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 A major obstacle to screening for early mobility disability ( ie , mobility difficulty ) , a major public health concern , is the lack of a method that identifies those who are at high risk . The goal of this study was to develop easy-to-use clinical nomograms for estimation of the probability of incident mobility difficulty . METHODS We conducted a population -based prospect i ve study using data from 266 high physically and cognitively functioning older women , aged 70 to 80 years , who were free of mobility disability at the baseline evaluation of the Women 's Health and Aging Study II . The outcome measure was incident mobility disability within 18 months , defined as self-reported difficulty walking 0.8 km , climbing 10 steps , or transferring from or into a car or bus . Logistic regression and receiver operating characteristic curve analyses were used for evaluation of the optimal combination of self-reported and performance-based mobility measures . Bootstrap sampling and estimation was used for validation . RESULTS Predictive nomograms were developed based on a final model that included 3 simple-to-obtain measures of pre clinical disability : self-report of modification in mobility tasks without having difficulty with them , one-leg stance balance , and time to walk 1 m at a usual pace . Final model accuracy ( as estimated by the area under the receiver operating characteristic curve ) was 73 % ( SE = 0.04 ) . Validation analysis confirmed the high accuracy of these nomograms . CONCLUSIONS An original tool was developed for assessment of the risk of mobility difficulty in older women that can be used to assist physicians and research ers in deciding which women to target for preventive interventions OBJECTIVES To evaluate the effectiveness of an enhanced balance training program in improving mobility and well-being of elderly people with balance problems . DESIGN Prospect i ve , single-blind , r and omized , controlled trial . SETTING District general hospital . PARTICIPANTS One hundred ninety-nine patients aged 60 and older with a Berg Balance Scale ( BBS ) score of less than 45 . INTERVENTIONS Six weeks enhanced balance training consisting of a series of repetitive tasks of increasing difficulty specific to functional balance . The control group received physiotherapy conforming to existing practice in elderly patients with mobility problems .  MEASUREMENTS Ten-meter timed walk test ( TWT ) , BBS , Frenchay Activities Index ( FAI ) , Falls H and icap Inventory ( FHI ) , and European Quality of Life question naire ( Euroqol ) measured at 6 , 12 , and 24 weeks after intervention . RESULTS The mean age + /- st and ard deviation of subjects was 82.7 + /- 5.6 , and baseline characteristics were comparable between the groups . Both groups showed improvements in TWT ( intervention : 22.5 - 16.5 seconds , P = .001 ; control : 20.5 - 15.8 seconds , P = .054 ) , BBS ( intervention : 33.3 - 42.7 , P = .001 ; control : 33.4 - 42.0 , P < .0001 ) , FAI ( 18 - 21 , P = .02 in both groups ) , FHI score ( intervention : 31 - 17 , P = .0001 ; control : 33 - 17 , P = .0001 ) and Euroqol score ( intervention : 58 - 65 , P = .04 ; control : 60 - 65 , P = .07 ) . There were no intergroup differences at any time . More patients reported increased confidence in walking indoors ( 36 % vs 28 % ; P = .04 ) and outdoors ( 27 % vs 18 % ; P = .02 ) in the enhanced balance-training group . CONCLUSION Exercise programs significantly improve balance and mobility in patients with balance problems , independent of strategy . Enhanced balance training may , in addition , improve confidence and quality of life but needs further investigation The purpose of this study was to determine whether a walking program supplemented by tasks design ed to challenge balance and mobility ( WALK+ ) could improve physical function more than a traditional walking program ( WALK ) in older adults at risk for mobility disability . 