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: OBJECTIVES This study aims to assess the impact of a structured education and home exercise programme in daily practice patients with ankylosing spondylitis . METHODS A total of 756 patients with ankylosing spondylitis ( 72 % males , mean age 45 years ) participated in a 6-month prospect i ve multicentre controlled study , 381 of whom were r and omised to an education intervention ( a 2-hour informative session about the disease and the implementation of a non-supervised physical activity programme at home ) and 375 to st and ard care ( controls ) . Main outcome measures included Bath Ankylosing Spondylitis Disease Activity and Functional Index ( BASDAI , BASFI ) . Secondary outcome measures were 0 - 10 cm visual analog scale ( VAS ) for total pain , nocturnal pain and global disease activity and quality of life ( ASQoL ) , knowledge of disease ( self-evaluation ordinal scale ) and daily exercise ( diary card ) . RESULTS At 6 months , the adjusted mean difference between control and educational groups for BASDAI was 0.32 , 95 % confidence interval ( CI ) 0.10 - 0.54 , p=0.005 , and for BASFI 0.31 , 95%CI 0.12 - 0.51 , p=0.002 . Significant differences were found also in VAS for total pain , patient´s global assessment and in ASQoL. Patients in the education group increased their knowledge about the disease and its treatments significantly ( p<0.001 ) and practised more regular exercise than controls ( p<0.001 ) . CONCLUSIONS A structured education and home exercise programme for patients with ankylosing spondylitis in daily practice was feasible and helped to increase knowledge and exercise . Although statistically significant , the magnitudes of the clinical benefits in terms of disease activity and physical function were poor Background The effect of exercise on specific impairments and activity limitations in people with hip osteoarthritis ( OA ) is limited . Objective The study objective was to evaluate the long-term effect of exercise therapy and patient education on range of motion ( ROM ) , muscle strength , physical fitness , walking capacity , and pain during walking in people with hip OA . Design This was a secondary outcome analysis of a r and omized clinical trial . Setting The setting was a university hospital . Participants One hundred nine people with clinical ly and radiographically evident hip OA were r and omly allocated to receive both exercise therapy and patient education ( exercise group ) or patient education only ( control group ) . Intervention All participants attended a patient education program consisting of 3 group meetings led by 2 physical therapists . Two other physical therapists were responsible for providing the exercise therapy program , consisting of 2 or 3 weekly sessions of strengthening , functional , and stretching exercises over 12 weeks . Both interventions were conducted at a sports medicine clinic . Measurements Outcome measures included ROM , isokinetic muscle strength , predicted maximal oxygen consumption determined with the Astr and bicycle ergometer test , and distance and pain during the Six-Minute Walk Test ( 6MWT ) . Follow-up assessment s were conducted 4 , 10 , and 29 months after enrollment by 5 physical therapists who were unaware of group allocations . Results No significant group differences were found for ROM , muscle strength , predicted maximal oxygen consumption , or distance during the 6MWT over the follow-up period , but the exercise group had less pain during the 6MWT than the control group at 10 months ( mean difference=−8.5 mm ; 95 % confidence interval=−16.1 , −0.9 ) and 29 months ( mean difference=−9.3 mm ; 95 % confidence interval=−18.1 , −0.6 ) . Limitations Limitations of the study were reduced statistical power and 53 % rate of adherence to the exercise therapy program . Conclusions The previously described effect of exercise on self-reported function was not reflected by beneficial results for ROM , muscle strength , physical fitness , and walking capacity , but exercise in addition to patient education result ed in less pain during walking in the long term We recruited 132 subjects with bilateral knee osteoarthritis ( Altman Grade II ) to compare the effects of different stretching techniques on the outcomes of isokinetic muscle strengthening exercises . Patients were r and omly divided into four groups ( I-IV ) . The patients in Group I received isokinetic muscular strengthening exercises , Group II received bilateral knee static stretching and isokinetic exercises , Group III received proprioceptive neuromuscular facilitation ( PNF ) stretching and isokinetic exercises , and Group IV acted as controls . Outcomes were measured by changes in Lequesne 's index , range of knee motion , visual analog pain scale , and peak muscle torques during knee flexion and extension . Patients in all the