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: OBJECTIVE To pilot , among women with gestational diabetes mellitus ( GDM ) , the feasibility of a prenatal/postpartum intervention to modify diet and physical activity similar to the Diabetes Prevention Program . The intervention was delivered by telephone , and support for breastfeeding was addressed . RESEARCH DESIGN AND METHODS The goal was to help women return to their prepregnancy weight , if it was normal , or achieve a 5 % reduction from prepregnancy weight if overweight . Eligible participants were identified shortly after a GDM diagnosis ; 83.8 % consented to be r and omly assigned to intervention or usual medical care ( 96 and 101 women , respectively ) . The retention was 85.2 % at 12 months postpartum . RESULTS The proportion of women who reached the postpartum weight goal was higher , although not statistically significant , in the intervention condition than among usual care ( 37.5 vs. 21.4 % , absolute difference 16.1 % , P = 0.07 ) . The intervention was more effective among women who did not exceed the recommended gestational weight gain ( difference in the proportion of women meeting the weight goals : 22.5 % , P = 0.04 ) . The intervention condition decreased dietary fat intake more than the usual care ( condition difference in the mean change in percent of calories from fat : −3.6 % , P = 0.002 ) and increased breastfeeding , although not significantly ( condition difference in proportion : 15.0 % , P = 0.09 ) . No differences in postpartum physical activity were observed between conditions . CONCLUSIONS This study suggests that a lifestyle intervention that starts during pregnancy and continues postpartum is feasible and may prevent pregnancy weight retention and help overweight women lose weight . Strategies to help postpartum women overcome barriers to increasing physical activity are needed The purpose of this study was to observe the influence of the fullness of breast milk in the breasts prior to exercise on the concentration of lactic acid in breast milk following exercise . Twenty-three lactating women were r and omly assigned to Group E ( n = 11 ) , which nursed and /or collected as much of the breast milk as possible prior to maximal exercise , and Group F ( n = 12 ) , which did not nurse or collect milk at least two hours prior to maximal exercise . Milk was collected at rest preexercise and 10 , 30 , 60 and 90 minutes postexercise and was analyzed for concentrations of lactic acid . ANOVA demonstrated 1 ) a significant increase in lactic acid in the milk at all postexercise collection s for both groups and 2 ) a significant group vs postexercise time interaction for lactic acid concentration in milk . These differences represented differences in 1 ) time to peak lactic acid concentrations in milk ( Group F = 10 min ; Group E = 30 min ) and 2 ) time for postexercise decreases in lactic acid concentrations in milk . Thus , the state of fullness of milk in the breasts is a factor which affects the concentration of lactic acid in breast milk following maximal exercise BACKGROUND No evidence -based recommendations exist concerning what dietary macronutrient composition optimizes weight loss during lactation while maintaining milk production . OBJECTIVES The study was design ed to test the following hypotheses : compared with a reduced-calorie , high-carbohydrate ( H-CHO ) diet , an isonitrogenous , isocaloric high-fat ( H-F ) diet will decrease milk production and carbohydrate oxidation , increase gluconeogenesis and hexoneogenesis , and not affect energy balance . DESIGN Seven healthy lactating mothers and their infants were studied on 2 occasions in r and om order for 8 d separated by 1 - 2 wk . On one occasion , the subjects received the H-F ( 30 % of energy as carbohydrate and 55 % as fat ) diet and on the other occasion received the H-CHO ( 60 % of energy as carbohydrate and 25 % as fat ) diet .  Milk production , infant intakes , and substrate and hormone concentrations were measured . Glucose rates of appearance , production , gluconeogenesis , glycogenolysis , and hexoneogenesis were measured by using stable-isotope gas chromatography-mass spectrometric techniques , and energy expenditure and substrate oxidation were measured by using indirect calorimetry . RESULTS Milk volume , lactose , and protein concentrations were unaffected . Milk fat , energy , and infant intakes were higher ( P < 0.05 ) during the H-F diet . Neither gluconeogenesis nor hexoneogenesis was different . During the H-F diet , energy expenditure and fat and protein oxidation rates were higher ( P < 0.05 ) , and the daily energy balance deficit was greater ( P < 0.01 ) . CONCLUSIONS Milk fat , energy output , and energy expenditure were higher during the H-F diet , which result ed in a greater negative energy