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 Intensive lifestyle interventions in well-controlled setting s are effective in lowering the risk of chronic diseases such as type 2 diabetes ( T2DM ) and cardiovascular diseases ( CVD ) , but there are still no effective lifestyle interventions for everyday practice . In the Hoorn Prevention Study we aim ed to assess the effectiveness of a primary care based lifestyle intervention to reduce the estimated risk of developing T2DM and for CVD mortality , and to motivate changes in lifestyle behaviors . Methods The Hoorn Prevention Study is a parallel group r and omized controlled trial , implemented in the region of West-Friesl and , the Netherl and s. 622 adults with ≥10 % estimated risk of T2DM and /or CVD mortality were r and omly assigned and monitored over a period of 12 months . The intervention group ( n=314 ) received a theory-based lifestyle intervention based on an innovative combination of motivational interviewing and problem solving treatment , provided by trained practice nurses in 12 general practice s. The control group ( n=308 ) received existing health brochures . Primary outcomes was the estimated diabetes risk according to the formula of the Atherosclerosis Risk In Communities ( ARIC ) Study , and the estimated risk for CVD mortality according to the Systematic COronary Risk Evaluation ( SCORE ) formula . Secondary outcomes included lifestyle behavior ( diet , physical activity and smoking ) . The research assistants , the principal investigator and the general practitioners were blinded to group assignment . Linear and logistic regression analysis was applied to examine the between-group differences in each outcome measure , adjusted for baseline values . Results 536 ( 86.2 % ) of the 622 participants ( age 43.5 years ) completed the 6-month follow-up , and 502 ( 81.2 % ) completed the 12-month follow-up . The mean baseline T2DM risk was 18.9 % ( SD 8.2 ) and the mean CVD mortality risk was 3.8 % ( SD 3.0 ) . The intervention group participated in a median of 2 sessions . Intention-to-treat analyses showed no significant differences in outcomes between the two groups at 6 or 12-months follow-up . Conclusions The lifestyle intervention was not more effective than health brochures in reducing risk scores for T2DM and CVD or improving lifestyle behavior in an at-risk population .Trial registration Current Controlled Trials : IS RCT BACKGROUND The Diabetes Prevention Program ( DPP ) found that an intensive lifestyle intervention can reduce the development of diabetes by more than half in adults with prediabetes , but there is little information about the feasibility of offering such an intervention in community setting s. This study evaluated the delivery of a group-based DPP lifestyle intervention in partnership with the YMCA . METHODS This pilot cluster-r and omized trial was design ed to compare group-based DPP lifestyle intervention delivery by the YMCA to brief counseling alone ( control ) in adults who attended a diabetes risk-screening event at one of two semi-urban YMCA facilities and who had a BMI > or=24 kg/m2 , > or=2 diabetes risk factors , and a r and om capillary blood glucose of 110 - 199 mg/dL. Multivariate regression was used to compare between-group differences in changes in body weight , blood pressures , HbA1c , total cholesterol , and HDL-cholesterol after 6 and 12 months . RESULTS Among 92 participants , controls were more often women ( 61 % vs 50 % ) and of nonwhite race ( 29 % vs 7 % ) . After 6 months , body weight decreased by 6.0 % ( 95 % CI=4.7 , 7.3 ) in intervention participants and 2.0 % ( 95 % CI=0.6 , 3.3 ) in controls ( p<0.001 ; difference between groups ) . Intervention participants also had greater changes in total cholesterol ( -22 mg/dL vs + 6 mg/dL controls ; p<0.001 ) . These differences were sustained after 12 months , and adjustment for differences in race and gender did not alter these findings . With only two matched YMCA sites , it was not possible to adjust for potential clustering by site . CONCLUSIONS The YMCA may be a promising channel for wide-scale dissemination of a low-cost approach to lifestyle diabetes prevention Data from two r and omized clinical trials ( RCT ) were used to examine the extent to which a health promotion intervention affected changes in growth trajectories of psychosocial constructs and if so , whether these constructs in turn explained changes in  physical activity ( PA ) . PA and psychosocial measures on 842 overweight adults in the United States were collected in two RCTs evaluating Internet-based behavior change