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 AND OBJECTIVE Cycle ergometer training is an important component of pulmonary rehabilitation for patients with COPD . However , incremental cycle tests from which individualized cycle training intensity can be prescribed may not be readily available to clinicians . The aims of the study were to ( i ) investigate the physiological and psychophysical responses to the 6-min walk test ( 6MWT ) , incremental shuttle walk test ( ISWT ) and cycle ergometer test ( CET ) ; and ( ii ) determine whether the distance walked in either the 6MWT or the ISWT could be used to estimate peak work rate on a cycle ergometer . METHODS A repeated measures study was undertaken in COPD patients in a stable condition . The 6MWT , ISWT and CET were performed in r and om order , and physiological responses , rate of perceived exertion and dyspnoea were measured . RESULTS Twenty-two patients with COPD completed the study . There was no significant difference in peak oxygen uptake between the 6MWT , ISWT and CET . The significant correlation between the 6MWD and incremental shuttle walk distance with peak watts on the CET ( r = 0.63 , P = 0.002 and r = 0.75 , P < 0.001 , respectively ) was strengthened by the inclusion of weight , age and gender ( r = 0.89 P = 0.001 and r = 0.91 , P < 0.001 ) . Bl and -Altman analysis demonstrated a strong agreement between peak work rate measured on the CET and that estimated from either the 6MWT or the ISWT . CONCLUSIONS The significant relationships found between the three exercise tests , and the regression equations predicting peak work rate on the CET from the 6MWT or the ISWT , may allow for the estimation of intensity of cycle exercise training from walk tests in COPD patients BACKGROUND The protocol used for the 6-min walk test ( 6MWT ) influences its results . The only study to examine the effect of modifying track layout performed a retrospective analysis and concluded that institutions using continuous tracks yield greater distances than those using straight tracks . Agreement between the distances measured on different tracks could not be examined . We evaluated the effect of modifying track layout on walk distance and examined the agreement and repeatability of distances measured on different tracks . METHODS In a prospect i ve , r and omized , cross-over study , 27 COPD subjects ( FEV(1 ) , 38 + /- 14 % [ mean + /- SD ] ; 15 men ) attended three separate test sessions , completing six 6MWTs . To familiarize all subjects with both tracks , the first two sessions comprised two 6MWTs on either a circular or straight track . During the final session , each subject was tested once on the straight and once on the circular track . RESULTS The distance walked on the circular track exceeded the straight track by 13 + /- 17 m ( p < 0.001 ) . The limit of agreement between tracks was 33 m. Coefficient of repeatability values when the test was completed on different days for the straight and circular tracks were 51 m and 65 m , respectively . CONCLUSIONS When evaluating changes in 6-min walk distance in groups of patients , track layout should be st and ardized . However , the effect of modifying track layout on an individual 's walking distance is small compared to their daily variability in walk distance . Therefore , st and ardizing track layout for any given individual may be inconsequential when evaluating the change in distances from tests performed on different days BACKGROUND Patients with Chronic Heart Failure ( CHF ) develop similar symptoms of exertional breathlessness and fatigue as patients with COPD . Although pulmonary ( exercise based ) rehabilitation ( PR ) is an integral part of the management of COPD , the potential for exercise rehabilitation ( ER ) to assist patients with CHF may not be as readily appreciated . We investigated whether combined ER for patients with CHF and COPD was feasible and effective using the model of PR . METHODS 57 patients with CHF were r and omized 2:1 to 7 weeks ER ( CHF-ER ) or 7 weeks of usual care ( CHF-UC )  . As a comparator 55 patients with COPD were simultaneously recruited to the same ER program ( COPD -ER ) . The primary outcome measure was the Incremental Shuttle Walk Test ( ISWT ) and the secondary outcome measures were the Endurance Shuttle Walk Test ( ESWT ) , isometric quadriceps strength and health status . RESULTS 27 CHF and 44 COPD patients completed ER and 17 patients with CHF completed UC . The CHF-ER group made significant improvements , compared to CHF-UC , in the mean ( 95%CI ) ISWT distance ; 62(35 - 89)m vs -6(-11 to 33)m p < 0.001 . The CHF-ER group also made statistically significant improvements in health status . The improvements in exercise performance and health status were similar between patients with CHF and COPD , treated with ER . CONCLUSION Patients with CHF who undergo ER improve similarly in their exercise performance and health status to COPD . Combined training programs for COPD and CHF are effective and feasible , such that service provision could be targeted around common disability rather than the primary organ disease Background : The responsiveness of the endurance shuttle walk to functional changes following bronchodilation has recently been reported . The current literature suggests that the 6 min walking test ( 6MWT ) is less responsive to bronchodilation than the endurance shuttle walk . Aim : To compare bronchodilator-induced changes in exercise performance with the 6MWT and the endurance shuttle walk . Methods : In a r and omised , double-blind , placebo-controlled , crossover trial , 14 patients with chronic obstructive pulmonary disease ( forced expiratory volume in 1 s ( FEV1 ) 50 (8)% predicted ) completed two 6MWTs and two endurance shuttle walks , each preceded by nebulised placebo or 500 μg ipratropium bromide .  Cardiorespiratory parameters were monitored during each walking test with a portable telemetric gas analyser . Quadriceps twitch force was measured by magnetic stimulation of the femoral nerve before and after each walking test . Results : The 6 min walking distance did not change significantly after bronchodilation despite a significant increase in FEV1 of 0.18 ( 0.09 ) litres ( p<0.001 ) . A similar change in FEV1 ( 0.18 ( 0.12 ) litres , p<0.001 ) was associated with a significant improvement in the distance walked on the endurance shuttle walk ( Δdistance ipratropium bromide – placebo = 144 ( 219 ) m , p = 0.03 ) . Quadriceps muscle fatigue was infrequent ( < 15 % of patients ) after both walking tests . Conclusion : The endurance shuttle walk is more responsive than the 6MWT for detecting changes in exercise performance following bronchodilation Background The COPD ( chronic obstructive pulmonary disease ) assessment test ( CAT ) is a recently introduced , simple to use patient-completed quality of life instrument that contains eight questions covering the impact of symptoms in COPD . It is not known how the CAT score performs in the context of clinical pulmonary rehabilitation ( PR ) programmes or what the minimum clinical ly important difference is . Methods The introduction of the  CAT score as an outcome measure was prospect ively studied by PR programmes across London . It was used alongside other measures including the St George 's Respiratory Question naire , the Chronic Respiratory Disease Question naire , the Clinical COPD Question naire , the Hospital Anxiety and Depression score , the Medical Research Council ( MRC ) dyspnoea score and a range of different walking tests . Patients completed a 5-point anchor question used to assess overall response to PR from ‘ I feel much better ’ to ‘ I feel much worse ’ . Results Data were available for 261 patients with COPD participating in seven programmes : mean ( SD ) age 69.0 ( 9.0 ) years , forced expiratory volume in 1 s ( FEV1 ) 51.1 ( 18.7 ) % predicted , MRC score 3.2 ( 1.0 ) . Mean change in CAT score after PR was 2.9 ( 5.6 ) points , improving by 3.8 ( 6.1 ) points in those scoring ‘ much better ’ ( n=162 ) , and by 1.3(4.5 ) in those who felt ‘ a little better ’ ( n=88 ) ( p=0.002 ) . Only eight individuals reported no difference after PR and three reported feeling ‘ a little worse ’ , so comparison with these smaller groups was not possible . Conclusion The CAT score is simple to implement as an outcome measure , it improves in response to PR and can distinguish categories of response QUESTIONS Does an eight-week program of walk training improve endurance walking capacity in people with COPD compared to cycle training ? Does walk training improve peak walking capacity , cycle capacity , and quality of life compared to cycle training ? Is the endurance shuttle walk test ( ESWT ) responsive to change in walking capacity elicited by exercise training ? DESIGN R and omised trial with concealed allocation , assessor blinding , and intention-to-treat analysis . PARTICIPANTS 36 people with stable COPD recruited with four dropouts . INTERVENTION Participants were r and omised into