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: Summary A 28-week resistance training with linear periodization was compared with an undulating model in 27 premenopausal women . In both groups , bone mineral density ( BMD ) was not changed but muscle strength increased , and there were changes in anthropometrical and muscle damage parameters , indicating that in this population , these models are similar concerning these variables . Introduction This study seeks to compare the effects of resistance training with undulating versus linear periodization on BMD , muscle strength , anthropometrical variables , and muscle damage parameters in premenopausal women . Methods Twenty-seven females ( 39.6 ± 0.41 years , mean ± st and ard error ) , without osteopenia or osteoporosis and without calcium supplementation , were r and omly assigned either to a linear periodization group ( LPG , n = 14 ) or to an undulating periodization group ( UPG , n = 13 ) . The subjects were trained three times a week for 28 weeks . Lumbar spine and femoral neck BMDs were measured through dual-energy X-ray absorptiometry . Maximal and submaximal dynamic muscle strengths were measured through the 1-RM and 20-RM tests , respectively . Anthropometrical ( body mass , skinfolds , and perimeters ) and muscle damage parameters were assessed through serum creatine kinase ( CK ) and delayed-onset muscle soreness ( DOMS ) . Results BMD remained unchanged in both groups , despite significant increases in maximal ( LPG , 37–73 % ; UPG , 40–70 % ) and submaximal ( LPG , 82–114 % ; UPG , 70–102 % ) muscle strength . The perimeter of the distal thigh was increased ( about 1.7 cm ) in both groups . CK and DOMS were greater in the first mesocycle than in the subsequent ones . After the 1st training session in each mesocycle , 24 and 48 h CK was increased as compared to pretraining values . Conclusions The resistance training of 28 weeks increased muscle strength in both training groups with no difference in BMD or in the occurrence of muscle damage BACKGROUND Recommending increased physical activity facilitates long-term weight loss , but the optimal level of physical activity to recommend is unknown . OBJECTIVE The objective of the study was to evaluate the efficacy for long-term weight loss of recommendations for much higher physical activity than those normally used in behavioral treatments . DESIGN Overweight men and women ( n = 202 ) were r and omly assigned to either a st and ard behavior therapy ( SBT ) for obesity , incorporating an energy expenditure ( EE ) goal of 1000 kcal/wk , or to a high physical activity ( HPA ) treatment , in which the goal was an EE of 2500 kcal/wk . To help HPA treatment group participants achieve this high exercise goal , their treatment included encouragement to recruit 1 - 3 exercise partners into the study , personal counseling from an exercise coach , and small monetary incentives . RESULTS The HPA treatment group reported achieving higher mean ( + /- SD ) physical activity levels than did the SBT group at 6 mo ( EE of 2399 + /- 1571 kcal/wk compared with 1837 + /- 1431 kcal/wk ) , 12 mo ( EE of 2249 + /- 1751 kcal/wk compared with 1565 + /- 1309 kcal/wk ) , and 18 mo ( EE of 2317 + /- 1854 kcal/wk compared with 1629 + /- 1483 kcal/wk ) ( all P < 0.01 ) . Mean ( + /- SEM ) cumulative weight losses at 6 , 12 , and 18 mo in the HPA treatment group were 9.0 + /- 7.1 , 8.5 + /- 7.9 , and 6.7 + /- 8.1 kg , respectively . In the SBT group , the corresponding weight losses were 8.1 + /- 7.4 , 6.1 + /- 8.8 , and 4.1 + /- 7.3 kg , respectively . Between-group differences in weight loss were significant at 12 and 18 mo . CONCLUSION These results suggest that recommendations of higher levels of physical activity ( EE of 2500 kcal/wk ) promote long-term weight loss better than do conventional recommendations Proper r and omisation means little if investigators can not include all r and omised participants in the primary analysis . Participants might ignore follow-up , leave town , or take aspartame when instructed to take aspirin . Exclusions before r and omisation do not bias the treatment comparison , but they can hurt generalisability . Eligibility criteria for a