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: Abstract Background : Falls and fall-related injuries are symptomatic of an aging population . This study aim ed to design , develop , and deliver a novel method of balance training , using an interactive game-based system to promote engagement , with the inclusion of older adults at both high and low risk of experiencing a fall . Study Design : Eighty-two older adults ( 65 years of age and older ) were recruited from sheltered accommodation and local activity groups . Forty volunteers were r and omly selected and received 5 weeks of balance game training ( 5 males , 35 females ; mean , 77.18 ± 6.59 years ) , whereas the remaining control participants recorded levels of physical activity ( 20 males , 22 females ; mean , 76.62 ± 7.28 years ) . The effect of balance game training was measured on levels of functional balance and balance confidence in individuals with and without quantifiable balance impairments . Results : Balance game training had a significant effect on levels of functional balance and balance confidence ( P < 0.05 ) . This was further demonstrated in participants who were deemed at high risk of falls . The overall pattern of results suggests the training program is effective and suitable for individuals at all levels of ability and may therefore play a role in reducing the risk of falls . Conclusions : Commercial hardware can be modified to deliver engaging methods of effective balance assessment and training for the older population BACKGROUND Many issues prevent elderly individuals from exercising in daily life . There is a need for a system that allows elderly individuals to engage in exercise regularly at a low cost . We developed an exergame that uses a Kinect ( ® ) sensor ( Microsoft Corp. , Redmond , WA ) and conducted a r and omized controlled trial of the effects of using this exergame on muscle strength and balance in healthy elderly individuals . SUBJECTS AND METHODS We enrolled 57 healthy elderly individuals and r and omly divided them into an  intervention group ( n=29 ) and a  control group ( n=28 ) using a table of r and om numbers . All participants underwent gait analyses and were examined using the Berg Balance Scale ( BBS ) , Functional Reach Test ( FRT ) , and the 30-second chair-st and ( CS-30 ) test before the intervention . Participants in the intervention group played the exergame once or twice a week , up to a total of 24 times . The tests were repeated after intervention , and the scores were compared with those obtained before intervention . RESULTS Our results indicated that walking , muscle strength , and motor function improved in participants in the intervention group . Decreased double st and ing time ( P=0.03 ) , minimum foot clearance ( P=0.04 ) , BBS scores ( P<0.01 ) , CS-30 scores ( P<0.01 ) , and FRT scores ( P<0.01 ) significantly improved in the intervention group compared with values in the control group . CONCLUSIONS The Kinect-based exergame developed in this study was found to be effective in improving walking , muscular strength , and balance in elderly people Background Stepping impairments are associated with physical and cognitive decline in older adults and increased fall risk . Exercise interventions can reduce fall risk , but adherence is often low . A new exergame involving step training may provide an enjoyable exercise alternative for preventing falls in older people . Purpose To assess the feasibility and safety of unsupervised , home-based step pad training and determine the effectiveness of this intervention on stepping performance and associated fall risk in older people . Design Single-blinded two-arm r and omized controlled trial comparing step pad training with control ( no-intervention ) . Setting / Participants Thirty-seven older adults residing in independent-living units of a retirement village in Sydney , Australia . Intervention Intervention group ( IG ) participants were provided with a computerized step pad system connected to their TVs and played a step game as often as they liked ( with a recommended dose of 2–3 sessions per week for 15–20 minutes each ) for eight weeks . In addition , IG participants were asked to complete a choice stepping reaction time ( CSRT ) task once each week . Main Outcome Measures CSRT , the Physiological Profile Assessment ( PPA ) , neuropsychological and functional mobility measures were assessed at baseline and eight week follow-up . Results Thirty-two participants completed the study ( 86.5 % ) . IG participants played a median 2.75 sessions/week and no adverse events were reported . Compared to the control group , the IG significantly improved their CSRT ( F31,1 = 18.203 , p<.001 ) , PPA composite scores ( F31,1 = 12.706 , p = 0.001 ) , as well as the postural sway ( F31,1 = 4.226 , p = 0.049 ) and contrast sensitivity ( F31,1 = 4.415 , p = 0.044 ) PPA