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: Employers commonly use adjustments to health insurance premiums as incentives to encourage healthy behavior , but the effectiveness of those adjustments is controversial . We gave 197 obese participants in a workplace wellness program a weight loss goal equivalent to 5 percent of their baseline weight . They were r and omly assigned to a control arm , with no financial incentive for achieving the goal , or to one of three intervention arms offering an incentive valued at $ 550 . Two intervention arms used health insurance premium adjustments , beginning the following year ( delayed ) or in the first pay period after achieving the goal ( immediate ) . A third arm used a daily lottery incentive separate from premiums . At twelve months there were no statistically significant differences in mean weight change either between the control group ( whose members had a mean gain of 0.1 pound ) and any of the incentive groups ( delayed premium adjustment , -1.2 pound ; immediate premium adjustment , -1.4 pound ; daily lottery incentive , -1.0 pound ) or among the intervention groups . The apparent failure of the incentives to promote weight loss suggests that employers that encourage weight reduction through workplace wellness programs should test alternatives to the conventional premium adjustment approach by using alternative incentive design s , larger incentives , or both OBJECTIVE To examine the viability of monetary incentives to increase fitness-center use and maintain/improve the Body Mass Indexes ( BMI s ) of first-year students over the fall semester . METHOD R and omized-controlled trial with no-treatment and incentive conditions involving 117 first-year students . For 12 weeks , students in the incentive condition received monetary payments ranging from $ 10 to $ 38.75 for meeting research er-set fitness-center use goals that were identical across conditions . Fitness-center use was monitored through electronic ID-card check-in and check-out records at the campus fitness center . RESULTS 63 % of incentive-condition participants met the weekly fitness-center use goals on average compared to only 13 % of control-condition participants , a significant difference , p<0.001 . Goal achievement significantly decreased over time , p<0.01 and at roughly the same rate in the control and incentive conditions , p=0.23 . Average BMI increases over the fall semester in the control ( 24.2 ( 0.6 ) to 24.6 (0.6)kg/m(2 ) ) versus incentive condition ( 23.1 ( 0.4 ) to 23.5 (0.4)kg/m(2 ) ) were not significantly different ( p=0.70 ) . CONCLUSION Weekly monetary incentives result ed in significantly more first-year students meeting weekly fitness-center use goals . However , the increased fitness-center use by the incentive condition did not prevent an increase in BMI during fall semester Exercise is the best predictor of long-term weight loss . This study evaluated two strategies for improving exercise adherence and long-term weight loss in obese out patients . Obese men and women ( N = 193 ) were r and omized to 1 of 5 treatment groups for 18 months : st and ard behavior therapy ( SBT ) ; SBT with supervised walks ( SW ) 3 times per week ; SBT + SW with personal trainers ( PT ) , who walked with participants , made phone reminders , and did make-up SW ; SBT + SW with monetary incentives ( I ) for completing SW ; and SBT + SW + PT + I. Both PT and I enhanced attendance at SWs , the combination producing the best adherence . Increased walk attendance did not result in higher overall energy expenditure , however , and long-term weight loss was also not improved . Post hoc analyses suggest that the level of exercise needed for successful long-term weight loss is much higher than that usually recommended in behavioral treatment programs Objective To examine whether adding either small , variable financial incentives or optional group sessions improves weight losses in a community-based , Internet behavioral program . Design and methods Participants ( N=268 ) from Shape Up Rhode Isl and 2012 , a 3 month Web-based community wellness initiative , were r and omized to : Shape Up+Internet behavioral program ( SI ) , Shape Up+Internet program+Incentives ( SII ) , or Shape Up+Internet program+Group sessions ( SIG ) . Results At the end of the 3 month program , SII achieved significantly greater weight losses than SI ( SII:6.4 % [ 5.1 - 7.7 ] ; SI:4.2 % [ 3.0 - 5.6 ] ; P=.03 ) ; weight losses in SIG were not significantly different