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2
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1
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Sa
m
ples
T
h
is
s
t
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d
y
w
as
co
n
d
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n
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co
m
m
u
n
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t
y
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n
g
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Ma
j
en
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Su
b
-
d
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tr
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la
w
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P
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n
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atien
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m
et
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in
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lu
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er
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s
elec
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in
cl
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2
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T
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Evaluation Warning : The document was created with Spire.PDF for Python.
I
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Cha
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Sim
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Mo
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[
4
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(
SD
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r
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3
.
6
.
Ana
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is
t
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re
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t
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pro
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s
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m
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ha
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T
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d
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th
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y
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s
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f
t
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s
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y
t
h
at
in
t
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to
an
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ti
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es
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o
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t
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m
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cle
p
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s
.
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t o
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av
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g
:
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y
w
as
ap
p
licatio
n
o
f
t
h
e
p
r
o
g
r
a
m
.
T
h
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p
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r
am
o
f
th
is
s
tu
d
y
w
as
d
ev
elo
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s
elf
-
e
f
f
icac
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m
o
d
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b
y
B
an
d
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a
(
1
9
9
4
)
[
5
]
.
Self
-
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f
f
icac
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c
o
u
ld
b
e
a
f
o
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n
d
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f
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m
p
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w
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in
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p
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to
in
cr
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s
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p
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p
s
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o
lo
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b
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m
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er
cise
ad
h
er
en
ce
a
n
d
ex
er
cise sel
f
-
e
f
f
icac
y
a
m
o
n
g
o
ld
er
p
eo
p
le
[
6
]
.
Seco
n
d
l
y
,
i
n
d
iv
id
u
al
e
d
u
ca
ti
o
n
,
in
d
iv
id
u
al
co
u
n
s
el
in
g
a
n
d
g
r
o
u
p
d
is
cu
s
s
io
n
ea
ch
w
ee
k
.
T
h
e
ed
u
ca
tio
n
s
es
s
io
n
w
as
co
n
d
u
cted
to
g
ain
m
o
r
e
k
n
o
w
le
d
g
e.
I
t
w
a
s
f
o
cu
s
ed
o
n
d
eliv
er
in
g
th
e
g
e
n
er
al
in
f
o
r
m
atio
n
r
elate
d
to
h
y
p
er
te
n
s
io
n
,
s
ig
n
s
an
d
s
y
m
p
to
m
s
o
f
h
y
p
er
ten
s
io
n
,
co
m
p
licat
io
n
s
,
an
d
th
e
i
m
p
o
r
ta
n
ce
o
f
r
elax
atio
n
p
r
o
g
r
es
s
iv
e
m
u
s
cle
in
ter
v
e
n
tio
n
f
o
r
m
a
n
a
g
in
g
h
y
p
er
te
n
s
io
n
T
h
e
th
ir
d
r
ea
s
o
n
is
r
elate
d
to
th
e
g
o
al
s
etti
n
g
a
n
d
ac
tio
n
p
lan
n
i
n
g
s
tr
ate
g
y
.
T
h
e
g
o
al
s
ettin
g
an
d
ac
tio
n
p
lan
n
in
g
s
tr
ate
g
y
ca
n
h
elp
th
e
p
atie
n
ts
to
in
ten
t
io
n
a
ll
y
ta
k
e
r
esp
o
n
s
ib
ilit
y
a
n
d
en
g
ag
e
i
n
i
n
f
lu
e
n
ci
n
g
th
e
d
ietar
y
an
d
ex
er
ci
s
e
b
eh
av
io
r
s
w
it
h
th
eir
o
w
n
ac
h
ie
v
ab
le
g
o
als
an
d
f
ea
s
ib
le
ac
tio
n
p
lan
s
.