31 community-dwelling older adults ( M + /- SD age = 76 + /- 5 yr ; Short Physical Performance Battery [ SPPB ] score = 8.4 + /- 1.7 ) were r and omized to treatment . Both interventions were 18 sessions ( 1 hr , 3x/wk ) and progressive in intensity and duration . Physical function was assessed using the SPPB and the 400-m-walk time . A subset of participants in the WALK group who had relatively lower baseline function showed only small improvement in their SPPB scores after the intervention ( 0.3 + /- 0.5 ) , whereas a subset of participants in the WALK+ group with low baseline function showed substantial improvement in their SPPB scores ( 2.2 + /- 0.7 ) . These preliminary data underscore the potential importance of tailoring interventions for older adults based on baseline levels of physical function Abstract Objective : To evaluate the effect of intensive geriatric rehabilitation on demented patients with hip fracture . Design : Preplanned sub analysis of r and omised intervention study . Settting : Jyväskylä Central Hospital , Finl and . Participants : 243 independently living patients aged 65 years or older admitted to hospital with hip fracture . Intervention : After surgery patients in the intervention group ( n=120 ) were referred to the geriatric ward whereas those in the control group were discharged to local hospitals . Main outcome measures : Length of hospital stay , mortality , and place of residence three months and one year after surgery for hip fracture . Results : The median length of hospital stay of hip fracture patients with moderate dementia ( mini mental state examination score 12 - 17 ) was 47 days in the intervention group ( n=24 ) and 147 days in the control group ( n=12 , P=0.04 ) . The corresponding figures for patients with mild dementia ( score 18 - 23 ) were 29 days in the intervention group ( n=35 ) and 46.5 days in the control group ( n=42 , P=0.002 ) . Three months after the operation , in the intervention group 91 % ( 32 ) of the patients with mild dementia and 63 % ( 15 ) of the patients with moderate dementia were living independently . In the control group , the corresponding figures were 67 % ( 28 ) and 17 % ( 2 ) . There were no significant differences in mortality or in the lengths of hospital stay of severely demented patients and patients with normal mini mental state examination scores . Conclusions : Hip fracture patients with mild or moderate dementia can often return to the community if they are provided with active geriatric rehabilitation OBJECTIVES To vali date self-reported pre clinical mobility limitation concept and self-report assessment method against muscle power and walking speed , and to study the predictive validity of pre clinical mobility limitation with respect to future risk of manifest mobility limitation . DESIGN Observational prospect i ve cohort study and cross-sectional analysis . SETTING Research laboratory and community . PARTICIPANTS A total of 632 community-living ( age range , 75 - 81 y ) women and men took part in the baseline assessment s and 302 persons in the semi-annual interviews on mobility limitation over 2 years . INTERVENTIONS Not applicable . MAIN OUTCOME MEASURES Walking speed , muscle power , and self-reported pre clinical and manifest mobility limitation . Pre clinical mobility limitation was defined as self-reported tiredness or modification of task performance without task difficulty . At baseline , 4 subgroups were created according to self-reported pre clinical mobility limitation in any of 3 mobility tasks ( walking 2 km , walking 0.5 km , climbing up stairs ) : no limitation , pre clinical limitation , and minor and major manifest limitation . RESULTS At baseline , participants with pre clinical mobility limitation showed intermediate levels of walking speed and muscle power , compared with those with no limitation or manifest mobility limitation . Participants reporting baseline pre clinical mobility limitation had 3- to 6-fold higher age- and sex-adjusted risk of progressing to major manifest mobility limitation during the 2-year follow-up compared with participants with no limitation at baseline , whereas the risk among those with minor limitation at baseline was 14- to 18-fold higher compared with those with no limitation . CONCLUSIONS The self-report assessment tool proved to be a valid measure to capture the early signs of disability and may serve as an inexpensive tool for identifying those nondisabled persons at high risk for future disability BACKGROUND The number of older adults living in the United States continues to increase , and recent research has begun to target interventions to older adults who have mobility limitations and are at risk for disability . The objective of this study is to describe and examine correlates of health-related quality of life in this population subgroup using baseline data from a larger intervention study . METHODS The Lifestyle Interventions and Independence for Elders-Pilot study ( LIFE-P ) was a r and omized controlled trial that compared a physical activity intervention to a non-exercise educational