trial should be clear , specific , and applied before r and omisation . Readers should assess whether any of the criteria make the trial sample atypical or unrepresentative of the people in which they are interested . In principle , assessment of exclusions after r and omisation is simple : none are allowed . For the primary analysis , all participants enrolled should be included and analysed as part of the original group assigned ( an intent-to-treat analysis ) . In reality , however , losses frequently occur . Investigators should , therefore , commit adequate re sources to develop and implement procedures to maximise retention of participants . Moreover , research ers should provide clear , explicit information on the progress of all r and omised participants through the trial by use of , for instance , a trial profile . Investigators can also do secondary analyses on , for instance , per- protocol or as-treated participants . Such analyses should be described as secondary and non-r and omised comparisons . Mish and ling of exclusions causes serious method ological difficulties . Unfortunately , some explanations for mish and ling exclusions intuitively appeal to readers , disguising the seriousness of the issues . Creative mismanagement of exclusions can undermine trial validity BACKGROUND High levels of exercise may be necessary for long-term maintenance of weight loss . OBJECTIVE We aim ed to determine in a r and omized prospect i ve design whether encouraging 2500 kcal physical activity/wk produced greater 30-mo weight losses than did the st and ard 1000 kcal physical activity/wk prescription . DESIGN Overweight adults ( n = 202 ) were r and omly assigned to either 18 mo of st and ard behavioral treatment ( SBT ) with an exercise goal of 1000 kcal/wk or a high physical activity ( HPA ) treatment with a goal of 2500 kcal/wk . The HPA treatment included all procedures in the SBT plus encouragement to recruit 1 - 3 exercise partners and small-group counseling with an exercise coach . Participants were followed for 30 mo . RESULTS The HPA group achieved significantly greater exercise levels and weight losses than did the SBT group at 12 and 18 mo ( P < 0.01 ) . Weight losses did not differ significantly at 30 mo : 0.90 + /- 8.9 and 2.86 + /- 8.6 kg for the SBT and HPA groups , respectively ( P = 0.16 ) . At 30 mo , average exercise levels no longer differed significantly between groups ( 1390 and 1696 kcal/wk , respectively ; P > 0.10 ) . Participants sustaining high exercise levels ( > 2500 kcal/wk ) for 30 mo had significantly ( P < 0.001 ) greater 30-mo weight loss than did those exercising less ( 12 + /- 8.8 and 0.8 + /- 8.1 kg , respectively ) . CONCLUSIONS Although participants in the HPA group sustained the 2500-kcal activity goal during the 18-mo treatment , activity declined once treatment ended , which result ed in no between-group differences in activity or weight loss at 2.5 y. Participants who reported continuing to engage in high levels of exercise maintained a significantly larger weight loss Abstract . There is evidence that high intensity resistance training promotes bone maintenance in older women , however , the effect of high intensity free weight training has not been investigated in older men or women . Furthermore , little is known about the chronic effect of weight training on serum insulin growth factor-I ( IGF-I ) in this population . We compared the effects of a moderate intensity seated resistance-training program with a high intensity st and ing free weight exercise program on bone mass and serum levels of IGF-I and IGFBP3 in healthy older men and women . Twenty-eight men ( 54.6 ± 3.2 years ) and 26 nonestrogen-replaced women ( 52.8 ± 3.3 years ) served as their own controls for 12 weeks , then were r and omly assigned to a moderate or high intensity training group and trained three times/week for 24 weeks . Prior to and after the control period and at the end of training , bone mass and body composition were assessed by dual energy X-ray absorptiometry ( DXA ) , muscle strength by isokinetic dynamometry , muscular power by Wingate Anaerobic Power Test , and IGF-I by radioimmunoassay ( RIA ) . A repeated measures analysis of