treated groups experienced significant reductions in knee pain and disability , and increased peak muscle torques after treatment and at follow-up . However , only patients in Groups II and III had significant improvements in range of motion and muscle strength gain during 60 degrees/second angular velocity peak torques . Group III demonstrated the greatest increase in muscle strength gain during 180 degrees/second angular velocity peak torques . In conclusion , stretching therapy could increase the effectiveness of isokinetic exercise in terms of functional improvement in patients with knee osteoarthritis . PNF techniques were more effective than static stretching The objective of this study was to evaluate the effectiveness of a sensorimotor training in patients with rheumatoid arthritis on the improvement of functional skills and quality of life , a double-blinded , prospect i ve , r and omized controlled trial . One hundred two participants with rheumatoid arthritis were selected . After the baseline evaluation , the participants were r and omized to two different groups : sensorimotor group ( 2 sessions per week , 30–50 min each session , besides continuing taking the same drugs as the control group ) and control group ( control group was only su bmi tted to the clinical drug treatment with Methotrexate , Leflunomide and /or Prednisone ( 5 mg ) , being then evaluated 4 months later ) . Functional capacity [ Health Assessment Question naire ( HAQ ) and Timed Up & Go Test ( TU > ) ] , Balance and Gait ( Berg Balance Scale ( BBS ) and Tinetti Test ) and Quality of Life ( Short Form Health Survey — SF-36 ) . The study had been concluded with ninety-one participants , and a statistically significant improvement was found in all variables assessed : HAQ ( P < .01 ) , TU > ( P < .01 ) , BBS ( P < .01 ) , Tinetti Test ( P < .01 ) and improvement in the subscales of SF-36 ( P < .01 ) in the sensorimotor group in comparison with the baseline evaluation and control group . No significant difference was found related to the pre- and post-evaluation in the control group . Therefore , the sensorimotor training is effective in the improvement of the functional capacity and quality of life of patients with rheumatoid arthritis The effect of 8 wk of progressive bicycle training on the immune system was evaluated in a controlled study on 18 patients with rheumatoid arthritis and moderate disease activity .  Maximal O2 uptake increased significantly , whereas heart rate at stage 2 and rate of perceived exertion decreased significantly , in the training group compared with the controls . Resting levels of a number of immune parameters were measured before and after 4 and 8 wk of training . Training did not induce changes in blood mononuclear cell sub population s , proliferative response , or natural killer cell activity . Furthermore the plasma concentrations of interleukin-1 alpha , interleukin-1 beta , and interleukin-6 did not change in response to training . It is concluded that 8 wk of bicycle training does not influence the immune system of patients with rheumatoid arthritis Patients with rheumatoid arthritis ( RA ) suffer from muscle loss , causing reduced muscle strength and endurance . The current study aim ed to : ( 1 ) evaluate the effects of combined strength and endurance training ( CT ) on disease activity and functional ability in patients with RA and ( 2 ) investigate the benefits of a 6-month supervised CT program on muscle strength , cardio-respiratory fitness , and body composition of RA patients . Forty patients with RA , aged 41–73 years , were recruited for the current study . Twenty of these patients ( 19 females , one male ) were r and omly assigned to a 6-month supervised CT program ; 20 patients ( 17 females , three males ) served as controls . Within the CT program , strength training consisted of sets of weight bearing exercises for all major muscle groups . In addition to strength training , systematic endurance training was performed on a cycle ergometer two times per week . For RA patients involved in CT , disease activity ( p = 0.06 ) and pain ( p = 0.05 ) were reduced after the 6-month training period while general health ( p = 0.04 ) and functional ability ( p = 0.06 ) improved . Cardio-respiratory endurance was found to have improved significantly ( by 10 % ) after 6 months of CT ( p < 0.001 ) . The overall strength of patients undertaking CT increased by an average of 14 % . Lean body mass increased , and the percentage of body fat was found to decrease significantly ( p < 0.05 ) . A combination of strength and endurance training result ed in considerable improvements in RA  patients ’ muscle strength and cardio-respiratory endurance , accompanied by positive changes in body composition and functional ability . Long-term training appears to be effective in reducing disease activity and associated pain and was found to have no deleterious effects Background Hip osteoarthritis ( OA ) is a common condition leading to pain , disability and reduced quality of life . There is currently limited evidence to support the use of conservative , non-pharmacological treatments for hip OA . Exercise and manual therapy have both shown promise and are typically used together by physiotherapists to manage painful hip OA . The aim of this r and omised controlled trial is to compare the efficacy of a physiotherapy treatment program with placebo treatment in reducing pain and improving physical function . Methods The trial will be conducted at the University of Melbourne Centre for Health , Exercise and Sports Medicine . 