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 Aerobic training has a number of well known beneficial effects in both normal and asthmatic children . However , the impact of training on the clinical management of the underlying bronchial asthma remains controversial , particularly in the most severe patients . METHODS Clinical evaluation , spirometric tests , symptom limited maximum exercise testing , and exercise challenge tests were performed in a group of children with stable moderate to severe asthma . Forty two patients ( 24 boys ) aged 8–16 were evaluated twice : before and after supervised aerobic training ( group 1 , n = 26 ) and two months apart ( untrained group 2 , n = 16 ) . RESULTS Spirometric and maximal exercise variables in the initial evaluation were significantly reduced in group 1 ( p<0.05 ) but medication and clinical scores and the occurrence of exercise induced bronchospasm ( EIB ) did not differ between the two groups . Aerobic improvement with training ( maximal oxygen uptake and /or anaerobic threshold increment > 10 % and 100 ml ) was inversely related to the baseline level of fitness and was independent of disease severity . Although the clinical score and the occurrence of EIB did not change after training , aerobic improvement was associated with a significant reduction in the medication score and the daily use of both inhaled and oral steroids ( p<0.05 ) . CONCLUSIONS Aerobic improvement with training in less fit asthmatic children is related to a short term decrease in the daily use of inhaled and oral steroids , independent of the severity of the disease The optimal exercise modality for reductions of abdominal obesity and risk factors for  type 2 diabetes in youth is unknown . We examined the effects of aerobic exercise ( AE ) versus resistance exercise ( RE ) without caloric restriction on abdominal adiposity , ectopic fat , and insulin sensitivity and secretion in youth . Forty-five obese adolescent boys were r and omly assigned to one of three 3-month interventions : AE , RE , or a nonexercising control . Abdominal fat was assessed by magnetic resonance imaging , and intrahepatic lipid and intramyocellular lipid were assessed by proton magnetic resonance spectroscopy . Insulin sensitivity and secretion were evaluated by a 3-h hyperinsulinemic-euglycemic clamp and a 2-h hyperglycemic clamp . Both AE and RE prevented the significant weight gain that was observed in controls . Compared with controls , significant reductions in total and visceral fat and intrahepatic lipid were observed in both exercise groups . Compared with controls , a significant improvement in insulin sensitivity ( 27 % ) was observed in the RE group . Collapsed across groups , changes in visceral fat were associated with changes in intrahepatic lipid ( r = 0.72 ) and insulin sensitivity ( r = −0.47 ) . Both AE and RE alone are effective for reducing abdominal fat and intrahepatic lipid in obese adolescent boys . RE but not AE is also associated with significant improvements in insulin sensitivity STUDY OBJECTIVE Exercise has the potential to improve the ability of a patient with cystic fibrosis ( CF ) to cope with the physical dem and s of everyday life , and may improve prognosis . The purpose of this study was to compare the effects of a home-based , semi-supervised , upper-body strength-training regimen with a similarly structured aerobic training regimen . DESIGN Data were collected during a 1-year r and omized clinical trial . SETTING Counselors conducted in-home visits with the participants once per week for the first 8 weeks followed by monthly visits for the remainder of the study . PATIENTS Sixty-seven patients with CF , aged 8 to 18 years , participated in the trial . INTERVENTION Participants in both exercise conditions were encouraged to exercise at least three times per week for 1 year . Each child in the aerobic group was given a stair-stepping machine , and each child in the upper-body strength training group was given an upper-body-only weight-resistance machine . MEASURES AND RESULTS Aerobic fitness , pulmonary function , quality of life , and strength were measured at baseline , at 6 months , and at 12 months . Strength training increased the maximum weight lifted for biceps curls significantly more than aerobic training ( p < 0.02 ) . However , this differential did not remain significant after control for increase in height . Both training procedures were associated with increased strength ( p < 