T
h
e
m
ea
s
u
r
ab
le,
s
p
ec
if
ic,
c
lear
,
an
d
s
h
o
r
t p
er
io
d
g
o
als a
n
d
ac
tio
n
p
la
n
al
s
o
ca
n
p
r
o
v
id
e
clea
r
g
u
id
an
ce
to
t
h
e
p
atien
t
s
i
n
r
e
g
ar
d
w
h
at
ac
tiv
ities
s
h
o
u
ld
b
e
d
o
n
e
an
d
h
o
w
m
a
n
y
ti
m
es
to
ac
h
ie
v
e
t
h
e
b
e
h
av
io
r
s
b
ased
o
n
r
ec
o
m
m
e
n
d
atio
n
s
a
n
d
also
an
ticip
ate
t
h
e
p
o
s
s
ib
ilit
y
b
ar
r
ier
s
w
h
ich
p
o
ten
tiall
y
v
io
late
th
e
g
o
als ac
h
ie
v
e
m
e
n
t
[
7
]
.
T
h
e
m
a
in
o
b
j
ec
tiv
e
o
f
th
e
ap
p
r
o
p
r
iate
g
o
al
s
ettin
g
an
d
an
ac
tio
n
p
lan
i
s
to
in
cr
e
ase
th
e
s
el
f
-
co
n
f
id
e
n
ce
o
f
th
e
p
atien
ts
,
i
n
o
r
d
er
to
b
e
ab
le
to
c
o
m
m
it t
h
e
g
o
al.
T
h
e
f
o
u
r
th
r
ea
s
o
n
i
s
r
elate
d
w
i
th
f
ac
e
to
f
ac
e
f
o
llo
w
-
u
p
.
Du
r
i
n
g
p
ar
ticip
ati
n
g
in
th
e
p
r
o
g
r
am
,
p
atien
ts
r
ec
ei
v
ed
a
f
ac
e
to
f
ac
e
f
o
llo
w
u
p
i
n
a
p
u
b
lic
h
ea
lt
h
ce
n
ter
b
ef
o
r
e
s
tar
ti
n
g
th
e
p
r
o
g
r
a
m
.
T
h
is
f
o
llo
w
-
u
p
f
o
r
ev
al
u
ati
n
g
g
o
als
ac
h
ie
v
e
m
en
t,
as
s
ess
in
g
t
h
e
p
r
o
b
le
m
an
d
cr
ea
tin
g
p
r
o
b
le
m
-
s
o
l
v
in
g
.
I
n
th
e
las
t
w
ee
k
,
th
e
y
r
ec
eiv
ed
a
f
ac
e
to
f
ac
e
f
o
llo
w
-
u
p
f
o
r
ev
alu
ati
n
g
th
e
o
v
er
all
ac
h
iev
e
m
e
n
t
an
d
as
s
es
s
in
g
t
h
e
clin
ical
o
u
tco
m
es.
I
n
ad
d
itio
n
,
r
esear
c
h
er
m
o
ti
v
ated
an
d
f
ac
ilit
ated
p
atie
n
ts
t
o
co
n
tin
u
e
t
h
e
p
r
o
g
r
a
m
.
D
u
r
i
n
g
th
is
p
r
o
ce
s
s
,
th
e
r
esear
ch
er
g
a
v
e
p
r
aise
a
n
d
r
ein
f
o
r
ce
m
e
n
t
f
o
r
p
atien
t
s
w
i
th
a
f
f
ir
m
at
io
n
s
.
T
h
is
m
et
h
o
d
in
f
l
u
en
ce
d
t
h
e
p
atie
n
t’
s
co
n
f
id
e
n
ce
an
d
ex
p
ec
tatio
n
s
t
o
m
ai
n
tai
n
t
h
e
p
o
s
iti
v
e
b
eh
av
i
o
r
.
T
h
e
f
i
f
th
r
ea
s
o
n
r
elate
d
to
s
o
cial
s
u
p
p
o
r
t.
I
n
t
h
is
s
t
u
d
y
,
p
atien
t
s
m
et
r
e
s
ea
r
ch
er
,
n
u
r
s
e
s
an
d
o
th
e
r
p
atien
ts
i
n
th
e
p
u
b
lic
h
ea
lt
h
ce
n
ter
.
T
h
e
co
llab
o
r
atio
n
o
f
th
e
co
m
m
u
n
it
y
h
ea
lt
h
v
o
lu
n
teer
s
s
y
m
b
o
lizes a
s
o
cia
l
s
u
p
p
o
r
t
w
h
ic
h
b
en
ef
its
t
h
e
p
atien
t
’
s
b
eh
a
v
io
r
al
ch
a
n
g
e.