from the other two conditions ( SIG : 5.8 % [ 4.5 - 7.1 ] , P’s≥.10 ) . However , at the 12 month no treatment follow-up visit , both SII and SIG had greater weight losses than SI ( SII : 3.1 % [ 1.8 - 4.4 ] ; SIG : 4.5 % [ 3.2 - 5.8 ] ; SI : 1.2 % [ -0.1 - 2.6 ] ; P’s≤.05 ) . SII was the most cost-effective approach at both 3 ( SII : $ 34/kg ; SI : $ 34/kg ; SIG : $ 87/kg ) and 12 months ( SII : $ 64/kg ; SI : $ 140/kg ; SIG : $ 113/kg ) . Conclusions Modest financial incentives  enhance weight losses during a community campaign and both incentives and optional group meetings improved overall weight loss outcomes during the follow-up period . However , the use of the financial incentives is the most cost-effective approach Background This research evaluated the effects of financial incentives and purchase restrictions on food purchasing in a food benefit program for low income people . Methods Participants ( n=279 ) were r and omized to groups : 1 ) Incentive- 30 % financial incentive for fruits and vegetables purchased with food benefits ; 2 ) Restriction- no purchase of sugar-sweetened beverages , sweet baked goods , or c and ies with food benefits ; 3 ) Incentive plus Restriction ; or 4 ) Control- no incentive or restrictions . Participants received a study -specific debit card where funds were added monthly for 12-weeks . Food purchase receipts were collected over 16 weeks . Total dollars spent on grocery purchases and by targeted food categories were computed from receipts . Group differences were examined using general linear models . Results Weekly purchases of fruit significantly increased in the Incentive plus Restriction ( $ 4.8 ) compared to the Restriction ( $ 1.7 ) and Control ( $ 2.1 ) groups ( p < .01 ) . Sugar-sweetened beverage purchases significantly decreased in the Incentive plus Restriction(−$0.8 per week ) and Restriction ( $ -1.4 per week ) groups compared to the Control group ( + $ 1.5 ; p < .0001 ) . Sweet baked goods purchases significantly decreased in the Restriction ( −$0.70 per week ) compared to the Control group ( + $ 0.82 per week ; p < .01 ) . Conclusions Paired financial incentives and restrictions on foods and beverages purchased with food program funds may support more healthful food purchases compared to no incentives or restrictions . Clinical trial registration Clinical trials.gov Identifier : NCT02643576 RCTs would be more useful if there were more realistic expectations of them and if their pitfalls were better recognized . For example , and contrary to many cl aims in the applied literature , r and omization does not equalize everything but the treatment across treatments and controls , it does not automatically deliver a precise estimate of the average treatment effect ( ATE ) , and it does not relieve us of the need to think about ( observed or unobserved ) confounders . Estimates apply to the trial sample only , sometimes a convenience sample , and usually selected ; justification is required to extend them to other groups , including any population to which the trial sample belongs . Dem and ing “ external validity � ? is unhelpful because it expects too much of an RCT while undervaluing its contribution . Statistical inference on ATEs involves hazards that are not always recognized . RCTs do indeed require minimal assumptions and can operate with little prior knowledge . This is an advantage when persuading distrustful audiences , but it is a disadvantage for cumulative scientific progress , where prior knowledge should be built upon and not discarded . RCTs can play a role in building scientific knowledge and useful predictions but they can only do so as part of a cumulative program , combining with other methods , including conceptual and theoretical development , to discover not “ what works , � ? but “ why things work � ? BACKGROUND Despite the increasing popularity of activity trackers , little evidence exists that they can improve health outcomes . We aim ed to investigate whether use of activity trackers , alone or in combination with cash incentives or charitable donations , lead to increases in physical activity and improvements in health outcomes . METHODS In this r and omised controlled trial , employees from 13 organisations in Singapore were r and omly assigned ( 1:1:1:1 ) with a computer generated assignment schedule to control ( no tracker or incentives ) , Fitbit Zip activity tracker , tracker plus charity incentives , or tracker plus cash incentives .  