0.002 ) and physical work capacity ( PWC ) [ p < 0.033 ] . CONCLUSIONS We concluded that strength and aerobic training may increase upper-body strength , and that both types of training may increase PWC for children with CF . Future trials should be conducted with no-training control subjects and larger sample s to increase statistical power This pilot aims to better underst and the market for childcare in Saudi Arabia – both the supply and dem and sides – and to design a r and omized controlled experiment to test whether access to affordable day care ( in the form of subsidies , for example ) would incentivize Saudi mothers to search actively for employment and to remain employed once they are hired . In addition , the study seeks to underst and the degree to which employment early on in one ’s life impacts employment in later stages . The pilot will provide information on the groups of women the experiment should target , appropriate levels for the childcare subsidy , and the quality and current geographic locations of daycare sites . Expected Impact Determine the effects of facilitating childcare access on Saudi women ’s employment . PRINCIPAL INVESTIGATORS  Boston University Patricia Cortes  Harvard University Claudia Goldin  Swarthmore College Jennifer Although exercise may be beneficial in cystic fibrosis ( CF ) , patients ' low tolerance to climatic heat stress means that physical exertion can increase morbidity and mortality . We postulated that the high salt content of CF patients ' sweat and the consequent absence of body-fluid hyperosmolality during a long episode of sweating might deprive such patients of a thirst stimulus . Eight children with CF ( four boys , four girls ; aged 9.5 - 14.1 years ) and eight controls , matched for age and sex , attended two r and omly ordered sessions of exercise ( cycling ) in a chamber at 31 - 33 degrees C , relative humidity 43 - 47 % . 20 min bouts of exercise ( at 45 % of predetermined maximum oxygen uptake ) were interspersed with 25 min rest periods . At one session , chilled water was given every 15 - 20 min to replace fluid lost ; at the other , drinking was guided by the child 's thirst . At the thirst-guided session , CF patients drank much less than the controls did ( 0.80 % vs 1.73 % initial body weight ) and lost twice as much fluid ( 1.57 % vs 0.78 % initial body weight ) . The recovery of heart rate after exercise was slower in CF patients , but there were no other signs of heat strain . The groups did not differ in any variable during the forced drinking session . We conclude that children with CF underestimate their fluid needs and undergo excessive dehydration during extended exposure to hot conditions The purpose of this study was to investigate symptoms , lactate accumulation and limiting factors at peak exercise in cystic fibrosis ( CF ) patients . In total , 104 CF adults attending an adult CF centre and 27 controls performed progressive cycle ergometry to a symptom-limited maximum . Measurements taken at peak exercise included : heart rate , ventilation , oxygen uptake , carbon dioxide output , oxygen saturation and blood lactate . Symptom scores of perceived breathlessness and muscle effort were recorded using Borg scales . The CF subjects had a lower mean body mass index , forced expiratory volume in one second ( FEV1 ) and peak oxygen uptake than controls . Peak lactate concentrations were very similar to controls ( mean±sd 6.8±2.0 mmol·L−1 versus 7.4±1.0 mmol·L−1 ) . Symptom scores were no different to controls for either breathlessness ( 4.5±2.0 versus 4.3±1.0 ) or perceived muscle effort ( 6.1±2.0 versus 6.5±1.0 ) , with higher scores for muscle effort than breathlessness in both groups . In addition , peak ventilation was lower than the predicted maximum , and high peak heart rates were recorded supporting nonpulmonary factors as important in limiting peak exercise . Peak oxygen uptake was correlated with FEV1 . Comparison of CF subjects with mild or moderate pulmonary disease and controls revealed similar exercise responses . In contrast , those CF patients with severe lung disease ( FEV1 < 40 % predicted ) had significantly higher breathlessness , lower muscle effort scores , lower peak lactate , lower peak heart rate and a mean ventilation exceeding predicted , thus confirming that ventilation was the major factor limiting exercise . In conclusion , cystic fibrosis subjects have a reduced peak exercise capacity , but their exercise response is similar to