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: The aim of this study was to assess the effectiveness of a 24-week exercise protocol carried out in geothermal spring water to improve overall physical function and muscle mass in a group of healthy elderly subjects . A further aim was to compare this water-based protocol with a l and -based protocol and a control group . For this purpose , 59 subjects were recruited and r and omly allocated to three groups : aquatic group ( AG ) , l and group ( LG ) , and control group ( CG ) . AG and LG followed a 6-month , twice-weekly , multimodality exercise intervention . AG underwent the protocol in hot-spring water ( 36 ° C ) while LG did it in a l and -based environment . After the intervention , knee-extension strength was maintained in AG and LG . The 8-foot up- and -go test showed a reduction in both exercise groups ( AG −19.3 % , P < 0.05 ; LG −12.6 % , P < 0.05 ) , with a significantly greater decrease in AG . The back-scratch test revealed an improvement only in AG ( 25.8 % ; P < 0.05 ) , while the sit- and -reach test improved in all groups . Finally , AG reduced fat mass by 4 % ( P < 0.05 ) , and dominant forearm fat decreased by 9.2 % ( P < 0.05 ) . In addition , calf muscle density increased by 1.8 % ( P < 0.05 ) . In summary , both water- and l and -based activities were beneficial in maintaining strength and in improving lower-body flexibility . Aquatic exercise appeared a better activity to improve dynamic balance . Thermal swimming pools and the use of rating of perceived exertion as a method of exercise monitoring should be considered potentially useful tools to enhance physical performance and body composition in healthy elderly CONTEXT The Consoli date d St and ards for Reporting of Trials ( CONSORT ) statement was developed to help improve the quality of reports of r and omized controlled trials ( RCTs ) . To date , a paucity of data exists regarding whether it has achieved this goal . OBJECTIVE To determine whether use of the CONSORT statement is associated with improvement in the quality of reports of RCTs . DESIGN AND SETTING Comparative before- and -after evaluation in which reports of RCTs published in 1994 ( pre-CONSORT ) were compared with RCT reports from the same journals published in 1998 ( post-CONSORT ) . We included 211 reports from BMJ , JAMA , and The Lancet ( journals that adopted CONSORT ) as well as The New Engl and Journal of Medicine ( a journal that did not adopt CONSORT and was used as a comparator ) . MAIN OUTCOME MEASURES Number of CONSORT items included in a report , frequency of unclear reporting of allocation concealment , and overall trial quality score based on the Jadad scale , a 5-point quality assessment instrument . RESULTS Compared with 1994 , the number of CONSORT checklist items in reports of RCTs increased in all 4 journals in 1998 , and this increase was statistically significant for the 3 adopter journals ( pre-CONSORT , 23.4 ; mean change , 3.7 ; 95 % confidence interval [ CI ] , 2.1 - 5.3 ) . The frequency of unclear reporting of allocation concealment decreased for each of the 4 journals , and this change was statistically significant for adopters ( pre-CONSORT , 61 % ; mean change , -22 % ; 95 % CI , -38 % to -6 % ) . Similarly , 3 of the 4 journals showed an improvement in the quality score for reports of RCTs , and this increase was statistically significant for adopter journals overall ( pre-CONSORT , 2.7 ; mean change , 0.4 ; 95 % CI , 0.1 - 0.8 ) . CONCLUSION Use of the CONSORT statement is associated with improvements in the quality of reports of RCTs The aim of the present study was to evaluate the effects of an AAG on BMD , osteocalcin and functional autonomy in older women . The sample consisted of eighty-two post-menopausal women with low BMD , r and omly divided into two groups : the Aquatic Aerobics Group [ AAG ; n=42 ; age : 66.8±4.2years ] , su bmi tted to two weekly sessions over eight months , and the  Control Group ( GC ; n=42 ; age : 66.9±3.2years ) , which did not participate in regular exercise . BMD was measured by  Dual Energy X-ray Absorptiometry [ DXA ] of the lumbar and femur , and serum osteocalcin was measured using electrochemiluminescence . A functional autonomy assessment protocol ( GDLAM , 2004 ) was also applied . Statistical analyses used were repeated measures ANOVA and Tukey 's post hoc tests . The results showed a significant improvement in tests following the GDLAM protocol : 10 meters walk ( 10mw ) -p=0.003 ; rising from a ventral decubitus position ( RVDP ) - Δ%=0.78 , p<0.001 ; rising from a chair and moving around the house ( RCMH ) -p<0.001 and autonomy index ( AI ) -p=0.007 , with more favorable results observed in the AAG when compared to the CG . The AAG achieved the best results for BMD ; however , no inter or intragroup statistical differences were recorded for total femur -p=0.975 and lumbar L(2)-L(4)p=0.597 . For serum osteocalcin , intra and intergroup statistical differences of p=0.042 and p=0.027 were observed in the AAG , respectively . This demonstrates that an eight-month aquatic aerobic exercise program can improve functional autonomy and osteocalcin levels , although training did not improve lumbar and total femur BMD in the older women [ Purpose ] The purpose of the present study was to examine the effects of an aqua aerobic therapy exercise for older adults on biomechanical and physiological factors affecting gait . [ Subjects ] A total of 15 subjects participated in this study and they were r and omly divided into the experimental and the control group . [ Methods ] Physiological variables , leg strength , power and flexibility , and biomechanical variables , both kinematic and kinetic , were measured before and after the aqua aerobic therapy exercise . Each subject was instructed to walk along an elevated walkway and during the trials a trapdoor opened at r and om to create a 10 cm falling perturbation . Full body motion and kinetics was gathered during the gait . [ Results ] There were significant reductions in body weight , and body fat mass , and stride time after the perturbation . Significant increases in leg strength corresponded to the maximum joint moment of the l and ing leg showing that the subjects ' ability for recovery of balance after the perturbation improved . [ Conclusion ] As the results showed significant improvements in gait pattern and recovery time after perturbed gait , we conclude that aqua aerobic therapy is an effective exercise method for training older adults to reduce their risk of falling This study evaluated the effects of a water exercise training program that includes perturbation exercises ( WEP ) to improve the speed of voluntary stepping reaction in older adults .  Speed of voluntary stepping considered as an important skill to prevent a fall when balance is lost . In a single-blinded r and omized controlled trial with a crossover design thirty-six independent old adults ( 64 - 88 years old ) were divided into two groups . Group A received WEP for the first 12 weeks , followed by no intervention for the second 12 weeks . Group B did not receive intervention for the first 12 weeks and received WEP for the second 12 weeks . Voluntary Step Execution Test and postural stability in upright st and ing ( eyes open and closed conditions ) were measured at baseline , 12 weeks , and 24 weeks . A significant interaction effect between group and time was found for the step execution , due to improvement in initiation phase and swing phase duration s in the WEP group . Also significant improvement in postural stability parameters in eyes open and closed conditions is noted . The present results indicate that the primary benefit of WEP that include perturbations to induce stepping , was a reduction in voluntary stepping times . The WEP generalized to a better control of balance in up-right st and ing OBJECTIVE To analyze the effects of a water-based exercise program on peak torque ( PT ) and rate of torque development ( RTD ) during maximal voluntary ballistic isometric contractions of the lower limb muscles and the performance of a number of functional tests in the elderly . METHOD Thirty-seven elderly were r and omly assigned to water-based training ( 3 d/wk for 12 wk ) or a control group .  Extensor and flexor PT and RTD of the ankle , knee , and hip joints and functional tests were evaluated before and after training . RESULTS PT increased after training for the hip flexors ( 18 % ) and extensors ( 40 % ) and the plantar-flexor ( 42 % ) muscles in the water-based group . RTD increased after training for the hip-extensor ( 10 % ) , knee-extensor ( 11 % ) , and ankle plantar-flexor ( 27 % ) muscles in the water-based group . Functional tests also improved after training in the water-based group ( p < .05 ) . CONCLUSION The water-based program improved PT and RTD and functional performance in the elderly UNLABELLED Aging of the worldwide population is a concern of most governmental entities , spanning practically all areas of prevention and rehabilitation . Aging leads to physiological alterations that result