either a walk or cycle training group . Both groups trained indoors for 30 to 45 minutes per session , three times weekly over eight weeks at Concord Hospital . Training intensities were based on baseline peak exercise tests and progressed as able . OUTCOME MEASURES The primary outcome was endurance walking capacity measured by the ESWT . Secondary outcomes included peak walking capacity , peak and endurance cycle capacity , and health-related quality of life . Measures were taken at baseline ( Week 0 ) and following training ( Week 8) . RESULTS The walk training group increased their endurance walking time by 279 seconds ( 95 % CI 70 to 483 ) more than the cycle training group . No significant differences between the groups were found for any other outcome . CONCLUSION Ground walk training increased endurance walking capacity more than cycle training and was similar to cycle training in improving peak walking capacity , peak and endurance cycle capacity and quality of life . This study provides evidence for ground walking as a mode of exercise training in pulmonary rehabilitation programs BACKGROUND high walking frames may improve exercise capacity in young patients with chronic obstructive pulmonary disease ( COPD ) . We have assessed the effect of Zimmer , rollator and gutter frames on 6-min walking distance and on arterial oxygenation during exercise in elderly patients with COPD . METHODS 27 out- patients ( 15 men ) aged 70 - 82 ( mean 75 ) years were recruited . Exclusions comprised : COPD exacerbation or oral steroid use within 6 weeks , confusional state , participation in a pulmonary rehabilitation programme and exercise limitation by other diseases . Subjects completed 6-min walk tests unaided and with the three frames on four separate days in r and om order 30 min after nebulized salbutamol ( 5 mg ) and ipratropium ( 0.5 mg ) and were accompanied by an investigator blinded to results of all other walk tests undertaken .  Oxygen saturation ( SaO2 ) was monitored by finger probe during exercise . Grouped t-tests were used to compare distances and reductions in SaO2 . RESULTS Unaided , the mean ( SEM ) 6-min walk distance was 210 ( 16 ) m and fall in oxygen saturation was 6.0 (1.1)% . Use of a rollator frame did not significantly affect either of these values . Using the Zimmer frame reduced the mean distance to 165 ( 13 ) m ( t=5.2 , P < 0.001 vs unaided walk ) with an SaO2 fall similar to that recorded during the unaided walk . Using the gutter frame increased the mean distance to 234 ( 150 ) m ( t=3 . 1 , P=0.004 vs unaided walk ) and reduced the fall in SaO2 to 3.7 (0.8)% ( t=2.3 , P=0.03 vs unaided walk ) . CONCLUSIONS gutter frames improve exercise capacity and SaO2 during exercise in elderly COPD patients who remain symptomatic on optimal therapy , whereas unwheeled Zimmer frames have a deleterious effect in such patients Supplemental oxygen has acute beneficial effects on exercise performance in patients with chronic obstructive pulmonary disease ( COPD ) . The purpose of this study was to investigate whether oxygen-supplemented training enhances the effects of training while breathing room air in patients with severe COPD . A r and omized controlled trial was performed in 24 patients with severe COPD who developed hypoxaemia during incremental cycle exercise ( arterial oxygen saturation ( Sa , O2 ) < 90 % at peak exercise ) . All patients participated in an in-patient pulmonary rehabilitation programme of 10 weeks duration . They were assigned either to general exercise training while breathing room air ( GET/RA group : forced expiratory volume in one second ( FEV1 ) 38 % of predicted ; arterial oxygen tension ( Pa , O2 ) 10.5 kPa at rest ; Pa , O2 7.3 kPa at peak exercise ) , or to GET while breathing supplemental oxygen ( GET/O2 group : FEV1 29 % pred ; Pa , O2 10.2 kPa at rest ; Pa , O2 7.2 kPa at peak exercise ) . Sa , O2 was not allowed to fall below 90 % during the training . The effects on exercise performance while breathing air and oxygen , and on quality of life were compared . Maximum workload ( Wmax ) significantly increased in the GET/RA group ( mean ( SD ) 17 ( 15 ) W , p<0.01 ) , but not in the GET/O2 group ( 7 ( 25 ) W ) . Six minute walking distance ( 6MWD ) , stair-climbing , weight-lifting exercise ( all while breathing room air ) and quality of life significantly increased in both 
    Output:
    
agent
Current data confirm that the 6MWT , ISWT and ESWT are valid , reliable and responsive to change with some interventions .