sub-component scores . In addition , the IG improved significantly in their dual-task ability as assessed by a timed up and go test/verbal fluency task ( F31,1 = 4.226 , p = 0.049 ) . Conclusions Step pad training can be safely undertaken at home to improve physical and cognitive parameters of fall risk in older people without major cognitive and physical impairments . Trial Registration Australian New Zeal and Clinical Trials Registry ACTRN12611001081909 Purpose Interactive cognitive-motor training ( ICMT ) requires individuals to perform both gross motor movements and complex information processing . This study investigated the effectiveness of ICMT on cognitive functions associated with falls in older adults . Methods A single-blinded r and omized controlled trial was conducted in community-dwelling older adults ( N = 90 , mean age 81.5±7 ) without major cognitive impairment . Participants in the intervention group ( IG ) played four stepping games that required them to divide attention , inhibit irrelevant stimuli , switch between tasks , rotate objects and make rapid decisions . The recommended minimum dose was three 20-minute sessions per week over a period of 16 weeks unsupervised at home . Participants in the control group ( CG ) received an evidence -based brochure on fall prevention .  Measures of processing speed , attention/executive function ( EF ) , visuo-spatial ability , concerns about falling and depression were assessed before and after the intervention . Results Eighty-one participants ( 90 % ) attended re- assessment . There were no improvements with respect to the Stroop Stepping Test ( primary outcome ) in the intervention group . Compared to the CG , the IG improved significantly in measures of processing speed , visuo-spatial ability and concern about falling . Significant interactions were observed for measures of EF and divided attention , indicating group differences varied for different levels of the covariate with larger improvements in IG participants with poorer baseline performance . The interaction for depression showed no change for the IG but an increase in the CG for those with low depressive symptoms at baseline . Additionally , low and high-adherer groups differed in their baseline performance and responded differently to the intervention . Compared to high adherers , low adherers improved more in processing speed and visual scanning while high-adherers improved more in tasks related to EF . Conclusions This study shows that unsupervised stepping ICMT led to improvements in specific cognitive functions associated with falls in older people . Low adherers improved in less complex functions while high-adherers improved in EF . Trial Registration Australian New Zeal and Clinical Trials Registry AIM To compare the effects of exergames ( EGs ) using the Xbox Kinect ™ device and home exercise ( HE ) on balance , functional mobility , and quality of life of individuals aged 65 years or older . METHOD One hundred participants who met the inclusion criteria were r and omized to the EG or HE group . The EG group took part in a 6-week programme using the Xbox360Kinect ™ device , and the HE group took part in a 6-week balance exercise programme at home 5 days a week  . The Berg Balance Scale ( BBS ) was used to assess balance , the Timed Up and Go ( TUG ) test was used to evaluate functional walking , and the Short Form 36 ( SF-36 ) was used to assess quality of life . RESULTS Forty-eight participants in the EG group and 42 participants in the HE group completed the study . The groups were similar in terms of age , sex , and pretreatment values of BBS , TUG , and SF-36 . Although the BBS scores of both groups improved significantly ( all p<0.05 ) , the post-treatment scores of the EG group were better than those of the HE group . The TUG scores improved only in the EG group ( p<0.05 ) . The increase in the BBS scores and decrease in the TUG test scores were significant only in the EG group ( all p<0.05 ) . A significant improvement was also observed in the quality of life parameters of physical functioning , social role functioning , physical role restriction , general health perceptions , and physical component scores in the post-exercise evaluations of the EG group . The participants commented that they found the EG programme very entertaining . CONCLUSION The EG can be considered a safe , entertaining and sustainable alternative to HE programmes , and it may have positive effects on balance , functional walking and quality of life in geriatric subjects OBJECTIVE To evaluate the effects of two exercise approaches , Tai Chi ( TC ) and computerized balance training ( BT ) , on specified primary outcomes ( biomedical , functional , and psychosocial indicators of frailty ) and secondary outcomes ( occurrence of falls ) . DESIGN The Atlanta FICSIT ( Frailty and Injuries : Cooperative Studies of