128 participants with hip pain greater or equal to 40/100 on visual analogue scale ( VAS ) and evidence of OA on x-ray will be recruited . Treatment will be provided by eight community physiotherapists in the Melbourne metropolitan region . The active physiotherapy treatment will comprise a semi-structured program of manual therapy and exercise plus education and advice . The placebo treatment will consist of sham ultrasound and the application of non-therapeutic gel . The participants and the study assessor will be blinded to the treatment allocation . Primary outcomes will be pain measured by VAS and physical function recorded on the Western Ontario and McMaster Universities Osteoarthritis Index ( WOMAC ) immediately after the 12 week intervention . Participants will also be followed up at 36 weeks post baseline . Conclusions The trial design has important strengths of reproducibility and reflecting contemporary physiotherapy practice . The findings from this r and omised trial will provide evidence for the efficacy of a physiotherapy program for painful hip OA.Trial Registration Australian New Zeal and Clinical Trials Registry reference : Background Physical activity can improve health outcomes in people with knee osteoarthritis ( OA ) ; however , participation in physical activity is very low in this population . Objective The objective of our study was to assess the feasibility and preliminary efficacy of the use of wearables ( Fitbit Flex ) and telephone counselling by a physical therapist ( PT ) for improving physical activity in people with a physician-confirmed diagnosis of knee OA , or who have passed 2 vali date d criteria for early OA . Methods We conducted a community-based feasibility r and omized controlled trial . The immediate group ( n=17 ) received a brief education session by a physical therapist , a Fitbit Flex activity tracker , and a weekly telephone call for activity counselling with the physical therapist . The delayed group ( n=17 ) received the same intervention 1 month later . All participants were assessed at baseline ( T0 ) , and the end of 1 month ( T1 ) and 2 months ( T2 ) . Outcomes were ( 1 ) mean moderate to vigorous physical activity time , ( 2 ) mean time spent on sedentary behavior , ( 3 ) Knee Injury and Osteoarthritis Outcome Score ( KOOS ) , and ( 4 ) Partners in Health Scale . Feasibility data were summarized with descriptive statistics . We used analysis of covariance to evaluate the effect of the group type on the outcome measures at T1 and T2 , after adjusting for blocking and T0 . We assessed planned contrasts of changes in outcome measures over measurement periods . Results We identified 46 eligible individuals ; of those , 34 ( 74 % ) enrolled and no one dropped out . All but 1 participant adhered to the intervention protocol . We found a significant effect , with the immediate intervention group having improved in the moderate to vigorous physical activity time and in the Partners in Health Scale at T0 to T1 compared with the delayed intervention group . The planned contrast of the immediate intervention group at T0 to T1 versus the delayed group at T1 to T2 showed a significant effect in the sedentary time and the KOOS symptoms subscale , favoring the delayed group . Conclusions This study demonstrated the feasibility of a behavioral intervention , supported by the use of a wearable device , to promote physical activity among people with knee OA . Trial Registration Clinical Trials.gov NCT02313506 ; https:// clinical trials.gov/ct2/show/NCT02313506 ( Archived by WebCite at http://www.webcitation.org/6r4P3Bub0 OBJECTIVE To compare the effectiveness and safety of supervised aerobic exercise and home aerobic exercise in female Chinese patients with rheumatoid arthritis . DESIGN Single-blind r and omized controlled trial . SUBJECTS Thirty female Chinese patients with rheumatoid arthritis were assigned to either supervised aer 
    Output:
    
agent
Conclusion Exercises and PA promotion according to public health recommendations  for PA improved cardiovascular fitness , muscle strength and PA behaviour , with moderate effect sizes in people with SpA , RA and HOA/KOA .
