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 —Whether cardiac rehabilitation ( CR ) is effective in patients older than 75 years , who have been excluded from most trials , remains unclear . We enrolled patients 46 to 86 years old in a r and omized trial and assessed the effects of 2 months of post-myocardial infa rct ion ( MI ) CR  on total work capacity ( TWC , in kilograms per meter ) and health-related quality of life ( HRQL ) . Methods and Results —Of 773 screened patients , 270 without cardiac failure , dementia , disability , or contraindications to exercise were r and omized to outpatient , hospital-based CR ( Hosp-CR ) , home-based CR ( Home-CR ) , or no CR within 3 predefined age groups ( middle-aged , 45 to 65 years ; old , 66 to 75 years ; and very old , > 75 years ) of 90 patients each .  TWC and HRQL were determined with cycle ergometry and Sickness Impact Profile at baseline , after CR , and 6 and 12 months later . Within each age group , TWC improved with Hosp-CR and Home-CR and was unchanged with no CR . The improvement was similar in middle-aged and old persons but smaller , although still significant , in very old patients . TWC reverted toward baseline by 12 months with Hosp-CR but not with Home-CR .  HRQL improved in middle-aged and old CR and control patients but only with CR in very old patients . Complications were similar across treatment and age groups . Costs were lower for Home-CR than for Hosp-CR . Conclusions —Post-MI Hosp-CR and Home-CR are similarly effective in the short term and improve TWC and HRQL in each age group . However , with lower costs and more prolonged positive effects , Home-CR may be the treatment of choice in low-risk older patients Introduction : Several established tools are available to assess study quality and reporting of r and omized controlled trials ; however , these tools were design ed with clinical intervention trials in mind . In exercise training intervention trials some of the traditional study quality criteria , such as participant or research er blinding , are extremely difficult to implement . Methods : We developed the Tool for the assEssment of Study qualiTy and reporting in EXercise ( TESTEX ) – a study quality and reporting assessment tool , design ed specifically for use in exercise training studies . Our tool is a 15-point scale ( 5 points for study quality and 10 points for reporting ) and addresses previously unmentioned quality assessment criteria specific to exercise training studies . Results : There were no systematic differences between the summated TESTEX scores of each observer [ H(2 ) = 0.392 , P = 0.822 ] . There was a significant association between the summated TESTEX scores of the three observers , with almost perfect agreement between observers 1 and 2 [ intra-class correlation coefficient ( ICC ) = 0.93 , 95 % confidence interval ( CI ) 0.82–0.97 , P < 0.001 ] , observers 1 and 3 ( ICC = 0.96 , 95 % CI 0.89–0.98 , P < 0.001 ) and observers 2 and 3 ( ICC = 0.91 , 95 % CI 0.75–0.96 , P < 0.001 ) . Conclusions : The TESTEX scale is a new , reliable tool , specific to exercise scientists , that facilitates a comprehensive review of exercise training trials Background Self-efficacy has been determined to be a strong predictor of who will engage in physical activity . We aim ed to evaluate the associations between self-efficacy to perform physical activity  ,  self-reported leisure-time physical activity  and cardiovascular events in a population -based cohort of middle-aged Swedish men with no previous cardiovascular disease , or treatment with cardiovascular drugs . Methods Analyses are based on 377 men r and omly selected and stratified for weight and insulin sensitivity from a population sample of 58-year-old men ( n = 1728 ) and who had answered a question about their competence to perform exercise ( as an assessment of physical self-efficacy ) . The Saltin-Grimby Physical Activity Level Scale was used to assess self-reported levels of leisure-time physical activity . Cardiovascular events were recorded during 13-years of follow-up . Results The group with poor self-efficacy to perform physical activity had a significantly higher incidence of cardiovascular events compared with the group with good physical self-efficacy ( 32.1 % vs 17.1 % , p < 0.01 ) . Multivariate analyses showed that poor physical self-efficacy was associated with an increased relative risk of 2.0 ( 95 % CI 1.2 to 3.0 ) , of having a cardiovascular event during follow-up also after adjustments for co-variates such as waist