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 test the hypothesis that oral creatine supplements with exercise are more effective than exercise alone in improving muscle function in patients with established dermatomyositis or polymyositis receiving chronic medical therapies who are clinical ly weak yet stable . METHODS In a 6-month , 2-center , double-blind , r and omized controlled trial , patients were r and omized to receive oral creatine supplements  ( 8 days , 20 gm/day then 3 gm/day ) or placebo . All patients followed a home exercise program . The primary outcome was aggregate functional performance time ( AFPT ) , reflecting the ability to undertake high-intensity exercise . Secondary outcomes included a functional index measuring endurance and muscle bioenergetics on (31)P magnetic resonance spectroscopy ( (31)P MRS ) .  Patients were receiving stable immunosuppressive treatment and /or corticosteroids . RESULTS A total of 37 patients with polymyositis or dermatomyositis were r and omized ( 19 to creatine , 18 to placebo ) ; 29 completed 6 months . Intent-to-treat analyses demonstrated that AFPT improved significantly at 6 months with creatine ( median decrease 13 % , range -32 - 8 % ) compared with placebo ( median decrease 3 % , range -13 - 16 % ; P = 0.029 by Mann-Whitney U test ) . A completer analysis also showed significant benefits from creatine ( P = 0.014 ) . The functional index improved significantly with both creatine and placebo ( P < 0.05 by paired Wilcoxon 's rank sum test ) , with a significant benefit between groups in the completer analysis only . Phosphocreatine/beta-nucleoside triphosphate ratios using MRS increased significantly in the creatine group ( P < 0.05 ) but not in the control group . No clinical ly relevant adverse events were associated with creatine . CONCLUSION Oral creatine supplements combined with home exercises improve functional performance without significant adverse effects in patients with polymyositis or dermatomyositis . They appear safe , effective , and inexpensive Objective . To evaluate the outcome of resistive home exercise and its possible longterm influence on health , disability , and disease activity in patients with active polymyositis ( PM ) or dermatomyositis ( DM ) . Methods . Nineteen patients with recent-onset PM/DM were included after introduction of high-dose prednisolone .  They were assessed by independent assessors as to perceived health , muscle performance , aerobic capacity , and serum creatine phosphokinase ( CPK ) at baseline and after 24 weeks , including repeated muscle biopsies at 24 weeks ( single-blinded r and omized controlled study ) , and in an open-label followup at 52 , 78 , and 104 weeks . Patients were r and omized to 12 weeks , 5 days/week resistive home exercise with telephone support and encouragement for another 12 weeks of twice-a-week home or gym exercise ( EG , n = 10 ) or to 24 weeks , 5 days/week range of motion exercise ( CG , n = 9 ) . Patients in the CG group without inflammatory infiltrates in muscle biopsies at 24 weeks were invited to the 12-week resistive home exercises . Results . At baseline , the EG had poorer perceived health , but otherwise the groups were comparable . At 24 weeks , both groups improved in muscle performance and aerobic capacity ( p < 0.001 to < 0.05 ) with no signs of increased inflammation assessed by CPK levels or muscle biopsies . Both groups improved in muscle performance and aerobic capacity up to 52 weeks ( p < 0.05 ) lasting to 104 weeks in the EG ( p < 0.05 ) and presented minor improvements in perceived health . Conclusion . Our study supports the safety of resistive exercise in patients with active PM/DM but did not reveal any between-group differences in exercise effects . An individually adapted physical therapist – supervised home exercise program might be recommended in early active PM/DM , with regular evaluation of muscle performance and health Introduction This r and omized , controlled study on patients with polymyositis or dermatomyositis was based on three hypotheses : patients display impaired endurance due to reduced aerobic capacity and muscle weakness , endurance training improves their exercise performance by increasing the aerobic capacity , and endurance training has general beneficial effects on their health status . Methods In the first part of this study , we compared 23 patients with polymyositis or dermatomyositis with 12 age- and gender-matched healthy controls . A subgroup of patients were r and omized to perform a 12-week endurance training program ( exercise group , n = 9 ) or to a non-exercising control group ( n = 6 ) . We measured  maximal oxygen uptake ( VO2 max ) and the associated power output  during a progressive cycling test . Endurance was assessed as the cycling time to exhaustion