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: Fernández-de-las-Peñas C , Alonso-Blanco C , Morales-Cabezas M , Miangolarra-Page JC : Two exercise interventions for the management of patients with ankylosing spondylitis : A r and omized controlled trial . Am J Phys Med Rehabil 2005;84:407–419 . Objective : The purpose of this clinical trial was to evaluate the impact of a 4-month comprehensive protocol of strengthening and flexibility exercises developed by our research group versus conventional exercises for patients with Ankylosing Spondylitis ( AS ) on functional and mobility outcomes . Design : R and omized controlled trial . Forty-five patients diagnosed with AS according to the modified criteria of New York were allocated to control or experimental groups using a r and om numbers table . The control group was treated with a conventional protocol of physical therapy in AS , whereas the experimental group was treated with the protocol suggested by our research group . The conventional intervention consisted of 20 exercises : motion and flexibility exercises of the cervical , thoracic , and lumbar spine ; stretching of the shortened muscles ; and chest expansion exercises . The experimental protocol is based on the postural affectation of the AS and the treatment of the shortened muscle chains in these patients according to the Global Posture Reeducation ( GPR ) method . This intervention employs specific strengthening and flexibility exercises in which the shortened muscle chains are stretched and strengthened . The study lasted 4 mos . During this period , patients received a weekly group session managed by an experienced physiotherapist . Each session lasted an hour , and there were 15 total sessions . Changes in activity , mobility , and functional capacity were evaluated by an assessor blinded to the intervention , using the following previously vali date d scores from the Bath group : BASMI ( tragus to wall distance , modified Schöber test , cervical rotation , lumbar side flexion , and intermalleolar distance ) , BASDAI ( The Bath Ankylosing Spondylitis Disease Activity Index ) , and BASFI ( The Bath Ankylosing Spondylitis Functional Index ) . Results : Both groups showed an improvement ( prepost scores ) in all the outcome measures , mobility measures of the BASMI index , as well as in BASFI and BASDAI indexes . In the control group , the improvement in tragus to wall distance ( P = 0.009 ) and in lumbar side flexion ( P = 0.02 ) was statistically significant . Although the rest of the outcomes also improved , they did not reach a significant level ( P > 0.05 ) . In the experimental group , the improvement in all the clinical measures of the BASMI index ( P < 0.01 ) and in the BASFI index ( P = 0.003 ) was statistically significant . The intergroup comparison between the improvement ( prepost scores ) in both groups showed that the experimental group obtained a greater improvement than the control group in all the clinical measures of the BASMI index , except in tragus to wall distance , as well as in the BASFI index . Conclusions : The experimental protocol developed by our research group , based on the GPR method and specific strengthening and flexibility exercises of the muscle chains , offers promising results in the management of patients suffering from AS . Further trials on this topic are required Despite advances in pharmacological therapy , physical treatment continues to be important in the management of ankylosing spondylitis ( AS ) . The objective of the present study was to evaluate the effects and tolerability of combined spa therapy and rehabilitation in a group of AS patients being treated with TNF inhibitors . Thirty AS patients attending the Rheumatology Unit of the University of Padova being treated with TNF inhibitors for at least 3 months were r and omized and assessed by an investigator independent from the spa staff : 15 were prescribed 10 sessions of spa therapy ( mud packs and thermal baths ) and  rehabilitation ( exercises in a thermal pool ) and the other 15 were considered controls . The patients in both groups had been receiving anti-TNF agents for at least three months . The outcome measures utilized were BASFI , BASDAI , BASMI , VAS for back pain and HAQ . The evaluations were performed in all patients at the entry to the study , at the end of the spa treatment , and after 3 and 6 months . Most of the evaluation indices were significantly improved at the end of the spa treatment , as well as at the 3 and 6 months follow-up assessment s. No significant alterations in the evaluation indices were found in the control group . Combined spa therapy and rehabilitation caused a clear , long-term clinical improvement in AS patients being treated with TNF inhibitors . Thermal treatment was found to be well