Intervention Techniques ) , a prospect i ve , r and omized , controlled clinical trial with three arms ( TC , BT , and education [ ED ] . Intervention length was 15 weeks , with primary outcomes measured before and after intervention and at 4-month follow-up . Falls were monitored continuously throughout the study . SETTING Persons aged 70 and older living in the community . PARTICIPANTS A total of 200 participants , 162 women and 38 men ; mean age was 76.2 . MEASUREMENTS Biomedical ( strength , flexibility , cardiovascular endurance , body composition ) , functional ( IADL ) , and psychosocial well-being ( CES-D scale , fear of falling question naire , self-perception of present and future health , mastery index , perceived quality of sleep , and intrusiveness ) variables . RESULTS Grip strength declined in all groups , and lower extremity range of motion showed limited but statistically significant changes . Lowered blood pressure before and after a 12-minute walk was seen following TC participation . Fear of falling responses and intrusiveness responses were reduced after the TC intervention compared with the ED group ( P = .046 and P = .058 , respectively ) . After adjusting for fall risk factors , TC was found to reduce the risk of multiple falls by 47.5 % . CONCLUSIONS A moderate TC intervention can impact favorably on defined biomedical and psychosocial indices of frailty . This intervention can also have favorable effects upon the occurrence of falls .  Tai Chi warrants further study as an exercise treatment to improve the health of older people Background Cognitive impairment is a health problem that concerns almost every second elderly person .  Physical and cognitive training have differential positive effects on cognition , but have been rarely applied in combination . This study evaluates synergistic effects of multicomponent physical exercise complemented with novel simultaneous cognitive training on cognition in older adults . We hypothesized that simultaneous cognitive – physical components would add training specific cognitive benefits compared to exclusively physical training . Methods Seniors , older than 70 years , without cognitive impairment , were r and omly assigned to either : 1 ) virtual reality video game dancing ( DANCE ) , 2 ) treadmill walking with simultaneous verbal memory training ( MEMORY ) , or 3 ) treadmill walking ( PHYS ) . Each program was complemented with strength and balance exercises . Two 1-hour training sessions per week over 6 months were applied . Cognitive performance was assessed at baseline , after 3 and 6 months , and at 1-year follow-up . Multiple regression analyses with planned comparisons were calculated . Results Eighty-nine participants were r and omized to the three groups initially , 71 completed the training , while 47 were available at 1-year follow-up . Advantages of the simultaneous cognitive – physical programs were found in two dimensions of executive function . “ Shifting attention ” showed a time × intervention interaction in favor of DANCE/MEMORY versus PHYS ( F[2 , 68 ] = 1.95 , trend P=0.075 , r=0.17 ) ; and “ working memory ” showed a time × intervention interaction in favor of DANCE versus MEMORY ( F[1 , 136 ] = 2.71 , trend P=0.051 , R2=0.006 ) . Performance improvements in executive functions , long-term visual memory ( episodic memory ) , and processing speed were maintained at follow-up in all groups . Conclusion Particular executive functions benefit from simultaneous cognitive – physical training compared to exclusively physical multicomponent training . Cognitive – physical training programs may counteract widespread cognitive impairments in the elderly Background Computer-based interventions have demonstrated consistent positive effects on various physical abilities in older adults . This study aims to compare two training groups that achieve similar amounts of strength and balance exercise where one group receives an intervention that includes additional dance video gaming . The aim is to investigate the different effects of the training programs on physical and psychological parameters in older adults . Methods Thirty-one participants ( mean age ± SD : 86.2 ± 4.6 years ) , residents of two Swiss hostels for the aged , were r and omly assigned to either the dance group ( n = 15 ) or the control group ( n = 16 ) . The dance group absolved a twelve-week cognitive-motor exercise program twice weekly that comprised progressive strength and balance training supplemented with additional dance video gaming . The control group performed only the strength and balance exercises during this period . Outcome measures were foot placement accuracy , gait performance under single and dual task conditions , and falls efficacy . Results After the intervention between-group comparison revealed significant differences for gait velocity ( U = 26 , P = . 
