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 Most public health guidelines recommend that adults participate in 30 minutes of moderate intensity physical activity on most days of the week . Establishing new ways to achieve these targets in sedentary population s need to be explored . This research evaluated whether the daily use of pedometers could increase physical activity and improve health outcomes in sedentary overweight and obese women . Methods Twenty six overweight and obese middle-aged women were r and omized into two groups : The control group was not able to record their steps daily , whilst the pedometer group , were asked to record the number of steps on a daily basis for 12 weeks . Results Our data showed that the pedometer group significantly increased their steps/day , by 36 % , at the end of the 12 weeks , whereas the control group 's physical activity levels remained unchanged . There was no significant difference in weight or body fat composition in the pedometer group compared to the control group . However , there was a significant decrease in systolic blood pressure in the pedometer group ( 112.8 ± 2.44 mm Hg ) compared to the control group ( 117.3 ± 2.03 mm Hg ) ( p = 0.003 ) . Conclusion In conclusion , this pilot study shows that the combination of having step goals and immediate feedback from using a pedometer was effective in increasing physical activity levels in sedentary overweight and obese women . Trial registration Background Despite considerable knowledge about musculoskeletal disorders ( MSD ) and physical , psychosocial and individual risk factors there is limited knowledge about physical activity as a factor in preventing MSD . In addition , studies of physical activity are often limited to either leisure activity or physical activity at work . Studies among military personnel on the association between physical activity at work and at leisure and MSD are lacking . This study was conducted to find the prevalence of MSD among personnel in the Royal Norwegian Navy and to assess the association between physical activity at work and at leisure and MSD . Methods A question naire about musculoskeletal disorders , physical activity and background data ( employment status , age , gender , body mass index , smoking , education and physical stressors ) was completed by 2265 workers ( 58 % ) 18 to 70 years old in the Royal Norwegian Navy .  Multiple logistic regression with 95 % confidence intervals was used to assess the relationship between physical activity and musculoskeletal disorders . Results A total of 32 % of the workers reported musculoskeletal disorders often or very often in one or more parts of the body in the past year . The most common musculoskeletal disorders were in the lower back ( 15 % often or very often ) , shoulders ( 12 % often or very often ) and neck ( 11 % often or very often ) . After adjustment for confounders , physical activity was inversely associated with musculoskeletal disorders for all body sites except elbows , knees and feet . Conclusion The one-year prevalence of musculoskeletal disorders among workers in the Royal Norwegian Navy was rather low . A physically active lifestyle both at work and at leisure was associated with fewer musculoskeletal disorders  among personnel in the Royal Norwegian Navy . Prospect i ve studies are necessary to confirm the cause and effect in this association OBJECTIVE To determine whether high exercise adherence improved physical function among older adults with knee osteoarthritis ( OA ) who were overweight or obese . METHODS Associations between  exercise adherence , changes in 6-minute walking distance in meters , and self-reported disability ( Western Ontario and McMaster Universities Osteoarthritis Index function subscale ) after 6 and 18 months were examined among an Arthritis , Diet , and Activity Promotion Trial sub sample ( n = 134 ) using multiple linear regression models . RESULTS Higher exercise adherence was associated with greater improvements in 6-minute walking distance after 6 and 18 months and in disability after 6 months . Pain and body mass index ( BMI ) contributed , to some extent , to explaining the link between exercise adherence  and changes in physical performance and self-reported disability . CONCLUSION Higher exercise adherence is associated with improved physical function in overweight and obese older adults with knee OA . This indicates that promoting adherence is clinical ly relevant when prescribing exercise regimens that also focus on decreasing pain and BMI Objectives : To evaluate the feasibility of an RCT of a pedometer-driven walking program and education/advice to remain active compared with education/advice only