to hip ratio , heart rate , fasting plasma glucose , serum triglycerides , systolic blood pressure , apoB/apoA-I ratio and leisure-time physical activity . ConclusionS elf-efficacy to perform physical activity was strongly and independently associated with cardiovascular events and was superior to self-assessed physical activity in predicting cardiovascular events during 13-years of follow-up in a group of middle-aged men , without known CVD or treatment with cardiovascular drugs Background The prevalence of coronary heart disease is increasing worldwide contributing to mortality and morbidity of millions of people . Cardiac rehabilitation is an interdisciplinary activity with the aim of facilitating and improving the physical , psychological and emotional state of the patients with cardiac complications . This study aim ed to evaluate the probable positive effects of continuing cardiac rehabilitation programs at home on self-efficacy of the patients with cardiac complications . Method In a r and omized controlled trial , 80 patients referred to rehabilitation center from Feb 2009 to Jan 2010 were r and omly divided into case and control groups . Both groups received routine cardiac rehabilitation programs in the rehabilitation center . In addition , the case group received education and practical training in various rehabilitation measures along with home visits of a community health nurse throughout the follow-up period . General Self Efficacy Scale ( GSES ) was used to assess self-efficacy between two groups at baseline and follow-up periods . Collected data from GSES question naires were analyzed using Minitab software and repeated measurement analysis model . Results No first time ( before beginning of rehabilitation program ) GESE differences were observed between case ( 26.36 ± 0.84 ) and control ( 28.53 ± 0.54 ) groups ( P = 0.44 ) . In the final measurement , GESE in case group was 36.59 ± 5.65 vs. 26.5 ± 0.91 in the control group . There was a statistically significant difference in self-efficacy between two groups and in different measurements ( P = 0.000 ) . Conclusion Home-based cardiac rehabilitation has a positive effect on patients ’ self-efficacy and therefore it is recommended for the patients suffering from heart diseases . Trial registration RCT registration number : I RCT 201106086747N1 Background Exercise capacity is a strong predictor of survival in patients with coronary artery disease ( CAD ) . Exercise capacity improves after cardiac rehabilitation exercise training , but previous studies have demonstrated a decline in peak oxygen uptake after ending a formal rehabilitation program . There is a lack of knowledge on how long-term exercise adherence can be achieved in CAD patients . We therefore assessed if a 12-month maintenance program following cardiac rehabilitation would lead to increased adherence to exercise and increased exercise capacity compared to usual care . Material s and Methods Two-centre , open , parallel r and omized controlled trial with 12 months follow-up comparing usual care to a maintenance program . The maintenance program consisted of one monthly supervised high intensity interval training session , a written exercise program and exercise diary , and a maximum exercise test every third month during follow-up . Forty-nine patients ( 15 women ) on optimal medical treatment were included following discharge from cardiac rehabilitation . The primary endpoint was change in peak oxygen uptake at follow-up ; secondary endpoints were physical activity level , quality of life and blood markers of cardiovascular risk . Results There was no change in peak oxygen uptake from baseline to follow-up in either group ( intervention group 27.9 ( ±4.7 ) to 28.8 ( ±5.6 ) mL·kg ( -1 ) min ( −1 ) , control group 32.0 ( ±6.2 ) to 32.8 ( ±5.8 ) mL·kg ( −1 ) min ( −1 ) , with no between-group difference , p = 0.22 ) . Quality of life and blood biomarkers remained essentially unchanged , and both self-reported and measured physical activity levels were similar between groups after 12 months . Conclusions A maintenance exercise program for 12 months did not improve adherence to exercise or peak oxygen uptake  in CAD patients after discharge from cardiac rehabilitation compared to usual care . This suggests that infrequent supervised high intensity interval training sessions are inadequate to improve peak oxygen uptake in this patient group . Trial Registration Clinical Trials.gov Background Methods to ensure sustained benefits of cardiac rehabilitation need to be