human
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background Poor aerobic fitness is associated with worsening of asthma symptoms , and fitness training may improve asthma control . The mechanism linking fitness with asthma is not known . We hypothesized that repeated bouts of exercise would lead to a downregulation of glucocorticoid receptor ( GR ) expression on circulating leukocytes , reflecting a reduced responsiveness to stress . Methods In a prospect i ve exercise training intervention of healthy and asthmatic adolescents , GR expression in leukocytes was measured using flow cytometry in response to an acute exercise challenge before and after the exercise training intervention .  Peripheral blood mononuclear cell ( P BMC ) gene expression of GR , GRβ , HSP70 , TGFβ1 , and TGFβ2 was determined using reverse-transcriptase PCR ( RT-PCR ) . Results Peak VO2 increased by 14.6±2.3 % , indicating an effective training ( P<0.01 ) . There was a significant difference in GR expression among leukocyte subtypes , with highest expression in eosinophils . Following the exercise training intervention , there was a significant decrease in baseline GR expression ( P<0.05 ) in leukocyte and monocyte subtypes in both healthy and asthmatic adolescents . Conclusions This is the first study in adolescents to show that exercise training reduces GR expression in circulating leukocytes . We speculate that exercise training downregulates the stress response in general , manifested by decreased GR expression , and may explain why improving fitness improves asthma health Background The benefits of aerobic training for the main features of asthma , such as bronchial hyperresponsiveness ( BHR ) and inflammation , are poorly understood . We investigated the effects of aerobic training on BHR ( primary outcome ) , serum inflammatory cytokines ( secondary outcome ) , clinical control and asthma quality of life ( Asthma Quality of Life Question naire ( AQLQ ) ) ( tertiary outcomes ) . Methods Fifty-eight patients were r and omly assigned to either the control group ( CG ) or the aerobic training group ( TG ) . Patients in the CG ( educational programme+breathing exercises ( sham ) ) and the TG ( same as the CG+aerobic training ) were followed for 3 months . BHR , serum cytokine , clinical control , AQLQ , induced sputum and fractional exhaled nitric oxide ( FeNO ) were evaluated before and after the intervention . Results After 12 weeks , 43 patients ( 21 CG/22 TG ) completed the study and were analysed . The TG improved in BHR by 1 doubling dose ( dd ) ( 95 % CI 0.3 to 1.7 dd ) , and they experienced reduced interleukin 6 ( IL-6 ) and monocyte chemoattractant protein 1 ( MCP-1 ) and improved AQLQ and asthma exacerbation ( p<0.05 ) . No effects were seen for IL-5 , IL-8 , IL-10 , sputum cellularity , FeNO or Asthma Control Question naire 7 ( ACQ-7 ; p>0.05 ) . A within-group difference was found in the ACQ-6 for patients with non-well-controlled asthma and in sputum eosinophil and FeNO in patients in the TG who had worse airway inflammation . Conclusions Aerobic training reduced BHR and serum proinflammatory cytokines and improved quality of life and asthma exacerbation  in patients with moderate or severe asthma . These results suggest that adding exercise as an adjunct therapy to pharmacological treatment could improve the main features of asthma . Trial registration number NCT02033122 OBJECTIVE To investigate the medium-term benefits of a swimming program in schoolchildren and adolescents with moderate persistent atopic asthma ( MPAA ) . METHODS A r and omized , prospect i ve study of children and adolescents ( age 7 - 18 years ) with MPAA was carried out at the Hospital de Clínicas of Universidade Estadual de Campinas ( UNICAMP ) , Campinas , Brazil . After a 1-month run-in period , 61 patients ( 34 female ) were r and omized into two groups , a swimming group ( n = 30 ) and a control group ( n = 31 ) , and followed for 3 months . Both patient groups received inhaled fluticasone ( dry powder , 250 mcg twice a day ) and salbutamol as needed . The swim training program consisted of two weekly classes over a 3-month period for a total of 24 sessions . Both groups underwent  spirometric assessment  and methacholine challenge test -- provocative concentration of methacholine causing a 20 % fall in FEV1 (PC₂₀)--before and after the