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: The mechanisms that underlie successful initiation and adherence to physical activity regimens are not well understood . Few theoretical models have used consistent explanatory variables that are theory-driven and many findings that use extant models are equivocal . Social Cognitive Theory ( SCT ) as presented by B and ura ( 1986 , 1997 ) appears to have strong promise as a guide to underst and ing physical activity behaviors and developing clinical ly relevant interventions to promote the initiation and maintenance of physical activity . This critical systematic review of research using SCT was completed to determine the predictive ability of model constructs in explaining physical activity behavior and in identifying key intervention components found to enhance physical activity initiation and maintenance . Following review for quality and adequacy , published research during the years 1990 - 1998 contained 27 studies that examined the relationship between the construct of SCT , self-efficacy  , and physical activity .  All of the descriptive studies found a statistically significant relationship between self-efficacy and exercise behavior . Intervention studies demonstrated that participation in an exercise program promoted self-efficacy , and that programs design ed to increase outcome expectations and self-efficacy significantly increased exercise behavior . Due to the central ity of self-efficacy in many of the social psychological theories that help explain the attitude-intention-behavior triad , a strong need remains to design interventions to maximize its usefulness . Clear , generalizable , systematic and theoretically comprehensive , r and omized , controlled studies are needed to underst and the usefulness of the construct Background The SenseWear ™ Armb and ( SWA ) ( BodyMedia , Inc. Pittsburgh , PA ) is a physical activity and lifestyle monitor that objective ly and accurately measures free-living energy balance and sleep and includes software for self-monitoring of daily energy expenditure and energy intake . The real-time feedback of the SWA can improve individual self-monitoring and , therefore , enhance weight loss outcomes . Methods We recruited 197 sedentary overweight or obese adults ( age , 46.8 ± 10.8 y ; body mass index ( BMI ) , 33.3 ± 5.2 kg/m2 ; 81 % women , 32 % African-American ) from the greater Columbia , South Carolina area . Participants were r and omized into 1 of 4 groups , a self-directed weight loss program via an evidence -based weight loss manual ( St and ard Care , n = 50 ) , a group-based behavioral weight loss program ( GWL , n = 49 ) , the armb and alone ( SWA-alone , n = 49 ) , or the GWL plus the armb and ( GWL+SWA , n = 49 ) , during the 9-month intervention . The primary outcome was change in body weight and waist circumference . A mixed-model repeated- measures analysis compared change in the intervention groups to the st and ard care group on weight and waist circumference status after adjusting for age , sex , race , education , energy expenditure , and recruitment wave . Results Body weight was available for 62 % of participants at 9 months ( 52 % st and ard care , 70 % intervention ) . There was significant weight loss in all 3 intervention groups ( GWL , 1.86 kg , P = 0.05 ; SWA-alone , 3.55 kg , P = 0.0002 ; GWL+SWA , 6.59 kg , P < 0.0001 ) but not in the St and ard Care group ( 0.89 kg , P = 0.39 ) at month 9 . Only the GWL+SWA group achieved significant weight loss at month 9 compared to the St and ard Care group ( P = 0.04 ) . Significant waist circumference reductions were achieved in all 4 groups at month 9 ( St and ard Care , 3.49 cm , P = 0.0004 ; GWL , 2.42 cm , P = 0.008 ; SWA-alone , 3.59 cm , P < 0.0001 ; GWL+SWA , 6.77 cm , P < 0.0001 ) , but no intervention group had significantly reduced waist circumference compared to the St and ard Care group . Conclusions Continuous self-monitoring from wearable technology with real-time feedback may be particularly useful to enhance lifestyle changes that promote weight loss in sedentary overweight or obese adults . This strategy , combined with a group-based behavioral intervention , may yield optimal weight loss . Trial Registration Clinical Trials.gov : People with heart failure ( HF ) are living longer but with disabling dyspnea that erodes quality of life ( QOL ) . Decreased strength of inspiratory muscles ( IMs ) may contribute to dyspnea in HF , and inspiratory muscle training ( IMT ) has been shown to improve the strength of IMs . The purpose of this study was to determine the effects of a 3-month