in adverse social and financial effects . There is a trend to emphasize prevention , which is less expensive and socially more desirable than therapeutic intervention . PURPOSE To assess the effect of a program of aquatic versus non-aquatic respiratory exercises on respiratory muscle strength in healthy aged persons . METHODS The respiratory muscle strength was measured in 81 subjects between 60 and 65 years , 59 of which completed the program . Subjects were r and omized into 3 groups . G(aquatic ) undertook a program of respiratory exercise in an aquatic environment . G(non-aquatic ) undertook the same program in a non-aquatic environment . G(control ) acted as the negative control . Programs were applied three times a week for 10 consecutive weeks . Subsequently , subjects were reevaluated , and results compared to each individual 's pre-treatment own result and between the groups . The data were statistically analyzed using the paired t test and the Sign test . Comparisons between the groups were performed through parametric and nonparametric variance . A comparison of G(aquatic ) and G(non-aquatic ) versus G(control ) was performed using the Dunnett test . RESULTS A significant improvement in the inspiratory muscle strength in the G(aquatic ) group compared to the G(control ) , group was found , suggesting beneficial effects mediated by the aquatic exercise . The expiratory muscles did not show significant alterations . CONCLUSION Aquatic respiratory exercise improves the inspiratory muscle strength of healthy aged persons . However , neither aquatic nor non-aquatic respiratory exercise influences the expiratory muscle strength BACKGROUND Aging compromises the ability of the central nervous system to maintain body balance and reduces the capacity for adaptive reactions . To prevent falls , the reception conditions for sensory information need to be improved . OBJECTIVES To evaluate the impact of a structured aquatic and a non-aquatic exercise program for lower-limb muscle endurance on the static and dynamic balance of elderly people . METHODS This was a prospect i ve r and omized clinical study in which the variables were assessed before and after the training program . Thirty-six elderly people were evaluated using four tests : the Berg Balance Scale , Dynamic Gait Index , gait speed and t and em gait . The participants were r and omized into three groups : aquatic exercise group , non-aquatic exercise group and control group . The exercise groups underwent a program for lower-limb muscle endurance that consisted of 40-minute sessions twice a week for six weeks . The participants were reevaluated after six weeks . The data were analyzed statistically using the univariate ANOVA test for comparisons between the groups before and after the intervention . RESULTS The program for lower-limb muscle endurance significantly increased balance ( p<0.05 ) in the evaluation tests after the training program . CONCLUSION The muscle endurance program provided a significant improvement in static and dynamic balance among community-dwelling elderly people . It was also possible to infer that this improvement occurred regardless of the environment , i.e. aquatic or non-aquatic . Article registered in the Australian New Zeal and Clinical Trials Registry ( ANZCTR ) under the number ACTRN 12609000780257 Objective This study aims to investigate the effects of an aquatic exercise program ( HydrOS ) on neuromuscular function and falls among postmenopausal women . Methods One hundred eight postmenopausal women ( mean [ SD ] age , 58.8 [ 6.4 ] y ) were r and omly divided into the  control group ( CG ; n = 44 ) and the  aquatic exercise group  ( AEG ; n = 64 ) . Both groups received elementary calcium 500 mg/day and cholecalciferol 1,000 IU/day . For 24 weeks , the AEG participated in the aquatic exercise program , whereas the CG remained sedentary . The following variables were measured before and after the program : number of falls and fallers ( 7 mo before and after the intervention ) ; flexibility , using Wells ’ Sit- and -Reach Test ( FLEX ) ; static balance , using the Unipedal Stance Test ( UST ) ; mobility , using the Timed-Up- and -Go test ( TUG ) ; h and grip strength of the dominant h and ( HGS ) ; and maximal isometric strength of back extensor muscles ( SBE ) , strength of hip flexor muscles ( SHF ) , and strength of knee extensor muscles ( SKE ) . The muscle strength tests were considered the primary outcome , whereas the other neuromuscular tests , together with falls , were considered secondary outcomes . 