tolerated and none of the patients had disease relapse Aims : To evaluate effects of physiotherapeutic intervention in terms of self- and manual mobilization on chest expansion , vital capacity , posture , spine mobility and experienced consequences of the disease in patients with ankylosing spondylitis . Design : A prospect i ve , r and omized controlled study . Methods : Thirty-two men , aged between 23 and 60 years , with ankylosing spondylitis were r and omized to active or no treatment for eight weeks . Physiotherapeutic intervention included individualized self- and manual mobilization for 1 hour twice a week and individually adjusted home exercises . Two blinded investigators made the assessment s of chest expansion , posture and spinal mobility before and after the treatment period . The patient filled in three and the physiotherapist one of the four Bath Ankylosing Spondylitis scales ( BAS scales ) . Results : In the treatment group chest expansion increased at the level of processus xiphoideus ( P<0.01 ) , with no difference in vital capacity compared with the control group . The posture improved in the cervical ( C7—wall distance ) ( P<0.001 ) and in the thoracic spine ( P<0.05 ) . Thoracic and lumbar spine flexion improved ( P<0.01 ) as did sagittal range of motion P<0.001 and P<0.01 , respectively . The Bath Ankylosing Spondylitis Metrology Index total scoring improved ( P<0.001 ) in the treatment group compared with the control group . The other three BAS scales showed no differences between groups . At four months follow-up of the treatment group , cervical spine posture , lumbar flexion and range of motion as well as BAS Metrology Index were still improved . Conclusion : This study shows that eight weeks of self- and manual mobilization treatment improved chest expansion , posture and spine mobility in patients with ankylosing spondylitis AIM The aim of the study was to compare the effects of conventional exercise ( CE ) , swimming and walking on the pulmonary functions , aerobic capacity , quality of life , Bath indexes and psychological symptoms in patients with ankylosing spondylitis ( AS ) . METHODS Forty-five patients were r and omised into either swimming ( group 1 ) , walking ( group 2 ) , CE group ( group 3 ) . Patients in Group 1 performed CE and swimming , patients in Group 2 performed CE and walking and patients in Group 3 performed CE only . Exercise sessions were performed three times a week for a period of six weeks . Patients were assessed before and after the rehabilitation program , with respect to , pulmonary function test ( forced vital capacity [ FVC , mL ] , forced expiration volume in one second [ FEV1 , mL ] , FEV1/FVC ( % ) and vital capacity [ VC , mL ] ) , maximal oxygen uptake ( pV.O2 ) , 6-minute walking test ( 6MWT ) , Bath Ankylosing Spondylitis Functional Index , Bath Ankylosing Spondylitis Disease Activity Index , Bath Ankylosing Spondylitis Metrology Index , Nottingham Health Profile and Beck Depression Inventory . RESULTS There were significant increases in pVO2 and 6MWT after treatment in Groups 1 and 2 ( P<0.05 ) . FeV1 , FVC and VC improved significantly with treatment in all three groups ( P<0.05 ) . A statistically significant improvement was observed in energy , emotional reaction and physical mobility sub-scores of NHP in three exercise groups after completion of the exercise program ( P<0.05 ) . CONCLUSIONS Swimming , walking and CE had beneficial effects on the quality of life and pulmonary functions . Aerobic exercises such as swimming and walking in addition to CE increased functional capacities of patients Fernández-de-las-Peñas C , Alonso-Blanco C , Alguacil-Diego IM , Miangolarra-Page JC : One-year follow-up of two exercise interventions for the management of patients with ankylosing spondylitis : A r and omized controlled trial . Am J Phys Med Rehabil 2006;85:559–567 . Objective : To assess the long-term effects on functional and mobility outcomes of two exercise interventions for the management of patients with ankylosing spondylitis . Design : In an extended 12-mo follow-up of a r and omized controlled trial , 40 patients who were diagnosed with ankylosing spondylitis according to the modified criteria of New York , allocated to control or experimental groups using a r and om numbers table , and who performed their respective exercise program at least three times per month , were included in this long-term study . The control group was treated during 15 sessions with a conventional exercise regimen in ankylosing spondylitis , whereas the experimental group received 15 sessions of exercises based on the treatment of the shortened muscle chains following the guidelines described by the Global Posture Reeducation method . These patients were followed up and assessed again 1 yr after entering