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 Improving mobility in elderly persons is a primary goal in geriatric rehabilitation . Self-regulated exercises with instruction leaflets are used to increase training volume but adherence is often low . Exergames may improve adherence . This study therefore compared exergames with self-regulated exercise using instruction leaflets . The primary outcome was adherence . Secondary outcomes were enjoyment , motivation and balance during walking . Methods Design : single center parallel group non-blinded r and omized controlled trial with central stratified r and omization . Setting : center for geriatric inpatient rehabilitation . Included were patients over 65 with mobility restrictions who were able to perform self-regulated exercise . Patients were assigned to self-regulated exercise using a ) exergames on Windows Kinect ® ( exergame group EG ) or b ) instruction leaflets ( conventional group CG ) . During two 30 min sessions physical therapists instructed self-regulated exercise to be conducted twice daily during thirty minutes during ten working days . Patients reported adherence ( primary outcome ) , enjoyment and motivation daily . Balance during walking was measured blind before and after the treatment phase with an accelerometer . Analysis was by intention to treat . Repeated measures mixed models and Cohen ’s d effect sizes ( ES , moderate if > 0.5 , large if > 0.8 ) with 95 % CIs were used to evaluate between-group effects over time . Alpha was set at 0.05 . Results From June 2014 to December 2015 217 patients were evaluated and 54 included , 26 in the EG and 28 in the CG . Adverse effects were observed in two patients in the EG who stopped because of pain during exercising . Adherence was comparable at day one ( 38 min . in the EG and 42 min . in the CG ) and significantly higher in the CG at day 10 ( 54 min . in the CG while decreasing to 28 min . in the EG , p = 0.007 , ES 0.94 , 0.39–0.151 ) . Benefits favoring the CG were also observed for enjoyment ( p = 0.001 , ES 0.88 , 0.32 – 1.44 ) and motivation ( p = 0.046 , ES 0.59 , 0.05–1.14 ) ) . There was no between-group effect in balance during walking . Conclusions Self-regulated exercise using instruction leaflets is superior to exergames  regarding adherence , enjoyment and motivation in a geriatric inpatient rehabilitation setting . Effects were moderate to large . There was no between group difference in balance during walking . Trial registration Clinical Trials.gov , NCT02077049 , 6 February 2014 BACKGROUND Several studies on the effect of physical exercise on activities of daily living ( ADL ) for people with dementia exist ; yet , data concerning the specific context of acute psychiatric hospitals remain scant . This study measured the effect of a physical exercise program on ADL scores in patients with moderate to severe dementia hospitalized in an acute psychiatric ward . METHODS A multicenter clinical trial was conducted in five Swiss and Belgian psychiatric hospitals . Participants were r and omly allocated to either an experimental group ( EG ) or a control group ( CG ) . Members of the EG received 20 physical exercise sessions ( strengthening , balance , and walking ) over a four-week period while members of the CG participated in social interaction sessions of equivalent duration and frequency , but without physical exercise . The effect of exercise on ADL was measured by comparing scores of the Barthel Index and the Functional Independence Measure in the EG and CG before and after the intervention , and two weeks later . RESULTS Hundred and sixty patients completed the program . Characteristics of participants of both groups were similar at the inception of the study . The mean ADL score of EG decreased slightly over time , whereas that of the CG significantly decreased compared to initial scores . Overall differences between groups were not significant ; however , significant differences were found for mobility-related items . CONCLUSIONS ADL scores in elderly with moderate to severe dementia deteriorate during acute psychiatric hospitalization . An exercise program delays the loss of mobility but does not have a significant impact on overall ADL scores UNLABELLED Aging population , increases the number of  major abdominal surgery ( MAS ) performed in the elderly . Main goal of physiotherapy after that surgery is prevention postoperative complications and reduction of functional limitation . The aim of the study was to asses functional status elderly people after MAS  during early postoperative physiotherapy . MATERIAL AND METHODS In a prospect i ve r and omized study involved 34 patients scheduled for elective MAS , aged 65 + . Patients were r and omly assigned to receive PNF or conventional physiotherapy . The study included  forced spirometry ( FVC , FEV1 , PEF )  and  functional tests ( gait