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 To evaluate the effectiveness and safety of water aerobics during pregnancy . Methods A r and omized controlled trial carried out in 71 low-risk sedentary pregnant women , r and omly allocated to water aerobics or no physical exercise .  Maternal body composition and perinatal outcomes were evaluated . For statistical analysis Chi-square , Fisher 's or Student 's t-tests were applied . Risk ratios and their 95 % CI were estimated for main outcomes . Body composition was evaluated across time using MANOVA or Friedman multiple analysis . Results There were no significant differences between the groups regarding maternal weight gain , BMI or percentage of body fat during pregnancy . Incidence of preterm births ( RR = 0.84 ; 95%CI:0.28–2.53 ) , vaginal births ( RR = 1.24 ; 95%CI:0.73–2.09 ) , low birthweight ( RR = 1.30 ; 95%CI:0.61–2.79 ) and adequate weight for gestational age ( RR = 1.50 ; 95%CI:0.65–3.48 ) were also not significantly different between groups . There were no significant differences in systolic and diastolic blood pressure and heart rate between before and immediately after the water aerobics session . Conclusion Water aerobics for sedentary pregnant women proved to be safe and was not associated with any alteration in maternal body composition , type of delivery , preterm birth rate , neonatal well-being or weight PURPOSE The present study examined the effects of exercise on physical and psychological variables in sedentary primigravidae ( PRA ) . METHODS A total of nine women r and omly assigned to an exercise ( E ) ( mean age = 31.3 + /- 3.1 yr ) and six subjects r and omly assigned to a control ( C ) group ( mean age = 27.8 + /- 3.1 yr ) fulfilled all requirements for the study . Exercise included a variety of exercise activities performed to a target heart rate of 150 - 156 beats x min(-1 ) , three times per week for 15 wk . RESULTS Results showed no significant differences between E and C groups in physical characteristics initially . A repeated measures ANOVA showed a significant group effect ( P < 0.05 ) and a significant group by time interaction ( P = 0.001 ) with the E group showing a significantly longer amount of time on the PWC150 test than the C group . There was no significant group , time , or group by time interaction for lactate accumulation . This occurred , despite the fact that the E group spent 56 % longer on the PWC150 test and the C group spent 30 % less time on the same test at the conclusion of the study . Finally , the E group in comparison to the C group showed more favorable improvements in several items related to health and well-being on the Body Cathexis Scale . There were no significant differences between E and C groups in any pregnancy outcome measures . All babies were delivered healthy  at term . CONCLUSIONS These data suggest that a vigorous exercise program can lead to significant improvements in aerobic fitness at similar lactate concentrations compared to a control group and can be well tolerated by low risk sedentary PRA without any deleterious effects occurring to herself or unborn child Objective To examine the effectiveness of a partially homebased , moderate-intensity aerobic exercise program for women with gestational diabetes . Methods This was a r and omized experimental design . Thirty-three women with gestational diabetes were r and omly assigned to the exercise or the no-exercise group . Subjects underwent hemoglobin A1C assay and submaximal cycle ergometer fitness tests at baseline and at study conclusion . Subjects kept diaries of home fasting and 2-hour postpr and ial blood glucose determinations . Exercise subjects were asked to exercise for 30 minutes three to four times weekly at 70 % of estimated maximal heart rate for the weeks of study participation . Two exercise sessions weekly were supervised by the investigator , and two were unsupervised at home .  