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: AIM The present study investigated the effectiveness of Baduanjin Qigong on symptoms related to gait , functional mobility and sleep in Parkinson disease ( PD ) patients . METHODS A total of 100 patients ( age 67.53 ± 8.56 years , range 55 - 80 years ) with mild to moderate PD were r and omly assigned to two groups . Participants in the Baduanjin Qigong group ( BQG ) received a Baduanjin Qigong program , consisting of four 45-min sessions each week and daily walking 30 min for 6 months . Participants in the control group were carried out daily walking for 30 min . Pre- and post-intervention testing was carried out to assess sleep quality , fatigue , functional mobility and gait performance in these participants . RESULTS After the 6-month Baduanjin Qigong intervention , the BQG showed sleep quality improvements in the Unified Parkinson 's Disease Rating Scale score ( P = 0.049 ) , Parkinson 's Disease Sleep Scale-2 ( PDSS-2 ) total score ( P = 0.039 ) , Motor Symptoms at Night ( PDSS-2 ) score ( P = 0.039 ) , PD Symptoms at Night ( PDSS-2 ) score ( P = 0.029 ) , Disturbed Sleep ( PDSS-2 ) score ( P = 0.037 ) . The BQG showing functional mobility capacity greater improvements in the Berg Balance Scale ( P = 0.041 ) and 6-minute walk test ( P = 0.042 ) , and greater decrease in the Timed Up & Go ( s ; P = 0.046 ) . The BQG showing gait function increased in the gait speed ( m/s ; P = 0.011 ) . However , this was not the case for the control group , which remained at the same level as pretest performance . CONCLUSIONS BQG improved the gait performance , functional mobility and sleep quality in older adults with PD at the 6-month follow up . It is as an alternative home exercise program for older adults in rehabilitation for PD . Geriatr Gerontol Int 2016 ; 16 : 911 - 919 This pilot study examines the effects of Tai Chi on balance , gait and mobility in people with Parkinson disease ( PD ) . Thirty-three people with PD were r and omly assigned to either a Tai Chi group or a control group . The Tai Chi group participated in 20 1-h long training sessions completed within 10 - 13 weeks ; whereas , the control group had two testing sessions between 10 and 13 weeks apart without interposed training . The Tai Chi group improved more than the control group on the Berg Balance Scale , UPDRS , Timed Up and Go , t and em stance test , six-minute walk , and backward walking . Neither group improved in forward walking or the one leg stance test . All Tai Chi participants reported satisfaction with the program and improvements in well-being .  Tai Chi appears to be an appropriate , safe and effective form of exercise for some individuals with mild-moderately severe PD OBJECTIVES There is evidence to support the effectiveness of tai chi for reducing pain-related symptoms across multiple musculoskeletal conditions , however , the mechanism(s ) are unclear . This study explores the role of pain-catastrophising as a possible mediator in the relationship between practising tai chi and back pain symptoms . DESIGN Exploratory mediation analyses using a Baron and Kenny approach and bootstrapping methods were employed as a secondary analysis of data from a previously published r and omised controlled trial . SETTING Adults with persistent low back pain were recruited via community advertisement in Sydney , NSW , Australia . INTERVENTIONS A 10-week tai chi intervention and a wait-list control . MAIN OUTCOME MEASURES Patients completed self- assessment s of pain intensity and bothersomeness using 0 - 10 numerical rating scales , disability using the Rol and Morris Disability Question naire and pain catastrophising using the Pain Coping Strategies Question naire pre and post intervention . RESULTS The results suggest partial mediation , by which a reduction in catastrophising explained approximately 1/3 of the effect on pain intensity and bothersomeness and 2/3 of the effect on disability . CONCLUSION As the first known mediation analysis of tai chi for reducing low back pain-symptoms , it provides initial evidence that it may do so by having an effect on cognitive appraisal outcomes such as pain-catastrophising and information for choosing appropriate process measures for future studies . As tai chi is growing in popularity as an alternative treatment for patients with chronic musculoskeletal conditions , it is important to gain a better underst and ing of how it might work using