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 . Resistance training research has demonstrated positive effects for persons with Parkinson 's disease ( PD ) , but the number of acute training variables that can be manipulated makes it difficult to determine the optimal resistance training program . Objective . The purpose of this investigation was to examine the effects of an 8-week resistance training intervention on strength and function in persons with PD . Methods . Eighteen men and women were r and omized to training or st and ard care for the 8-week intervention . The training group performed 3 sets of 5–8 repetitions of the leg press , leg curl , and calf press twice weekly . Tests included leg press strength relative to body mass , timed up- and -go , six-minute walk , and Activities-specific Balance Confidence question naire . Results . There was a significant group-by-time effect for maximum leg press strength relative to body mass , with the training group significantly increasing their maximum relative strength ( P < .05 ) . No other significant interactions were noted ( P > .05 ) . Conclusions . Moderate volume , high-load weight training is effective for increasing lower-body strength in persons with PD OBJECTIVES To determine whether changes in strength or cardiorespiratory fitness after exercise training improve walking ability in individuals who have had a stroke . DESIGN A sham exercise-controlled , r and omized two-by-two factorial design , in which the two factors investigated were cycle training ( AEROBIC ) and resistance training ( STRENGTH ) . SETTING University exercise laboratory . PARTICIPANTS Fifty-two individuals with a history of stroke ( aged 63+/-9 ; time since stroke , 57+/-54 months ) . INTERVENTION Participants undertook 30 exercise sessions over 10 to 12 weeks . Depending on group allocation , individuals underwent aerobic cycling plus sham progressive resistance training ( PRT ) ( n=13 ) , sham cycling plus PRT ( n=13 ) , aerobic cycling plus PRT ( n=14 ) , or sham cycling plus sham PRT ( n=12 ) . MEASUREMENTS Primary outcomes were 6-minute walk distance , habitual and fast gait velocities , and stair climbing power . Secondary outcomes included measures of cardiorespiratory fitness ; muscle strength , power , and endurance ; and psychosocial attributes . RESULTS Neither AEROBIC nor STRENGTH improved walking distance or gait velocity significantly more than sham exercise , although STRENGTH significantly improved participants ' stair climbing power by 17 % ( P=.009 ) , as well as their muscle strength , power , and endurance ; cycling peak power output ; and self-efficacy . Conversely , AEROBIC improved indicators of cardiorespiratory fitness only . Cycling plus PRT produced larger effects than either single modality for mobility and impairment outcomes . CONCLUSION Single-modality exercises targeted at existing impairments do not optimally address the functional deficits of walking but do ameliorate the underlying impairments . The underlying cardiovascular and musculoskeletal impairments are significantly modifiable years after stroke with targeted robust exercise OBJECTIVE To determine whether progressive resistance training improves muscle strength , muscle endurance , and physical function in adults with Down syndrome . DESIGN Single-blind r and omized controlled trial . SETTING General community . PARTICIPANTS Adults ( N=20 ) with Down syndrome ( 13 men , 7 women ; mean age , 26.8+/-7.8 y ) were r and omly assigned through a concealed allocation block r and omized method to either an intervention group ( n=9 ) or a control group ( n=11 ) . INTERVENTION The intervention was a supervised , group progressive resistance training program , consisting of 6 exercises using weight machines performed twice a week for 10 weeks . Participants completed 2 to 3 sets of between 10 to 12 repetitions of each exercise until they reached fatigue . The control group continued with their usual activities . MAIN OUTCOME MEASURES The outcomes measured by blinded assessors were muscle strength ( 1-repetition maximum [ 1-RM ] ) , muscle endurance ( number of repetitions at 50 % of 1-RM ) for chest press and leg press , timed stairs test , and the grocery shelving task . RESULTS The intervention group showed significant improvement in upper-limb muscle endurance compared with the control group ( mean difference in the number of repetitions of the chest press at 50 % of 1-RM was 16.7 , 95 % confidence interval , [ CI ] 7.1 - 26.2 ) ; and a trend toward an improvement in upper-limb muscle strength ( mean difference in chest press 