at 65 % of VO2 max . Lactate levels in the vastus lateralis muscle were measured with microdialysis . Mitochondrial function was assessed by measuring citrate synthase ( CS ) and β-hydroxyacyl-CoA dehydrogenase ( β-HAD ) activities in muscle biopsies . Clinical improvement was assessed according to the International Myositis Assessment and Clinical Studies Group ( IMACS ) improvement criteria . All assessors were blinded to the type of intervention ( that is , training or control ) . Results Exercise performance and aerobic capacity were lower in patients than in healthy controls , whereas lactate levels at exhaustion were similar . Patients in the exercise group increased their cycling time , aerobic capacity and CS and β-HAD activities , whereas lactate levels at exhaustion decreased . Six of nine patients in the exercise group met the IMACS improvement criteria . Patients in the control group did not show any consistent changes during the 12-week study . Conclusions Polymyositis and dermatomyositis patients have impaired endurance , which could be improved by 12 weeks of endurance training . The clinical improvement corresponds to increases in aerobic capacity and muscle mitochondrial enzyme activities . The results emphasize the importance of endurance exercise in addition to immunosuppressive treatment of patients with polymyositis or dermatomyositis . Trial registration Clinical Trials.gov : Background Reaction time , coordination , and cognition performance typically diminish in older adults , which may lead to gait impairments , falls , and injuries . Regular strength – balance exercises are highly recommended to reduce this problem and to improve health , well-being , and independence in old age . However , many older people face a lack of motivation in addition to other strong barriers to exercise . We developed ActiveLifestyle , an information technology (IT)-based system for active and healthy aging aim ing at improving balance and strength . ActiveLifestyle is a training app that runs on a tablet and assists , monitors , and motivates older people to follow personalized training plans autonomously at home . Objective The objectives were to ( 1 ) investigate which IT-mediated motivation strategies increase adherence to physical exercise training plans in older people , ( 2 ) assess the impact of ActiveLifestyle on physical activity behavior change , and ( 3 ) demonstrate the effectiveness of the ActiveLifestyle training to improve gait speed . Methods A total of 44 older adults followed personalized , 12-week strength and balance training plans . All participants performed the exercises autonomously at home . Question naires were used to assess the technological familiarity and stage of behavior change , as well as the effectiveness of the motivation instruments adopted by ActiveLifestyle . Adherence to the exercise plan was evaluated using performance data collected by the app and through information given by the participants during the study . Pretests and posttests were performed to evaluate gait speed of the participants before and after the study . Results Participants were 75 years ( SD 6 ) , predominantly female ( 64 % ) , held a trade or professional diploma ( 54 % ) , and their past profession was in a sitting position ( 43 % ) . Of the 44 participants who enrolled , 33 ( 75 % ) completed the study . The app proved to assist and motivate independently living and healthy older adults to autonomously perform strength – balance exercises ( median 6 on a 7-point Likert scale ) . Social motivation strategies proved more effective than individual strategies to stimulate the participants to comply with the training plan , as well as to change their behavior permanently toward a more physically active lifestyle . The exercises were effective to improve preferred and fast gait speed . Conclusions ActiveLifestyle assisted and motivated independently living and healthy older people to autonomously perform strength – balance exercises over 12 weeks and had low dropout rates . The social motivation strategies were more effective to stimulate the participants to comply with the training plan and remain on the intervention . The adoption of assistive technology devices for physical intervention tends to motivate and retain older people exercising for longer periods of time Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more Objectives : The study aim ed to investigate the effects of a combined functional and aerobic exercise program on aerobic capacity , muscle strength , and functional mobility in a group of patients with sporadic inclusion body myositis ( IBM ) . Methods : Aerobic capacity , muscle strength , and functional capacity assessment s were conducted on 7 participants with sporadic IBM before and after a 12-week exercise program , which