the study , reapplying the same vali date d indexes : BASMI ( Bath Ankylosing Spondylitis Metrology Index [ tragus to wall distance , modified Schober test , cervical rotation , lumbar side flexion , and intermalleolar distance ] ) , BASDAI ( Bath Ankylosing Spondylitis Disease Activity Index ) , and BASFI ( Bath Ankylosing Spondylitis Functional Index ) . Results : The intragroup comparison between follow-up and postintervention data showed that both groups decrease their clinical and functional measures during the follow-up period . This decrease was only significant for lumbar side flexion and intermalleolar distance measurements , being more significant in the control group ( P = 0.001 and P = 0.002 , respectively ) . Intragroup differences between follow-up and preintervention assessment s revealed that improvements in all mobility measures of the BASMI index and in the BASFI index were partially maintained at the 12-mo follow-up in the experimental group but not in the control group . The intergroup comparison ( unpaired t test analysis ) between changes on each outcome during the long-term follow-up ( post – follow-up ; and pre – follow-up ) showed no significant differences in the decrease between postintervention and follow-up data between the study groups . On the other h and , the intergroup comparison between preintervention and follow-up data revealed significant differences in almost all mobility measures of the BASMI index ( except for cervical rotation ) and in the BASFI index , in favor of the experimental group . Conclusions : An exercise regimen based on the Global Posture Reeducation method and focusing on specific strengthening and flexibility exercises of the shortened muscle chains offers promising short- and long-term results in the management of patients who have ankylosing spondylitis The home-based exercise therapy recommended to the patients with ankylosing spondylitis ( AS ) is a simply applicable and cheap method . The aim of this study was to investigate the effects of home-based exercise therapy on pain , mobility , function , disease activity , quality of life , and respiratory functions in patients with AS . Eighty patients diagnosed with AS according to the modified New York criteria were included in the study .  Home-based exercise program including range of motion , stretching , strengthening , posture , and respiratory exercises was practically demonstrated by a physiotherapist . A training and exercise manual booklet was given to all patients . Patients following home-based exercise program five times a week at least 30 min per session ( exercise group ) for 3 months were compared with those exercising less than five times a week ( control group ) . Visual analog scale pain ( VASp ) values at baseline were significantly higher in the exercise group . The exercise group showed improvements in VASp , tragus – wall distance , morning stiffness , finger – floor distance , modified Schober 's test , chest expansion , the Bath Ankylosing Spondylitis Disease Activity Index , the Bath Ankylosing Spondylitis Functional Index , Ankylosing Spondylitis Quality of Life Question naire ( ASQoL ) , forced expiratory volume in first second , and forced vital capacity at third month . There was significant difference in ASQoL scores between the two groups in favor of the exercise group at third month . Regular home-based exercise therapy should be a part of main therapy in patients with AS . Physicians should recommend that patients with AS do exercise at least five times a week at least 30 min per session OBJECTIVE To investigate the sustained effect of a rehabilitation programme for patients with ankylosing spondylitis , and to compare the effect of this intervention given in a Mediterranean vs a Norwegian setting . METHODS A total of 107 patients with ankylosing spondylitis applying for rehabilitation were r and omized to a  4-week inpatient rehabilitation programme in a Mediterranean country or in Norway . The participants were evaluated clinical ly before and after the rehabilitation period ( week 0 and 4 ) and in week 16 . The ASsessment s in Ankylosing Spondylitis working group 's Improvement Criteria ( ASAS-IC ) , and tests of spinal mobility and physical capacity were used to measure treatment response . RESULTS An ASAS20 improvement was still present at week 16 in 50 % of the patients treated in a Mediterranean and 23 % in a Norwegian centre ( p = 0.006 ) . The tests of spinal mobility , physical capacity , and almost all patient 's assessment s of health status ( ASAS-IC components ) were still improved at week 16 after therapy in both climatic setting s. While the improvements in physical capacity were comparable , the spinal mobility and ASAS-IC components improved more , and improvements were sustained 
