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 : Few studies have considered the neighborhood as a context in which to examine the physical activity and quality of life relationship . Purpose : The goal of this study was to evaluate the effects of a neighborhood walking program on  quality of life among older adults . It was design ed as a r and omized trial involving a multilevel design with neighborhoods corresponding to primary sampling units and residents to secondary units . Methods : Five hundred eighty-two communitydwelling senior residents ( 65 years of age or older ) in neighborhoods in the northeast metropolitan area of Portl and , Oregon , were recruited through telephone , direct mail , and referrals . The walking intervention was delivered at the neighborhood level . Neighborhoods ( N = 56 ) were r and omly assigned to a 6-month , 3 times per week , leader-led walking group activity ( n = 28 ) or an information-only control group ( n = 28 ) . Primary outcome measures included SF-12 ( Physical , Mental summary scores ) and life satisfaction ( SWLS ) ; the secondary outcome measure was neighborhood walking activity , assessed at baseline , 3 months , and 6 months of the study period . Results : Compared to the control neighborhoods , results from multilevel , longitudinal analyses indicated significant improvements in the primary outcomes of SF-12 Physical ( p < .05 ) , SF-12 Mental ( p < .05 ) summary scores , and SWLS ( p < .05 ) , over the course of the 6-month intervention . A significant increase was also observed in the secondary outcome of walking activity ( p < .05 ) . Conclusions : Implementing a neighborhood-based walking program of low to moderate intensity is feasible and beneficial for promoting quality of life among senior residents at a community level Abstract Introduction Fibromyalgia ( FM ) is characterized by chronic pain . Impaired growth hormone responses and reduced serum insulin-like growth factor 1 ( IGF-1 ) are common in FM . The aim was to examine changes in serum IGF-1 , cerebrospinal fluid ( CSF ) , neuropeptides , and cytokines during aerobic exercise in FM patients . Methods In total , 49 patients ( median age , 52 years ) with FM were included in the study . They were r and omized to either the  moderate- to high-intensity Nordic Walking ( NW ) program  ( n = 26 ) or the  supervised low-intensity walking ( LIW ) program  ( n = 23 ) . Patients participated in blood tests before and after 15 weeks of aerobic exercise .  Changes in serum levels of free IGF-1 , pain rating on a 0- to 100-mm scale , pain threshold , and 6-minute walk test ( 6MWT ) were examined . CSF , neuropeptides , matrix metalloproteinase 3 ( MMP-3 ) , and inflammatory cytokines were determined . Nonparametric tests were used for group comparisons and correlation analyses . Results Serum free IGF-1 levels did not change during 15 weeks of exercise between the two groups , although the 6MWT significantly improved in the NW group ( p = 0.033 ) when compared with LIW . Pain did not significantly change in any of the groups , but tended to decrease ( p = 0.052 ) over time in the total group . A tendency toward a correlation was noted between baseline IGF-1 and a decrease of pain in response to exercise ( r = 0.278 ; p = 0.059 ) . When adjusted for age , this tendency disappeared . The change in serum free IGF-1 correlated positively with an alteration in CSF substance P ( SP ) levels ( rs= 0.495 ; p = 0.072 ) , neuropeptide Y ( NPY ) ( rs = 0.802 ; p = 0.001 ) , and pain threshold ( rs = 0.276 ; p = 0.058 ) . Differing CSF SP levels correlated positively to a change in pain threshold ( rs= 0.600 ; p = 0.023 ) , whereas the shift in CSF MMP-3 inversely correlated with an altered pain threshold ( rs= -0.569 ; p = 0.034 ) . Conclusions The baseline level of serum free IGF-1 did not change during high or low intensity of aerobic exercise . Changes in IGF-1 correlated positively with a variation in CSF SP , NPY , and pain threshold . These data indicate a beneficial role of IGF-1 during exercise in FM.Trial registration : Clinical Trials.gov NCT00643006 Objectives To examine the effect of walking and vitamin B supplementation on quality -of-life ( QoL ) in community-dwelling adults with mild cognitive impairment . Methods One year , double-blind , placebo-controlled trial . Participants were r and omized to : ( 1 ) twice-weekly , group-based , moderate-intensity walking program ( n = 77 )  or a light-intensity placebo activity program  ( n = 75 ) ; and ( 2 ) daily vitamin B pills containing 5 mg folic acid , 0.4 mg B12 , 50 mg B6 ( n = 78 ) or placebo pills ( n = 74 ) . QoL was measured at baseline , after six and 12 months using the population -specific Dementia Quality -of-Life ( D-QoL ) to assess overall QoL and the generic Short-Form 12 mental and physical component scales ( SF12-MCS and SF12-PCS ) to assess health-related QoL. Results Baseline levels of QoL were relatively high . Modified intention-to-treat analyses revealed no positive main intervention effect of walking or vitamin supplementation . In both men and women , ratings of D-QoL-belonging and D-QoL-positive affect subscales improved with 0.003 ( P = 0.04 ) and 0.002 points ( P = 0.06 ) with each percent increase in attendance to the walking program . Only in men , SF12-MCS increased with 0.03 points with each percent increase in attendance ( P = 0.08 ) . ConclusionS everal small but significant improvements in QoL were observed with increasing attendance to the walking program . No effect of vitamin B supplementation was observed . Trial Registration International St and ard R and omized Controlled Trial Number Register , 19227688 , http://www.controlled-trials.com/is rct Introduction The objective of this study was to investigate the effects of moderate-to-high intensity Nordic walking ( NW ) on functional capacity and pain in fibromyalgia ( FM ) . Methods A total of 67 women with FM were recruited to the study and r and omized either to moderate-to-high intensity Nordic Walking ( n = 34 , age 48 ± 7.8 years ) or to a control group engaging in supervised low-intensity walking ( LIW , n = 33 , age 50 ± 7.6 years ) . Primary outcomes were the six-minute walk test ( 6MWT ) and the Fibromyalgia Impact Question naire Pain scale ( FIQ Pain ) . Secondary outcomes were : exercise heart rate in a submaximal ergometer bicycle test , the FIQ Physical ( activity limitations ) and the FIQ total score . Results A total of 58 patients completed the post-test . Significantly greater improvement in the 6MWT was found in the NW group ( P = 0.009 ) , as compared with the LIW group . No between-group difference was found for the FIQ Pain ( P = 0.626 ) . A significantly larger decrease in exercise heart rate ( P = 0.020 ) and significantly improved scores on the FIQ Physical ( P = 0.027 ) were found in the NW group as compared with the LIW group . No between-group difference was found for the change in the FIQ total . The effect sizes were moderate for the above mentioned outcomes . Conclusions Moderate-to-high intensity aerobic exercise by means of Nordic walking twice a week for 15 weeks was found to be a feasible mode of exercise , result ing in improved functional capacity and a decreased level of activity limitations . Pain severity did not change over time during the exercise period . Trial registration Clinical trials.gov identifier NCT00643006 Objective : To examine the effects of aerobic exercise or vitamin B supplementation on cognitive function in older adults with mild cognitive impairment ( MCI ) . Design : R and omised placebo-controlled trial . Setting : General community . Participants : Community-dwelling adults aged 70–80 with MCI . Interventions : The 152 participants were r and omly assigned to two interventions : ( 1 ) a twice-weekly , group-based , moderate-intensity walking programme ( WP , n = 77 ) or a low-intensity placebo activity programme ( n = 75 ) for one year ; and ( 2 ) daily vitamin pill containing 5 mg folic acid , 0.4 mg vitamin B-12 , 50 mg vitamin B-6 ( FA/B12/B6 , n = 78 ) or placebo pill ( n = 74 ) for one year . Outcome measures : Cognitive function , measured with neuropsychological tests at baseline and after six and 12 months . Results : Median session attendance at the exercise programmes ( 25th–75th percentile ) was 63 % ( 2%–81 % ) and median compliance with taking pills ( 25th–75th percentile ) was 100 % ( 99%–100 % ) . Gender was an effect modifier . Intention-to-treat analysis revealed no main intervention effect for either intervention . In women in the WP , attention ( Stroop combination task ) improved by 0.3 seconds ( p = 0.04 ) and memory ( auditory verbal learning test ) by 0.04 words ( p = 0.06 ) with each percentage increase in session attendance . In men attending at least 75 % of the sessions , the WP improved memory ( β 1.5 ( 95 % CI : 0.1 to 3.0 ) words ) . Conclusion : The walking programme and /or FA/B12/B6 supplementation were not effective in improving cognition within one year . The walking programme , however , was efficacious in improving memory in men and memory and attention in women with better adherence . Trial registration : International St and ard