balance . The lactating mothers adapted to a low carbohydrate intake by decreasing carbohydrate oxidation . Additional studies are warranted to determine whether a hypocaloric H-F diet might promote weight loss to a greater extent than the H-CHO diet while maintaining milk production BACKGROUND Pregnancy and the postpartum period have been suggested as important contributors to overweight and obesity among women . This paper presents the design , rationale , and baseline participant characteristics of a r and omized controlled intervention trial to enhance weight loss in postpartum women who entered pregnancy overweight or obese . METHODS Active Mothers Postpartum ( AMP ) is based on the rationale that the birth of a child can be a teachable moment . AMP 's primary objectives are to promote and sustain a reduction in body mass index ( BMI ) up to 2 years postpartum via changes in diet and exercise behavior , with a secondary aim to assess racial differences in these outcomes . Women in the intervention arm participate in ten physical activity group sessions , eight healthy eating classes , and six telephone counseling sessions over a 9-month period . They also receive motivational tools , including a workbook with recipes and exercises , a pedometer , and a sport stroller . RESULTS Four hundred fifty women aged > or = 18 ( mean 30.9 ) , with a BMI > or = 25 kg/m(2 ) ( mean 33.0 ) at baseline ( 6 weeks postpartum ) were enrolled ; 45 % of the final sample are black and 53 % are white . Baseline characteristics by study arm and by race are presented . CONCLUSIONS Our intervention is design ed to be disseminated broadly to benefit the public health . Behavior change interventions based on principles of social cognitive theory , stage of readiness , and other models that coincide with a teachable moment , such as the birth of a child , could be important motivators for postpartum weight loss OBJECTIVE to examine the effect of individual counselling on diet and physical activity from pregnancy to six months post partum , or from birth to six months post partum , on weight retention among Taiwanese women . DESIGN a r and omised controlled trial assigned participants to two experimental groups [ from pregnancy to six months post partum ( EP ) and from birth to six months post partum ( EPP ) ] and one comparison group . SETTING a 3900-bed medical centre in northern Taiwan with around 3000 births annually . PARTICIPANTS a sample of 189 women who had regular check-ups during pregnancy and gave birth at the medical centre . INTERVENTIONS the comparison group received the routine outpatient department obstetric educational programme . The EP group attended regularly scheduled clinic visits with individualised dietary and physical activity education plans from 16 gestational weeks to six months post partum , and received on brochure . The EPP group received the same educational intervention as the EP group from 24 - 48 hours after birth to six months post partum . MEASUREMENTS body weight , body mass index , health-promoting behaviour and psycho-social variables ( self-efficacy , body image , depression and social support ) . FINDINGS average gestational weight gain was 14.02 , 15.27 and 16.22 kg in the three EP , EPP and comparison groups respectively , and average weight retention at six months post partum was 2.34 , 4.06 and 5.08 kg in the three groups , respectively . KEY CONCLUSIONS a diet and physical activity intervention from pregnancy is effective for reducing post-pregnancy weight retention . IMPLICATION S FOR PRACTICE the findings of the present study should be taken into consideration when incorporating significant others and weight-loss maintenance strategies with interventions for a healthier family lifestyle Promotoras from the communities in which interventions are implemented can be effective contributors to validity and fidelity efforts . This article describes a 48-week r and omized controlled trial Madres para la Salud ( Mothers for Health ) and illustrates the use of promotoras as collaborative members of the research team to contribute to attaining integrative validity and treatment fidelity . Madres para la Salud implements a culturally tailored physical activity program to effect changes in body fat , systemic and fat tissue inflammation , and depression symptoms . The significance of Madres para la Salud treatment validity and fidelity processes includes cultural tailoring of a social support intervention , and a promotora model to incorporate initial and ongoing fidelity monitoring Background Many postnatal women are insufficiently physically active in the year after childbirth and could benefit from interventions to increase activity levels . However , there is limited information about the efficacy , feasibility and acceptability of motivational and