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: Multimodal exercise programs incorporating traditional progressive resistance training ( PRT ) , weight-bearing impact training and /or balance training are recommended to reduce risk factors for falls and fracture . However , muscle power , or the ability to produce force rapidly , has emerged as a more crucial variable to functional decline than muscle strength or mass . The aim of this 12-month community-based r and omized controlled trial , termed Osteo-cise : Strong Bones for Life , was to evaluate the effectiveness and feasibility of a multimodal exercise program incorporating high-velocity (HV)-PRT , combined with an osteoporosis education and behavioral change program , on bone mineral density ( BMD ) , body composition , muscle strength and functional muscle performance in older adults . Falls incidence was evaluated as a secondary outcome . A total of 162 older adults ( mean ± SD ; 67 ± 6 years ) with risk factors for falls and /or low BMD were r and omized to the Osteo-cise program ( n = 81 ) or a control group ( n = 81 ) . Exercise consisted of fitness center-based HV-PRT , weight-bearing impact and challenging balance/mobility activities performed three times weekly . After 12 months , the Osteo-cise program led to modest but significant net gains in femoral neck and lumbar spine BMD ( 1.0 % to 1.1 % , p < 0.05 ) , muscle strength ( 10 % to 13 % , p < 0.05 ) , functional muscle power ( Timed Stair Climb , 5 % , p < 0.05 ) and dynamic balance ( Four Square Step Test 6 % , p < 0.01 ; Sit-to-St and , 16 % , p < 0.001 ) relative to controls . There was no effect on total body lean mass or mobility ( timed-up- and -go ) , and no difference in falls rate ( incidence rate ratio [ IRR ] , 1.22 ; 95 % confidence interval [ CI ] , 0.72 - 2.04 ) . In conclusion , this study demonstrates that the Osteo-cise : Strong Bones for Life community-based , multimodal exercise program represents an effective approach to improve multiple musculoskeletal and functional performance measures in older adults with risk factors for falls and /or low BMD . Although this did not translate into a reduction in the rate of falls , further large-scale trials are needed to evaluate the efficacy of this multimodal approach on reducing falls and fracture Physical exercise has a favorable impact on bones , but optimum training strategies are still under discussion . In this study , we compared the effect of slow and fast resistance exercises on various osteodensitometric parameters .  Fifty-three postmenopausal women were r and omly assigned to a strength training ( ST ) or a power training group ( PT ) . Both groups carried out a progressive resistance training , a gymnastics session , and a home training over a period of 12 mo . During the resistance training , the ST group used slow and the PT group fast movements ; otherwise there were no training differences . All subjects were supplemented with Ca and vitamin D. At baseline and after 12 mo , bone mineral density ( BMD ) was measured at the lumbar spine , proximal femur , and distal forearm by dual-energy X-ray absorptiometry . We also measured anthropometric data and maximum static strength . Frequency and grade of pain were assessed by question naire . After 12 mo , significant between-group differences were observed for BMD at the lumbar spine ( P < 0.05 ) and the total hip ( P < 0.05 ) . Whereas the PT group maintained BMD at the spine ( + 0.7 + /- 2.1 % , not significant ) and the total hip ( 0.0 + /- 1.7 % , not significant ) , the ST group lost significantly at both sites ( spine : -0.9 + /- 1.9 % ; P < 0.05 ; total hip : -1.2 + /- 1.5 % ; P < 0.01 ) . No significant between-group differences were observed for anthropometric data , maximum strength , BMD of the forearm , or frequency and grade of pain . These findings suggest that power training is more effective than strength training in reducing bone loss in postmenopausal women OBJECTIVES To assess whether group exercise and coping classes reduce physical and psychological impairments and functional disability in older women with prevalent vertebral fractures ( VFs ) . DESIGN R and omized , controlled trial ( modified cross-over ) with site as unit of assignment ; testing at baseline and 3 , 6 , 9 , and 12 months . SETTING Nine North Carolina retirement communities . PARTICIPANTS One hundred eighty-five postmenopausal Caucasian women ( mean age 81 ) , each with at least one VFs . INTERVENTION The intervention group had 6 months of exercise ( 3 meetings weekly , 45 minutes each ) and