    Output:
    
agent
AE may improve physical functioning in healthy older people and is at least as effective as LE
***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: The aim of this study was to assess the effectiveness of a 24-week exercise protocol carried out in geothermal spring water to improve overall physical function and muscle mass in a group of healthy elderly subjects . A further aim was to compare this water-based protocol with a l and -based protocol and a control group . For this purpose , 59 subjects were recruited and r and omly allocated to three groups : aquatic group ( AG ) , l and group ( LG ) , and control group ( CG ) . AG and LG followed a 6-month , twice-weekly , multimodality exercise intervention . AG underwent the protocol in hot-spring water ( 36 ° C ) while LG did it in a l and -based environment . After the intervention , knee-extension strength was maintained in AG and LG . The 8-foot up- and -go test showed a reduction in both exercise groups ( AG −19.3 % , P < 0.05 ; LG −12.6 % , P < 0.05 ) , with a significantly greater decrease in AG . The back-scratch test revealed an improvement only in AG ( 25.8 % ; P < 0.05 ) , while the sit- and -reach test improved in all groups . Finally , AG reduced fat mass by 4 % ( P < 0.05 ) , and dominant forearm fat decreased by 9.2 % ( P < 0.05 ) . In addition , calf muscle density increased by 1.8 % ( P < 0.05 ) . In summary , both water- and l and -based activities were beneficial in maintaining strength and in improving lower-body flexibility . Aquatic exercise appeared a better activity to improve dynamic balance . Thermal swimming pools and the use of rating of perceived exertion as a method of exercise monitoring should be considered potentially useful tools to enhance physical performance and body composition in healthy elderly CONTEXT The Consoli date d St and ards for Reporting of Trials ( CONSORT ) statement was developed to help improve the quality of reports of r and omized controlled trials ( RCTs ) . To date , a paucity of data exists regarding whether it has achieved this goal . OBJECTIVE To determine whether use of the CONSORT statement is associated with improvement in the quality of reports of RCTs . DESIGN AND SETTING Comparative before- and -after evaluation in which reports of RCTs published in 1994 ( pre-CONSORT ) were compared with RCT reports from the same journals published in 1998 ( post-CONSORT ) . We included 211 reports from BMJ , JAMA , and The Lancet ( journals that adopted CONSORT ) as well as The New Engl and Journal of Medicine ( a journal that did not adopt CONSORT and was used as a comparator ) . MAIN OUTCOME MEASURES Number of CONSORT items included in a report , frequency of unclear reporting of allocation concealment , and overall trial quality score based on the Jadad scale , a 5-point quality assessment instrument . RESULTS Compared with 1994 , the number of CONSORT checklist items in reports of RCTs increased in all 4 journals in 1998 , and this increase was statistically significant for the 3 adopter journals ( pre-CONSORT , 23.4 ; mean change , 3.7 ; 95 % confidence interval [ CI ] , 2.1 - 5.3 ) . The frequency of unclear reporting of allocation concealment decreased for each of the 4 journals , and this change was statistically significant for adopters ( pre-CONSORT , 61 % ; mean change , -22 % ; 95 % CI , -38 % to -6 % ) . Similarly , 3 of the 4 journals showed an improvement in the quality score for reports of RCTs , and this increase was statistically significant for adopter journals overall ( pre-CONSORT , 2.7 ; mean change , 0.4 ; 95 % CI , 0.1 - 0.8 ) . CONCLUSION Use of the CONSORT statement is associated with improvements in the quality of reports of RCTs The aim of the present study was to evaluate the effects of an AAG on BMD , osteocalcin and functional autonomy in older women . The sample consisted of eighty-two post-menopausal women with low BMD , r and omly divided into two groups : the Aquatic Aerobics Group [ AAG ; n=42 ; age : 66.8±4.2years ] , su bmi tted to two weekly sessions over eight months , and the  Control Group ( GC ; n=42 ; age : 66.9±3.2years ) , which did not participate in regular exercise . BMD was measured by  Dual Energy X-ray Absorptiometry [ DXA ] of the lumbar and femur , and serum osteocalcin was measured using electrochemiluminescence . A functional autonomy assessment protocol ( GDLAM , 2004 ) was also applied . Statistical analyses used were repeated measures ANOVA and Tukey 's post hoc tests . The results showed a significant improvement in tests following the GDLAM protocol : 10 meters