explored . The aim was to assess the effect of a home-based intervention ( INT ) on exercise adherence and risk factors after cardiac rehabilitation . Design Prospect i ve r and omized study . Methods We evaluated patients who were followed for 1 year after either inpatient ( ICR ) or outpatient cardiac rehabilitation ( OCR ) by assessment of exercise capacity , physical activity , risk factors and quality of life  , both at the completion of rehabilitation , and after 1 year . Patients were r and omized to either be instructed how to use a diary of physical activities complemented by quarterly group meetings ( INT ) or to receive st and ard treatment ( usual care ) . Results Two hundred and sixty-one patients gave consent to be reevaluated after 1 year . Of these patients 33 were lost to follow-up ( two deaths ) ; thus 228 patients had complete 1-year follow-up data ( 195 male and 33 female , 91 % with coronary artery disease ) . At 1-year follow-up significantly more patients of the INT group than of the control group adhered to regular physical activity ( 73 vs. 40 % , P < 0.0001 ) . Moreover , INT patients showed a better evolution of body mass index and lipid values . In a stepwise multiple regression analysis the following variables showed a significant impact on regular physical activity at follow-up : study INT [ odds ratio ( OR ) : 4.19 , P < 0.0001 ] , previous cardiac surgery ( OR : 2.50 , P = 0.008 ) , BMI at baseline ( OR : 0.89 , P = 0.018 ) and quality of life at baseline ( OR : 1.58 , P = 0.041 ) . Conclusion Sustained benefits of cardiac rehabilitation can be documented 1 year after both inpatient and outpatient programmes . Self-monitoring of physical activity greatly increased long-term adherence to regular exercise , which in turn was associated with greater improvements of risk factors and quality of life Background Home-based cardiac rehabilitation ( CR ) has been demonstrated to be as effective as institution-based CR in post-coronary artery bypass graft surgery ( CABG ) patients in terms of short-term physical and psychosocial outcomes . The sustainability of these effects is less well studied . The aim of this study was to examine the sustainability of observed changes in physical , quality of life ( HRQL ) , and social support ( SS ) outcomes in patients 12 months after discharge from a r and omized controlled trial ( RCT ) of 6 months of monitored home-based versus supervised hospital-based CR .  Design Two-hundred and twenty-two ( n = 222 ) patients were followed-up 12 months after discharge from a RCT of 6 months of monitored ‘ Home ' versus supervised ‘ Hospital ' CR after CABG . Methods At discharge from the 6-month RCT , participants who consented to the 12-month follow-up study , were given individualized guidelines for ongoing exercise , and were not contacted for 1 year . The primary outcome was peak oxygen uptake ( VO2 ) . Secondary outcomes were : HRQL , SS and habitual physical activity .  Results One hundred and ninety-eight patients ( 89.2 % ) , 102 ‘ Hospital ' and 96 ‘ Home ' , returned for follow-up 12-months after discharge from CR . Both groups had similar medical and socio-demographic characteristics . Peak VO2 declined in ‘ Hospital ' but was sustained in ‘ Home ' patients 12 months after discharge from CR ( P=0.002 ) . Physical HRQL was higher in the ‘ Home ' group at the 12-month follow-up ( P<0.01 ) . Mental HRQL showed general , minor deterioration over time in both groups ( P=0.019 ) . Twelve months after discharge from CR , physical and mental HRQL remained higher than at entry to CR in both groups . ‘ Home ' patients had higher habitual physical activity scores compared to ‘ Hospital ' patients . Conclusions This follow-up study suggests that low-risk patients whose CR  is initiated in the home environment may be more likely to sustain positive physical and psychosocial changes over time than patients whose program is initially institution-based BACKGROUND AND PURPOSE Exercise adherence in general is reported to be problematic after cardiac rehabilitation . Additionally , vigorous exercise is associated with impaired exercise adherence . As high-intensity interval training ( HIT ) is frequently used as a therapy to patients with coronary artery disease in cardiac rehabilitation , the objective was to assess long-term exercise adherence following an HIT cardiac rehabilitation programme . METHODS A multicentre r 
    Output:
    
agent
Conclusions HB exercise is slightly more effective than CB rehabilitation in terms of maintaining EC .