Control-group  subjects were asked to maintain their current activity level . Results Daily fasting and postpr and ial blood glucose levels , hemoglobin A1C , incidence of exogenous insulin therapy , and incidence of newborn hypoglycemia were not different between the groups . There was a training effect in the exercise group ( P = .005 ) but not in the control group ( P = .25 ) . A significant decline in daily grams of carbohydrate consumed was observed in the control group ( P = .03 ) , but not in the exercise group ( P = .97 ) . No complications were found in the subjects who exercised . Conclusions A partially home-based exercise program did not reduce blood glucose levels , but did result in a modest increase in cardiorespiratory fitness . The intervention appeared safe Background Pregnancy is a period in the life of women that is often associated with decreased daily physical activity and /or exercise . However , maintaining adequate levels of daily physical activity during pregnancy is important for mother and child . Studies suggest that moderate daily physical activity and exercise during pregnancy are associated with reductions in the risk of gestational diabetes mellitus ( GDM ) . However , at present , physical activity is not routinely advised to pregnant women at risk for gestational diabetes in the Netherl and s. In FitFor2- study we aim to assess whether an exercise program can improve insulin sensitivity and fasting plasma glucose levels of women at high risk for gestational diabetes , assuming that this will lower their risk of gestational diabetes . Methods The FitFor2- study is a r and omised controlled trial . Women who visit one of the participating hospitals or midwifery practice s and who are at risk for gestational diabetes are eligible to participate . After baseline measurement they are r and omly allocated to in the intervention or control group . The intervention group receives an exercise program twice a week in addition to usual care . The exercise program consist of aerobic and strength exercises and takes place under close supervision of a physiotherapist . Data are collected at 15 , 24 and 32 weeks of pregnancy and 12 weeks after delivery . Primary maternal outcome measures are fasting plasma glucose and relative increase in insulin resistance . Primary neonatal outcome is birth weight . Secondary outcome measures are : maternal serum triglycerides , HDL , cholesterol , HbA1c , maternal weight gain during pregnancy , maternal physical activity level , foetal growth . Discussion If the FitFor2 intervention program proves to be effective , obstetricians and midwives should refer women at risk for GDM to a special exercise program . Exercise programs for pregnant women under supervision of an experienced trainer are already available in the Netherl and s , and these programs could be adjusted easily for this target group . Furthermore , the costs of these programs should be refunded by including them in the basic health care cost reimbursement schemes . Trial registration Please cite this paper as : Hui A , Back L , Ludwig S , Gardiner P , Sevenhuysen G , Dean H , Sellers E , McGavock J , Morris M , Bruce S , Murray R , Shen G. Lifestyle intervention on diet and exercise reduced excessive gestational weight gain in pregnant women under a r and omised controlled trial . BJOG 2012;119:70–77 Background To evaluate the association between water aerobics , maternal cardiovascular capacity during pregnancy , labor and neonatal outcomes . Methods A r and omized , controlled clinical trial was carried out in which 34 pregnant women were allocated to a water aerobics group and 37 to a control group .  All women were su bmi tted to submaximal ergometric tests on a treadmill at 19 , 25 and 35 weeks of pregnancy and were followed up until delivery . Oxygen consumption ( VO2 max ) , cardiac output ( CO ) , physical fitness , skin temperature , data on labor and delivery , and neonate outcomes were evaluated . Frequency distributions of the baseline variables of both groups were initially performed and then analysis of the outcomes was carried out . Categorical data were compared using the chi-square test , and numerical using Student 's t or Mann-Whitney tests . Wilk 's Lambda or Friedman 's analysis of repeat measurements were applied for comparison of physical capacity , cardiovascular outcomes and maternal temperature . Results VO2 max and physical fitness were higher in both groups in the second trimester , returning to basal levels in the third trimester . In both groups , CO increased as pregnancy progressed and peak exercise temperature was higher than resting temperature , increasing further after five minutes of recovery and remaining at this level until 15 minutes after exercise completion . There was no difference between the two groups regarding duration ( 457.9 ± SD 249.6 vs 428.9 ± SD 203.2 minutes ) or type of delivery . Labor analgesia was requested by significantly fewer women in the water aerobics group ( 27 % vs 65 % ; RR = 0.42 95%CI 0.23–0.77 ) . Neonatal results were similar in both groups . Conclusion The regular practice of moderate water aerobics by sedentary and low risk pregnant women was not detrimental to the health of the mother or the child . There was no influence on maternal cardiovascular capacity , duration of labor or type of delivery ; however , there were fewer requests for analgesia during labor in the water aerobics group Objective The influence of an exercise programme performed by healthy pregnant women on maternal glucose tolerance was studied . Study design A physical activity ( PA , l and /aquatic activities ) programme during the entire pregnancy ( three sessions per week ) was conducted by a qualified instructor . 