1-RM , 8.6 kg ; 95 % CI , -1.3 to 18.5 kg ) and in upper-limb function ( mean difference in grocery shelving task , -20.3s ; 95 % CI , -45.7 to 5.2s ) . There were no significant differences between the groups for lower-limb muscle performance or physical function measures . No major adverse events for the intervention were noted . CONCLUSIONS Progressive resistance training is a safe and feasible fitness option that can improve upper-limb muscle endurance in adults with Down syndrome ( ACTR identifier ACTRN 012606000515594 . ) Background : Resistance training studies in multiple sclerosis ( MS ) often use short intervention periods . Furthermore , training efficiency could be optimized by unilateral training and /or electrical stimulation . Objective : To examine the effect(s ) of unilateral long-term ( 20 weeks ) st and ardized resistance training with and without simultaneous electro-stimulation on leg muscle strength and overall functional mobility . Methods : A r and omized controlled trial involving 36 persons with MS . At baseline ( PRE ) and after 10 ( MID ) and 20 ( POST ) weeks of st and ardized ( ACSM ) light to moderately intense unilateral leg resistance training ( RESO , n = 11 ) only or resistance training with simultaneous electro-stimulation ( RESE , n = 11 , 100 Hz , biphasic symmetrical wave , 400 µs ) , maximal isometric strength of the knee extensors and flexors ( 45 ° , 90 ° knee angle ) and dynamic ( 60–180 ° /s ) knee-extensor strength was measured and compared with a control group ( CON , n = 14 ) . Functional mobility was evaluated using the Timed Get Up and Go , Timed 25 Foot Walk , Two-Minute Walk Test , Functional Reach and Rivermead Mobility Index . Results : Maximal isometric knee extensor ( 90 ° , MID : + 10 ± 3 % , POST : + 10 ± 4 % ) in RESO and knee flexor ( 45 ° , POST : + 7 ± 4 % ; 90 ° , POST : + 9 ± 5 % ) in RESE strength increased ( p < 0.05 ) compared with CON but RESO and RESE did not differ . Also , impaired legs responded positively to resistance training ( unilateral leg strength analysis ) and functional reaching increased significantly in RESO ( + 18 % ) compared with CON . Dynamic muscle strength and the remaining functional mobility tests did not change . Conclusion : Long-term light to moderately intense resistance training improves muscle strength in persons with MS but simultaneous electro-stimulation does not further improve training outcome BACKGROUND AND PURPOSE Rehabilitation care after stroke is highly variable and increasingly shorter in duration . The effect of therapeutic exercise on impairments and functional limitations after stroke is not clear . The objective of this study was to determine whether a structured , progressive , physiologically based exercise program for subacute stroke produces gains greater than those attributable to spontaneous recovery and usual care . METHODS This r and omized , controlled , single-blind clinical trial was conducted in a metropolitan area and 17 participating healthcare institutions . We included persons with stroke who were living in the community . One hundred patients ( mean age , 70 years ; mean Orpington score , 3.4 ) consented and were r and omized from a screened sample of 582 . Ninety-two subjects completed the trial . Intervention was a structured , progressive , physiologically based , therapist-supervised , in-home program of thirty-six 90-minute sessions over 12 weeks targeting flexibility , strength , balance , endurance , and upper-extremity function . Main outcome measures were postintervention strength ( ankle and knee isometric peak torque , grip strength ) , upper- and lower-extremity motor control ( Fugl Meyer ) , balance ( Berg and functional reach ) , endurance ( peak aerobic capacity and exercise duration ) , upper-extremity function ( Wolf Motor Function Test ) , and mobility ( timed 10-m walk and 6-minute walk distance ) . RESULTS In the intention-to-treat multivariate analysis of variance testing the overall effect , the intervention produced greater gains than usual care ( Wilk 's lambda=0.64 , P=0.0056 ) . Both intervention and usual care groups improved in strength , balance , upper- and lower-extremity motor control , upper-extremity function , and gait velocity . Gains for the intervention group exceeded those in the usual care group in balance , endurance , peak aerobic capacity , and mobility . Upper-extremity gains exceeded those in the usual care group only in patients with higher baseline function . CONCLUSIONS This structured , progressive program of therapeutic exercise in persons who had completed acute rehabilitation