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: Abstract Objective : To assess the efficacy of an educational intervention explaining symptoms to encourage grade d exercise in patients with chronic fatigue syndrome . Design : R and omised controlled trial . Setting : Chronic fatigue clinic and infectious diseases outpatient clinic . Subjects : 148 consecutively referred patients fulfilling Oxford criteria for chronic fatigue syndrome . Interventions : Patients r and omised to the control group received st and ardised medical care .  Patients r and omised to intervention received two individual treatment sessions and two telephone follow up calls , supported by a comprehensive educational pack , describing the role of disrupted physiological regulation in fatigue symptoms and encouraging home based grade d exercise . The minimum intervention group had no further treatment , but the telephone intervention group received an additional seven follow up calls and the maximum intervention group an additional seven face to face sessions over four months . Main outcome measure : A score of 25 or an increase of 10 on the SF-36 physical functioning subscale ( range 10 to 30 ) 12 months after r and omisation . Results : 21 patients dropped out , mainly from the intervention groups . Intention to treat analysis showed 79 ( 69 % ) of patients in the intervention groups achieved a satisfactory outcome in physical functioning compared with two ( 6 % ) of controls , who received st and ardised medical care ( P<0.0001 ) . Similar improvements were observed in fatigue , sleep , disability , and mood . No significant differences were found between the three intervention groups . Conclusions : Treatment incorporating evidence based physiological explanations for symptoms  was effective in encouraging self managed grade d exercise . This result ed in substantial improvement compared with st and ardised medical care Background Scant research has adequately addressed the impact of chronic fatigue syndrome on patients ' daily activities and quality of life . Enumerating specific problems related to quality of life in chronic fatigue syndrome patients can help us to better underst and and manage this illness . This study addresses issues of functional status in persons with chronic fatigue syndrome and other fatiguing illnesses in a population based sample , which can be generalized to all persons with chronic fatigue . Methods We conducted a r  and om telephone survey in Wichita , Kansas to identify persons with chronic fatigue syndrome and other fatiguing illnesses . Respondents reporting severe fatigue of at least 1 month 's duration and r and omly selected non-fatigued respondents were asked to participate in a detailed telephone interview . Participants were asked about symptoms , medical and psychiatric illnesses , and about physical , social , and recreational functioning . Those meeting the 1994 chronic fatigue syndrome case definition , as determined on the basis of their telephone responses , were invited for clinical evaluation to confirm a diagnosis of chronic fatigue syndrome . For this analysis , we evaluated  unemployment due to fatigue , number of hours per week spent on work , chores , and other activities ( currently and prior to the onset of fatigue ) , and energy level .  Results There was no difference between persons with chronic fatigue syndrome and persons with a chronic fatigue syndrome-like illness that could be explained by a medical or psychiatric condition for any of the outcomes we measured except for unemployment due to fatigue ( 15 % vs. 40 % , P < .01 ) . Persons with chronic fatigue syndrome and other fatiguing illnesses had substantially less energy and spent less time on hobbies , schooling , or volunteer work than did non-fatigued controls ( P < .01 ) . Conclusions Persons with chronic fatigue syndrome are as impaired as persons whose fatigue could be explained by a medical or psychiatric condition , and they have less energy than non-fatigued controls OBJECTIVES This study aim ed to examine the associations between bodily pain , pain catastrophizing , depression , activity limitations /participation restrictions , employment status , and exercise performance in female patients with chronic fatigue syndrome ( CFS ) who experience widespread pain . DESIGN Cross-sectional observational study . SETTING A university-based clinic . PATIENTS Thirty-six female CFS patients who experienced widespread pain . OUTCOME MEASURES Patients filled in the  Medical Outcomes Short-Form 36 Health Status Survey ,  the  Chronic Fatigue Syndrome Activities and Participation Question naire , the Beck Depression Inventory , and the Pain Catastrophizing Scale , and underwent a maximal exercise stress test with continuous monitoring of electrocardiographic and ventilatory parameters . RESULTS Pain catastrophizing was related to bodily pain ( r = -0.70 ) , depression ( r = 0.55 ) , activity limitations /participation restrictions ( r = 0.68 ) , various aspects of quality of life ( r varied between -0.51 and -0.64 ) , and exercise capacity ( r varied between -0.41 and -0.61 ) . Based on hierarchical multiple regression analysis , pain