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: OBJECTIVES The purpose of this study was to test the value of gait speed , a clinical marker for frailty , to improve the prediction of mortality and major morbidity in elderly patients undergoing cardiac surgery . BACKGROUND It is increasingly difficult to predict the elderly patient 's risk posed by cardiac surgery because existing risk assessment tools are incomplete . METHODS A multicenter prospect i ve cohort of elderly patients undergoing cardiac surgery was assembled at 4 tertiary care hospitals between 2008 and 2009 . Patients were eligible if they were 70 years of age or older and were scheduled for coronary artery bypass and /or valve replacement or repair . The primary predictor was slow gait speed , defined as a time taken to walk 5 m of ≥ 6 s. The primary end point was a composite of in-hospital post-operative mortality or major morbidity . RESULTS The cohort consisted of 131 patients with a mean age of 75.8 ± 4.4 years ; 34 % were female patients . Sixty patients ( 46 % ) were classified as slow walkers before cardiac surgery . Slow walkers were more likely to be female ( 43 % vs. 25 % , p = 0.03 ) and diabetic ( 50 % vs. 28 % , p = 0.01 ) . Thirty patients ( 23 % ) experienced the primary composite end point of mortality or major morbidity after cardiac surgery . Slow gait speed was an independent predictor of the composite end point after adjusting for the Society of Thoracic Surgeons risk score ( odds ratio : 3.05 ; 95 % confidence interval : 1.23 to 7.54 ) . CONCLUSIONS Gait speed is a simple and effective test that may identify a subset of vulnerable elderly patients at incrementally higher risk of mortality and major morbidity after cardiac surgery The aim of this study was to establish whether removal of breathing exercises from a regimen including early mobilisation changes the incidence of post-operative pulmonary complications for patients after cardiac surgery . Two hundred and thirty patients undergoing open heart surgery at Monash Medical Centre , Melbourne , were enrolled in this r and omised controlled trial . All patients received physiotherapy treatment pre-operatively and post-operatively for three days . Patients were mobilised as soon as possible after surgery . Breathing group ( control ) patients performed a set routine of deep breathing exercises at each physiotherapy visit while those in the intervention group did not perform this routine . Other than the breathing exercises , patient management was similar between groups in terms of assessment , positioning and mobility . The incidence of postoperative pulmonary complications , post-operative length of stay , oxyhaemoglobin saturation and pulmonary function were measured pre-operatively and post-operatively . Intention-to-treat analysis was performed for post-operative pulmonary complications and length of stay . Other data were analysed using t-tests , chi square and repeated measures analysis of variance . There were no significant differences between the groups in the primary dependent variables . It is concluded that removal of breathing exercises from the routine physiotherapy management of open heart surgery patients does not significantly alter patient outcome OBJECTIVES The purpose of this study was to compare the effectiveness of moderate-intensity stationary cycling and walking exercise programmes in the early postoperative period after first-time coronary artery bypass graft surgery . METHODS In this prospect i ve trial , 64 patients ( 57 men , 7 women , mean age = 66 ± 9 years ) performed twice daily , moderate-intensity exercise sessions  , of 10-min duration , from postoperative day 3 until discharge from hospital . Patients were r and omly assigned to stationary cycling or walking exercise intervention groups . Preoperative and discharge functional exercise capacity and health-related quality of life were assessed using 6-min walk and cycle assessment s and the SF-36 version 2.0 question naire . Compliance with exercise was calculated as the proportion of scheduled exercise sessions completed . RESULTS There were no significant differences between intervention groups at hospital discharge for 6-min walk distance ( cyclists : 402 ± 93 m vs walkers : 417 ± 86 m , P = 0.803 ) , 6-min cycle work ( cyclists : 15.0 ± 6.4 kJ vs