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: We evaluated a 12-week recreation center-based healthy lifestyle intervention for 30 obese home-dwelling young adults ( YA ) with intellectual disabilities . Three cohorts participated : YA only , YA and parents , and parents only . The YA cohorts received a nutrition/exercise intervention ; parents focused on modeling healthy lifestyle behaviors . Outcomes included YA blood , nutrition , anthropometric , and fitness measures at pre , post , and 3-month follow-up . Compared with wait-list controls , the YA-only cohort improved immediately postintervention in blood pressure ( BP ) , weight , and balance ( p < .05 ) . At 3-month follow-up , no intervention was consistently superior ; overall reductions in weight , BP , hip circumference , and exercise barriers were obtained ( p < .05 ) . Linear and curvilinear changes from baseline to 3 months after the intervention varied by outcome and participant . Participants with Down syndrome lost less weight Background Walking interventions have been shown to have a positive impact on physical activity ( PA ) levels , health and wellbeing for adult and older adult population s. There has been very little work carried out to explore the effectiveness of walking interventions for adults with intellectual disabilities . This paper will provide details of the Walk Well intervention , design ed for adults with intellectual disabilities , and a r and omised controlled trial ( RCT ) to test its effectiveness . Methods / design This study will adopt a RCT design , with participants allocated to the walking intervention group or a waiting list control group . The intervention consists of three PA consultations ( baseline , six weeks and 12 weeks ) and an individualised 12 week walking programme . A range of measures will be completed by participants at baseline , post intervention ( three months from baseline ) and at follow up ( three months post intervention and six months from baseline ) . All outcome measures will be collected by a research er who will be blinded to the study groups . The primary outcome will be steps walked per day , measured using accelerometers . Secondary outcome measures will include time spent in PA per day ( across various intensity levels ) , time spent in sedentary behaviour per day , quality of life , self-efficacy and anthropometric measures to monitor weight change . Discussion Since there are currently no published RCTs of walking interventions for adults with intellectual disabilities , this RCT will examine if a walking intervention can successfully increase PA , health and wellbeing of adults with intellectual disabilities . Trial registration IS RCT N : IS RCT Background National obesity rates have dramatically risen over the last decade . Being obese significantly reduces life expectancy , increases the risk of a range of diseases , and compromises quality of life . Costs to both the National Health Service and society are high . An increased prevalence of obesity in people with learning disabilities has been demonstrated . The consequences of obesity are particularly relevant to people with learning disabilities who are already confronted by health and social inequalities . In order to provide healthcare for all , and ensure e quality of treatment for people with learning disabilities , services must be developed specifically with this population in mind . The aim of this project is to pilot the evaluation of a manualised weight management programme for  overweight and obese persons with mild-moderate learning disabilities ( Shape Up-LD ) . Methods / Design An individually r and omised , controlled pilot trial in 60 overweight and obese ( body mass index ≥ 25 ) adults ( age ≥ 18 ) with mild-moderate learning disabilities and their carers will be carried out , comparing “ Shape Up-LD ” with usual care . The manualised Shape Up-LD intervention will involve 12 weekly sessions , which include healthy eating messages , advice on physical activity and use of behaviour change techniques to help people manage their weight . Assessment s of participants will be conducted at baseline , 12 weeks and 6 months . Service users and their carers and service providers will also give their perspectives on the experience of Shape Up-LD in qualitative interviews at 12 weeks . Feasibility outcomes will include recruitment rates , loss to follow-up , compliance rates , completion rates , collection of information for a cost-effectiveness analysis and an estimation of the treatment effect on weight . Discussion The findings from this study will inform our preparation for a definitive r and omised controlled trial to test the efficacy of the programme with respect to weight loss and maintenance in this population . Weight loss through Shape Up-LD could lead to improvements in health and quality of life . Costs to the National Health Service might be reduced through decreased overall service use because of improved health . The programme would also ensure a more equitable service for overweight service users with learning disabilities and fill the current gap in weight management services for this population .Trial registration International St and ard R and omised