study period . Maximal inspiratory pressure ( MIP ) and maximal expiratory pressure ( MEP ) were measured only in the swimming group . RESULTS Significant increases in PC₂₀ ( pre-training , 0.31±0.25 ; post-training , 0.63±0.78 ; p = 0.008 ) , MIP ( pre-training , 67.08±17.13 cm H₂O ; post-training 79.46±18.66 ; p < 0.001 ) , and MEP ( pre-training , 71.69±20.01 cm H₂O ; post-training , 78.92±21.45 cm H₂O ; p < 0.001 ) were found in the swimming group . CONCLUSION Children and adolescents with MPAA subjected to a swim training program experienced a significant decrease in bronchial hyperresponsiveness , as determined by increased PC₂₀ values , when compared with asthmatic controls who did not undergo swim training . Participants in the swimming group also showed improvement in elastic recoil of the chest wall INTRODUCTION There are limited studies evaluating the role of pulmonary rehabilitation ( PR ) in pediatric asthma . METHODS A retrospective chart review was performed of all pediatric patients with a diagnosis of asthma enrolled in PR . Demographics , medications , and clinical records were review ed . In addition , PFTs , 6-min walk test ( 6MWT ) , and patient/parent symptom and quality of life surveys before and after PR were evaluated . RESULTS A total of 38 patients were enrolled in PR ; 18 ( 47 % ) female and 20 ( 53 % ) male . Mean participant age was 11.33 ± 3.37 ( range 4 - 19 ) years . Twenty-two ( 58 % ) were Caucasian and nine ( 24 % ) African American . Chart review was limited by incomplete data sets for many participants . Following PR , significant improvement was noted in mean 6MWT distance ( 1541 vs 1616 feet , P = 0.05 ) and FEV1 ( 89.9 % of predicted versus 96.4 % , P = 0.04 ) . Survey instruments demonstrated improvement in several clinical factors , however , there was no significant change in weight following PR despite scheduled cardiovascular exercise and dietary counseling . CONCLUSIONS Structured PR for pediatric patients with asthma can improve 6MWT distance and FEV1 as well as subjective measures of SOB and QOL , suggesting a role for PR in the chronic management of pediatric asthma . Further prospect i ve investigation is needed to determine if PR has positive effects on other clinical parameters of asthma control and its overall impact on childhood obesity The effects of a 3-month physical training programme on airway inflammation and clinical outcomes were studied in school-aged children with asthma . Subjects with persistent allergic asthma ( aged 12.7±3.4 yrs ; n = 34 ) were r and omly allocated into training and control groups . Exercise consisted of twice-weekly 50-min sessions for 12 weeks . Inflammation was assessed by levels of exhaled nitric oxide , blood eosinophils , eosinophil cationic protein , C-reactive protein , and total and mite-specific immunoglobulin (Ig)E. Lung volumes and bronchial responsiveness to methacholine were determined . The Paediatric Asthma Quality of Life Question naire and Paediatric Asthma Caregiver 's Quality of Life Question naire were used to evaluate activity restrictions , symptoms and emotional stress . The efficacy of the training was assessed by accelerometry . Following the programme , the exercise group spent twice as much time as the controls undertaking moderate-to-vigorous activities . No differences in changes were seen between groups for asthma outcomes . However , total IgE decreased more in the exercise group , as did mite-specific IgE. Training did not increase inflammation in children with persistent asthma , and may have decreased both total and allergen-specific immunoglobulin E levels . It is concluded that there is no reason to discourage asthmatic children with controlled disease to exercise PURPOSE Aerobic training has been shown to be effective in improving cardiopulmonary fitness in asthmatic children . However , the actual impact of physical training on clinical indicators of disease control remains controversial . METHODS Thirty-eight children with moderate to severe persistent asthma were r and omly assigned to control ( N=17 ) and training ( N=21 ) groups . Spirometry , exercise challenge , and maximum incremental cardiopulmonary exercise tests were performed 16 wk apart . Daily doses of inhaled steroids and Pediatric Asthma Quality of Life Question naire ( PAQLQ ) scores were also recorded . RESULTS Physical