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 : This study aim ed to determine whether morbidly obese women have an alteration of heart rate ( HR ) kinetics and HR variability ( HRV ) during the 6-min walk test ( 6MWT ) and if an aerobic exercise training can modify these indexes after gastric bypass surgery ( GBS ) . Design and methods : Nineteen morbidly obese women were r and omized to a trained ( TG ) or control group and 12 women of eutrophic group ( EG ) were also evaluated . The obese women were tested on two occasions : 1 week before and 4 months after GBS through record of HR and R-R intervals during 6MWT for analysis HR kinetics . The TG underwent an aerobic exercise training program on a treadmill ( 1-h session , totaling 36 sessions over 12-week ) . Results : Both obese groups demonstrated a significant reduction of rMSSD and slower HR kinetics during the 6MWT when compared to the EG . In addition , only the TG demonstrated a significant improvement in HRV indexes , walking distance , faster time constant and mean response time of HR during 6MWT after training ( p < 0.05 ) . Conclusion : Morbidly obese women have slower HR kinetics and altered cardiac modulation during submaximal exercise . However , aerobic exercise training can produce beneficial adaptations in HRV and faster HR kinetics following GBS . Implication s for Rehabilitation The obesity is one of the most important threats to health in developed countries and bariatric surgery is an option for treatment of morbid obesity . Exercise is an effective means of improving health after this procedure due alterations of autonomic nervous system in this population . This study showed that a program of aerobic physical training after bariatric surgery was able to improve the kinetics of heart rate and the cardiac autonomic modulation , both evaluated during submaximal exercise Background Patients undergoing bariatric surgery  do not seem to increase objective ly measured  physical activity ( PA ) after surgery , despite substantial weight loss . The aims of the present study were ( i ) to objective ly characterize 3 months pre-surgery to 9 months postsurgery PA and sedentary behavior changes in women undergoing Roux-en-Y gastric bypass ( RYGB )  using tri-axial accelerometers and ( ii ) to examine associations between pre-surgery versus postsurgery PA and sedentary behavior with anthropometric measures taken in home environment . Methods Fifty-six women , with an average pre-surgery body mass index ( BMI ) of 37.6 ( SD 2.6 ) and of age 39.5 years ( SD 5.7 ) , were recruited at five Swedish hospitals .  PA  was measured for 1 week by the Actigraph GT3X+ accelerometer , and anthropometric measures were taken at home visits 3 months pre-surgery and 9 months postsurgery , thus limiting seasonal effects . Results Average BMI loss , 9 months postsurgery , was 11.7 ( SD 2.7 ) BMI units . There were no significant pre- to postsurgery differences in PA or sedentary behavior . However , pre-surgery PA showed negative association with PA change and positive association with postsurgery PA . Adjustments for pre-surgery BMI had no impact on these associations . Conclusions No significant differences were observed in objective ly measured changes in PA or time spent sedentary from 3 months pre-surgery to 9 months postsurgery among women undergoing RYGB . However , women with higher pre-surgery PA decreased their PA postsurgery while women with lower pre-surgery PA increased their PA 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 The purpose of this study was to determine whether pre- to postoperative increases in physical activity ( PA ) are associated with weight loss and health-related quality of life ( HRQoL )  following bariatric surgery . Participants were 199 Roux-en-Y gastric bypass ( RYGB ) surgery patients . The International Physical Activity Question naire ( IPAQ ) was used to categorize participants into three groups according to their preoperative and /1-year postoperative PA level : ( i ) Inactive/Active ( < 200-min/week/>or=200-min/week ) , ( ii ) Active/Active ( > or=200-min/week/>or=200-min/week ) and ( iii ) Inactive/Inactive ( < 200-min/week/<200-min/week ) . The  Medical Outcomes Study Short Form-36 ( SF-36 ) was used to assess HRQoL. Analyses of covariance were conducted to examine the effects of PA group on weight and HRQoL changes . Inactive/Active participants , compared with Inactive/Inactive individuals , had greater reductions in weight ( 52.5 + /- 15.4 vs. 46.4 + /- 12.8 kg ) and BMI ( 18.9 + /- 4.6 vs. 16.9 + /- 4.2 kg/m(2 ) ) . Weight loss outcomes