interventions with assessment s at baseline , 6 and 12 months . A physical activity latent variable at 12 months was created using indicators of self-reported walking and leisure time activities . Intervention-mediated effects on  PA  at 12 months were found via latent growth curves representing self-efficacy and behavioral strategies , where increasing growth curves across time were associated with higher  PA values at 12 months . These findings provide some evidence that web-based self-help intervention programs worked through targeted behavior change constructs to influence physical activity levels in overweight adults Background The Weight Loss Maintenance Trial tested strategies for maintenance of weight loss .  Personal contact was superior to interactive technology and self-directed conditions . Purpose We aim ed to identify behavioral mediators of the superior effect of personal contact vs. interactive technology and of personal contact vs. self-directed arms . Methods Overweight/obese adults at risk for cardiovascular disease ( n = 1,032 ) who lost at least 4 kg were r and omized to personal contact , interactive technology , or self-directed . After 30 months , 880 participants had data on weight and behavioral strategies . Results Reported increase of intake of fruits and vegetables and physical activity and more frequent self-weighing met criteria as mediators of the better outcome of personal contact vs. interactive technology .  Increased intake of fruits and vegetables , more frequent self-weighing , and decreased dessert consumption were mediators of the difference between personal contact vs. self-directed . Conclusion Inducing changes in the identified behaviors might yield better outcomes in future weight loss maintenance trials . ( Clinical Trials.gov number NCT00054925 Background Successfully transferring the findings of expensive and tightly controlled programmes of intensive lifestyle modification to the primary care setting is necessary if such knowledge is to be of clinical utility . The objective of this study was to test whether intensive lifestyle modification , shown previously in tightly-controlled clinical trials to be efficacious for diabetes risk-reduction among high-risk individuals , can reduce cardiovascular risk factor levels in the primary care setting . Methodology / Principal Findings The Swedish Björknäs study was a r and omized controlled trial conducted from 2003 to 2006 with follow-up on cardiovascular risk factors at 3 , 12 , 24 and 36 months . A total of 151 middle-aged men and women at moderate- to high-risk of cardiovascular disease from northern Sweden were r and omly assigned to either an intensive lifestyle intervention ( n = 75 ) or control ( n = 76 ) group . The intervention was based broadly on the protocol of the Diabetes Prevention Program . The three-month intervention period was administered in the primary care setting and consisted of supervised exercise sessions and diet counselling , followed by regular group meetings during three years . The control group was given general advice about diet and exercise and received st and ard clinical care . Outcomes were changes in anthropometrics , aerobic fitness , self-reported physical activity , blood pressure , and metabolic traits . At 36 months post-r and omisation , intensive lifestyle modification  reduced waist circumference ( −2.2 cm : p = 0.001 ) , waist-hip ratio ( −0.02 : p<0.0001 ) , systolic blood pressure ( −4.9 mmHg : p = 0.036 ) , and diastolic blood pressure ( −1.6 mmHg : p = 0.005 ) , and improved aerobic fitness ( 5 % ; p = 0.038 ) . Changes in lipid or glucose values did not differ statistically between groups . At 36 months , self-reported time spent exercising and total physical activity had increased more in the intervention group than in the control group ( p<0.001 ) . Conclusion / Significance A program of intensive lifestyle modification undertaken in the primary health care setting can favourably influence cardiovascular risk-factor profiles in high-risk individuals . Trial Registration Clinical Trials.gov Purpose . To determine the effects and mediating factors of a physical activity ( PA ) or vegetable and fruit ( VF ) group cohesion intervention . Design . Longitudinal design . Setting . Harris County and Travis County , Texas . Participants . Community-dwelling African-American and Hispanic or Latina women . Intervention . Three hundred ten women were r and omized to a PA ( n = 204 ) or VF ( n = 106 ) intervention group . Women met in groups six times over the course of 6 months and were exposed to a group cohesion intervention to promote walking or to increase VF consumption . Measures . Women completed the International PA  Question naire , National Cancer Institute VF and fat screeners , PA Group Environment Question naire , and 7-day accelerometer protocol at baseline and post-intervention . Analyses . The direct and mediated effects of the intervention on outcomes were evaluated using a mediational chain model , controlling for baseline values and covariates using path analysis . Results . Women were middle aged ( mean = 44.4 years ) and overweight or obese ( mean body mass index = 34.0 kg/m2 ) .  