83 healthy pregnant women were r and omly assigned to either an exercise group ( EG , n=40 ) or a control ( CG , n=43 ) group . 50 g maternal glucose screen ( MGS ) , maternal weight gain and several pregnancy outcomes were recorded . Results Significant differences were found between study groups on the 50 g MGS . Values corresponding to the EG ( 103.8±20.4 mg/dl ) were better than those of the CG ( 126.9±29.5 mg/dl ) , p=0.000 . In addition , no differences in maternal weight gain and no cases of gestational diabetes in EG versus 3 in CG ( 7 % ) ( p>0.05 ) were found . Conclusion A moderate PA programme performed during pregnancy improves levels of maternal glucose tolerance OBJECTIVE We have studied the effect of moderate physical activity that is performed by healthy women during their entire pregnancy on their perception of health status . STUDY DESIGN Eighty sedentary women were assigned r and omly to either an exercise group ( n = 40 ) or a control group ( n = 40 ) . Maternal perception of health status and several pregnancy outcomes were recorded . RESULTS Significant differences ( P = .03 ) were found between study groups in the percentage of women who perceived their health status as " very good " ; the values that corresponded to the exercise group ( n = 18 ; 54.5 % ) were better than those of the control group ( n = 9 ; 27.3 % ) . In addition , the women of the exercise group gained less weight ( 11,885 ± 3146 g ) than those of the control group ( 13,903 ± 2113 ; P = .03 ) . CONCLUSION A moderate physical activity program that is performed over the first , second , and third trimester of pregnancy improves the maternal perception of health status OBJECTIVE To investigate if water-gymnastics during pregnancy may reduce the intensity of back/low back pain and the number of days on sick-leave . METHODS A prospect i ve , r and omized study . One hundred and twenty-nine women were r and omized to participate in water-gymnastics once a week during the second half of pregnancy and 129 were r and omized to a control group . The women in both groups filled in question naires in gestational weeks 18 , 34 and within the first postpartum week . Every day from week 18 to labor they assessed the intensity of back/low back pain . RESULTS Back pain intensity increased during pregnancy . No excess risk for the pregnancy associated with water-gymnastics was observed . The women participating in water-gymnastics recorded a lower intensity of back/low back pain . The total number of days on sick-leave because of back/low back pain was 982 in the water-gymnastics group ( 124 women ) compared with 1484 in the control group ( 120 women ) . After weeks 32 33 , seven women in the water-gymnastics group compared with 17 in the control group were on sickleave because of back/ low back pain ( p=0.031 ) . CONCLUSIONS Intensity of back/low back pain increased with advancing pregnancy . There was no excess risk for urinary or vaginal infections associated with water-gymnastics . Water-gymnastics during the second half of pregnancy significantly reduced the intensity of back/ low back pain .  Water-gymnastics decreased the number of women on sick-leave because of back/low back pain .  Water-gymnastics during pregnancy can be recommended as a method to relieve back pain and may reduce the need for sick-leave Objective : We examined the effect of light intensity resistance exercise training performed during the second and third trimester of pregnancy on the  newborn 's birth size . We also studied the association between  maternal body weight prior to pregnancy and newborn 's birth size .  Design : R and omised controlled trial . Subjects : We r and omly assigned 160 sedentary gravidae to either a training ( n=80 ) or a control ( n=80 ) group . The training programme focused on light resistance and toning exercises ( three times per week , 35–40 min per session ) . We recorded the Apgar score , birth weight , birth length , and head circumference of the newborn , as well as gestational age at time of delivery from hospital perinatal 