Controlled Trial No IS RCT Background Many adults with intellectual disabilities have poor dietary habits , low physical activity and weight disturbances . This study protocol describes the design and evaluation of a health intervention aim ing to improve diet and physical activity in this target group . In Sweden , adults with intellectual disabilities often live in community residences where the staff has insufficient education regarding the special health needs of residents . No published lifestyle interventions have simultaneously targeted both residents and staff . Methods / Design The intervention is design ed to suit the ordinary work routines of community residences . It is based on social cognitive theory and takes 12 - 15 months to complete . The intervention includes three components : 1 ) Ten health education sessions for residents in their homes ; 2 ) the appointment of a health ambassador among the staff in each residence and formation of a network ; and 3 ) a study circle for staff in each residence . The intervention is implemented by consultation with managers , training of health educators , and coaching of health ambassadors . Fidelity is assessed based on the participation of residents and staff in the intervention activities . The study design is a cluster-r and omised trial with physical activity as primary outcome objective ly assessed by pedometry . Secondary outcomes are dietary quality assessed by digital photography , measured weight , height and waist circumference , and quality of life assessed by a quality of life scale . Intermediate outcomes are changes in work routines in the residences assessed by a question naire to managers . Adults with mild to moderate intellectual disabilities living in community residences in Stockholm County are eligible for inclusion .  Multilevel analysis is used to evaluate effects on primary and secondary outcomes . The impact of the intervention on work routines in community residences is analysed by ordinal regression analysis . Barriers and facilitators of implementation are identified in an explorative qualitative study through observations and semi-structured interviews . Discussion Despite several challenges it is our hope that the results from this intervention will lead to new and improved health promotion programs to the benefit of the target group . Trial registration numberIS RCT Background Programs to change health behaviours have been identified as one way to reduce health inequalities experienced by disadvantaged groups . The objective of this study was to examine the effectiveness of a behaviour change programme to increase walking and reduce sedentary behaviour of adults with intellectual disabilities . Methods We used a cluster r and omised controlled design and recruited participants over 18 years old and not regularly involved in physical activity from intellectual disabilities community-based organisations . Assessment s were carried out blind to allocation . Clusters of participants were r and omly allocated to the Walk Well program or a 12-week waiting list control . Walk Well consisted of three face-to-face physical activity consultations incorporating behaviour change techniques , written re sources for participants and carers , and an individualised , structured walking programme . The primary outcome measured with accelerometers was change in mean step count per day between baseline and 12 weeks . Secondary outcomes included percentage time per day sedentary and in moderate-vigorous physical activity ( MVPA ) , body mass index ( BMI ) , and subjective well being . Results One hundred two participants in 50 clusters were r and omised . 82 ( 80.4 % ) participants completed the primary outcome . 66.7 % of participants lived in the most deprived quintile on the Scottish Index of Multiple Deprivation . At baseline , participants walked 4780 ( st and ard deviation 2432 ) steps per day , spent 65.5 % ( st and ard deviation 10.9 ) of time sedentary and 59 % percent had a body mass in the obesity range . After the walking programme , the difference between mean counts of the Walk Well and control group was 69.5 steps per day [ 95 % confidence interval ( CI ) -1054 to 1193.3 ] . There were no significant between group differences in percentage time sedentary 1.6 % ( 95 % CI −2.984 to 6.102 ) , percentage time in MVPA 0.3 % ( 95 % CI −0.7 to 1.3 ) , BMI −0.2 kg/m2 ( 95 % CI −0.8 to 0.4 ) or subjective well-being 0.3 ( 95 % CI −0.9 to 1.5 ) . Conclusions This is the first published trial of a walking program for adults with intellectual disabilities . Positively changing physical activity and sedentary behaviours may require more intensive programmes or upstream approaches to address the multiple social disadvantages experienced by adults with intellectual disabilities . Since participants spent the majority of their time sedentary , home-based programmes to reduce sitting time may be a viable health improvement approach . Trial registration Current Controlled Trials IS RCT BACKGROUND The physical activity level of older adults with intellectual disabilities ( ID ) is extremely low , and their fitness levels are far beneath accepted norms for older people with normal intelligence and