confirmatory mediation analysis alongside future RCTs AIM To investigate the effects of an aerobic training in subjects with Parkinson 's disease ( PD ) as compared to a medical Chinese exercise ( Qigong ) . METHODS DESIGN r and omized controlled trial with a cross over design . SETTING PD out- patients referred to a Neurorehabilitation facility for the management of motor disability . SUBJECTS 26 PD patients in Hoehn and Yahr stage II to III under stable medication were r and omly allocated to either Group AT1+QG2 ( receiving 20 aerobic training sessions followed by 20 ' ' Qigong ' ' group sessions with 2 month interval between the interventions ) , or Group QG1+AT2 ( performing the same treatments with an inverted sequence ) . MAIN OUTCOME MEASURES clinical effects of treatment were sought through the Unified Parkinson 's Disease Rating Scale ( UPDRS ) , Brown 's Disability Scale ( B'DS ) , six-Minute Walking Test ( 6MWT ) , Borg scale for breathlessness , Beck Depression Inventory ( BDI ) and Parkinson 's Disease Question naire-39 items ( PDQ-39 ) . A spirometry test and maximum cardiopulmonary exercise test ( CPET ) were also performed to determine the pulmonary function , the metabolic and cardio-respiratory requests at rest and under exercise . All measures were taken immediately before and at the completion of each treatment phase . RESULTS The statistical analysis focusing on the evolution of motor disability and quality of life revealed a significant interaction effect between group and time for the 6MWT ( time x group effect : F : 5.4 P=0.002 ) and the Borg scale ( time x group effect : F : 4.2 P=0.009 ) . Post hoc analysis showed a significant increase in 6MWT and a larger decrease in Borg score after aerobic training within each subgroup , whereas no significant changes were observed during Qigong . No significant changes over time were detected through the analysis of UPDRS , B'DS , BDI and PDQ-39 scores . The analysis of cardiorespiratory parameters showed significant interaction effects between group and time for the Double Productpeak ( time x group effect : F : 7.7 P=0.0003 ) , the VO(2peak ) ( time x group effect : F : 4.8 P=0.007 ) , and the VO(2)/kg ratio ( time x group effect : F : 4.3 P=0.009 ) , owing to their decrease after aerobic training to an extent that was never observed after Qigong treatment . CONCLUSIONS Aerobic training exerts a significant impact on the ability of moderately disabled PD patients to cope with exercise , although it does not improve their self-sufficiency and quality of life Background Tai Chi ( TC ) exercise improves balance and reduces falls in older , health-impaired adults .  TC ’s impact on dual task ( DT ) gait parameters predictive of falls , especially in healthy active older adults , however , is unknown . Purpose To compare differences in usual and DT gait between long-term TC-expert practitioners and age-/gender-matched TC-naïve adults , and to determine the effects of short-term TC training on gait in healthy , non-sedentary older adults . Methods A cross-sectional study compared gait in healthy TC-naïve and TC-expert ( 24.5 ± 12 years experience ) older adults . TC-naïve adults then completed a 6-month , two-arm , wait-list r and omized clinical trial of TC training . Gait speed and stride time variability ( Coefficient of Variation % ) were assessed during 90 s trials of undisturbed and cognitive DT ( serial subtractions ) conditions . Results During DT , gait speed decreased ( p < 0.003 ) and stride time variability increased ( p < 0.004 ) in all groups . Cross-sectional comparisons indicated that stride time variability was lower in the TC-expert vs. TC-naïve group , significantly so during DT ( 2.11 vs. 2.55 % ; p = 0.027 ) ; by contrast , gait speed during both undisturbed and DT conditions did not differ between groups . Longitudinal analyses of TC-naïve adults r and omized to 6 months of TC training or usual care identified improvement in DT gait speed in both groups . A small improvement in DT stride time variability ( effect size = 0.2 ) was estimated with TC training , but no significant differences between groups were observed . Potentially important improvements after TC training could not be excluded in this small study . Conclusion In healthy active older adults , positive effects of short- and long-term TC were observed only under cognitively challenging DT conditions and only for stride time variability . DT stride time variability offers a