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: 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 Background and Purpose — The SPARCL trial showed that atorvastatin 80 mg/d reduces the risk of stroke and other cardiovascular events in patients with recent stroke or transient ischemic attack ( TIA ) . We tested the hypothesis that the benefit of treatment varies according to index event stroke subtype . Methods — Subjects with stroke or TIA without known coronary heart disease were r and omized to atorvastatin 80 mg/d or placebo .  The SPARCL primary end point was fatal or nonfatal stroke . Secondary end points included major cardiovascular events ( MCVE ; stroke plus major coronary events ) . Cox regression models testing for an interaction with treatment assignment were used to explore potential differences in efficacy based on stroke subtype . Results — For subjects r and omized to atorvastatin versus placebo  , a primary end point occurred in 13.1 % versus 18.6 % of those classified as having large vessel disease ( LVD , 15.8 % of 4,731 participants ) , in 13.1 % versus 15.5 % of those with small vessel disease ( SVD , 29.8 % ) , in 11.2 % versus 12.7 % of those with ischemic stroke of unknown cause ( 21.5 % ) , in 7.6 % versus 8.8 % of those with TIA ( 30.9 % ) , and in 22.2 % versus 8.3 % of those with hemorrhagic stroke ( HS , 2 % ) at baseline . There was no difference in the efficacy of treatment for either the primary end point ( LVD hazard ratio [ HR ] 0.70 , 95 % confidence interval [ CI ] 0.49 to 1.02 , TIA HR 0.81 , CI 0.57 to 1.17 , SVD HR 0.85 , CI 0.64 to 1.12 , unknown cause HR 0.87 , CI 0.61 to 1.24 , HS HR 3.24 , CI 1.01 to 10.4 ; P for heterogeneity=0.421 ) , or MCVEs ( P for heterogeneity=0.360 ) based on subtype of the index event . As compared to subjects with LVD strokes , those with SVD had similar MCVE rates ( 19.2 % versus 18.5 % over the course of the trial ) , and similar overall reductions in stroke and MCVEs . Conclusions — Atorvastatin 80 mg/d is similarly efficacious in preventing strokes and other cardiovascular events , irrespective of baseline ischemic stroke subtype Objective : Despite evidence demonstrating that risk-factor management is effective in reducing recurrent cerebrovascular disease , there are very few structured care programmes for stroke survivors . The aim was to implement and evaluate an integrated care programme in stroke . Methods : 186 patients with stroke were r and omised to either the treatment ( integrated care ) or control ( usual care ) group and were followed up over 12 months . The Integrated Care for the Reduction of Secondary Stroke ( ICARUSS ) model of integrated care involved collaboration between a specialist stroke service , a hospital coordinator and a patient ’s general practitioner . The primary aim was to promote the management of vascular risk factors through ongoing patient contact and education . Results : In the 12 months poststroke , systolic blood pressure ( sBP ) decreased in the treatment group but increased in controls . The group difference was significant , and remained so when age , sex , disability and sBP at discharge were accounted for ( p = 0.04 ) . Treatment patients also exhibited better modification of body mass index ( p = 0.007 ) and number of walks taken ( p<0.001 ) than controls . Rankin scores indicated significantly reduced disability in treatment patients relative to controls in the year poststroke ( p = 0.003 ) . Conclusions : Through an integrated system of education , advice and support to both patient and GP , the ICARUSS model was effective in modifying a variety of vascular risk factors and therefore should decrease the likelihood or recurrent stroke or vascular event Objectives To investigate if repeated verbal instructions about physical activity to patients with ischaemic stroke could increase long term physical activity . Design Multicentre , multinational , r and omised clinical trial with masked outcome assessment . Setting Stroke units in Denmark , China , Pol and , and Estonia . Participants 314 patients with ischaemic stroke aged ≥40 years who were able to walk—157 ( mean age 69.7 years ) r and omised to the intervention , 157 ( mean age 69.4 years ) in the control group . Interventions Patients r and omised to the intervention were instructed in a detailed training programme before discharge and at five follow-up visits