catastrophizing accounted for 41 % of the variance in bodily pain in female CFS patients who experience chronic widespread musculoskeletal pain . Among the three subscale scores of the Pain Catastrophizing Scale , helplessness and rumination rather than magnification were strongly related to bodily pain . Neither pain catastrophizing nor depression was related to employment status . CONCLUSIONS These data provide evidence favoring a significant association between pain catastrophizing , bodily pain , exercise performance , and self-reported disability in female patients with CFS who experience widespread pain . Further prospect i ve longitudinal study ing of these variables is required Abstract The effect of therapists in psychotherapy is a much debated topic , with a number of studies showing therapist variance being large while other studies show little or no variability in outcomes due to therapists . The aim of this study was to investigate therapist effects in a well-defined sample of patients and therapists from an outpatient service which specializes in providing cognitive behaviour therapy ( CBT ) for patients with chronic fatigue syndrome ( CFS ) . Therapy was provided in a highly specialized clinical setting for CFS and was delivered by qualified CBT therapists with at least 2 years experience with this client group . Three hundred and seventy-four patients with CFS and 12 cognitive behavioural psychotherapists took part .  Therapist effects on the primary outcomes of fatigue and disability were investigated with multilevel r and om effects models and variance component analysis . Different models were computed and compared . Results showed a reduction in fatigue and disability scores after therapy . Variance explained by therapists , when demographic covariates were accounted for , was 0 % for fatigue and under 2 % for disability . A number of important factors may have played a significant role in minimizing therapist effects in our study . These are : specialist setting , single centre , patients with the same primary diagnosis , therapists of the same orientation and training , shared environment and supervision . Future studies may stress the importance of these factors in the investigation of the therapist effect in psychotherapy Abstract Objective : To evaluate the acceptability and efficacy of adding cognitive behaviour therapy to the medical care of patients presenting with the chronic fatigue syndrome . Design : R and omised controlled trial with final assessment at 12 months . Setting : An infectious diseases outpatient clinic . Subjects : 60 consecutively referred patients meeting consensus criteria for the chronic fatigue syndrome . Interventions : Medical care comprised assessment , advice , and follow up in general practice . Patients who received cognitive behaviour therapy were offered 16 individual weekly sessions in addition to their medical care . Main outcome measures : The proportions of patients ( a ) who achieved normal daily functioning ( Karnofsky score 80 or more ) and ( b ) who achieved a clinical ly significant improvement in functioning ( change in Karnofsky score 10 points or more ) by 12 months after r and omisation . Results : Only two eligible patients refused to participate . All r and omised patients completed treatment . An intention to treat analysis showed that 73 % ( 22/30 ) of recipients of cognitive behaviour therapy achieved a satisfactory outcome as compared with 27 % ( 8/30 ) of patients who were given only medical care ( difference 47 percentage points ; 95 % confidence interval 24 to 69 ) . Similar differences were observed in subsidiary outcome measures . The improvement in disability among patients given cognitive behaviour therapy continued after completion of therapy . Illness beliefs and coping behaviour previously associated with a poor outcome changed more with cognitive behaviour therapy than with medical care alone . Conclusion : Adding cognitive behaviour therapy to the medical care of patients with the chronic fatigue syndrome is acceptable to patients and leads to a sustained reduction in functional impairment . Key messages Key messages There is no generally accepted form of treatment New findings show that patients referred to hospital for the chronic fatigue syndrome have a better outcome if they are given a course of cognitive behaviour therapy than if they receive only basic medical care Clinical improvement with cognitive behaviour therapy may be slow but often continues after treatment has ended Cognitive behaviour therapy should be considered as an option for patients presenting with the chronic fatigue Objectives For the measurement of  patient-reported outcomes , such as ( health-related ) quality of life , often many measurement instruments exist that intend to measure the same construct . To facilitate instrument selection , our aim was to develop a highly sensitive search filter for finding studies on measurement properties of measurement instruments in PubMed and a more precise search filter that needs less abstract s to be screened , but at a higher risk of missing relevant studies . Methods A r and om sample of 10,000 PubMed records ( 01 - 01 - 1990 