walk ( 10mw ) -p=0.003 ; rising from a ventral decubitus position ( RVDP ) - Δ%=0.78 , p<0.001 ; rising from a chair and moving around the house ( RCMH ) -p<0.001 and autonomy index ( AI ) -p=0.007 , with more favorable results observed in the AAG when compared to the CG . The AAG achieved the best results for BMD ; however , no inter or intragroup statistical differences were recorded for total femur -p=0.975 and lumbar L(2)-L(4)p=0.597 . For serum osteocalcin , intra and intergroup statistical differences of p=0.042 and p=0.027 were observed in the AAG , respectively . This demonstrates that an eight-month aquatic aerobic exercise program can improve functional autonomy and osteocalcin levels , although training did not improve lumbar and total femur BMD in the older women [ Purpose ] The purpose of the present study was to examine the effects of an aqua aerobic therapy exercise for older adults on biomechanical and physiological factors affecting gait . [ Subjects ] A total of 15 subjects participated in this study and they were r and omly divided into the experimental and the control group . [ Methods ] Physiological variables , leg strength , power and flexibility , and biomechanical variables , both kinematic and kinetic , were measured before and after the aqua aerobic therapy exercise . Each subject was instructed to walk along an elevated walkway and during the trials a trapdoor opened at r and om to create a 10 cm falling perturbation . Full body motion and kinetics was gathered during the gait . [ Results ] There were significant reductions in body weight , and body fat mass , and stride time after the perturbation . Significant increases in leg strength corresponded to the maximum joint moment of the l and ing leg showing that the subjects ' ability for recovery of balance after the perturbation improved . [ Conclusion ] As the results showed significant improvements in gait pattern and recovery time after perturbed gait , we conclude that aqua aerobic therapy is an effective exercise method for training older adults to reduce their risk of falling This study evaluated the effects of a water exercise training program that includes perturbation exercises ( WEP ) to improve the speed of voluntary stepping reaction in older adults .  Speed of voluntary stepping considered as an important skill to prevent a fall when balance is lost . In a single-blinded r and omized controlled trial with a crossover design thirty-six independent old adults ( 64 - 88 years old ) were divided into two groups . Group A received WEP for the first 12 weeks , followed by no intervention for the second 12 weeks . Group B did not receive intervention for the first 12 weeks and received WEP for the second 12 weeks . Voluntary Step Execution Test and postural stability in upright st and ing ( eyes open and closed conditions ) were measured at baseline , 12 weeks , and 24 weeks . A significant interaction effect between group and time was found for the step execution , due to improvement in initiation phase and swing phase duration s in the WEP group . Also significant improvement in postural stability parameters in eyes open and closed conditions is noted . The present results indicate that the primary benefit of WEP that include perturbations to induce stepping , was a reduction in voluntary stepping times . The WEP generalized to a better control of balance in up-right st and ing OBJECTIVE To analyze the effects of a water-based exercise program on peak torque ( PT ) and rate of torque development ( RTD ) during maximal voluntary ballistic isometric contractions of the lower limb muscles and the performance of a number of functional tests in the elderly . METHOD Thirty-seven elderly were r and omly assigned to water-based training ( 3 d/wk for 12 wk ) or a control group .  Extensor and flexor PT and RTD of the ankle , knee , and hip joints and functional tests were evaluated before and after training . RESULTS PT increased after training for the hip flexors ( 18 % ) and extensors ( 40 % ) and the plantar-flexor ( 42 % ) muscles in the water-based group . RTD increased after training for the hip-extensor ( 10 % ) , knee-extensor ( 11 % ) , and ankle plantar-flexor ( 27 % ) muscles in the water-based group . Functional tests also improved after training in the water-based group ( p < .05 ) . CONCLUSION The water-based program improved PT and RTD and functional performance in the elderly UNLABELLED Aging of the worldwide population is a concern of most governmental entities , spanning practically all areas of prevention and rehabilitation . Aging leads to physiological