for treatment of chronic low back pain ( CLBP ) . Methods : Fifty-seven participants with CLBP recruited from primary care were r and omly allocated to either : ( 1 ) education/advice ( E , n=17 ) or ( 2 ) education/advice plus an 8-week pedometer-driven walking program ( EWP , n=40 ) . Step targets , actual daily step counts , and adverse events were recorded in a walking diary over the 8 weeks of intervention for the EWP group only . All other outcomes ( eg , functional disability using the Oswestry Disability Question naire ( ODQ ) , pain scores , physical activity ( PA ) measurement etc . ) were recorded at baseline , week 9 ( immediately post-intervention ) , and 6 months in both groups . Results : The recruitment rate was 22 % and the dropout rate was lower than anticipated ( 13 % to 18 % at 6 mo ) . Adherence with the EWP was high , 93 % ( n=37/40 ) walked for ≥6 weeks , and increased their steps/day ( mean absolute increase in steps/d , 2776 , 95 % confidence interval [ CI ] , 1996 - 3557 ) by 59 % ( 95 % CI , 40.73%-76.25 % ) from baseline . Mean percentage adherence with weekly step targets was 70 % ( 95 % CI , 62%-77 % ) . Eight ( 20 % ) minor-related adverse events were observed in 13 % ( 5/40 ) of the participants . The EWP group participants demonstrated an 8.2 % point improvement ( 95 % CI , −13 to −3.4 ) on the ODQ at 6 months compared with 1.6 % points ( 95 % CI , –9.3 to 6.1 ) for the E group ( between group d=0.44 ) . There was also a larger mean improvement in pain ( d=0.4 ) and a larger increase in PA ( d=0.59 ) at 6 months in EWP . Discussion : This preliminary study demonstrated that a main RCT is feasible . EWP was safe and produced a real increase in walking ; CLBP function and pain improved , and participants perceived a greater improvement in their PA levels . These improvements require confirmation in a fully powered RCT Purpose The purpose of this study was to evaluate the effectiveness of a  self-help physical activity program  for persons with type 2 diabetes . Effectiveness was measured by cardiovascular indicators , hemoglobin A1C , anthropometric indicators , and activity levels . Methods This intervention study included 53 individuals with type 2 diabetes . Participants were r and omly assigned . Participants in the intervention group attended the usual Diabetes Self-Management Education Program ( DSMEP ) and received a copy of the book , Manpo-kei ; a concise h and out summarizing the key points of Manpo-kei ; and a pedometer . Participants not assigned to the intervention attended the usual DSMEP only . Data collection was completed at the beginning of the study and 3 months later using a lifestyle and diabetes question naire , a physical activity question naire , and cardiovascular and anthropometric measures . Results Those who participated in the intervention demonstrated a significant decrease in hemoglobin A1C , weight , and body fat . In addition , they increased their number of daily steps as measured by the pedometer . The control group also demonstrated a significant decrease in hemoglobin A1C and weight . Both groups demonstrated increases in their regular weekly activity . At the end of the study period , the intervention group had a significantly lower diastolic blood pressure than the control group . Conclusions Pedometers can be a helpful strategy to motivate persons with diabetes to increase physical activity . However , it appears that attendance at DSMEP alone may be enough to increase physical activity for persons with type 2 diabetes Introduction Management of osteoarthritis ( OA ) includes the use of non-pharmacological and pharmacological therapies . Although walking is commonly recommended for reducing pain and increasing physical function in people with OA , glucosamine sulphate has also been used to alleviate pain and slow the progression of OA . This study evaluated the effects of a progressive walking program and glucosamine sulphate intake on OA symptoms and physical activity participation in people with mild to moderate hip or knee OA . Methods Thirty-six low active participants ( aged 42 to 73 years ) were provided with 1500 mg glucosamine sulphate per day for 6 weeks , after which they began a 12-week progressive walking program , while continuing to take glucosamine . They were r and omized to walk 3 or 5 days per week and given a pedometer to monitor step counts . For both groups , step level of walking was gradually increased to 3000 steps/day during the first 6 weeks of walking , and to 6000 steps/day for the next 6 weeks . Primary outcomes included physical activity levels , physical function ( self-paced step test ) , and the WOMAC Osteoarthritis Index for pain , stiffness and