    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: Background To evaluate the effectiveness and safety of water aerobics during pregnancy . Methods A r and omized controlled trial carried out in 71 low-risk sedentary pregnant women , r and omly allocated to water aerobics or no physical exercise .  Maternal body composition and perinatal outcomes were evaluated . For statistical analysis Chi-square , Fisher 's or Student 's t-tests were applied . Risk ratios and their 95 % CI were estimated for main outcomes . Body composition was evaluated across time using MANOVA or Friedman multiple analysis . Results There were no significant differences between the groups regarding maternal weight gain , BMI or percentage of body fat during pregnancy . Incidence of preterm births ( RR = 0.84 ; 95%CI:0.28–2.53 ) , vaginal births ( RR = 1.24 ; 95%CI:0.73–2.09 ) , low birthweight ( RR = 1.30 ; 95%CI:0.61–2.79 ) and adequate weight for gestational age ( RR = 1.50 ; 95%CI:0.65–3.48 ) were also not significantly different between groups . There were no significant differences in systolic and diastolic blood pressure and heart rate between before and immediately after the water aerobics session . Conclusion Water aerobics for sedentary pregnant women proved to be safe and was not associated with any alteration in maternal body composition , type of delivery , preterm birth rate , neonatal well-being or weight PURPOSE The present study examined the effects of exercise on physical and psychological variables in sedentary primigravidae ( PRA ) . METHODS A total of nine women r and omly assigned to an exercise ( E ) ( mean age = 31.3 + /- 3.1 yr ) and six subjects r and omly assigned to a control ( C ) group ( mean age = 27.8 + /- 3.1 yr ) fulfilled all requirements for the study . Exercise included a variety of exercise activities performed to a target heart rate of 150 - 156 beats x min(-1 ) , three times per week for 15 wk . RESULTS Results showed no significant differences between E and C groups in physical characteristics initially . A repeated measures ANOVA showed a significant group effect ( P < 0.05 ) and a significant group by time interaction ( P = 0.001 ) with the E group showing a significantly longer amount of time on the PWC150 test than the C group . There was no significant group , time , or group by time interaction for lactate accumulation . This occurred , despite the fact that the E group spent 56 % longer on the PWC150 test and the C group spent 30 % less time on the same test at the conclusion of the study . Finally , the E group in comparison to the C group showed more favorable improvements in several items related to health and well-being on the Body Cathexis Scale . There were no significant differences between E and C groups in any pregnancy outcome measures . All babies were delivered healthy  at term . CONCLUSIONS These data suggest that a vigorous exercise program can lead to significant improvements in aerobic fitness at similar lactate concentrations compared to a control group and can be well tolerated by low risk sedentary PRA without any deleterious effects occurring to herself or unborn child Objective To examine the effectiveness of a partially homebased , moderate-intensity aerobic exercise program for women with gestational diabetes . Methods This was a r and omized experimental design . Thirty-three women with gestational diabetes were r and omly assigned to the exercise or the no-exercise group . Subjects underwent hemoglobin A1C assay and submaximal cycle ergometer fitness tests at baseline and at study conclusion . Subjects kept diaries of home fasting and 2-hour postpr and ial blood glucose determinations . Exercise subjects were asked to exercise for 30 minutes three to four times weekly at 70 % of estimated maximal heart rate for the weeks of study participation . Two exercise sessions weekly were supervised by the investigator , and two were unsupervised at home .  