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 Patients with Parkinson 's disease ( PD ) suffer from a high fall risk . Previous approaches for evaluating fall risk are based on self-report or testing at a given time point and may , therefore , be insufficient to optimally capture fall risk . We tested , for the first time , whether metrics derived from 3 day continuous recordings are associated with fall risk in PD . Methods and Material s 107 patients ( Hoehn & Yahr Stage : 2.6±0.7 ) wore a small , body-fixed sensor ( 3D accelerometer ) on lower back for 3 days .  Walking quantity ( e.g. , steps per 3-days ) and quality ( e.g. , frequency-derived measures of gait variability ) were determined . Subjects were classified as fallers or non-fallers based on fall history . Subjects were also followed for one year to evaluate predictors of the transition from non-faller to faller . Results The 3 day acceleration derived measures were significantly different in fallers and non-fallers and were significantly correlated with previously vali date d measures of fall risk . Walking quantity was similar in the two groups . In contrast , the fallers walked with higher step-to-step variability , e.g. , anterior-posterior width of the dominant frequency was larger ( p = 0.012 ) in the fallers ( 0.78±0.17 Hz ) compared to the non-fallers ( 0.71±0.07 Hz ) . Among subjects who reported no falls in the year prior to testing , sensor-derived measures predicted the time to first fall ( p = 0.0034 ) , whereas many traditional measures did not . Cox regression analysis showed that anterior-posterior width was significantly ( p = 0.0039 ) associated with time to fall during the follow-up period , even after adjusting for traditional measures . Conclusions / Significance These findings indicate that a body-fixed sensor worn continuously can evaluate fall risk in PD . This sensor-based approach was able to identify transition from non-faller to faller , whereas many traditional metrics were not successful . This approach may facilitate earlier detection of fall risk and may in the future , help reduce high costs associated with falls Background and Purpose — Individuals with chronic stroke often demonstrate a “ plateau , ” or deceleration of motor recovery , which may lead to discharge from physical therapy ( PT ) . However , numerous studies report improvements in motor function when individuals are provided intensive practice of motor tasks . We suggest that reduced task-specific walking practice during clinical PT contributes to limited gains in ambulatory function in those with a perceived plateau poststroke , and suggest that further gains can be realized if intensive stepping , or locomotor training ( LT ) is provided after discharge . Methods — Twenty subjects with chronic stroke completed a repeated baseline measures , r and omized crossover trial in which walking performance was assessed during the last 4 weeks of clinical PT before discharge secondary to reaching a plateau , followed by 4 weeks of intensive LT and 4 weeks of no intervention . Outcome measures included clinical and physiological ( metabolic ) measures of walking overground and on a treadmill , and measures of daily stepping activity in the home and community , including during clinical PT and subsequent LT sessions . Results — Stepping practice was more than 4-fold higher during LT versus clinical PT sessions , with significant improvements in daily stepping and gait efficiency only after LT . Changes in daily stepping after clinical PT and intensive LT were correlated ( P<0.001 ) with the amount of stepping practice received during these interventions . Conclusions — Intensive LT results in improved daily stepping in individuals poststroke who have been discharged from PT because of a perceived plateau in motor function . These improvements may be related to the amount and intensity of stepping practice OBJECTIVE This prospect i ve study examined symptoms of depression , fatigue , pain , self-efficacy , and social support as possible intermediaries in the pathway between changes in physical activity and quality of life ( QOL ) across a 6-month period in persons with multiple sclerosis ( MS ) . DESIGN AND MAIN OUTCOME MEASURES Adults with a definite diagnosis of MS wore an accelerometer for 7 days and then completed a battery of question naires at baseline ( n = 292 ) and 6-months follow-up ( n = 276 ) . The data were analyzed using panel analysis and covariance modeling in Mplus 3.0 . RESULTS The initial analysis indicated that change in physical activity was associated with a statistically significant and small residual change in QOL ( beta = .07 ) . The subsequent analysis indicated that change in physical activity was associated with residual changes in fatigue ( gamma = -.17 ) , pain ( gamma = -.13 ) , social support ( gamma = .07 ) , and self-efficacy ( gamma = .11 ) , and , in turn , changes in fatigue ( beta = -.13 ) , pain ( beta = -.09 ) , social support ( beta = .18 ) , and self-efficacy ( beta = .10 ) were associated with a residual change in QOL . CONCLUSION The observed pattern of relationships supports the possibility that physical activity is indirectly