intervention among 424 older adults at risk for disability . Baseline data ( collected in April-December 2004 , analyzed in 2006 ) included demographics , medical history , the Quality of Well-Being Scale ( QWB-SA ) , a timed 400-m walk , and the Short Physical Performance Battery ( SPPB ) . Descriptive health-related quality of life ( HRQOL ) data are presented . Hierarchical linear regression models were used to examine correlates of HRQOL . RESULTS The mean QWB-SA score for the sample was 0.630 on an interval scale ranging from 0.0 ( death ) to 1.0 ( asymptomatic , optimal functioning ) . The mean of 0.630 is 0.070 lower than a comparison group of healthy older adults . The variables associated with lower HRQOL included white ethnicity , more comorbid conditions , slower 400-m walk times , and lower SPPB balance and chair st and scores . CONCLUSIONS Older adults who are at risk for disability had reduced HRQOL . Surprisingly , however , mobility was a stronger correlate of HRQOL than an index of comorbidity , suggesting that interventions addressing mobility limitations may provide significant health benefits to this population BACKGROUND Little is known about the effect of diabetes mellitus on subsequent lower body disability in older Mexican Americans , one of the fastest growing ethnic groups in the United States . The aim of this study is to examine the relationship between diabetes mellitus and incident lower body disability over a 7-year follow-up period . METHODS Ours was a 7-year prospect i ve cohort study of 1835 Mexican-American individuals > or = 65 years old , nondisabled at baseline , and residing in five Southwestern states . Measures included self-reported physician diagnosis of diabetes , stroke , heart attack , hip fracture , arthritis , or cancer . Disability measures  included  activities of daily living ( ADLs ) , mobility tasks , and an 8-foot walk test . Body mass index , depressive symptoms , and vision function  were also measured . RESULTS At 7-year follow-up , 48.7 % of diabetic participants nondisabled at baseline developed limitations in one or more measures of lower body function . Cox proportional regression analyses showed that diabetic participants were more likely to report any limitation in lower body ADL function ( hazard ratio [ HR ] = 2.05 , 95 % confidence interval [ CI ] , 1.58 - 2.67 ) , mobility tasks ( HR = 1.69 , 95 % CI , 1.39 - 2.04 ) , and 8-foot walk ( HR = 1.46 , 95 % CI , 1.15 - 1.85 ) compared with nondiabetic participants , after controlling for relevant factors . Older age and having one or more diabetic complications were significantly associated with increased risk of limitations in any lower body ADL and mobility task at follow-up . CONCLUSION Older Mexican Americans with diabetes mellitus are at high risk for development of lower body disability over time . Awareness of disability as a potentially modifiable complication and use of interventions to reduce disability should become health priorities for older Mexican Americans with diabetes Background and aims : This study investigated whether high-velocity high-power training ( POW )  improved lower extremity muscle power and quality in functionally-limited elders greater than traditional slow-velocity progressive resistance training ( STR ) . Methods : Fifty-seven community-dwelling older adults aged 74.2±7 ( range 65–94 yrs ) , Short Physical Performance Battery score 7.7±1.4 , were r and omized to either POW ( n=23 ) ( 12 females ) , STR ( n=22 ) ( 13 females ) or a control group of lower extremity stretching ( CON ) ( n=12 ) ( 6 females ) . Training was performed three times per week for 12 weeks and subjects completed three sets of double leg press and knee extension exercises at 70 % of the one repetition maximum ( 1RM ) . Outcome measures included 1RM strength and peak power ( PP ) . Total leg lean mass was determined using dual-energy X-ray absorptiometry to estimate specific strength and specific PP . Results : During training , power output was consistently higher in POW compared to STR for knee extension ( ∼2.3-fold ) and leg press ( ∼2.8-fold ) exercises ( p<0.01 ) . Despite this , PP and specific PP of the knee extensors increased similarly from baseline in POW and STR compared to CON ( p<0.01 ) , and no significant time-group interaction occurred for PP of the leg extensors . However , gains 
    Output:
    
agent
Several tools are available to assess mobility in the ambulatory setting .
Relatively few studies support therapeutic exercise to improve mobility limitation .