***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: OBJECTIVES This study aims to assess the impact of a structured education and home exercise programme in daily practice patients with ankylosing spondylitis . METHODS A total of 756 patients with ankylosing spondylitis ( 72 % males , mean age 45 years ) participated in a 6-month prospect i ve multicentre controlled study , 381 of whom were r and omised to an education intervention ( a 2-hour informative session about the disease and the implementation of a non-supervised physical activity programme at home ) and 375 to st and ard care ( controls ) . Main outcome measures included Bath Ankylosing Spondylitis Disease Activity and Functional Index ( BASDAI , BASFI ) . Secondary outcome measures were 0 - 10 cm visual analog scale ( VAS ) for total pain , nocturnal pain and global disease activity and quality of life ( ASQoL ) , knowledge of disease ( self-evaluation ordinal scale ) and daily exercise ( diary card ) . RESULTS At 6 months , the adjusted mean difference between control and educational groups for BASDAI was 0.32 , 95 % confidence interval ( CI ) 0.10 - 0.54 , p=0.005 , and for BASFI 0.31 , 95%CI 0.12 - 0.51 , p=0.002 . Significant differences were found also in VAS for total pain , patient´s global assessment and in ASQoL. Patients in the education group increased their knowledge about the disease and its treatments significantly ( p<0.001 ) and practised more regular exercise than controls ( p<0.001 ) . CONCLUSIONS A structured education and home exercise programme for patients with ankylosing spondylitis in daily practice was feasible and helped to increase knowledge and exercise . Although statistically significant , the magnitudes of the clinical benefits in terms of disease activity and physical function were poor Background The effect of exercise on specific impairments and activity limitations in people with hip osteoarthritis ( OA ) is limited . Objective The study objective was to evaluate the long-term effect of exercise therapy and patient education on range of motion ( ROM ) , muscle strength , physical fitness , walking capacity , and pain during walking in people with hip OA . Design This was a secondary outcome analysis of a r and omized clinical trial . Setting The setting was a university hospital . Participants One hundred nine people with clinical ly and radiographically evident hip OA were r and omly allocated to receive both exercise therapy and patient education ( exercise group ) or patient education only ( control group ) . Intervention All participants attended a patient education program consisting of 3 group meetings led by 2 physical therapists . Two other physical therapists were responsible for providing the exercise therapy program , consisting of 2 or 3 weekly sessions of strengthening , functional , and stretching exercises over 12 weeks . Both interventions were conducted at a sports medicine clinic . Measurements Outcome measures included ROM , isokinetic muscle strength , predicted maximal oxygen consumption determined with the Astr and bicycle ergometer test , and distance and pain during the Six-Minute Walk Test ( 6MWT ) . Follow-up assessment s were conducted 4 , 10 , and 29 months after enrollment by 5 physical therapists who were unaware of group allocations . Results No significant group differences were found for ROM , muscle strength , predicted maximal oxygen consumption , or distance during the 6MWT over the follow-up period , but the exercise group had less pain during the 6MWT than the control group at 10 months ( mean difference=−8.5 mm ; 95 % confidence interval=−16.1 , −0.9 ) and 29 months ( mean difference=−9.3 mm ; 95 % confidence interval=−18.1 , −0.6 ) . Limitations Limitations of the study were reduced statistical power and 53 % rate of adherence to the exercise therapy program . Conclusions The previously described effect of exercise on self-reported function was not reflected by beneficial results for ROM , muscle strength , physical fitness , and walking capacity , but exercise in addition to patient education result ed in less pain during walking in the long term We recruited 132 subjects with bilateral knee osteoarthritis ( Altman Grade II ) to compare the effects of different stretching techniques on the outcomes of isokinetic muscle strengthening exercises . Patients were r and omly divided into four groups ( I-IV ) . The patients in Group I received isokinetic muscular strengthening exercises , Group II received bilateral knee static stretching and isokinetic exercises , Group III received proprioceptive neuromuscular facilitation ( PNF ) stretching and isokinetic exercises , and Group IV acted as controls . Outcomes were measured by changes in Lequesne 's index , range of knee motion , visual analog pain scale , and