associated with improved QOL through pathways that include fatigue , pain , social support , and self-efficacy in individuals with MS This study examined the correlation of physical activity with  neurological impairment and disability in persons with multiple sclerosis ( MS ) . Eighty individuals with MS wore an accelerometer for 7 days and completed the Symptom Inventory ( SI ) , Performance Scales ( PS ) , and Exp and ed Disability Status Scale . There were large negative correlations between the accelerometer and SI ( r = −0.56 ; ρ = −0.58 ) and Exp and ed Disability Status Scale ( r = −0.60 ; ρ = −0.69 ) and a moderate negative correlation between the accelerometer and PS ( r = −0.39 ; ρ = −0.48 ) indicating that physical activity was associated with reduced neurological impairment and disability . Such findings provide a preliminary basis for using an accelerometer and the SI and PS as outcome measures in large-scale prospect i ve and experimental examinations of the effect of physical activity behavior on disability and dependence in MS Background and Purpose — The purpose of this study was to quantitatively measure and describe the amount and pattern of physical activity in patients within the first week after acute ischemic stroke and transient ischemic attack using accelerometers . Methods — A total of 100 patients with acute ischemic stroke or transient ischemic attack admitted to our acute stroke unit wore Actical accelerometers attached to both wrists and ankles and the hip for ⩽7 days . Patients were included within 72 hours of symptom onset . Accelerometer output was measured in activity counts ( AC ) . Patients were tested daily with Sc and inavian Stroke Scale . Results — Physical activity peaked in the morning and declined during the rest of the day . In patients with stroke , total AC were 71 % lower than in patients with transient ischemic attack . AC were 80 % lower in the paretic compared with those in the nonparetic arm in patients with ischemic stroke . For the legs AC were 44 % lower on the paretic side and an overall increase in AC with time was found . There was a significant increase in AC with increasing Sc and inavian Stroke Scale and a decrease in AC with increasing age . Conclusions — This study demonstrates the feasibility of using accelerometers to quantitatively and continuously measure physical activity simultaneously from all 4 extremities and the hip in patients with acute ischemic stroke and transient ischemic attack . Our study provides quantitative evidence of physical inactivity in patients with acute ischemic stroke . The method offers a low cost and noninvasive tool for future clinical interventional physiotherapeutic and early mobilization studies . Clinical Trial Registration — URL : http://www . clinical trials.gov . Unique identifier : NCT01560520 Background Chronic fatigue and inactivity are prevalent problems among individuals with multiple sclerosis ( MS ) and may independently or interactively have detrimental effects on quality of life and ability to participate in life roles . However , no studies to date have systematic ally evaluated the benefits of an intervention for both managing fatigue and promoting physical activity in individuals with MS . This study involves a r and omized controlled trial to examine the effectiveness of a telehealth intervention that supports individuals with MS in managing fatigue and increasing physical activity levels . Methods / Design A r and omly-allocated , three-parallel group , time-series design with a social support program serving as the control group will be used to accomplish the purpose of the study . Our goal is to recruit 189 ambulatory individuals with MS who will be r and omized into one of three  telehealth interventions : ( 1 ) a contact-control social support intervention , ( 2 ) a physical activity-only intervention , and ( 3 ) a physical activity plus fatigue management intervention . All interventions will last 12 weeks and will be delivered entirely over the phone . Our hypothesis is that , in comparison to the contact-control condition , both the physical activity-only intervention and the physical activity plus fatigue management intervention will yield significant increases in physical activity levels as well as improve fatigue and health and function , with the physical activity plus fatigue management intervention yielding significantly larger improvements . To test this hypothesis , outcome measures will be administered at Weeks 1 , 12 , and 24 . Primary outcomes will be the Fatigue Impact Scale , the Godin Leisure-Time Exercise Question naire ( GLTEQ ) , and Actigraph accelerometers . Secondary outcomes will include the SF-12 Survey , Mental Health Inventory , Multiple Sclerosis Impact Scale , the Community Participation Indicator , and psychosocial constructs ( e.g. , self-efficacy ) . Discussion The proposed study is novel , in that it represents a multi-disciplinary effort to merge two promising lines of research on MS : fatigue management and physical activity promotion . Collectively , the proposed study will be the largest r and omized controlled trial to examine the effects of a lifestyle physical