potentially sensitive metric for monitoring TC ’s impact on fall risk with healthy older adults INTRODUCTION Aging is typically associated with progressive multi-system impairment that leads to decreased physical and cognitive function and reduced adaptability to stress . Due to its capacity to characterize complex dynamics within and between physiological systems , the emerging field of complex systems biology and its array of quantitative tools show great promise for improving our underst and ing of aging , monitoring senescence , and providing biomarkers for evaluating novel interventions , including promising mind-body exercises , that treat age-related disease and promote healthy aging . MATERIAL AND METHODS An ongoing , two-arm r and omized clinical trial is evaluating the potential of Tai Chi mind-body exercise to attenuate age-related loss of complexity . A total of 60 Tai Chi-naïve healthy older adults ( aged 50 - 79 ) are being r and omized to either six months of Tai Chi training ( n=30 ) , or to a waitlist control receiving unaltered usual medical care ( n=30 ) . Our primary outcomes are complexity-based measures of heart rate , st and ing postural sway and gait stride interval dynamics assessed at 3 and 6months . Multiscale entropy and detrended fluctuation analysis are used as entropy- and fractal-based measures of complexity , respectively . Secondary outcomes include measures of physical and psychological function and tests of physiological adaptability also assessed at 3 and 6months . DISCUSSION Results of this study may lead to novel biomarkers that help us monitor and underst and the physiological processes of aging and explore the potential benefits of Tai Chi and related mind-body exercises for healthy aging Objective This study investigates the breathing frequency (BF)-independent effect of Tai Chi Chuan ( TCC ) on autonomic nervous modulation in  TCC practitioners . Methods Twenty-five TCC practitioners and 25 sedentary normal controls were recruited . The stationary heart rate variability ( HRV ) measures of TCC practitioners and controls were compared . The same HRV measures in TCC practitioners and among the controls , TCC practitioners before TCC and TCC practitioners 30 min after TCC were compared . Results In TCC practitioners , the BF , normalized high-frequency power ( nHFP ) , and normalized very low-frequency power were significantly increased , while the normalized low-frequency power ( nLFP ) was significantly decreased 30 min after TCC . The BF correlated significantly and negatively with heart rate ( HR ) , nHFP and nLFP , and correlated significantly and positively with mean RR interval ( MnRR ) before TCC in TCC practitioners . A slower BF is associated with a higher HR , a greater vagal modulation , and a greater combined sympatho-vagal modulation before TCC . To remove the effect of BF on HRV measures , new indices such as HR*BF , nHFP*BF , nLFP*BF , and MnRR/BF were introduced for comparison among the controls , TCC practitioners before TCC , and TCC practitioners 30 min after TCC . Thirty minutes after TCC , the MnRR/BF of TCC practitioner was smaller whereas HR*BF and nHFP*BF were greater than those before TCC.InterpretationThe BF-independent effects of TCC on the autonomic nervous modulation of TCC practitioners are an increase in vagal modulation and HR , and a decrease in mean RR interval . The mechanism underlying the parallel increase in HR and vagal modulation in TCC practitioners is not understood yet at present The purpose of the study is to investigate the effects of therapeutic Tai chi ( TTC ) on the functional fitness status and activities of daily living ( ADL ) of patients with Parkinson disease ( PD ) . The participants were clinical ly stable PDs in Hoehn and Yahr stage 1–2 . These patients were r and omly assigned to either the TTC group ( n=11 ) or the control ( CON ) group ( n=9 ) . The TTC exercised at the clinic 2 times a week and performed home-based activity 1 time per week for 12 weeks . All the PDs were evaluated for functional fitness test and ADL screen before and after the 12-week trial . There was a significant Time × group interaction effect on the arm curl ( P<0.01 ) , functional reach ( P<0.05 ) , and st and on foot with eyes opened ( P<0.05 ) of the functional fitness as compared to the CON . The results of the functional reach test in the CON worsened significantly during the 12-week intervention in comparison with 
    Output:
    
agent