***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 —Whether cardiac rehabilitation ( CR ) is effective in patients older than 75 years , who have been excluded from most trials , remains unclear . We enrolled patients 46 to 86 years old in a r and omized trial and assessed the effects of 2 months of post-myocardial infa rct ion ( MI ) CR  on total work capacity ( TWC , in kilograms per meter ) and health-related quality of life ( HRQL ) . Methods and Results —Of 773 screened patients , 270 without cardiac failure , dementia , disability , or contraindications to exercise were r and omized to outpatient , hospital-based CR ( Hosp-CR ) , home-based CR ( Home-CR ) , or no CR within 3 predefined age groups ( middle-aged , 45 to 65 years ; old , 66 to 75 years ; and very old , > 75 years ) of 90 patients each .  TWC and HRQL were determined with cycle ergometry and Sickness Impact Profile at baseline , after CR , and 6 and 12 months later . Within each age group , TWC improved with Hosp-CR and Home-CR and was unchanged with no CR . The improvement was similar in middle-aged and old persons but smaller , although still significant , in very old patients . TWC reverted toward baseline by 12 months with Hosp-CR but not with Home-CR .  HRQL improved in middle-aged and old CR and control patients but only with CR in very old patients . Complications were similar across treatment and age groups . Costs were lower for Home-CR than for Hosp-CR . Conclusions —Post-MI Hosp-CR and Home-CR are similarly effective in the short term and improve TWC and HRQL in each age group . However , with lower costs and more prolonged positive effects , Home-CR may be the treatment of choice in low-risk older patients Introduction : Several established tools are available to assess study quality and reporting of r and omized controlled trials ; however , these tools were design ed with clinical intervention trials in mind . In exercise training intervention trials some of the traditional study quality criteria , such as participant or research er blinding , are extremely difficult to implement . Methods : We developed the Tool for the assEssment of Study qualiTy and reporting in EXercise ( TESTEX ) – a study quality and reporting assessment tool , design ed specifically for use in exercise training studies . Our tool is a 15-point scale ( 5 points for study quality and 10 points for reporting ) and addresses previously unmentioned quality assessment criteria specific to exercise training studies . Results : There were no systematic differences between the summated TESTEX scores of each observer [ H(2 ) = 0.392 , P = 0.822 ] . There was a significant association between the summated TESTEX scores of the three observers , with almost perfect agreement between observers 1 and 2 [ intra-class correlation coefficient ( ICC ) = 0.93 , 95 % confidence interval ( CI ) 0.82–0.97 , P < 0.001 ] , observers 1 and 3 ( ICC = 0.96 , 95 % CI 0.89–0.98 , P < 0.001 ) and observers 2 and 3 ( ICC = 0.91 , 95 % CI 0.75–0.96 , P < 0.001 ) . Conclusions : The TESTEX scale is a new , reliable tool , specific to exercise scientists , that facilitates a comprehensive review of exercise training trials Background Self-efficacy has been determined to be a strong predictor of who will engage in physical activity . We aim ed to evaluate the associations between self-efficacy to perform physical activity  ,  self-reported leisure-time physical activity  and cardiovascular events in a population -based cohort of middle-aged Swedish men with no previous cardiovascular disease , or treatment with cardiovascular drugs . Methods Analyses are based on 377 men r and omly selected and stratified for weight and insulin sensitivity from a population sample of 58-year-old men ( n = 1728 ) and who had answered a question about their competence to perform exercise ( as an assessment of physical self-efficacy ) . The Saltin-Grimby Physical Activity Level Scale was used to assess self-reported levels of leisure-time physical activity . Cardiovascular events were recorded during 13-years of follow-up . Results The group with poor self-efficacy to perform physical activity had a significantly higher incidence of cardiovascular events compared with the group with good physical self-efficacy ( 32.1 % vs 17.1 % , p < 0.01 ) . Multivariate analyses showed that poor physical self-efficacy was associated with an increased relative risk of 2.0 ( 95 % CI 1.2 to 3.0 ) , of having a cardiovascular event during follow-up also after