    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: Fernández-de-las-Peñas C , Alonso-Blanco C , Morales-Cabezas M , Miangolarra-Page JC : Two exercise interventions for the management of patients with ankylosing spondylitis : A r and omized controlled trial . Am J Phys Med Rehabil 2005;84:407–419 . Objective : The purpose of this clinical trial was to evaluate the impact of a 4-month comprehensive protocol of strengthening and flexibility exercises developed by our research group versus conventional exercises for patients with Ankylosing Spondylitis ( AS ) on functional and mobility outcomes . Design : R and omized controlled trial . Forty-five patients diagnosed with AS according to the modified criteria of New York were allocated to control or experimental groups using a r and om numbers table . The control group was treated with a conventional protocol of physical therapy in AS , whereas the experimental group was treated with the protocol suggested by our research group . The conventional intervention consisted of 20 exercises : motion and flexibility exercises of the cervical , thoracic , and lumbar spine ; stretching of the shortened muscles ; and chest expansion exercises . The experimental protocol is based on the postural affectation of the AS and the treatment of the shortened muscle chains in these patients according to the Global Posture Reeducation ( GPR ) method . This intervention employs specific strengthening and flexibility exercises in which the shortened muscle chains are stretched and strengthened . The study lasted 4 mos . During this period , patients received a weekly group session managed by an experienced physiotherapist . Each session lasted an hour , and there were 15 total sessions . Changes in activity , mobility , and functional capacity were evaluated by an assessor blinded to the intervention , using the following previously vali date d scores from the Bath group : BASMI ( tragus to wall distance , modified Schöber test , cervical rotation , lumbar side flexion , and intermalleolar distance ) , BASDAI ( The Bath Ankylosing Spondylitis Disease Activity Index ) , and BASFI ( The Bath Ankylosing Spondylitis Functional Index ) . Results : Both groups showed an improvement ( prepost scores ) in all the outcome measures , mobility measures of the BASMI index , as well as in BASFI and BASDAI indexes . In the control group , the improvement in tragus to wall distance ( P = 0.009 ) and in lumbar side flexion ( P = 0.02 ) was statistically significant . Although the rest of the outcomes also improved , they did not reach a significant level ( P > 0.05 ) . In the experimental group , the improvement in all the clinical measures of the BASMI index ( P < 0.01 ) and in the BASFI index ( P = 0.003 ) was statistically significant . The intergroup comparison between the improvement ( prepost scores ) in both groups showed that the experimental group obtained a greater improvement than the control group in all the clinical measures of the BASMI index , except in tragus to wall distance , as well as in the BASFI index . Conclusions : The experimental protocol developed by our research group , based on the GPR method and specific strengthening and flexibility exercises of the muscle chains , offers promising results in the management of patients suffering from AS . Further trials on this topic are required Despite advances in pharmacological therapy , physical treatment continues to be important in the management of ankylosing spondylitis ( AS ) . The objective of the present study was to evaluate the effects and tolerability of combined spa therapy and rehabilitation in a group of AS patients being treated with TNF inhibitors . Thirty AS patients attending the Rheumatology Unit of the University of Padova being treated with TNF inhibitors for at least 3 months were r and omized and assessed by an investigator independent from the spa staff : 15 were prescribed 10 sessions of spa therapy ( mud packs and thermal baths ) and  rehabilitation ( exercises in a thermal pool ) and the other 15 were considered controls . The patients in both groups had been receiving anti-TNF agents for at least three months . The outcome measures utilized were BASFI , BASDAI , BASMI , VAS for back pain and HAQ . The evaluations were performed in all patients at the entry to the study , at the end of the spa treatment , and after 3 and 6 months . Most of the evaluation indices were significantly improved at the end of the spa treatment , as well as at the 3 and 6 months follow-up assessment s. No significant alterations in the evaluation indices were found in the control group . Combined spa therapy and rehabilitation caused a clear , long-term clinical improvement in AS patients being treated with TNF inhibitors . Thermal treatment was found to be well tolerated