nurse-coached IMT program . B and ura 's Self-Efficacy Theory directed nursing interventions . This r and omized controlled trial employed an experimental group ( IMT ) and a control group ( education ) . Data were collected during six home visits . Outcome measures included maximal inspiratory pressure , perceived dyspnea , self-efficacy , and health-related QOL . Significant differences in PI(max ) , dyspnea , and respiratory rate were found . Implication s for further research and practice are discussed Background Many studies have reported significant behavioral impact of physical activity interventions . However , few have examined changes in potential mediators of change preceding behavioral changes , result ing in a lack of information concerning how the intervention worked . Our purpose was to examine mediation effects of changes in psychosocial variables on changes in physical activity in type 2 diabetes patients . Methods Ninety-two patients ( 62 ± 9 years , 30 , 0 ± 2.5 kg/m2 , 69 % males ) participated in a r and omized controlled trial . The 24-week intervention was based on social-cognitive constructs and consisted of a face-to-face session , telephone follow-ups , and the use of a pedometer .  Social-cognitive variables and physical activity  ( device-based and self-reported ) were collected at baseline , after the 24-week intervention and at one year post-baseline . PA was measured by pedometer , accelerometer and question naire . Results Post-intervention physical activity changes were mediated by coping with relapse , changes in social norm , and social modeling from family members ( p ≤ 0.05 ) . One-year physical activity changes were mediated by coping with relapse , changes in social support from family and self-efficacy towards physical activity barriers ( p ≤ 0.05 ) Conclusions For patients with type 2 diabetes , initiatives to increase their physical activity could usefully focus on strategies for resuming regular patterns of activity , on engaging family social support and on building confidence about dealing with actual and perceived barriers to activity . Trial Registration NCT00903500 , Clinical Trials.gov Background This study assessed the effect of a 1-year internet-based weight loss intervention  for men . Methods Four hundred forty-one overweight and obese men were r and omized to intervention or delayed treatment . Participants completed a Web-based assessment of diet and physical activity behaviors and weekly tailored Web modules addressing weight-related behaviors . Results At 12 months compared to controls , intervention men decreased percent of energy from saturated fat and increased grams of fiber and fruit/vegetable servings per 1.000 kcal ( p values < 0.001 ) and walked 16 min more per day ( p < 0.05 ) . No between-group differences in body mass index ( BMI ) , weight , or waist circumference were seen , but among completers , men in the highest tertile of intervention participation had lower weight ( 98.74 vs. 102.37 kg ) , BMI ( 32.38 vs. 33.46 ) , and waist circumference ( 42.17 vs. 43.47 cm ) compared to men who participated less often . Conclusions The intervention improved diet and activity behaviors , but weight loss occurred only for those with the highest adherence Background Weight reduction limits disease progression in obese people with coronary heart disease ( CHD ) and /or type 2 diabetes mellitus ( T2DM ) . Purpose To test a 16-week group-based weight reduction intervention combining exercise , diet and behaviour change strategies aim ed to increase self-efficacy  ( Healthy Eating and Exercise Lifestyle Program — HEELP ) on weight , body mass index ( BMI ) , waist circumference and exercise . Methods Participants with CHD and /or T2DM and BMI between 27 to 39 kg/m2 were r and omised to HEELP  ( n = 83 ) or usual care ( n = 65 ) . Results Participants were aged a mean 63.47 years ( SD 8.9 ) , male ( 58 % ) and Caucasian ( 79 % ) . HEELP participants lost significantly more weight , BMI and waist circumference and exercised more days/week for a longer duration /week than usual care . Clinical ly significant weight loss ( ≥5 % ) was more common in HEELP than usual care . Conclusion The HEELP result ed in weight loss and improved exercise behaviour in obese people with CHD and T2DM Background Delivering effective multiple health behavior interventions to large numbers of adults with chronic conditions via primary care setting s is a public health priority . Purpose Within a 12-month , telephone-delivered diet and physical activity intervention with multiple behavioral outcomes , we examined the extent and co-variation of multiple health behavior change . Methods A cluster-r and omized trial with 434 patients with type 2 diabetes or hypertension were recruited from 10 general practice s , which were r and omized to receive telephone counseling or usual care .  