PA increased and fat consumption decreased for both groups , whereas  VF consumption increased for women in VF group only ( all p < . 05 ) . Increased task cohesion led to hypothesized increases in psychosocial factors in the PA group but not to behavioral changes . Conclusions . Group cohesion interventions may have psychological and physical health benefits for African-American and Hispanic or Latina women , but refinement of measures and intervention delivery is needed to determine whether hypothesized mediational pathways are valid Long-term behavioral self-regulation is the hallmark of successful weight control . We tested mediators of weight loss and weight loss maintenance in middle-aged women who participated in a r and omized controlled 12-month weight management intervention . Overweight and obese women ( N = 225 , BMI = 31.3 + /- 4.1 kg/m(2 ) ) were r and omly assigned to a control or a 1-year group intervention design ed to promote autonomous self-regulation of body weight . Key exercise , eating behavior , and body image variables were assessed before and after the program , and tested as mediators of weight loss ( 12 months , 86 % retention ) and weight loss maintenance ( 24 months , 81 % retention ) . Multiple mediation was employed and an intention-to-treat analysis conducted . Treatment effects were observed for all putative mediators ( Effect size : 0.32 - 0.79 , P < 0.01 vs. controls ) . Weight change was -7.3 + /- 5.9 % ( 12-month ) and -5.5 + /- 5.0 % ( 24-month ) in the intervention group and -1.7 + /- 5.0 % and -2.2 + /- 7.5 % in controls . Change in most psychosocial variables was associated with 12-month weight change , but only flexible cognitive restraint ( P < 0.01 ) , disinhibition ( P < 0.05 ) , exercise self-efficacy ( P < 0.001 ) , exercise intrinsic motivation ( P < 0.01 ) , and body dissatisfaction ( P < 0.05 ) predicted 24-month weight change . Lower emotional eating , increased flexible cognitive restraint , and fewer exercise barriers mediated 12-month weight loss ( R(2 ) = 0.31 , P < 0.001 ; effect ratio : 0.37 ) , but only flexible restraint and exercise self-efficacy mediated 24-month weight loss ( R(2 ) = 0.17 , P < 0.001 ; effect ratio : 0.89 ) . This is the first study to evaluate self-regulation mediators of weight loss and 2-year weight loss maintenance , in a large sample of overweight women . Results show that lowering emotional eating and adopting a flexible dietary restraint pattern are critical for sustained weight loss . For long-term success , interventions must also be effective in promoting exercise intrinsic motivation and self-efficacy Theoretical approaches to behaviour change are now pervasive in the health psychology literature ( Abraham & Michie , 2008 ; Michie , Johnston , Francis , Hardeman , & Eccles , 2008 ) . Many are developed in the social psychology literature and applied in health context s to provide a hypothesis-testing framework for empirical investigations into health behaviours and outcomes ( Michie , Rothman , & Sheeran , 2007 ) . Numerous theoretical perspectives have been applied in the health sphere : the health action process model ( Schwartzer , 1992 ) , the health belief model ( Becker , 1974 ) , protection motivation theory ( PMT ; Rogers , 1975 ) , self-determination theory ( Deci & Ryan , 1985 ) , self-regulation theory ( Leventhal , Leventhal , & Contrada , 1998 ) , social cognitive theory ( B and ura , 1977 ) , subjective expected utility theory ( Edwards , 1954 ) , the theories of reasoned action ( Ajzen & Fishbein , 198 
    Output:
    
agent
Identified mediators for medium-/long-term weight control were higher levels of autonomous motivation , self-efficacy/barriers , self-regulation skills ( such as self-monitoring ) , flexible eating restraint , and positive body image .
For physical activity , significant putative mediators were high autonomous motivation , self-efficacy , and use of self-regulation skills .
For dietary intake , the evidence was much less clear , and no consistent mediators were identified .