services produced gains in endurance , balance , and mobility beyond those attributable to spontaneous recovery and usual care Background and Purpose : Resistance exercise via negative , eccentrically induced work ( RENEW ) has been shown to be associated with improvements in strength , mobility , and balance in multiple clinical population s. However , RENEW has not been reported for individuals with multiple sclerosis ( MS ) . Methods : Nineteen individuals with MS ( 8 men , 11 women ; age mean = 49 ± 11 years ; Exp and ed Disability Status Scale [ EDSS ] mean = 5.2 ± 0.9 ) were r and omized into either st and ard exercise ( ST AND ) or st and ard exercise and RENEW training ( RENEW ) for 3 × /week for 12 weeks . Outcome measures were lower extremity strength ( hip/knee flexion and extension , ankle plantar and dorsiflexion , and the sum of these individual values [ sum strength ] ) ; Timed Up and Go ( TUG ) , 10-m walk , self-selected pace ( TMWSS ) and maximal-pace ( TMWMP ) , stair ascent ( S-A ) and descent ( S-D ) and 6-Minute Walk Test ( 6MWT ) , Berg Balance Scale ( BBS ) , Fatigue Severity Scale ( FSS ) . Results : No significant time effects or interactions were observed for strength , TUG , TMWSS , TMWMP , or 6MWT . However , the mean difference in sum strength in the RENEW group was 38.60 ( representing a 15 % increase ) compared to the sum strength observed in the ST AND group with a mean difference of 5.58 ( a 2 % increase ) . A significant interaction was observed for S-A , S-D , and BBS as the ST AND group improved whereas the RENEW group did not improve in these measures . Discussion and Conclusions : Contrary to results in other population s , the addition of eccentric training to st and ard exercises did not result in significantly greater lower extremity strength gains in this group of individuals with MS . Further this training was not as effective as st and ard exercise alone in improving balance or the ability to ascend and descend stairs . Following data collection , re assessment of required sample size indicates we were likely underpowered to detect strength differences between groups BACKGROUND Patients with Parkinson 's disease have substantially impaired balance , leading to diminished functional ability and an increased risk of falling . Although exercise is routinely encouraged by health care providers , few programs have been proven effective . METHODS We conducted a r and omized , controlled trial to determine whether a tailored tai chi program could improve postural control in patients with idiopathic Parkinson 's disease . We r and omly assigned 195 patients with stage 1 to 4 disease on the Hoehn and Yahr staging scale ( which ranges from 1 to 5 , with higher stages indicating more severe disease ) to one of three groups : tai chi , resistance training , or stretching . The patients participated in 60-minute exercise sessions twice weekly for 24 weeks . The primary outcomes were changes from baseline in the limits-of-stability test ( maximum excursion and directional control ; range , 0 to 100 % ) . Secondary outcomes included measures of gait and strength , scores on functional-reach and timed up- and -go tests , motor scores on the Unified Parkinson 's Disease Rating Scale , and number of falls . RESULTS The tai chi group performed consistently better than the resistance-training and stretching groups in maximum excursion ( between-group difference in the change from baseline , 5.55 percentage points ; 95 % confidence interval [ CI ] , 1.12 to 9.97 ; and 11.98 percentage points ; 95 % CI , 7.21 to 16.74 , respectively ) and in directional control ( 10.45 percentage points ; 95 % CI , 3.89 to 17.00 ; and 11.38 percentage points ; 95 % CI , 5.50 to 17.27 , respectively ) . The tai chi group also performed better than the stretching group in all secondary outcomes and outperformed the resistance-training group in stride length and functional reach .  Tai chi lowered the incidence of falls as compared with stretching but not as compared with resistance training . The effects of tai chi training were maintained at 3 months after the intervention . No serious adverse events were observed . CONCLUSIONS Tai chi training appears to reduce balance impairments in patients with mild-to-moderate Parkinson ' 
    Output:
    
agent
The results revealed that despite significant strength gains , many studies failed to show a significant improvement in walking capacity .
Strength testing and strengthening exercises were prioritized for the knee extensors and flexors , despite their relatively minor role in human walking .