in the Inactive/Active and Active/Active groups were similar to each other . Inactive/Active and Active/Active participants reported greater improvements than Inactive/Inactive participants on the mental component summary ( MCS ) score and the general health , vitality and mental health domains ( P < 0.01 ) . Although the direction of causation is not clear , these findings suggest that RYGB patients who become active postoperatively achieve weight losses and HRQoL improvements that are greater than those experienced by patients who remain inactive and comparable to those attained by patients who stay active . Future r and omized controlled trials should examine whether assisting patients who are inactive preoperatively to increase their PA postoperatively contributes to optimization of weight loss and HRQoL outcomes Obesity and high blood pressure ( BP ) often coexist . Weight reduction lowers resting BP but its effect on BP during exercise ( a predictor of target organ damage ) has not been evaluated . Blood pressure was measured at rest and during cycling , before and after weight reduction induced by gastric restriction . Nineteen subjects ( 4 male ) , 41 + /-2 ( SEM ) years of age and body mass index ( BMI ) of 43 + /- 0.9 kg/m2 , were studied . On each occasion  BP was measured at rest , at a steady state of 0 and 25 watts , at peak exercise and 1 min into recovery .  Body weight was reduced by 28 % + /- 6 % and BMI decreased from 43.3 + /- 0.9 to 31.5 + /- 0.7 kg/m2 ( P < .01 ) . Both BP and heart rate , at rest and at all exercise intensities , were significantly lower after weight reduction . Resting BP decreased from 133 + /-4/87 + /- 3 mm Hg to 115 + /- 4/77 + /- 2 mm Hg ( P < .001 ) , and BP at peak exercise decreased from 181 + /- 8/98 + /- 4 to 162 + /- 6/83 + /- 5 mm Hg ( P < .001 ) . The change in resting systolic BP did not correlate with the change in body weight or with the change in heart rate , but it correlated with the baseline systolic BP ( R = 0.61 ; P < .005 ) . It is concluded that marked weight reduction reduces BP at rest and at all exercise intensities . Gastroplasty should be considered as an option in morbidly obese hypertensive patients who are not well controlled with conventional treatment , and who fail to lose or to maintain a reduced weight by calorie restriction alone Background : The six-minute walk test ( 6mWT ) is a simple index of functional capacity in healthy people , and it has been used to estimate exercise capacity in obese subjects . The aim of this study was to determine whether weight reduction induced by laparoscopic adjustable gastric b and ing ( LAGB ) improves the functional capacity in the severely obese on the 6mWT . Methods : A prospect i ve 1-year study was carried out at the Hospital Casoria , Naples , involving 15 consecutive severely obese patients who underwent the 6mWT before and 1 year after LAGB .  BMI , walking distance , heart rate , dyspnea , and respiratory function tests were also measured . Patients served as their own controls . Results : 15 patients ( all females ) were evaluated .  Mean BMI decreased from 42.1 ( range 39 - 49 ) before to 31.9 ( range 25 - 38 ) postoperatively . The distance walked increased from 475.7 meters ( range 380 - 580 ) before LAGB to 626.3 meters ( range 435 - 880 ) 1 year postoperatively ( P<0.0001 ) , and the dyspnea score after the 6mWT was significantly reduced postoperatively . All functional variables after the 6mWT showed improvement postoperatively at 1 year study . Conclusion : Weight reduction in the obese increases the functional capacity during walking . The improvements are refected in the patients ' own assessment BACKGROUND Physical , emotional , and social functioning are impaired in obesity . It is unknown whether and , if so , to what extent and in which domain obese subjects who lose weight may catch up to normal-weight levels . Our objective was to compare the health-related quality -of-life ( HRQL ) of obese subjects with that of a normal-weight reference group before and 1 year after a weight loss program that centered around laparoscopic and open gastric b and ing . METHODS An HRQL question naire consisting of a battery of both generic and specific measures was administered to 50 morbidly obese subjects on 2 occasions and to 100 healthy , normal-weight subjects , matched for age , gender , education , and vocational training . In addition to weight loss and health gain , the influences of achieved weight loss goals , satisfaction with outcome and operative approach ( laparoscopy/laparotomy ) were assessed . RESULTS