activity intervention in people with MS.Trial registration Background and Purpose : Relatively little is known about the natural evolution of physical activity – related participation restrictions associated with Parkinson 's disease ( PD ) . We examined this issue prospect ively , using continuous monitoring technology to capture the free-living ambulatory activity of persons with PD engaging in life situations . We specifically sought ( 1 ) to explore natural , long-term changes in daily ambulatory activity and ( 2 ) to compare the responsiveness of ambulatory activity parameters to clinical measures of gait and disease severity . Methods : Thirty-three persons with PD participated ( Hoehn and Yahr range of 1–3 ) . Participants wore a step activity monitor for up to 7 days at baseline and again at 1-year follow-up . Mean daily values were calculated for parameters indicative of amount , intensity , frequency , and duration of ambulatory activity . Clinical measures included the Unified Parkinson Disease Rating Scale , the 6-Minute Walk , and Maximal Gait Speed . Parametric tests for paired sample s were used to investigate changes in ambulatory activity parameters and clinical measures . Results : Participants had significant declines in the amount and intensity of daily ambulatory activity but not in its frequency and duration ( P < 0.007 ) . Declines occurred in the absence of changes in clinical measures of gait or disease severity . The greatest 1-year decline occurred in the number of daily minutes participants spent engaging in at least moderate-intensity ambulatory activity . Conclusion : Continuous monitoring of ambulatory activity beyond mere step counts may serve as a distinct and important means of quantifying declining ambulatory behavior associated with disease progression or improved ambulatory behavior result ing from rehabilitation and medical and /or surgical interventions in persons with PD Reliability estimates are important parameters for power analyses and sample -size calculations in behavioral interventions for increasing physical activity among persons with multiple sclerosis ( MS ) . This study involved a secondary data analysis for providing reliability estimates for measures of physical activity over a six-month period in MS . On two occasions separated by six months , participants completed the Godin Leisure-Time Exercise Question naire ( GLTEQ ) and wore an ActiGraph model 7164 accelerometer on a belt around the waist for a seven-day period . The outcomes from the accelerometer were total activity counts and minutes of moderate-to-vigorous physical activity ( MVPA ) per day . The main analyses involved two-way , r and om effects intraclass correlation coefficients ( ICCs ) . The ICCs for GLTEQ scores , total activity counts , and minutes of MVPA were .66 , .84 , and .84 , respectively . Additionally , the sample was less physically active than adults without MS , and correlation analyses supported the validity of the measures , but within a substantially larger sample . Overall , the measures had acceptable , but different , reliability over six months in this sample of mostly women with relapsing – remitting MS . Power analyses using the reliability estimates indicated vastly different sample sizes for the measures of physical activity and when compared with the default parameter in software packages OBJECTIVE This brief report describes the possibility of reactivity in the baseline assessment of physical activity using accelerometry from two separate r and omized controlled trials of a behavior intervention for increasing physical activity in persons with multiple sclerosis ( MS ) . METHOD The sample s included 18 persons with multiple sclerosis ( MS ) from Study 1 and 20 from Study 2 who were r and omized into treatment arms of the intervention . The participants initially wore an accelerometer over a 7-day period for collection of baseline data , and one week later wore a pedometer over a 7-day period for collection of data for self-monitoring and goal setting in week 1 of the 12-week intervention . The accelerometer and pedometer data were both expressed in average steps per day over a 7-day period . RESULTS There was a moderate ( d = .56 ) , statistically significant ( p = .03 ) difference of 1,822 steps per day between baseline and week 1 of the intervention in Study 1 . There was a large ( d = 1.36 ) , statistically significant ( p = .0001 ) difference of 2,338 steps per day in Study 2 . CONCLUSION We are unaware of other research describing a significant change in physical activity between baseline and the first week of a behavioral intervention and believe that this change reflects reactivity in the 
    Output:
    
agent
Physical activity levels measured by remote monitoring are consistently low in people with MS , stroke and dementia , and patterns of physical activity are altered in PD .
In MS , decreased ambulatory activity assessed via remote monitoring is associated with greater disability and lower quality of life .
In stroke , remote measures of upper limb function and ambulation are associated with functional recovery following rehabilitation and goal -directed interventions .