Results Those receiving telephone counseling were significantly more likely than those in usual care to make greater reductions in multiple behaviors after adjusting for baseline risk behaviors ( OR 2.42 ; 95%CI 1.43 , 4.11 ) . Controlling for baseline risk and group allocation , making changes to either physical activity , fat , vegetable , or fiber intake was associated with making significantly more improvements in other behaviors . Conclusions For patients with chronic conditions , telephone counseling can significantly improve multiple health behaviors , with behavioral changes tending to co-vary OBJECTIVE Although behavioral weight-loss interventions produce short-term weight loss , long-term maintenance remains elusive . This r and omized trial examined whether learning a novel set of " stability skills " before losing weight improved long-term weight management . Stability skills were design ed to optimize individuals ' current satisfaction with lifestyle and self-regulatory habits while requiring the minimum effort and attention necessary . METHOD Overweight/obese women ( N = 267 ) were r and omly assigned to one of two 6-month interventions and assessed at baseline and at 6 , 12 , and 18 months . Maintenance First women participated first in an 8-week stability skills maintenance module and then in a st and ard 20-week behavioral weight-loss program . Weight Loss First women participated first in a st and ard 20-week behavioral weight-loss program and then in a st and ard 8-week problem-solving skills maintenance module . There was no intervention staff contact during the 12-month follow-up period ( 6 - 18 months ) . RESULTS As design ed , Maintenance First participants lost the same percentage of initial weight during the 6-month intervention period as Weight Loss First participants ( M = -8.6 % , SD = 5.7 , vs. M = -9.1 % , SD = 6.9 ; t = -0.6 , p = .52 ) . However , Maintenance First participants regained significantly less weight during the 12-month follow-up period ( 6 - 18 months ) than Weight Loss First participants ( M = 3.2 lb , SD = 10.4 , vs. M = 7.3 lb , SD = 9.9 [ M = 1.4 kg , SD = 4.7 , vs. M = 3.3 kg , SD = 4.5 ] ; t = 3.3 , p = .001 , d = 0.4 ) . CONCLUSION Learning stability skills before losing weight was successful in helping women to maintain weight loss without intervention staff contact during follow-up . These results can inform the study design of future innovative interventions Background Males experience a shorter life expectancy and higher rates of chronic diseases compared to their female counterparts . To improve health outcomes among males , interventions specifically developed for males that target their health behaviors are needed . Information technology (IT)-based interventions may be a promising intervention approach in this population group , however , little is known about how to maximize engagement and retention in Web-based programs . Objective The current study sought to explore attributes hypothesized to influence user engagement among a sub sample of participants from the ManUp study , a r and omized controlled trial testing the efficacy of an interactive Web-based intervention for promoting physical activity and nutrition among middle-aged males . Methods Semistructured interviews were conducted and audiotaped with 20 of the ManUp participants . Interview questions were based on a conceptual model of engagement and centered on why participants took part in the study , what they liked and did not like about the intervention they received , and how they think the intervention could be improved . Interview recordings were transcribed and coded into themes . Results There were five themes that were identified in the study . These themes were : ( 1 ) users ’ motives , ( 2 ) users ’ desired outcomes , ( 3 ) users ’ positive experiences , ( 4 ) users ’ negative emotions , and ( 5 ) attributes desired by user . Conclusions There is little research in the field that has explored user experiences in human-computer interactions and how such experiences may relate to engagement , especially among males . Although not conclusive , the current study provides some insight into what personal attributes of middle-aged males ( such as their key motives and goals for participating ) and attributes of the intervention material s ( such as usability , control , and interactivity ) may impact 