    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: Abstract Background : Falls and fall-related injuries are symptomatic of an aging population . This study aim ed to design , develop , and deliver a novel method of balance training , using an interactive game-based system to promote engagement , with the inclusion of older adults at both high and low risk of experiencing a fall . Study Design : Eighty-two older adults ( 65 years of age and older ) were recruited from sheltered accommodation and local activity groups . Forty volunteers were r and omly selected and received 5 weeks of balance game training ( 5 males , 35 females ; mean , 77.18 ± 6.59 years ) , whereas the remaining control participants recorded levels of physical activity ( 20 males , 22 females ; mean , 76.62 ± 7.28 years ) . The effect of balance game training was measured on levels of functional balance and balance confidence in individuals with and without quantifiable balance impairments . Results : Balance game training had a significant effect on levels of functional balance and balance confidence ( P < 0.05 ) . This was further demonstrated in participants who were deemed at high risk of falls . The overall pattern of results suggests the training program is effective and suitable for individuals at all levels of ability and may therefore play a role in reducing the risk of falls . Conclusions : Commercial hardware can be modified to deliver engaging methods of effective balance assessment and training for the older population BACKGROUND Many issues prevent elderly individuals from exercising in daily life . There is a need for a system that allows elderly individuals to engage in exercise regularly at a low cost . We developed an exergame that uses a Kinect ( ® ) sensor ( Microsoft Corp. , Redmond , WA ) and conducted a r and omized controlled trial of the effects of using this exergame on muscle strength and balance in healthy elderly individuals . SUBJECTS AND METHODS We enrolled 57 healthy elderly individuals and r and omly divided them into an  intervention group ( n=29 ) and a  control group ( n=28 ) using a table of r and om numbers . All participants underwent gait analyses and were examined using the Berg Balance Scale ( BBS ) , Functional Reach Test ( FRT ) , and the 30-second chair-st and ( CS-30 ) test before the intervention . Participants in the intervention group played the exergame once or twice a week , up to a total of 24 times . The tests were repeated after intervention , and the scores were compared with those obtained before intervention . RESULTS Our results indicated that walking , muscle strength , and motor function improved in participants in the intervention group . Decreased double st and ing time ( P=0.03 ) , minimum foot clearance ( P=0.04 ) , BBS scores ( P<0.01 ) , CS-30 scores ( P<0.01 ) , and FRT scores ( P<0.01 ) significantly improved in the intervention group compared with values in the control group . CONCLUSIONS The Kinect-based exergame developed in this study was found to be effective in improving walking , muscular strength , and balance in elderly people Background Stepping impairments are associated with physical and cognitive decline in older adults and increased fall risk . Exercise interventions can reduce fall risk , but adherence is often low . A new exergame involving step training may provide an enjoyable exercise alternative for preventing falls in older people . Purpose To assess the feasibility and safety of unsupervised , home-based step pad training and determine the effectiveness of this intervention on stepping performance and associated fall risk in older people . Design Single-blinded two-arm r and omized controlled trial comparing step pad training with control ( no-intervention ) . Setting / Participants Thirty-seven older adults residing in independent-living units of a retirement village in Sydney , Australia . Intervention Intervention group ( IG ) participants were provided with a computerized step pad system connected to their TVs and played a step game as often as they liked ( with a recommended dose of 2–3 sessions per week for 15–20 minutes each ) for eight weeks . In addition , IG participants were asked to complete a choice stepping reaction time ( CSRT ) task once each week . Main Outcome Measures CSRT , the Physiological Profile Assessment ( PPA ) , neuropsychological and functional mobility measures were assessed at baseline and eight week follow-up . Results Thirty-two participants completed the study ( 86.5 % ) . IG participants played a median 2.75 sessions/week and no adverse events were reported . Compared to the control group , the IG significantly improved their CSRT ( F31,1 = 18.203 , p<.001 ) , PPA composite scores ( F31,1 = 12.706 , p = 0.001 ) , as well as the postural sway ( F31,1 = 4.226 , p = 0.049 ) and contrast sensitivity ( F31,1 = 4.415 , p = 0.044 ) PPA