walkers : 14.0 ± 6.3 kJ , P = 0.798 ) or health-related quality of life . There was no significant difference between intervention groups for postoperative length of hospital stay ( P = 0.335 ) . Compliance rates for intervention groups were cyclists : 185/246 ( 75 % ) scheduled exercise sessions completed vs walkers : 199/242 ( 82 % ) scheduled exercise sessions completed ( P = 0.162 ) . CONCLUSIONS Stationary cycling provides a well-tolerated and clinical ly effective alternative to walking in the early postoperative period after coronary artery bypass graft surgery . The optimal frequency , intensity and duration of exercise in the early postoperative period require further investigation . ( Clinical trials register : Australian New Zeal and Clinical Trials Registry ; identification number : ACTRN12608000359336 ; http://www.anzctr.org.au/trial_view.aspx?ID=82978 ) Background — Cardiac surgery risk scores perform poorly in elderly patients , in part because they do not take into account frailty and disability which are critical determinants of health status with advanced age . There is an unmet need to combine established cardiac surgery risk scores with measures of frailty and disability to provide a more complete model for risk prediction in elderly patients undergoing cardiac surgery .  Methods and Results — This was a prospect i ve , multicenter cohort study of elderly patients ( ≥70 years ) undergoing coronary artery bypass and /or valve surgery in the United States and Canada . Four different frailty scales , 3 disability scales , and 5 cardiac surgery risk scores were measured in all patients . The primary outcome was the STS composite end point of in-hospital postoperative mortality or major morbidity . A total of 152 patients were enrolled , with a mean age of 75.9±4.4 years and 34 % women . Depending on the scale used , 20–46 % of patients were found to be frail , and 5–76 % were found to have at least 1 disability . The most predictive scale in each domain was : 5-meter gait speed ≥6 seconds as a measure of frailty ( odds ratio [ OR ] , 2.63 ; 95 % confidence interval [ CI ] , 1.17–5.90 ) , ≥3 impairments in the Nagi scale as a measure of disability ( OR , 2.98 ; 95 % CI , 1.35–6.56 ) and either the Parsonnet score ( OR , 1.08 ; 95 % CI , 1.04–1.13 ) or Society of Thoracic Surgeons Predicted Risk of Mortality or Major Morbidity ( STS-PROMM ) ( OR , 1.05 ; 95 % CI , 1.01–1.09 ) as a cardiac surgery risk score . Compared with the Parsonnet score or STS-PROMM alone , ( area under the curve , 0.68–0.72 ) , addition of frailty and disability provided incremental value and improved model discrimination ( area under the curve , 0.73–0.76 ) . Conclusions — Clinicians should use an integrative approach combining frailty , disability , and risk scores to better characterize elderly patients referred for cardiac surgery and identify those that are at increased risk Analysis of heart rate variability ( HRV ) can identify patients at risk of sudden cardiac death after myocardial infa rct ion . The present study examined the effect of 2 weeks of supervised aerobic exercise training on the recovery of the autonomic nervous activity , exercise capacity , and cardiac output ( CO ) after  coronary artery bypass grafting ( CABG ) . Twenty-eight patients were r and omly divided into the training group or the control group and performed exercise tests at 1 week , 3 weeks , 3 months , 6 months and 1 year after CABG . The HRV was measured , and the high-frequency component of HRV was used as an index of parasympathetic nerve activity ( PNA ) ; the plasma norepinephrine concentration ( NE ) was used as an index of sympathetic nervous activity . Cardiac output was also measured . In the training group , peak VO2 , peak CO and PNA during exercise had improved at 3 weeks , but there was no improvement in these indices in the control group . NE decreased 1 week after CABG in both groups . These results indicate that physical training soon after CABG improves not only the exercise capacity , but also PNA PURPOSE The aim of this study was to assess the effects on exercise performance of supplementing a st and ard cardiac rehabilitation program with additional exercise programming compared to the st and ard cardiac rehabilitation program alone in elderly patients after heart surgery . METHODS