Go
o
d
s
o
cial
s
u
p
p
o
r
t
h
as
a
v
ital
r
o
le
in
p
atien
t
s
p
er
f
o
r
m
in
g
g
o
o
d
d
ietar
y
a
n
d
ex
er
cise
ad
h
er
e
n
ce
.
Fa
m
ilie
s
o
r
f
r
ien
d
s
m
u
s
t
b
e
a
w
ar
e,
s
u
p
p
o
r
tiv
e
an
d
s
h
o
u
ld
tr
y
to
av
o
id
s
ch
ed
u
li
n
g
e
v
en
t
s
w
h
ic
h
m
a
y
i
n
ter
f
er
e
w
ith
e
x
er
cise
ti
m
e.
T
h
is
ca
n
h
elp
to
av
o
id
an
y
p
o
ten
tial
Evaluation Warning : The document was created with Spire.PDF for Python.
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405
co
n
f
lic
ts
o
r
d
is
tr
ac
t
io
n
s
th
a
t
w
ill
a
f
f
ec
t
o
f
e
x
er
cise
ad
h
e
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en
ce
.
T
h
is
f
i
n
d
in
g
w
a
s
al
s
o
co
n
s
i
s
ten
t
w
it
h
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p
r
ev
io
u
s
s
tu
d
y
co
n
f
ir
m
ed
t
h
a
t
ac
tiv
e
b
eh
a
v
io
r
s
e
x
er
cise
was
ass
o
ciate
d
w
it
h
s
o
cial
s
u
p
p
o
r
t
ca
r
e
[
8
]
.
I
n
ad
d
itio
n
,
p
atien
t's
p
r
ef
er
e
n
ce
s
also
h
ad
a
p
o
s
itiv
e
i
m
p
ac
t
o
f
in
f
l
u
e
n
ce
ex
er
cise
ad
h
er
en
ce
an
d
m
a
x
i
m
ize
o
u
tco
m
es
[9
]
.
3
.
7
.
Ana
ly
s
is
t
he
ef
f
ec
t
o
f
re
la
x
a
t
io
n
pro
g
re
s
s
iv
e
m
us
cle
pro
g
ra
m
o
n
blo
o
d
pre
s
s
ur
e
lev
el
a
nd
cho
leste
ro
l t
o
t
a
l le
v
el
T
h
e
p
r
esen
t
o
f
th
is
s
t
u
d
y
s
tat
ed
th
at
th
e
b
lo
o
d
p
r
ess
u
r
e
an
d
ch
o
lest
er
o
l
lev
el
o
f
th
e
p
ati
en
ts
i
n
th
e
ex
p
er
i
m
e
n
tal
g
r
o
u
p
a
m
o
n
g
p
atien
t
s
w
ith
h
y
p
er
te
n
s
io
n
s
h
o
w
ed
th
at
s
ig
n
i
f
ica
n
t
r
ed
u
ctio
n
af
ter
p
ar
ticip
atin
g
th
e
r
elax
atio
n
p
r
o
g
r
ess
i
v
e
m
u
s
cle
p
r
o
g
r
a
m
th
a
n
th
o
s
e
o
f
th
e
co
n
tr
o
l
g
r
o
u
p
.
T
h
e
r
esu
lts
w
er
e
s
i
m
i
lar
to
th
e
p
r
ev
io
u
s
s
t
u
d
y
w
h
ic
h
f
o
u
n
d
t
h
at
t
h
e
b
lo
o
d
p
r
ess
u
r
e
a
n
d
to
tal
ch
o
le
s
ter
o
l
to
tal
lev
el
o
f
t
h
e
s
u
b
j
ec
ts
i
n
t
h
e
ex
p
er
i
m
e
n
tal
g
r
o
u
p
h
ad
s
tati
s
ticall
y
s
i
g
n
if
ica
n
t
d
ec
r
ea
s
e
co
m
p
ar
ed
to
th
e
p
atien
t
s
in
th
e
co
n
tr
o
l
g
r
o
u
p
(p
<
0
.