***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: AIM The present study investigated the effectiveness of Baduanjin Qigong on symptoms related to gait , functional mobility and sleep in Parkinson disease ( PD ) patients . METHODS A total of 100 patients ( age 67.53 ± 8.56 years , range 55 - 80 years ) with mild to moderate PD were r and omly assigned to two groups . Participants in the Baduanjin Qigong group ( BQG ) received a Baduanjin Qigong program , consisting of four 45-min sessions each week and daily walking 30 min for 6 months . Participants in the control group were carried out daily walking for 30 min . Pre- and post-intervention testing was carried out to assess sleep quality , fatigue , functional mobility and gait performance in these participants . RESULTS After the 6-month Baduanjin Qigong intervention , the BQG showed sleep quality improvements in the Unified Parkinson 's Disease Rating Scale score ( P = 0.049 ) , Parkinson 's Disease Sleep Scale-2 ( PDSS-2 ) total score ( P = 0.039 ) , Motor Symptoms at Night ( PDSS-2 ) score ( P = 0.039 ) , PD Symptoms at Night ( PDSS-2 ) score ( P = 0.029 ) , Disturbed Sleep ( PDSS-2 ) score ( P = 0.037 ) . The BQG showing functional mobility capacity greater improvements in the Berg Balance Scale ( P = 0.041 ) and 6-minute walk test ( P = 0.042 ) , and greater decrease in the Timed Up & Go ( s ; P = 0.046 ) . The BQG showing gait function increased in the gait speed ( m/s ; P = 0.011 ) . However , this was not the case for the control group , which remained at the same level as pretest performance . CONCLUSIONS BQG improved the gait performance , functional mobility and sleep quality in older adults with PD at the 6-month follow up . It is as an alternative home exercise program for older adults in rehabilitation for PD . Geriatr Gerontol Int 2016 ; 16 : 911 - 919 This pilot study examines the effects of Tai Chi on balance , gait and mobility in people with Parkinson disease ( PD ) . Thirty-three people with PD were r and omly assigned to either a Tai Chi group or a control group . The Tai Chi group participated in 20 1-h long training sessions completed within 10 - 13 weeks ; whereas , the control group had two testing sessions between 10 and 13 weeks apart without interposed training . The Tai Chi group improved more than the control group on the Berg Balance Scale , UPDRS , Timed Up and Go , t and em stance test , six-minute walk , and backward walking . Neither group improved in forward walking or the one leg stance test . All Tai Chi participants reported satisfaction with the program and improvements in well-being .  Tai Chi appears to be an appropriate , safe and effective form of exercise for some individuals with mild-moderately severe PD OBJECTIVES There is evidence to support the effectiveness of tai chi for reducing pain-related symptoms across multiple musculoskeletal conditions , however , the mechanism(s ) are unclear . This study explores the role of pain-catastrophising as a possible mediator in the relationship between practising tai chi and back pain symptoms . DESIGN Exploratory mediation analyses using a Baron and Kenny approach and bootstrapping methods were employed as a secondary analysis of data from a previously published r and omised controlled trial . SETTING Adults with persistent low back pain were recruited via community advertisement in Sydney , NSW , Australia . INTERVENTIONS A 10-week tai chi intervention and a wait-list control . MAIN OUTCOME MEASURES Patients completed self- assessment s of pain intensity and bothersomeness using 0 - 10 numerical rating scales , disability using the Rol and Morris Disability Question naire and pain catastrophising using the Pain Coping Strategies Question naire pre and post intervention . RESULTS The results suggest partial mediation , by which a reduction in catastrophising explained approximately 1/3 of the effect on pain intensity and bothersomeness and 2/3 of the effect on disability . CONCLUSION As the first known mediation analysis of tai chi for reducing low back pain-symptoms , it provides initial evidence that it may do so by having an effect on cognitive appraisal outcomes such as pain-catastrophising and information for choosing appropriate process measures for future studies . As tai chi is growing in popularity as an alternative treatment for patients with chronic musculoskeletal conditions , it is important to gain a better underst and ing of how it might work using