Conclusions This is the first systematic review of mediational psychological mechanisms of successful outcomes in obesity-related lifestyle change interventions .
Despite limited evidence , higher autonomous motivation , self-efficacy , and self-regulation skills emerged as the best predictors of beneficial weight and physical activity outcomes ; for weight control , positive body image and flexible eating restraint may additionally improve outcomes .
These variables represent possible targets for future lifestyle interventions in overweight/obese population
***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 Intensive lifestyle interventions in well-controlled setting s are effective in lowering the risk of chronic diseases such as type 2 diabetes ( T2DM ) and cardiovascular diseases ( CVD ) , but there are still no effective lifestyle interventions for everyday practice . In the Hoorn Prevention Study we aim ed to assess the effectiveness of a primary care based lifestyle intervention to reduce the estimated risk of developing T2DM and for CVD mortality , and to motivate changes in lifestyle behaviors . Methods The Hoorn Prevention Study is a parallel group r and omized controlled trial , implemented in the region of West-Friesl and , the Netherl and s. 622 adults with ≥10 % estimated risk of T2DM and /or CVD mortality were r and omly assigned and monitored over a period of 12 months . The intervention group ( n=314 ) received a theory-based lifestyle intervention based on an innovative combination of motivational interviewing and problem solving treatment , provided by trained practice nurses in 12 general practice s. The control group ( n=308 ) received existing health brochures . Primary outcomes was the estimated diabetes risk according to the formula of the Atherosclerosis Risk In Communities ( ARIC ) Study , and the estimated risk for CVD mortality according to the Systematic COronary Risk Evaluation ( SCORE ) formula . Secondary outcomes included lifestyle behavior ( diet , physical activity and smoking ) . The research assistants , the principal investigator and the general practitioners were blinded to group assignment . Linear and logistic regression analysis was applied to examine the between-group differences in each outcome measure , adjusted for baseline values . Results 536 ( 86.2 % ) of the 622 participants ( age 43.5 years ) completed the 6-month follow-up , and 502 ( 81.2 % ) completed the 12-month follow-up . The mean baseline T2DM risk was 18.9 % ( SD 8.2 ) and the mean CVD mortality risk was 3.8 % ( SD 3.0 ) . The intervention group participated in a median of 2 sessions . Intention-to-treat analyses showed no significant differences in outcomes between the two groups at 6 or 12-months follow-up . Conclusions The lifestyle intervention was not more effective than health brochures in reducing risk scores for T2DM and CVD or improving lifestyle behavior in an at-risk population .Trial registration Current Controlled Trials : IS RCT BACKGROUND The Diabetes Prevention Program ( DPP ) found that an intensive lifestyle intervention can reduce the development of diabetes by more than half in adults with prediabetes , but there is little information about the feasibility of offering such an intervention in community setting s. This study evaluated the delivery of a group-based DPP lifestyle intervention in partnership with the YMCA . METHODS This pilot cluster-r and omized trial was design ed to compare group-based DPP lifestyle intervention delivery by the YMCA to brief counseling alone ( control ) in adults who attended a diabetes risk-screening event at one of two semi-urban YMCA facilities and who had a BMI > or=24 kg/m2 , > or=2 diabetes risk factors , and a r and om capillary blood glucose of 110 - 199 mg/dL. Multivariate regression was used to compare between-group differences in changes in body weight , blood pressures , HbA1c , total cholesterol , and HDL-cholesterol after 6 and 12 months . RESULTS Among 92 participants , controls were more often women ( 61 % vs 50 % ) and of nonwhite race ( 29 % vs 7 % ) . After 6 months , body weight decreased by 6.0 % ( 95 % CI=4.7 , 7.3 ) in intervention participants and 2.0 % ( 95 % CI=0.6 , 3.3 ) in controls ( p<0.001 ; difference between groups ) . Intervention participants also had greater changes in total cholesterol ( -22 mg/dL vs + 6 mg/dL controls ; p<0.001 ) . These differences were sustained after 12 months , and adjustment for differences in race and gender did not alter these findings . With only two matched YMCA sites , it was not possible to adjust for potential clustering by site . CONCLUSIONS The YMCA may be