to 31 - 12 - 2006 ) was used as a gold st and ard . Studies on measurement properties were identified using an exclusion filter and h and search ing . Search terms were selected from the relevant records in the gold st and ard as well as from 100 systematic review s of measurement properties and combined based on sensitivity and precision . The performance of the filters was tested in the gold st and ard as well as in two validation sets , by calculating sensitivity , precision , specificity , and number needed to read . Results We identified 116 studies on measurement properties in the gold st and ard . The sensitive search filter was able to retrieve 113 of these 116 studies ( sensitivity 97.4 % , precision 4.4 % ) . The precise search filter had a sensitivity of 93.1 % and a precision of 9.4 % . Both filters performed very well in the validation sets . Conclusion The use of these search filters will contribute to evidence -based selection of measurement instruments in all medical fields Given the lack of evidence in support of pacing self-management for patients with chronic fatigue syndrome ( CFS ) , we examined whether physical behavior and health status of patients with CFS would improve in response to a pacing self-management program . We performed an observational study of pacing self-management in seven CFS patients using a single-case study design . Stages A1 and A2 ( 7-day assessment periods ) of the A1-B-A2 design corresponded to the baseline and posttreatment measurements of physical behavior ( real-time activity monitoring ) and health status ( self-reported measures ) , respectively . Stage B ( 3 weeks of treatment ) consisted of three individual treatment sessions of pacing self-management . When comparing pre- versus posttreatment data , we found that the patients ' ability to perform daily activities and the severity of their symptom complexes were improved ( p = 0.043 ) . Concentration difficulties , mood swings , muscle weakness , and intolerance to bright light improved as well . A statistically significant decrease in the mean time spent doing light activity ( <3 metabolic equivalents ) was observed , but a change in the way physical activity was spread throughout the day was not . We found that 3 weeks of pacing self-management was accompanied by a modest improvement in symptom severity and daily functioning . The outcome of the present study calls for a r and omized controlled clinical trial to examine the effectiveness of pacing self-management for people with CFS BACKGROUND Disability is a defining feature of chronic conditions , and it is an increasingly used measure of therapy effectiveness . The  Work and Social Adjustment Scale ( WSAS )  is a simple and clear measure of disability . Although the scale is widely used , no study has yet investigated its psychometric properties in patients with chronic fatigue syndrome ( CFS ) . METHODS Data from two sample s of patients were used , one from a multicenter r and omized controlled clinical trial of treatments for CFS ( n = 639 ) and the other from a clinic that specializes in CFS ( n=384 ) . All patients completed the WSAS as well as other measures . RESULTS Internal consistency and the Spearman-Brown split-half coefficient values indicated that the scale is reliable . CFS patients who had comorbid diagnoses of depression , anxiety or fibromyalgia had higher WSAS scores . High levels of disability were associated with high number of physical symptoms , severe fatigue , depression , anxiety , poor sleep quality and poor physical fitness , with correlation coefficients ranging between 0.41 and 0.11 . Lower scores on the WSAS were modestly associated with better physical functioning as well as higher levels of physical capacity as assessed by a walking test . Sensitivity to change was evaluated in a subgroup of patients who had undergone a course of cognitive behavioral therapy .  Disability significantly decreased after therapy and remained stable at follow-ups . CONCLUSION The WSAS is a reliable and valid assessment tool for disability in patients with CFS Objective : To evaluate the outcome of a multidisciplinary treatment programme for patients with chronic fatigue syndrome , including health-related quality of life ( HRQoL ) and psychosocial variables , and exercise capacity measures . Design : A six-month prospect i ve outcome study . Setting : University outpatient rehabilitation clinic ; group setting . Subjects : One hundred and sixteen women fulfilling chronic fatigue syndrome criteria . Interventions : Cognitive behaviourally and grade d exercise-based strategies ; emphasis on adaptive lifestyle changes . Measures : Short Form General Health Survey ( SF-36 ) ; Symptom Checklist ( SCL-90 ) ; Causal Attribution List ( CAL ) ; Self-Efficacy Scale ( SE ) ; maximum progressive bicycle ergometer test with respiratory gas analysis ; and isokinetic leg strength test  , before and after treatment . Results : The total group significantly improved on nearly all reported HRQoL/ psychosocial variables . Changes in exercise capacity 
    Output:
    
agent
Limited evidence was found for the psychometric properties and clinical usability of these instruments .