peak muscle torques during knee flexion and extension . Patients in all the treated groups experienced significant reductions in knee pain and disability , and increased peak muscle torques after treatment and at follow-up . However , only patients in Groups II and III had significant improvements in range of motion and muscle strength gain during 60 degrees/second angular velocity peak torques . Group III demonstrated the greatest increase in muscle strength gain during 180 degrees/second angular velocity peak torques . In conclusion , stretching therapy could increase the effectiveness of isokinetic exercise in terms of functional improvement in patients with knee osteoarthritis . PNF techniques were more effective than static stretching The objective of this study was to evaluate the effectiveness of a sensorimotor training in patients with rheumatoid arthritis on the improvement of functional skills and quality of life , a double-blinded , prospect i ve , r and omized controlled trial . One hundred two participants with rheumatoid arthritis were selected . After the baseline evaluation , the participants were r and omized to two different groups : sensorimotor group ( 2 sessions per week , 30–50 min each session , besides continuing taking the same drugs as the control group ) and control group ( control group was only su bmi tted to the clinical drug treatment with Methotrexate , Leflunomide and /or Prednisone ( 5 mg ) , being then evaluated 4 months later ) . Functional capacity [ Health Assessment Question naire ( HAQ ) and Timed Up & Go Test ( TU > ) ] , Balance and Gait ( Berg Balance Scale ( BBS ) and Tinetti Test ) and Quality of Life ( Short Form Health Survey — SF-36 ) . The study had been concluded with ninety-one participants , and a statistically significant improvement was found in all variables assessed : HAQ ( P < .01 ) , TU > ( P < .01 ) , BBS ( P < .01 ) , Tinetti Test ( P < .01 ) and improvement in the subscales of SF-36 ( P < .01 ) in the sensorimotor group in comparison with the baseline evaluation and control group . No significant difference was found related to the pre- and post-evaluation in the control group . Therefore , the sensorimotor training is effective in the improvement of the functional capacity and quality of life of patients with rheumatoid arthritis The effect of 8 wk of progressive bicycle training on the immune system was evaluated in a controlled study on 18 patients with rheumatoid arthritis and moderate disease activity .  Maximal O2 uptake increased significantly , whereas heart rate at stage 2 and rate of perceived exertion decreased significantly , in the training group compared with the controls . Resting levels of a number of immune parameters were measured before and after 4 and 8 wk of training . Training did not induce changes in blood mononuclear cell sub population s , proliferative response , or natural killer cell activity . Furthermore the plasma concentrations of interleukin-1 alpha , interleukin-1 beta , and interleukin-6 did not change in response to training . It is concluded that 8 wk of bicycle training does not influence the immune system of patients with rheumatoid arthritis Patients with rheumatoid arthritis ( RA ) suffer from muscle loss , causing reduced muscle strength and endurance . The current study aim ed to : ( 1 ) evaluate the effects of combined strength and endurance training ( CT ) on disease activity and functional ability in patients with RA and ( 2 ) investigate the benefits of a 6-month supervised CT program on muscle strength , cardio-respiratory fitness , and body composition of RA patients . Forty patients with RA , aged 41–73 years , were recruited for the current study . Twenty of these patients ( 19 females , one male ) were r and omly assigned to a 6-month supervised CT program ; 20 patients ( 17 females , three males ) served as controls . Within the CT program , strength training consisted of sets of weight bearing exercises for all major muscle groups . In addition to strength training , systematic endurance training was performed on a cycle ergometer two times per week . For RA patients involved in CT , disease activity ( p = 0.06 ) and pain ( p = 0.05 ) were reduced after the 6-month training period while general health ( p = 0.04 ) and functional ability ( p = 0.06 ) improved . Cardio-respiratory endurance was found to have improved significantly ( by 10 % ) after 6 months of CT ( p < 0.001 ) . The overall strength of patients undertaking CT increased by an average of 14 % . Lean body mass increased , and the percentage of body fat was found to decrease significantly ( p < 0.05 ) . A combination of strength and endurance training result ed in considerable improvements in RA  patients ’ muscle strength and cardio-respiratory endurance , accompanied