coping classes ( 2 meetings weekly , 45 minutes each ) in Phase 1 , followed by 6 months of self-maintenance . The control group had 6 months of health education control intervention ( 1 meeting weekly , 45 minutes ) in Phase 1 , followed by the intervention described above . MEASUREMENTS Change in trunk extension strength , change in pain with activities , and change in psychological symptoms . RESULTS Between-group differences in the change in trunk extension strength ( 10.68 foot pounds , P<.001 ) and psychological symptoms ( -0.08 , P=.011 ) were significant for Phase 1 . Changes in pain with activities did not differ between groups ( -0.03 , P=.64 ) ; there was no change in the pain endpoint . In Phase 2 , controls showed significant changes in trunk strength ( 15.02 foot pounds , P<.001 ) and psychological symptoms ( -0.11 , P=.006 ) from baseline . Change in pain with activities was not significant ( -0.03 , P=.70 ) . During self-maintenance , the intervention group did not worsen in psychological symptoms , but improved trunk extension strength was not maintained . CONCLUSION Weak trunk extension strength and psychological symptoms associated with VFs can be improved in older women using group treatment , and psychological improvements are retained for at least 6 months Background Tai Chi ( TC ) is a mind-body exercise that shows potential as an effective and safe intervention for preventing fall-related fractures in the elderly . Few r and omized trials have simultaneously evaluated TC 's potential to reduce bone loss and improve fall-predictive balance parameters in osteopenic women . Methods In a pragmatic r and omized trial , 86 post-menopausal osteopenic women , aged 45 - 70 , were recruited from community clinics . Women were assigned to either nine months of TC training plus usual care ( UC ) vs. UC alone . Primary outcomes were changes between baseline and nine months of bone mineral density ( BMD ) of the proximal femur and lumbar spine ( dual-energy X-ray absorptiometry ) and serum markers of bone resorption and formation . Secondary outcomes included quality of life . In a sub sample ( n = 16 ) , quiet st and ing fall-predictive sway parameters and clinical balance tests were also assessed . Both intent-to-treat and per- protocol analyses were employed . Results For BMD , no intent-to-treat analyses were statistically significant ; however , per protocol analyses ( i.e. , only including TC participants who completed ≥ 75 % training requirements ) of femoral neck BMD changes were significantly different between TC and UC ( + 0.04 vs. -0.98 % ; P = 0.05 ) . Changes in bone formation markers and physical domains of quality of life were also more favorable in per protocol TC vs. UC ( P = 0.05 ) . Changes in sway parameters were significantly improved by TC vs. UC ( average sway velocity , P = 0.027 ; anterior-posterior sway range , P = 0.014 ) . Clinical measures of balance and function showed non-significant trends in favor of TC . Conclusions TC training offered through existing community-based programs is a safe , feasible , and promising intervention for reducing multiple fracture risks . Our results affirm the value of a more definitive , longer-term trial of TC for osteopenic women , adequately powered to detect clinical ly relevant effects of TC on attenuation of BMD loss and reduction of fall risk in this population .Trial Registration Clinical Trials.gov : Summary The EFOPS trial clearly established the positive effect of long-term exercise on clinical low-trauma fractures in postmenopausal women at risk . Bearing in mind that the complex anti-fracture exercise protocol s also affect a large variety of diseases of increased age , we strongly encourage older adults to perform multi purpose exercise programs . Introduction Physical exercise may be an efficient option for autonomous fracture prevention during increasing age . The aim of the study was to evaluate the effect of exercise on clinical overall fracture incidence and bone mineral density ( BMD ) in elderly subjects at risk . Methods In 1998 initially , 137 early-postmenopausal , osteopenic women living in Erlangen-Nuremberg , Germany , were included in the EFOPS trial . Subjects of the exercise group ( EG ; n = 86 ) conducted two supervised group and two home exercise sessions/week while the control group ( CG ; n = 51 ) was requested to maintain their physical activity . Primary study endpoints were clinical overall low-trauma fractures determined by question naires , structured interviews , and BMD at the lumbar spine and femoral neck assessed by dual-energy X-ray absorptiometry . Results In 2014 , 105 subjects ( EG : n = 59 vs. CG : n = 46 ) representing 1680 participant-years were included in the 16-year follow-up analysis .  