    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: The mechanisms that underlie successful initiation and adherence to physical activity regimens are not well understood . Few theoretical models have used consistent explanatory variables that are theory-driven and many findings that use extant models are equivocal . Social Cognitive Theory ( SCT ) as presented by B and ura ( 1986 , 1997 ) appears to have strong promise as a guide to underst and ing physical activity behaviors and developing clinical ly relevant interventions to promote the initiation and maintenance of physical activity . This critical systematic review of research using SCT was completed to determine the predictive ability of model constructs in explaining physical activity behavior and in identifying key intervention components found to enhance physical activity initiation and maintenance . Following review for quality and adequacy , published research during the years 1990 - 1998 contained 27 studies that examined the relationship between the construct of SCT , self-efficacy  , and physical activity .  All of the descriptive studies found a statistically significant relationship between self-efficacy and exercise behavior . Intervention studies demonstrated that participation in an exercise program promoted self-efficacy , and that programs design ed to increase outcome expectations and self-efficacy significantly increased exercise behavior . Due to the central ity of self-efficacy in many of the social psychological theories that help explain the attitude-intention-behavior triad , a strong need remains to design interventions to maximize its usefulness . Clear , generalizable , systematic and theoretically comprehensive , r and omized , controlled studies are needed to underst and the usefulness of the construct Background The SenseWear ™ Armb and ( SWA ) ( BodyMedia , Inc. Pittsburgh , PA ) is a physical activity and lifestyle monitor that objective ly and accurately measures free-living energy balance and sleep and includes software for self-monitoring of daily energy expenditure and energy intake . The real-time feedback of the SWA can improve individual self-monitoring and , therefore , enhance weight loss outcomes . Methods We recruited 197 sedentary overweight or obese adults ( age , 46.8 ± 10.8 y ; body mass index ( BMI ) , 33.3 ± 5.2 kg/m2 ; 81 % women , 32 % African-American ) from the greater Columbia , South Carolina area . Participants were r and omized into 1 of 4 groups , a self-directed weight loss program via an evidence -based weight loss manual ( St and ard Care , n = 50 ) , a group-based behavioral weight loss program ( GWL , n = 49 ) , the armb and alone ( SWA-alone , n = 49 ) , or the GWL plus the armb and ( GWL+SWA , n = 49 ) , during the 9-month intervention . The primary outcome was change in body weight and waist circumference . A mixed-model repeated- measures analysis compared change in the intervention groups to the st and ard care group on weight and waist circumference status after adjusting for age , sex , race , education , energy expenditure , and recruitment wave . Results Body weight was available for 62 % of participants at 9 months ( 52 % st and ard care , 70 % intervention ) . There was significant weight loss in all 3 intervention groups ( GWL , 1.86 kg , P = 0.05 ; SWA-alone , 3.55 kg , P = 0.0002 ; GWL+SWA , 6.59 kg , P < 0.0001 ) but not in the St and ard Care group ( 0.89 kg , P = 0.39 ) at month 9 . Only the GWL+SWA group achieved significant weight loss at month 9 compared to the St and ard Care group ( P = 0.04 ) . Significant waist circumference reductions were achieved in all 4 groups at month 9 ( St and ard Care , 3.49 cm , P = 0.0004 ; GWL , 2.42 cm , P = 0.008 ; SWA-alone , 3.59 cm , P < 0.0001 ; GWL+SWA , 6.77 cm , P < 0.0001 ) , but no intervention group had significantly reduced waist circumference compared to the St and ard Care group . Conclusions Continuous self-monitoring from wearable technology with real-time feedback may be particularly useful to enhance lifestyle changes that promote weight loss in sedentary overweight or obese adults . This strategy , combined with a group-based behavioral intervention , may yield optimal weight loss . Trial Registration Clinical Trials.gov : People with heart failure ( HF ) are living longer but with disabling dyspnea that erodes quality of life ( QOL ) . Decreased strength of inspiratory muscles ( IMs ) may contribute to dyspnea in HF , and inspiratory muscle training ( IMT ) has been shown to improve the strength of IMs . The purpose of this study was to determine the effects of a 3-month nurse-coached