In this prospect i ve , r and omized controlled trial , 60 patients ( 32 men and 28 women , mean age 73.1 ± 4.7 years ) completed cardiac rehabilitation ( initiated 12.2 ± 4.9 days postsurgery ) . Subjects were assigned to either a control group ( CG , st and ard cardiac rehabilitation program [ n = 19 ] ) , or an intervention group ( IG , additional walking [ n = 19 ] , or cycle ergometry training [ n = 22 ] ) . A symptom limited cardiopulmonary exercise test and 6-minute walk test ( 6MWT ) were performed before and after 4 weeks of cardiac rehabilitation . The MacNew question naire was used to assess quality of life ( QOL ) . RESULTS At baseline , no significant differences for peak oxygen uptake ( & OV0312;O2 ) , maximal power output , or the 6MWT were detected between IG and CG . Global QOL was significantly higher in IG . After 4 weeks of cardiac rehabilitation , patients significantly improved in absolute values of the cardiopulmonary exercise test , 6MWT , and QOL scores . Significant differences between groups were found for peak & OV0312;O2 ( IG : 18.2 ± 3.1 mL·kg−1·min−1 vs. CG : 16.5 ± 2.2 mL·kg−1·min−1 , P < .05 ) ; maximal power output ( IG : 72.2 ± 16 W vs. CG : 60.7 ± 15 W , P < .05 ) ; 6MWT ( IG : 454.8 ± 76.3 m vs. CG : 400.5 ± 75.5 m , P < .05 ) ; and QOL global ( IG : 6.5 ± 0.5 vs. CG : 6.3 ± 0.6 , P < .05 ) . CONCLUSION The supplementation of additional walking or cycle exercise training to st and ard cardiac rehabilitation programming compared to st and ard cardiac rehabilitation alone in elderly patients after heart surgery leads to significantly better exercise tolerance BACKGROUND This study aim ed to determine whether a structured , inpatient ( or Phase 1 cardiac rehabilitation ) , physiotherapy-supervised walking program , with or without musculoskeletal and respiratory exercises , might improve walking capacity and other parameters for patients undergoing coronary artery bypass graft surgery ( CABG ) . METHODS Ninety-three patients awaiting first-time CABG over a 12-month period were r and omised to one of three post-operative physiotherapy regimens : ' st and ard intervention ' , consisting of gentle mobilisation ; ' walking exercise ' , consisting of a physiotherapy-supervised , moderate intensity walking program ; and ' walking/breathing exercise ' , consisting of the same moderate intensity walking program , musculoskeletal exercises and respiratory exercises . Primary outcomes ; six-minute walking assessment ( 6MWA ) distance , vital capacity and health-related quality of life , were measured pre-operatively , at discharge from hospital and at four weeks following discharge . RESULTS Walking and walking/breathing exercise groups had significantly higher 6MWA distance ( 444+/-84 m , 431+/-98 m , respectively ) than the st and ard intervention group ( 377+/-90 m ) at discharge from hospital . There was no significant difference between intervention groups for 6MWA distance at four-week follow-up . There was no significant difference between intervention groups in terms of vital capacity and health-related quality of life . CONCLUSIONS A physiotherapy-supervised , moderate intensity walking program in the inpatient phase following CABG improves walking capacity at discharge from hospital . The performance of respiratory and musculoskeletal exercises confers no additional benefit to the measured outcomes Objective . Coronary artery bypass grafting ( CABG )  is accompanied by severe impairment of cardiac autonomous regulation ( CAR ) . This study aim ed to determine whether a short-term physiotherapy exercise protocol post-CABG , during inpatient cardiac rehabilitation ( CR ) , might improve CAR . Design . Seventy-four patients eligible for CABG were recruited and r and omised into physiotherapy exercise group ( EG ) or physiotherapy usual care group ( UCG ) . EG patients underwent a short-term supervised inpatient physiotherapy exercise protocol consisting of an early mobilisation with progressive exercises plus usual care ( respiratory exercises ) . UCG only received respiratory exercises .  Forty-seven patients ( 24 EG and 23 UGC ) completed the study . Outcome measures of CAR included linear and non-linear measures of heart rate variability ( HRV ) assessed before discharge . Results . By hospital discharge , EG presented significantly 