covariance ( ANCOVA ) revealed that high intensity training result ed in a gain in spine BMD in men ( 1.9 % ) , P < 0.05 , but not in women , whereas moderate intensity training produced no changes in either gender at this site . Increases were observed at the greater trochanter , P < 0.03 , in men regardless of training intensity , but not in women at any hip site . However , when compared with zero , both men and women in the high intensity group demonstrated significant increases in trochanteric BMD ( 1.3 % and 2.0 % , respectively ) and a decrease in femoral BMD ( −1.8 % ) . Neither circulating serum IGF-I nor IGFBP3 were altered by either training regimen , but both training programs result ed in improvements in total body strength ( 37.62 % ) and lean mass ( males 4.1 % , females 3.1 % ) . We conclude that although resistance training of moderate to high intensity produced similar muscle changes in older adults , a higher magnitude is necessary to stimulate osteogenesis at the spine . However , at the spine , intensity was not sufficient to offset low levels of estrogen in early postmenopausal women . Furthermore , bone changes were not accompanied by changes in circulating serum levels of IGF-I or IGFBP3 The impact of resistance training has not been thoroughly examined in overweight older adults undergoing weight loss . Subjects ( n = 27 ) were overweight and obese ( BMI 31.7 ± 3.6 kg/m2 ) older ( age 67 ± 4 years ) adults and were r and omized into either a 10-week Dietary Approaches to Stop Hypertension for weight loss diet ( DASH , n = 12 ) or DASH plus moderate intensity resistance training ( DASH-RT , n = 15 ) . Outcomes included weight loss , total body and mid-thigh composition , muscle and physical function . There were no significant weight loss differences between the DASH-RT and DASH groups ( −3.6 ± 0.8 vs. −2.0 ± 0.9 % , p = 0.137 ) . The DASH-RT group had a greater reduction in body fat than the DASH group ( −4.1 ± 0.9 vs. −0.2 ± 1.0 kg , p = 0.005 ) . The DASH-RT group had greater changes in lean mass ( + 0.8 ± 0.4 vs. −1.4 ± 0.4 kg , p = 0.002 ) and strength ( + 60 ± 18 vs. −5 ± 9 N , p = 0.008 ) than the DASH group . There were favorable changes in mid-thigh composition variables in the DASH-RT group that were different than the lack of changes observed in the DASH group , except for intermuscular adipose tissue . Both groups experienced decreases in 400-m walk times showed ( DASH −36 ± 11 s , DASH-RT −40 ± 7 s ) with no differences between groups . Moderate intensity resistance training  during weight loss appears to improve fat mass and thigh composition , but weight loss only does not . However , global measures of physical functioning may improve with a weight loss-only program CONTEXT A higher duration and intensity of exercise may improve long-term weight loss . OBJECTIVE To compare the effects of different duration s and intensities of exercise on 12-month weight loss and cardiorespiratory fitness . DESIGN , SETTING , AND PARTICIPANTS R and omized trial conducted from January 2000 through December 2001 involving 201 sedentary women ( mean [ SD ] age , 37.0 [ 5.7 ] years ; mean [ SD ] body mass index , 32.6 [ 4.2 ] ) in a university-based weight control program . INTERVENTION Participants were r and omly assigned to 1 of 4 exercise groups ( vigorous intensity/high duration ; moderate intensity/high duration ; moderate intensity/moderate duration ; or vigorous intensity/moderate duration ) based on estimated energy expenditure ( 1000 kcal/wk vs 2000 kcal/wk ) and exercise intensity ( moderate vs vigorous ) . All women were instructed to reduce intake of energy to between 1200 and 1500 kcal/d and dietary fat to between 20 % and 30 % of total energy intake . MAIN OUTCOME MEASURES Body weight , cardiorespiratory fitness , and exercise participation . RESULTS After exclusions , 184 of 196 r and omized participants completed 12 months of treatment ( 94 % ) . In intention-to-treat analysis , mean ( SD ) weight loss following 12 months of treatment was statistically significant ( P < .001 ) in all exercise groups ( vigorous intensity/high duration = 8.9 [ 7.3 ] kg ; moderate intensity/high duration = 8.2 [ 7.6 ] kg ; moder 