Strong evidence supports resistance and balance exercises for improving mobility-limiting physical weakness and balance disorders .
Addressing functional deficits and environmental barriers with exercise and mobility devices can lead to improved function , safety , and quality of life for patients with mobility limitations
***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 A major obstacle to screening for early mobility disability ( ie , mobility difficulty ) , a major public health concern , is the lack of a method that identifies those who are at high risk . The goal of this study was to develop easy-to-use clinical nomograms for estimation of the probability of incident mobility difficulty . METHODS We conducted a population -based prospect i ve study using data from 266 high physically and cognitively functioning older women , aged 70 to 80 years , who were free of mobility disability at the baseline evaluation of the Women 's Health and Aging Study II . The outcome measure was incident mobility disability within 18 months , defined as self-reported difficulty walking 0.8 km , climbing 10 steps , or transferring from or into a car or bus . Logistic regression and receiver operating characteristic curve analyses were used for evaluation of the optimal combination of self-reported and performance-based mobility measures . Bootstrap sampling and estimation was used for validation . RESULTS Predictive nomograms were developed based on a final model that included 3 simple-to-obtain measures of pre clinical disability : self-report of modification in mobility tasks without having difficulty with them , one-leg stance balance , and time to walk 1 m at a usual pace . Final model accuracy ( as estimated by the area under the receiver operating characteristic curve ) was 73 % ( SE = 0.04 ) . Validation analysis confirmed the high accuracy of these nomograms . CONCLUSIONS An original tool was developed for assessment of the risk of mobility difficulty in older women that can be used to assist physicians and research ers in deciding which women to target for preventive interventions OBJECTIVES To evaluate the effectiveness of an enhanced balance training program in improving mobility and well-being of elderly people with balance problems . DESIGN Prospect i ve , single-blind , r and omized , controlled trial . SETTING District general hospital . PARTICIPANTS One hundred ninety-nine patients aged 60 and older with a Berg Balance Scale ( BBS ) score of less than 45 . INTERVENTIONS Six weeks enhanced balance training consisting of a series of repetitive tasks of increasing difficulty specific to functional balance . The control group received physiotherapy conforming to existing practice in elderly patients with mobility problems .  MEASUREMENTS Ten-meter timed walk test ( TWT ) , BBS , Frenchay Activities Index ( FAI ) , Falls H and icap Inventory ( FHI ) , and European Quality of Life question naire ( Euroqol ) measured at 6 , 12 , and 24 weeks after intervention . RESULTS The mean age + /- st and ard deviation of subjects was 82.7 + /- 5.6 , and baseline characteristics were comparable between the groups . Both groups showed improvements in TWT ( intervention : 22.5 - 16.5 seconds , P = .001 ; control : 20.5 - 15.8 seconds , P = .054 ) , BBS ( intervention : 33.3 - 42.7 , P = .001 ; control : 33.4 - 42.0 , P < .0001 ) , FAI ( 18 - 21 , P = .02 in both groups ) , FHI score ( intervention : 31 - 17 , P = .0001 ; control : 33 - 17 , P = .0001 ) and Euroqol score ( intervention : 58 - 65 , P = .04 ; control : 60 - 65 , P = .07 ) . There were no intergroup differences at any time . More patients reported increased confidence in walking indoors ( 36 % vs 28 % ; P = .04 ) and outdoors ( 27 % vs 18 % ; P = .02 ) in the enhanced balance-training group . CONCLUSION Exercise programs significantly improve balance and mobility in patients with balance problems , independent of strategy . Enhanced balance training may , in addition , improve confidence and quality of life but needs further investigation The purpose of this study was to determine whether a walking program supplemented by tasks design ed to challenge balance and mobility ( WALK+ ) could improve physical function more than a traditional walking program ( WALK ) in older adults at risk for mobility disability . 