Control-group  subjects were asked to maintain their current activity level . Results Daily fasting and postpr and ial blood glucose levels , hemoglobin A1C , incidence of exogenous insulin therapy , and incidence of newborn hypoglycemia were not different between the groups . There was a training effect in the exercise group ( P = .005 ) but not in the control group ( P = .25 ) . A significant decline in daily grams of carbohydrate consumed was observed in the control group ( P = .03 ) , but not in the exercise group ( P = .97 ) . No complications were found in the subjects who exercised . Conclusions A partially home-based exercise program did not reduce blood glucose levels , but did result in a modest increase in cardiorespiratory fitness . The intervention appeared safe Background Pregnancy is a period in the life of women that is often associated with decreased daily physical activity and /or exercise . However , maintaining adequate levels of daily physical activity during pregnancy is important for mother and child . Studies suggest that moderate daily physical activity and exercise during pregnancy are associated with reductions in the risk of gestational diabetes mellitus ( GDM ) . However , at present , physical activity is not routinely advised to pregnant women at risk for gestational diabetes in the Netherl and s. In FitFor2- study we aim to assess whether an exercise program can improve insulin sensitivity and fasting plasma glucose levels of women at high risk for gestational diabetes , assuming that this will lower their risk of gestational diabetes . Methods The FitFor2- study is a r and omised controlled trial . Women who visit one of the participating hospitals or midwifery practice s and who are at risk for gestational diabetes are eligible to participate . After baseline measurement they are r and omly allocated to in the intervention or control group . The intervention group receives an exercise program twice a week in addition to usual care . The exercise program consist of aerobic and strength exercises and takes place under close supervision of a physiotherapist . Data are collected at 15 , 24 and 32 weeks of pregnancy and 12 weeks after delivery . Primary maternal outcome measures are fasting plasma glucose and relative increase in insulin resistance . Primary neonatal outcome is birth weight . Secondary outcome measures are : maternal serum triglycerides , HDL , cholesterol , HbA1c , maternal weight gain during pregnancy , maternal physical activity level , foetal growth . Discussion If the FitFor2 intervention program proves to be effective , obstetricians and midwives should refer women at risk for GDM to a special exercise program . Exercise programs for pregnant women under supervision of an experienced trainer are already available in the Netherl and s , and these programs could be adjusted easily for this target group . Furthermore , the costs of these programs should be refunded by including them in the basic health care cost reimbursement schemes . Trial registration Please cite this paper as : Hui A , Back L , Ludwig S , Gardiner P , Sevenhuysen G , Dean H , Sellers E , McGavock J , Morris M , Bruce S , Murray R , Shen G. Lifestyle intervention on diet and exercise reduced excessive gestational weight gain in pregnant women under a r and omised controlled trial . BJOG 2012;119:70–77 Background To evaluate the association between water aerobics , maternal cardiovascular capacity during pregnancy , labor and neonatal outcomes . Methods A r and omized , controlled clinical trial was carried out in which 34 pregnant women were allocated to a water aerobics group and 37 to a control group .  All women were su bmi tted to submaximal ergometric tests on a treadmill at 19 , 25 and 35 weeks of pregnancy and were followed up until delivery . Oxygen consumption ( VO2 max ) , cardiac output ( CO ) , physical fitness , skin temperature , data on labor and delivery , and neonate outcomes were evaluated . Frequency distributions of the baseline variables of both groups were initially performed and then analysis of the outcomes was carried out . Categorical data were compared using the chi-square test , and numerical using Student 's t or Mann-Whitney tests . Wilk 's Lambda or Friedman 's analysis of repeat measurements were applied for comparison of physical capacity , cardiovascular outcomes and maternal temperature . Results VO2 max and physical fitness were higher in both groups in the second trimester , returning to basal levels in the third trimester . In both groups , CO increased as pregnancy progressed and peak exercise temperature was higher than resting temperature , increasing further after five minutes of recovery and remaining at this level until 15 minutes after exercise completion . There was no difference between the two groups regarding duration ( 457.9 ± SD 249.6 vs 428.9 ± SD 203.2 minutes ) or type of delivery . Labor analgesia was requested by significantly fewer women in the water aerobics group ( 27 % vs 65 % ; RR = 0.42 95%CI 0.23–0.77 ) . Neonatal results were similar in both groups . Conclusion The regular practice of moderate water aerobics by sedentary and low risk pregnant women was not detrimental to the health of the mother or the child . There was no influence on maternal cardiovascular capacity , duration of labor or type of delivery ; however , there were fewer requests for analgesia during labor in the water aerobics group Objective The influence of an exercise programme performed by healthy pregnant women on maternal glucose tolerance was studied . Study design A physical activity ( PA , l and /aquatic activities ) programme during the entire pregnancy ( three sessions per week ) was conducted by a qualified instructor . 