Overall , both arms experienced significant improvements in DQ , PA , and BMI from baseline to 2-year follow-up ( P < .001 ) . CONCLUSION Older cancer survivors respond favorably to lifestyle interventions and make durable changes in DQ and PA that contribute to sustained weight loss . These changes positively reorient functional decline trajectories during intervention delivery Background and Purpose — To evaluate the efficacy of supervised high-intensity progressive resistance training ( PRT ) on lower extremity strength , function , and disability in older , long-term stroke survivors . Methods — Forty-two volunteers aged 50 years and above , 6 months to 6 years after a single mild to moderate stroke , were r and omized into either a control group of upper extremity stretching or a PRT group that received a 12-week supervised high-intensity resistance training program consisting of bilateral leg press ( LP ) , unilateral paretic and nonparetic knee extension ( KE ) , ankle dorsiflexion ( DF ) , and plantarflexion ( PF ) exercises .  Functional performance was assessed using the 6-minute walk , stair-climb time , repeated chair-rise time , and habitual and maximal gait velocities . Self-reported changes in function and disability were evaluated using the Late Life Function and Disability Instrument ( LLFDI ) . Results — Single-repetition maximum strength significantly improved in the PRT group for LP ( 16.2 % ) , paretic KE ( 31.4 % ) , and nonparetic KE ( 38.2 % ) with no change in the control group . Paretic ankle DF ( 66.7 % versus −24.0 % ) , paretic ankle PF ( 35.5 % versus −20.3 % ) , and nonparetic ankle PF ( 14.7 % versus −13.8 % ) significantly improved in the PRT group compared with the control . The PRT group showed significant improvement in self-reported function and disability with no change in the control . There was 
    Output:
    
agent
High test-retest reliability was found for the Function component , while results for the Disability component were more variable .
Conclusions There is extensive evidence to support the construct validity and sensitivity to change of the LLFDI among various clinical population s of community-dwelling older adults .
***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: CONTEXT Testosterone in Older Men with Mobility Limitations Trial determined the effects of testosterone on muscle performance and physical function in older men with mobility limitation . Trial 's Data and Safety Monitoring Board recommended enrollment cessation due to increased frequency of adverse events in testosterone arm . The changes in muscle performance and physical function were evaluated in relation to participant 's perception of change . METHODS Men aged 65 years and older , with mobility limitation , total testosterone 100 - 350 ng/dL , or free testosterone less than 50 pg/mL , were r and omized to placebo or 10 g testosterone gel daily for 6 months . Primary outcome was leg-press strength . Secondary outcomes included chest-press strength , stair-climb , 40-m walk , muscle mass , physical activity , self-reported function , and fatigue . Proportions of participants exceeding minimally important difference in study arms were compared . RESULTS Of 209 r and omized participants , 165 had follow-up efficacy measures . Mean ( SD ) age was 74 ( 5.4 ) years and short physical performance battery score 7.7 ( 1.4 ) .  Testosterone arm exhibited greater improvements in leg-press strength , chest-press strength and power , and loaded stair-climb than placebo . Compared with placebo , significantly greater proportion of men receiving testosterone improved their leg-press and chest-press strengths ( 43 % vs 18 % , p = .01 ) and stair-climbing power ( 28 % vs 10 % , p = .03 ) more than minimally important difference . Increases in leg-press strength and stair-climbing power were associated with changes in testosterone levels and muscle mass . Physical activity , walking speed , self-reported function , and fatigue did not change . CONCLUSIONS Testosterone administration in older men with mobility limitation was associated with patient-important improvements in muscle strength and stair-climbing power . Improvements in muscle strength and only some physical function measures should be weighed against the risk of adverse events in this population OBJECTIVES To determine the effects of primary care-based , multicomponent physical activity counseling ( PAC ) promoting physical activity ( PA ) guidelines on gait speed and related measures of PA and function in older veterans . DESIGN R and omized controlled trial . SETTING Veterans Affairs Medical Center of Durham , North Carolina . PARTICIPANTS Three hundred ninety-eight male veterans aged 70 and older . INTERVENTION Twelve months of usual care ( UC ) or multicomponent PAC consisting of baseline in-person and every other week and then monthly telephone counseling by a lifestyle counselor , one-time clinical endorsement of PA , monthly automated telephone messaging from the primary care provider , and quarterly tailored mailings of progress in PA . MEASUREMENTS Gait speed ( usual and rapid ) , self-reported PA , function , and disability at baseline and 3 , 6 , and 12 months . RESULTS Although no between-group differences were