However , results are sensitive to small changes in methodology .
***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 AND OBJECTIVE Cycle ergometer training is an important component of pulmonary rehabilitation for patients with COPD . However , incremental cycle tests from which individualized cycle training intensity can be prescribed may not be readily available to clinicians . The aims of the study were to ( i ) investigate the physiological and psychophysical responses to the 6-min walk test ( 6MWT ) , incremental shuttle walk test ( ISWT ) and cycle ergometer test ( CET ) ; and ( ii ) determine whether the distance walked in either the 6MWT or the ISWT could be used to estimate peak work rate on a cycle ergometer . METHODS A repeated measures study was undertaken in COPD patients in a stable condition . The 6MWT , ISWT and CET were performed in r and om order , and physiological responses , rate of perceived exertion and dyspnoea were measured . RESULTS Twenty-two patients with COPD completed the study . There was no significant difference in peak oxygen uptake between the 6MWT , ISWT and CET . The significant correlation between the 6MWD and incremental shuttle walk distance with peak watts on the CET ( r = 0.63 , P = 0.002 and r = 0.75 , P < 0.001 , respectively ) was strengthened by the inclusion of weight , age and gender ( r = 0.89 P = 0.001 and r = 0.91 , P < 0.001 ) . Bl and -Altman analysis demonstrated a strong agreement between peak work rate measured on the CET and that estimated from either the 6MWT or the ISWT . CONCLUSIONS The significant relationships found between the three exercise tests , and the regression equations predicting peak work rate on the CET from the 6MWT or the ISWT , may allow for the estimation of intensity of cycle exercise training from walk tests in COPD patients BACKGROUND The protocol used for the 6-min walk test ( 6MWT ) influences its results . The only study to examine the effect of modifying track layout performed a retrospective analysis and concluded that institutions using continuous tracks yield greater distances than those using straight tracks . Agreement between the distances measured on different tracks could not be examined . We evaluated the effect of modifying track layout on walk distance and examined the agreement and repeatability of distances measured on different tracks . METHODS In a prospect i ve , r and omized , cross-over study , 27 COPD subjects ( FEV(1 ) , 38 + /- 14 % [ mean + /- SD ] ; 15 men ) attended three separate test sessions , completing six 6MWTs . To familiarize all subjects with both tracks , the first two sessions comprised two 6MWTs on either a circular or straight track . During the final session , each subject was tested once on the straight and once on the circular track . RESULTS The distance walked on the circular track exceeded the straight track by 13 + /- 17 m ( p < 0.001 ) . The limit of agreement between tracks was 33 m. Coefficient of repeatability values when the test was completed on different days for the straight and circular tracks were 51 m and 65 m , respectively . CONCLUSIONS When evaluating changes in 6-min walk distance in groups of patients , track layout should be st and ardized . However , the effect of modifying track layout on an individual 's walking distance is small compared to their daily variability in walk distance . Therefore , st and ardizing track layout for any given individual may be inconsequential when evaluating the change in distances from tests performed on different days BACKGROUND Patients with Chronic Heart Failure ( CHF ) develop similar symptoms of exertional breathlessness and fatigue as patients with COPD . Although pulmonary ( exercise based ) rehabilitation ( PR ) is an integral part of the management of COPD , the potential for exercise rehabilitation ( ER ) to assist patients with CHF may not be as readily appreciated . We investigated whether combined ER for patients with CHF and COPD was feasible and effective using the model of PR . METHODS 57 patients with CHF were r and omized 2:1 to 7 weeks ER ( CHF-ER ) or 7 weeks of usual care ( CHF-UC )  . As a comparator 55 patients with COPD were simultaneously recruited to the same ER program ( COPD -ER ) . The primary outcome measure was the Incremental Shuttle Walk Test ( ISWT ) and the secondary outcome measures were the Endurance Shuttle Walk Test ( ESWT ) , isometric quadriceps strength and health status . RESULTS 27 CHF and 44 COPD patients completed