Participants had to be English speaking , full-time employees , aged 21 - 65 years , able to walk at least ten steps continuously , and non-pregnant . Incentives were tied to weekly steps , and the primary outcome , moderate-to-vigorous physical activity ( MVPA ) bout min per week , was measured via a sealed accelerometer and assessed on an intention-to-treat basis at 6 months ( end of intervention ) and 12 months ( after a 6 month post-intervention follow-up period ) . Other outcome measures included steps , participants meeting 70 000 steps per week target , and health-related outcomes including weight , blood pressure , and quality -of-life measures . This trial is registered at Clinical Trials.gov , number NCT01855776 . FINDINGS Between June 13 , 2013 , and Aug 15 , 2014 , 800 participants were recruited and r and omly assigned to the control ( n=201 ) , Fitbit ( n=203 ) , charity ( n=199 ) , and cash ( n=197 ) groups . At 6 months , compared with control , the cash group logged an additional 29 MVPA bout min per week ( 95 % CI 10 - 47 ; p=0·0024 ) and the charity group an additional 21 MVPA bout min per week ( 2 - 39 ; p=0·0310 ) ; the difference between Fitbit only and control was not significant ( 16 MVPA bout min per week [ -2 to 35 ; p=0·0854 ] ) . Increases in MVPA bout min per week in the cash and charity groups were not significantly greater than that of the Fitbit group . At 12 months , the Fitbit group logged an additional 37 MVPA bout min per week ( 19 - 56 ; p=0·0001 ) and the charity group an additional 32 MVPA bout min per week ( 12 - 51 ; p=0·0013 ) compared with control ; the difference between cash and control was not significant ( 15 MVPA bout min per week [ -5 to 34 ; p=0·1363 ] ) . A decrease in physical activity of -23 MVPA bout min per week ( 95 % CI -42 to -4 ; p=0·0184 ) was seen when comparing the cash group with the Fitbit group . There were no improvements in any health outcomes ( weight , blood pressure , etc ) at either assessment . INTERPRETATION The cash incentive was most effective at increasing MVPA bout min per week at 6 months , but this effect was not sustained 6 months after the incentives were discontinued . At 12 months , the activity tracker with or without charity incentives were effective at stemming the reduction in MVPA bout min per week seen in the control group , but we identified no evidence of improvements in health outcomes , either with or without incentives , calling into question the value of these devices for health promotion . Although other incentive strategies might generate greater increases in step activity and improvements in health outcomes , incentives would probably need to be in place long term to avoid any potential decrease in physical activity result ing from discontinuation . FUNDING Ministry of Health , Singapore Many older adults do not meet physical activity recommendations and suffer from health-related complications . Reinforcement interventions can have pronounced effects on promoting behavior change ; this study evaluated the efficacy of a reinforcement intervention to enhance walking in older adults . Forty-five sedentary adults with mild to moderate hypertension were r and omized to 12-week interventions consisting of pedometers and guidelines to walk 10,000 steps/day or that same intervention with chances to win $ 1-$100 prizes for meeting recommendations . Patients walked an average of about 4,000 steps/day at baseline . Throughout the intervention , participants in the reinforcement intervention  met walking goals on 82.5 % ± 25.8 % of days versus 55.3 % ± 37.1 % of days in the control condition , p < .01 . Even though steps walked increased significantly in both groups relative to baseline , participants in the reinforcement condition walked an average of about 2,000 more steps/day than participants in the control condition , p < .02 . Beneficial effects of the reinforcement condition relative to the control condition persisted at a 24-week follow-up evaluation , p < .02 , although steps/day were lower than during the intervention period in both groups . Participants in the reinforcement intervention also evidence d greater reductions in blood pressure and weight over time and improvements in fitness indices , ps < .05 . This reinforcement-based intervention substantially increased walking and improved clinical parameters , suggesting that larger 
    Output:
    
agent
Our primary conclusion is that there is a lack of compelling evidence that incentives of any form represent a compelling NCD reduction strategy .