Quality -of-life was significantly impaired in obese subjects . With a substantial weight loss of 35 kg and 42 % loss of excessive weight , and correction of disturbed metabolic parameters , they significantly improved in general well-being , health distress , and perceived attractiveness , approaching halfway the values of a normal-weight reference group . Improvement in values for depression and self-regard lagged behind . In physical activity , they bypassed the reference group . Days of sick leave decreased to the level of the reference group . Improvements in HRQL paralleled the rate of weight loss . Personal satisfaction and surgical approach were of minor influence . CONCLUSIONS The obese subjects ' impaired physical and social functioning improved considerably , catching up midway to normal-weight reference values after weight loss . Psychologic amelioration lagged behind . Whether the latter will catch up later and physical/social improvements will be maintained is the subject of further studies BACKGROUND Joint pain is a common musculoskeletal complaint of morbidly obese patients that can result in gait abnormalities , perceived mobility limitations , and declining quality of life ( QOL ) . It is not yet known whether weight loss 3 months after bariatric surgery can induce favorable changes in joint pain , gait , perceived mobility , and QOL . Our objectives were to examine whether participants who had undergone bariatric surgery ( n = 25 ; laparoscopic Roux-en-Y gastric bypass or laparoscopic adjustable gastric b and ing )  demonstrate improvements in joint pain , gait ( speed , stride/step length , width of base of support , toe angles , single/double support , swing and stance time , functional ambulatory profile ) , mobility , and QOL by 3 months compared with nonsurgical controls ( n = 20 ) . The setting was an orthopedics laboratory at a university hospital in the United States . METHODS The present study was a prospect i ve , comparative study . Numeric pain scales ( indicating the presence and severity of pain ) , mobility-related surveys , and the Medical Outcomes Study short-form 36-item question naire ( SF-36 ) were completed , and gait and walking speed were assessed at baseline and 
    Output:
    
agent
No relationship was identified between changes in weight and walking performance post-surgery .
***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 : This study aim ed to determine whether morbidly obese women have an alteration of heart rate ( HR ) kinetics and HR variability ( HRV ) during the 6-min walk test ( 6MWT ) and if an aerobic exercise training can modify these indexes after gastric bypass surgery ( GBS ) . Design and methods : Nineteen morbidly obese women were r and omized to a trained ( TG ) or control group and 12 women of eutrophic group ( EG ) were also evaluated . The obese women were tested on two occasions : 1 week before and 4 months after GBS through record of HR and R-R intervals during 6MWT for analysis HR kinetics . The TG underwent an aerobic exercise training program on a treadmill ( 1-h session , totaling 36 sessions over 12-week ) . Results : Both obese groups demonstrated a significant reduction of rMSSD and slower HR kinetics during the 6MWT when compared to the EG . In addition , only the TG demonstrated a significant improvement in HRV indexes , walking distance , faster time constant and mean response time of HR during 6MWT after training ( p < 0.05 ) . Conclusion : Morbidly obese women have slower HR kinetics and altered cardiac modulation during submaximal exercise . However , aerobic exercise training can produce beneficial adaptations in HRV and faster HR kinetics following GBS . Implication s for Rehabilitation The obesity is one of the most important threats to health in developed countries and bariatric surgery is an option for treatment of morbid obesity . Exercise is an effective means of improving health after this procedure due alterations of autonomic nervous system in this population . This study showed that a program of aerobic physical training after bariatric surgery was able to improve the kinetics of heart rate and the cardiac autonomic modulation , both evaluated during submaximal exercise Background Patients undergoing bariatric surgery  do not seem to increase objective ly measured  physical activity ( PA ) after surgery , despite substantial weight loss . The aims of the present study were ( i ) to objective ly characterize 3 months pre-surgery to 9 months postsurgery PA and sedentary behavior changes in women undergoing Roux-en-Y gastric bypass ( RYGB )  using tri-axial accelerometers and ( ii ) to examine associations between pre-surgery versus postsurgery PA and sedentary behavior with anthropometric measures taken in home environment . Methods Fifty-six women , with an average pre-surgery body mass index ( BMI ) of 37.6 ( SD 2.6 ) and of age 39.5 years ( SD 5.7 ) , were recruited at five Swedish hospitals .  