0
5
)
[1
0
]
.
T
h
e
in
cr
ea
s
ed
le
v
el
o
f
e
x
er
ci
s
e
b
eh
a
v
io
r
i
n
t
h
e
e
x
p
er
i
m
e
n
tal
g
r
o
u
p
in
d
icate
d
th
at
t
h
e
r
elax
atio
n
p
r
o
g
r
ess
iv
e
m
u
s
cle
p
r
o
g
r
a
m
m
a
y
b
e
ef
f
ec
ti
v
e
in
d
ec
r
ea
s
i
n
g
t
h
e
lev
el
o
f
b
lo
o
d
p
r
ess
u
r
e
lev
el
an
d
to
tal
ch
o
lest
er
o
l
to
tal
le
v
el.
P
atien
t
s
in
th
e
ex
p
er
i
m
en
ta
l
g
r
o
u
p
w
er
e
e
n
co
u
r
ag
ed
to
p
er
f
o
r
m
r
eg
u
lar
l
y
r
ela
x
atio
n
p
r
o
g
r
ess
iv
e
m
u
s
cle
p
r
o
g
r
a
m
to
im
p
r
o
v
e
e
x
er
cise
b
eh
a
v
io
r
at
least
1
5
0
m
in
u
te
s
p
er
w
ee
k
b
y
w
ar
m
i
n
g
u
p
b
ef
o
r
e
ex
er
cise,
p
r
o
g
r
ess
i
v
e
m
u
s
cle
b
y
r
ela
x
i
n
g
.
E
x
er
cise
b
eh
av
io
r
s
m
i
g
h
t
d
ec
r
ea
s
e
t
h
e
b
lo
o
d
p
r
ess
u
r
e
an
d
ch
o
lest
er
o
l
t
o
tal
lev
el
s
tat
u
s
b
y
i
n
cr
ea
s
i
n
g
t
h
e
u
p
ta
k
e
o
f
b
lo
o
d
g
lu
co
s
e
in
t
h
e
m
u
s
c
le
[1
1
]
.
Si
m
ilar
l
y
,
t
h
e
p
r
ev
io
u
s
s
t
u
d
y
f
o
u
n
d
th
at
ex
er
cise
ca
n
i
m
p
r
o
v
e
b
lo
o
d
p
r
ess
u
r
e
an
d
c
h
o
les
ter
o
l
to
tal
le
v
el
[1
2
]
.
T
h
is
s
tu
d
y
w
a
s
co
n
s
is
te
n
t
w
i
th
a
p
r
e
v
io
u
s
s
tu
d
y
w
h
ic
h
s
tated
t
h
at
s
elf
-
ef
f
icac
y
a
n
d
ad
h
er
en
ce
i
n
ex
er
cise
b
e
h
av
io
r
s
ig
n
i
f
ica
n
tl
y
lo
w
er
b
lo
o
d
p
r
ess
u
r
e
lev
e
l in
p
atie
n
ts
w
i
th
h
y
p
er
ten
s
io
n
[1
3
]
.
4.
CO
NCLU
SI
O
N
T
h
e
r
esu
lt
s
o
f
t
h
is
s
t
u
d
y
cle
ar
l
y
i
n
d
icate
t
h
e
p
o
s
i
tiv
e
i
m
p
ac
t
o
f
r
ela
x
atio
n
p
r
o
g
r
ess
i
v
e
m
u
s
cle
p
r
o
g
r
am
o
n
ex
er
ci
s
e
b
eh
a
v
io
r
,
b
lo
o
d
p
r
ess
u
r
e
le
v
el
a
n
d
c
h
o
lest
er
o
l
to
tal
le
v
el.
T
h
i
s
f
i
n
d
in
g
s
in
d
icate
d
t
h
at
en
co
u
r
ag
in
g
h
y
p
er
te
n
s
io
n
p
atien
ts
to
ad
o
p
t
an
d
im
p
l
e
m
en
t
th
e
p
r
o
g
r
am
i
n
th
e
d
ail
y
li
v
in
g
.