training was associated with significant improvements in physiological variables at peak and submaximal exercise ( P<0.05 ) ; in contrast , no significant changes were found in controls . Severity of exercise-induced bronchoconstriction ( EIB ) and postexercise breathlessness were significantly lessened in trained patients ; improvement in fitness and EIB , however , were not linearly related ( P>0.05 ) . In addition , PAQLQ scores improved only in trained children ( P<0.01 ) . Daily doses of inhaled steroids were reduced in trained patients ( 52 % ) , but they remained unchanged or increased in controls ( 70.6 % ) ( P=0.07 ) . CONCLUSION Supervised exercise training might be associated with beneficial effects on disease control and quality of life in asthmatic children . These data suggest an adjunct role of physical conditioning on clinical management of patients with more advanced disease PURPOSE there is evidence suggesting that physical activity has anti-inflammatory effects in many chronic diseases ; however , the role of exercise in airway inflammation in asthma is poorly understood . We aim ed to evaluate the effects of an aerobic training program on eosinophil inflammation ( primary aim ) and nitric oxide ( secondary aim ) in patients with moderate or severe persistent asthma . METHODS sixty-eight patients r and omly assigned to either  control  ( CG ) or aerobic training ( TG ) groups were studied during the period between medical consultations . Patients in the CG ( educational program + breathing exercises ; N = 34 ) and TG ( educational program + breathing exercises + aerobic training ; N = 34 ) were examined twice a week during a 3-month period . Before and after the intervention , patients underwent induced sputum , fractional exhaled nitric oxide ( FeNO ) , pulmonary function , and cardiopulmonary exercise testing . Asthma symptom-free days were quantified monthly , and asthma exacerbation was monitored during 3 months of intervention . RESULTS at 3 months , decreases in the total and eosinophil cell counts in induced sputum ( P = 0.004 ) and in the levels of FeNO ( P = 0.009 ) were observed after intervention only in the TG . The number of asthma symptom-free days and VO(2max ) also significantly improved ( P < 0.001 ) , and lower asthma exacerbation occurred in the TG ( P < 0.01 ) . In addition , the TG presented a strong positive relationship between baseline FeNO and eosinophil counts as well as their improvement after training ( r = 0.77 and r = 0.9 , respectively ) . CONCLUSIONS aerobic training reduces sputum eosinophil and FeNO in patients with moderate or severe asthma , and these benefits were more significant in subjects with higher levels of inflammation . These results suggest that aerobic training might be useful as an adjuvant therapy in asthmatic patients under optimized medical treatment BACKGROUND Asthma symptoms reduce patients ' daily activities , impair their health-related quality of life ( HRQoL ) , and increase their reports of anxiety and depression , all of which seem to be related to a decrease in asthma control . Aerobic exercise training is known to improve aerobic fitness and reduce dyspnea in asthmatics ; however , its effect in reducing psychologic distress and symptoms remains poorly understood . We evaluated the role of an aerobic training program in improving HRQoL ( primary aim ) and reducing psychologic distress and asthma symptoms ( secondary aims ) for patients with moderate or severe persistent asthma . METHODS A total of 101 patients were r and omly assigned to either a control group or an aerobic training group and studied during the period between medical consultations . Control group patients ( educational program plus breathing exercises ) ( n = 51 ) and training group patients ( educational program plus breathing exercises plus aerobic training ) ( n = 50 ) were followed twice a week during a 3-month period . HRQoL and levels of anxiety and depression were quantified before and after treatment . Asthma symptoms were evaluated monthly . RESULTS At 3 months , the domains ( physical limitations , frequency of symptoms , and psychosocial ) and total scores of HRQoL significantly improved only in the training group patients ( P < .001 ) ; the number of asthma-symptom-free days and anxiety and depression levels also significantly improved in this group ( 