However , the CFS-activities and participation question naire ( APQ ) is a disease-specific instrument with moderate content and construct validity .
***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: Abstract Objective : To assess the efficacy of an educational intervention explaining symptoms to encourage grade d exercise in patients with chronic fatigue syndrome . Design : R and omised controlled trial . Setting : Chronic fatigue clinic and infectious diseases outpatient clinic . Subjects : 148 consecutively referred patients fulfilling Oxford criteria for chronic fatigue syndrome . Interventions : Patients r and omised to the control group received st and ardised medical care .  Patients r and omised to intervention received two individual treatment sessions and two telephone follow up calls , supported by a comprehensive educational pack , describing the role of disrupted physiological regulation in fatigue symptoms and encouraging home based grade d exercise . The minimum intervention group had no further treatment , but the telephone intervention group received an additional seven follow up calls and the maximum intervention group an additional seven face to face sessions over four months . Main outcome measure : A score of 25 or an increase of 10 on the SF-36 physical functioning subscale ( range 10 to 30 ) 12 months after r and omisation . Results : 21 patients dropped out , mainly from the intervention groups . Intention to treat analysis showed 79 ( 69 % ) of patients in the intervention groups achieved a satisfactory outcome in physical functioning compared with two ( 6 % ) of controls , who received st and ardised medical care ( P<0.0001 ) . Similar improvements were observed in fatigue , sleep , disability , and mood . No significant differences were found between the three intervention groups . Conclusions : Treatment incorporating evidence based physiological explanations for symptoms  was effective in encouraging self managed grade d exercise . This result ed in substantial improvement compared with st and ardised medical care Background Scant research has adequately addressed the impact of chronic fatigue syndrome on patients ' daily activities and quality of life . Enumerating specific problems related to quality of life in chronic fatigue syndrome patients can help us to better underst and and manage this illness . This study addresses issues of functional status in persons with chronic fatigue syndrome and other fatiguing illnesses in a population based sample , which can be generalized to all persons with chronic fatigue . Methods We conducted a r  and om telephone survey in Wichita , Kansas to identify persons with chronic fatigue syndrome and other fatiguing illnesses . Respondents reporting severe fatigue of at least 1 month 's duration and r and omly selected non-fatigued respondents were asked to participate in a detailed telephone interview . Participants were asked about symptoms , medical and psychiatric illnesses , and about physical , social , and recreational functioning . Those meeting the 1994 chronic fatigue syndrome case definition , as determined on the basis of their telephone responses , were invited for clinical evaluation to confirm a diagnosis of chronic fatigue syndrome . For this analysis , we evaluated  unemployment due to fatigue , number of hours per week spent on work , chores , and other activities ( currently and prior to the onset of fatigue ) , and energy level .  Results There was no difference between persons with chronic fatigue syndrome and persons with a chronic fatigue syndrome-like illness that could be explained by a medical or psychiatric condition for any of the outcomes we measured except for unemployment due to fatigue ( 15 % vs. 40 % , P < .01 ) . Persons with chronic fatigue syndrome and other fatiguing illnesses had substantially less energy and spent less time on hobbies , schooling , or volunteer work than did non-fatigued controls ( P < .01 ) . Conclusions Persons with chronic fatigue syndrome are as impaired as persons whose fatigue could be explained by a medical or psychiatric condition , and they have less energy than non-fatigued controls OBJECTIVES This study aim ed to examine the associations between bodily pain , pain catastrophizing , depression , activity limitations /participation restrictions , employment status , and exercise performance in female patients with chronic fatigue syndrome ( CFS ) who experience widespread pain . DESIGN Cross-sectional observational study . SETTING A university-based clinic . PATIENTS Thirty-six female CFS patients who experienced widespread pain . OUTCOME MEASURES Patients filled in the  Medical Outcomes Short-Form 36 Health Status Survey ,  the  Chronic Fatigue Syndrome Activities and Participation Question naire , the Beck Depression Inventory , and the Pain Catastrophizing Scale , and underwent a maximal exercise stress test with continuous monitoring of electrocardiographic and ventilatory parameters . RESULTS Pain catastrophizing was related to bodily pain ( r = -0.70 ) , depression ( r = 0.55 ) , activity limitations /participation restrictions ( r = 0.68 ) , various aspects of quality of life ( r varied between -0.51 