Strengthening exercises performed in the neurologic population are not specific to the main muscle groups responsible for the power generation required for walking .
There is a predisposition for strength testing and strengthening exercises to focus on the knee flexors and extensors despite their relatively minor role during walking .
***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 . Resistance training research has demonstrated positive effects for persons with Parkinson 's disease ( PD ) , but the number of acute training variables that can be manipulated makes it difficult to determine the optimal resistance training program . Objective . The purpose of this investigation was to examine the effects of an 8-week resistance training intervention on strength and function in persons with PD . Methods . Eighteen men and women were r and omized to training or st and ard care for the 8-week intervention . The training group performed 3 sets of 5–8 repetitions of the leg press , leg curl , and calf press twice weekly . Tests included leg press strength relative to body mass , timed up- and -go , six-minute walk , and Activities-specific Balance Confidence question naire . Results . There was a significant group-by-time effect for maximum leg press strength relative to body mass , with the training group significantly increasing their maximum relative strength ( P < .05 ) . No other significant interactions were noted ( P > .05 ) . Conclusions . Moderate volume , high-load weight training is effective for increasing lower-body strength in persons with PD OBJECTIVES To determine whether changes in strength or cardiorespiratory fitness after exercise training improve walking ability in individuals who have had a stroke . DESIGN A sham exercise-controlled , r and omized two-by-two factorial design , in which the two factors investigated were cycle training ( AEROBIC ) and resistance training ( STRENGTH ) . SETTING University exercise laboratory . PARTICIPANTS Fifty-two individuals with a history of stroke ( aged 63+/-9 ; time since stroke , 57+/-54 months ) . INTERVENTION Participants undertook 30 exercise sessions over 10 to 12 weeks . Depending on group allocation , individuals underwent aerobic cycling plus sham progressive resistance training ( PRT ) ( n=13 ) , sham cycling plus PRT ( n=13 ) , aerobic cycling plus PRT ( n=14 ) , or sham cycling plus sham PRT ( n=12 ) . MEASUREMENTS Primary outcomes were 6-minute walk distance , habitual and fast gait velocities , and stair climbing power . Secondary outcomes included measures of cardiorespiratory fitness ; muscle strength , power , and endurance ; and psychosocial attributes . RESULTS Neither AEROBIC nor STRENGTH improved walking distance or gait velocity significantly more than sham exercise , although STRENGTH significantly improved participants ' stair climbing power by 17 % ( P=.009 ) , as well as their muscle strength , power , and endurance ; cycling peak power output ; and self-efficacy . Conversely , AEROBIC improved indicators of cardiorespiratory fitness only . Cycling plus PRT produced larger effects than either single modality for mobility and impairment outcomes . CONCLUSION Single-modality exercises targeted at existing impairments do not optimally address the functional deficits of walking but do ameliorate the underlying impairments . The underlying cardiovascular and musculoskeletal impairments are significantly modifiable years after stroke with targeted robust exercise OBJECTIVE To determine whether progressive resistance training improves muscle strength , muscle endurance , and physical function in adults with Down syndrome . DESIGN Single-blind r and omized controlled trial . SETTING General community . PARTICIPANTS Adults ( N=20 ) with Down syndrome ( 13 men , 7 women ; mean age , 26.8+/-7.8 y ) were r and omly assigned through a concealed allocation block r and omized method to either an intervention group ( n=9 ) or a control group ( n=11 ) . INTERVENTION The intervention was a supervised , group progressive resistance training program , consisting of 6 exercises using weight machines performed twice a week for 10 weeks . Participants completed 2 to 3 sets of between 10 to 12 repetitions of each exercise until they reached fatigue . The control group continued with their usual activities . MAIN OUTCOME MEASURES The outcomes measured by blinded assessors were muscle strength ( 1-repetition maximum [ 1-RM ] ) , muscle endurance ( number of repetitions at 50 % of 1-RM ) for chest press and leg press , timed stairs test , and the grocery shelving task . RESULTS The intervention group showed