during 24 months . Control patients had follow-up visits with the same frequency but without instructions in physical activity . Main outcome measures Physical activity assessed with the Physical Activity Scale for the Elderly ( PASE ) at each visit . Secondary outcomes were clinical events . Results The estimated mean PASE scores were 69.1 in the intervention group and 64.0 in the control group ( difference 5.0 ( 95 % confidence interval −5.8 to 15.9 ) , P=0.36 . The intervention had no significant effect on mortality , recurrent stroke , myocardial infa rct ion , or falls and fractures . Conclusion Repeated encouragement and verbal instruction in being physically active did not lead to a significant increase in physical activity measured by the PASE score . More intensive strategies seem to be needed to promote physical activity after ischaemic stroke . Trial registration Clinical Trials Background and Purpose — Numerous effective strategies for the secondary prevention of cardiovascular events in high-risk patients have now been established . We sought to calculate the cumulative benefit of combining multiple strategies for preventing recurrent events in patients with a history of ischemic stroke or transient ischemic attack . Methods — A comprehensive literature search was undertaken to identify meta-analyses of r and omized controlled trials reporting on the efficacy of secondary prevention strategies . The baseline incidence of vascular events was modeled from the Life Long After Cerebral Ischemia study . Strategies were combined on a multiplicative scale and cumulative risk reductions were computed over a 5-year interval . Results — The combination of 5 proven strategies applied to survivors of an initial stroke or transient ischemic attack — dietary modification , exercise , aspirin , a statin , and an antihypertensive agent — could result in a cumulative relative risk reduction of 80 % . Given a 5-year major cardiovascular event rate of 24 % , this translates to a number needed to treat of about 5 . Further gains would result from applying multimodality therapy over longer intervals and enriching the base strategy with dual antiplatelet therapy , high-dose statins , and more intensive blood pressure – lowering . Even more benefit would be present in high-risk subgroups with the addition , where appropriate , of carotid endarterectomy , moderate intensity oral anticoagulants , glycemic control , and smoking cessation . Conclusions — At least four-fifths of recurrent vascular events in patients with cerebrovascular disease might be prevented by application of a comprehensive , multifactorial approach Objective : To evaluate risk factor reduction and health-related quality of life following a 10-week cardiac rehabilitation programme in non-acute ischaemic stroke subjects . Design : Single-blinded r and omized control trial . Setting : Outpatient rehabilitation . Subjects : Forty-eight community-dwelling ischaemic stroke patients ( 38 independently mobile , 9 requiring assistance , 1 non-ambulatory ) were r and omly assigned to intervention or control groups by concealed allocation . Intervention : The trial consisted of a 10-week schedule with measures taken at weeks 1 and 10 . Both groups continued usual care ( excluding aerobic exercise ) ; intervention subjects attended 16 cycle ergometry sessions of aerobic-training intensity and two stress-management classes . Main outcome measures : Cardiac risk score ( CRS ) ; VO2 ( mL O2/kg per minute ) and Borg Rate of Perceived Exertion ( RPE ) assessed during a st and ardized ergometry test ; Hospital Anxiety and Depression Scale ( HADS ) ; Frenchay Activity Index ; Fasting Lipid Profiles and Resting Blood Pressure . Results : Group comparison with independent t-tests showed significantly greater improvement at follow-up by intervention subjects than controls in VO2 ( intervention 10.6 ±1.6 to 12.0 ± 2.2 , control 11.1 ±1.8 to 11.1 ±1.9 t=4.734 , P<0.001 ) and CRS ( intervention 13.4 ±10.1 to 12.4 ±10.5 , control 9.4 ±6.7 to 15.0 ±6.1 t=-2.537 , P<0.05 ) . RPE rating decreased in intervention subjects ( 13.4 ±12.2 to 12.4 ±2.0 ) and increased in controls ( 13.8 ±1.8 to 14.4 ±1.6 ) ; Mann — Whitney U ( U = 173.5 , P<0.05 ) . Within-group comparison showed significant decrease in the HADS depression subscale in the intervention group alone ( 5.1 ±3.4 to 3.0 ±2.8 ) ( Wilcoxon signed ranks test