Risk ratio in the EG for overall low-trauma fractures was 0.51 ( 95 % confidence interval ( 95 % CI ) 0.23 to 0.97 , p = .046 ) , rate ratio was 0.42 ( 95 % CI 0.20 to 0.86 , p = .018 ) . Based on comparable baseline values , lumbar spine ( MV −1.5 % , 95 % CI −0.1 to −2.8 vs. −5.8 % , −3.3 to −7.2 % ) and femoral neck ( −6.5 % , −5.2 to −7.7 vs. −9.6 % , −8.2 to 11.1 % ) BMD decreased in both groups ; however , the reduction was more pronounced in the CG ( p ≤ .001 ) . Conclusion This study clearly evidence d the high anti-fracture efficiency of multi purpose exercise programs . Considering furthermore the favorable effect of exercise on most other risk factors of increasing age , we strongly encourage older adults to perform multi purpose exercise programs How should health care professionals choose among the many therapies cl aim ed to be efficacious for treating specific disorders ? The practice of evidence -based medicine provides an answer . Advocates of this approach urge health care professionals to base treatment choices on the best evidence from systematic research on both the efficacy and adverse effects of various therapeutic alternatives . Ideally , health care professionals would compare different treatments by referring to r and omized , double-blind , head-to-head trials that compared the treatment options . Although individual medications are typically well research ed when these placebo-controlled studies are performed , studies that directly compare treatments are rare . In the absence of direct head-to-head trials , other evidence comes from indirect comparisons of two or more therapies by examining individual studies involving each treatment . This article provides an introductory review of methods of such indirect comparisons of therapies across studies , provides examples of how these methods can be used to make treatment decisions , and presents a general overview of relevant issues and statistics for readers interested in underst and ing these methods more thoroughly Objectives To determine whether a lifestyle integrated approach to balance and strength training is effective in reducing the rate of falls  in older , high risk people living at home . Design Three arm , r and omised parallel trial ; assessment s at baseline and after six and 12 months . R and omisation done by computer generated r and om blocks , stratified by sex and fall history and concealed by an independent secure website . Setting Residents in metropolitan Sydney , Australia . Participants Participants aged 70 years or older who had two or more falls or one injurious fall in past 12 months , recruited from Veteran ’s Affairs data bases and general practice data bases . Exclusion criteria were moderate to severe cognitive problems , inability to ambulate independently , neurological conditions that severely influenced gait and mobility , resident in a nursing home or hostel , or any unstable or terminal illness that would affect ability to do exercises . Interventions Three home based interventions : Lifestyle integrated Functional Exercise ( LiFE ) approach ( n=107 ; taught principles of balance and strength training and integrated selected activities into everyday routines ) , structured programme ( n=105 ; exercises for balance and lower limb strength , done three times a week ) , sham control programme ( n=105 ; gentle exercise ) . LiFE and structured groups received five sessions with two booster visits and two phone calls ; controls received three home visits and six phone calls . Assessment s made at baseline and after six and 12 months . Main outcome measures Primary measure : rate of falls over 12 months , collected by self report . Secondary measures : static and dynamic balance ; ankle , knee and hip strength ; balance self efficacy ; daily living activities ; participation ; habitual physical activity ; quality of life ; energy expenditure ; body mass index ; and fat free mass . Results After 12 months ’ follow-up , we recorded 172 , 193 , and 224 falls in the LiFE , structured exercise , and control groups , respectively . The overall incidence of falls in the LiFE programme was 1.66 per person years , compared with 1.90 in the structured programme and 2 
    Output:
    
agent
Conclusions A multicomponent exercise program of high-speed training combined with simulated functional tasks is promising to enhance functional outcomes .