controls in generating high blood-lactate concentrations and symptoms of muscle effort in excess of dyspnoea . Nonpulmonary factors influence peak performance more in those without severe disease We determined the effect of a school-based exercise training ( ET ) without dietary intervention , on body composition , fitness and cardiovascular risk in overweight/obese children . Subjects were 51 overweight/obese 6.5- to 12.5-year-old children ( 23 boys , 28 girls ; BMI 25.6+/-4.3 kg/m 2 ) , of whom 48 completed the program . Participants were enrolled in a 15-week aerobic training ( three 60-minute sessions/week ) . Working heart rate was between 120 - 185 beats/minute . Participation rate was 87 % . BMI , waist circumference , body composition ( bioimpedance ) , aerobic capacity ( treadmill ) , blood pressure , lipids and insulin sensitivity ( HOMA ) were assessed . Waist circumference ( 85.9+/-12.4 vs. 80.9+/-10.2 cm ) , muscle mass ( 32.4+/-6.2 vs. 33.7+/-6.1 kg ) , maximal oxygen consumption ( 37.0+/-3.9 vs. 42.6+/-11.2 ml/kg per minute ) , systolic blood pressure ( 113.3+/-11.2 vs. 106.7+/-11.6 mmHg ) and LDL cholesterol ( 2.4+/-0.6 vs. 1.9+/-0.6 mM/l ) improved significantly . Number of children with abdominal obesity ( 29 vs. 20 ) , hypertension ( 10 vs. 5 ) and elevated triglyceride ( 18 vs. 14 ) also declined significantly over time . We concluded that as a result of high attendance and appropriate training program , cardiovascular fitness and abdominal obesity improved in overweight/obese children along with the improvement in metabolic risk factor profile OBJECTIVE To examine the effectiveness of high-intensity aerobic training compared with low-intensity training in terms of energy cost of locomotion , peak oxygen uptake , peak power , and self-reported physical function in children with juvenile idiopathic arthritis ( JIA ) . METHODS Eighty children with JIA , ages 8 - 16 years , were enrolled in a r and omized , single-blind controlled trial . Both groups participated in a 12-week , 3-times-weekly training program consisting of high-intensity aerobics in the experimental group and qigong in the control group . Subjects underwent exercise testing measuring submaximal oxygen uptake at 3 km/hour ( VO(2submax ) ) as the primary outcome , maximal oxygen uptake , and peak power at the beginning and end of the program . Physical function was measured using the Child Health Assessment Question naire ( C-HAQ ) . RESULTS The exercise program was well tolerated in both groups . There was no difference in VO(2submax ) or any other exercise testing measures between the groups through the study period and no indication of improvement . Both groups showed significant improvements in C-HAQ with no difference between the groups . Adherence was higher in the control group than the experimental group . CONCLUSION Our findings suggest that activity programs with or without an aerobic training component are safe and may result in an important improvement in physical function . The intensity of aerobic training did not seem to provide any additional benefits , but higher adherence in the qigong program may suggest that less intensive regimens are easier for children with JIA to comply with , and provide a degree of benefit equivalent to more intensive programs OBJECTIVES The aim of this study was to determine the effects of physical activity on systemic blood pressure ( BP ) and early markers of atherosclerosis in pre-pubertal obese children . BACKGROUND Hypertension and endothelial dysfunction are premature complications of obesity . METHODS We performed a 3-month r and omized controlled trial with a modified crossover design : 44 pre-pubertal obese children ( age 8.9 + or - 1.5 years ) were r and omly assigned ( 1:1 ) to an exercise ( n = 22 ) or a control group ( n = 22 ) . We recruited 22 lean children ( age 8.5 + or - 1.5 years ) for baseline comparison . The exercise group trained 60 min 3 times/week during 3 months , whereas control subjects remained relatively inactive . Then , both groups trained twice/week during 3 months . We assessed changes at 3 and 6 months in office and 24-h BP , arterial intima-media thickness ( IMT ) and stiffness , endothelial function ( flow-mediated dilation ) , body mass index ( BMI ) , body fat , cardiorespiratory fitness ( maximal oxygen consumption [ VO(2)max ] ) , physical activity , and biological markers . RESULTS Obese children had higher 
    Output:
    
agent