and none of the patients had disease relapse Aims : To evaluate effects of physiotherapeutic intervention in terms of self- and manual mobilization on chest expansion , vital capacity , posture , spine mobility and experienced consequences of the disease in patients with ankylosing spondylitis . Design : A prospect i ve , r and omized controlled study . Methods : Thirty-two men , aged between 23 and 60 years , with ankylosing spondylitis were r and omized to active or no treatment for eight weeks . Physiotherapeutic intervention included individualized self- and manual mobilization for 1 hour twice a week and individually adjusted home exercises . Two blinded investigators made the assessment s of chest expansion , posture and spinal mobility before and after the treatment period . The patient filled in three and the physiotherapist one of the four Bath Ankylosing Spondylitis scales ( BAS scales ) . Results : In the treatment group chest expansion increased at the level of processus xiphoideus ( P<0.01 ) , with no difference in vital capacity compared with the control group . The posture improved in the cervical ( C7—wall distance ) ( P<0.001 ) and in the thoracic spine ( P<0.05 ) . Thoracic and lumbar spine flexion improved ( P<0.01 ) as did sagittal range of motion P<0.001 and P<0.01 , respectively . The Bath Ankylosing Spondylitis Metrology Index total scoring improved ( P<0.001 ) in the treatment group compared with the control group . The other three BAS scales showed no differences between groups . At four months follow-up of the treatment group , cervical spine posture , lumbar flexion and range of motion as well as BAS Metrology Index were still improved . Conclusion : This study shows that eight weeks of self- and manual mobilization treatment improved chest expansion , posture and spine mobility in patients with ankylosing spondylitis AIM The aim of the study was to compare the effects of conventional exercise ( CE ) , swimming and walking on the pulmonary functions , aerobic capacity , quality of life , Bath indexes and psychological symptoms in patients with ankylosing spondylitis ( AS ) . METHODS Forty-five patients were r and omised into either swimming ( group 1 ) , walking ( group 2 ) , CE group ( group 3 ) . Patients in Group 1 performed CE and swimming , patients in Group 2 performed CE and walking and patients in Group 3 performed CE only . Exercise sessions were performed three times a week for a period of six weeks . Patients were assessed before and after the rehabilitation program , with respect to , pulmonary function test ( forced vital capacity [ FVC , mL ] , forced expiration volume in one second [ FEV1 , mL ] , FEV1/FVC ( % ) and vital capacity [ VC , mL ] ) , maximal oxygen uptake ( pV.O2 ) , 6-minute walking test ( 6MWT ) , Bath Ankylosing Spondylitis Functional Index , Bath Ankylosing Spondylitis Disease Activity Index , Bath Ankylosing Spondylitis Metrology Index , Nottingham Health Profile and Beck Depression Inventory . RESULTS There were significant increases in pVO2 and 6MWT after treatment in Groups 1 and 2 ( P<0.05 ) . FeV1 , FVC and VC improved significantly with treatment in all three groups ( P<0.05 ) . A statistically significant improvement was observed in energy , emotional reaction and physical mobility sub-scores of NHP in three exercise groups after completion of the exercise program ( P<0.05 ) . CONCLUSIONS Swimming , walking and CE had beneficial effects on the quality of life and pulmonary functions . Aerobic exercises such as swimming and walking in addition to CE increased functional capacities of patients Fernández-de-las-Peñas C , Alonso-Blanco C , Alguacil-Diego IM , Miangolarra-Page JC : One-year follow-up of two exercise interventions for the management of patients with ankylosing spondylitis : A r and omized controlled trial . Am J Phys Med Rehabil 2006;85:559–567 . Objective : To assess the long-term effects on functional and mobility outcomes of two exercise interventions for the management of patients with ankylosing spondylitis . Design : In an extended 12-mo follow-up of a r and omized controlled trial , 40 patients who were diagnosed with ankylosing spondylitis according to the modified criteria of New York , allocated to control or experimental groups using a r and om numbers table , and who performed their respective exercise program at least three times per month , were included in this long-term study . The control group was treated during 15 sessions with a conventional exercise regimen in ankylosing spondylitis , whereas the experimental group received 15 sessions of exercises based on the treatment of the shortened muscle chains following the guidelines described by the Global Posture Reeducation method . These patients were followed up and assessed again 1 yr after entering the