Due to substantial clinical heterogeneity of the target groups and specific dem and s of exercise modes , it is unclear which exercise program is optimal
***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: Multimodal exercise programs incorporating traditional progressive resistance training ( PRT ) , weight-bearing impact training and /or balance training are recommended to reduce risk factors for falls and fracture . However , muscle power , or the ability to produce force rapidly , has emerged as a more crucial variable to functional decline than muscle strength or mass . The aim of this 12-month community-based r and omized controlled trial , termed Osteo-cise : Strong Bones for Life , was to evaluate the effectiveness and feasibility of a multimodal exercise program incorporating high-velocity (HV)-PRT , combined with an osteoporosis education and behavioral change program , on bone mineral density ( BMD ) , body composition , muscle strength and functional muscle performance in older adults . Falls incidence was evaluated as a secondary outcome . A total of 162 older adults ( mean ± SD ; 67 ± 6 years ) with risk factors for falls and /or low BMD were r and omized to the Osteo-cise program ( n = 81 ) or a control group ( n = 81 ) . Exercise consisted of fitness center-based HV-PRT , weight-bearing impact and challenging balance/mobility activities performed three times weekly . After 12 months , the Osteo-cise program led to modest but significant net gains in femoral neck and lumbar spine BMD ( 1.0 % to 1.1 % , p < 0.05 ) , muscle strength ( 10 % to 13 % , p < 0.05 ) , functional muscle power ( Timed Stair Climb , 5 % , p < 0.05 ) and dynamic balance ( Four Square Step Test 6 % , p < 0.01 ; Sit-to-St and , 16 % , p < 0.001 ) relative to controls . There was no effect on total body lean mass or mobility ( timed-up- and -go ) , and no difference in falls rate ( incidence rate ratio [ IRR ] , 1.22 ; 95 % confidence interval [ CI ] , 0.72 - 2.04 ) . In conclusion , this study demonstrates that the Osteo-cise : Strong Bones for Life community-based , multimodal exercise program represents an effective approach to improve multiple musculoskeletal and functional performance measures in older adults with risk factors for falls and /or low BMD . Although this did not translate into a reduction in the rate of falls , further large-scale trials are needed to evaluate the efficacy of this multimodal approach on reducing falls and fracture Physical exercise has a favorable impact on bones , but optimum training strategies are still under discussion . In this study , we compared the effect of slow and fast resistance exercises on various osteodensitometric parameters .  Fifty-three postmenopausal women were r and omly assigned to a strength training ( ST ) or a power training group ( PT ) . Both groups carried out a progressive resistance training , a gymnastics session , and a home training over a period of 12 mo . During the resistance training , the ST group used slow and the PT group fast movements ; otherwise there were no training differences . All subjects were supplemented with Ca and vitamin D. At baseline and after 12 mo , bone mineral density ( BMD ) was measured at the lumbar spine , proximal femur , and distal forearm by dual-energy X-ray absorptiometry . We also measured anthropometric data and maximum static strength . Frequency and grade of pain were assessed by question naire . After 12 mo , significant between-group differences were observed for BMD at the lumbar spine ( P < 0.05 ) and the total hip ( P < 0.05 ) . Whereas the PT group maintained BMD at the spine ( + 0.7 + /- 2.1 % , not significant ) and the total hip ( 0.0 + /- 1.7 % , not significant ) , the ST group lost significantly at both sites ( spine : -0.9 + /- 1.9 % ; P < 0.05 ; total hip : -1.2 + /- 1.5 % ; P < 0.01 ) . No significant between-group differences were observed for anthropometric data , maximum strength , BMD of the forearm , or frequency and grade of pain . These findings suggest that power training is more effective than strength training in reducing bone loss in postmenopausal women OBJECTIVES To assess whether group exercise and coping classes reduce physical and psychological impairments and functional disability in older women with prevalent vertebral fractures ( VFs ) . DESIGN R and omized , controlled trial ( modified cross-over ) with site as unit of assignment ; testing at baseline and 3 , 6 , 9 , and 12 months . SETTING Nine North Carolina retirement communities . PARTICIPANTS One hundred eighty-five postmenopausal Caucasian