adjustments for co-variates such as waist to hip ratio , heart rate , fasting plasma glucose , serum triglycerides , systolic blood pressure , apoB/apoA-I ratio and leisure-time physical activity . ConclusionS elf-efficacy to perform physical activity was strongly and independently associated with cardiovascular events and was superior to self-assessed physical activity in predicting cardiovascular events during 13-years of follow-up in a group of middle-aged men , without known CVD or treatment with cardiovascular drugs Background The prevalence of coronary heart disease is increasing worldwide contributing to mortality and morbidity of millions of people . Cardiac rehabilitation is an interdisciplinary activity with the aim of facilitating and improving the physical , psychological and emotional state of the patients with cardiac complications . This study aim ed to evaluate the probable positive effects of continuing cardiac rehabilitation programs at home on self-efficacy of the patients with cardiac complications . Method In a r and omized controlled trial , 80 patients referred to rehabilitation center from Feb 2009 to Jan 2010 were r and omly divided into case and control groups . Both groups received routine cardiac rehabilitation programs in the rehabilitation center . In addition , the case group received education and practical training in various rehabilitation measures along with home visits of a community health nurse throughout the follow-up period . General Self Efficacy Scale ( GSES ) was used to assess self-efficacy between two groups at baseline and follow-up periods . Collected data from GSES question naires were analyzed using Minitab software and repeated measurement analysis model . Results No first time ( before beginning of rehabilitation program ) GESE differences were observed between case ( 26.36 ± 0.84 ) and control ( 28.53 ± 0.54 ) groups ( P = 0.44 ) . In the final measurement , GESE in case group was 36.59 ± 5.65 vs. 26.5 ± 0.91 in the control group . There was a statistically significant difference in self-efficacy between two groups and in different measurements ( P = 0.000 ) . Conclusion Home-based cardiac rehabilitation has a positive effect on patients ’ self-efficacy and therefore it is recommended for the patients suffering from heart diseases . Trial registration RCT registration number : I RCT 201106086747N1 Background Exercise capacity is a strong predictor of survival in patients with coronary artery disease ( CAD ) . Exercise capacity improves after cardiac rehabilitation exercise training , but previous studies have demonstrated a decline in peak oxygen uptake after ending a formal rehabilitation program . There is a lack of knowledge on how long-term exercise adherence can be achieved in CAD patients . We therefore assessed if a 12-month maintenance program following cardiac rehabilitation would lead to increased adherence to exercise and increased exercise capacity compared to usual care . Material s and Methods Two-centre , open , parallel r and omized controlled trial with 12 months follow-up comparing usual care to a maintenance program . The maintenance program consisted of one monthly supervised high intensity interval training session , a written exercise program and exercise diary , and a maximum exercise test every third month during follow-up . Forty-nine patients ( 15 women ) on optimal medical treatment were included following discharge from cardiac rehabilitation . The primary endpoint was change in peak oxygen uptake at follow-up ; secondary endpoints were physical activity level , quality of life and blood markers of cardiovascular risk . Results There was no change in peak oxygen uptake from baseline to follow-up in either group ( intervention group 27.9 ( ±4.7 ) to 28.8 ( ±5.6 ) mL·kg ( -1 ) min ( −1 ) , control group 32.0 ( ±6.2 ) to 32.8 ( ±5.8 ) mL·kg ( −1 ) min ( −1 ) , with no between-group difference , p = 0.22 ) . Quality of life and blood biomarkers remained essentially unchanged , and both self-reported and measured physical activity levels were similar between groups after 12 months . Conclusions A maintenance exercise program for 12 months did not improve adherence to exercise or peak oxygen uptake  in CAD patients after discharge from cardiac rehabilitation compared to usual care . This suggests that infrequent supervised high intensity interval training sessions are inadequate to improve peak oxygen uptake in this patient group . Trial Registration Clinical Trials.gov Background