In PD , remote monitoring may help to predict falls .
In dementia , remote physical activity measures correlate with disease severity and can detect w and ering .
Conclusions These studies show that remote physical activity monitoring is feasible in neurological diseases , including in people with moderate to severe neurological disability .
Remote monitoring can be a psychometrically sound and responsive way to assess physical activity in neurological disease .
***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 Patients with Parkinson 's disease ( PD ) suffer from a high fall risk . Previous approaches for evaluating fall risk are based on self-report or testing at a given time point and may , therefore , be insufficient to optimally capture fall risk . We tested , for the first time , whether metrics derived from 3 day continuous recordings are associated with fall risk in PD . Methods and Material s 107 patients ( Hoehn & Yahr Stage : 2.6±0.7 ) wore a small , body-fixed sensor ( 3D accelerometer ) on lower back for 3 days .  Walking quantity ( e.g. , steps per 3-days ) and quality ( e.g. , frequency-derived measures of gait variability ) were determined . Subjects were classified as fallers or non-fallers based on fall history . Subjects were also followed for one year to evaluate predictors of the transition from non-faller to faller . Results The 3 day acceleration derived measures were significantly different in fallers and non-fallers and were significantly correlated with previously vali date d measures of fall risk . Walking quantity was similar in the two groups . In contrast , the fallers walked with higher step-to-step variability , e.g. , anterior-posterior width of the dominant frequency was larger ( p = 0.012 ) in the fallers ( 0.78±0.17 Hz ) compared to the non-fallers ( 0.71±0.07 Hz ) . Among subjects who reported no falls in the year prior to testing , sensor-derived measures predicted the time to first fall ( p = 0.0034 ) , whereas many traditional measures did not . Cox regression analysis showed that anterior-posterior width was significantly ( p = 0.0039 ) associated with time to fall during the follow-up period , even after adjusting for traditional measures . Conclusions / Significance These findings indicate that a body-fixed sensor worn continuously can evaluate fall risk in PD . This sensor-based approach was able to identify transition from non-faller to faller , whereas many traditional metrics were not successful . This approach may facilitate earlier detection of fall risk and may in the future , help reduce high costs associated with falls Background and Purpose — Individuals with chronic stroke often demonstrate a “ plateau , ” or deceleration of motor recovery , which may lead to discharge from physical therapy ( PT ) . However , numerous studies report improvements in motor function when individuals are provided intensive practice of motor tasks . We suggest that reduced task-specific walking practice during clinical PT contributes to limited gains in ambulatory function in those with a perceived plateau poststroke , and suggest that further gains can be realized if intensive stepping , or locomotor training ( LT ) is provided after discharge . Methods — Twenty subjects with chronic stroke completed a repeated baseline measures , r and omized crossover trial in which walking performance was assessed during the last 4 weeks of clinical PT before discharge secondary to reaching a plateau , followed by 4 weeks of intensive LT and 4 weeks of no intervention . Outcome measures included clinical and physiological ( metabolic ) measures of walking overground and on a treadmill , and measures of daily stepping activity in the home and community , including during clinical PT and subsequent LT sessions . Results — Stepping practice was more than 4-fold higher during LT versus clinical PT sessions , with significant improvements in daily stepping and gait efficiency only after LT . Changes in daily stepping after clinical PT and intensive LT were correlated ( P<0.001 ) with the amount of stepping practice received during these interventions . Conclusions — Intensive LT results in improved daily stepping in individuals poststroke who have been discharged from PT because of a perceived plateau in motor function . These improvements may be related to the amount and intensity of stepping practice OBJECTIVE This prospect i ve study examined symptoms of depression , fatigue , pain , self-efficacy , and social support as possible intermediaries in the pathway between changes in physical activity and quality of life ( QOL ) across a 6-month period in persons with multiple sclerosis ( MS ) . DESIGN AND MAIN OUTCOME MEASURES Adults with a definite diagnosis of MS wore an accelerometer for 7 days and then completed a battery of question naires at baseline ( n = 292 ) and 6-months follow-up ( n = 276 ) . The data were analyzed using panel analysis and covariance modeling in Mplus 3.0 . RESULTS The initial analysis indicated that change in physical activity was associated with a statistically significant and small residual change in QOL ( beta = .07 ) . The subsequent analysis indicated that change in