Hea
lt
h
ca
r
e
p
r
o
v
id
er
s
also
s
h
o
u
ld
f
o
cu
s
i
n
p
r
o
m
o
ti
n
g
t
h
is
p
r
o
g
r
a
m
a
m
o
n
g
p
atien
t
s
w
it
h
h
y
p
er
ten
s
io
n
.
ACK
NO
WL
E
D
G
E
M
E
NT
S
T
h
is
s
tu
d
y
w
as
s
u
p
p
o
r
ted
b
y
t
h
e
r
esear
ch
f
u
n
d
f
r
o
m
t
h
e
co
m
m
ittee
o
f
r
esear
c
h
u
n
it
o
f
Y
ar
s
i
Nu
r
s
i
n
g
C
o
lleg
e,
P
o
n
tia
n
ak
.
RE
F
E
R
E
NC
E
S
[1
]
Am
e
rica
n
He
a
rt
A
ss
o
c
iatio
n
(A
H
A
),
“
T
o
p
c
o
n
tr
ib
u
ti
n
g
f
a
c
to
rs t
o
h
ig
h
b
l
o
o
d
p
re
ss
u
re
-
k
n
o
w
y
o
u
r
risk
,”
2
0
1
2
.
[2
]
K.
S
li
w
a
,
e
t
a
l.
,
“
Re
v
iew
:
H
y
p
e
rt
e
n
sio
n
a
n
d
h
y
p
e
rten
siv
e
h
e
a
rth
d
ise
a
se
in
Af
ric
a
n
w
o
m
e
n
,
”
Cli
n
ica
l
Res
p
ir
a
to
ry
Ca
rd
io
lo
g
y
,
v
o
l.
1
0
3
,
p
p
.
5
1
5
-
5
2
3
,
2
0
1
4
.
[3
]
T
.
S
.
G
e
ra
c
i
a
n
d
S
.
A
.
Ge
ra
c
i,
“
Re
v
ie
w
a
rti
c
le:
c
o
n
sid
e
ra
ti
o
n
in
w
o
m
e
n
w
it
h
h
y
p
e
rten
sio
n
,”
T
h
e
S
o
u
th
e
n
M
e
d
ica
l
Asso
c
ia
ti
o
n
,
2
0
1
3
.
[4
]
S.
L
e
w
in
g
to
n
a
n
d
R
.
Clark
e
,
“
C
o
m
b
in
e
e
ff
e
c
t
o
f
s
y
sto
li
c
b
lo
o
d
p
re
ss
u
re
a
n
d
to
tal
c
h
o
les
tero
l
o
n
c
a
rd
io
v
a
sc
u
lar
d
ise
a
se
s ri
sk
,”
Ame
ric
a
n
He
a
rt A
ss
o
c
ia
ti
o
n
,
v
o
l
.
1
1
2
,
p
p
.
3
3
7
3
-
3
3
7
4
,
2
0
1
6
.
[5
]
A
.
B
a
n
d
u
ra
,
“
S
e
lf
-
e
ff
ica
c
y
.
In
V
.
S
.
Ra
m
a
c
h
a
u
d
ra
n
(Ed
.
)
,
”
En
c
y
c
lo
p
e
d
i
a
o
f
Hu
ma
n
Beh
a
v
io
r,
Ne
w
Yo
rk
:
A
c
a
d
e
m
ic P
re
ss
,
p
p
.
7
1
-
8
1
,
1
9
9
4
.
[6
]
A
.
Az
iza
n
,
e
t
a
l.
,
“
Ef
fe
c
t
o
f
a
b
e
h
a
v
io
ra
l
p
r
o
g
ra
m
o
n
e
x
e
rc
ise
a
d
h
e
re
n
c
e
a
n
d
e
x
e
rc
ise
se
l
f
-
e
ff
ica
c
y
in
C
o
m
m
u
n
it
y
Dw
e
ll
in
g
Old
e
r
P
e
rso
n
s
,”
C
u
rr
e
n
t
Ge
ro
n
to
lo
g
y
a
n
d
Ge
ria
trics
Res
e
a
rc
h
,
2
0
1
3
.