Results Overall , exercise intolerance is prevalent in pediatric chronic 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 Aerobic training has a number of well known beneficial effects in both normal and asthmatic children . However , the impact of training on the clinical management of the underlying bronchial asthma remains controversial , particularly in the most severe patients . METHODS Clinical evaluation , spirometric tests , symptom limited maximum exercise testing , and exercise challenge tests were performed in a group of children with stable moderate to severe asthma . Forty two patients ( 24 boys ) aged 8–16 were evaluated twice : before and after supervised aerobic training ( group 1 , n = 26 ) and two months apart ( untrained group 2 , n = 16 ) . RESULTS Spirometric and maximal exercise variables in the initial evaluation were significantly reduced in group 1 ( p<0.05 ) but medication and clinical scores and the occurrence of exercise induced bronchospasm ( EIB ) did not differ between the two groups . Aerobic improvement with training ( maximal oxygen uptake and /or anaerobic threshold increment > 10 % and 100 ml ) was inversely related to the baseline level of fitness and was independent of disease severity . Although the clinical score and the occurrence of EIB did not change after training , aerobic improvement was associated with a significant reduction in the medication score and the daily use of both inhaled and oral steroids ( p<0.05 ) . CONCLUSIONS Aerobic improvement with training in less fit asthmatic children is related to a short term decrease in the daily use of inhaled and oral steroids , independent of the severity of the disease The optimal exercise modality for reductions of abdominal obesity and risk factors for  type 2 diabetes in youth is unknown . We examined the effects of aerobic exercise ( AE ) versus resistance exercise ( RE ) without caloric restriction on abdominal adiposity , ectopic fat , and insulin sensitivity and secretion in youth . Forty-five obese adolescent boys were r and omly assigned to one of three 3-month interventions : AE , RE , or a nonexercising control . Abdominal fat was assessed by magnetic resonance imaging , and intrahepatic lipid and intramyocellular lipid were assessed by proton magnetic resonance spectroscopy . Insulin sensitivity and secretion were evaluated by a 3-h hyperinsulinemic-euglycemic clamp and a 2-h hyperglycemic clamp . Both AE and RE prevented the significant weight gain that was observed in controls . Compared with controls , significant reductions in total and visceral fat and intrahepatic lipid were observed in both exercise groups . Compared with controls , a significant improvement in insulin sensitivity ( 27 % ) was observed in the RE group . Collapsed across groups , changes in visceral fat were associated with changes in intrahepatic lipid ( r = 0.72 ) and insulin sensitivity ( r = −0.47 ) . Both AE and RE alone are effective for reducing abdominal fat and intrahepatic lipid in obese adolescent boys . RE but not AE is also associated with significant improvements in insulin sensitivity STUDY OBJECTIVE Exercise has the potential to improve the ability of a patient with cystic fibrosis ( CF ) to cope with the physical dem and s of everyday life , and may improve prognosis . The purpose of this study was to compare the effects of a home-based , semi-supervised , upper-body strength-training regimen with a similarly structured aerobic training regimen . DESIGN Data were collected during a 1-year r and omized clinical trial . SETTING Counselors conducted in-home visits with the participants once per week for the first 8 weeks followed by monthly visits for the remainder of the study . PATIENTS Sixty-seven patients with CF , aged 8 to 18 years , participated in the trial . INTERVENTION Participants in both exercise conditions were encouraged to exercise at least three times per week for 1 year . Each child in the aerobic group was given a stair-stepping machine , and each child in the upper-body strength training group was given an upper-body-only weight-resistance machine . MEASURES AND RESULTS Aerobic fitness , pulmonary function , quality of life , and strength were measured at baseline , at 6 months , and at 12 months . Strength training increased the maximum weight lifted for biceps curls significantly more than aerobic training ( p < 0.02 ) . However , this differential did not remain significant after control for increase in height . Both training procedures were