ER and 17 patients with CHF completed UC . The CHF-ER group made significant improvements , compared to CHF-UC , in the mean ( 95%CI ) ISWT distance ; 62(35 - 89)m vs -6(-11 to 33)m p < 0.001 . The CHF-ER group also made statistically significant improvements in health status . The improvements in exercise performance and health status were similar between patients with CHF and COPD , treated with ER . CONCLUSION Patients with CHF who undergo ER improve similarly in their exercise performance and health status to COPD . Combined training programs for COPD and CHF are effective and feasible , such that service provision could be targeted around common disability rather than the primary organ disease Background : The responsiveness of the endurance shuttle walk to functional changes following bronchodilation has recently been reported . The current literature suggests that the 6 min walking test ( 6MWT ) is less responsive to bronchodilation than the endurance shuttle walk . Aim : To compare bronchodilator-induced changes in exercise performance with the 6MWT and the endurance shuttle walk . Methods : In a r and omised , double-blind , placebo-controlled , crossover trial , 14 patients with chronic obstructive pulmonary disease ( forced expiratory volume in 1 s ( FEV1 ) 50 (8)% predicted ) completed two 6MWTs and two endurance shuttle walks , each preceded by nebulised placebo or 500 μg ipratropium bromide .  Cardiorespiratory parameters were monitored during each walking test with a portable telemetric gas analyser . Quadriceps twitch force was measured by magnetic stimulation of the femoral nerve before and after each walking test . Results : The 6 min walking distance did not change significantly after bronchodilation despite a significant increase in FEV1 of 0.18 ( 0.09 ) litres ( p<0.001 ) . A similar change in FEV1 ( 0.18 ( 0.12 ) litres , p<0.001 ) was associated with a significant improvement in the distance walked on the endurance shuttle walk ( Δdistance ipratropium bromide – placebo = 144 ( 219 ) m , p = 0.03 ) . Quadriceps muscle fatigue was infrequent ( < 15 % of patients ) after both walking tests . Conclusion : The endurance shuttle walk is more responsive than the 6MWT for detecting changes in exercise performance following bronchodilation Background The COPD ( chronic obstructive pulmonary disease ) assessment test ( CAT ) is a recently introduced , simple to use patient-completed quality of life instrument that contains eight questions covering the impact of symptoms in COPD . It is not known how the CAT score performs in the context of clinical pulmonary rehabilitation ( PR ) programmes or what the minimum clinical ly important difference is . Methods The introduction of the  CAT score as an outcome measure was prospect ively studied by PR programmes across London . It was used alongside other measures including the St George 's Respiratory Question naire , the Chronic Respiratory Disease Question naire , the Clinical COPD Question naire , the Hospital Anxiety and Depression score , the Medical Research Council ( MRC ) dyspnoea score and a range of different walking tests . Patients completed a 5-point anchor question used to assess overall response to PR from ‘ I feel much better ’ to ‘ I feel much worse ’ . Results Data were available for 261 patients with COPD participating in seven programmes : mean ( SD ) age 69.0 ( 9.0 ) years , forced expiratory volume in 1 s ( FEV1 ) 51.1 ( 18.7 ) % predicted , MRC score 3.2 ( 1.0 ) . Mean change in CAT score after PR was 2.9 ( 5.6 ) points , improving by 3.8 ( 6.1 ) points in those scoring ‘ much better ’ ( n=162 ) , and by 1.3(4.5 ) in those who felt ‘ a little better ’ ( n=88 ) ( p=0.002 ) . Only eight individuals reported no difference after PR and three reported feeling ‘ a little worse ’ , so comparison with these smaller groups was not possible . Conclusion The CAT score is simple to implement as an outcome measure , it improves in response to PR and can distinguish categories of response QUESTIONS Does an eight-week program of walk training improve endurance walking capacity in people with COPD compared to cycle training ? Does walk training improve peak walking capacity , cycle capacity , and quality of life compared to cycle training ? Is the endurance shuttle walk test ( ESWT ) responsive to change in walking capacity elicited by exercise training ? DESIGN R and omised trial with concealed allocation , assessor blinding , and intention-to-treat analysis . PARTICIPANTS 