***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: Employers commonly use adjustments to health insurance premiums as incentives to encourage healthy behavior , but the effectiveness of those adjustments is controversial . We gave 197 obese participants in a workplace wellness program a weight loss goal equivalent to 5 percent of their baseline weight . They were r and omly assigned to a control arm , with no financial incentive for achieving the goal , or to one of three intervention arms offering an incentive valued at $ 550 . Two intervention arms used health insurance premium adjustments , beginning the following year ( delayed ) or in the first pay period after achieving the goal ( immediate ) . A third arm used a daily lottery incentive separate from premiums . At twelve months there were no statistically significant differences in mean weight change either between the control group ( whose members had a mean gain of 0.1 pound ) and any of the incentive groups ( delayed premium adjustment , -1.2 pound ; immediate premium adjustment , -1.4 pound ; daily lottery incentive , -1.0 pound ) or among the intervention groups . The apparent failure of the incentives to promote weight loss suggests that employers that encourage weight reduction through workplace wellness programs should test alternatives to the conventional premium adjustment approach by using alternative incentive design s , larger incentives , or both OBJECTIVE To examine the viability of monetary incentives to increase fitness-center use and maintain/improve the Body Mass Indexes ( BMI s ) of first-year students over the fall semester . METHOD R and omized-controlled trial with no-treatment and incentive conditions involving 117 first-year students . For 12 weeks , students in the incentive condition received monetary payments ranging from $ 10 to $ 38.75 for meeting research er-set fitness-center use goals that were identical across conditions . Fitness-center use was monitored through electronic ID-card check-in and check-out records at the campus fitness center . RESULTS 63 % of incentive-condition participants met the weekly fitness-center use goals on average compared to only 13 % of control-condition participants , a significant difference , p<0.001 . Goal achievement significantly decreased over time , p<0.01 and at roughly the same rate in the control and incentive conditions , p=0.23 . Average BMI increases over the fall semester in the control ( 24.2 ( 0.6 ) to 24.6 (0.6)kg/m(2 ) ) versus incentive condition ( 23.1 ( 0.4 ) to 23.5 (0.4)kg/m(2 ) ) were not significantly different ( p=0.70 ) . CONCLUSION Weekly monetary incentives result ed in significantly more first-year students meeting weekly fitness-center use goals . However , the increased fitness-center use by the incentive condition did not prevent an increase in BMI during fall semester Exercise is the best predictor of long-term weight loss . This study evaluated two strategies for improving exercise adherence and long-term weight loss in obese out patients . Obese men and women ( N = 193 ) were r and omized to 1 of 5 treatment groups for 18 months : st and ard behavior therapy ( SBT ) ; SBT with supervised walks ( SW ) 3 times per week ; SBT + SW with personal trainers ( PT ) , who walked with participants , made phone reminders , and did make-up SW ; SBT + SW with monetary incentives ( I ) for completing SW ; and SBT + SW + PT + I. Both PT and I enhanced attendance at SWs , the combination producing the best adherence . Increased walk attendance did not result in higher overall energy expenditure , however , and long-term weight loss was also not improved . Post hoc analyses suggest that the level of exercise needed for successful long-term weight loss is much higher than that usually recommended in behavioral treatment programs Objective To examine whether adding either small , variable financial incentives or optional group sessions improves weight losses in a community-based , Internet behavioral program . Design and methods Participants ( N=268 ) from Shape Up Rhode Isl and 2012 , a 3 month Web-based community wellness initiative , were r and omized to : Shape Up+Internet behavioral program ( SI ) , Shape Up+Internet program+Incentives ( SII ) , or Shape Up+Internet program+Group sessions ( SIG ) . Results At the end of the 3 month program , SII achieved significantly greater weight losses than SI ( SII:6.4 % [ 5.1 - 7.7 ] ; SI:4.2 % [ 3.0 - 5.6 ] ; P=.03 ) ; weight losses in SIG were not significantly different from the other two conditions ( SIG : 5.8 % [ 4.5 - 7.1 ] , P’s≥.10 ) . However , at the 12 month no treatment follow-up visit , both SII and SIG had greater weight losses than SI ( SII : 3.1 % [ 1.8 - 4.4 ] ; SIG : 4.5 % [ 3.2 - 5.8 ] ; SI : 1.2 % [ -0.1 - 2.6 ] ; P’s≤.05 ) . SII was the most cost-effective approach at both 3 ( SII : $ 34/kg ; SI : $ 34/kg ; SIG : $ 87/kg ) and 12 months ( SII : $ 64/kg ; SI : $ 140/kg ; SIG : $ 113/kg ) . Conclusions Modest financial incentives  enhance weight losses during a community campaign and both incentives and optional group meetings improved overall weight loss outcomes during the follow-up period . However , the use of the financial incentives is the most cost-effective approach Background This research evaluated the effects of financial incentives and purchase restrictions on food purchasing in a food benefit program for low income people . Methods Participants ( n=279 ) were r and omized to groups : 1 ) Incentive- 30 % financial incentive for fruits and vegetables purchased with food benefits ; 2 ) Restriction- no purchase of sugar-sweetened beverages , sweet baked goods , or c and ies with food benefits ; 3 ) Incentive plus Restriction ; or 4 ) Control- no incentive or restrictions . Participants received a study -specific debit card where funds were added monthly for 12-weeks . Food purchase receipts were collected over 16 weeks . Total dollars spent on grocery purchases and by targeted food categories were computed from receipts . Group differences were examined using general linear models . Results Weekly purchases of fruit significantly increased in the Incentive plus Restriction ( $ 4.8 ) compared to the Restriction ( $ 1.7 ) and Control ( $ 2.1 ) groups ( p < .01 ) . Sugar-sweetened beverage purchases significantly decreased in the Incentive plus Restriction(−$0.8 per week ) and Restriction ( $ -1.4 per week ) groups compared to the Control group ( + $ 1.5 ; p < .0001 ) . Sweet baked goods purchases significantly decreased in the Restriction ( −$0.70 per week ) compared to the Control group ( + $ 0.82 per week ; p < .01 ) . Conclusions Paired financial incentives and restrictions on foods and beverages purchased with food program funds may support more healthful food purchases compared to no incentives or restrictions . Clinical trial registration Clinical trials.gov Identifier : NCT02643576 RCTs would be more useful if there were more realistic expectations of them and if their pitfalls were better recognized . For example , and contrary to many cl aims in the applied literature , r and omization does not equalize everything but the treatment across treatments and controls , it does not automatically deliver a precise estimate of the average treatment effect ( ATE ) , and it does not relieve us of the need to think about ( observed or unobserved ) confounders . Estimates apply to the trial sample only , sometimes a convenience sample , and usually selected ; justification is required to extend them to other groups , including any population to which the trial sample belongs . Dem and ing “ external validity � ? is unhelpful because it expects too much of an RCT while undervaluing its contribution . Statistical inference on ATEs involves hazards that are not always recognized . RCTs do indeed require minimal assumptions and can operate with little prior knowledge . This is an advantage when persuading distrustful audiences , but it is a disadvantage for cumulative scientific progress , where prior knowledge should be built upon and not discarded . RCTs can play a role in building scientific knowledge and useful predictions but they can only do so as part of a cumulative program , combining with other methods , including conceptual and theoretical development , to discover not “ what works , � ? but “ why things work � ? BACKGROUND Despite the increasing popularity of activity trackers , little evidence exists that they can improve health outcomes . We aim ed to investigate whether use of activity trackers , alone or in combination with cash incentives or charitable donations , lead to increases in physical activity and improvements in health outcomes . METHODS In this r and omised controlled trial , employees from 13 organisations in Singapore were r and omly assigned ( 1:1:1:1 ) with a computer generated assignment schedule to control ( no tracker or incentives ) , Fitbit Zip activity tracker , tracker plus charity incentives , or tracker plus cash incentives .  