comparable with frail older people . A physical activity programme , including an education programme , was developed for older adults with ID using behaviour change techniques . The programme aim ed at improving or maintaining adequate levels of physical activity ( primary outcome measure ) and motor fitness , cardio respiratory fitness , morphologic and metabolic fitness , activities of daily living , cognitive functioning and depressive symptoms ( secondary outcome measures ) . METHOD The programme 's efficacy was evaluated in a cluster-r and omised clinical trial among people aged 43 years and over with mild-moderate levels of ID . Five day-activity centres were r and omised to the participation group . In these centres , 81 older adults participated in groups of 8 to 10 in the programme , three times a week during 8 months . The programme was executed by physical activity instructors and staff of day-activity centres . Five other day-activity centres were r and omised to the control group ; 70 older adults in these centres received care as usual . The generalised linear model with mixed effects was used to test the programme 's effectiveness . RESULTS Significant effects were found on physical activity , muscle strength , systolic and diastolic blood pressure , serum cholesterol level and cognitive functioning , in favour of the programme 's participants . No significant improvements were found on balance , serum glucose , weight , waist circumference , walking speed , mobility , depression or instrumental activities of daily living . CONCLUSIONS The physical activity and fitness programme has established small but significant effects in this sample , but generalising the findings to other setting s is difficult due to significant participant dropout . Implementation of evidence -based physical activity programmes among older adults with ID is recommended . Further research is needed to investigate the effectiveness of physical activity on daily life functioning and the development on chronic diseases in the long run Objective : Although there are evaluation and effectiveness studies of health promotion interventions for adults with intellectual disabilities ( ID ) , r and omized efficacy trials of such interventions are lacking . Design : A r and omized active control intervention trial . Setting : The participants attended the health promotion classes in local disability agency service facilities . Method : We enrolled 443 individuals and r and omly assigned them to one of two eight-week participatory classes . The ‘ Steps to Your Health ’ ( STYH ) classes emphasized moderate to vigorous physical activity ( MVPA ) , healthy eating and  body mass index ( BMI )  reduction . The control intervention focused on hygiene and safety . Results : We did not find a statistically significant difference in mean MVPA or BMI change between completers of the STYH group compared to the control group one year after the intervention was completed . We did find that participation in STYH classes had a non-significant association with odds of reduction in BMI ( odds ratio [ OR ] 2.87 , 95 % confidence interval [ CI ] 0.91–9.11 ) and completers who lived in group homes were more likely than their counterparts who lived with families or in apartments to decrease their BMI ( OR 4.61 ; 95 % CI 1.14–18.64 ) . Conclusions : This trial did not demonstrate a significant effect of STYH participation on change in mean minutes of MVPA or mean BMI 12 months after classes ended , although there was a non-significant association with odds of reduction of BMI ( p = 0.07 ) . This study has implication s for design of intervention studies in people with intellectual disability ( ID ) BACKGROUND Age-related declines in balance and muscle power are largely responsible for the changes in the various components of gait performance among elderly people . But these can often be remedied with strength training .  People with cognitive impairment frequently demonstrate impaired gait , putting them at increased risks for falls and serious injury . OBJECTIVES This paper reports on the effects of a six-week pilot study of moderate intensity strength training on the gait of elderly individuals with dementia who attend a day-care center . METHODS Twenty-six adults ( 23 female , three male ) , age = 79.2 + /- 6.6 years , completed the study . Each subject completed a baseline assessment of lower extremity strength and gait . Gait was evaluated using free- and fast-gait speed over a 6-meter course , the Tinetti-Gait Assessment scale , the ' Timed-Up- and -Go ' , and the Gait Assessment Rating Scale ( GARS ) . The intervention consisted of moderate-intensity progressive resistance lower extremity exercise using Therab and , for two to three sessions per week over the six weeks . Post-intervention assessment of strength and gait was repeated at the completion of the sixth week . Multiple paired t-tests were calculated for each outcome measure . RESULTS The baseline assessment of gait suggests a high degree of frailty and risk for falls in the sample . Although post-intervention scores reflected improvement on all gait measures , the only statistically significant change observed was in fast-gait 