study , reapplying the same vali date d indexes : BASMI ( Bath Ankylosing Spondylitis Metrology Index [ tragus to wall distance , modified Schober test , cervical rotation , lumbar side flexion , and intermalleolar distance ] ) , BASDAI ( Bath Ankylosing Spondylitis Disease Activity Index ) , and BASFI ( Bath Ankylosing Spondylitis Functional Index ) . Results : The intragroup comparison between follow-up and postintervention data showed that both groups decrease their clinical and functional measures during the follow-up period . This decrease was only significant for lumbar side flexion and intermalleolar distance measurements , being more significant in the control group ( P = 0.001 and P = 0.002 , respectively ) . Intragroup differences between follow-up and preintervention assessment s revealed that improvements in all mobility measures of the BASMI index and in the BASFI index were partially maintained at the 12-mo follow-up in the experimental group but not in the control group . The intergroup comparison ( unpaired t test analysis ) between changes on each outcome during the long-term follow-up ( post – follow-up ; and pre – follow-up ) showed no significant differences in the decrease between postintervention and follow-up data between the study groups . On the other h and , the intergroup comparison between preintervention and follow-up data revealed significant differences in almost all mobility measures of the BASMI index ( except for cervical rotation ) and in the BASFI index , in favor of the experimental group . Conclusions : An exercise regimen based on the Global Posture Reeducation method and focusing on specific strengthening and flexibility exercises of the shortened muscle chains offers promising short- and long-term results in the management of patients who have ankylosing spondylitis The home-based exercise therapy recommended to the patients with ankylosing spondylitis ( AS ) is a simply applicable and cheap method . The aim of this study was to investigate the effects of home-based exercise therapy on pain , mobility , function , disease activity , quality of life , and respiratory functions in patients with AS . Eighty patients diagnosed with AS according to the modified New York criteria were included in the study .  Home-based exercise program including range of motion , stretching , strengthening , posture , and respiratory exercises was practically demonstrated by a physiotherapist . A training and exercise manual booklet was given to all patients . Patients following home-based exercise program five times a week at least 30 min per session ( exercise group ) for 3 months were compared with those exercising less than five times a week ( control group ) . Visual analog scale pain ( VASp ) values at baseline were significantly higher in the exercise group . The exercise group showed improvements in VASp , tragus – wall distance , morning stiffness , finger – floor distance , modified Schober 's test , chest expansion , the Bath Ankylosing Spondylitis Disease Activity Index , the Bath Ankylosing Spondylitis Functional Index , Ankylosing Spondylitis Quality of Life Question naire ( ASQoL ) , forced expiratory volume in first second , and forced vital capacity at third month . There was significant difference in ASQoL scores between the two groups in favor of the exercise group at third month . Regular home-based exercise therapy should be a part of main therapy in patients with AS . Physicians should recommend that patients with AS do exercise at least five times a week at least 30 min per session OBJECTIVE To investigate the sustained effect of a rehabilitation programme for patients with ankylosing spondylitis , and to compare the effect of this intervention given in a Mediterranean vs a Norwegian setting . METHODS A total of 107 patients with ankylosing spondylitis applying for rehabilitation were r and omized to a  4-week inpatient rehabilitation programme in a Mediterranean country or in Norway . The participants were evaluated clinical ly before and after the rehabilitation period ( week 0 and 4 ) and in week 16 . The ASsessment s in Ankylosing Spondylitis working group 's Improvement Criteria ( ASAS-IC ) , and tests of spinal mobility and physical capacity were used to measure treatment response . RESULTS An ASAS20 improvement was still present at week 16 in 50 % of the patients treated in a Mediterranean and 23 % in a Norwegian centre ( p = 0.006 ) . The tests of spinal mobility , physical capacity , and almost all patient 's assessment s of health status ( ASAS-IC components ) were still improved at week 16 after therapy in both climatic setting s. While the improvements in physical capacity were comparable , the spinal mobility and ASAS-IC components improved more , and improvements were sustained 
    Output:
    