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: In a study of the effectiveness of systematic relaxation training alone or combined with biofeedback in the treatment of  hypertension in pregnancy , 60 women were seen weekly for 6 weeks . 18 were given relaxation therapy alone ( group A ) , 18 relaxation plus biofeedback ( group B ) , and there were 24 controls . Whereas two-thirds of the control group had to be admitted to hospital during their pregnancies , less than a third of each experimental group had to be admitted . The experimental groups also had significantly lower systolic and diastolic blood pressure than the control group . There were no significant differences between groups A and B in hospital admission rates or blood-pressure measurements The histomorphometry of term placentae from women who exercised regularly throughout either the first half or all of pregnancy was compared to that of placentae from matched controls to determine if regular exercise during pregnancy produced histomorphometric evidence of altered development and transport capacity . Conventional stereological techniques were used to estimate placental volumetric composition , surface areas , and villous and vascular configurations in the three groups . Exercise confined to early pregnancy increased the parenchymal component of the placenta , total vascular volume and site-specific capillary volume and surface area .  Exercise throughout pregnancy increased these and multiple other histomorphometric parameters associated with the rate of placental perfusion and transfer function . However , significant changes were confined to villi > 80 microns in diameter . The localization of both the timing of the stimulus and the anatomical sites affected indicates that regular , sustained exercise modifies placental development primarily in early and mid-pregnancy . We speculate that the lack of significant changes in the structure and configuration of the smaller villi indicates that other adaptive mechanisms , such as increased rates of placental blood flow , must be well developed by the latter portion of the mid-trimester and adequately maintain fetal oxygenation and substrate delivery throughout the third trimester 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 A group of 62 healthy primigravidae aged 20–26 years participated in an investigation concerning physical work capacity and cardiovascular dynamics during pregnancy and the effect of physical training beginning in the 10th or 14th week of pregnancy and lasting until term . The training group consisted of 31 women who were examined every 4 weeks throughout pregnancy , the last examination occurring in the 38th week . The r and omly selected control group consisted of 31 women who were examined in the 10th or 14th , in the 26th , and in the 38th week of pregnancy . During the examination the  pulse rate and blood pressure were measured in the left lateral position after rest , in the sitting position , and at nearly maximal exertion . The  pulse-conducted triangular ECG test  was used for determination of physical work capacity . All forms of voluntary exercise were allowed and recommended to the training group , emphasizing strenuous physical exertion . The physical work capacity in the control group spontaneously rose 10 % The purpose of this study was to determine by two groups of physicians the use of  pregnancy bed rest , the types of activity restriction prescribed , if there is variability in prescription , and if side effects of this treatment are observed . A national survey of 44 directors of maternal fetal medicine ( MFM ) and a r and om selection of 47 practicing obstetricians certified by the American College of Obstetricians and Gynecologists ( ACOG ) was conducted . The survey contained questions about home and hospital bed rest and whether or not side effects of bed rest were observed . Physicians were also asked to indicate the type/degree of activity restriction prescribed for 16 diagnostic scenarios for women with mild hypertension , chronic hypertension , incompetent cervix , preterm labor , premature rupture of membranes , placenta previa , and twin pregnancy . Repeated measures analysis of variance was used to analyze the type of activity restriction prescribed at 20 , 24 , 28 , 32 , and 36 weeks ' gestation . Results reveal that bed rest was prescribed extensively ( 89%-93 % ) , but few any physical and psychologic side effects .  Physicians in both groups demonstrated marked variability in prescribing the location ( home or hospital ) and the severity of activity restriction even when treating the same condition . MFM directors were significantly more likely to treat pregnancy-induced hypertension ( p < 0.01 ) and placenta previa with hospital bed rest ( p < 0.05 ) . ACOG physicians preferred to prescribe either home or hospital bed rest across all diagnostic scenarios , whereas the prescription by MFM directors related more to the individual diagnosis than to a general preference . Choice of location of bed rest and the severity of activity restriction appear to be functions of physicians ' practice style Use of an exercise intervention for high-risk and vulnerable population s , such as pregnant women at risk for gestational hypertension or preeclampsia , requires special consideration . A comparative trial testing the effects of two types of physical exercises - stretching ( a comparator ) and walking ( a testing intervention ) - for sedentary pregnant women at risk for preeclampsia - is presented in this paper . The study