Z=-3.278 , P<0.001 ) . Conclusion : Preliminary findings suggest non-acute ischaemic stroke patients can improve their cardiovascular fitness and reduce their CRS with a cardiac rehabilitation programme . The intervention was associated with improvement in self-reported depression INTRODUCTION AND OBJECTIVES To assess the efficacy of a comprehensive program of secondary prevention of cardiovascular disease in general practice . METHODS A cluster r and omized clinical trial was carried out in a regular general practice setting . Male and female patients aged under 86 years with a diagnosis of ischemic heart disease , stroke or peripheral artery disease were recruited between January 2004 and May 2005 . Study participants were seen at 42 health centers throughout the whole of Spain . The primary endpoint was the combination of all-cause mortality and hospital cardiovascular readmission at 3-year follow-up . RESULTS In total , 1224 patients were recruited : 624 in the intervention group and 600 in the control group . The primary endpoint was observed in 29.9 % ( 95 % confidence interval [ CI ] , 25.5 - 34.8 % ) in the intervention group and 25.6 % ( 22.3 - 29.2 % ) in the control group ( P=.15 ) . At the end of follow-up , 8.5 % ( 6.3 - 11.3 % ) in the intervention group and 11 % ( 7.4 - 16 % ) in the control group were smokers ( P=.07 ) . The mean waist circumference of patients in the intervention and control groups was 100.44 cm ( 95 % CI , 98.97 - 101.91 cm ) and 102.58 cm ( 95 % CI , 100.96 - 104.21 cm ) , respectively ( P=.07 ) . Overall , 20.9 % ( 15.6 - 27.7 % ) of patients in the intervention group and 29.6 % ( 23.9 - 36.1 % ) in the control group suffered from anxiety ( P=.05 ) , and 29.6 % ( 22.4 - 37.9 % ) in the intervention group and 41.4 % ( 35.8 - 47.3 % ) in the control group had depression ( P=.02 ) . CONCLUSIONS A comprehensive program of secondary prevention of cardiovascular disease in general 
    Output:
    
agent
Similar results were reported for total cholesterol .
Blood pressure reductions were noted but were non-significant when corrected for multimodal packages including enhanced pharmacotherapy compliance .
Conclusions There is currently insufficient high quality research to support lifestyle interventions post-stroke or TIA on mortality , CVD event rates and cardio-metabolic risk factor profiles .
Promising blood pressure reductions were noted in multimodal interventions which addressed lifestyle
***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: 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 Background and Purpose — The SPARCL trial showed that atorvastatin 80 mg/d reduces the risk of stroke and other cardiovascular events in patients with recent stroke or transient ischemic attack ( TIA ) . We tested the hypothesis that the benefit of treatment varies according to index event stroke subtype . Methods — Subjects with stroke or TIA without known coronary heart disease were r and omized to atorvastatin 80 mg/d or placebo .  The SPARCL primary end point was fatal or nonfatal stroke . Secondary end points included major cardiovascular events ( MCVE ; stroke plus major coronary events ) . Cox regression models testing for an interaction with treatment assignment were used to explore potential differences in efficacy based on stroke subtype . Results — For subjects r and omized to atorvastatin versus placebo  , a primary end point occurred in 13.1 % versus 18.6 % of those classified as having large vessel disease ( LVD , 15.8 % of 4,731 participants ) , in 13.1 % versus 15.5 % of those with small vessel disease ( SVD , 29.8 % ) , in 11.2 % versus 12.7 % of those with ischemic stroke of unknown cause ( 21.5 % ) , in 7.6 % versus 8.8 % of those with TIA ( 30.9 % ) , and in 22.2 % versus 8.3 % of those with hemorrhagic stroke ( HS , 2 % ) at baseline . There was no difference in the efficacy of treatment for either the primary end point ( LVD hazard ratio [ HR ] 0.70 , 95 % confidence interval [ CI ] 0.49 to 1.02 , TIA HR 0.81 , CI 0.57 to 1.17 , SVD HR 0.85 , CI 0.64 to 1.12 , unknown cause HR 0.87 , CI 0.61 to 1.24 , HS HR 3.24 , CI 1.01 to 10.4 ; P for heterogeneity=0.421 ) , or MCVEs ( P for heterogeneity=0.360 ) based on subtype of the index event . As compared to subjects with LVD strokes , those with SVD had similar MCVE rates ( 19.2 % versus 18.5 % over the course of the trial ) , and similar overall reductions