sub-component scores . In addition , the IG improved significantly in their dual-task ability as assessed by a timed up and go test/verbal fluency task ( F31,1 = 4.226 , p = 0.049 ) . Conclusions Step pad training can be safely undertaken at home to improve physical and cognitive parameters of fall risk in older people without major cognitive and physical impairments . Trial Registration Australian New Zeal and Clinical Trials Registry ACTRN12611001081909 Purpose Interactive cognitive-motor training ( ICMT ) requires individuals to perform both gross motor movements and complex information processing . This study investigated the effectiveness of ICMT on cognitive functions associated with falls in older adults . Methods A single-blinded r and omized controlled trial was conducted in community-dwelling older adults ( N = 90 , mean age 81.5±7 ) without major cognitive impairment . Participants in the intervention group ( IG ) played four stepping games that required them to divide attention , inhibit irrelevant stimuli , switch between tasks , rotate objects and make rapid decisions . The recommended minimum dose was three 20-minute sessions per week over a period of 16 weeks unsupervised at home . Participants in the control group ( CG ) received an evidence -based brochure on fall prevention .  Measures of processing speed , attention/executive function ( EF ) , visuo-spatial ability , concerns about falling and depression were assessed before and after the intervention . Results Eighty-one participants ( 90 % ) attended re- assessment . There were no improvements with respect to the Stroop Stepping Test ( primary outcome ) in the intervention group . Compared to the CG , the IG improved significantly in measures of processing speed , visuo-spatial ability and concern about falling . Significant interactions were observed for measures of EF and divided attention , indicating group differences varied for different levels of the covariate with larger improvements in IG participants with poorer baseline performance . The interaction for depression showed no change for the IG but an increase in the CG for those with low depressive symptoms at baseline . Additionally , low and high-adherer groups differed in their baseline performance and responded differently to the intervention . Compared to high adherers , low adherers improved more in processing speed and visual scanning while high-adherers improved more in tasks related to EF . Conclusions This study shows that unsupervised stepping ICMT led to improvements in specific cognitive functions associated with falls in older people . Low adherers improved in less complex functions while high-adherers improved in EF . Trial Registration Australian New Zeal and Clinical Trials Registry AIM To compare the effects of exergames ( EGs ) using the Xbox Kinect ™ device and home exercise ( HE ) on balance , functional mobility , and quality of life of individuals aged 65 years or older . METHOD One hundred participants who met the inclusion criteria were r and omized to the EG or HE group . The EG group took part in a 6-week programme using the Xbox360Kinect ™ device , and the HE group took part in a 6-week balance exercise programme at home 5 days a week  . The Berg Balance Scale ( BBS ) was used to assess balance , the Timed Up and Go ( TUG ) test was used to evaluate functional walking , and the Short Form 36 ( SF-36 ) was used to assess quality of life . RESULTS Forty-eight participants in the EG group and 42 participants in the HE group completed the study . The groups were similar in terms of age , sex , and pretreatment values of BBS , TUG , and SF-36 . Although the BBS scores of both groups improved significantly ( all p<0.05 ) , the post-treatment scores of the EG group were better than those of the HE group . The TUG scores improved only in the EG group ( p<0.05 ) . The increase in the BBS scores and decrease in the TUG test scores were significant only in the EG group ( all p<0.05 ) . A significant improvement was also observed in the quality of life parameters of physical functioning , social role functioning , physical role restriction , general health perceptions , and physical component scores in the post-exercise evaluations of the EG group . The participants commented that they found the EG programme very entertaining . CONCLUSION The EG can be considered a safe , entertaining and sustainable alternative to HE programmes , and it may have positive effects on balance , functional walking and quality of life in geriatric subjects OBJECTIVE To evaluate the effects of two exercise approaches , Tai Chi ( TC ) and computerized balance training ( BT ) , on specified primary outcomes ( biomedical , functional , and psychosocial indicators of frailty ) and secondary outcomes ( occurrence of falls ) . DESIGN The Atlanta FICSIT ( Frailty and Injuries : Cooperative Studies of Intervention