PA  was measured for 1 week by the Actigraph GT3X+ accelerometer , and anthropometric measures were taken at home visits 3 months pre-surgery and 9 months postsurgery , thus limiting seasonal effects . Results Average BMI loss , 9 months postsurgery , was 11.7 ( SD 2.7 ) BMI units . There were no significant pre- to postsurgery differences in PA or sedentary behavior . However , pre-surgery PA showed negative association with PA change and positive association with postsurgery PA . Adjustments for pre-surgery BMI had no impact on these associations . Conclusions No significant differences were observed in objective ly measured changes in PA or time spent sedentary from 3 months pre-surgery to 9 months postsurgery among women undergoing RYGB . However , women with higher pre-surgery PA decreased their PA postsurgery while women with lower pre-surgery PA increased their PA 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 The purpose of this study was to determine whether pre- to postoperative increases in physical activity ( PA ) are associated with weight loss and health-related quality of life ( HRQoL )  following bariatric surgery . Participants were 199 Roux-en-Y gastric bypass ( RYGB ) surgery patients . The International Physical Activity Question naire ( IPAQ ) was used to categorize participants into three groups according to their preoperative and /1-year postoperative PA level : ( i ) Inactive/Active ( < 200-min/week/>or=200-min/week ) , ( ii ) Active/Active ( > or=200-min/week/>or=200-min/week ) and ( iii ) Inactive/Inactive ( < 200-min/week/<200-min/week ) . The  Medical Outcomes Study Short Form-36 ( SF-36 ) was used to assess HRQoL. Analyses of covariance were conducted to examine the effects of PA group on weight and HRQoL changes . Inactive/Active participants , compared with Inactive/Inactive individuals , had greater reductions in weight ( 52.5 + /- 15.4 vs. 46.4 + /- 12.8 kg ) and BMI ( 18.9 + /- 4.6 vs. 16.9 + /- 4.2 kg/m(2 ) ) . Weight loss outcomes in the Inactive/Active and Active/Active groups were similar to each other . Inactive/Active and Active/Active participants reported greater improvements than Inactive/Inactive participants on the mental component summary ( MCS ) score and the general health , vitality and mental health domains ( P < 0.01 ) . Although the direction of causation is not clear , these findings suggest that RYGB patients who become active postoperatively achieve weight losses and HRQoL improvements that are greater than those experienced by patients who remain inactive and comparable to those attained by patients who stay active . Future r and omized controlled trials should examine whether assisting patients who are inactive preoperatively to increase their PA postoperatively contributes to optimization of weight loss and HRQoL outcomes Obesity and high blood pressure ( BP ) often coexist . Weight reduction lowers resting BP but its effect on BP during exercise ( a predictor of target organ damage ) has not been evaluated . Blood pressure was measured at rest and during cycling , before and after weight reduction induced by gastric restriction . Nineteen subjects ( 4 male ) , 41 + /-2 ( SEM ) years of age and body mass index ( BMI ) of 43 + /- 0.9 kg/m2 , were studied . On each occasion  BP was measured at rest , at a steady state of 0 and 25 watts , at peak exercise and 1 min into recovery .  Body weight was reduced by 28 % + /- 6 % and BMI decreased from 43.3 + /- 0.9 to 31.5 + /- 0.7 kg/m2 ( P < .01 ) . Both BP and heart rate , at rest and at all exercise intensities , were significantly lower after weight reduction . Resting BP decreased from 133 + /-4/87 + /- 3 mm Hg to 115 + /- 4/77 + /- 2 mm Hg ( P < .001 ) , and BP at peak exercise decreased from 181 + /- 8/98 + /- 4 to 162 + /- 6/83 + /- 5 mm Hg ( P < .001 ) . The change in resting systolic BP did not correlate with the change in body weight or with the change in heart rate , but it correlated with the baseline systolic BP ( R = 0.61 ; P < .005 ) . It is concluded that marked weight reduction reduces BP at rest and at all exercise intensities . Gastroplasty should be considered as an option in morbidly obese hypertensive patients who are not well controlled with conventional treatment , and who fail to lose or to maintain a reduced weight by calorie restriction alone Background : The six-minute walk test ( 6mWT ) is a simple index of functional capacity in healthy people , and it has been used to estimate exercise capacity in obese subjects . The aim of this study was to determine whether weight reduction induced by laparoscopic adjustable gastric b and ing ( LAGB ) improves the functional capacity in the severely obese on the 6mWT . Methods : A prospect i ve 1-year study was carried out at the Hospital Casoria , Naples , involving 15 consecutive severely obese patients who underwent the 6mWT before and 1 year after LAGB .  