associated with increased strength ( p < 0.002 ) and physical work capacity ( PWC ) [ p < 0.033 ] . CONCLUSIONS We concluded that strength and aerobic training may increase upper-body strength , and that both types of training may increase PWC for children with CF . Future trials should be conducted with no-training control subjects and larger sample s to increase statistical power This pilot aims to better underst and the market for childcare in Saudi Arabia – both the supply and dem and sides – and to design a r and omized controlled experiment to test whether access to affordable day care ( in the form of subsidies , for example ) would incentivize Saudi mothers to search actively for employment and to remain employed once they are hired . In addition , the study seeks to underst and the degree to which employment early on in one ’s life impacts employment in later stages . The pilot will provide information on the groups of women the experiment should target , appropriate levels for the childcare subsidy , and the quality and current geographic locations of daycare sites . Expected Impact Determine the effects of facilitating childcare access on Saudi women ’s employment . PRINCIPAL INVESTIGATORS  Boston University Patricia Cortes  Harvard University Claudia Goldin  Swarthmore College Jennifer Although exercise may be beneficial in cystic fibrosis ( CF ) , patients ' low tolerance to climatic heat stress means that physical exertion can increase morbidity and mortality . We postulated that the high salt content of CF patients ' sweat and the consequent absence of body-fluid hyperosmolality during a long episode of sweating might deprive such patients of a thirst stimulus . Eight children with CF ( four boys , four girls ; aged 9.5 - 14.1 years ) and eight controls , matched for age and sex , attended two r and omly ordered sessions of exercise ( cycling ) in a chamber at 31 - 33 degrees C , relative humidity 43 - 47 % . 20 min bouts of exercise ( at 45 % of predetermined maximum oxygen uptake ) were interspersed with 25 min rest periods . At one session , chilled water was given every 15 - 20 min to replace fluid lost ; at the other , drinking was guided by the child 's thirst . At the thirst-guided session , CF patients drank much less than the controls did ( 0.80 % vs 1.73 % initial body weight ) and lost twice as much fluid ( 1.57 % vs 0.78 % initial body weight ) . The recovery of heart rate after exercise was slower in CF patients , but there were no other signs of heat strain . The groups did not differ in any variable during the forced drinking session . We conclude that children with CF underestimate their fluid needs and undergo excessive dehydration during extended exposure to hot conditions The purpose of this study was to investigate symptoms , lactate accumulation and limiting factors at peak exercise in cystic fibrosis ( CF ) patients . In total , 104 CF adults attending an adult CF centre and 27 controls performed progressive cycle ergometry to a symptom-limited maximum . Measurements taken at peak exercise included : heart rate , ventilation , oxygen uptake , carbon dioxide output , oxygen saturation and blood lactate . Symptom scores of perceived breathlessness and muscle effort were recorded using Borg scales . The CF subjects had a lower mean body mass index , forced expiratory volume in one second ( FEV1 ) and peak oxygen uptake than controls . Peak lactate concentrations were very similar to controls ( mean±sd 6.8±2.0 mmol·L−1 versus 7.4±1.0 mmol·L−1 ) . Symptom scores were no different to controls for either breathlessness ( 4.5±2.0 versus 4.3±1.0 ) or perceived muscle effort ( 6.1±2.0 versus 6.5±1.0 ) , with higher scores for muscle effort than breathlessness in both groups . In addition , peak ventilation was lower than the predicted maximum , and high peak heart rates were recorded supporting nonpulmonary factors as important in limiting peak exercise . Peak oxygen uptake was correlated with FEV1 . Comparison of CF subjects with mild or moderate pulmonary disease and controls revealed similar exercise responses . In contrast , those CF patients with severe lung disease ( FEV1 < 40 % predicted ) had significantly higher breathlessness , lower muscle effort scores , lower peak lactate , lower peak heart rate and a mean ventilation exceeding predicted , thus confirming that ventilation was the major factor limiting exercise . In conclusion , cystic fibrosis subjects have a reduced peak exercise capacity , but