Methods to ensure sustained benefits of cardiac rehabilitation need to be explored . The aim was to assess the effect of a home-based intervention ( INT ) on exercise adherence and risk factors after cardiac rehabilitation . Design Prospect i ve r and omized study . Methods We evaluated patients who were followed for 1 year after either inpatient ( ICR ) or outpatient cardiac rehabilitation ( OCR ) by assessment of exercise capacity , physical activity , risk factors and quality of life  , both at the completion of rehabilitation , and after 1 year . Patients were r and omized to either be instructed how to use a diary of physical activities complemented by quarterly group meetings ( INT ) or to receive st and ard treatment ( usual care ) . Results Two hundred and sixty-one patients gave consent to be reevaluated after 1 year . Of these patients 33 were lost to follow-up ( two deaths ) ; thus 228 patients had complete 1-year follow-up data ( 195 male and 33 female , 91 % with coronary artery disease ) . At 1-year follow-up significantly more patients of the INT group than of the control group adhered to regular physical activity ( 73 vs. 40 % , P < 0.0001 ) . Moreover , INT patients showed a better evolution of body mass index and lipid values . In a stepwise multiple regression analysis the following variables showed a significant impact on regular physical activity at follow-up : study INT [ odds ratio ( OR ) : 4.19 , P < 0.0001 ] , previous cardiac surgery ( OR : 2.50 , P = 0.008 ) , BMI at baseline ( OR : 0.89 , P = 0.018 ) and quality of life at baseline ( OR : 1.58 , P = 0.041 ) . Conclusion Sustained benefits of cardiac rehabilitation can be documented 1 year after both inpatient and outpatient programmes . Self-monitoring of physical activity greatly increased long-term adherence to regular exercise , which in turn was associated with greater improvements of risk factors and quality of life Background Home-based cardiac rehabilitation ( CR ) has been demonstrated to be as effective as institution-based CR in post-coronary artery bypass graft surgery ( CABG ) patients in terms of short-term physical and psychosocial outcomes . The sustainability of these effects is less well studied . The aim of this study was to examine the sustainability of observed changes in physical , quality of life ( HRQL ) , and social support ( SS ) outcomes in patients 12 months after discharge from a r and omized controlled trial ( RCT ) of 6 months of monitored home-based versus supervised hospital-based CR .  Design Two-hundred and twenty-two ( n = 222 ) patients were followed-up 12 months after discharge from a RCT of 6 months of monitored ‘ Home ' versus supervised ‘ Hospital ' CR after CABG . Methods At discharge from the 6-month RCT , participants who consented to the 12-month follow-up study , were given individualized guidelines for ongoing exercise , and were not contacted for 1 year . The primary outcome was peak oxygen uptake ( VO2 ) . Secondary outcomes were : HRQL , SS and habitual physical activity .  Results One hundred and ninety-eight patients ( 89.2 % ) , 102 ‘ Hospital ' and 96 ‘ Home ' , returned for follow-up 12-months after discharge from CR . Both groups had similar medical and socio-demographic characteristics . Peak VO2 declined in ‘ Hospital ' but was sustained in ‘ Home ' patients 12 months after discharge from CR ( P=0.002 ) . Physical HRQL was higher in the ‘ Home ' group at the 12-month follow-up ( P<0.01 ) . Mental HRQL showed general , minor deterioration over time in both groups ( P=0.019 ) . Twelve months after discharge from CR , physical and mental HRQL remained higher than at entry to CR in both groups . ‘ Home ' patients had higher habitual physical activity scores compared to ‘ Hospital ' patients . Conclusions This follow-up study suggests that low-risk patients whose CR  is initiated in the home environment may be more likely to sustain positive physical and psychosocial changes over time than patients whose program is initially institution-based BACKGROUND AND PURPOSE Exercise adherence in general is reported to be problematic after cardiac rehabilitation . Additionally , vigorous exercise is associated with impaired exercise adherence . As high-intensity interval training ( HIT ) is frequently used as a therapy to patients with coronary artery disease in cardiac rehabilitation , the objective was to assess long-term exercise adherence following an HIT cardiac rehabilitation programme . METHODS A multicentre r 
    Output:
    