physical activity was associated with residual changes in fatigue ( gamma = -.17 ) , pain ( gamma = -.13 ) , social support ( gamma = .07 ) , and self-efficacy ( gamma = .11 ) , and , in turn , changes in fatigue ( beta = -.13 ) , pain ( beta = -.09 ) , social support ( beta = .18 ) , and self-efficacy ( beta = .10 ) were associated with a residual change in QOL . CONCLUSION The observed pattern of relationships supports the possibility that physical activity is indirectly associated with improved QOL through pathways that include fatigue , pain , social support , and self-efficacy in individuals with MS This study examined the correlation of physical activity with  neurological impairment and disability in persons with multiple sclerosis ( MS ) . Eighty individuals with MS wore an accelerometer for 7 days and completed the Symptom Inventory ( SI ) , Performance Scales ( PS ) , and Exp and ed Disability Status Scale . There were large negative correlations between the accelerometer and SI ( r = −0.56 ; ρ = −0.58 ) and Exp and ed Disability Status Scale ( r = −0.60 ; ρ = −0.69 ) and a moderate negative correlation between the accelerometer and PS ( r = −0.39 ; ρ = −0.48 ) indicating that physical activity was associated with reduced neurological impairment and disability . Such findings provide a preliminary basis for using an accelerometer and the SI and PS as outcome measures in large-scale prospect i ve and experimental examinations of the effect of physical activity behavior on disability and dependence in MS Background and Purpose — The purpose of this study was to quantitatively measure and describe the amount and pattern of physical activity in patients within the first week after acute ischemic stroke and transient ischemic attack using accelerometers . Methods — A total of 100 patients with acute ischemic stroke or transient ischemic attack admitted to our acute stroke unit wore Actical accelerometers attached to both wrists and ankles and the hip for ⩽7 days . Patients were included within 72 hours of symptom onset . Accelerometer output was measured in activity counts ( AC ) . Patients were tested daily with Sc and inavian Stroke Scale . Results — Physical activity peaked in the morning and declined during the rest of the day . In patients with stroke , total AC were 71 % lower than in patients with transient ischemic attack . AC were 80 % lower in the paretic compared with those in the nonparetic arm in patients with ischemic stroke . For the legs AC were 44 % lower on the paretic side and an overall increase in AC with time was found . There was a significant increase in AC with increasing Sc and inavian Stroke Scale and a decrease in AC with increasing age . Conclusions — This study demonstrates the feasibility of using accelerometers to quantitatively and continuously measure physical activity simultaneously from all 4 extremities and the hip in patients with acute ischemic stroke and transient ischemic attack . Our study provides quantitative evidence of physical inactivity in patients with acute ischemic stroke . The method offers a low cost and noninvasive tool for future clinical interventional physiotherapeutic and early mobilization studies . Clinical Trial Registration — URL : http://www . clinical trials.gov . Unique identifier : NCT01560520 Background Chronic fatigue and inactivity are prevalent problems among individuals with multiple sclerosis ( MS ) and may independently or interactively have detrimental effects on quality of life and ability to participate in life roles . However , no studies to date have systematic ally evaluated the benefits of an intervention for both managing fatigue and promoting physical activity in individuals with MS . This study involves a r and omized controlled trial to examine the effectiveness of a telehealth intervention that supports individuals with MS in managing fatigue and increasing physical activity levels . Methods / Design A r and omly-allocated , three-parallel group , time-series design with a social support program serving as the control group will be used to accomplish the purpose of the study . Our goal is to recruit 189 ambulatory individuals with MS who will be r and omized into one of three  telehealth interventions : ( 1 ) a contact-control social support intervention , ( 2 ) a physical activity-only intervention , and ( 3 ) a physical activity plus fatigue management intervention . All interventions will last 12 weeks and will be delivered entirely over the phone . Our hypothesis is that , in comparison to the contact-control condition , both the physical activity-only intervention and the physical activity plus fatigue management intervention will yield significant increases in physical activity levels as well as improve fatigue and health and function , with the physical activity plus fatigue management intervention yielding significantly larger improvements . To test this hypothesis , outcome measures will be administered at Weeks 1 , 12 , and 24 . Primary outcomes will be the Fatigue Impact Scale , the Godin Leisure-Time Exercise Question naire ( GLTEQ ) , and Actigraph accelerometers . Secondary outcomes will include the SF-12 Survey , Mental