    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: OBJECTIVES The purpose of this study was to test the value of gait speed , a clinical marker for frailty , to improve the prediction of mortality and major morbidity in elderly patients undergoing cardiac surgery . BACKGROUND It is increasingly difficult to predict the elderly patient 's risk posed by cardiac surgery because existing risk assessment tools are incomplete . METHODS A multicenter prospect i ve cohort of elderly patients undergoing cardiac surgery was assembled at 4 tertiary care hospitals between 2008 and 2009 . Patients were eligible if they were 70 years of age or older and were scheduled for coronary artery bypass and /or valve replacement or repair . The primary predictor was slow gait speed , defined as a time taken to walk 5 m of ≥ 6 s. The primary end point was a composite of in-hospital post-operative mortality or major morbidity . RESULTS The cohort consisted of 131 patients with a mean age of 75.8 ± 4.4 years ; 34 % were female patients . Sixty patients ( 46 % ) were classified as slow walkers before cardiac surgery . Slow walkers were more likely to be female ( 43 % vs. 25 % , p = 0.03 ) and diabetic ( 50 % vs. 28 % , p = 0.01 ) . Thirty patients ( 23 % ) experienced the primary composite end point of mortality or major morbidity after cardiac surgery . Slow gait speed was an independent predictor of the composite end point after adjusting for the Society of Thoracic Surgeons risk score ( odds ratio : 3.05 ; 95 % confidence interval : 1.23 to 7.54 ) . CONCLUSIONS Gait speed is a simple and effective test that may identify a subset of vulnerable elderly patients at incrementally higher risk of mortality and major morbidity after cardiac surgery The aim of this study was to establish whether removal of breathing exercises from a regimen including early mobilisation changes the incidence of post-operative pulmonary complications for patients after cardiac surgery . Two hundred and thirty patients undergoing open heart surgery at Monash Medical Centre , Melbourne , were enrolled in this r and omised controlled trial . All patients received physiotherapy treatment pre-operatively and post-operatively for three days . Patients were mobilised as soon as possible after surgery . Breathing group ( control ) patients performed a set routine of deep breathing exercises at each physiotherapy visit while those in the intervention group did not perform this routine . Other than the breathing exercises , patient management was similar between groups in terms of assessment , positioning and mobility . The incidence of postoperative pulmonary complications , post-operative length of stay , oxyhaemoglobin saturation and pulmonary function were measured pre-operatively and post-operatively . Intention-to-treat analysis was performed for post-operative pulmonary complications and length of stay . Other data were analysed using t-tests , chi square and repeated measures analysis of variance . There were no significant differences between the groups in the primary dependent variables . It is concluded that removal of breathing exercises from the routine physiotherapy management of open heart surgery patients does not significantly alter patient outcome OBJECTIVES The purpose of this study was to compare the effectiveness of moderate-intensity stationary cycling and walking exercise programmes in the early postoperative period after first-time coronary artery bypass graft surgery . METHODS In this prospect i ve trial , 64 patients ( 57 men , 7 women , mean age = 66 ± 9 years ) performed twice daily , moderate-intensity exercise sessions  , of 10-min duration , from postoperative day 3 until discharge from hospital . Patients were r and omly assigned to stationary cycling or walking exercise intervention groups . Preoperative and discharge functional exercise capacity and health-related quality of life were assessed using 6-min walk and cycle assessment s and the SF-36 version 2.0 question naire . Compliance with exercise was calculated as the proportion of scheduled exercise sessions completed . RESULTS There were no significant differences between intervention groups at hospital discharge for 6-min walk distance ( cyclists : 402 ± 93 m vs walkers : 417 ± 86 m , P = 0.803 ) , 6-min cycle work ( cyclists : 15.0 ± 6.4 kJ vs walkers : 14.0 ± 6.3 kJ , P = 0.798 ) or health-related quality of life . There was no significant difference between intervention groups for postoperative length of hospital stay ( P = 0.335 ) . Compliance rates for intervention groups were cyclists : 185/246 ( 75 % ) scheduled exercise sessions completed vs walkers : 199/242 ( 82 % ) scheduled exercise sessions completed ( P = 0.162 ) . CONCLUSIONS Stationary cycling provides a well-tolerated and clinical ly effective alternative to walking in the early postoperative period after coronary artery bypass graft surgery . The optimal frequency , intensity and duration of exercise in the early postoperative period require further investigation . ( Clinical trials register : Australian New Zeal and Clinical Trials Registry ; identification number : ACTRN12608000359336 ; http://www.anzctr.org.au/trial_view.aspx?ID=82978 ) Background — Cardiac surgery risk scores perform poorly in elderly patients , in part because they do not take into account frailty and disability which are critical determinants of health status with advanced age . There is an unmet need to combine established cardiac surgery risk scores with measures of frailty and disability to provide a more complete model for risk prediction in elderly patients undergoing cardiac surgery .  Methods and Results — This was a prospect i ve , multicenter cohort study of elderly patients ( ≥70 years ) undergoing coronary artery bypass and /or valve surgery in the United States and Canada . Four different frailty scales , 3 disability scales , and 5 cardiac surgery risk scores were measured in all patients . The primary outcome was the STS composite end point of in-hospital postoperative mortality or major morbidity . A total of 152 patients were enrolled , with a mean age of 75.9±4.4 years and 34 % women . Depending on the scale used , 20–46 % of patients were found to be frail , and 5–76 % were found to have at least 1 disability . The most predictive scale in each domain was : 5-meter gait speed ≥6 seconds as a measure of frailty ( odds ratio [ OR ] , 2.63 ; 95 % confidence interval [ CI ] , 1.17–5.90 ) , ≥3 impairments in the Nagi scale as a measure of disability ( OR , 2.98 ; 95 % CI , 1.35–6.56 ) and either the Parsonnet score ( OR , 1.08 ; 95 % CI , 1.04–1.13 ) or Society of Thoracic Surgeons Predicted Risk of Mortality or Major Morbidity ( STS-PROMM ) ( OR , 1.05 ; 95 % CI , 1.01–1.09 ) as a cardiac surgery risk score . Compared with the Parsonnet score or STS-PROMM alone , ( area under the curve , 0.68–0.72 ) , addition of frailty and disability provided incremental value and improved model discrimination ( area under the curve , 0.73–0.76 ) . Conclusions — Clinicians should use an integrative approach combining frailty , disability , and risk scores to better characterize elderly patients referred for cardiac surgery and identify those that are at increased risk Analysis of heart rate variability ( HRV ) can identify patients at risk of sudden cardiac death after myocardial infa rct ion . The present study examined the effect of 2 weeks of supervised aerobic exercise training on the recovery of the autonomic nervous activity , exercise capacity , and cardiac output ( CO ) after  coronary artery bypass grafting ( CABG ) . Twenty-eight patients were r and omly divided into the training group or the control group and performed exercise tests at 1 week , 3 weeks , 3 months , 6 months and 1 year after CABG . The HRV was measured , and the high-frequency component of HRV was used as an index of parasympathetic nerve activity ( PNA ) ; the plasma norepinephrine concentration ( NE ) was used as an index of sympathetic nervous activity . Cardiac output was also measured . In the training group , peak VO2 , peak CO and PNA during exercise had improved at 3 weeks , but there was no improvement in these indices in the control group . NE decreased 1 week after CABG in both groups . These results indicate that physical training soon after CABG improves not only the exercise capacity , but also PNA PURPOSE The aim of this study was to assess the effects on exercise performance of supplementing a st and ard cardiac rehabilitation program with additional exercise programming compared to the st and ard cardiac rehabilitation program alone in elderly patients after heart surgery . METHODS In this