noted for usual gait speed , rapid gait speed improved significantly more for the PAC group ( 1.56 + /- 0.41 m/s to 1.68 + /- 0.44 m/s ) than with UC ( 1.57 + /- 0.40 m/sec to 1.59 + /- 0.42 m/sec , P=.04 ) . Minutes of moderate/vigorous PA increased significantly in the PAC group ( from 57.1 + /- 99.3 to 126.6 + /- 142.9 min/wk ) but not in the UC group ( from 60.2 + /- 116.1 to 69.6 + /- 116.1 min/wk , P<.001 ) . Changes in other functional/disability outcomes were small . CONCLUSION In this group of older male veterans , multicomponent PA significantly improved rapid gait and PA . Translation from increased PA to overall functioning was not observed . Integration with primary care was successful Background and Purpose — To determine the effect of a multifaceted stroke telerehabilitation ( STeleR ) intervention on physical function , and secondarily on disability , in veterans poststroke . Methods — We conducted a prospect i ve , r and omized , multisite , single-blinded trial in 52 veterans with stroke from 3 Veterans Affairs medical centers . Veterans with a stroke in the preceding 24 months were r and omized to the STeleR intervention or usual care .  The STeleR intervention consisted of 3 home visits , 5 telephone calls , and an in-home messaging device provided over 3 months to instruct patients in functionally based exercises and adaptive strategies . Usual care participants received routine rehabilitation care as prescribed by their physicians . The primary outcome measures were improvement in function at 6 months , measured by both the motor subscale of the Telephone Version of Functional Independence Measure and by the function scales of the Late-Life Function and Disability Instrument . Results — The 2 complementary primary outcomes ( Late-Life Function and Disability Instrument Function and Telephone Version of Functional Independence Measure ) improved at 6 months for the STeleR group and declined for the usual care group , but the differences were not statistically significant ( P=0.25 , Late-Life Function and Disability Instrument ; P=0.316 ) . Several of secondary outcomes were statistically significant . At 6 months , compared with the usual care group , the STeleR group showed statistically significant improvements in 4 of the 5 Late-Life Function and Disability Instrument disability component subscales ( P<0.05 ) , and approached significance in 1 of the 3 Function component subscales ( P=0.06 ) . Conclusions — The STeleR intervention significantly improved physical function , with improvements persisting up to 3 months after completing the intervention . STeleR could be a useful supplement to traditional poststroke rehabilitation given the limited re sources available for in-home rehabilitation for stroke survivors . Clinical Trial Registration — URL : http://www . clinical trials.gov . Unique identifier : NCT00384748 Background Self-rated health ( SRH ) is a widely used indicator of general health and multiple studies have supported the predictive validity of SRH in older population s concerning future health , functional decline , disability , and mortality . The aim of this study was to use the theoretical framework of the International Classification of Functioning , Disability and Health ( ICF ) to create a better underst and ing of factors associated with SRH among community-dwelling older people in urban and rural areas . Methods The study design was population -based and cross-sectional . Participants were 185 Icel and ers , r and omly selected from a national registry , community-dwelling , 65 - 88 years old , 63 % urban residents , and 52 % men . Participants were asked : " In general , would you say your health is excellent , very good , good , fair , or poor ? " Associations with SRH were analyzed with ordinal logistic regression . Explanatory variables represented aspects of body functions , activities , participation , environmental factors and personal factors components of the ICF . Results Univariate analysis revealed that SRH was significantly associated with all analyzed ICF components through 16 out of 18 explanatory variables . Multivariate analysis , however , demonstrated that SRH had an independent association with five variables representing ICF body functions , activities , and personal factors components : The likelihood of a better SRH increased with advanced lower extremity capacity ( adjusted odds ratio [ adjOR ] = 1.05 , p < 0.001 ) , upper extremity capacity ( adjOR = 1.13 , p = 0.040 ) , household physical activity ( adjOR = 1.01 , p = 0.016 ) , and older age ( adjOR = 1.09 , p = 0.006 ) ; but decreased with more depressive symptoms ( adjOR = 0.79 , p < 0.001 ) . Conclusions The results highlight a collection of ICF body functions , activities and personal factors associated with higher SRH among community-dwelling older people . Some of these , such as physical capacity , depressive symptoms , and habitual physical activity are of particular interest due to their potential for change through public health interventions . The use of ICF conceptual framework and widely accepted st and ardized assessment s should make these results comparable and relevant in an international context Introduction Older breast cancer survivors ( BCS ) report more falls and functional limitations than women with no cancer history .  