significant improvement in upper-limb muscle endurance compared with the control group ( mean difference in the number of repetitions of the chest press at 50 % of 1-RM was 16.7 , 95 % confidence interval , [ CI ] 7.1 - 26.2 ) ; and a trend toward an improvement in upper-limb muscle strength ( mean difference in chest press 1-RM , 8.6 kg ; 95 % CI , -1.3 to 18.5 kg ) and in upper-limb function ( mean difference in grocery shelving task , -20.3s ; 95 % CI , -45.7 to 5.2s ) . There were no significant differences between the groups for lower-limb muscle performance or physical function measures . No major adverse events for the intervention were noted . CONCLUSIONS Progressive resistance training is a safe and feasible fitness option that can improve upper-limb muscle endurance in adults with Down syndrome ( ACTR identifier ACTRN 012606000515594 . ) Background : Resistance training studies in multiple sclerosis ( MS ) often use short intervention periods . Furthermore , training efficiency could be optimized by unilateral training and /or electrical stimulation . Objective : To examine the effect(s ) of unilateral long-term ( 20 weeks ) st and ardized resistance training with and without simultaneous electro-stimulation on leg muscle strength and overall functional mobility . Methods : A r and omized controlled trial involving 36 persons with MS . At baseline ( PRE ) and after 10 ( MID ) and 20 ( POST ) weeks of st and ardized ( ACSM ) light to moderately intense unilateral leg resistance training ( RESO , n = 11 ) only or resistance training with simultaneous electro-stimulation ( RESE , n = 11 , 100 Hz , biphasic symmetrical wave , 400 µs ) , maximal isometric strength of the knee extensors and flexors ( 45 ° , 90 ° knee angle ) and dynamic ( 60–180 ° /s ) knee-extensor strength was measured and compared with a control group ( CON , n = 14 ) . Functional mobility was evaluated using the Timed Get Up and Go , Timed 25 Foot Walk , Two-Minute Walk Test , Functional Reach and Rivermead Mobility Index . Results : Maximal isometric knee extensor ( 90 ° , MID : + 10 ± 3 % , POST : + 10 ± 4 % ) in RESO and knee flexor ( 45 ° , POST : + 7 ± 4 % ; 90 ° , POST : + 9 ± 5 % ) in RESE strength increased ( p < 0.05 ) compared with CON but RESO and RESE did not differ . Also , impaired legs responded positively to resistance training ( unilateral leg strength analysis ) and functional reaching increased significantly in RESO ( + 18 % ) compared with CON . Dynamic muscle strength and the remaining functional mobility tests did not change . Conclusion : Long-term light to moderately intense resistance training improves muscle strength in persons with MS but simultaneous electro-stimulation does not further improve training outcome BACKGROUND AND PURPOSE Rehabilitation care after stroke is highly variable and increasingly shorter in duration . The effect of therapeutic exercise on impairments and functional limitations after stroke is not clear . The objective of this study was to determine whether a structured , progressive , physiologically based exercise program for subacute stroke produces gains greater than those attributable to spontaneous recovery and usual care . METHODS This r and omized , controlled , single-blind clinical trial was conducted in a metropolitan area and 17 participating healthcare institutions . We included persons with stroke who were living in the community . One hundred patients ( mean age , 70 years ; mean Orpington score , 3.4 ) consented and were r and omized from a screened sample of 582 . Ninety-two subjects completed the trial . Intervention was a structured , progressive , physiologically based , therapist-supervised , in-home program of thirty-six 90-minute sessions over 12 weeks targeting flexibility , strength , balance , endurance , and upper-extremity function . Main outcome measures were postintervention strength ( ankle and knee isometric peak torque , grip strength ) , upper- and lower-extremity motor control ( Fugl Meyer ) , balance ( Berg and functional reach ) , endurance ( peak aerobic capacity and exercise duration ) , upper-extremity function ( Wolf Motor Function Test ) , and mobility ( timed 10-m walk and 6-minute walk distance ) . RESULTS In the intention-to-treat multivariate analysis of variance testing the overall effect , the intervention produced greater gains than usual care ( Wilk 's lambda=0.64 , P=0.0056 ) . Both intervention and usual care groups improved in strength , balance , upper- and lower-extremity motor control , upper-extremity function , and gait velocity . Gains for the intervention group exceeded those in