R and omised Controlled Trial Number Register , 19227688 , http://www.controlled-trials.com/is rct 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 To evaluate the effects of a revised 6‐week walking program for adults with arthritis , Walk With Ease ( WWE ) , delivered in 2 formats , instructor‐led group or self‐directed OBJECTIVES To evaluate and compare the effectiveness and cost-effectiveness of a leisure centre-based exercise programme , an instructor-led walking programme and advice-only in patients referred for exercise by their GPs . DESIGN A single-centre , parallel-group , r and omised controlled trial , consisting of three arms , with the primary comparison at 6 months . SETTING Assessment s were carried out at Copthall Leisure Centre in Barnet , an outer London borough , and exercise programmes conducted there and at three other leisure centres and a variety of locations suitable for supervised walking throughout the borough . PARTICIPANTS Participants were aged between 40 and 74 years , not currently physically active and with at least one cardiovascular risk factor . INTERVENTIONS The 943 patients who agreed to participate in the trial were assessed in cohorts and r and omised to one of the following three arms : a 10-week programme of supervised exercise classes , two to three times a week in a local leisure centre ; a 10-week instructor-led walking programme , two to three times a week ; an advice-only control group who received tailored advice and information on physical activity including information on local exercise facilities . After 6 months the control group were rer and omised to one of the other trial arms . Assessment s took place before r and omisation , at 10 weeks ( in a r and om 50 % sub sample of participants ) , 6 months and 1 year in the leisure centre and walking arms . The control participants were similarly assessed up to 6 months and then reassessed at the same intervals as those initially r and omised to the leisure centre and walking groups . MA 
    Output:
    
agent
There is evidence that walking groups have wide-ranging health benefits .
The evidence was less clear for other outcomes such as waist circumference fasting glucose , SF-36 ( mental health ) and serum lipids such as high-density lipids .
There were no notable adverse side effects reported in any of the studies .
CONCLUSIONS Walking groups are effective and safe with good adherence and wide-ranging health benefits .
They could be a promising intervention as an adjunct to other healthcare or as a proactive health-promoting activity
***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 : Few studies have considered the neighborhood as a context in which to examine the physical activity and quality of life relationship . Purpose : The goal of this study was to evaluate the effects of a neighborhood walking program on  quality of life among older adults . It was design ed as a r and omized trial involving a multilevel design with neighborhoods corresponding to primary sampling units and residents to secondary units . Methods : Five hundred eighty-two communitydwelling senior residents ( 65 years of age or older ) in neighborhoods in the northeast metropolitan area of Portl and , Oregon , were recruited through telephone , direct mail , and referrals . The walking intervention was delivered at the neighborhood level . Neighborhoods ( N = 56 ) were r and omly assigned to a 6-month , 3 times per week , leader-led walking group activity ( n = 28 ) or an information-only control group ( n = 28 ) . Primary outcome measures included SF-12 ( Physical , Mental summary scores ) and life satisfaction ( SWLS ) ; the secondary outcome measure was neighborhood walking activity , assessed at baseline , 3 months , and 6 months of the study period . Results : Compared to the control neighborhoods , results from multilevel , longitudinal analyses indicated significant improvements in the primary outcomes of SF-12 Physical ( p < .05 ) , SF-12 Mental ( p < .05 ) summary scores , and SWLS ( p < .05 ) , over the course of the 6-month intervention . A significant increase was also observed in the secondary outcome of walking activity ( p < .05 ) . Conclusions : Implementing a neighborhood-based walking program of low to moderate intensity is feasible and beneficial for promoting quality of life among senior residents at a community level Abstract Introduction Fibromyalgia ( FM ) is characterized by chronic pain . Impaired growth hormone responses and reduced serum insulin-like growth factor 1 ( IGF-1 ) are common in FM . The aim was to examine changes in serum IGF-1 , cerebrospinal fluid ( CSF ) , neuropeptides , and cytokines during aerobic exercise in FM patients . Methods In total , 49 patients ( median age , 52 years ) with FM were included in the study . They were r and omized to either the  moderate- to high-intensity Nordic Walking ( NW ) program  ( n = 26 ) or the  supervised low-intensity walking ( LIW ) program  ( n = 23 ) . Patients participated in blood tests before and after 15 weeks of aerobic exercise .  