83 healthy pregnant women were r and omly assigned to either an exercise group ( EG , n=40 ) or a control ( CG , n=43 ) group . 50 g maternal glucose screen ( MGS ) , maternal weight gain and several pregnancy outcomes were recorded . Results Significant differences were found between study groups on the 50 g MGS . Values corresponding to the EG ( 103.8±20.4 mg/dl ) were better than those of the CG ( 126.9±29.5 mg/dl ) , p=0.000 . In addition , no differences in maternal weight gain and no cases of gestational diabetes in EG versus 3 in CG ( 7 % ) ( p>0.05 ) were found . Conclusion A moderate PA programme performed during pregnancy improves levels of maternal glucose tolerance OBJECTIVE We have studied the effect of moderate physical activity that is performed by healthy women during their entire pregnancy on their perception of health status . STUDY DESIGN Eighty sedentary women were assigned r and omly to either an exercise group ( n = 40 ) or a control group ( n = 40 ) . Maternal perception of health status and several pregnancy outcomes were recorded . RESULTS Significant differences ( P = .03 ) were found between study groups in the percentage of women who perceived their health status as " very good " ; the values that corresponded to the exercise group ( n = 18 ; 54.5 % ) were better than those of the control group ( n = 9 ; 27.3 % ) . In addition , the women of the exercise group gained less weight ( 11,885 ± 3146 g ) than those of the control group ( 13,903 ± 2113 ; P = .03 ) . CONCLUSION A moderate physical activity program that is performed over the first , second , and third trimester of pregnancy improves the maternal perception of health status OBJECTIVE To investigate if water-gymnastics during pregnancy may reduce the intensity of back/low back pain and the number of days on sick-leave . METHODS A prospect i ve , r and omized study . One hundred and twenty-nine women were r and omized to participate in water-gymnastics once a week during the second half of pregnancy and 129 were r and omized to a control group . The women in both groups filled in question naires in gestational weeks 18 , 34 and within the first postpartum week . Every day from week 18 to labor they assessed the intensity of back/low back pain . RESULTS Back pain intensity increased during pregnancy . No excess risk for the pregnancy associated with water-gymnastics was observed . The women participating in water-gymnastics recorded a lower intensity of back/low back pain . The total number of days on sick-leave because of back/low back pain was 982 in the water-gymnastics group ( 124 women ) compared with 1484 in the control group ( 120 women ) . After weeks 32 33 , seven women in the water-gymnastics group compared with 17 in the control group were on sickleave because of back/ low back pain ( p=0.031 ) . CONCLUSIONS Intensity of back/low back pain increased with advancing pregnancy . There was no excess risk for urinary or vaginal infections associated with water-gymnastics . Water-gymnastics during the second half of pregnancy significantly reduced the intensity of back/ low back pain .  Water-gymnastics decreased the number of women on sick-leave because of back/low back pain .  Water-gymnastics during pregnancy can be recommended as a method to relieve back pain and may reduce the need for sick-leave Objective : We examined the effect of light intensity resistance exercise training performed during the second and third trimester of pregnancy on the  newborn 's birth size . We also studied the association between  maternal body weight prior to pregnancy and newborn 's birth size .  Design : R and omised controlled trial . Subjects : We r and omly assigned 160 sedentary gravidae to either a training ( n=80 ) or a control ( n=80 ) group . The training programme focused on light resistance and toning exercises ( three times per week , 35–40 min per session ) . We recorded the Apgar score , birth weight , birth length , and head circumference of the newborn , as well as gestational age at time of delivery from hospital perinatal 
    Output:
    