physical function . Assessment s were conducted at baseline and at 6- , 12- , 18- , and 24-week follow-ups . The Mann Whitney Test was used to examine differences in outcome measures between groups at each assessment , and the Wilcoxon Signed Ranks Test was used to examine differences in outcome measures between assessment s. Results During the first 6 weeks of the study ( glucosamine supplementation only ) , physical activity levels , physical function , and total WOMAC scores improved ( P < 0.05 ) . Between the start of the walking program ( Week 6 ) and the final follow-up ( Week 24 ) , further improvements were seen in these outcomes ( P < 0.05 ) although most improvements were seen between Weeks 6 and 12 . No significant differences were found between walking groups . Conclusions In people with hip or knee OA , walking a minimum of 3000 steps ( ~30 minutes ) , at least 3 days/week , in combination with glucosamine sulphate , may reduce OA symptoms . A more robust study with a larger sample is needed to support these preliminary findings .Trial Registration Australian Clinical Trials Registry ACTRN012607000159459 OBJECTIVE The Arthritis , Diet , and Activity Promotion Trial ( ADAPT ) was a r and omized , single-blind clinical trial lasting 18 months that was design ed to determine whether long-term exercise and dietary weight loss are more effective , either separately or in combination , than usual care in improving physical function , pain , and mobility in older overweight and obese adults with knee osteoarthritis ( OA ) . METHODS Three hundred sixteen community-dwelling overweight and obese adults ages 60 years and older , with a body mass index of > or = 28 kg/m(2 ) , knee pain , radiographic evidence of knee OA , and self-reported physical disability , were r and omized into healthy lifestyle ( control ) , diet only , exercise only , and diet plus exercise groups . The primary outcome was self-reported physical function as measured with the Western Ontario and McMaster Universities Osteoarthritis Index ( WOMAC ) . Secondary outcomes included weight loss , 6-minute walk distance , stair-climb time , WOMAC pain and stiffness scores , and joint space width . RESULTS Of the 316 r and omized participants , 252 ( 80 % ) completed the study .  Adherence was as follows : for healthy lifestyle , 73 % ; for diet only , 72 % ; for exercise only , 60 % ; and for diet plus exercise , 64 % . In the diet plus exercise group , significant improvements in self-reported physical function ( P < 0.05 ) , 6-minute walk distance ( P < 0.05 ) , stair-climb time ( P < 0.05 ) , and knee pain ( P < 0.05 ) relative to the healthy lifestyle group were observed . In the exercise group , a significant improvement in the 6-minute walk distance ( P < 0.05 ) was observed . The diet-only group was not significantly different from the healthy lifestyle group for any of the functional or mobility measures . The weight-loss groups lost significantly ( P < 0.05 ) more body weight ( for diet , 4.9 % ; for diet plus exercise , 5.7 % ) than did the healthy lifestyle group ( 1.2 % ) . Finally , changes in joint space width were not different between the groups . CONCLUSION The combination of modest weight loss plus moderate exercise provides better overall improvements in self-reported measures of function and pain and in performance measures of mobility in older overweight and obese adults with knee OA compared with either intervention alone Background People over the age of 70 carry the greatest burden of chronic disease , disability and health care use . Participation in physical activity is crucial for health , and walking accounts for much of the physical activity undertaken by sedentary individuals . Pedometers are a useful motivational tool to encourage increased walking and they are cheap and easy to use . The aim of this pilot study was to evaluate the feasibility of the use of pedometers plus a theory-based intervention to assist sedentary older women to accumulate increasing amounts of physical activity , mainly through walking . Methods Female participants over the age of 70 were recruited from primary care and r and omised to receive either pedometer plus a theory-based intervention or a theory-based intervention alone . The theory-based intervention consisted of motivational techniques , goal - setting , barrier identification and self-monitoring with pedometers and daily diaries . The pedometer group were further r and omised to one of three target groups : a 10 % , 15 % or 20 % monthly increase in 
    Output:
    
agent
Conclusion This study provides strong evidence for the effectiveness of pedometer walking interventions in increasing PA levels for patients with MSDs .