a promising channel for wide-scale dissemination of a low-cost approach to lifestyle diabetes prevention Data from two r and omized clinical trials ( RCT ) were used to examine the extent to which a health promotion intervention affected changes in growth trajectories of psychosocial constructs and if so , whether these constructs in turn explained changes in  physical activity ( PA ) . PA and psychosocial measures on 842 overweight adults in the United States were collected in two RCTs evaluating Internet-based behavior change interventions with assessment s at baseline , 6 and 12 months . A physical activity latent variable at 12 months was created using indicators of self-reported walking and leisure time activities . Intervention-mediated effects on  PA  at 12 months were found via latent growth curves representing self-efficacy and behavioral strategies , where increasing growth curves across time were associated with higher  PA values at 12 months . These findings provide some evidence that web-based self-help intervention programs worked through targeted behavior change constructs to influence physical activity levels in overweight adults Background The Weight Loss Maintenance Trial tested strategies for maintenance of weight loss .  Personal contact was superior to interactive technology and self-directed conditions . Purpose We aim ed to identify behavioral mediators of the superior effect of personal contact vs. interactive technology and of personal contact vs. self-directed arms . Methods Overweight/obese adults at risk for cardiovascular disease ( n = 1,032 ) who lost at least 4 kg were r and omized to personal contact , interactive technology , or self-directed . After 30 months , 880 participants had data on weight and behavioral strategies . Results Reported increase of intake of fruits and vegetables and physical activity and more frequent self-weighing met criteria as mediators of the better outcome of personal contact vs. interactive technology .  Increased intake of fruits and vegetables , more frequent self-weighing , and decreased dessert consumption were mediators of the difference between personal contact vs. self-directed . Conclusion Inducing changes in the identified behaviors might yield better outcomes in future weight loss maintenance trials . ( Clinical Trials.gov number NCT00054925 Background Successfully transferring the findings of expensive and tightly controlled programmes of intensive lifestyle modification to the primary care setting is necessary if such knowledge is to be of clinical utility . The objective of this study was to test whether intensive lifestyle modification , shown previously in tightly-controlled clinical trials to be efficacious for diabetes risk-reduction among high-risk individuals , can reduce cardiovascular risk factor levels in the primary care setting . Methodology / Principal Findings The Swedish Björknäs study was a r and omized controlled trial conducted from 2003 to 2006 with follow-up on cardiovascular risk factors at 3 , 12 , 24 and 36 months . A total of 151 middle-aged men and women at moderate- to high-risk of cardiovascular disease from northern Sweden were r and omly assigned to either an intensive lifestyle intervention ( n = 75 ) or control ( n = 76 ) group . The intervention was based broadly on the protocol of the Diabetes Prevention Program . The three-month intervention period was administered in the primary care setting and consisted of supervised exercise sessions and diet counselling , followed by regular group meetings during three years . The control group was given general advice about diet and exercise and received st and ard clinical care . Outcomes were changes in anthropometrics , aerobic fitness , self-reported physical activity , blood pressure , and metabolic traits . At 36 months post-r and omisation , intensive lifestyle modification  reduced waist circumference ( −2.2 cm : p = 0.001 ) , waist-hip ratio ( −0.02 : p<0.0001 ) , systolic blood pressure ( −4.9 mmHg : p = 0.036 ) , and diastolic blood pressure ( −1.6 mmHg : p = 0.005 ) , and improved aerobic fitness ( 5 % ; p = 0.038 ) . Changes in lipid or glucose values did not differ statistically between groups . At 36 months , self-reported time spent exercising and total physical activity had increased more in the intervention group than in the control group ( p<0.001 ) . Conclusion / Significance A program of intensive lifestyle modification undertaken in the primary health care setting can favourably influence cardiovascular risk-factor profiles in high-risk individuals . Trial Registration Clinical Trials.gov Purpose . To determine the effects