prospect i ve , r and omized controlled trial , 60 patients ( 32 men and 28 women , mean age 73.1 ± 4.7 years ) completed cardiac rehabilitation ( initiated 12.2 ± 4.9 days postsurgery ) . Subjects were assigned to either a control group ( CG , st and ard cardiac rehabilitation program [ n = 19 ] ) , or an intervention group ( IG , additional walking [ n = 19 ] , or cycle ergometry training [ n = 22 ] ) . A symptom limited cardiopulmonary exercise test and 6-minute walk test ( 6MWT ) were performed before and after 4 weeks of cardiac rehabilitation . The MacNew question naire was used to assess quality of life ( QOL ) . RESULTS At baseline , no significant differences for peak oxygen uptake ( & OV0312;O2 ) , maximal power output , or the 6MWT were detected between IG and CG . Global QOL was significantly higher in IG . After 4 weeks of cardiac rehabilitation , patients significantly improved in absolute values of the cardiopulmonary exercise test , 6MWT , and QOL scores . Significant differences between groups were found for peak & OV0312;O2 ( IG : 18.2 ± 3.1 mL·kg−1·min−1 vs. CG : 16.5 ± 2.2 mL·kg−1·min−1 , P < .05 ) ; maximal power output ( IG : 72.2 ± 16 W vs. CG : 60.7 ± 15 W , P < .05 ) ; 6MWT ( IG : 454.8 ± 76.3 m vs. CG : 400.5 ± 75.5 m , P < .05 ) ; and QOL global ( IG : 6.5 ± 0.5 vs. CG : 6.3 ± 0.6 , P < .05 ) . CONCLUSION The supplementation of additional walking or cycle exercise training to st and ard cardiac rehabilitation programming compared to st and ard cardiac rehabilitation alone in elderly patients after heart surgery leads to significantly better exercise tolerance BACKGROUND This study aim ed to determine whether a structured , inpatient ( or Phase 1 cardiac rehabilitation ) , physiotherapy-supervised walking program , with or without musculoskeletal and respiratory exercises , might improve walking capacity and other parameters for patients undergoing coronary artery bypass graft surgery ( CABG ) . METHODS Ninety-three patients awaiting first-time CABG over a 12-month period were r and omised to one of three post-operative physiotherapy regimens : ' st and ard intervention ' , consisting of gentle mobilisation ; ' walking exercise ' , consisting of a physiotherapy-supervised , moderate intensity walking program ; and ' walking/breathing exercise ' , consisting of the same moderate intensity walking program , musculoskeletal exercises and respiratory exercises . Primary outcomes ; six-minute walking assessment ( 6MWA ) distance , vital capacity and health-related quality of life , were measured pre-operatively , at discharge from hospital and at four weeks following discharge . RESULTS Walking and walking/breathing exercise groups had significantly higher 6MWA distance ( 444+/-84 m , 431+/-98 m , respectively ) than the st and ard intervention group ( 377+/-90 m ) at discharge from hospital . There was no significant difference between intervention groups for 6MWA distance at four-week follow-up . There was no significant difference between intervention groups in terms of vital capacity and health-related quality of life . CONCLUSIONS A physiotherapy-supervised , moderate intensity walking program in the inpatient phase following CABG improves walking capacity at discharge from hospital . The performance of respiratory and musculoskeletal exercises confers no additional benefit to the measured outcomes Objective . Coronary artery bypass grafting ( CABG )  is accompanied by severe impairment of cardiac autonomous regulation ( CAR ) . This study aim ed to determine whether a short-term physiotherapy exercise protocol post-CABG , during inpatient cardiac rehabilitation ( CR ) , might improve CAR . Design . Seventy-four patients eligible for CABG were recruited and r and omised into physiotherapy exercise group ( EG ) or physiotherapy usual care group ( UCG ) . EG patients underwent a short-term supervised inpatient physiotherapy exercise protocol consisting of an early mobilisation with progressive exercises plus usual care ( respiratory exercises ) . UCG only received respiratory exercises .  Forty-seven patients ( 24 EG and 23 UGC ) completed the study . Outcome measures of CAR included linear and non-linear measures of heart rate variability ( HRV ) assessed before discharge . Results . By hospital discharge , EG presented significantly 
    Output:
    