in stroke and MCVEs . Conclusions — Atorvastatin 80 mg/d is similarly efficacious in preventing strokes and other cardiovascular events , irrespective of baseline ischemic stroke subtype Objective : Despite evidence demonstrating that risk-factor management is effective in reducing recurrent cerebrovascular disease , there are very few structured care programmes for stroke survivors . The aim was to implement and evaluate an integrated care programme in stroke . Methods : 186 patients with stroke were r and omised to either the treatment ( integrated care ) or control ( usual care ) group and were followed up over 12 months . The Integrated Care for the Reduction of Secondary Stroke ( ICARUSS ) model of integrated care involved collaboration between a specialist stroke service , a hospital coordinator and a patient ’s general practitioner . The primary aim was to promote the management of vascular risk factors through ongoing patient contact and education . Results : In the 12 months poststroke , systolic blood pressure ( sBP ) decreased in the treatment group but increased in controls . The group difference was significant , and remained so when age , sex , disability and sBP at discharge were accounted for ( p = 0.04 ) . Treatment patients also exhibited better modification of body mass index ( p = 0.007 ) and number of walks taken ( p<0.001 ) than controls . Rankin scores indicated significantly reduced disability in treatment patients relative to controls in the year poststroke ( p = 0.003 ) . Conclusions : Through an integrated system of education , advice and support to both patient and GP , the ICARUSS model was effective in modifying a variety of vascular risk factors and therefore should decrease the likelihood or recurrent stroke or vascular event Objectives To investigate if repeated verbal instructions about physical activity to patients with ischaemic stroke could increase long term physical activity . Design Multicentre , multinational , r and omised clinical trial with masked outcome assessment . Setting Stroke units in Denmark , China , Pol and , and Estonia . Participants 314 patients with ischaemic stroke aged ≥40 years who were able to walk—157 ( mean age 69.7 years ) r and omised to the intervention , 157 ( mean age 69.4 years ) in the control group . Interventions Patients r and omised to the intervention were instructed in a detailed training programme before discharge and at five follow-up visits during 24 months . Control patients had follow-up visits with the same frequency but without instructions in physical activity . Main outcome measures Physical activity assessed with the Physical Activity Scale for the Elderly ( PASE ) at each visit . Secondary outcomes were clinical events . Results The estimated mean PASE scores were 69.1 in the intervention group and 64.0 in the control group ( difference 5.0 ( 95 % confidence interval −5.8 to 15.9 ) , P=0.36 . The intervention had no significant effect on mortality , recurrent stroke , myocardial infa rct ion , or falls and fractures . Conclusion Repeated encouragement and verbal instruction in being physically active did not lead to a significant increase in physical activity measured by the PASE score . More intensive strategies seem to be needed to promote physical activity after ischaemic stroke . Trial registration Clinical Trials Background and Purpose — Numerous effective strategies for the secondary prevention of cardiovascular events in high-risk patients have now been established . We sought to calculate the cumulative benefit of combining multiple strategies for preventing recurrent events in patients with a history of ischemic stroke or transient ischemic attack . Methods — A comprehensive literature search was undertaken to identify meta-analyses of r and omized controlled trials reporting on the efficacy of secondary prevention strategies . The baseline incidence of vascular events was modeled from the Life Long After Cerebral Ischemia study . Strategies were combined on a multiplicative scale and cumulative risk reductions were computed over a 5-year interval . Results — The combination of 5 proven strategies applied to survivors of an initial stroke or transient ischemic attack — dietary modification , exercise , aspirin , a statin , and an antihypertensive agent — could result in a cumulative relative risk reduction of 80 % . Given a 5-year major