31 community-dwelling older adults ( M + /- SD age = 76 + /- 5 yr ; Short Physical Performance Battery [ SPPB ] score = 8.4 + /- 1.7 ) were r and omized to treatment . Both interventions were 18 sessions ( 1 hr , 3x/wk ) and progressive in intensity and duration . Physical function was assessed using the SPPB and the 400-m-walk time . A subset of participants in the WALK group who had relatively lower baseline function showed only small improvement in their SPPB scores after the intervention ( 0.3 + /- 0.5 ) , whereas a subset of participants in the WALK+ group with low baseline function showed substantial improvement in their SPPB scores ( 2.2 + /- 0.7 ) . These preliminary data underscore the potential importance of tailoring interventions for older adults based on baseline levels of physical function Abstract Objective : To evaluate the effect of intensive geriatric rehabilitation on demented patients with hip fracture . Design : Preplanned sub analysis of r and omised intervention study . Settting : Jyväskylä Central Hospital , Finl and . Participants : 243 independently living patients aged 65 years or older admitted to hospital with hip fracture . Intervention : After surgery patients in the intervention group ( n=120 ) were referred to the geriatric ward whereas those in the control group were discharged to local hospitals . Main outcome measures : Length of hospital stay , mortality , and place of residence three months and one year after surgery for hip fracture . Results : The median length of hospital stay of hip fracture patients with moderate dementia ( mini mental state examination score 12 - 17 ) was 47 days in the intervention group ( n=24 ) and 147 days in the control group ( n=12 , P=0.04 ) . The corresponding figures for patients with mild dementia ( score 18 - 23 ) were 29 days in the intervention group ( n=35 ) and 46.5 days in the control group ( n=42 , P=0.002 ) . Three months after the operation , in the intervention group 91 % ( 32 ) of the patients with mild dementia and 63 % ( 15 ) of the patients with moderate dementia were living independently . In the control group , the corresponding figures were 67 % ( 28 ) and 17 % ( 2 ) . There were no significant differences in mortality or in the lengths of hospital stay of severely demented patients and patients with normal mini mental state examination scores . Conclusions : Hip fracture patients with mild or moderate dementia can often return to the community if they are provided with active geriatric rehabilitation OBJECTIVES To vali date self-reported pre clinical mobility limitation concept and self-report assessment method against muscle power and walking speed , and to study the predictive validity of pre clinical mobility limitation with respect to future risk of manifest mobility limitation . DESIGN Observational prospect i ve cohort study and cross-sectional analysis . SETTING Research laboratory and community . PARTICIPANTS A total of 632 community-living ( age range , 75 - 81 y ) women and men took part in the baseline assessment s and 302 persons in the semi-annual interviews on mobility limitation over 2 years . INTERVENTIONS Not applicable . MAIN OUTCOME MEASURES Walking speed , muscle power , and self-reported pre clinical and manifest mobility limitation . Pre clinical mobility limitation was defined as self-reported tiredness or modification of task performance without task difficulty . At baseline , 4 subgroups were created according to self-reported pre clinical mobility limitation in any of 3 mobility tasks ( walking 2 km , walking 0.5 km , climbing up stairs ) : no limitation , pre clinical limitation , and minor and major manifest limitation . RESULTS At baseline , participants with pre clinical mobility limitation showed intermediate levels of walking speed and muscle power , compared with those with no limitation or manifest mobility limitation . Participants reporting baseline pre clinical mobility limitation had 3- to 6-fold higher age- and sex-adjusted risk of progressing to major manifest mobility limitation during the 2-year follow-up compared with participants with no limitation at baseline , whereas the risk among those with minor limitation at baseline was 14- to 18-fold higher compared with those with no limitation . CONCLUSIONS The self-report assessment tool proved to be a valid measure to capture the early signs of disability and may serve as an inexpensive tool for identifying those nondisabled persons at high risk for future disability BACKGROUND The number of older adults living in the United States continues to increase , and recent research has begun to target interventions to older adults who have mobility limitations and are at risk for disability . The objective of this study is to describe and examine correlates of health-related quality of life in this population subgroup using baseline data from a larger