BMI , walking distance , heart rate , dyspnea , and respiratory function tests were also measured . Patients served as their own controls . Results : 15 patients ( all females ) were evaluated .  Mean BMI decreased from 42.1 ( range 39 - 49 ) before to 31.9 ( range 25 - 38 ) postoperatively . The distance walked increased from 475.7 meters ( range 380 - 580 ) before LAGB to 626.3 meters ( range 435 - 880 ) 1 year postoperatively ( P<0.0001 ) , and the dyspnea score after the 6mWT was significantly reduced postoperatively . All functional variables after the 6mWT showed improvement postoperatively at 1 year study . Conclusion : Weight reduction in the obese increases the functional capacity during walking . The improvements are refected in the patients ' own assessment BACKGROUND Physical , emotional , and social functioning are impaired in obesity . It is unknown whether and , if so , to what extent and in which domain obese subjects who lose weight may catch up to normal-weight levels . Our objective was to compare the health-related quality -of-life ( HRQL ) of obese subjects with that of a normal-weight reference group before and 1 year after a weight loss program that centered around laparoscopic and open gastric b and ing . METHODS An HRQL question naire consisting of a battery of both generic and specific measures was administered to 50 morbidly obese subjects on 2 occasions and to 100 healthy , normal-weight subjects , matched for age , gender , education , and vocational training . In addition to weight loss and health gain , the influences of achieved weight loss goals , satisfaction with outcome and operative approach ( laparoscopy/laparotomy ) were assessed . RESULTS Quality -of-life was significantly impaired in obese subjects . With a substantial weight loss of 35 kg and 42 % loss of excessive weight , and correction of disturbed metabolic parameters , they significantly improved in general well-being , health distress , and perceived attractiveness , approaching halfway the values of a normal-weight reference group . Improvement in values for depression and self-regard lagged behind . In physical activity , they bypassed the reference group . Days of sick leave decreased to the level of the reference group . Improvements in HRQL paralleled the rate of weight loss . Personal satisfaction and surgical approach were of minor influence . CONCLUSIONS The obese subjects ' impaired physical and social functioning improved considerably , catching up midway to normal-weight reference values after weight loss . Psychologic amelioration lagged behind . Whether the latter will catch up later and physical/social improvements will be maintained is the subject of further studies BACKGROUND Joint pain is a common musculoskeletal complaint of morbidly obese patients that can result in gait abnormalities , perceived mobility limitations , and declining quality of life ( QOL ) . It is not yet known whether weight loss 3 months after bariatric surgery can induce favorable changes in joint pain , gait , perceived mobility , and QOL . Our objectives were to examine whether participants who had undergone bariatric surgery ( n = 25 ; laparoscopic Roux-en-Y gastric bypass or laparoscopic adjustable gastric b and ing )  demonstrate improvements in joint pain , gait ( speed , stride/step length , width of base of support , toe angles , single/double support , swing and stance time , functional ambulatory profile ) , mobility , and QOL by 3 months compared with nonsurgical controls ( n = 20 ) . The setting was an orthopedics laboratory at a university hospital in the United States . METHODS The present study was a prospect i ve , comparative study . Numeric pain scales ( indicating the presence and severity of pain ) , mobility-related surveys , and the Medical Outcomes Study short-form 36-item question naire ( SF-36 ) were completed , and gait and walking speed were assessed at baseline and 
    Output:
    