cardiovascular event rate of 24 % , this translates to a number needed to treat of about 5 . Further gains would result from applying multimodality therapy over longer intervals and enriching the base strategy with dual antiplatelet therapy , high-dose statins , and more intensive blood pressure – lowering . Even more benefit would be present in high-risk subgroups with the addition , where appropriate , of carotid endarterectomy , moderate intensity oral anticoagulants , glycemic control , and smoking cessation . Conclusions — At least four-fifths of recurrent vascular events in patients with cerebrovascular disease might be prevented by application of a comprehensive , multifactorial approach Objective : To evaluate risk factor reduction and health-related quality of life following a 10-week cardiac rehabilitation programme in non-acute ischaemic stroke subjects . Design : Single-blinded r and omized control trial . Setting : Outpatient rehabilitation . Subjects : Forty-eight community-dwelling ischaemic stroke patients ( 38 independently mobile , 9 requiring assistance , 1 non-ambulatory ) were r and omly assigned to intervention or control groups by concealed allocation . Intervention : The trial consisted of a 10-week schedule with measures taken at weeks 1 and 10 . Both groups continued usual care ( excluding aerobic exercise ) ; intervention subjects attended 16 cycle ergometry sessions of aerobic-training intensity and two stress-management classes . Main outcome measures : Cardiac risk score ( CRS ) ; VO2 ( mL O2/kg per minute ) and Borg Rate of Perceived Exertion ( RPE ) assessed during a st and ardized ergometry test ; Hospital Anxiety and Depression Scale ( HADS ) ; Frenchay Activity Index ; Fasting Lipid Profiles and Resting Blood Pressure . Results : Group comparison with independent t-tests showed significantly greater improvement at follow-up by intervention subjects than controls in VO2 ( intervention 10.6 ±1.6 to 12.0 ± 2.2 , control 11.1 ±1.8 to 11.1 ±1.9 t=4.734 , P<0.001 ) and CRS ( intervention 13.4 ±10.1 to 12.4 ±10.5 , control 9.4 ±6.7 to 15.0 ±6.1 t=-2.537 , P<0.05 ) . RPE rating decreased in intervention subjects ( 13.4 ±12.2 to 12.4 ±2.0 ) and increased in controls ( 13.8 ±1.8 to 14.4 ±1.6 ) ; Mann — Whitney U ( U = 173.5 , P<0.05 ) . Within-group comparison showed significant decrease in the HADS depression subscale in the intervention group alone ( 5.1 ±3.4 to 3.0 ±2.8 ) ( Wilcoxon signed ranks test Z=-3.278 , P<0.001 ) . Conclusion : Preliminary findings suggest non-acute ischaemic stroke patients can improve their cardiovascular fitness and reduce their CRS with a cardiac rehabilitation programme . The intervention was associated with improvement in self-reported depression INTRODUCTION AND OBJECTIVES To assess the efficacy of a comprehensive program of secondary prevention of cardiovascular disease in general practice . METHODS A cluster r and omized clinical trial was carried out in a regular general practice setting . Male and female patients aged under 86 years with a diagnosis of ischemic heart disease , stroke or peripheral artery disease were recruited between January 2004 and May 2005 . Study participants were seen at 42 health centers throughout the whole of Spain . The primary endpoint was the combination of all-cause mortality and hospital cardiovascular readmission at 3-year follow-up . RESULTS In total , 1224 patients were recruited : 624 in the intervention group and 600 in the control group . The primary endpoint was observed in 29.9 % ( 95 % confidence interval [ CI ] , 25.5 - 34.8 % ) in the intervention group and 25.6 % ( 22.3 - 29.2 % ) in the control group ( P=.15 ) . At the end of follow-up , 8.5 % ( 6.3 - 11.3 % ) in the intervention group and 11 % ( 7.4 - 16 % ) in the control group were smokers ( P=.07 ) . The mean waist circumference of patients in the intervention and control groups was 100.44 cm ( 95 % CI , 98.97 - 101.91 cm ) and 102.58 cm ( 95 % CI , 100.96 - 104.21 cm ) , respectively ( P=.07 ) . Overall , 20.9 % ( 15.6 - 27.7 % ) of patients in the intervention group and 29.6 % ( 23.9 - 36.1 % ) in the control group suffered from anxiety ( P=.05 ) , and 29.6 % ( 22.4 - 37.9 % ) in the intervention group and 41.4 % ( 35.8 - 47.3 % ) in the control group had depression ( P=.02 ) . CONCLUSIONS A comprehensive program of secondary prevention of cardiovascular disease in general 
    Output:
    