by positive changes in body composition and functional ability . Long-term training appears to be effective in reducing disease activity and associated pain and was found to have no deleterious effects Background Hip osteoarthritis ( OA ) is a common condition leading to pain , disability and reduced quality of life . There is currently limited evidence to support the use of conservative , non-pharmacological treatments for hip OA . Exercise and manual therapy have both shown promise and are typically used together by physiotherapists to manage painful hip OA . The aim of this r and omised controlled trial is to compare the efficacy of a physiotherapy treatment program with placebo treatment in reducing pain and improving physical function . Methods The trial will be conducted at the University of Melbourne Centre for Health , Exercise and Sports Medicine . 128 participants with hip pain greater or equal to 40/100 on visual analogue scale ( VAS ) and evidence of OA on x-ray will be recruited . Treatment will be provided by eight community physiotherapists in the Melbourne metropolitan region . The active physiotherapy treatment will comprise a semi-structured program of manual therapy and exercise plus education and advice . The placebo treatment will consist of sham ultrasound and the application of non-therapeutic gel . The participants and the study assessor will be blinded to the treatment allocation . Primary outcomes will be pain measured by VAS and physical function recorded on the Western Ontario and McMaster Universities Osteoarthritis Index ( WOMAC ) immediately after the 12 week intervention . Participants will also be followed up at 36 weeks post baseline . Conclusions The trial design has important strengths of reproducibility and reflecting contemporary physiotherapy practice . The findings from this r and omised trial will provide evidence for the efficacy of a physiotherapy program for painful hip OA.Trial Registration Australian New Zeal and Clinical Trials Registry reference : Background Physical activity can improve health outcomes in people with knee osteoarthritis ( OA ) ; however , participation in physical activity is very low in this population . Objective The objective of our study was to assess the feasibility and preliminary efficacy of the use of wearables ( Fitbit Flex ) and telephone counselling by a physical therapist ( PT ) for improving physical activity in people with a physician-confirmed diagnosis of knee OA , or who have passed 2 vali date d criteria for early OA . Methods We conducted a community-based feasibility r and omized controlled trial . The immediate group ( n=17 ) received a brief education session by a physical therapist , a Fitbit Flex activity tracker , and a weekly telephone call for activity counselling with the physical therapist . The delayed group ( n=17 ) received the same intervention 1 month later . All participants were assessed at baseline ( T0 ) , and the end of 1 month ( T1 ) and 2 months ( T2 ) . Outcomes were ( 1 ) mean moderate to vigorous physical activity time , ( 2 ) mean time spent on sedentary behavior , ( 3 ) Knee Injury and Osteoarthritis Outcome Score ( KOOS ) , and ( 4 ) Partners in Health Scale . Feasibility data were summarized with descriptive statistics . We used analysis of covariance to evaluate the effect of the group type on the outcome measures at T1 and T2 , after adjusting for blocking and T0 . We assessed planned contrasts of changes in outcome measures over measurement periods . Results We identified 46 eligible individuals ; of those , 34 ( 74 % ) enrolled and no one dropped out . All but 1 participant adhered to the intervention protocol . We found a significant effect , with the immediate intervention group having improved in the moderate to vigorous physical activity time and in the Partners in Health Scale at T0 to T1 compared with the delayed intervention group . The planned contrast of the immediate intervention group at T0 to T1 versus the delayed group at T1 to T2 showed a significant effect in the sedentary time and the KOOS symptoms subscale , favoring the delayed group . Conclusions This study demonstrated the feasibility of a behavioral intervention , supported by the use of a wearable device , to promote physical activity among people with knee OA . Trial Registration Clinical Trials.gov NCT02313506 ; https:// clinical trials.gov/ct2/show/NCT02313506 ( Archived by WebCite at http://www.webcitation.org/6r4P3Bub0 OBJECTIVE To compare the effectiveness and safety of supervised aerobic exercise and home aerobic exercise in female Chinese patients with rheumatoid arthritis . DESIGN Single-blind r and omized controlled trial . SUBJECTS Thirty female Chinese patients with rheumatoid arthritis were assigned to either supervised aer 
    Output:
    