was design ed to reduce post-r and omization bias and dropout rates from both groups , and closely to monitor safety of subjects . The strengths of the study design and methods include use of a run-in phase ; use of a stretching exercise as a comparator ; multiple ways to measure daily physical activities and the exercise intervention ; and tailored support to remove barriers to exercise for subjects . The intervention consists of 40 min of walking at moderate intensity ( i.e. , 55 - 69 % of maximum heart rate and rating of perceived exhaustion 12 - 13 ) five times a week from 18 weeks gestation until birth . The comparator exercise consists of 40 min of stretching exercise without increasing heart rate to more than 10 % of resting heart rate , five times a week from 18 weeks gestation until birth . The primary outcome is the incidence of preeclampsia . Secondary outcomes include the physiologic effects of the intervention and birth outcomes 34 hypertensive patients were assigned at r and om either to six weeks ' treatment by yoga relaxation methods with bio-feedback or to placebo therapy ( general relaxation ) . Both groups showed a reduction in blood-pressure ( from 168/100 to 141/84 mm . Hg in the treated group and from 169/101 to 160/96 mm Hg in the control group ) . The difference was highly significant . The control group was then trained in yoga relaxation , and their blood-pressure fell to that of the other group ( now used as controls ) Forty-one patients with gestational diabetes requiring insulin were enrolled in a r and omized study to investigate the efficacy of an exercise program in normalizing glucose tolerance . Seventeen of 21 patients completed the exercise program while maintaining normoglycemia and obviating  insulin therapy . Maternal and neonatal complications did not differ between the study and control groups . The type of program described appears to be safe and can serve as a model for exercise prescription for pregnant diabetic women to attain improved glucose tolerance OBJECTIVE To prospect ively determine whether moderate exercise during pregnancy lowers blood pressure . STUDY DESIGN A r and omized , controlled trial with one test group and one control group . All subjects have a history of mild hypertension , gestational hypertensive disorders or a family history of hypertensive disorders . Subjects were recruited before 14 weeks ' gestation . After four weeks of observation , the subjects were r and omly assigned to either the exercise or control group . The exercise group visited the laboratory three times a week for 10 weeks ( 18 - 28 gestation weeks ) to perform 30 minutes of exercise at Rating of Perceived Exertion level 13 . RESULTS A total of 16 pregnant women ( mean age , 30 years ) participated . The mean metabolic equivalent during exercise sessions was 4.7 ( SD = 0.8 ) . Blood pressure measurements were compared before and after the 10-week exercise period in the two groups . Systolic blood pressures did not change significantly , but diastolic blood pressure ( DBP ) in the exercise group decreased by 3.5 mm Hg , while that in the control group increased by 1.1 mm Hg . Thus , the pre-post change in DBP differed by 4.6 mm Hg between groups . Exercise treatment reduced the diastolic blood pressure to a near-significant level in the exercise group ( t = 2.34 , df = 7 , P = .052 ) . Percent body fat did not differ between the exercise and control groups either before or after exercise treatment . ANOVA revealed that pregnancy had a significant effect ( F(1 , 14 ) = 5.7 , P = .03 ) on increasing the percentage of fat , but exercise treatment did not ( F(1 , 14 ) = .18 , P = .68 ) . Estimated energy expenditure in overall daily physical activities during the intervention did not differ between the two groups despite the inclusion of exercise . CONCLUSION This study detected a strong trend that 10 weeks of moderate exercise lowered the  diastolic blood pressure among pregnant women at risk of hypertensive disorders . The reductions were probably due to the effect of exercise itself , not to weight or overall daily physical activity levels The mainstay of management of the gestational diabetic woman is dietary manipulation to achieve and maintain normoglycemia . If normoglycemia can not be sustained by diet alone , then insulin therapy is initiated . We instituted a series of studies to observe the value and safety of a cardiovascular fitness program to improve glucose tolerance in gestational diabetic women . We first evaluated the safety for pregnant women of five aerobic exercise machines  by observing the effect of these different forms of exercise on uterine activity during the third trimester . We found that upper-extremity exercise produced no uterine contractions , but lower-extremity exercise tended to produce contractions .  Upper-extremity exercise , in addition to dietary therapy , was then assigned to 10 gestational diabetic women who were matched for amount of glucose intolerance to 10 gestational diabetic women managed by diet alone .  The mean fasting plasma glucose ± SD after 6 wk was 4.87 ± 0.34 mM in the diet group versus 3.89 ± 0.37 mM in the diet-plus-exercise group . The mean postglucose challenge in the diet group was 10.40 ± 0.16 mM versus 5.9 ± 1.1 mM in the diet-plus-exercise group . Thus , upper-arm exercise may provide a useful treatment option for gestational diabetes and may obviate the need for insulin Background : How Canadian practitioners are managing the hypertensive disorders of pregnancy ( HDP ) is not known 