[7
]
F
.
H.
Ka
n
f
e
r
a
n
d
L
.
G
.
Bu
y
s,
“
S
e
lf
-
m
a
n
a
g
e
m
e
n
t
m
e
th
o
d
s
,”
i
n
F
.
H.
Ka
n
f
e
r
a
n
d
A
.
P
G
o
ld
ste
in
(e
d
s.),
“
He
lp
i
n
g
p
e
o
p
le c
h
a
n
g
e
:
A
tex
tb
o
o
k
o
f
m
e
t
h
o
d
s
,”
Ne
w
Yo
rk
:
P
e
rg
a
m
o
n
P
re
ss
,
p
p
.
3
0
5
-
3
6
0
,
1
9
9
1
.
[8
]
R.
D.
G
ra
v
e
,
e
t
a
l.
,
“
Re
v
ie
w
A
rti
c
le:
Co
g
n
it
iv
e
-
Be
h
a
v
io
ra
l
S
trate
g
ies
to
In
c
re
a
se
th
e
A
d
h
e
re
n
c
e
to
Ex
e
rc
ise
in
th
e
M
a
n
a
g
e
m
e
n
t
o
f
Ob
e
sit
y
,”
J
o
u
rn
a
l
o
f
O
b
e
sity
,
p
p
.
1
-
11
,
2
0
1
0
.
[9
]
E.
He
m
m
in
g
ss
o
n
,
e
t
a
l.
,
“
In
f
lu
e
n
c
in
g
a
d
h
e
re
n
c
e
to
p
h
y
sic
a
l
a
c
ti
v
it
y
b
e
h
a
v
io
r
c
h
a
n
g
e
in
o
b
e
se
a
d
u
lt
s,”
S
c
a
n
d
in
a
v
ia
n
J
o
u
rn
a
l
o
f
Nu
tri
ti
o
n
/Na
rs
in
g
f
o
r sk
n
i
n
g
,
v
o
l.
45,
p
p
.
114
-
1
1
9
,
2
0
0
1
.
[1
0
]
R.
A
.
P
a
m
u
n
g
k
a
s,
e
t
a
l.
,
“
Die
t
a
r
y
b
e
h
a
v
io
r
a
m
o
n
g
M
u
slim
p
a
ti
e
n
ts
w
it
h
p
o
o
rly
c
o
n
tr
o
ll
e
d
ty
p
e
2
DM
in
a
c
o
m
m
u
n
it
y
se
tt
in
g
in
In
d
o
n
e
sia
,
2
0
1
5
.
[1
1
]
S
.
R.
C
o
lb
e
rg
,
e
t
a
l
.,
“
Ex
e
rc
ise
a
n
d
Ty
p
e
2
Dia
b
e
tes
,”
Dia
b
e
tes
C
a
re
,
v
o
l.
3
3
,
p
p
.
e
1
4
7
–
e
1
6
7
,
2
0
1
0
.
[1
2
]
R.
J.
S
ig
a
l,
e
t
a
l.
,
“
Cli
n
ica
l
p
ra
c
ti
c
e
g
u
id
e
li
n
e
s:
p
h
y
sic
a
l
a
c
ti
v
it
y
a
n
d
d
iab
e
tes
,
”
Ca
n
a
d
i
a
n
J
o
u
rn
a
l
o
f
Dia
b
e
te,
v
o
l.
37,
p
p
.
S
4
0
-
S
4
4
,
2
0
1
3
.
[1
3
]
T
.
J.
Cris
we
ll
,
e
t
a
l.
,
“
Eff
e
c
t
o
f
se
l
f
-
e
ff
ic
a
c
y
a
n
d
so
c
ial
su
p
p
o
rt
o
n
a
d
h
e
re
n
c
e
to
a
n
ti
h
y
p
e
rten
siv
e
d
ru
g
s,”
Ph
a
rm
a
c
o
th
e
ra
p
y
,
v
o
l/
issu
e
:
3
0
(5
)
,
p
p
.
4
3
2
-
4
4
1
,
2
0
1
0
.
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