Changes in serum levels of free IGF-1 , pain rating on a 0- to 100-mm scale , pain threshold , and 6-minute walk test ( 6MWT ) were examined . CSF , neuropeptides , matrix metalloproteinase 3 ( MMP-3 ) , and inflammatory cytokines were determined . Nonparametric tests were used for group comparisons and correlation analyses . Results Serum free IGF-1 levels did not change during 15 weeks of exercise between the two groups , although the 6MWT significantly improved in the NW group ( p = 0.033 ) when compared with LIW . Pain did not significantly change in any of the groups , but tended to decrease ( p = 0.052 ) over time in the total group . A tendency toward a correlation was noted between baseline IGF-1 and a decrease of pain in response to exercise ( r = 0.278 ; p = 0.059 ) . When adjusted for age , this tendency disappeared . The change in serum free IGF-1 correlated positively with an alteration in CSF substance P ( SP ) levels ( rs= 0.495 ; p = 0.072 ) , neuropeptide Y ( NPY ) ( rs = 0.802 ; p = 0.001 ) , and pain threshold ( rs = 0.276 ; p = 0.058 ) . Differing CSF SP levels correlated positively to a change in pain threshold ( rs= 0.600 ; p = 0.023 ) , whereas the shift in CSF MMP-3 inversely correlated with an altered pain threshold ( rs= -0.569 ; p = 0.034 ) . Conclusions The baseline level of serum free IGF-1 did not change during high or low intensity of aerobic exercise . Changes in IGF-1 correlated positively with a variation in CSF SP , NPY , and pain threshold . These data indicate a beneficial role of IGF-1 during exercise in FM.Trial registration : Clinical Trials.gov NCT00643006 Objectives To examine the effect of walking and vitamin B supplementation on quality -of-life ( QoL ) in community-dwelling adults with mild cognitive impairment . Methods One year , double-blind , placebo-controlled trial . Participants were r and omized to : ( 1 ) twice-weekly , group-based , moderate-intensity walking program ( n = 77 )  or a light-intensity placebo activity program  ( n = 75 ) ; and ( 2 ) daily vitamin B pills containing 5 mg folic acid , 0.4 mg B12 , 50 mg B6 ( n = 78 ) or placebo pills ( n = 74 ) . QoL was measured at baseline , after six and 12 months using the population -specific Dementia Quality -of-Life ( D-QoL ) to assess overall QoL and the generic Short-Form 12 mental and physical component scales ( SF12-MCS and SF12-PCS ) to assess health-related QoL. Results Baseline levels of QoL were relatively high . Modified intention-to-treat analyses revealed no positive main intervention effect of walking or vitamin supplementation . In both men and women , ratings of D-QoL-belonging and D-QoL-positive affect subscales improved with 0.003 ( P = 0.04 ) and 0.002 points ( P = 0.06 ) with each percent increase in attendance to the walking program . Only in men , SF12-MCS increased with 0.03 points with each percent increase in attendance ( P = 0.08 ) . ConclusionS everal small but significant improvements in QoL were observed with increasing attendance to the walking program . No effect of vitamin B supplementation was observed . Trial Registration International St and ard R and omized Controlled Trial Number Register , 19227688 , http://www.controlled-trials.com/is rct Introduction The objective of this study was to investigate the effects of moderate-to-high intensity Nordic walking ( NW ) on functional capacity and pain in fibromyalgia ( FM ) . Methods A total of 67 women with FM were recruited to the study and r and omized either to moderate-to-high intensity Nordic Walking ( n = 34 , age 48 ± 7.8 years ) or to a control group engaging in supervised low-intensity walking ( LIW , n = 33 , age 50 ± 7.6 years ) . Primary outcomes were the six-minute walk test ( 6MWT ) and the Fibromyalgia Impact Question naire Pain scale ( FIQ Pain ) . Secondary outcomes were : exercise heart rate in a submaximal ergometer bicycle test , the FIQ Physical ( activity limitations ) and the FIQ total score . Results A total of 58 patients completed the post-test . Significantly greater improvement in the 6MWT was found in the NW group ( P = 0.009 ) , as compared with the LIW group . No