    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: In a study of the effectiveness of systematic relaxation training alone or combined with biofeedback in the treatment of  hypertension in pregnancy , 60 women were seen weekly for 6 weeks . 18 were given relaxation therapy alone ( group A ) , 18 relaxation plus biofeedback ( group B ) , and there were 24 controls . Whereas two-thirds of the control group had to be admitted to hospital during their pregnancies , less than a third of each experimental group had to be admitted . The experimental groups also had significantly lower systolic and diastolic blood pressure than the control group . There were no significant differences between groups A and B in hospital admission rates or blood-pressure measurements The histomorphometry of term placentae from women who exercised regularly throughout either the first half or all of pregnancy was compared to that of placentae from matched controls to determine if regular exercise during pregnancy produced histomorphometric evidence of altered development and transport capacity . Conventional stereological techniques were used to estimate placental volumetric composition , surface areas , and villous and vascular configurations in the three groups . Exercise confined to early pregnancy increased the parenchymal component of the placenta , total vascular volume and site-specific capillary volume and surface area .  Exercise throughout pregnancy increased these and multiple other histomorphometric parameters associated with the rate of placental perfusion and transfer function . However , significant changes were confined to villi > 80 microns in diameter . The localization of both the timing of the stimulus and the anatomical sites affected indicates that regular , sustained exercise modifies placental development primarily in early and mid-pregnancy . We speculate that the lack of significant changes in the structure and configuration of the smaller villi indicates that other adaptive mechanisms , such as increased rates of placental blood flow , must be well developed by the latter portion of the mid-trimester and adequately maintain fetal oxygenation and substrate delivery throughout the third trimester 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 A group of 62 healthy primigravidae aged 20–26 years participated in an investigation concerning physical work capacity and cardiovascular dynamics during pregnancy and the effect of physical training beginning in the 10th or 14th week of pregnancy and lasting until term . The training group consisted of 31 women who were examined every 4 weeks throughout pregnancy , the last examination occurring in the 38th week . The r and omly selected control group consisted of 31 women who were examined in the 10th or 14th , in the 26th , and in the 38th week of pregnancy . During the examination the  pulse rate and blood pressure were measured in the left lateral position after rest , in the sitting position , and at nearly maximal exertion . The  pulse-conducted triangular ECG test  was used for determination of physical work capacity . All forms of voluntary exercise were allowed and recommended to the training group , emphasizing strenuous physical exertion . The physical work capacity in the control group spontaneously rose 10 % The purpose of this study was to determine by two groups of physicians the use of  pregnancy bed rest , the types of activity restriction prescribed , if there is variability in prescription , and if side effects of this treatment are observed . A national survey of 44 directors of maternal fetal medicine ( MFM ) and a r and om selection of 47 practicing obstetricians certified by the American College of Obstetricians and Gynecologists ( ACOG ) was conducted . The survey contained questions about home and hospital bed rest and whether or not side effects of bed rest were observed . Physicians were also asked to indicate the type/degree of activity restriction prescribed for 16 diagnostic scenarios for women with mild hypertension , chronic hypertension , incompetent cervix , preterm labor , premature rupture of membranes , placenta previa , and twin pregnancy . Repeated measures analysis of variance was used to analyze the type of activity restriction prescribed at 20 , 24 , 28 , 32 , and 36 weeks ' gestation . Results reveal that bed rest was prescribed extensively ( 89%-93 % ) , but few any physical and psychologic side effects .  Physicians in both groups demonstrated marked variability in prescribing the location ( home or hospital ) and the severity of activity restriction even when treating the same condition . MFM directors were significantly more likely to treat pregnancy-induced hypertension ( p < 0.01 ) and placenta previa with hospital bed rest ( p < 0.05 ) . ACOG physicians preferred to prescribe either home or hospital bed rest across all diagnostic scenarios , whereas the prescription by MFM directors related more to the individual diagnosis than to a general preference . Choice of location of bed rest and the severity of activity restriction appear to be functions of physicians ' practice style Use of an exercise intervention for high-risk and vulnerable population s , such as pregnant women at risk for gestational hypertension or preeclampsia , requires special consideration . A comparative trial testing the effects of two types of physical exercises - stretching ( a comparator ) and walking ( a testing intervention ) - for sedentary pregnant women at risk for preeclampsia - is presented in this paper . The study was