    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: Summary A 28-week resistance training with linear periodization was compared with an undulating model in 27 premenopausal women . In both groups , bone mineral density ( BMD ) was not changed but muscle strength increased , and there were changes in anthropometrical and muscle damage parameters , indicating that in this population , these models are similar concerning these variables . Introduction This study seeks to compare the effects of resistance training with undulating versus linear periodization on BMD , muscle strength , anthropometrical variables , and muscle damage parameters in premenopausal women . Methods Twenty-seven females ( 39.6 ± 0.41 years , mean ± st and ard error ) , without osteopenia or osteoporosis and without calcium supplementation , were r and omly assigned either to a linear periodization group ( LPG , n = 14 ) or to an undulating periodization group ( UPG , n = 13 ) . The subjects were trained three times a week for 28 weeks . Lumbar spine and femoral neck BMDs were measured through dual-energy X-ray absorptiometry . Maximal and submaximal dynamic muscle strengths were measured through the 1-RM and 20-RM tests , respectively . Anthropometrical ( body mass , skinfolds , and perimeters ) and muscle damage parameters were assessed through serum creatine kinase ( CK ) and delayed-onset muscle soreness ( DOMS ) . Results BMD remained unchanged in both groups , despite significant increases in maximal ( LPG , 37–73 % ; UPG , 40–70 % ) and submaximal ( LPG , 82–114 % ; UPG , 70–102 % ) muscle strength . The perimeter of the distal thigh was increased ( about 1.7 cm ) in both groups . CK and DOMS were greater in the first mesocycle than in the subsequent ones . After the 1st training session in each mesocycle , 24 and 48 h CK was increased as compared to pretraining values . Conclusions The resistance training of 28 weeks increased muscle strength in both training groups with no difference in BMD or in the occurrence of muscle damage BACKGROUND Recommending increased physical activity facilitates long-term weight loss , but the optimal level of physical activity to recommend is unknown . OBJECTIVE The objective of the study was to evaluate the efficacy for long-term weight loss of recommendations for much higher physical activity than those normally used in behavioral treatments . DESIGN Overweight men and women ( n = 202 ) were r and omly assigned to either a st and ard behavior therapy ( SBT ) for obesity , incorporating an energy expenditure ( EE ) goal of 1000 kcal/wk , or to a high physical activity ( HPA ) treatment , in which the goal was an EE of 2500 kcal/wk . To help HPA treatment group participants achieve this high exercise goal , their treatment included encouragement to recruit 1 - 3 exercise partners into the study , personal counseling from an exercise coach , and small monetary incentives . RESULTS The HPA treatment group reported achieving higher mean ( + /- SD ) physical activity levels than did the SBT group at 6 mo ( EE of 2399 + /- 1571 kcal/wk compared with 1837 + /- 1431 kcal/wk ) , 12 mo ( EE of 2249 + /- 1751 kcal/wk compared with 1565 + /- 1309 kcal/wk ) , and 18 mo ( EE of 2317 + /- 1854 kcal/wk compared with 1629 + /- 1483 kcal/wk ) ( all P < 0.01 ) . Mean ( + /- SEM ) cumulative weight losses at 6 , 12 , and 18 mo in the HPA treatment group were 9.0 + /- 7.1 , 8.5 + /- 7.9 , and 6.7 + /- 8.1 kg , respectively . In the SBT group , the corresponding weight losses were 8.1 + /- 7.4 , 6.1 + /- 8.8 , and 4.1 + /- 7.3 kg , respectively . Between-group differences in weight loss were significant at 12 and 18 mo . CONCLUSION These results suggest that recommendations of higher levels of physical activity ( EE of 2500 kcal/wk ) promote long-term weight loss better than do conventional recommendations Proper r and omisation means little if investigators can not include all r and omised participants in the primary analysis . Participants might ignore follow-up , leave town , or take aspartame when instructed to take aspirin . Exclusions before r and omisation do not bias the treatment comparison , but they can hurt generalisability . Eligibility criteria for a trial