behavioral interventions promoting postnatal physical activity in the UK . Methods The MAMMiS study is a r and omized , controlled trial , conducted within a large National Health Service ( NHS ) region in Scotl and . Up to 76 postnatal women will be recruited to test the impact of two physical activity consultations and a 10-week group pram-walking program on physical activity behavior change . The intervention uses evidence -based motivational and behavioral techniques and will be systematic ally evaluated using objective measures ( accelerometers ) at three months , with a maintenance measure taken at a six-month follow-up . Secondary health and well-being measures and psychological mediators of physical activity change are included . Discussion The ( MAMMiS study will provide a test of a theoretical and evidence -based physical activity behavior change intervention for postnatal women and provide information to inform future intervention development and testing within this population .Trial registration Current Controlled Trials IS RCT During the postpartum period , ethnic minority women have higher rates of inactivity/under-activity than white women . The Nā Mikimiki ( “ the active ones ” ) Project is design ed to increase  moderate-to-vigorous physical activity  over 18 months among multiethnic women with infants 2–12 months old . The study was design ed to test , via a r and omized controlled trial , the effectiveness of a tailored telephone counseling of moderate-to-vigorous physical activity intervention compared to a print/website material s-only condition .  Healthy , underactive women ( mean age = 32 ± 5.6 years ) with a baby ( mean age = 5.7 ± 2.8 months ) were enrolled from 2008–2009 ( N = 278 ) . Of the total sample , 84 % were ethnic minority women , predominantly Asian – American and Native Hawaiian . Mean self-reported baseline level of moderate-to-vigorous physical activity was 40 minutes/week with no significant differences by study condition , ethnicity , infant 's age , maternal body mass index , or maternal employment . Women had high scores on perceived benefits , self-efficacy , and environmental support for exercise but low scores on social support for exercise . This multiethnic sample 's demographic and psychosocial characteristics and their perceived barriers to exercise were comparable to previous physical activity studies conducted largely with white postpartum women . The Nā Mikimiki Project 's innovative tailored technology-based intervention and unique population are significant contributions to the literature on moderate-to-vigorous physical activity in postpartum women Low-income , multi-ethnic women are at elevated risk for obesity and chronic diseases , yet influences at different levels may act as barriers to changing risk behaviors . Following the birth of a child , childrearing and social isolation can exacerbate these influences . The social ecological framework integrates behavior-change strategies at different levels , providing a strong theoretical base for developing interventions in this high-risk population . The primary purpose of this r and omized controlled trial is to test the efficacy of an educational model delivered by community-based paraprofessionals in improving diet , activity and weight loss  among new mothers over a 12-month postpartum period and a 6-month maintenance period . This model fosters institutional change to support behavior changes influenced at intrapersonal and interpersonal levels , through collaboration with federal programs for low-income families : the Special Supplemental Food Program for Women , Infants and Children ( WIC ) , and the Exp and ed Food and Nutrition Education Program ( EFNEP ) . Participants are r and omized to the Usual Care , e.g. WIC nutrition and breastfeeding education , or Enhanced EFNEP intervention arm , consisting of Usual WIC Care plus a sustained , multi-component intervention including home visits , group classes and monthly telephone counseling . If shown to be efficacious , this program will be readily sustainable through existing federal agencies Background Postnatal women ( < 12 months postpartum ) are at increased risk of physical inactivity . Purpose To evaluate the efficacy and feasibility of a theory-based physical activity ( PA ) intervention delivered to postnatal women primarily via mobile telephone short message service ( SMS ) . Methods Eighty-eight women were r and omized to the intervention ( n = 45 ) or minimal contact control ( n = 43 ) condition . The 12-week intervention consisted of a face-to-face PA goal - setting consultation , a goal - setting magnet , three to five personally tailored SMS/week and a nominated support person who received two SMS per week . SMS content targeted constructs of social cognitive theory . Frequency ( days 