the usual care group in balance , endurance , peak aerobic capacity , and mobility . Upper-extremity gains exceeded those in the usual care group only in patients with higher baseline function . CONCLUSIONS This structured , progressive program of therapeutic exercise in persons who had completed acute rehabilitation services produced gains in endurance , balance , and mobility beyond those attributable to spontaneous recovery and usual care Background and Purpose : Resistance exercise via negative , eccentrically induced work ( RENEW ) has been shown to be associated with improvements in strength , mobility , and balance in multiple clinical population s. However , RENEW has not been reported for individuals with multiple sclerosis ( MS ) . Methods : Nineteen individuals with MS ( 8 men , 11 women ; age mean = 49 ± 11 years ; Exp and ed Disability Status Scale [ EDSS ] mean = 5.2 ± 0.9 ) were r and omized into either st and ard exercise ( ST AND ) or st and ard exercise and RENEW training ( RENEW ) for 3 × /week for 12 weeks . Outcome measures were lower extremity strength ( hip/knee flexion and extension , ankle plantar and dorsiflexion , and the sum of these individual values [ sum strength ] ) ; Timed Up and Go ( TUG ) , 10-m walk , self-selected pace ( TMWSS ) and maximal-pace ( TMWMP ) , stair ascent ( S-A ) and descent ( S-D ) and 6-Minute Walk Test ( 6MWT ) , Berg Balance Scale ( BBS ) , Fatigue Severity Scale ( FSS ) . Results : No significant time effects or interactions were observed for strength , TUG , TMWSS , TMWMP , or 6MWT . However , the mean difference in sum strength in the RENEW group was 38.60 ( representing a 15 % increase ) compared to the sum strength observed in the ST AND group with a mean difference of 5.58 ( a 2 % increase ) . A significant interaction was observed for S-A , S-D , and BBS as the ST AND group improved whereas the RENEW group did not improve in these measures . Discussion and Conclusions : Contrary to results in other population s , the addition of eccentric training to st and ard exercises did not result in significantly greater lower extremity strength gains in this group of individuals with MS . Further this training was not as effective as st and ard exercise alone in improving balance or the ability to ascend and descend stairs . Following data collection , re assessment of required sample size indicates we were likely underpowered to detect strength differences between groups BACKGROUND Patients with Parkinson 's disease have substantially impaired balance , leading to diminished functional ability and an increased risk of falling . Although exercise is routinely encouraged by health care providers , few programs have been proven effective . METHODS We conducted a r and omized , controlled trial to determine whether a tailored tai chi program could improve postural control in patients with idiopathic Parkinson 's disease . We r and omly assigned 195 patients with stage 1 to 4 disease on the Hoehn and Yahr staging scale ( which ranges from 1 to 5 , with higher stages indicating more severe disease ) to one of three groups : tai chi , resistance training , or stretching . The patients participated in 60-minute exercise sessions twice weekly for 24 weeks . The primary outcomes were changes from baseline in the limits-of-stability test ( maximum excursion and directional control ; range , 0 to 100 % ) . Secondary outcomes included measures of gait and strength , scores on functional-reach and timed up- and -go tests , motor scores on the Unified Parkinson 's Disease Rating Scale , and number of falls . RESULTS The tai chi group performed consistently better than the resistance-training and stretching groups in maximum excursion ( between-group difference in the change from baseline , 5.55 percentage points ; 95 % confidence interval [ CI ] , 1.12 to 9.97 ; and 11.98 percentage points ; 95 % CI , 7.21 to 16.74 , respectively ) and in directional control ( 10.45 percentage points ; 95 % CI , 3.89 to 17.00 ; and 11.38 percentage points ; 95 % CI , 5.50 to 17.27 , respectively ) . The tai chi group also performed better than the stretching group in all secondary outcomes and outperformed the resistance-training group in stride length and functional reach .  Tai chi lowered the incidence of falls as compared with stretching but not as compared with resistance training . The effects of tai chi training were maintained at 3 months after the intervention . No serious adverse events were observed . CONCLUSIONS Tai chi training appears to reduce balance impairments in patients with mild-to-moderate Parkinson ' 
    Output:
    