Our findings suggest that a combination of interventions is likely to be the most effective strategy to maximize health benefits in the short term .
***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 Most public health guidelines recommend that adults participate in 30 minutes of moderate intensity physical activity on most days of the week . Establishing new ways to achieve these targets in sedentary population s need to be explored . This research evaluated whether the daily use of pedometers could increase physical activity and improve health outcomes in sedentary overweight and obese women . Methods Twenty six overweight and obese middle-aged women were r and omized into two groups : The control group was not able to record their steps daily , whilst the pedometer group , were asked to record the number of steps on a daily basis for 12 weeks . Results Our data showed that the pedometer group significantly increased their steps/day , by 36 % , at the end of the 12 weeks , whereas the control group 's physical activity levels remained unchanged . There was no significant difference in weight or body fat composition in the pedometer group compared to the control group . However , there was a significant decrease in systolic blood pressure in the pedometer group ( 112.8 ± 2.44 mm Hg ) compared to the control group ( 117.3 ± 2.03 mm Hg ) ( p = 0.003 ) . Conclusion In conclusion , this pilot study shows that the combination of having step goals and immediate feedback from using a pedometer was effective in increasing physical activity levels in sedentary overweight and obese women . Trial registration Background Despite considerable knowledge about musculoskeletal disorders ( MSD ) and physical , psychosocial and individual risk factors there is limited knowledge about physical activity as a factor in preventing MSD . In addition , studies of physical activity are often limited to either leisure activity or physical activity at work . Studies among military personnel on the association between physical activity at work and at leisure and MSD are lacking . This study was conducted to find the prevalence of MSD among personnel in the Royal Norwegian Navy and to assess the association between physical activity at work and at leisure and MSD . Methods A question naire about musculoskeletal disorders , physical activity and background data ( employment status , age , gender , body mass index , smoking , education and physical stressors ) was completed by 2265 workers ( 58 % ) 18 to 70 years old in the Royal Norwegian Navy .  Multiple logistic regression with 95 % confidence intervals was used to assess the relationship between physical activity and musculoskeletal disorders . Results A total of 32 % of the workers reported musculoskeletal disorders often or very often in one or more parts of the body in the past year . The most common musculoskeletal disorders were in the lower back ( 15 % often or very often ) , shoulders ( 12 % often or very often ) and neck ( 11 % often or very often ) . After adjustment for confounders , physical activity was inversely associated with musculoskeletal disorders for all body sites except elbows , knees and feet . Conclusion The one-year prevalence of musculoskeletal disorders among workers in the Royal Norwegian Navy was rather low . A physically active lifestyle both at work and at leisure was associated with fewer musculoskeletal disorders  among personnel in the Royal Norwegian Navy . Prospect i ve studies are necessary to confirm the cause and effect in this association OBJECTIVE To determine whether high exercise adherence improved physical function among older adults with knee osteoarthritis ( OA ) who were overweight or obese . METHODS Associations between  exercise adherence , changes in 6-minute walking distance in meters , and self-reported disability ( Western Ontario and McMaster Universities Osteoarthritis Index function subscale ) after 6 and 18 months were examined among an Arthritis , Diet , and Activity Promotion Trial sub sample ( n = 134 ) using multiple linear regression models . RESULTS Higher exercise adherence was associated with greater improvements in 6-minute walking distance after 6 and 18 months and in disability after 6 months . Pain and body mass index ( BMI ) contributed , to some extent , to explaining the link between exercise adherence  and changes in physical performance and self-reported disability . CONCLUSION Higher exercise adherence is associated with improved physical function in overweight and obese older adults with knee OA . This indicates that promoting adherence is clinical ly relevant when prescribing exercise regimens that also focus on decreasing pain and BMI Objectives : To evaluate the feasibility of an RCT of a pedometer-driven walking program and education/advice to remain active compared with education/advice only for treatment of chronic low back pain ( CLBP ) . Methods : Fifty-seven participants with CLBP recruited from primary care were r and omly allocated to either : ( 1 ) education/advice ( E , n=17 ) or ( 2 ) education/advice plus an 8-week pedometer-driven walking program ( EWP , n=40 ) . Step targets , actual daily step counts , and adverse events were recorded in a walking diary over the 8 weeks of intervention for the EWP group only . All other outcomes ( eg , functional disability using the Oswestry Disability Question naire ( ODQ ) , pain scores , physical activity ( PA ) measurement etc . ) were recorded at baseline , week 9 ( immediately post-intervention ) , and 6 months in both groups . Results : The recruitment rate was 22 % and the dropout rate was lower than anticipated ( 13 % to 18 % at 6 mo ) . Adherence with the EWP was high , 93 % ( n=37/40 ) walked for ≥6 weeks , and increased their steps/day ( mean absolute increase in steps/d , 2776 , 95 % confidence interval [ CI ] , 1996 - 3557 ) by 59 % ( 95 % CI , 40.73%-76.25 % ) from baseline . Mean percentage adherence with weekly step targets was 70 % ( 95 % CI , 62%-77 % ) . Eight ( 20 % ) minor-related adverse events were observed in 13 % ( 5/40 ) of the participants . The EWP group participants demonstrated an 8.2 % point improvement ( 95 % CI , −13 to −3.4 ) on the ODQ at 6 months compared with 1.6 % points ( 95 % CI , –9.3 to 6.1 ) for the E group ( between group d=0.44 ) . There was also a larger mean improvement in pain ( d=0.4 ) and a larger increase in PA ( d=0.59 ) at 6 months in EWP . Discussion : This preliminary study demonstrated that a main RCT is feasible . EWP was safe and produced a real increase in walking ; CLBP function and pain improved , and participants perceived a greater improvement in their PA levels . These improvements require confirmation in a fully powered RCT Purpose The purpose of this study was to evaluate the effectiveness of a  self-help physical activity program  for persons with type 2 diabetes . Effectiveness was measured by cardiovascular indicators , hemoglobin A1C , anthropometric indicators , and activity levels . Methods This intervention study included 53 individuals with type 2 diabetes . Participants were r and omly assigned . Participants in the intervention group attended the usual Diabetes Self-Management Education Program ( DSMEP ) and received a copy of the book , Manpo-kei ; a concise h and out summarizing the key points of Manpo-kei ; and a pedometer . Participants not assigned to the intervention attended the usual DSMEP only . Data collection was completed at the beginning of the study and 3 months later using a lifestyle and diabetes question naire , a physical activity question naire , and cardiovascular and anthropometric measures . Results Those who participated in the intervention demonstrated a significant decrease in hemoglobin A1C , weight , and body fat . In addition , they increased their number of daily steps as measured by the pedometer . The control group also demonstrated a significant decrease in hemoglobin A1C and weight . Both groups demonstrated increases in their regular weekly activity . At the end of the study period , the intervention group had a significantly lower diastolic blood pressure than the control group . Conclusions Pedometers can be a helpful strategy to motivate persons with diabetes to increase physical activity . However , it appears that attendance at DSMEP alone may be enough to increase physical activity for persons with type 2 diabetes Introduction Management of osteoarthritis ( OA ) includes the use of non-pharmacological and pharmacological therapies . Although walking is commonly recommended for reducing pain and increasing physical function in people with OA , glucosamine sulphate has also been used to alleviate pain and slow the progression of OA . This study evaluated the effects of a progressive walking program and glucosamine sulphate intake on OA symptoms and physical activity participation in people with mild to moderate hip or knee OA . Methods Thirty-six low active participants ( aged 42 to 73 years ) were provided with 1500 mg glucosamine sulphate per day for 6 weeks , after which they began a 12-week progressive walking program , while continuing to take glucosamine . They were r and omized to walk 3 or 5 days per week and given a pedometer to monitor step counts . For both groups , step level of walking was gradually increased to 3000 steps/day during the first 6 weeks of walking , and to 6000 steps/day for the next 6 weeks . Primary