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: Background Poor aerobic fitness is associated with worsening of asthma symptoms , and fitness training may improve asthma control . The mechanism linking fitness with asthma is not known . We hypothesized that repeated bouts of exercise would lead to a downregulation of glucocorticoid receptor ( GR ) expression on circulating leukocytes , reflecting a reduced responsiveness to stress . Methods In a prospect i ve exercise training intervention of healthy and asthmatic adolescents , GR expression in leukocytes was measured using flow cytometry in response to an acute exercise challenge before and after the exercise training intervention .  Peripheral blood mononuclear cell ( P BMC ) gene expression of GR , GRβ , HSP70 , TGFβ1 , and TGFβ2 was determined using reverse-transcriptase PCR ( RT-PCR ) . Results Peak VO2 increased by 14.6±2.3 % , indicating an effective training ( P<0.01 ) . There was a significant difference in GR expression among leukocyte subtypes , with highest expression in eosinophils . Following the exercise training intervention , there was a significant decrease in baseline GR expression ( P<0.05 ) in leukocyte and monocyte subtypes in both healthy and asthmatic adolescents . Conclusions This is the first study in adolescents to show that exercise training reduces GR expression in circulating leukocytes . We speculate that exercise training downregulates the stress response in general , manifested by decreased GR expression , and may explain why improving fitness improves asthma health Background The benefits of aerobic training for the main features of asthma , such as bronchial hyperresponsiveness ( BHR ) and inflammation , are poorly understood . We investigated the effects of aerobic training on BHR ( primary outcome ) , serum inflammatory cytokines ( secondary outcome ) , clinical control and asthma quality of life ( Asthma Quality of Life Question naire ( AQLQ ) ) ( tertiary outcomes ) . Methods Fifty-eight patients were r and omly assigned to either the control group ( CG ) or the aerobic training group ( TG ) . Patients in the CG ( educational programme+breathing exercises ( sham ) ) and the TG ( same as the CG+aerobic training ) were followed for 3 months . BHR , serum cytokine , clinical control , AQLQ , induced sputum and fractional exhaled nitric oxide ( FeNO ) were evaluated before and after the intervention . Results After 12 weeks , 43 patients ( 21 CG/22 TG ) completed the study and were analysed . The TG improved in BHR by 1 doubling dose ( dd ) ( 95 % CI 0.3 to 1.7 dd ) , and they experienced reduced interleukin 6 ( IL-6 ) and monocyte chemoattractant protein 1 ( MCP-1 ) and improved AQLQ and asthma exacerbation ( p<0.05 ) . No effects were seen for IL-5 , IL-8 , IL-10 , sputum cellularity , FeNO or Asthma Control Question naire 7 ( ACQ-7 ; p>0.05 ) . A within-group difference was found in the ACQ-6 for patients with non-well-controlled asthma and in sputum eosinophil and FeNO in patients in the TG who had worse airway inflammation . Conclusions Aerobic training reduced BHR and serum proinflammatory cytokines and improved quality of life and asthma exacerbation  in patients with moderate or severe asthma . These results suggest that adding exercise as an adjunct therapy to pharmacological treatment could improve the main features of asthma . Trial registration number NCT02033122 OBJECTIVE To investigate the medium-term benefits of a swimming program in schoolchildren and adolescents with moderate persistent atopic asthma ( MPAA ) . METHODS A r and omized , prospect i ve study of children and adolescents ( age 7 - 18 years ) with MPAA was carried out at the Hospital de Clínicas of Universidade Estadual de Campinas ( UNICAMP ) , Campinas , Brazil . After a 1-month run-in period , 61 patients ( 34 female ) were r and omized into two groups , a swimming group ( n = 30 ) and a control group ( n = 31 ) , and followed for 3 months . Both patient groups received inhaled fluticasone ( dry powder , 250 mcg twice a day ) and salbutamol as needed . The swim training program consisted of two weekly classes over a 3-month period for a total of 24 sessions . Both groups underwent  spirometric assessment  and methacholine challenge test -- provocative concentration of methacholine causing a 20 % fall in FEV1 (PC₂₀)--before and after the study period . Maximal inspiratory pressure ( MIP ) and maximal expiratory pressure ( MEP ) were measured only in the swimming group . RESULTS Significant increases in PC₂₀ ( pre-training , 0.31±0.25 ; post-training , 0.63±0.78 ; p = 0.008 ) , MIP ( pre-training , 67.08±17.13 cm H₂O ; post-training 79.46±18.66 ; p < 0.001 ) , and MEP ( pre-training , 71.69±20.01 cm H₂O ; post-training , 78.92±21.45 cm H₂O ; p < 0.001 ) were found in the swimming group . CONCLUSION Children and adolescents with MPAA subjected to a swim training program experienced a significant decrease in bronchial hyperresponsiveness , as determined by increased PC₂₀ values , when compared with asthmatic controls who did not undergo swim training . Participants in the swimming group also showed improvement in elastic recoil of the chest wall INTRODUCTION There are limited studies evaluating the role of pulmonary rehabilitation ( PR ) in pediatric asthma . METHODS A retrospective chart review was performed of all pediatric patients with a diagnosis of asthma enrolled in PR . Demographics , medications , and clinical records were review ed . In addition , PFTs , 6-min walk test ( 6MWT ) , and patient/parent symptom and quality of life surveys before and after PR were evaluated . RESULTS A total of 38 patients were enrolled in PR ; 18 ( 47 % ) female and 20 ( 53 % ) male . Mean participant age was 11.33 ± 3.37 ( range 4 - 19 ) years . Twenty-two ( 58 % ) were Caucasian and nine ( 24 % ) African American . Chart review was limited by incomplete data sets for many participants . Following PR , significant improvement was noted in mean 6MWT distance ( 1541 vs 1616 feet , P = 0.05 ) and FEV1 ( 89.9 % of predicted versus 96.4 % , P = 0.04 ) . Survey instruments demonstrated improvement in several clinical factors , however , there was no significant change in weight following PR despite scheduled cardiovascular exercise and dietary counseling . CONCLUSIONS Structured PR for pediatric patients with asthma can improve 6MWT distance and FEV1 as well as subjective measures of SOB and QOL , suggesting a role for PR in the chronic management of pediatric asthma . Further prospect i ve investigation is needed to determine if PR has positive effects on other clinical parameters of asthma control and its overall impact on childhood obesity The effects of a 3-month physical training programme on airway inflammation and clinical outcomes were studied in school-aged children with asthma . Subjects with persistent allergic asthma ( aged 12.7±3.4 yrs ; n = 34 ) were r and omly allocated into training and control groups . Exercise consisted of twice-weekly 50-min sessions for 12 weeks . Inflammation was assessed by levels of exhaled nitric oxide , blood eosinophils , eosinophil cationic protein , C-reactive protein , and total and mite-specific immunoglobulin (Ig)E. Lung volumes and bronchial responsiveness to methacholine were determined . The Paediatric Asthma Quality of Life Question naire and Paediatric Asthma Caregiver 's Quality of Life Question naire were used to evaluate activity restrictions , symptoms and emotional stress . The efficacy of the training was assessed by accelerometry . Following the programme , the exercise group spent twice as much time as the controls undertaking moderate-to-vigorous activities . No differences in changes were seen between groups for asthma outcomes . However , total IgE decreased more in the exercise group , as did mite-specific IgE. Training did not increase inflammation in children with persistent asthma , and may have decreased both total and allergen-specific immunoglobulin E levels . It is concluded that there is no reason to discourage asthmatic children with controlled disease to exercise PURPOSE Aerobic training has been shown to be effective in improving cardiopulmonary fitness in asthmatic children . However , the actual impact of physical training on clinical indicators of disease control remains controversial . METHODS Thirty-eight children with moderate to severe persistent asthma were r and omly assigned to control ( N=17 ) and training ( N=21 ) groups . Spirometry , exercise challenge , and maximum incremental cardiopulmonary exercise tests were performed 16 wk apart . Daily doses of inhaled steroids and Pediatric Asthma Quality of Life Question naire ( PAQLQ ) scores were also recorded . RESULTS Physical training was