confirmatory mediation analysis alongside future RCTs AIM To investigate the effects of an aerobic training in subjects with Parkinson 's disease ( PD ) as compared to a medical Chinese exercise ( Qigong ) . METHODS DESIGN r and omized controlled trial with a cross over design . SETTING PD out- patients referred to a Neurorehabilitation facility for the management of motor disability . SUBJECTS 26 PD patients in Hoehn and Yahr stage II to III under stable medication were r and omly allocated to either Group AT1+QG2 ( receiving 20 aerobic training sessions followed by 20 ' ' Qigong ' ' group sessions with 2 month interval between the interventions ) , or Group QG1+AT2 ( performing the same treatments with an inverted sequence ) . MAIN OUTCOME MEASURES clinical effects of treatment were sought through the Unified Parkinson 's Disease Rating Scale ( UPDRS ) , Brown 's Disability Scale ( B'DS ) , six-Minute Walking Test ( 6MWT ) , Borg scale for breathlessness , Beck Depression Inventory ( BDI ) and Parkinson 's Disease Question naire-39 items ( PDQ-39 ) . A spirometry test and maximum cardiopulmonary exercise test ( CPET ) were also performed to determine the pulmonary function , the metabolic and cardio-respiratory requests at rest and under exercise . All measures were taken immediately before and at the completion of each treatment phase . RESULTS The statistical analysis focusing on the evolution of motor disability and quality of life revealed a significant interaction effect between group and time for the 6MWT ( time x group effect : F : 5.4 P=0.002 ) and the Borg scale ( time x group effect : F : 4.2 P=0.009 ) . Post hoc analysis showed a significant increase in 6MWT and a larger decrease in Borg score after aerobic training within each subgroup , whereas no significant changes were observed during Qigong . No significant changes over time were detected through the analysis of UPDRS , B'DS , BDI and PDQ-39 scores . The analysis of cardiorespiratory parameters showed significant interaction effects between group and time for the Double Productpeak ( time x group effect : F : 7.7 P=0.0003 ) , the VO(2peak ) ( time x group effect : F : 4.8 P=0.007 ) , and the VO(2)/kg ratio ( time x group effect : F : 4.3 P=0.009 ) , owing to their decrease after aerobic training to an extent that was never observed after Qigong treatment . CONCLUSIONS Aerobic training exerts a significant impact on the ability of moderately disabled PD patients to cope with exercise , although it does not improve their self-sufficiency and quality of life Background Tai Chi ( TC ) exercise improves balance and reduces falls in older , health-impaired adults .  TC ’s impact on dual task ( DT ) gait parameters predictive of falls , especially in healthy active older adults , however , is unknown . Purpose To compare differences in usual and DT gait between long-term TC-expert practitioners and age-/gender-matched TC-naïve adults , and to determine the effects of short-term TC training on gait in healthy , non-sedentary older adults . Methods A cross-sectional study compared gait in healthy TC-naïve and TC-expert ( 24.5 ± 12 years experience ) older adults . TC-naïve adults then completed a 6-month , two-arm , wait-list r and omized clinical trial of TC training . Gait speed and stride time variability ( Coefficient of Variation % ) were assessed during 90 s trials of undisturbed and cognitive DT ( serial subtractions ) conditions . Results During DT , gait speed decreased ( p < 0.003 ) and stride time variability increased ( p < 0.004 ) in all groups . Cross-sectional comparisons indicated that stride time variability was lower in the TC-expert vs. TC-naïve group , significantly so during DT ( 2.11 vs. 2.55 % ; p = 0.027 ) ; by contrast , gait speed during both undisturbed and DT conditions did not differ between groups . Longitudinal analyses of TC-naïve adults r and omized to 6 months of TC training or usual care identified improvement in DT gait speed in both groups . A small improvement in DT stride time variability ( effect size = 0.2 ) was estimated with TC training , but no significant differences between groups were observed . Potentially important improvements after TC training could not be excluded in this small study . Conclusion In healthy active older adults , positive effects of short- and long-term TC were observed only under cognitively challenging DT conditions and only for stride time variability . DT stride time variability offers