included resistance exercises and aerobic stationary cycling 3 times per week on alternative days . Results : Aerobic capacity of the group increased significantly by 38 % , and significant strength improvements were observed in 4 of the muscle groups tested ( P < 0.05 ) . The exercise program was well tolerated , and there was no significant change in the serum creatine kinase level after the exercise period . Conclusions : An aerobic exercise program can be safely tolerated by patients with sporadic IBM and can improve aerobic capacity and muscle strength when combined with resistance training . These findings indicate that aerobic and functional muscle strengthening exercise should be considered in the management of patients with IBM Background No previous studies have examined the effect of intensive exercise in systemic sclerosis patients with pulmonary impairment . The objective of this study was to examine the effect of an eight-week intensive aerobic exercise and muscle endurance training program for patients with systemic sclerosis with 50–100 % of forced vital capacity . Methods A single-subject experimental design with repeated systematic measures during a six week A-phase ( non-interventional baseline period ) and an eight week B-phase ( exercise intervention period ) was used . Three women and one man with median age 66 years and median disease duration of 3.5 years completed aerobic exercise corresponding to 15 on the Borg RPE scale ( strenuous ) and muscular endurance training three times/week . Physical capacity ( six-minute walk test ) , aerobic capacity ( submaximal treadmill test ) and muscle endurance in shoulder and hip flexion ( Functional Index 2 ) were assessed every other week throughout the 14-week study . Activity limitation ( Health Assessment Question naire ) , quality of life ( Short Form 36 ) , Raynaud , Fatigue and Global Health during the recent week ( Visual Analogue Scales ) were assessed at weeks 0 , 6 , 14 . Results Three participants improved significantly in muscular endurance , and two participants improved significantly or clinical ly relevant in aerobic capacity . All other variables remained unchanged , except for a trend towards reduced fatigue . Conclusions This eight week exercise program was largely successful with positive effects on aerobic capacity and muscle endurance . Trial registration Clinical trials.gov Identifier : OBJECTIVE The benefit of long-term physical training in patients with chronic polymyositis or dermatomyositis ( PM/DM ) was studied prospect ively . METHODS Eight patients with chronic PM/DM participated in a training programme for 6 months . A group of five PM/DM patients without any physical training  was observed for control purpose s. RESULTS While there was no significant change in serum creatine phosphokinase ( CPK ) levels , the ' activities of daily living ( ADL ) ' score improved significantly ( P < 0.03 ) , peak isometric torque ( PIT ) generated by muscle groups in the lower extremities rose significantly ( P < 0.03 ) and there was a statistically highly significant increase in peak oxygen uptake ( VO2max ) relative to body weight ( P < 0.02 ) due to the long-term training . The patients improved their aerobic capacity by 28 % , which is clinical ly significant . In the untrained patients , no improvement in these target parameters was observed . CONCLUSION In clinical ly stable DM/PM patients , long-term physical training can safely be performed and is recommended as part of a comprehensive rehabilitation management , particularly in view of the cardiopulmonary risk in these patients OBJECTIVE : To test the feasibility of creating a valid and reliable checklist with the following features : appropriate for assessing both r and omised and non-r and omised studies ; provision of both an overall score for study quality and a profile of scores not only for the quality of reporting , internal validity ( bias and confounding ) and power , but also for external validity . DESIGN : A pilot version was first developed , based on epidemiological principles , review s , and existing checklists for r and omised studies . Face and content validity were assessed by three experienced review ers and reliability was determined using two raters assessing 10 r and omised and 10 non-r and omised studies . Using different raters , the checklist was revised and tested for internal consistency ( Kuder-Richardson 20 ) , test-retest and inter-rater reliability ( Spearman correlation coefficient and sign rank test ; kappa statistics ) , criterion validity , and respondent burden . MAIN RESULTS : The performance of the checklist improved considerably after revision of a pilot version . The Quality Index had high internal consistency ( KR-20 : 0.89 ) as did the subscales apart from external validity 