Participants had to be English speaking , full-time employees , aged 21 - 65 years , able to walk at least ten steps continuously , and non-pregnant . Incentives were tied to weekly steps , and the primary outcome , moderate-to-vigorous physical activity ( MVPA ) bout min per week , was measured via a sealed accelerometer and assessed on an intention-to-treat basis at 6 months ( end of intervention ) and 12 months ( after a 6 month post-intervention follow-up period ) . Other outcome measures included steps , participants meeting 70 000 steps per week target , and health-related outcomes including weight , blood pressure , and quality -of-life measures . This trial is registered at Clinical Trials.gov , number NCT01855776 . FINDINGS Between June 13 , 2013 , and Aug 15 , 2014 , 800 participants were recruited and r and omly assigned to the control ( n=201 ) , Fitbit ( n=203 ) , charity ( n=199 ) , and cash ( n=197 ) groups . At 6 months , compared with control , the cash group logged an additional 29 MVPA bout min per week ( 95 % CI 10 - 47 ; p=0·0024 ) and the charity group an additional 21 MVPA bout min per week ( 2 - 39 ; p=0·0310 ) ; the difference between Fitbit only and control was not significant ( 16 MVPA bout min per week [ -2 to 35 ; p=0·0854 ] ) . Increases in MVPA bout min per week in the cash and charity groups were not significantly greater than that of the Fitbit group . At 12 months , the Fitbit group logged an additional 37 MVPA bout min per week ( 19 - 56 ; p=0·0001 ) and the charity group an additional 32 MVPA bout min per week ( 12 - 51 ; p=0·0013 ) compared with control ; the difference between cash and control was not significant ( 15 MVPA bout min per week [ -5 to 34 ; p=0·1363 ] ) . A decrease in physical activity of -23 MVPA bout min per week ( 95 % CI -42 to -4 ; p=0·0184 ) was seen when comparing the cash group with the Fitbit group . There were no improvements in any health outcomes ( weight , blood pressure , etc ) at either assessment . INTERPRETATION The cash incentive was most effective at increasing MVPA bout min per week at 6 months , but this effect was not sustained 6 months after the incentives were discontinued . At 12 months , the activity tracker with or without charity incentives were effective at stemming the reduction in MVPA bout min per week seen in the control group , but we identified no evidence of improvements in health outcomes , either with or without incentives , calling into question the value of these devices for health promotion . Although other incentive strategies might generate greater increases in step activity and improvements in health outcomes , incentives would probably need to be in place long term to avoid any potential decrease in physical activity result ing from discontinuation . FUNDING Ministry of Health , Singapore Many older adults do not meet physical activity recommendations and suffer from health-related complications . Reinforcement interventions can have pronounced effects on promoting behavior change ; this study evaluated the efficacy of a reinforcement intervention to enhance walking in older adults . Forty-five sedentary adults with mild to moderate hypertension were r and omized to 12-week interventions consisting of pedometers and guidelines to walk 10,000 steps/day or that same intervention with chances to win $ 1-$100 prizes for meeting recommendations . Patients walked an average of about 4,000 steps/day at baseline . Throughout the intervention , participants in the reinforcement intervention  met walking goals on 82.5 % ± 25.8 % of days versus 55.3 % ± 37.1 % of days in the control condition , p < .01 . Even though steps walked increased significantly in both groups relative to baseline , participants in the reinforcement condition walked an average of about 2,000 more steps/day than participants in the control condition , p < .02 . Beneficial effects of the reinforcement condition relative to the control condition persisted at a 24-week follow-up evaluation , p < .02 , although steps/day were lower than during the intervention period in both groups . Participants in the reinforcement intervention also evidence d greater reductions in blood pressure and weight over time and improvements in fitness indices , ps < .05 . This reinforcement-based intervention substantially increased walking and improved clinical parameters , suggesting that larger 
    Output:
    