a potentially sensitive metric for monitoring TC ’s impact on fall risk with healthy older adults INTRODUCTION Aging is typically associated with progressive multi-system impairment that leads to decreased physical and cognitive function and reduced adaptability to stress . Due to its capacity to characterize complex dynamics within and between physiological systems , the emerging field of complex systems biology and its array of quantitative tools show great promise for improving our underst and ing of aging , monitoring senescence , and providing biomarkers for evaluating novel interventions , including promising mind-body exercises , that treat age-related disease and promote healthy aging . MATERIAL AND METHODS An ongoing , two-arm r and omized clinical trial is evaluating the potential of Tai Chi mind-body exercise to attenuate age-related loss of complexity . A total of 60 Tai Chi-naïve healthy older adults ( aged 50 - 79 ) are being r and omized to either six months of Tai Chi training ( n=30 ) , or to a waitlist control receiving unaltered usual medical care ( n=30 ) . Our primary outcomes are complexity-based measures of heart rate , st and ing postural sway and gait stride interval dynamics assessed at 3 and 6months . Multiscale entropy and detrended fluctuation analysis are used as entropy- and fractal-based measures of complexity , respectively . Secondary outcomes include measures of physical and psychological function and tests of physiological adaptability also assessed at 3 and 6months . DISCUSSION Results of this study may lead to novel biomarkers that help us monitor and underst and the physiological processes of aging and explore the potential benefits of Tai Chi and related mind-body exercises for healthy aging Objective This study investigates the breathing frequency (BF)-independent effect of Tai Chi Chuan ( TCC ) on autonomic nervous modulation in  TCC practitioners . Methods Twenty-five TCC practitioners and 25 sedentary normal controls were recruited . The stationary heart rate variability ( HRV ) measures of TCC practitioners and controls were compared . The same HRV measures in TCC practitioners and among the controls , TCC practitioners before TCC and TCC practitioners 30 min after TCC were compared . Results In TCC practitioners , the BF , normalized high-frequency power ( nHFP ) , and normalized very low-frequency power were significantly increased , while the normalized low-frequency power ( nLFP ) was significantly decreased 30 min after TCC . The BF correlated significantly and negatively with heart rate ( HR ) , nHFP and nLFP , and correlated significantly and positively with mean RR interval ( MnRR ) before TCC in TCC practitioners . A slower BF is associated with a higher HR , a greater vagal modulation , and a greater combined sympatho-vagal modulation before TCC . To remove the effect of BF on HRV measures , new indices such as HR*BF , nHFP*BF , nLFP*BF , and MnRR/BF were introduced for comparison among the controls , TCC practitioners before TCC , and TCC practitioners 30 min after TCC . Thirty minutes after TCC , the MnRR/BF of TCC practitioner was smaller whereas HR*BF and nHFP*BF were greater than those before TCC.InterpretationThe BF-independent effects of TCC on the autonomic nervous modulation of TCC practitioners are an increase in vagal modulation and HR , and a decrease in mean RR interval . The mechanism underlying the parallel increase in HR and vagal modulation in TCC practitioners is not understood yet at present The purpose of the study is to investigate the effects of therapeutic Tai chi ( TTC ) on the functional fitness status and activities of daily living ( ADL ) of patients with Parkinson disease ( PD ) . The participants were clinical ly stable PDs in Hoehn and Yahr stage 1–2 . These patients were r and omly assigned to either the TTC group ( n=11 ) or the control ( CON ) group ( n=9 ) . The TTC exercised at the clinic 2 times a week and performed home-based activity 1 time per week for 12 weeks . All the PDs were evaluated for functional fitness test and ADL screen before and after the 12-week trial . There was a significant Time × group interaction effect on the arm curl ( P<0.01 ) , functional reach ( P<0.05 ) , and st and on foot with eyes opened ( P<0.05 ) of the functional fitness as compared to the CON . The results of the functional reach test in the CON worsened significantly during the 12-week intervention in comparison with 
    Output:
    