alterations that result in adverse social and financial effects . There is a trend to emphasize prevention , which is less expensive and socially more desirable than therapeutic intervention . PURPOSE To assess the effect of a program of aquatic versus non-aquatic respiratory exercises on respiratory muscle strength in healthy aged persons . METHODS The respiratory muscle strength was measured in 81 subjects between 60 and 65 years , 59 of which completed the program . Subjects were r and omized into 3 groups . G(aquatic ) undertook a program of respiratory exercise in an aquatic environment . G(non-aquatic ) undertook the same program in a non-aquatic environment . G(control ) acted as the negative control . Programs were applied three times a week for 10 consecutive weeks . Subsequently , subjects were reevaluated , and results compared to each individual 's pre-treatment own result and between the groups . The data were statistically analyzed using the paired t test and the Sign test . Comparisons between the groups were performed through parametric and nonparametric variance . A comparison of G(aquatic ) and G(non-aquatic ) versus G(control ) was performed using the Dunnett test . RESULTS A significant improvement in the inspiratory muscle strength in the G(aquatic ) group compared to the G(control ) , group was found , suggesting beneficial effects mediated by the aquatic exercise . The expiratory muscles did not show significant alterations . CONCLUSION Aquatic respiratory exercise improves the inspiratory muscle strength of healthy aged persons . However , neither aquatic nor non-aquatic respiratory exercise influences the expiratory muscle strength BACKGROUND Aging compromises the ability of the central nervous system to maintain body balance and reduces the capacity for adaptive reactions . To prevent falls , the reception conditions for sensory information need to be improved . OBJECTIVES To evaluate the impact of a structured aquatic and a non-aquatic exercise program for lower-limb muscle endurance on the static and dynamic balance of elderly people . METHODS This was a prospect i ve r and omized clinical study in which the variables were assessed before and after the training program . Thirty-six elderly people were evaluated using four tests : the Berg Balance Scale , Dynamic Gait Index , gait speed and t and em gait . The participants were r and omized into three groups : aquatic exercise group , non-aquatic exercise group and control group . The exercise groups underwent a program for lower-limb muscle endurance that consisted of 40-minute sessions twice a week for six weeks . The participants were reevaluated after six weeks . The data were analyzed statistically using the univariate ANOVA test for comparisons between the groups before and after the intervention . RESULTS The program for lower-limb muscle endurance significantly increased balance ( p<0.05 ) in the evaluation tests after the training program . CONCLUSION The muscle endurance program provided a significant improvement in static and dynamic balance among community-dwelling elderly people . It was also possible to infer that this improvement occurred regardless of the environment , i.e. aquatic or non-aquatic . Article registered in the Australian New Zeal and Clinical Trials Registry ( ANZCTR ) under the number ACTRN 12609000780257 Objective This study aims to investigate the effects of an aquatic exercise program ( HydrOS ) on neuromuscular function and falls among postmenopausal women . Methods One hundred eight postmenopausal women ( mean [ SD ] age , 58.8 [ 6.4 ] y ) were r and omly divided into the  control group ( CG ; n = 44 ) and the  aquatic exercise group  ( AEG ; n = 64 ) . Both groups received elementary calcium 500 mg/day and cholecalciferol 1,000 IU/day . For 24 weeks , the AEG participated in the aquatic exercise program , whereas the CG remained sedentary . The following variables were measured before and after the program : number of falls and fallers ( 7 mo before and after the intervention ) ; flexibility , using Wells ’ Sit- and -Reach Test ( FLEX ) ; static balance , using the Unipedal Stance Test ( UST ) ; mobility , using the Timed-Up- and -Go test ( TUG ) ; h and grip strength of the dominant h and ( HGS ) ; and maximal isometric strength of back extensor muscles ( SBE ) , strength of hip flexor muscles ( SHF ) , and strength of knee extensor muscles ( SKE ) . The muscle strength tests were considered the primary outcome , whereas the other neuromuscular tests , together with falls , were considered secondary outcomes . 
    Output:
    