    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 test the hypothesis that oral creatine supplements with exercise are more effective than exercise alone in improving muscle function in patients with established dermatomyositis or polymyositis receiving chronic medical therapies who are clinical ly weak yet stable . METHODS In a 6-month , 2-center , double-blind , r and omized controlled trial , patients were r and omized to receive oral creatine supplements  ( 8 days , 20 gm/day then 3 gm/day ) or placebo . All patients followed a home exercise program . The primary outcome was aggregate functional performance time ( AFPT ) , reflecting the ability to undertake high-intensity exercise . Secondary outcomes included a functional index measuring endurance and muscle bioenergetics on (31)P magnetic resonance spectroscopy ( (31)P MRS ) .  Patients were receiving stable immunosuppressive treatment and /or corticosteroids . RESULTS A total of 37 patients with polymyositis or dermatomyositis were r and omized ( 19 to creatine , 18 to placebo ) ; 29 completed 6 months . Intent-to-treat analyses demonstrated that AFPT improved significantly at 6 months with creatine ( median decrease 13 % , range -32 - 8 % ) compared with placebo ( median decrease 3 % , range -13 - 16 % ; P = 0.029 by Mann-Whitney U test ) . A completer analysis also showed significant benefits from creatine ( P = 0.014 ) . The functional index improved significantly with both creatine and placebo ( P < 0.05 by paired Wilcoxon 's rank sum test ) , with a significant benefit between groups in the completer analysis only . Phosphocreatine/beta-nucleoside triphosphate ratios using MRS increased significantly in the creatine group ( P < 0.05 ) but not in the control group . No clinical ly relevant adverse events were associated with creatine . CONCLUSION Oral creatine supplements combined with home exercises improve functional performance without significant adverse effects in patients with polymyositis or dermatomyositis . They appear safe , effective , and inexpensive Objective . To evaluate the outcome of resistive home exercise and its possible longterm influence on health , disability , and disease activity in patients with active polymyositis ( PM ) or dermatomyositis ( DM ) . Methods . Nineteen patients with recent-onset PM/DM were included after introduction of high-dose prednisolone .  They were assessed by independent assessors as to perceived health , muscle performance , aerobic capacity , and serum creatine phosphokinase ( CPK ) at baseline and after 24 weeks , including repeated muscle biopsies at 24 weeks ( single-blinded r and omized controlled study ) , and in an open-label followup at 52 , 78 , and 104 weeks . Patients were r and omized to 12 weeks , 5 days/week resistive home exercise with telephone support and encouragement for another 12 weeks of twice-a-week home or gym exercise ( EG , n = 10 ) or to 24 weeks , 5 days/week range of motion exercise ( CG , n = 9 ) . Patients in the CG group without inflammatory infiltrates in muscle biopsies at 24 weeks were invited to the 12-week resistive home exercises . Results . At baseline , the EG had poorer perceived health , but otherwise the groups were comparable . At 24 weeks , both groups improved in muscle performance and aerobic capacity ( p < 0.001 to < 0.05 ) with no signs of increased inflammation assessed by CPK levels or muscle biopsies . Both groups improved in muscle performance and aerobic capacity up to 52 weeks ( p < 0.05 ) lasting to 104 weeks in the EG ( p < 0.05 ) and presented minor improvements in perceived health . Conclusion . Our study supports the safety of resistive exercise in patients with active PM/DM but did not reveal any between-group differences in exercise effects . An individually adapted physical therapist – supervised home exercise program might be recommended in early active PM/DM , with regular evaluation of muscle performance and health Introduction This r and omized , controlled study on patients with polymyositis or dermatomyositis was based on three hypotheses : patients display impaired endurance due to reduced aerobic capacity and muscle weakness , endurance training improves their exercise performance by increasing the aerobic capacity , and endurance training has general beneficial effects on their health status . Methods In the first part of this study , we compared 23 patients with polymyositis or dermatomyositis with 12 age- and gender-matched healthy controls . A subgroup of patients were r and omized to perform a 12-week endurance training program ( exercise group , n = 9 ) or to a non-exercising control group ( n = 6 ) . We measured  maximal oxygen uptake ( VO2 max ) and the associated power output  during a progressive cycling test . Endurance was assessed as the cycling time to exhaustion at 65 % of VO2 max . Lactate levels in the vastus lateralis muscle were measured with microdialysis . Mitochondrial function was assessed by measuring citrate synthase ( CS ) and β-hydroxyacyl-CoA dehydrogenase ( β-HAD ) activities in muscle biopsies . Clinical improvement was assessed according to the International Myositis Assessment and Clinical Studies Group ( IMACS ) improvement criteria . All assessors were blinded to the type of intervention ( that is , training or control ) . Results Exercise performance and aerobic capacity were lower in patients than in healthy controls , whereas lactate levels at exhaustion were similar . Patients in the exercise group increased their cycling time , aerobic capacity and CS and β-HAD activities , whereas lactate levels at exhaustion decreased . Six of nine patients in the exercise group met the IMACS improvement criteria . Patients in the control group did not show any consistent changes during the 12-week study . Conclusions Polymyositis and dermatomyositis patients have impaired endurance , which could be improved by 12 weeks of endurance training . The clinical improvement corresponds to increases in aerobic capacity and muscle mitochondrial enzyme activities . The results emphasize the importance of endurance exercise in addition to immunosuppressive treatment of patients with polymyositis or dermatomyositis . Trial registration Clinical Trials.gov : Background Reaction time , coordination , and cognition performance typically diminish in older adults , which may lead to gait impairments , falls , and injuries . Regular strength – balance exercises are highly recommended to reduce this problem and to improve health , well-being , and independence in old age . However , many older people face a lack of motivation in addition to other strong barriers to exercise . We developed ActiveLifestyle , an information technology (IT)-based system for active and healthy aging aim ing at improving balance and strength . ActiveLifestyle is a training app that runs on a tablet and assists , monitors , and motivates older people to follow personalized training plans autonomously at home . Objective The objectives were to ( 1 ) investigate which IT-mediated motivation strategies increase adherence to physical exercise training plans in older people , ( 2 ) assess the impact of ActiveLifestyle on physical activity behavior change , and ( 3 ) demonstrate the effectiveness of the ActiveLifestyle training to improve gait speed . Methods A total of 44 older adults followed personalized , 12-week strength and balance training plans . All participants performed the exercises autonomously at home . Question naires were used to assess the technological familiarity and stage of behavior change , as well as the effectiveness of the motivation instruments adopted by ActiveLifestyle . Adherence to the exercise plan was evaluated using performance data collected by the app and through information given by the participants during the study . Pretests and posttests were performed to evaluate gait speed of the participants before and after the study . Results Participants were 75 years ( SD 6 ) , predominantly female ( 64 % ) , held a trade or professional diploma ( 54 % ) , and their past profession was in a sitting position ( 43 % ) . Of the 44 participants who enrolled , 33 ( 75 % ) completed the study . The app proved to assist and motivate independently living and healthy older adults to autonomously perform strength – balance exercises ( median 6 on a 7-point Likert scale ) . Social motivation strategies proved more effective than individual strategies to stimulate the participants to comply with the training plan , as well as to change their behavior permanently toward a more physically active lifestyle . The exercises were effective to improve preferred and fast gait speed . Conclusions ActiveLifestyle assisted and motivated independently living and healthy older people to autonomously perform strength – balance exercises over 12 weeks and had low dropout rates . The social motivation strategies were more effective to stimulate the participants to comply with the training plan and remain on the intervention . The adoption of assistive technology devices for physical intervention tends to motivate and retain older people exercising for longer periods of time Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more Objectives : The study aim ed to investigate the effects of a combined functional and aerobic exercise program on aerobic capacity , muscle strength , and functional mobility in a group of patients with sporadic inclusion body myositis ( IBM ) . Methods : Aerobic capacity , muscle strength , and functional capacity assessment s were conducted on 7 participants with sporadic IBM before and after a 12-week exercise program , which included