their exercise response is similar to controls in generating high blood-lactate concentrations and symptoms of muscle effort in excess of dyspnoea . Nonpulmonary factors influence peak performance more in those without severe disease We determined the effect of a school-based exercise training ( ET ) without dietary intervention , on body composition , fitness and cardiovascular risk in overweight/obese children . Subjects were 51 overweight/obese 6.5- to 12.5-year-old children ( 23 boys , 28 girls ; BMI 25.6+/-4.3 kg/m 2 ) , of whom 48 completed the program . Participants were enrolled in a 15-week aerobic training ( three 60-minute sessions/week ) . Working heart rate was between 120 - 185 beats/minute . Participation rate was 87 % . BMI , waist circumference , body composition ( bioimpedance ) , aerobic capacity ( treadmill ) , blood pressure , lipids and insulin sensitivity ( HOMA ) were assessed . Waist circumference ( 85.9+/-12.4 vs. 80.9+/-10.2 cm ) , muscle mass ( 32.4+/-6.2 vs. 33.7+/-6.1 kg ) , maximal oxygen consumption ( 37.0+/-3.9 vs. 42.6+/-11.2 ml/kg per minute ) , systolic blood pressure ( 113.3+/-11.2 vs. 106.7+/-11.6 mmHg ) and LDL cholesterol ( 2.4+/-0.6 vs. 1.9+/-0.6 mM/l ) improved significantly . Number of children with abdominal obesity ( 29 vs. 20 ) , hypertension ( 10 vs. 5 ) and elevated triglyceride ( 18 vs. 14 ) also declined significantly over time . We concluded that as a result of high attendance and appropriate training program , cardiovascular fitness and abdominal obesity improved in overweight/obese children along with the improvement in metabolic risk factor profile OBJECTIVE To examine the effectiveness of high-intensity aerobic training compared with low-intensity training in terms of energy cost of locomotion , peak oxygen uptake , peak power , and self-reported physical function in children with juvenile idiopathic arthritis ( JIA ) . METHODS Eighty children with JIA , ages 8 - 16 years , were enrolled in a r and omized , single-blind controlled trial . Both groups participated in a 12-week , 3-times-weekly training program consisting of high-intensity aerobics in the experimental group and qigong in the control group . Subjects underwent exercise testing measuring submaximal oxygen uptake at 3 km/hour ( VO(2submax ) ) as the primary outcome , maximal oxygen uptake , and peak power at the beginning and end of the program . Physical function was measured using the Child Health Assessment Question naire ( C-HAQ ) . RESULTS The exercise program was well tolerated in both groups . There was no difference in VO(2submax ) or any other exercise testing measures between the groups through the study period and no indication of improvement . Both groups showed significant improvements in C-HAQ with no difference between the groups . Adherence was higher in the control group than the experimental group . CONCLUSION Our findings suggest that activity programs with or without an aerobic training component are safe and may result in an important improvement in physical function . The intensity of aerobic training did not seem to provide any additional benefits , but higher adherence in the qigong program may suggest that less intensive regimens are easier for children with JIA to comply with , and provide a degree of benefit equivalent to more intensive programs OBJECTIVES The aim of this study was to determine the effects of physical activity on systemic blood pressure ( BP ) and early markers of atherosclerosis in pre-pubertal obese children . BACKGROUND Hypertension and endothelial dysfunction are premature complications of obesity . METHODS We performed a 3-month r and omized controlled trial with a modified crossover design : 44 pre-pubertal obese children ( age 8.9 + or - 1.5 years ) were r and omly assigned ( 1:1 ) to an exercise ( n = 22 ) or a control group ( n = 22 ) . We recruited 22 lean children ( age 8.5 + or - 1.5 years ) for baseline comparison . The exercise group trained 60 min 3 times/week during 3 months , whereas control subjects remained relatively inactive . Then , both groups trained twice/week during 3 months . We assessed changes at 3 and 6 months in office and 24-h BP , arterial intima-media thickness ( IMT ) and stiffness , endothelial function ( flow-mediated dilation ) , body mass index ( BMI ) , body fat , cardiorespiratory fitness ( maximal oxygen consumption [ VO(2)max ] ) , physical activity , and biological markers . RESULTS Obese children had higher 
    Output:
    