speed , up&go ) . Measurements were performed before surgery and the fourth day after surgery . Also analyzed age , sex , BMI and the level of postoperative independence ( postoperative independence scale SAP ) . Kolmogorow- Smirnow test was used to check normal distribution , t-Student was used to check whether two sets of data differ significantly , and r-Pearsons for correlations testing . p values < 0.05 were considered significant . RESULTS After surgery the time of gait speed test and up and go test was significant longer in comparison to preoperative value . FVC% , FEV1 % , PEF% values was decrease . In the PNF group was found significantly higher postoperative independence(SAP ) and shorter length of stay in hospital compared to conventional physiotherapy group . Results of SAP and functional tests were significantly positive correlated . CONCLUSIONS Major abdominal surgery decrees efficiency of walking and lung ventilation after 65 year old in early postoperative period . Some techniques of the PNF concept used in improving older patients after the MAS may favourably affect the postoperative increase independence and reduce the time of hospitalization Objective : To evaluate the effect of progressive resistance strength training as additional training measured on functional outcomes in older hospitalized patients . Design : A single-blinded r and omized controlled trial . Setting : Department of Geriatric Rehabilitation in university hospital . Participants : A sample of 71 patients were successively included and r and omized either to the treatment group ( TG ) ( n = 36 ) or the control group ( CG ) ( n = 35 ) . Fifteen participants dropped out ( TG n = 7 ; CG n = 8) , leaving 56 participants with a mean age of 79 ( SD 7 ) . Intervention : Participants in the treatment group were treated in groups with progressive resistance strength training in addition to st and ard care . Progressive resistance strength training of the lower extremities was performed in three sets of 12–15 repetitions , intensity 60–70 % of one repetition maximum , in four 50-minute sessions per week . Main measures : The effect was evaluated by timed up & go test , 30-second chair-st and test , 10-m walk test , three tasks ( transfer , walking , stairs ) of the Barthel Index , and use of walking aids . Results : Significant improvements in the 10-m walk test ( P < 0.01 ) and Barthel Index ( walking ) ( P = 0.01 ) were demonstrated within the treatment group but not in the control group . Both groups had significant improvements in timed up & go , 30-second chair-st and ( modified ) and Barthel Index ( transfer and walking ) . No significant difference was found between groups except for the Barthel Index ( stairs ) ( P = 0.05 ) . Analysis by the mixed-effects model showed that the treatment group improved more than the control group in all outcome variables . Conclusion : The results indicate that for older hospitalized patients  progressive resistance strength training as additional training may have an effect compared to st and ard care , but no statistically significant effects were demonstrated when measured by functional outcomes OBJECTIVES To examine the proportion of time spent in three levels of mobility ( lying , sitting , and st and ing or walking ) by a cohort of hospitalized older veterans as measured by vali date d wireless accelerometers . DESIGN A prospect i ve , observational cohort study . SETTING One hundred fifty-bed Department of Veterans Affairs hospital . PARTICIPANTS Forty-five hospitalized medical patients , aged 65 and older who were not delirious , did not have dementia , and were able to walk in the 2 weeks before admission were eligible . MEASUREMENTS Wireless accelerometers were attached to the thigh and ankle of patients for the first 7 days after admission or until hospital discharge , whichever came first . The mean proportion of time spent lying , sitting , and st and ing or walking  was determined for each hour after hospital admission using a previously vali date d algorithm . RESULTS Forty-five male patients ( mean age 74.2 ) with a mean length of stay of 5.1 days generated 2,592 one-hour periods of data . A baseline functional assessment indicated that 35 ( 77.8 % ) study patients were willing and able to walk a short distance independently . No patient remained in bed the entire measured hospital stay , but on average , 83 % of the measured hospital stay was spent lying in bed . The average amount of time that any one individual spent st and ing or walking ranged from a low of 0.2 % to a high of 21 % , with a median of 3 % , or 43 minutes per day . CONCLUSION This is the first study to continuously monitor mobility levels early during a hospital stay . On average , older hospitalized patients spent most of their time lying in bed , despite an ability to walk independently [ Purpose ] The aim of this study was to