and mediating factors of a physical activity ( PA ) or vegetable and fruit ( VF ) group cohesion intervention . Design . Longitudinal design . Setting . Harris County and Travis County , Texas . Participants . Community-dwelling African-American and Hispanic or Latina women . Intervention . Three hundred ten women were r and omized to a PA ( n = 204 ) or VF ( n = 106 ) intervention group . Women met in groups six times over the course of 6 months and were exposed to a group cohesion intervention to promote walking or to increase VF consumption . Measures . Women completed the International PA  Question naire , National Cancer Institute VF and fat screeners , PA Group Environment Question naire , and 7-day accelerometer protocol at baseline and post-intervention . Analyses . The direct and mediated effects of the intervention on outcomes were evaluated using a mediational chain model , controlling for baseline values and covariates using path analysis . Results . Women were middle aged ( mean = 44.4 years ) and overweight or obese ( mean body mass index = 34.0 kg/m2 ) .  PA increased and fat consumption decreased for both groups , whereas  VF consumption increased for women in VF group only ( all p < . 05 ) . Increased task cohesion led to hypothesized increases in psychosocial factors in the PA group but not to behavioral changes . Conclusions . Group cohesion interventions may have psychological and physical health benefits for African-American and Hispanic or Latina women , but refinement of measures and intervention delivery is needed to determine whether hypothesized mediational pathways are valid Long-term behavioral self-regulation is the hallmark of successful weight control . We tested mediators of weight loss and weight loss maintenance in middle-aged women who participated in a r and omized controlled 12-month weight management intervention . Overweight and obese women ( N = 225 , BMI = 31.3 + /- 4.1 kg/m(2 ) ) were r and omly assigned to a control or a 1-year group intervention design ed to promote autonomous self-regulation of body weight . Key exercise , eating behavior , and body image variables were assessed before and after the program , and tested as mediators of weight loss ( 12 months , 86 % retention ) and weight loss maintenance ( 24 months , 81 % retention ) . Multiple mediation was employed and an intention-to-treat analysis conducted . Treatment effects were observed for all putative mediators ( Effect size : 0.32 - 0.79 , P < 0.01 vs. controls ) . Weight change was -7.3 + /- 5.9 % ( 12-month ) and -5.5 + /- 5.0 % ( 24-month ) in the intervention group and -1.7 + /- 5.0 % and -2.2 + /- 7.5 % in controls . Change in most psychosocial variables was associated with 12-month weight change , but only flexible cognitive restraint ( P < 0.01 ) , disinhibition ( P < 0.05 ) , exercise self-efficacy ( P < 0.001 ) , exercise intrinsic motivation ( P < 0.01 ) , and body dissatisfaction ( P < 0.05 ) predicted 24-month weight change . Lower emotional eating , increased flexible cognitive restraint , and fewer exercise barriers mediated 12-month weight loss ( R(2 ) = 0.31 , P < 0.001 ; effect ratio : 0.37 ) , but only flexible restraint and exercise self-efficacy mediated 24-month weight loss ( R(2 ) = 0.17 , P < 0.001 ; effect ratio : 0.89 ) . This is the first study to evaluate self-regulation mediators of weight loss and 2-year weight loss maintenance , in a large sample of overweight women . Results show that lowering emotional eating and adopting a flexible dietary restraint pattern are critical for sustained weight loss . For long-term success , interventions must also be effective in promoting exercise intrinsic motivation and self-efficacy Theoretical approaches to behaviour change are now pervasive in the health psychology literature ( Abraham & Michie , 2008 ; Michie , Johnston , Francis , Hardeman , & Eccles , 2008 ) . Many are developed in the social psychology literature and applied in health context s to provide a hypothesis-testing framework for empirical investigations into health behaviours and outcomes ( Michie , Rothman , & Sheeran , 2007 ) . Numerous theoretical perspectives have been applied in the health sphere : the health action process model ( Schwartzer , 1992 ) , the health belief model ( Becker , 1974 ) , protection motivation theory ( PMT ; Rogers , 1975 ) , self-determination theory ( Deci & Ryan , 1985 ) , self-regulation theory ( Leventhal , Leventhal , & Contrada , 1998 ) , social cognitive theory ( B and ura , 1977 ) , subjective expected utility theory ( Edwards , 1954 ) , the theories of reasoned action ( Ajzen & Fishbein , 198 
    Output:
    