women ( mean age 81 ) , each with at least one VFs . INTERVENTION The intervention group had 6 months of exercise ( 3 meetings weekly , 45 minutes each ) and coping classes ( 2 meetings weekly , 45 minutes each ) in Phase 1 , followed by 6 months of self-maintenance . The control group had 6 months of health education control intervention ( 1 meeting weekly , 45 minutes ) in Phase 1 , followed by the intervention described above . MEASUREMENTS Change in trunk extension strength , change in pain with activities , and change in psychological symptoms . RESULTS Between-group differences in the change in trunk extension strength ( 10.68 foot pounds , P<.001 ) and psychological symptoms ( -0.08 , P=.011 ) were significant for Phase 1 . Changes in pain with activities did not differ between groups ( -0.03 , P=.64 ) ; there was no change in the pain endpoint . In Phase 2 , controls showed significant changes in trunk strength ( 15.02 foot pounds , P<.001 ) and psychological symptoms ( -0.11 , P=.006 ) from baseline . Change in pain with activities was not significant ( -0.03 , P=.70 ) . During self-maintenance , the intervention group did not worsen in psychological symptoms , but improved trunk extension strength was not maintained . CONCLUSION Weak trunk extension strength and psychological symptoms associated with VFs can be improved in older women using group treatment , and psychological improvements are retained for at least 6 months Background Tai Chi ( TC ) is a mind-body exercise that shows potential as an effective and safe intervention for preventing fall-related fractures in the elderly . Few r and omized trials have simultaneously evaluated TC 's potential to reduce bone loss and improve fall-predictive balance parameters in osteopenic women . Methods In a pragmatic r and omized trial , 86 post-menopausal osteopenic women , aged 45 - 70 , were recruited from community clinics . Women were assigned to either nine months of TC training plus usual care ( UC ) vs. UC alone . Primary outcomes were changes between baseline and nine months of bone mineral density ( BMD ) of the proximal femur and lumbar spine ( dual-energy X-ray absorptiometry ) and serum markers of bone resorption and formation . Secondary outcomes included quality of life . In a sub sample ( n = 16 ) , quiet st and ing fall-predictive sway parameters and clinical balance tests were also assessed . Both intent-to-treat and per- protocol analyses were employed . Results For BMD , no intent-to-treat analyses were statistically significant ; however , per protocol analyses ( i.e. , only including TC participants who completed ≥ 75 % training requirements ) of femoral neck BMD changes were significantly different between TC and UC ( + 0.04 vs. -0.98 % ; P = 0.05 ) . Changes in bone formation markers and physical domains of quality of life were also more favorable in per protocol TC vs. UC ( P = 0.05 ) . Changes in sway parameters were significantly improved by TC vs. UC ( average sway velocity , P = 0.027 ; anterior-posterior sway range , P = 0.014 ) . Clinical measures of balance and function showed non-significant trends in favor of TC . Conclusions TC training offered through existing community-based programs is a safe , feasible , and promising intervention for reducing multiple fracture risks . Our results affirm the value of a more definitive , longer-term trial of TC for osteopenic women , adequately powered to detect clinical ly relevant effects of TC on attenuation of BMD loss and reduction of fall risk in this population .Trial Registration Clinical Trials.gov : Summary The EFOPS trial clearly established the positive effect of long-term exercise on clinical low-trauma fractures in postmenopausal women at risk . Bearing in mind that the complex anti-fracture exercise protocol s also affect a large variety of diseases of increased age , we strongly encourage older adults to perform multi purpose exercise programs . Introduction Physical exercise may be an efficient option for autonomous fracture prevention during increasing age . The aim of the study was to evaluate the effect of exercise on clinical overall fracture incidence and bone mineral density ( BMD ) in elderly subjects at risk . Methods In 1998 initially , 137 early-postmenopausal , osteopenic women living in Erlangen-Nuremberg , Germany , were included in the EFOPS trial . Subjects of the exercise group ( EG ; n = 86 ) conducted two supervised group and two home exercise sessions/week while the control group ( CG ; n = 51 ) was requested to maintain their physical activity . Primary study endpoints were clinical overall low-trauma fractures determined by question naires , structured interviews , and BMD at the lumbar spine and femoral neck assessed by dual-energy X-ray absorptiometry . Results In 2014 , 105 subjects ( EG : n = 59 vs. CG : n = 46 ) representing 1680 participant-years were included in the 16-year follow-up analysis .  