    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: We evaluated a 12-week recreation center-based healthy lifestyle intervention for 30 obese home-dwelling young adults ( YA ) with intellectual disabilities . Three cohorts participated : YA only , YA and parents , and parents only . The YA cohorts received a nutrition/exercise intervention ; parents focused on modeling healthy lifestyle behaviors . Outcomes included YA blood , nutrition , anthropometric , and fitness measures at pre , post , and 3-month follow-up . Compared with wait-list controls , the YA-only cohort improved immediately postintervention in blood pressure ( BP ) , weight , and balance ( p < .05 ) . At 3-month follow-up , no intervention was consistently superior ; overall reductions in weight , BP , hip circumference , and exercise barriers were obtained ( p < .05 ) . Linear and curvilinear changes from baseline to 3 months after the intervention varied by outcome and participant . Participants with Down syndrome lost less weight Background Walking interventions have been shown to have a positive impact on physical activity ( PA ) levels , health and wellbeing for adult and older adult population s. There has been very little work carried out to explore the effectiveness of walking interventions for adults with intellectual disabilities . This paper will provide details of the Walk Well intervention , design ed for adults with intellectual disabilities , and a r and omised controlled trial ( RCT ) to test its effectiveness . Methods / design This study will adopt a RCT design , with participants allocated to the walking intervention group or a waiting list control group . The intervention consists of three PA consultations ( baseline , six weeks and 12 weeks ) and an individualised 12 week walking programme . A range of measures will be completed by participants at baseline , post intervention ( three months from baseline ) and at follow up ( three months post intervention and six months from baseline ) . All outcome measures will be collected by a research er who will be blinded to the study groups . The primary outcome will be steps walked per day , measured using accelerometers . Secondary outcome measures will include time spent in PA per day ( across various intensity levels ) , time spent in sedentary behaviour per day , quality of life , self-efficacy and anthropometric measures to monitor weight change . Discussion Since there are currently no published RCTs of walking interventions for adults with intellectual disabilities , this RCT will examine if a walking intervention can successfully increase PA , health and wellbeing of adults with intellectual disabilities . Trial registration IS RCT N : IS RCT Background National obesity rates have dramatically risen over the last decade . Being obese significantly reduces life expectancy , increases the risk of a range of diseases , and compromises quality of life . Costs to both the National Health Service and society are high . An increased prevalence of obesity in people with learning disabilities has been demonstrated . The consequences of obesity are particularly relevant to people with learning disabilities who are already confronted by health and social inequalities . In order to provide healthcare for all , and ensure e quality of treatment for people with learning disabilities , services must be developed specifically with this population in mind . The aim of this project is to pilot the evaluation of a manualised weight management programme for  overweight and obese persons with mild-moderate learning disabilities ( Shape Up-LD ) . Methods / Design An individually r and omised , controlled pilot trial in 60 overweight and obese ( body mass index ≥ 25 ) adults ( age ≥ 18 ) with mild-moderate learning disabilities and their carers will be carried out , comparing “ Shape Up-LD ” with usual care . The manualised Shape Up-LD intervention will involve 12 weekly sessions , which include healthy eating messages , advice on physical activity and use of behaviour change techniques to help people manage their weight . Assessment s of participants will be conducted at baseline , 12 weeks and 6 months . Service users and their carers and service providers will also give their perspectives on the experience of Shape Up-LD in qualitative interviews at 12 weeks . Feasibility outcomes will include recruitment rates , loss to follow-up , compliance rates , completion rates , collection of information for a cost-effectiveness analysis and an estimation of the treatment effect on weight . Discussion The findings from this study will inform our preparation for a definitive r and omised controlled trial to test the efficacy of the programme with respect to weight loss and maintenance in this population . Weight loss through Shape Up-LD could lead to improvements in health and quality of life . Costs to the National Health Service might be reduced through decreased overall service use because of improved health . The programme would also ensure a more equitable service for overweight service users with learning disabilities and fill the current gap in weight management services for this population .Trial registration International St and ard R and omised