IMT program . B and ura 's Self-Efficacy Theory directed nursing interventions . This r and omized controlled trial employed an experimental group ( IMT ) and a control group ( education ) . Data were collected during six home visits . Outcome measures included maximal inspiratory pressure , perceived dyspnea , self-efficacy , and health-related QOL . Significant differences in PI(max ) , dyspnea , and respiratory rate were found . Implication s for further research and practice are discussed Background Many studies have reported significant behavioral impact of physical activity interventions . However , few have examined changes in potential mediators of change preceding behavioral changes , result ing in a lack of information concerning how the intervention worked . Our purpose was to examine mediation effects of changes in psychosocial variables on changes in physical activity in type 2 diabetes patients . Methods Ninety-two patients ( 62 ± 9 years , 30 , 0 ± 2.5 kg/m2 , 69 % males ) participated in a r and omized controlled trial . The 24-week intervention was based on social-cognitive constructs and consisted of a face-to-face session , telephone follow-ups , and the use of a pedometer .  Social-cognitive variables and physical activity  ( device-based and self-reported ) were collected at baseline , after the 24-week intervention and at one year post-baseline . PA was measured by pedometer , accelerometer and question naire . Results Post-intervention physical activity changes were mediated by coping with relapse , changes in social norm , and social modeling from family members ( p ≤ 0.05 ) . One-year physical activity changes were mediated by coping with relapse , changes in social support from family and self-efficacy towards physical activity barriers ( p ≤ 0.05 ) Conclusions For patients with type 2 diabetes , initiatives to increase their physical activity could usefully focus on strategies for resuming regular patterns of activity , on engaging family social support and on building confidence about dealing with actual and perceived barriers to activity . Trial Registration NCT00903500 , Clinical Trials.gov Background This study assessed the effect of a 1-year internet-based weight loss intervention  for men . Methods Four hundred forty-one overweight and obese men were r and omized to intervention or delayed treatment . Participants completed a Web-based assessment of diet and physical activity behaviors and weekly tailored Web modules addressing weight-related behaviors . Results At 12 months compared to controls , intervention men decreased percent of energy from saturated fat and increased grams of fiber and fruit/vegetable servings per 1.000 kcal ( p values < 0.001 ) and walked 16 min more per day ( p < 0.05 ) . No between-group differences in body mass index ( BMI ) , weight , or waist circumference were seen , but among completers , men in the highest tertile of intervention participation had lower weight ( 98.74 vs. 102.37 kg ) , BMI ( 32.38 vs. 33.46 ) , and waist circumference ( 42.17 vs. 43.47 cm ) compared to men who participated less often . Conclusions The intervention improved diet and activity behaviors , but weight loss occurred only for those with the highest adherence Background Weight reduction limits disease progression in obese people with coronary heart disease ( CHD ) and /or type 2 diabetes mellitus ( T2DM ) . Purpose To test a 16-week group-based weight reduction intervention combining exercise , diet and behaviour change strategies aim ed to increase self-efficacy  ( Healthy Eating and Exercise Lifestyle Program — HEELP ) on weight , body mass index ( BMI ) , waist circumference and exercise . Methods Participants with CHD and /or T2DM and BMI between 27 to 39 kg/m2 were r and omised to HEELP  ( n = 83 ) or usual care ( n = 65 ) . Results Participants were aged a mean 63.47 years ( SD 8.9 ) , male ( 58 % ) and Caucasian ( 79 % ) . HEELP participants lost significantly more weight , BMI and waist circumference and exercised more days/week for a longer duration /week than usual care . Clinical ly significant weight loss ( ≥5 % ) was more common in HEELP than usual care . Conclusion The HEELP result ed in weight loss and improved exercise behaviour in obese people with CHD and T2DM Background Delivering effective multiple health behavior interventions to large numbers of adults with chronic conditions via primary care setting s is a public health priority . Purpose Within a 12-month , telephone-delivered diet and physical activity intervention with multiple behavioral outcomes , we examined the extent and co-variation of multiple health behavior change . Methods A cluster-r and omized trial with 434 patients with type 2 diabetes or hypertension were recruited from 10 general practice s , which were r and omized to receive telephone counseling or usual care .  