associated with significant improvements in physiological variables at peak and submaximal exercise ( P<0.05 ) ; in contrast , no significant changes were found in controls . Severity of exercise-induced bronchoconstriction ( EIB ) and postexercise breathlessness were significantly lessened in trained patients ; improvement in fitness and EIB , however , were not linearly related ( P>0.05 ) . In addition , PAQLQ scores improved only in trained children ( P<0.01 ) . Daily doses of inhaled steroids were reduced in trained patients ( 52 % ) , but they remained unchanged or increased in controls ( 70.6 % ) ( P=0.07 ) . CONCLUSION Supervised exercise training might be associated with beneficial effects on disease control and quality of life in asthmatic children . These data suggest an adjunct role of physical conditioning on clinical management of patients with more advanced disease PURPOSE there is evidence suggesting that physical activity has anti-inflammatory effects in many chronic diseases ; however , the role of exercise in airway inflammation in asthma is poorly understood . We aim ed to evaluate the effects of an aerobic training program on eosinophil inflammation ( primary aim ) and nitric oxide ( secondary aim ) in patients with moderate or severe persistent asthma . METHODS sixty-eight patients r and omly assigned to either  control  ( CG ) or aerobic training ( TG ) groups were studied during the period between medical consultations . Patients in the CG ( educational program + breathing exercises ; N = 34 ) and TG ( educational program + breathing exercises + aerobic training ; N = 34 ) were examined twice a week during a 3-month period . Before and after the intervention , patients underwent induced sputum , fractional exhaled nitric oxide ( FeNO ) , pulmonary function , and cardiopulmonary exercise testing . Asthma symptom-free days were quantified monthly , and asthma exacerbation was monitored during 3 months of intervention . RESULTS at 3 months , decreases in the total and eosinophil cell counts in induced sputum ( P = 0.004 ) and in the levels of FeNO ( P = 0.009 ) were observed after intervention only in the TG . The number of asthma symptom-free days and VO(2max ) also significantly improved ( P < 0.001 ) , and lower asthma exacerbation occurred in the TG ( P < 0.01 ) . In addition , the TG presented a strong positive relationship between baseline FeNO and eosinophil counts as well as their improvement after training ( r = 0.77 and r = 0.9 , respectively ) . CONCLUSIONS aerobic training reduces sputum eosinophil and FeNO in patients with moderate or severe asthma , and these benefits were more significant in subjects with higher levels of inflammation . These results suggest that aerobic training might be useful as an adjuvant therapy in asthmatic patients under optimized medical treatment BACKGROUND Asthma symptoms reduce patients ' daily activities , impair their health-related quality of life ( HRQoL ) , and increase their reports of anxiety and depression , all of which seem to be related to a decrease in asthma control . Aerobic exercise training is known to improve aerobic fitness and reduce dyspnea in asthmatics ; however , its effect in reducing psychologic distress and symptoms remains poorly understood . We evaluated the role of an aerobic training program in improving HRQoL ( primary aim ) and reducing psychologic distress and asthma symptoms ( secondary aims ) for patients with moderate or severe persistent asthma . METHODS A total of 101 patients were r and omly assigned to either a control group or an aerobic training group and studied during the period between medical consultations . Control group patients ( educational program plus breathing exercises ) ( n = 51 ) and training group patients ( educational program plus breathing exercises plus aerobic training ) ( n = 50 ) were followed twice a week during a 3-month period . HRQoL and levels of anxiety and depression were quantified before and after treatment . Asthma symptoms were evaluated monthly . RESULTS At 3 months , the domains ( physical limitations , frequency of symptoms , and psychosocial ) and total scores of HRQoL significantly improved only in the training group patients ( P < .001 ) ; the number of asthma-symptom-free days and anxiety and depression levels also significantly improved in this group ( P 
    Output:
    