outcomes included physical activity levels , physical function ( self-paced step test ) , and the WOMAC Osteoarthritis Index for pain , stiffness and physical function . Assessment s were conducted at baseline and at 6- , 12- , 18- , and 24-week follow-ups . The Mann Whitney Test was used to examine differences in outcome measures between groups at each assessment , and the Wilcoxon Signed Ranks Test was used to examine differences in outcome measures between assessment s. Results During the first 6 weeks of the study ( glucosamine supplementation only ) , physical activity levels , physical function , and total WOMAC scores improved ( P < 0.05 ) . Between the start of the walking program ( Week 6 ) and the final follow-up ( Week 24 ) , further improvements were seen in these outcomes ( P < 0.05 ) although most improvements were seen between Weeks 6 and 12 . No significant differences were found between walking groups . Conclusions In people with hip or knee OA , walking a minimum of 3000 steps ( ~30 minutes ) , at least 3 days/week , in combination with glucosamine sulphate , may reduce OA symptoms . A more robust study with a larger sample is needed to support these preliminary findings .Trial Registration Australian Clinical Trials Registry ACTRN012607000159459 OBJECTIVE The Arthritis , Diet , and Activity Promotion Trial ( ADAPT ) was a r and omized , single-blind clinical trial lasting 18 months that was design ed to determine whether long-term exercise and dietary weight loss are more effective , either separately or in combination , than usual care in improving physical function , pain , and mobility in older overweight and obese adults with knee osteoarthritis ( OA ) . METHODS Three hundred sixteen community-dwelling overweight and obese adults ages 60 years and older , with a body mass index of > or = 28 kg/m(2 ) , knee pain , radiographic evidence of knee OA , and self-reported physical disability , were r and omized into healthy lifestyle ( control ) , diet only , exercise only , and diet plus exercise groups . The primary outcome was self-reported physical function as measured with the Western Ontario and McMaster Universities Osteoarthritis Index ( WOMAC ) . Secondary outcomes included weight loss , 6-minute walk distance , stair-climb time , WOMAC pain and stiffness scores , and joint space width . RESULTS Of the 316 r and omized participants , 252 ( 80 % ) completed the study .  Adherence was as follows : for healthy lifestyle , 73 % ; for diet only , 72 % ; for exercise only , 60 % ; and for diet plus exercise , 64 % . In the diet plus exercise group , significant improvements in self-reported physical function ( P < 0.05 ) , 6-minute walk distance ( P < 0.05 ) , stair-climb time ( P < 0.05 ) , and knee pain ( P < 0.05 ) relative to the healthy lifestyle group were observed . In the exercise group , a significant improvement in the 6-minute walk distance ( P < 0.05 ) was observed . The diet-only group was not significantly different from the healthy lifestyle group for any of the functional or mobility measures . The weight-loss groups lost significantly ( P < 0.05 ) more body weight ( for diet , 4.9 % ; for diet plus exercise , 5.7 % ) than did the healthy lifestyle group ( 1.2 % ) . Finally , changes in joint space width were not different between the groups . CONCLUSION The combination of modest weight loss plus moderate exercise provides better overall improvements in self-reported measures of function and pain and in performance measures of mobility in older overweight and obese adults with knee OA compared with either intervention alone Background People over the age of 70 carry the greatest burden of chronic disease , disability and health care use . Participation in physical activity is crucial for health , and walking accounts for much of the physical activity undertaken by sedentary individuals . Pedometers are a useful motivational tool to encourage increased walking and they are cheap and easy to use . The aim of this pilot study was to evaluate the feasibility of the use of pedometers plus a theory-based intervention to assist sedentary older women to accumulate increasing amounts of physical activity , mainly through walking . Methods Female participants over the age of 70 were recruited from primary care and r and omised to receive either pedometer plus a theory-based intervention or a theory-based intervention alone . The theory-based intervention consisted of motivational techniques , goal - setting , barrier identification and self-monitoring with pedometers and daily diaries . The pedometer group were further r and omised to one of three target groups : a 10 % , 15 % or 20 % monthly increase in 
    Output:
    