intervention study . METHODS The Lifestyle Interventions and Independence for Elders-Pilot study ( LIFE-P ) was a r and omized controlled trial that compared a physical activity intervention to a non-exercise educational intervention among 424 older adults at risk for disability . Baseline data ( collected in April-December 2004 , analyzed in 2006 ) included demographics , medical history , the Quality of Well-Being Scale ( QWB-SA ) , a timed 400-m walk , and the Short Physical Performance Battery ( SPPB ) . Descriptive health-related quality of life ( HRQOL ) data are presented . Hierarchical linear regression models were used to examine correlates of HRQOL . RESULTS The mean QWB-SA score for the sample was 0.630 on an interval scale ranging from 0.0 ( death ) to 1.0 ( asymptomatic , optimal functioning ) . The mean of 0.630 is 0.070 lower than a comparison group of healthy older adults . The variables associated with lower HRQOL included white ethnicity , more comorbid conditions , slower 400-m walk times , and lower SPPB balance and chair st and scores . CONCLUSIONS Older adults who are at risk for disability had reduced HRQOL . Surprisingly , however , mobility was a stronger correlate of HRQOL than an index of comorbidity , suggesting that interventions addressing mobility limitations may provide significant health benefits to this population BACKGROUND Little is known about the effect of diabetes mellitus on subsequent lower body disability in older Mexican Americans , one of the fastest growing ethnic groups in the United States . The aim of this study is to examine the relationship between diabetes mellitus and incident lower body disability over a 7-year follow-up period . METHODS Ours was a 7-year prospect i ve cohort study of 1835 Mexican-American individuals > or = 65 years old , nondisabled at baseline , and residing in five Southwestern states . Measures included self-reported physician diagnosis of diabetes , stroke , heart attack , hip fracture , arthritis , or cancer . Disability measures  included  activities of daily living ( ADLs ) , mobility tasks , and an 8-foot walk test . Body mass index , depressive symptoms , and vision function  were also measured . RESULTS At 7-year follow-up , 48.7 % of diabetic participants nondisabled at baseline developed limitations in one or more measures of lower body function . Cox proportional regression analyses showed that diabetic participants were more likely to report any limitation in lower body ADL function ( hazard ratio [ HR ] = 2.05 , 95 % confidence interval [ CI ] , 1.58 - 2.67 ) , mobility tasks ( HR = 1.69 , 95 % CI , 1.39 - 2.04 ) , and 8-foot walk ( HR = 1.46 , 95 % CI , 1.15 - 1.85 ) compared with nondiabetic participants , after controlling for relevant factors . Older age and having one or more diabetic complications were significantly associated with increased risk of limitations in any lower body ADL and mobility task at follow-up . CONCLUSION Older Mexican Americans with diabetes mellitus are at high risk for development of lower body disability over time . Awareness of disability as a potentially modifiable complication and use of interventions to reduce disability should become health priorities for older Mexican Americans with diabetes Background and aims : This study investigated whether high-velocity high-power training ( POW )  improved lower extremity muscle power and quality in functionally-limited elders greater than traditional slow-velocity progressive resistance training ( STR ) . Methods : Fifty-seven community-dwelling older adults aged 74.2±7 ( range 65–94 yrs ) , Short Physical Performance Battery score 7.7±1.4 , were r and omized to either POW ( n=23 ) ( 12 females ) , STR ( n=22 ) ( 13 females ) or a control group of lower extremity stretching ( CON ) ( n=12 ) ( 6 females ) . Training was performed three times per week for 12 weeks and subjects completed three sets of double leg press and knee extension exercises at 70 % of the one repetition maximum ( 1RM ) . Outcome measures included 1RM strength and peak power ( PP ) . Total leg lean mass was determined using dual-energy X-ray absorptiometry to estimate specific strength and specific PP . Results : During training , power output was consistently higher in POW compared to STR for knee extension ( ∼2.3-fold ) and leg press ( ∼2.8-fold ) exercises ( p<0.01 ) . Despite this , PP and specific PP of the knee extensors increased similarly from baseline in POW and STR compared to CON ( p<0.01 ) , and no significant time-group interaction occurred for PP of the leg extensors . However , gains 
    Output:
    