resistance exercises and aerobic stationary cycling 3 times per week on alternative days . Results : Aerobic capacity of the group increased significantly by 38 % , and significant strength improvements were observed in 4 of the muscle groups tested ( P < 0.05 ) . The exercise program was well tolerated , and there was no significant change in the serum creatine kinase level after the exercise period . Conclusions : An aerobic exercise program can be safely tolerated by patients with sporadic IBM and can improve aerobic capacity and muscle strength when combined with resistance training . These findings indicate that aerobic and functional muscle strengthening exercise should be considered in the management of patients with IBM Background No previous studies have examined the effect of intensive exercise in systemic sclerosis patients with pulmonary impairment . The objective of this study was to examine the effect of an eight-week intensive aerobic exercise and muscle endurance training program for patients with systemic sclerosis with 50–100 % of forced vital capacity . Methods A single-subject experimental design with repeated systematic measures during a six week A-phase ( non-interventional baseline period ) and an eight week B-phase ( exercise intervention period ) was used . Three women and one man with median age 66 years and median disease duration of 3.5 years completed aerobic exercise corresponding to 15 on the Borg RPE scale ( strenuous ) and muscular endurance training three times/week . Physical capacity ( six-minute walk test ) , aerobic capacity ( submaximal treadmill test ) and muscle endurance in shoulder and hip flexion ( Functional Index 2 ) were assessed every other week throughout the 14-week study . Activity limitation ( Health Assessment Question naire ) , quality of life ( Short Form 36 ) , Raynaud , Fatigue and Global Health during the recent week ( Visual Analogue Scales ) were assessed at weeks 0 , 6 , 14 . Results Three participants improved significantly in muscular endurance , and two participants improved significantly or clinical ly relevant in aerobic capacity . All other variables remained unchanged , except for a trend towards reduced fatigue . Conclusions This eight week exercise program was largely successful with positive effects on aerobic capacity and muscle endurance . Trial registration Clinical trials.gov Identifier : OBJECTIVE The benefit of long-term physical training in patients with chronic polymyositis or dermatomyositis ( PM/DM ) was studied prospect ively . METHODS Eight patients with chronic PM/DM participated in a training programme for 6 months . A group of five PM/DM patients without any physical training  was observed for control purpose s. RESULTS While there was no significant change in serum creatine phosphokinase ( CPK ) levels , the ' activities of daily living ( ADL ) ' score improved significantly ( P < 0.03 ) , peak isometric torque ( PIT ) generated by muscle groups in the lower extremities rose significantly ( P < 0.03 ) and there was a statistically highly significant increase in peak oxygen uptake ( VO2max ) relative to body weight ( P < 0.02 ) due to the long-term training . The patients improved their aerobic capacity by 28 % , which is clinical ly significant . In the untrained patients , no improvement in these target parameters was observed . CONCLUSION In clinical ly stable DM/PM patients , long-term physical training can safely be performed and is recommended as part of a comprehensive rehabilitation management , particularly in view of the cardiopulmonary risk in these patients OBJECTIVE : To test the feasibility of creating a valid and reliable checklist with the following features : appropriate for assessing both r and omised and non-r and omised studies ; provision of both an overall score for study quality and a profile of scores not only for the quality of reporting , internal validity ( bias and confounding ) and power , but also for external validity . DESIGN : A pilot version was first developed , based on epidemiological principles , review s , and existing checklists for r and omised studies . Face and content validity were assessed by three experienced review ers and reliability was determined using two raters assessing 10 r and omised and 10 non-r and omised studies . Using different raters , the checklist was revised and tested for internal consistency ( Kuder-Richardson 20 ) , test-retest and inter-rater reliability ( Spearman correlation coefficient and sign rank test ; kappa statistics ) , criterion validity , and respondent burden . MAIN RESULTS : The performance of the checklist improved considerably after revision of a pilot version . The Quality Index had high internal consistency ( KR-20 : 0.89 ) as did the subscales apart from external validity 
    Output:
    