Exercise training could reduce risk factors for future falls and disability . Methods We conducted a r and omized , controlled trial in 106 early-stage , postmenopausal BCS who were ≥50 years old at diagnosis and post-treatment . Women were r and omly assigned to a 1-year resistance + impact exercise program or a stretching placebo program . Endpoints were one repetition maximum bench press and leg press strength , timed five chair st and s , 4 m usual walk speed , timed stance tests , h and grip strength , self-report physical function , and fatigue . We also examined the influence of age , adjuvant hormone therapy use , and exercise adherence on study outcomes . Results Women in the resistance + impact training program significantly improved maximal leg ( p < 0 .02 ) and bench ( p < 0 .02 ) press strength compared to the stretching group . Women who attended 50 % or more of prescribed resistance training sessions had significantly better changes in maximal strength measures compared to less adherent women . Conclusions Resistance + impact exercise is superior to stretching at improving maximal muscle strength and exercise adherence contributes to the degree of improvement . Implication s for cancer survivorsOlder BCS can safely engage in resistance exercise that improves lower and upper body strength , thereby reducing a risk factor for falls and future disability . However , the ability of resistance training to shift other indices of fall and disability risk , i.e. , balance and function , is unclear . Strategies to promote adherence to resistance training could lead to greater improvements in strength PURPOSE Diet and exercise interventions have been tested in cancer survivors as a means to reduce late effects and comorbidity , but few have assessed adherence and health outcomes long term . METHODS Between July 2005 and May 2007 , the Reach Out to Enhance Wellness ( RENEW ) trial accrued 641 locoregionally staged , long-term ( ≥ 5 years from diagnosis ) colorectal , breast , and prostate cancer survivors in the United States ( 21 states ) , Canada , and the United Kingdom . All participants were sedentary ( < 150 minutes of physical activity [ PA ] a week ) , overweight or obese ( body mass index , 25 to 40 kg/m(2 ) ) , and over age 65 years . The trial tested a diet-exercise intervention delivered via mailed print material s and telephone counseling . RENEW used a wait-list control , cross-over design ( ie , participants received the year-long intervention immediately or after a 1-year delay ) , which allowed the opportunity to assess program efficacy ( previously reported primary outcome ) , durability , and reproducibility ( reported herein ) . Measures included diet quality ( DQ ) , PA , BMI , and physical function ( PF ) . RESULTS No significant relapse was observed in the immediate-intervention arm for DQ , PA , and BMI ; however , rates of functional decline increased when the intervention ceased . From year 1 to year 2 , significant improvements were observed in the delayed-intervention arm ; mean change scores in behaviors and BMI and PF slopes were as follows : DQ score , 5.2 ( 95 % CI , 3.4 to 7.0 ) ; PA , 45.8 min/wk ( 95 % CI , 26.9 to 64.6 min/wk ) ; BMI , -0.56 ( 95 % CI , -0.75 to -0.36 ) ; and Short Form-36 PF , -1.02 versus -5.52 ( P < .001 for all measures ) . Overall , both arms experienced significant improvements in DQ , PA , and BMI from baseline to 2-year follow-up ( P < .001 ) . CONCLUSION Older cancer survivors respond favorably to lifestyle interventions and make durable changes in DQ and PA that contribute to sustained weight loss . These changes positively reorient functional decline trajectories during intervention delivery Background and Purpose — To evaluate the efficacy of supervised high-intensity progressive resistance training ( PRT ) on lower extremity strength , function , and disability in older , long-term stroke survivors . Methods — Forty-two volunteers aged 50 years and above , 6 months to 6 years after a single mild to moderate stroke , were r and omized into either a control group of upper extremity stretching or a PRT group that received a 12-week supervised high-intensity resistance training program consisting of bilateral leg press ( LP ) , unilateral paretic and nonparetic knee extension ( KE ) , ankle dorsiflexion ( DF ) , and plantarflexion ( PF ) exercises .  Functional performance was assessed using the 6-minute walk , stair-climb time , repeated chair-rise time , and habitual and maximal gait velocities . Self-reported changes in function and disability were evaluated using the Late Life Function and Disability Instrument ( LLFDI ) . Results — Single-repetition maximum strength significantly improved in the PRT group for LP ( 16.2 % ) , paretic KE ( 31.4 % ) , and nonparetic KE ( 38.2 % ) with no change in the control group . Paretic ankle DF ( 66.7 % versus −24.0 % ) , paretic ankle PF ( 35.5 % versus −20.3 % ) , and nonparetic ankle PF ( 14.7 % versus −13.8 % ) significantly improved in the PRT group compared with the control . The PRT group showed significant improvement in self-reported function and disability with no change in the control . There was 
    Output:
    