should be clear , specific , and applied before r and omisation . Readers should assess whether any of the criteria make the trial sample atypical or unrepresentative of the people in which they are interested . In principle , assessment of exclusions after r and omisation is simple : none are allowed . For the primary analysis , all participants enrolled should be included and analysed as part of the original group assigned ( an intent-to-treat analysis ) . In reality , however , losses frequently occur . Investigators should , therefore , commit adequate re sources to develop and implement procedures to maximise retention of participants . Moreover , research ers should provide clear , explicit information on the progress of all r and omised participants through the trial by use of , for instance , a trial profile . Investigators can also do secondary analyses on , for instance , per- protocol or as-treated participants . Such analyses should be described as secondary and non-r and omised comparisons . Mish and ling of exclusions causes serious method ological difficulties . Unfortunately , some explanations for mish and ling exclusions intuitively appeal to readers , disguising the seriousness of the issues . Creative mismanagement of exclusions can undermine trial validity BACKGROUND High levels of exercise may be necessary for long-term maintenance of weight loss . OBJECTIVE We aim ed to determine in a r and omized prospect i ve design whether encouraging 2500 kcal physical activity/wk produced greater 30-mo weight losses than did the st and ard 1000 kcal physical activity/wk prescription . DESIGN Overweight adults ( n = 202 ) were r and omly assigned to either 18 mo of st and ard behavioral treatment ( SBT ) with an exercise goal of 1000 kcal/wk or a high physical activity ( HPA ) treatment with a goal of 2500 kcal/wk . The HPA treatment included all procedures in the SBT plus encouragement to recruit 1 - 3 exercise partners and small-group counseling with an exercise coach . Participants were followed for 30 mo . RESULTS The HPA group achieved significantly greater exercise levels and weight losses than did the SBT group at 12 and 18 mo ( P < 0.01 ) . Weight losses did not differ significantly at 30 mo : 0.90 + /- 8.9 and 2.86 + /- 8.6 kg for the SBT and HPA groups , respectively ( P = 0.16 ) . At 30 mo , average exercise levels no longer differed significantly between groups ( 1390 and 1696 kcal/wk , respectively ; P > 0.10 ) . Participants sustaining high exercise levels ( > 2500 kcal/wk ) for 30 mo had significantly ( P < 0.001 ) greater 30-mo weight loss than did those exercising less ( 12 + /- 8.8 and 0.8 + /- 8.1 kg , respectively ) . CONCLUSIONS Although participants in the HPA group sustained the 2500-kcal activity goal during the 18-mo treatment , activity declined once treatment ended , which result ed in no between-group differences in activity or weight loss at 2.5 y. Participants who reported continuing to engage in high levels of exercise maintained a significantly larger weight loss Abstract . There is evidence that high intensity resistance training promotes bone maintenance in older women , however , the effect of high intensity free weight training has not been investigated in older men or women . Furthermore , little is known about the chronic effect of weight training on serum insulin growth factor-I ( IGF-I ) in this population . We compared the effects of a moderate intensity seated resistance-training program with a high intensity st and ing free weight exercise program on bone mass and serum levels of IGF-I and IGFBP3 in healthy older men and women . Twenty-eight men ( 54.6 ± 3.2 years ) and 26 nonestrogen-replaced women ( 52.8 ± 3.3 years ) served as their own controls for 12 weeks , then were r and omly assigned to a moderate or high intensity training group and trained three times/week for 24 weeks . Prior to and after the control period and at the end of training , bone mass and body composition were assessed by dual energy X-ray absorptiometry ( DXA ) , muscle strength by isokinetic dynamometry , muscular power by Wingate Anaerobic Power Test , and IGF-I by radioimmunoassay ( RIA ) . A repeated measures analysis of covariance ( ANCOVA ) revealed that high intensity training result ed in a gain in spine BMD in men ( 1.9 % ) , P < 0.05 , but not in women , whereas moderate intensity training produced no changes in either gender at this site . Increases were observed at the greater trochanter , P < 0.03 , in men regardless of training intensity , but not in women at any hip site . However , when compared with zero , both men and women in the high intensity group demonstrated significant increases in trochanteric BMD ( 1.3 % and 2.0 % , respectively ) and a decrease in femoral BMD ( −1.8 % ) . Neither circulating serum IGF-I nor IGFBP3 were altered by either training regimen , but both training programs result ed in improvements in total body strength ( 37.62 % ) and lean mass ( males 4.1 % , females 3.1 % ) . We conclude that although resistance training of moderate to high intensity produced similar muscle changes in older adults , a higher magnitude is necessary to stimulate osteogenesis at the spine . However , at the spine , intensity was not sufficient to offset low levels of estrogen in early postmenopausal women . Furthermore , bone changes were not accompanied by changes in circulating serum levels of IGF-I or IGFBP3 The impact of resistance training has not been thoroughly examined in overweight older adults undergoing weight loss . Subjects ( n = 27 ) were overweight and obese ( BMI 31.7 ± 3.6 kg/m2 ) older ( age 67 ± 4 years ) adults and were r and omized into either a 10-week Dietary Approaches to Stop Hypertension for weight loss diet ( DASH , n = 12 ) or DASH plus moderate intensity resistance training ( DASH-RT , n = 15 ) . Outcomes included weight loss , total body and mid-thigh composition , muscle and physical function . There were no significant weight loss differences between the DASH-RT and DASH groups ( −3.6 ± 0.8 vs. −2.0 ± 0.9 % , p = 0.137 ) . The DASH-RT group had a greater reduction in body fat than the DASH group ( −4.1 ± 0.9 vs. −0.2 ± 1.0 kg , p = 0.005 ) . The DASH-RT group had greater changes in lean mass ( + 0.8 ± 0.4 vs. −1.4 ± 0.4 kg , p = 0.002 ) and strength ( + 60 ± 18 vs. −5 ± 9 N , p = 0.008 ) than the DASH group . There were favorable changes in mid-thigh composition variables in the DASH-RT group that were different than the lack of changes observed in the DASH group , except for intermuscular adipose tissue . Both groups experienced decreases in 400-m walk times showed ( DASH −36 ± 11 s , DASH-RT −40 ± 7 s ) with no differences between groups . Moderate intensity resistance training  during weight loss appears to improve fat mass and thigh composition , but weight loss only does not . However , global measures of physical functioning may improve with a weight loss-only program CONTEXT A higher duration and intensity of exercise may improve long-term weight loss . OBJECTIVE To compare the effects of different duration s and intensities of exercise on 12-month weight loss and cardiorespiratory fitness . DESIGN , SETTING , AND PARTICIPANTS R and omized trial conducted from January 2000 through December 2001 involving 201 sedentary women ( mean [ SD ] age , 37.0 [ 5.7 ] years ; mean [ SD ] body mass index , 32.6 [ 4.2 ] ) in a university-based weight control program . INTERVENTION Participants were r and omly assigned to 1 of 4 exercise groups ( vigorous intensity/high duration ; moderate intensity/high duration ; moderate intensity/moderate duration ; or vigorous intensity/moderate duration ) based on estimated energy expenditure ( 1000 kcal/wk vs 2000 kcal/wk ) and exercise intensity ( moderate vs vigorous ) . All women were instructed to reduce intake of energy to between 1200 and 1500 kcal/d and dietary fat to between 20 % and 30 % of total energy intake . MAIN OUTCOME MEASURES Body weight , cardiorespiratory fitness , and exercise participation . RESULTS After exclusions , 184 of 196 r and omized participants completed 12 months of treatment ( 94 % ) . In intention-to-treat analysis , mean ( SD ) weight loss following 12 months of treatment was statistically significant ( P < .001 ) in all exercise groups ( vigorous intensity/high duration = 8.9 [ 7.3 ] kg ; moderate intensity/high duration = 8.2 [ 7.6 ] kg ; moder 
    Output:
    