Techniques ) , a prospect i ve , r and omized , controlled clinical trial with three arms ( TC , BT , and education [ ED ] . Intervention length was 15 weeks , with primary outcomes measured before and after intervention and at 4-month follow-up . Falls were monitored continuously throughout the study . SETTING Persons aged 70 and older living in the community . PARTICIPANTS A total of 200 participants , 162 women and 38 men ; mean age was 76.2 . MEASUREMENTS Biomedical ( strength , flexibility , cardiovascular endurance , body composition ) , functional ( IADL ) , and psychosocial well-being ( CES-D scale , fear of falling question naire , self-perception of present and future health , mastery index , perceived quality of sleep , and intrusiveness ) variables . RESULTS Grip strength declined in all groups , and lower extremity range of motion showed limited but statistically significant changes . Lowered blood pressure before and after a 12-minute walk was seen following TC participation . Fear of falling responses and intrusiveness responses were reduced after the TC intervention compared with the ED group ( P = .046 and P = .058 , respectively ) . After adjusting for fall risk factors , TC was found to reduce the risk of multiple falls by 47.5 % . CONCLUSIONS A moderate TC intervention can impact favorably on defined biomedical and psychosocial indices of frailty . This intervention can also have favorable effects upon the occurrence of falls .  Tai Chi warrants further study as an exercise treatment to improve the health of older people Background Cognitive impairment is a health problem that concerns almost every second elderly person .  Physical and cognitive training have differential positive effects on cognition , but have been rarely applied in combination . This study evaluates synergistic effects of multicomponent physical exercise complemented with novel simultaneous cognitive training on cognition in older adults . We hypothesized that simultaneous cognitive – physical components would add training specific cognitive benefits compared to exclusively physical training . Methods Seniors , older than 70 years , without cognitive impairment , were r and omly assigned to either : 1 ) virtual reality video game dancing ( DANCE ) , 2 ) treadmill walking with simultaneous verbal memory training ( MEMORY ) , or 3 ) treadmill walking ( PHYS ) . Each program was complemented with strength and balance exercises . Two 1-hour training sessions per week over 6 months were applied . Cognitive performance was assessed at baseline , after 3 and 6 months , and at 1-year follow-up . Multiple regression analyses with planned comparisons were calculated . Results Eighty-nine participants were r and omized to the three groups initially , 71 completed the training , while 47 were available at 1-year follow-up . Advantages of the simultaneous cognitive – physical programs were found in two dimensions of executive function . “ Shifting attention ” showed a time × intervention interaction in favor of DANCE/MEMORY versus PHYS ( F[2 , 68 ] = 1.95 , trend P=0.075 , r=0.17 ) ; and “ working memory ” showed a time × intervention interaction in favor of DANCE versus MEMORY ( F[1 , 136 ] = 2.71 , trend P=0.051 , R2=0.006 ) . Performance improvements in executive functions , long-term visual memory ( episodic memory ) , and processing speed were maintained at follow-up in all groups . Conclusion Particular executive functions benefit from simultaneous cognitive – physical training compared to exclusively physical multicomponent training . Cognitive – physical training programs may counteract widespread cognitive impairments in the elderly Background Computer-based interventions have demonstrated consistent positive effects on various physical abilities in older adults . This study aims to compare two training groups that achieve similar amounts of strength and balance exercise where one group receives an intervention that includes additional dance video gaming . The aim is to investigate the different effects of the training programs on physical and psychological parameters in older adults . Methods Thirty-one participants ( mean age ± SD : 86.2 ± 4.6 years ) , residents of two Swiss hostels for the aged , were r and omly assigned to either the dance group ( n = 15 ) or the control group ( n = 16 ) . The dance group absolved a twelve-week cognitive-motor exercise program twice weekly that comprised progressive strength and balance training supplemented with additional dance video gaming . The control group performed only the strength and balance exercises during this period . Outcome measures were foot placement accuracy , gait performance under single and dual task conditions , and falls efficacy . Results After the intervention between-group comparison revealed significant differences for gait velocity ( U = 26 , P = . 
    Output:
    