Controlled Trial No IS RCT Background Many adults with intellectual disabilities have poor dietary habits , low physical activity and weight disturbances . This study protocol describes the design and evaluation of a health intervention aim ing to improve diet and physical activity in this target group . In Sweden , adults with intellectual disabilities often live in community residences where the staff has insufficient education regarding the special health needs of residents . No published lifestyle interventions have simultaneously targeted both residents and staff . Methods / Design The intervention is design ed to suit the ordinary work routines of community residences . It is based on social cognitive theory and takes 12 - 15 months to complete . The intervention includes three components : 1 ) Ten health education sessions for residents in their homes ; 2 ) the appointment of a health ambassador among the staff in each residence and formation of a network ; and 3 ) a study circle for staff in each residence . The intervention is implemented by consultation with managers , training of health educators , and coaching of health ambassadors . Fidelity is assessed based on the participation of residents and staff in the intervention activities . The study design is a cluster-r and omised trial with physical activity as primary outcome objective ly assessed by pedometry . Secondary outcomes are dietary quality assessed by digital photography , measured weight , height and waist circumference , and quality of life assessed by a quality of life scale . Intermediate outcomes are changes in work routines in the residences assessed by a question naire to managers . Adults with mild to moderate intellectual disabilities living in community residences in Stockholm County are eligible for inclusion .  Multilevel analysis is used to evaluate effects on primary and secondary outcomes . The impact of the intervention on work routines in community residences is analysed by ordinal regression analysis . Barriers and facilitators of implementation are identified in an explorative qualitative study through observations and semi-structured interviews . Discussion Despite several challenges it is our hope that the results from this intervention will lead to new and improved health promotion programs to the benefit of the target group . Trial registration numberIS RCT Background Programs to change health behaviours have been identified as one way to reduce health inequalities experienced by disadvantaged groups . The objective of this study was to examine the effectiveness of a behaviour change programme to increase walking and reduce sedentary behaviour of adults with intellectual disabilities . Methods We used a cluster r and omised controlled design and recruited participants over 18 years old and not regularly involved in physical activity from intellectual disabilities community-based organisations . Assessment s were carried out blind to allocation . Clusters of participants were r and omly allocated to the Walk Well program or a 12-week waiting list control . Walk Well consisted of three face-to-face physical activity consultations incorporating behaviour change techniques , written re sources for participants and carers , and an individualised , structured walking programme . The primary outcome measured with accelerometers was change in mean step count per day between baseline and 12 weeks . Secondary outcomes included percentage time per day sedentary and in moderate-vigorous physical activity ( MVPA ) , body mass index ( BMI ) , and subjective well being . Results One hundred two participants in 50 clusters were r and omised . 82 ( 80.4 % ) participants completed the primary outcome . 66.7 % of participants lived in the most deprived quintile on the Scottish Index of Multiple Deprivation . At baseline , participants walked 4780 ( st and ard deviation 2432 ) steps per day , spent 65.5 % ( st and ard deviation 10.9 ) of time sedentary and 59 % percent had a body mass in the obesity range . After the walking programme , the difference between mean counts of the Walk Well and control group was 69.5 steps per day [ 95 % confidence interval ( CI ) -1054 to 1193.3 ] . There were no significant between group differences in percentage time sedentary 1.6 % ( 95 % CI −2.984 to 6.102 ) , percentage time in MVPA 0.3 % ( 95 % CI −0.7 to 1.3 ) , BMI −0.2 kg/m2 ( 95 % CI −0.8 to 0.4 ) or subjective well-being 0.3 ( 95 % CI −0.9 to 1.5 ) . Conclusions This is the first published trial of a walking program for adults with intellectual disabilities . Positively changing physical activity and sedentary behaviours may require more intensive programmes or upstream approaches to address the multiple social disadvantages experienced by adults with intellectual disabilities . Since participants spent the majority of their time sedentary , home-based programmes to reduce sitting time may be a viable health improvement approach . Trial registration Current Controlled Trials IS RCT BACKGROUND The physical activity level of older adults with intellectual disabilities ( ID ) is extremely low , and their fitness levels are far beneath accepted norms for older people with normal intelligence and