between-group difference was found for the FIQ Pain ( P = 0.626 ) . A significantly larger decrease in exercise heart rate ( P = 0.020 ) and significantly improved scores on the FIQ Physical ( P = 0.027 ) were found in the NW group as compared with the LIW group . No between-group difference was found for the change in the FIQ total . The effect sizes were moderate for the above mentioned outcomes . Conclusions Moderate-to-high intensity aerobic exercise by means of Nordic walking twice a week for 15 weeks was found to be a feasible mode of exercise , result ing in improved functional capacity and a decreased level of activity limitations . Pain severity did not change over time during the exercise period . Trial registration Clinical trials.gov identifier NCT00643006 Objective : To examine the effects of aerobic exercise or vitamin B supplementation on cognitive function in older adults with mild cognitive impairment ( MCI ) . Design : R and omised placebo-controlled trial . Setting : General community . Participants : Community-dwelling adults aged 70–80 with MCI . Interventions : The 152 participants were r and omly assigned to two interventions : ( 1 ) a twice-weekly , group-based , moderate-intensity walking programme ( WP , n = 77 ) or a low-intensity placebo activity programme ( n = 75 ) for one year ; and ( 2 ) daily vitamin pill containing 5 mg folic acid , 0.4 mg vitamin B-12 , 50 mg vitamin B-6 ( FA/B12/B6 , n = 78 ) or placebo pill ( n = 74 ) for one year . Outcome measures : Cognitive function , measured with neuropsychological tests at baseline and after six and 12 months . Results : Median session attendance at the exercise programmes ( 25th–75th percentile ) was 63 % ( 2%–81 % ) and median compliance with taking pills ( 25th–75th percentile ) was 100 % ( 99%–100 % ) . Gender was an effect modifier . Intention-to-treat analysis revealed no main intervention effect for either intervention . In women in the WP , attention ( Stroop combination task ) improved by 0.3 seconds ( p = 0.04 ) and memory ( auditory verbal learning test ) by 0.04 words ( p = 0.06 ) with each percentage increase in session attendance . In men attending at least 75 % of the sessions , the WP improved memory ( β 1.5 ( 95 % CI : 0.1 to 3.0 ) words ) . Conclusion : The walking programme and /or FA/B12/B6 supplementation were not effective in improving cognition within one year . The walking programme , however , was efficacious in improving memory in men and memory and attention in women with better adherence . Trial registration : International St and ard R and omised Controlled Trial Number Register , 19227688 , http://www.controlled-trials.com/is rct 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 To evaluate the effects of a revised 6‐week walking program for adults with arthritis , Walk With Ease ( WWE ) , delivered in 2 formats , instructor‐led group or self‐directed OBJECTIVES To evaluate and compare the effectiveness and cost-effectiveness of a leisure centre-based exercise programme , an instructor-led walking programme and advice-only in patients referred for exercise by their GPs . DESIGN A single-centre , parallel-group , r and omised controlled trial , consisting of three arms , with the primary comparison at 6 months . SETTING Assessment s were carried out at Copthall Leisure Centre in Barnet , an outer London borough , and exercise programmes conducted there and at three other leisure centres and a variety of locations suitable for supervised walking throughout the borough . PARTICIPANTS Participants were aged between 40 and 74 years , not currently physically active and with at least one cardiovascular risk factor . INTERVENTIONS The 943 patients who agreed to participate in the trial were assessed in cohorts and r and omised to one of the following three arms : a 10-week programme of supervised exercise classes , two to three times a week in a local leisure centre ; a 10-week instructor-led walking programme , two to three times a week ; an advice-only control group who received tailored advice and information on physical activity including information on local exercise facilities . After 6 months the control group were rer and omised to one of the other trial arms . Assessment s took place before r and omisation , at 10 weeks ( in a r and om 50 % sub sample of participants ) , 6 months and 1 year in the leisure centre and walking arms . The control participants were similarly assessed up to 6 months and then reassessed at the same intervals as those initially r and omised to the leisure centre and walking groups . MA 
    Output:
    