Results Those receiving telephone counseling were significantly more likely than those in usual care to make greater reductions in multiple behaviors after adjusting for baseline risk behaviors ( OR 2.42 ; 95%CI 1.43 , 4.11 ) . Controlling for baseline risk and group allocation , making changes to either physical activity , fat , vegetable , or fiber intake was associated with making significantly more improvements in other behaviors . Conclusions For patients with chronic conditions , telephone counseling can significantly improve multiple health behaviors , with behavioral changes tending to co-vary OBJECTIVE Although behavioral weight-loss interventions produce short-term weight loss , long-term maintenance remains elusive . This r and omized trial examined whether learning a novel set of " stability skills " before losing weight improved long-term weight management . Stability skills were design ed to optimize individuals ' current satisfaction with lifestyle and self-regulatory habits while requiring the minimum effort and attention necessary . METHOD Overweight/obese women ( N = 267 ) were r and omly assigned to one of two 6-month interventions and assessed at baseline and at 6 , 12 , and 18 months . Maintenance First women participated first in an 8-week stability skills maintenance module and then in a st and ard 20-week behavioral weight-loss program . Weight Loss First women participated first in a st and ard 20-week behavioral weight-loss program and then in a st and ard 8-week problem-solving skills maintenance module . There was no intervention staff contact during the 12-month follow-up period ( 6 - 18 months ) . RESULTS As design ed , Maintenance First participants lost the same percentage of initial weight during the 6-month intervention period as Weight Loss First participants ( M = -8.6 % , SD = 5.7 , vs. M = -9.1 % , SD = 6.9 ; t = -0.6 , p = .52 ) . However , Maintenance First participants regained significantly less weight during the 12-month follow-up period ( 6 - 18 months ) than Weight Loss First participants ( M = 3.2 lb , SD = 10.4 , vs. M = 7.3 lb , SD = 9.9 [ M = 1.4 kg , SD = 4.7 , vs. M = 3.3 kg , SD = 4.5 ] ; t = 3.3 , p = .001 , d = 0.4 ) . CONCLUSION Learning stability skills before losing weight was successful in helping women to maintain weight loss without intervention staff contact during follow-up . These results can inform the study design of future innovative interventions Background Males experience a shorter life expectancy and higher rates of chronic diseases compared to their female counterparts . To improve health outcomes among males , interventions specifically developed for males that target their health behaviors are needed . Information technology (IT)-based interventions may be a promising intervention approach in this population group , however , little is known about how to maximize engagement and retention in Web-based programs . Objective The current study sought to explore attributes hypothesized to influence user engagement among a sub sample of participants from the ManUp study , a r and omized controlled trial testing the efficacy of an interactive Web-based intervention for promoting physical activity and nutrition among middle-aged males . Methods Semistructured interviews were conducted and audiotaped with 20 of the ManUp participants . Interview questions were based on a conceptual model of engagement and centered on why participants took part in the study , what they liked and did not like about the intervention they received , and how they think the intervention could be improved . Interview recordings were transcribed and coded into themes . Results There were five themes that were identified in the study . These themes were : ( 1 ) users ’ motives , ( 2 ) users ’ desired outcomes , ( 3 ) users ’ positive experiences , ( 4 ) users ’ negative emotions , and ( 5 ) attributes desired by user . Conclusions There is little research in the field that has explored user experiences in human-computer interactions and how such experiences may relate to engagement , especially among males . Although not conclusive , the current study provides some insight into what personal attributes of middle-aged males ( such as their key motives and goals for participating ) and attributes of the intervention material s ( such as usability , control , and interactivity ) may impact 
    Output:
    