36 people with stable COPD recruited with four dropouts . INTERVENTION Participants were r and omised into either a walk or cycle training group . Both groups trained indoors for 30 to 45 minutes per session , three times weekly over eight weeks at Concord Hospital . Training intensities were based on baseline peak exercise tests and progressed as able . OUTCOME MEASURES The primary outcome was endurance walking capacity measured by the ESWT . Secondary outcomes included peak walking capacity , peak and endurance cycle capacity , and health-related quality of life . Measures were taken at baseline ( Week 0 ) and following training ( Week 8) . RESULTS The walk training group increased their endurance walking time by 279 seconds ( 95 % CI 70 to 483 ) more than the cycle training group . No significant differences between the groups were found for any other outcome . CONCLUSION Ground walk training increased endurance walking capacity more than cycle training and was similar to cycle training in improving peak walking capacity , peak and endurance cycle capacity and quality of life . This study provides evidence for ground walking as a mode of exercise training in pulmonary rehabilitation programs BACKGROUND high walking frames may improve exercise capacity in young patients with chronic obstructive pulmonary disease ( COPD ) . We have assessed the effect of Zimmer , rollator and gutter frames on 6-min walking distance and on arterial oxygenation during exercise in elderly patients with COPD . METHODS 27 out- patients ( 15 men ) aged 70 - 82 ( mean 75 ) years were recruited . Exclusions comprised : COPD exacerbation or oral steroid use within 6 weeks , confusional state , participation in a pulmonary rehabilitation programme and exercise limitation by other diseases . Subjects completed 6-min walk tests unaided and with the three frames on four separate days in r and om order 30 min after nebulized salbutamol ( 5 mg ) and ipratropium ( 0.5 mg ) and were accompanied by an investigator blinded to results of all other walk tests undertaken .  Oxygen saturation ( SaO2 ) was monitored by finger probe during exercise . Grouped t-tests were used to compare distances and reductions in SaO2 . RESULTS Unaided , the mean ( SEM ) 6-min walk distance was 210 ( 16 ) m and fall in oxygen saturation was 6.0 (1.1)% . Use of a rollator frame did not significantly affect either of these values . Using the Zimmer frame reduced the mean distance to 165 ( 13 ) m ( t=5.2 , P < 0.001 vs unaided walk ) with an SaO2 fall similar to that recorded during the unaided walk . Using the gutter frame increased the mean distance to 234 ( 150 ) m ( t=3 . 1 , P=0.004 vs unaided walk ) and reduced the fall in SaO2 to 3.7 (0.8)% ( t=2.3 , P=0.03 vs unaided walk ) . CONCLUSIONS gutter frames improve exercise capacity and SaO2 during exercise in elderly COPD patients who remain symptomatic on optimal therapy , whereas unwheeled Zimmer frames have a deleterious effect in such patients Supplemental oxygen has acute beneficial effects on exercise performance in patients with chronic obstructive pulmonary disease ( COPD ) . The purpose of this study was to investigate whether oxygen-supplemented training enhances the effects of training while breathing room air in patients with severe COPD . A r and omized controlled trial was performed in 24 patients with severe COPD who developed hypoxaemia during incremental cycle exercise ( arterial oxygen saturation ( Sa , O2 ) < 90 % at peak exercise ) . All patients participated in an in-patient pulmonary rehabilitation programme of 10 weeks duration . They were assigned either to general exercise training while breathing room air ( GET/RA group : forced expiratory volume in one second ( FEV1 ) 38 % of predicted ; arterial oxygen tension ( Pa , O2 ) 10.5 kPa at rest ; Pa , O2 7.3 kPa at peak exercise ) , or to GET while breathing supplemental oxygen ( GET/O2 group : FEV1 29 % pred ; Pa , O2 10.2 kPa at rest ; Pa , O2 7.2 kPa at peak exercise ) . Sa , O2 was not allowed to fall below 90 % during the training . The effects on exercise performance while breathing air and oxygen , and on quality of life were compared . Maximum workload ( Wmax ) significantly increased in the GET/RA group ( mean ( SD ) 17 ( 15 ) W , p<0.01 ) , but not in the GET/O2 group ( 7 ( 25 ) W ) . Six minute walking distance ( 6MWD ) , stair-climbing , weight-lifting exercise ( all while breathing room air ) and quality of life significantly increased in both 
    Output:
    