examine the effects of horse riding exercise using a horse riding simulator ( HRS ) and a ball on static and dynamic balance of elderly people . [ Methods ] Thirty-two elderly people hospitalized in geriatric hospitals were r and omly assigned to the HRS exercise group or the ball exercise groups , and they performed exercise for eight weeks . [ Results ] The length of postural sway during quite st and ing with and without eyes closed significantly decreased in both groups after the exercises and there was no significant difference between both groups in the Romberg test . In the functional reach test ( FRT ) , there were significant increases in distance in both groups after the exercises , and the distance of the HRS exercise group was significantly greater than that of the ball exercise group . In the Timed Up & Go test ( TUG ) and Timed 10-meter walk test ( 10MWT ) , the time significantly decreased in both groups , and there was a more significant decrease in the HRS exercise group than in the ball exercise group . [ Conclusion ] The results of this study indicate that HRS and ball exercises may improve the balance and gait ability of elderly people hospitalized in nursing homes or geriatric hospitals QUESTION What are the effects of additional exercise on hospital and patient outcomes for acutely-hospitalised older medical patients ? DESIGN Controlled clinical trial . PARTICIPANTS 236 Patients aged 65 or older admitted to an acute care hospital with a medical illness between October 2002 and July 2003 . INTERVENTION The experimental group received usual care plus an individually tailored exercise program administered twice daily from hospital admission to discharge . The control group received usual care only . OUTCOME MEASURES The primary outcome was discharge destination . Secondary outcomes were measures of activity limitation ( Barthel Index , Timed Up and Go , Functional Ambulation Classification ) , length of stay , and adverse events . RESULTS There was no significant effect of the additional exercise program on any outcome . There were no significant differences between groups for the proportion of the patients discharged to home ( RR 0.99 , 95 % CI 0.86 to 1.14 ) or inpatient rehabilitation ( RR 0.76 , 95 % CI 0.30 to 1.51 ) or for measures of activity limitation at hospital discharge . A one day difference in length of stay was identified between groups but this difference was not significant ( p = 0.45 ) . There were no significant differences between groups for adverse events : 28-day readmission ( RR 1.10 , 95 % CI 0.65 to 1.86 ) , patient mortality ( RR 1.15 , 95 % CI 0.16 to 8.0 ) , intensive care admission ( RR 0.16 , 95 % CI 0.01 to 3.13 ) and falls ( RR 0.69 , 95 % CI 0.17 to 2.81 ) . CONCLUSION Additional physiotherapy intervention during hospitalisation did not significantly improve hospital or patient outcomes Background Older adults receiving inpatient rehabilitation have low activity levels and poor mobility outcomes . Increased physical activity may improve mobility . The objective of this Phase II study was to evaluate the feasibility of a r and omized controlled trial ( RCT ) of enhanced physical activity in older adults receiving rehabilitation . Methods Patients admitted to aged care rehabilitation with reduced mobility were r and omized to receive usual care or usual care plus additional physical activity  , which was delivered by a physiotherapist or physiotherapy assistant . The feasibility and safety of the proposed RCT protocol was evaluated . The primary clinical outcome was mobility , which was assessed on hospital admission and discharge by an assessor blinded to group assignment . To determine the most appropriate measure of mobility , three measures were trialled ; the Timed Up and Go , the Elderly Mobility Scale and the de Morton Mobility Index . Results The protocol was feasible . Thirty-four percent of people admitted to the ward were recruited , with 47 participants r and omised to a control ( n = 25 ) or intervention group ( n = 22 ) . The rates of adverse events ( death , falls and readmission to an acute service ) did not differ between the groups . Usual care therapists remained blind to group allocation , with no change in usual practice . Physical activity targets were met on weekdays but not weekends and the intervention was acceptable to participants . The de Morton Mobility Index was the most appropriate measure of mobility . Conclusions The proposed RCT of enhanced physical activity in older adults receiving rehabilitation was feasible . A larger multi-centre RCT to establish whether this intervention 
    Output:
    
agent
Overall , the effect of physical interventions on physical performance was inconsistent .
Patient tailored interventions , i.e. continuously adapted to the capabilities of the patient were not found to be superior over interventions that were not .