    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: OBJECTIVE To pilot , among women with gestational diabetes mellitus ( GDM ) , the feasibility of a prenatal/postpartum intervention to modify diet and physical activity similar to the Diabetes Prevention Program . The intervention was delivered by telephone , and support for breastfeeding was addressed . RESEARCH DESIGN AND METHODS The goal was to help women return to their prepregnancy weight , if it was normal , or achieve a 5 % reduction from prepregnancy weight if overweight . Eligible participants were identified shortly after a GDM diagnosis ; 83.8 % consented to be r and omly assigned to intervention or usual medical care ( 96 and 101 women , respectively ) . The retention was 85.2 % at 12 months postpartum . RESULTS The proportion of women who reached the postpartum weight goal was higher , although not statistically significant , in the intervention condition than among usual care ( 37.5 vs. 21.4 % , absolute difference 16.1 % , P = 0.07 ) . The intervention was more effective among women who did not exceed the recommended gestational weight gain ( difference in the proportion of women meeting the weight goals : 22.5 % , P = 0.04 ) . The intervention condition decreased dietary fat intake more than the usual care ( condition difference in the mean change in percent of calories from fat : −3.6 % , P = 0.002 ) and increased breastfeeding , although not significantly ( condition difference in proportion : 15.0 % , P = 0.09 ) . No differences in postpartum physical activity were observed between conditions . CONCLUSIONS This study suggests that a lifestyle intervention that starts during pregnancy and continues postpartum is feasible and may prevent pregnancy weight retention and help overweight women lose weight . Strategies to help postpartum women overcome barriers to increasing physical activity are needed The purpose of this study was to observe the influence of the fullness of breast milk in the breasts prior to exercise on the concentration of lactic acid in breast milk following exercise . Twenty-three lactating women were r and omly assigned to Group E ( n = 11 ) , which nursed and /or collected as much of the breast milk as possible prior to maximal exercise , and Group F ( n = 12 ) , which did not nurse or collect milk at least two hours prior to maximal exercise . Milk was collected at rest preexercise and 10 , 30 , 60 and 90 minutes postexercise and was analyzed for concentrations of lactic acid . ANOVA demonstrated 1 ) a significant increase in lactic acid in the milk at all postexercise collection s for both groups and 2 ) a significant group vs postexercise time interaction for lactic acid concentration in milk . These differences represented differences in 1 ) time to peak lactic acid concentrations in milk ( Group F = 10 min ; Group E = 30 min ) and 2 ) time for postexercise decreases in lactic acid concentrations in milk . Thus , the state of fullness of milk in the breasts is a factor which affects the concentration of lactic acid in breast milk following maximal exercise BACKGROUND No evidence -based recommendations exist concerning what dietary macronutrient composition optimizes weight loss during lactation while maintaining milk production . OBJECTIVES The study was design ed to test the following hypotheses : compared with a reduced-calorie , high-carbohydrate ( H-CHO ) diet , an isonitrogenous , isocaloric high-fat ( H-F ) diet will decrease milk production and carbohydrate oxidation , increase gluconeogenesis and hexoneogenesis , and not affect energy balance . DESIGN Seven healthy lactating mothers and their infants were studied on 2 occasions in r and om order for 8 d separated by 1 - 2 wk . On one occasion , the subjects received the H-F ( 30 % of energy as carbohydrate and 55 % as fat ) diet and on the other occasion received the H-CHO ( 60 % of energy as carbohydrate and 25 % as fat ) diet .  Milk production , infant intakes , and substrate and hormone concentrations were measured . Glucose rates of appearance , production , gluconeogenesis , glycogenolysis , and hexoneogenesis were measured by using stable-isotope gas chromatography-mass spectrometric techniques , and energy expenditure and substrate oxidation were measured by using indirect calorimetry . RESULTS Milk volume , lactose , and protein concentrations were unaffected . Milk fat , energy , and infant intakes were higher ( P < 0.05 ) during the H-F diet . Neither gluconeogenesis nor hexoneogenesis was different . During the H-F diet , energy expenditure and fat and protein oxidation rates were higher ( P < 0.05 ) , and the daily energy balance deficit was greater ( P < 0.01 ) . CONCLUSIONS Milk fat , energy output , and energy expenditure were higher during the H-F diet , which result ed in a greater negative energy balance . The lactating mothers adapted to a low carbohydrate intake by decreasing carbohydrate oxidation . Additional studies are warranted to determine whether a hypocaloric H-F diet might promote weight loss to a greater extent than the H-CHO diet while maintaining milk production BACKGROUND Pregnancy and the postpartum period have been suggested as important contributors to overweight and obesity among women . This paper presents the design , rationale , and baseline participant characteristics of a r and omized controlled intervention trial to enhance weight loss in postpartum women who entered pregnancy overweight or obese . METHODS Active Mothers Postpartum ( AMP ) is based on the rationale that the birth of a child can be a teachable moment . AMP 's primary objectives are to promote and sustain a reduction in body mass index ( BMI ) up to 2 years postpartum via changes in diet and exercise behavior , with a secondary aim to assess racial differences in these outcomes . Women in the intervention arm participate in ten physical activity group sessions , eight healthy eating classes , and six telephone counseling sessions over a 9-month period . They also receive motivational tools , including a workbook with recipes and exercises , a pedometer , and a sport stroller . RESULTS Four hundred fifty women aged > or = 18 ( mean 30.9 ) , with a BMI > or = 25 kg/m(2 ) ( mean 33.0 ) at baseline ( 6 weeks postpartum ) were enrolled ; 45 % of the final sample are black and 53 % are white . Baseline characteristics by study arm and by race are presented . CONCLUSIONS Our intervention is design ed to be disseminated broadly to benefit the public health . Behavior change interventions based on principles of social cognitive theory , stage of readiness , and other models that coincide with a teachable moment , such as the birth of a child , could be important motivators for postpartum weight loss OBJECTIVE to examine the effect of individual counselling on diet and physical activity from pregnancy to six months post partum , or from birth to six months post partum , on weight retention among Taiwanese women . DESIGN a r and omised controlled trial assigned participants to two experimental groups [ from pregnancy to six months post partum ( EP ) and from birth to six months post partum ( EPP ) ] and one comparison group . SETTING a 3900-bed medical centre in northern Taiwan with around 3000 births annually . PARTICIPANTS a sample of 189 women who had regular check-ups during pregnancy and gave birth at the medical centre . INTERVENTIONS the comparison group received the routine outpatient department obstetric educational programme . The EP group attended regularly scheduled clinic visits with individualised dietary and physical activity education plans from 16 gestational weeks to six months post partum , and received on brochure . The EPP group received the same educational intervention as the EP group from 24 - 48 hours after birth to six months post partum . MEASUREMENTS body weight , body mass index , health-promoting behaviour and psycho-social variables ( self-efficacy , body image , depression and social support ) . FINDINGS average gestational weight gain was 14.02 , 15.27 and 16.22 kg in the three EP , EPP and comparison groups respectively , and average weight retention at six months post partum was 2.34 , 4.06 and 5.08 kg in the three groups , respectively . KEY CONCLUSIONS a diet and physical activity intervention from pregnancy is effective for reducing post-pregnancy weight retention . IMPLICATION S FOR PRACTICE the findings of the present study should be taken into consideration when incorporating significant others and weight-loss maintenance strategies with interventions for a healthier family lifestyle Promotoras from the communities in which interventions are implemented can be effective contributors to validity and fidelity efforts . This article describes a 48-week r and omized controlled trial Madres para la Salud ( Mothers for Health ) and illustrates the use of promotoras as collaborative members of the research team to contribute to attaining integrative validity and treatment fidelity . Madres para la Salud implements a culturally tailored physical activity program to effect changes in body fat , systemic and fat tissue inflammation , and depression symptoms . The significance of Madres para la Salud treatment validity and fidelity processes includes cultural tailoring of a social support intervention , and a promotora model to incorporate initial and ongoing fidelity monitoring Background Many postnatal women are insufficiently physically active in the year after childbirth and could benefit from interventions to increase activity levels . However , there is limited information about the efficacy , feasibility and acceptability of motivational and behavioral