and -0.64 ) , and exercise capacity ( r varied between -0.41 and -0.61 ) . Based on hierarchical multiple regression analysis , pain catastrophizing accounted for 41 % of the variance in bodily pain in female CFS patients who experience chronic widespread musculoskeletal pain . Among the three subscale scores of the Pain Catastrophizing Scale , helplessness and rumination rather than magnification were strongly related to bodily pain . Neither pain catastrophizing nor depression was related to employment status . CONCLUSIONS These data provide evidence favoring a significant association between pain catastrophizing , bodily pain , exercise performance , and self-reported disability in female patients with CFS who experience widespread pain . Further prospect i ve longitudinal study ing of these variables is required Abstract The effect of therapists in psychotherapy is a much debated topic , with a number of studies showing therapist variance being large while other studies show little or no variability in outcomes due to therapists . The aim of this study was to investigate therapist effects in a well-defined sample of patients and therapists from an outpatient service which specializes in providing cognitive behaviour therapy ( CBT ) for patients with chronic fatigue syndrome ( CFS ) . Therapy was provided in a highly specialized clinical setting for CFS and was delivered by qualified CBT therapists with at least 2 years experience with this client group . Three hundred and seventy-four patients with CFS and 12 cognitive behavioural psychotherapists took part .  Therapist effects on the primary outcomes of fatigue and disability were investigated with multilevel r and om effects models and variance component analysis . Different models were computed and compared . Results showed a reduction in fatigue and disability scores after therapy . Variance explained by therapists , when demographic covariates were accounted for , was 0 % for fatigue and under 2 % for disability . A number of important factors may have played a significant role in minimizing therapist effects in our study . These are : specialist setting , single centre , patients with the same primary diagnosis , therapists of the same orientation and training , shared environment and supervision . Future studies may stress the importance of these factors in the investigation of the therapist effect in psychotherapy Abstract Objective : To evaluate the acceptability and efficacy of adding cognitive behaviour therapy to the medical care of patients presenting with the chronic fatigue syndrome . Design : R and omised controlled trial with final assessment at 12 months . Setting : An infectious diseases outpatient clinic . Subjects : 60 consecutively referred patients meeting consensus criteria for the chronic fatigue syndrome . Interventions : Medical care comprised assessment , advice , and follow up in general practice . Patients who received cognitive behaviour therapy were offered 16 individual weekly sessions in addition to their medical care . Main outcome measures : The proportions of patients ( a ) who achieved normal daily functioning ( Karnofsky score 80 or more ) and ( b ) who achieved a clinical ly significant improvement in functioning ( change in Karnofsky score 10 points or more ) by 12 months after r and omisation . Results : Only two eligible patients refused to participate . All r and omised patients completed treatment . An intention to treat analysis showed that 73 % ( 22/30 ) of recipients of cognitive behaviour therapy achieved a satisfactory outcome as compared with 27 % ( 8/30 ) of patients who were given only medical care ( difference 47 percentage points ; 95 % confidence interval 24 to 69 ) . Similar differences were observed in subsidiary outcome measures . The improvement in disability among patients given cognitive behaviour therapy continued after completion of therapy . Illness beliefs and coping behaviour previously associated with a poor outcome changed more with cognitive behaviour therapy than with medical care alone . Conclusion : Adding cognitive behaviour therapy to the medical care of patients with the chronic fatigue syndrome is acceptable to patients and leads to a sustained reduction in functional impairment . Key messages Key messages There is no generally accepted form of treatment New findings show that patients referred to hospital for the chronic fatigue syndrome have a better outcome if they are given a course of cognitive behaviour therapy than if they receive only basic medical care Clinical improvement with cognitive behaviour therapy may be slow but often continues after treatment has ended Cognitive behaviour therapy should be considered as an option for patients presenting with the chronic fatigue Objectives For the measurement of  patient-reported outcomes , such as ( health-related ) quality of life , often many measurement instruments exist that intend to measure the same construct . To facilitate instrument selection , our aim was to develop a highly sensitive search filter for finding studies on measurement properties of measurement instruments in PubMed and a more precise search filter that needs less abstract s to be screened , but at a higher risk of missing relevant studies . Methods A r and om sample of 10,000 PubMed records ( 01 - 01 - 1990 to 31 - 12 - 2006 ) was used as a gold st and ard . Studies on measurement properties were identified using an exclusion filter and h and search ing . Search terms were selected from the relevant records in the gold st and ard as well as from 100 systematic review s of measurement properties and combined based on sensitivity and precision . The performance of the filters was tested in the gold st and ard as well as in two validation sets , by calculating sensitivity , precision , specificity , and number needed to read . Results We identified 116 studies on measurement properties in the gold st and ard . The sensitive search filter was able to retrieve 113 of these 116 studies ( sensitivity 97.4 % , precision 4.4 % ) . The precise search filter had a sensitivity of 93.1 % and a precision of 9.4 % . Both filters performed very well in the validation sets . Conclusion The use of these search filters will contribute to evidence -based selection of measurement instruments in all medical fields Given the lack of evidence in support of pacing self-management for patients with chronic fatigue syndrome ( CFS ) , we examined whether physical behavior and health status of patients with CFS would improve in response to a pacing self-management program . We performed an observational study of pacing self-management in seven CFS patients using a single-case study design . Stages A1 and A2 ( 7-day assessment periods ) of the A1-B-A2 design corresponded to the baseline and posttreatment measurements of physical behavior ( real-time activity monitoring ) and health status ( self-reported measures ) , respectively . Stage B ( 3 weeks of treatment ) consisted of three individual treatment sessions of pacing self-management . When comparing pre- versus posttreatment data , we found that the patients ' ability to perform daily activities and the severity of their symptom complexes were improved ( p = 0.043 ) . Concentration difficulties , mood swings , muscle weakness , and intolerance to bright light improved as well . A statistically significant decrease in the mean time spent doing light activity ( <3 metabolic equivalents ) was observed , but a change in the way physical activity was spread throughout the day was not . We found that 3 weeks of pacing self-management was accompanied by a modest improvement in symptom severity and daily functioning . The outcome of the present study calls for a r and omized controlled clinical trial to examine the effectiveness of pacing self-management for people with CFS BACKGROUND Disability is a defining feature of chronic conditions , and it is an increasingly used measure of therapy effectiveness . The  Work and Social Adjustment Scale ( WSAS )  is a simple and clear measure of disability . Although the scale is widely used , no study has yet investigated its psychometric properties in patients with chronic fatigue syndrome ( CFS ) . METHODS Data from two sample s of patients were used , one from a multicenter r and omized controlled clinical trial of treatments for CFS ( n = 639 ) and the other from a clinic that specializes in CFS ( n=384 ) . All patients completed the WSAS as well as other measures . RESULTS Internal consistency and the Spearman-Brown split-half coefficient values indicated that the scale is reliable . CFS patients who had comorbid diagnoses of depression , anxiety or fibromyalgia had higher WSAS scores . High levels of disability were associated with high number of physical symptoms , severe fatigue , depression , anxiety , poor sleep quality and poor physical fitness , with correlation coefficients ranging between 0.41 and 0.11 . Lower scores on the WSAS were modestly associated with better physical functioning as well as higher levels of physical capacity as assessed by a walking test . Sensitivity to change was evaluated in a subgroup of patients who had undergone a course of cognitive behavioral therapy .  Disability significantly decreased after therapy and remained stable at follow-ups . CONCLUSION The WSAS is a reliable and valid assessment tool for disability in patients with CFS Objective : To evaluate the outcome of a multidisciplinary treatment programme for patients with chronic fatigue syndrome , including health-related quality of life ( HRQoL ) and psychosocial variables , and exercise capacity measures . Design : A six-month prospect i ve outcome study . Setting : University outpatient rehabilitation clinic ; group setting . Subjects : One hundred and sixteen women fulfilling chronic fatigue syndrome criteria . Interventions : Cognitive behaviourally and grade d exercise-based strategies ; emphasis on adaptive lifestyle changes . Measures : Short Form General Health Survey ( SF-36 ) ; Symptom Checklist ( SCL-90 ) ; Causal Attribution List ( CAL ) ; Self-Efficacy Scale ( SE ) ; maximum progressive bicycle ergometer test with respiratory gas analysis ; and isokinetic leg strength test  , before and after treatment . Results : The total group significantly improved on nearly all reported HRQoL/ psychosocial variables . Changes in exercise capacity 
    Output:
    