Health Inventory , Multiple Sclerosis Impact Scale , the Community Participation Indicator , and psychosocial constructs ( e.g. , self-efficacy ) . Discussion The proposed study is novel , in that it represents a multi-disciplinary effort to merge two promising lines of research on MS : fatigue management and physical activity promotion . Collectively , the proposed study will be the largest r and omized controlled trial to examine the effects of a lifestyle physical activity intervention in people with MS.Trial registration Background and Purpose : Relatively little is known about the natural evolution of physical activity – related participation restrictions associated with Parkinson 's disease ( PD ) . We examined this issue prospect ively , using continuous monitoring technology to capture the free-living ambulatory activity of persons with PD engaging in life situations . We specifically sought ( 1 ) to explore natural , long-term changes in daily ambulatory activity and ( 2 ) to compare the responsiveness of ambulatory activity parameters to clinical measures of gait and disease severity . Methods : Thirty-three persons with PD participated ( Hoehn and Yahr range of 1–3 ) . Participants wore a step activity monitor for up to 7 days at baseline and again at 1-year follow-up . Mean daily values were calculated for parameters indicative of amount , intensity , frequency , and duration of ambulatory activity . Clinical measures included the Unified Parkinson Disease Rating Scale , the 6-Minute Walk , and Maximal Gait Speed . Parametric tests for paired sample s were used to investigate changes in ambulatory activity parameters and clinical measures . Results : Participants had significant declines in the amount and intensity of daily ambulatory activity but not in its frequency and duration ( P < 0.007 ) . Declines occurred in the absence of changes in clinical measures of gait or disease severity . The greatest 1-year decline occurred in the number of daily minutes participants spent engaging in at least moderate-intensity ambulatory activity . Conclusion : Continuous monitoring of ambulatory activity beyond mere step counts may serve as a distinct and important means of quantifying declining ambulatory behavior associated with disease progression or improved ambulatory behavior result ing from rehabilitation and medical and /or surgical interventions in persons with PD Reliability estimates are important parameters for power analyses and sample -size calculations in behavioral interventions for increasing physical activity among persons with multiple sclerosis ( MS ) . This study involved a secondary data analysis for providing reliability estimates for measures of physical activity over a six-month period in MS . On two occasions separated by six months , participants completed the Godin Leisure-Time Exercise Question naire ( GLTEQ ) and wore an ActiGraph model 7164 accelerometer on a belt around the waist for a seven-day period . The outcomes from the accelerometer were total activity counts and minutes of moderate-to-vigorous physical activity ( MVPA ) per day . The main analyses involved two-way , r and om effects intraclass correlation coefficients ( ICCs ) . The ICCs for GLTEQ scores , total activity counts , and minutes of MVPA were .66 , .84 , and .84 , respectively . Additionally , the sample was less physically active than adults without MS , and correlation analyses supported the validity of the measures , but within a substantially larger sample . Overall , the measures had acceptable , but different , reliability over six months in this sample of mostly women with relapsing – remitting MS . Power analyses using the reliability estimates indicated vastly different sample sizes for the measures of physical activity and when compared with the default parameter in software packages OBJECTIVE This brief report describes the possibility of reactivity in the baseline assessment of physical activity using accelerometry from two separate r and omized controlled trials of a behavior intervention for increasing physical activity in persons with multiple sclerosis ( MS ) . METHOD The sample s included 18 persons with multiple sclerosis ( MS ) from Study 1 and 20 from Study 2 who were r and omized into treatment arms of the intervention . The participants initially wore an accelerometer over a 7-day period for collection of baseline data , and one week later wore a pedometer over a 7-day period for collection of data for self-monitoring and goal setting in week 1 of the 12-week intervention . The accelerometer and pedometer data were both expressed in average steps per day over a 7-day period . RESULTS There was a moderate ( d = .56 ) , statistically significant ( p = .03 ) difference of 1,822 steps per day between baseline and week 1 of the intervention in Study 1 . There was a large ( d = 1.36 ) , statistically significant ( p = .0001 ) difference of 2,338 steps per day in Study 2 . CONCLUSION We are unaware of other research describing a significant change in physical activity between baseline and the first week of a behavioral intervention and believe that this change reflects reactivity in the 
    Output:
    