comparable with frail older people . A physical activity programme , including an education programme , was developed for older adults with ID using behaviour change techniques . The programme aim ed at improving or maintaining adequate levels of physical activity ( primary outcome measure ) and motor fitness , cardio respiratory fitness , morphologic and metabolic fitness , activities of daily living , cognitive functioning and depressive symptoms ( secondary outcome measures ) . METHOD The programme 's efficacy was evaluated in a cluster-r and omised clinical trial among people aged 43 years and over with mild-moderate levels of ID . Five day-activity centres were r and omised to the participation group . In these centres , 81 older adults participated in groups of 8 to 10 in the programme , three times a week during 8 months . The programme was executed by physical activity instructors and staff of day-activity centres . Five other day-activity centres were r and omised to the control group ; 70 older adults in these centres received care as usual . The generalised linear model with mixed effects was used to test the programme 's effectiveness . RESULTS Significant effects were found on physical activity , muscle strength , systolic and diastolic blood pressure , serum cholesterol level and cognitive functioning , in favour of the programme 's participants . No significant improvements were found on balance , serum glucose , weight , waist circumference , walking speed , mobility , depression or instrumental activities of daily living . CONCLUSIONS The physical activity and fitness programme has established small but significant effects in this sample , but generalising the findings to other setting s is difficult due to significant participant dropout . Implementation of evidence -based physical activity programmes among older adults with ID is recommended . Further research is needed to investigate the effectiveness of physical activity on daily life functioning and the development on chronic diseases in the long run Objective : Although there are evaluation and effectiveness studies of health promotion interventions for adults with intellectual disabilities ( ID ) , r and omized efficacy trials of such interventions are lacking . Design : A r and omized active control intervention trial . Setting : The participants attended the health promotion classes in local disability agency service facilities . Method : We enrolled 443 individuals and r and omly assigned them to one of two eight-week participatory classes . The ‘ Steps to Your Health ’ ( STYH ) classes emphasized moderate to vigorous physical activity ( MVPA ) , healthy eating and  body mass index ( BMI )  reduction . The control intervention focused on hygiene and safety . Results : We did not find a statistically significant difference in mean MVPA or BMI change between completers of the STYH group compared to the control group one year after the intervention was completed . We did find that participation in STYH classes had a non-significant association with odds of reduction in BMI ( odds ratio [ OR ] 2.87 , 95 % confidence interval [ CI ] 0.91–9.11 ) and completers who lived in group homes were more likely than their counterparts who lived with families or in apartments to decrease their BMI ( OR 4.61 ; 95 % CI 1.14–18.64 ) . Conclusions : This trial did not demonstrate a significant effect of STYH participation on change in mean minutes of MVPA or mean BMI 12 months after classes ended , although there was a non-significant association with odds of reduction of BMI ( p = 0.07 ) . This study has implication s for design of intervention studies in people with intellectual disability ( ID ) BACKGROUND Age-related declines in balance and muscle power are largely responsible for the changes in the various components of gait performance among elderly people . But these can often be remedied with strength training .  People with cognitive impairment frequently demonstrate impaired gait , putting them at increased risks for falls and serious injury . OBJECTIVES This paper reports on the effects of a six-week pilot study of moderate intensity strength training on the gait of elderly individuals with dementia who attend a day-care center . METHODS Twenty-six adults ( 23 female , three male ) , age = 79.2 + /- 6.6 years , completed the study . Each subject completed a baseline assessment of lower extremity strength and gait . Gait was evaluated using free- and fast-gait speed over a 6-meter course , the Tinetti-Gait Assessment scale , the ' Timed-Up- and -Go ' , and the Gait Assessment Rating Scale ( GARS ) . The intervention consisted of moderate-intensity progressive resistance lower extremity exercise using Therab and , for two to three sessions per week over the six weeks . Post-intervention assessment of strength and gait was repeated at the completion of the sixth week . Multiple paired t-tests were calculated for each outcome measure . RESULTS The baseline assessment of gait suggests a high degree of frailty and risk for falls in the sample . Although post-intervention scores reflected improvement on all gait measures , the only statistically significant change observed was in fast-gait 
    Output:
    