Conclusions Evidence for the effect of physical interventions on physical performance in older patients during hospitalization was found uncertain .
***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 Improving mobility in elderly persons is a primary goal in geriatric rehabilitation . Self-regulated exercises with instruction leaflets are used to increase training volume but adherence is often low . Exergames may improve adherence . This study therefore compared exergames with self-regulated exercise using instruction leaflets . The primary outcome was adherence . Secondary outcomes were enjoyment , motivation and balance during walking . Methods Design : single center parallel group non-blinded r and omized controlled trial with central stratified r and omization . Setting : center for geriatric inpatient rehabilitation . Included were patients over 65 with mobility restrictions who were able to perform self-regulated exercise . Patients were assigned to self-regulated exercise using a ) exergames on Windows Kinect ® ( exergame group EG ) or b ) instruction leaflets ( conventional group CG ) . During two 30 min sessions physical therapists instructed self-regulated exercise to be conducted twice daily during thirty minutes during ten working days . Patients reported adherence ( primary outcome ) , enjoyment and motivation daily . Balance during walking was measured blind before and after the treatment phase with an accelerometer . Analysis was by intention to treat . Repeated measures mixed models and Cohen ’s d effect sizes ( ES , moderate if > 0.5 , large if > 0.8 ) with 95 % CIs were used to evaluate between-group effects over time . Alpha was set at 0.05 . Results From June 2014 to December 2015 217 patients were evaluated and 54 included , 26 in the EG and 28 in the CG . Adverse effects were observed in two patients in the EG who stopped because of pain during exercising . Adherence was comparable at day one ( 38 min . in the EG and 42 min . in the CG ) and significantly higher in the CG at day 10 ( 54 min . in the CG while decreasing to 28 min . in the EG , p = 0.007 , ES 0.94 , 0.39–0.151 ) . Benefits favoring the CG were also observed for enjoyment ( p = 0.001 , ES 0.88 , 0.32 – 1.44 ) and motivation ( p = 0.046 , ES 0.59 , 0.05–1.14 ) ) . There was no between-group effect in balance during walking . Conclusions Self-regulated exercise using instruction leaflets is superior to exergames  regarding adherence , enjoyment and motivation in a geriatric inpatient rehabilitation setting . Effects were moderate to large . There was no between group difference in balance during walking . Trial registration Clinical Trials.gov , NCT02077049 , 6 February 2014 BACKGROUND Several studies on the effect of physical exercise on activities of daily living ( ADL ) for people with dementia exist ; yet , data concerning the specific context of acute psychiatric hospitals remain scant . This study measured the effect of a physical exercise program on ADL scores in patients with moderate to severe dementia hospitalized in an acute psychiatric ward . METHODS A multicenter clinical trial was conducted in five Swiss and Belgian psychiatric hospitals . Participants were r and omly allocated to either an experimental group ( EG ) or a control group ( CG ) . Members of the EG received 20 physical exercise sessions ( strengthening , balance , and walking ) over a four-week period while members of the CG participated in social interaction sessions of equivalent duration and frequency , but without physical exercise . The effect of exercise on ADL was measured by comparing scores of the Barthel Index and the Functional Independence Measure in the EG and CG before and after the intervention , and two weeks later . RESULTS Hundred and sixty patients completed the program . Characteristics of participants of both groups were similar at the inception of the study . The mean ADL score of EG decreased slightly over time , whereas that of the CG significantly decreased compared to initial scores . Overall differences between groups were not significant ; however , significant differences were found for mobility-related items . CONCLUSIONS ADL scores in elderly with moderate to severe dementia deteriorate during acute psychiatric hospitalization . An exercise program delays the loss of mobility but does not have a significant impact on overall ADL scores UNLABELLED Aging population , increases the number of  major abdominal surgery ( MAS ) performed in the elderly . Main goal of physiotherapy after that surgery is prevention postoperative complications and reduction of functional limitation . The aim of the study was to asses functional status elderly people after MAS  during early postoperative physiotherapy . MATERIAL AND METHODS In a prospect i ve r and omized study involved 34 patients scheduled for elective MAS , aged 65 + . Patients were r and omly assigned to receive PNF or conventional physiotherapy . The study included  forced spirometry ( FVC , FEV1 , PEF )  and  functional tests ( gait speed , up&go ) . Measurements were performed before surgery and the fourth day after surgery . Also analyzed age , sex , BMI and the level of postoperative independence ( postoperative independence scale SAP ) . Kolmogorow- Smirnow test was used to check normal distribution , t-Student was used to check whether two sets of data differ significantly , and r-Pearsons for correlations testing . p values < 0.05 were considered significant . RESULTS After surgery the time of gait speed test and up and go test was significant longer in comparison to preoperative value . FVC% , FEV1 % , PEF% values was decrease . In the PNF group was found significantly higher postoperative independence(SAP ) and shorter length of stay in hospital compared to conventional physiotherapy group . Results of SAP and functional tests were significantly positive correlated . CONCLUSIONS Major abdominal surgery decrees efficiency of walking and lung ventilation after 65 year old in early postoperative period . Some techniques of the PNF concept used in improving older patients after the MAS may favourably affect the postoperative increase independence and reduce the time of hospitalization Objective : To evaluate the effect of progressive resistance strength training as additional training measured on functional outcomes in older hospitalized patients . Design : A single-blinded r and omized controlled trial . Setting : Department of Geriatric Rehabilitation in university hospital . Participants : A sample of 71 patients were successively included and r and omized either to the treatment group ( TG ) ( n = 36 ) or the control group ( CG ) ( n = 35 ) . Fifteen participants dropped out ( TG n = 7 ; CG n = 8) , leaving 56 participants with a mean age of 79 ( SD 7 ) . Intervention : Participants in the treatment group were treated in groups with progressive resistance strength training in addition to st and ard care . Progressive resistance strength training of the lower extremities was performed in three sets of 12–15 repetitions , intensity 60–70 % of one repetition maximum , in four 50-minute sessions per week . Main measures : The effect was evaluated by timed up & go test , 30-second chair-st and test , 10-m walk test , three tasks ( transfer , walking , stairs ) of the Barthel Index , and use of walking aids . Results : Significant improvements in the 10-m walk test ( P < 0.01 ) and Barthel Index ( walking ) ( P = 0.01 ) were demonstrated within the treatment group but not in the control group . Both groups had significant improvements in timed up & go , 30-second chair-st and ( modified ) and Barthel Index ( transfer and walking ) . No significant difference was found between groups except for the Barthel Index ( stairs ) ( P = 0.05 ) . Analysis by the mixed-effects model showed that the treatment group improved more than the control group in all outcome variables . Conclusion : The results indicate that for older hospitalized patients  progressive resistance strength training as additional training may have an effect compared to st and ard care , but no statistically significant effects were demonstrated when measured by functional outcomes OBJECTIVES To examine the proportion of time spent in three levels of mobility ( lying , sitting , and st and ing or walking ) by a cohort of hospitalized older veterans as measured by vali date d wireless accelerometers . DESIGN A prospect i ve , observational cohort study . SETTING One hundred fifty-bed Department of Veterans Affairs hospital . PARTICIPANTS Forty-five hospitalized medical patients , aged 65 and older who were not delirious , did not have dementia , and were able to walk in the 2 weeks before admission were eligible . MEASUREMENTS Wireless accelerometers were attached to the thigh and ankle of patients for the first 7 days after admission or until hospital discharge , whichever came first . The mean proportion of time spent lying , sitting , and st and ing or walking  was determined for each hour after hospital admission using a previously vali date d algorithm . RESULTS Forty-five male patients ( mean age 74.2 ) with a mean length of stay of 5.1 days generated 2,592 one-hour periods of data . A baseline functional assessment indicated that 35 ( 77.8 % ) study patients were willing and able to walk a short distance independently . No patient remained in bed the entire measured hospital stay , but on average , 83 % of the measured hospital stay was spent lying in bed . The average amount of time that any one individual spent st and ing or walking ranged from a low of 0.2 % to a high of 21 % , with a median of 3 % , or 43 minutes per day . CONCLUSION This is the first study to continuously