Risk ratio in the EG for overall low-trauma fractures was 0.51 ( 95 % confidence interval ( 95 % CI ) 0.23 to 0.97 , p = .046 ) , rate ratio was 0.42 ( 95 % CI 0.20 to 0.86 , p = .018 ) . Based on comparable baseline values , lumbar spine ( MV −1.5 % , 95 % CI −0.1 to −2.8 vs. −5.8 % , −3.3 to −7.2 % ) and femoral neck ( −6.5 % , −5.2 to −7.7 vs. −9.6 % , −8.2 to 11.1 % ) BMD decreased in both groups ; however , the reduction was more pronounced in the CG ( p ≤ .001 ) . Conclusion This study clearly evidence d the high anti-fracture efficiency of multi purpose exercise programs . Considering furthermore the favorable effect of exercise on most other risk factors of increasing age , we strongly encourage older adults to perform multi purpose exercise programs How should health care professionals choose among the many therapies cl aim ed to be efficacious for treating specific disorders ? The practice of evidence -based medicine provides an answer . Advocates of this approach urge health care professionals to base treatment choices on the best evidence from systematic research on both the efficacy and adverse effects of various therapeutic alternatives . Ideally , health care professionals would compare different treatments by referring to r and omized , double-blind , head-to-head trials that compared the treatment options . Although individual medications are typically well research ed when these placebo-controlled studies are performed , studies that directly compare treatments are rare . In the absence of direct head-to-head trials , other evidence comes from indirect comparisons of two or more therapies by examining individual studies involving each treatment . This article provides an introductory review of methods of such indirect comparisons of therapies across studies , provides examples of how these methods can be used to make treatment decisions , and presents a general overview of relevant issues and statistics for readers interested in underst and ing these methods more thoroughly Objectives To determine whether a lifestyle integrated approach to balance and strength training is effective in reducing the rate of falls  in older , high risk people living at home . Design Three arm , r and omised parallel trial ; assessment s at baseline and after six and 12 months . R and omisation done by computer generated r and om blocks , stratified by sex and fall history and concealed by an independent secure website . Setting Residents in metropolitan Sydney , Australia . Participants Participants aged 70 years or older who had two or more falls or one injurious fall in past 12 months , recruited from Veteran ’s Affairs data bases and general practice data bases . Exclusion criteria were moderate to severe cognitive problems , inability to ambulate independently , neurological conditions that severely influenced gait and mobility , resident in a nursing home or hostel , or any unstable or terminal illness that would affect ability to do exercises . Interventions Three home based interventions : Lifestyle integrated Functional Exercise ( LiFE ) approach ( n=107 ; taught principles of balance and strength training and integrated selected activities into everyday routines ) , structured programme ( n=105 ; exercises for balance and lower limb strength , done three times a week ) , sham control programme ( n=105 ; gentle exercise ) . LiFE and structured groups received five sessions with two booster visits and two phone calls ; controls received three home visits and six phone calls . Assessment s made at baseline and after six and 12 months . Main outcome measures Primary measure : rate of falls over 12 months , collected by self report . Secondary measures : static and dynamic balance ; ankle , knee and hip strength ; balance self efficacy ; daily living activities ; participation ; habitual physical activity ; quality of life ; energy expenditure ; body mass index ; and fat free mass . Results After 12 months ’ follow-up , we recorded 172 , 193 , and 224 falls in the LiFE , structured exercise , and control groups , respectively . The overall incidence of falls in the LiFE programme was 1.66 per person years , compared with 1.90 in the structured programme and 2 
    Output:
    