design ed to reduce post-r and omization bias and dropout rates from both groups , and closely to monitor safety of subjects . The strengths of the study design and methods include use of a run-in phase ; use of a stretching exercise as a comparator ; multiple ways to measure daily physical activities and the exercise intervention ; and tailored support to remove barriers to exercise for subjects . The intervention consists of 40 min of walking at moderate intensity ( i.e. , 55 - 69 % of maximum heart rate and rating of perceived exhaustion 12 - 13 ) five times a week from 18 weeks gestation until birth . The comparator exercise consists of 40 min of stretching exercise without increasing heart rate to more than 10 % of resting heart rate , five times a week from 18 weeks gestation until birth . The primary outcome is the incidence of preeclampsia . Secondary outcomes include the physiologic effects of the intervention and birth outcomes 34 hypertensive patients were assigned at r and om either to six weeks ' treatment by yoga relaxation methods with bio-feedback or to placebo therapy ( general relaxation ) . Both groups showed a reduction in blood-pressure ( from 168/100 to 141/84 mm . Hg in the treated group and from 169/101 to 160/96 mm Hg in the control group ) . The difference was highly significant . The control group was then trained in yoga relaxation , and their blood-pressure fell to that of the other group ( now used as controls ) Forty-one patients with gestational diabetes requiring insulin were enrolled in a r and omized study to investigate the efficacy of an exercise program in normalizing glucose tolerance . Seventeen of 21 patients completed the exercise program while maintaining normoglycemia and obviating  insulin therapy . Maternal and neonatal complications did not differ between the study and control groups . The type of program described appears to be safe and can serve as a model for exercise prescription for pregnant diabetic women to attain improved glucose tolerance OBJECTIVE To prospect ively determine whether moderate exercise during pregnancy lowers blood pressure . STUDY DESIGN A r and omized , controlled trial with one test group and one control group . All subjects have a history of mild hypertension , gestational hypertensive disorders or a family history of hypertensive disorders . Subjects were recruited before 14 weeks ' gestation . After four weeks of observation , the subjects were r and omly assigned to either the exercise or control group . The exercise group visited the laboratory three times a week for 10 weeks ( 18 - 28 gestation weeks ) to perform 30 minutes of exercise at Rating of Perceived Exertion level 13 . RESULTS A total of 16 pregnant women ( mean age , 30 years ) participated . The mean metabolic equivalent during exercise sessions was 4.7 ( SD = 0.8 ) . Blood pressure measurements were compared before and after the 10-week exercise period in the two groups . Systolic blood pressures did not change significantly , but diastolic blood pressure ( DBP ) in the exercise group decreased by 3.5 mm Hg , while that in the control group increased by 1.1 mm Hg . Thus , the pre-post change in DBP differed by 4.6 mm Hg between groups . Exercise treatment reduced the diastolic blood pressure to a near-significant level in the exercise group ( t = 2.34 , df = 7 , P = .052 ) . Percent body fat did not differ between the exercise and control groups either before or after exercise treatment . ANOVA revealed that pregnancy had a significant effect ( F(1 , 14 ) = 5.7 , P = .03 ) on increasing the percentage of fat , but exercise treatment did not ( F(1 , 14 ) = .18 , P = .68 ) . Estimated energy expenditure in overall daily physical activities during the intervention did not differ between the two groups despite the inclusion of exercise . CONCLUSION This study detected a strong trend that 10 weeks of moderate exercise lowered the  diastolic blood pressure among pregnant women at risk of hypertensive disorders . The reductions were probably due to the effect of exercise itself , not to weight or overall daily physical activity levels The mainstay of management of the gestational diabetic woman is dietary manipulation to achieve and maintain normoglycemia . If normoglycemia can not be sustained by diet alone , then insulin therapy is initiated . We instituted a series of studies to observe the value and safety of a cardiovascular fitness program to improve glucose tolerance in gestational diabetic women . We first evaluated the safety for pregnant women of five aerobic exercise machines  by observing the effect of these different forms of exercise on uterine activity during the third trimester . We found that upper-extremity exercise produced no uterine contractions , but lower-extremity exercise tended to produce contractions .  Upper-extremity exercise , in addition to dietary therapy , was then assigned to 10 gestational diabetic women who were matched for amount of glucose intolerance to 10 gestational diabetic women managed by diet alone .  The mean fasting plasma glucose ± SD after 6 wk was 4.87 ± 0.34 mM in the diet group versus 3.89 ± 0.37 mM in the diet-plus-exercise group . The mean postglucose challenge in the diet group was 10.40 ± 0.16 mM versus 5.9 ± 1.1 mM in the diet-plus-exercise group . Thus , upper-arm exercise may provide a useful treatment option for gestational diabetes and may obviate the need for insulin Background : How Canadian practitioners are managing the hypertensive disorders of pregnancy ( HDP ) is not known 
    Output:
    