interventions promoting postnatal physical activity in the UK . Methods The MAMMiS study is a r and omized , controlled trial , conducted within a large National Health Service ( NHS ) region in Scotl and . Up to 76 postnatal women will be recruited to test the impact of two physical activity consultations and a 10-week group pram-walking program on physical activity behavior change . The intervention uses evidence -based motivational and behavioral techniques and will be systematic ally evaluated using objective measures ( accelerometers ) at three months , with a maintenance measure taken at a six-month follow-up . Secondary health and well-being measures and psychological mediators of physical activity change are included . Discussion The ( MAMMiS study will provide a test of a theoretical and evidence -based physical activity behavior change intervention for postnatal women and provide information to inform future intervention development and testing within this population .Trial registration Current Controlled Trials IS RCT During the postpartum period , ethnic minority women have higher rates of inactivity/under-activity than white women . The Nā Mikimiki ( “ the active ones ” ) Project is design ed to increase  moderate-to-vigorous physical activity  over 18 months among multiethnic women with infants 2–12 months old . The study was design ed to test , via a r and omized controlled trial , the effectiveness of a tailored telephone counseling of moderate-to-vigorous physical activity intervention compared to a print/website material s-only condition .  Healthy , underactive women ( mean age = 32 ± 5.6 years ) with a baby ( mean age = 5.7 ± 2.8 months ) were enrolled from 2008–2009 ( N = 278 ) . Of the total sample , 84 % were ethnic minority women , predominantly Asian – American and Native Hawaiian . Mean self-reported baseline level of moderate-to-vigorous physical activity was 40 minutes/week with no significant differences by study condition , ethnicity , infant 's age , maternal body mass index , or maternal employment . Women had high scores on perceived benefits , self-efficacy , and environmental support for exercise but low scores on social support for exercise . This multiethnic sample 's demographic and psychosocial characteristics and their perceived barriers to exercise were comparable to previous physical activity studies conducted largely with white postpartum women . The Nā Mikimiki Project 's innovative tailored technology-based intervention and unique population are significant contributions to the literature on moderate-to-vigorous physical activity in postpartum women Low-income , multi-ethnic women are at elevated risk for obesity and chronic diseases , yet influences at different levels may act as barriers to changing risk behaviors . Following the birth of a child , childrearing and social isolation can exacerbate these influences . The social ecological framework integrates behavior-change strategies at different levels , providing a strong theoretical base for developing interventions in this high-risk population . The primary purpose of this r and omized controlled trial is to test the efficacy of an educational model delivered by community-based paraprofessionals in improving diet , activity and weight loss  among new mothers over a 12-month postpartum period and a 6-month maintenance period . This model fosters institutional change to support behavior changes influenced at intrapersonal and interpersonal levels , through collaboration with federal programs for low-income families : the Special Supplemental Food Program for Women , Infants and Children ( WIC ) , and the Exp and ed Food and Nutrition Education Program ( EFNEP ) . Participants are r and omized to the Usual Care , e.g. WIC nutrition and breastfeeding education , or Enhanced EFNEP intervention arm , consisting of Usual WIC Care plus a sustained , multi-component intervention including home visits , group classes and monthly telephone counseling . If shown to be efficacious , this program will be readily sustainable through existing federal agencies Background Postnatal women ( < 12 months postpartum ) are at increased risk of physical inactivity . Purpose To evaluate the efficacy and feasibility of a theory-based physical activity ( PA ) intervention delivered to postnatal women primarily via mobile telephone short message service ( SMS ) . Methods Eighty-eight women were r and omized to the intervention ( n = 45 ) or minimal contact control ( n = 43 ) condition . The 12-week intervention consisted of a face-to-face PA goal - setting consultation , a goal - setting magnet , three to five personally tailored SMS/week and a nominated support person who received two SMS per week . SMS content targeted constructs of social cognitive theory . Frequency ( days 
    Output:
    