monitor mobility levels early during a hospital stay . On average , older hospitalized patients spent most of their time lying in bed , despite an ability to walk independently [ Purpose ] The aim of this study was to examine the effects of horse riding exercise using a horse riding simulator ( HRS ) and a ball on static and dynamic balance of elderly people . [ Methods ] Thirty-two elderly people hospitalized in geriatric hospitals were r and omly assigned to the HRS exercise group or the ball exercise groups , and they performed exercise for eight weeks . [ Results ] The length of postural sway during quite st and ing with and without eyes closed significantly decreased in both groups after the exercises and there was no significant difference between both groups in the Romberg test . In the functional reach test ( FRT ) , there were significant increases in distance in both groups after the exercises , and the distance of the HRS exercise group was significantly greater than that of the ball exercise group . In the Timed Up & Go test ( TUG ) and Timed 10-meter walk test ( 10MWT ) , the time significantly decreased in both groups , and there was a more significant decrease in the HRS exercise group than in the ball exercise group . [ Conclusion ] The results of this study indicate that HRS and ball exercises may improve the balance and gait ability of elderly people hospitalized in nursing homes or geriatric hospitals QUESTION What are the effects of additional exercise on hospital and patient outcomes for acutely-hospitalised older medical patients ? DESIGN Controlled clinical trial . PARTICIPANTS 236 Patients aged 65 or older admitted to an acute care hospital with a medical illness between October 2002 and July 2003 . INTERVENTION The experimental group received usual care plus an individually tailored exercise program administered twice daily from hospital admission to discharge . The control group received usual care only . OUTCOME MEASURES The primary outcome was discharge destination . Secondary outcomes were measures of activity limitation ( Barthel Index , Timed Up and Go , Functional Ambulation Classification ) , length of stay , and adverse events . RESULTS There was no significant effect of the additional exercise program on any outcome . There were no significant differences between groups for the proportion of the patients discharged to home ( RR 0.99 , 95 % CI 0.86 to 1.14 ) or inpatient rehabilitation ( RR 0.76 , 95 % CI 0.30 to 1.51 ) or for measures of activity limitation at hospital discharge . A one day difference in length of stay was identified between groups but this difference was not significant ( p = 0.45 ) . There were no significant differences between groups for adverse events : 28-day readmission ( RR 1.10 , 95 % CI 0.65 to 1.86 ) , patient mortality ( RR 1.15 , 95 % CI 0.16 to 8.0 ) , intensive care admission ( RR 0.16 , 95 % CI 0.01 to 3.13 ) and falls ( RR 0.69 , 95 % CI 0.17 to 2.81 ) . CONCLUSION Additional physiotherapy intervention during hospitalisation did not significantly improve hospital or patient outcomes Background Older adults receiving inpatient rehabilitation have low activity levels and poor mobility outcomes . Increased physical activity may improve mobility . The objective of this Phase II study was to evaluate the feasibility of a r and omized controlled trial ( RCT ) of enhanced physical activity in older adults receiving rehabilitation . Methods Patients admitted to aged care rehabilitation with reduced mobility were r and omized to receive usual care or usual care plus additional physical activity  , which was delivered by a physiotherapist or physiotherapy assistant . The feasibility and safety of the proposed RCT protocol was evaluated . The primary clinical outcome was mobility , which was assessed on hospital admission and discharge by an assessor blinded to group assignment . To determine the most appropriate measure of mobility , three measures were trialled ; the Timed Up and Go , the Elderly Mobility Scale and the de Morton Mobility Index . Results The protocol was feasible . Thirty-four percent of people admitted to the ward were recruited , with 47 participants r and omised to a control ( n = 25 ) or intervention group ( n = 22 ) . The rates of adverse events ( death , falls and readmission to an acute service ) did not differ between the groups . Usual care therapists remained blind to group allocation , with no change in usual practice . Physical activity targets were met on weekdays but not weekends and the intervention was acceptable to participants . The de Morton Mobility Index was the most appropriate measure of mobility . Conclusions The proposed RCT of enhanced physical activity in older adults receiving rehabilitation was feasible . A larger multi-centre RCT to establish whether this intervention 
    Output:
    