***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: Clinical and experimental studies have shown that a moderately increased physical activity level may have beneficial effects in terms of exercise conditioning , resistance to infection and decreased relative risk of cancer . Modulation of the innate and adaptive components of the immune system with a shift of cytokines and their antagonists to a more pro- and less anti-inflammatory response was found to be a prominent feature in non-tumor patients and healthy volunteers . As quantitative data concerning the cytokine/antagonist response following exercise are not available for tumor patients , we compared the effects of a post-operative rehabilitation program with moderate exercise ( ME ) intensity ( 0.55 - 0.65 x maximal aerobic power ) with a program with low exercise ( LE ) intensity ( 0.30 - 0.40 x maximal aerobic power ) in patients with curatively treated colorectal carcinoma ( UICC II and III ) measuring pro- ( IL-1beta , IL-6 , tumour necrosis factor ( TNF ) ) and anti-inflammatory cytokines ( IL-1 receptor antagonist , sTNF receptors I and II ) . Twenty-three patients participated in this prospect i ve trial , N = 13 in the ME group , N = 10 in the LE group . Exercise was performed daily 30 - 40 min for 2 weeks . Basal ( circulating ) and LPS-stimulated ( phasic ) cytokine and antagonist response was determined before exercise and after 1 and 2 weeks using appropriate ELISA tests . The LPS-stimulated interleukin-1 receptor antagonist ( IL-1ra ) response in the ME group gradually decreased from 31,532.6 ( 160.0 - 70,028.0 ) to 18,033.0 pg/ml ( 5040.0 - 52,570.0 ) after one and to 22,892.0 pg/ml ( 6376.0 - 34,726.0 ) after 2 weeks ( P < 0.05 ) with a concomitant decrease of the corresponding IL-1ra/IL-6 and IL-1ra/IL-1beta ratio : 2.51 - 1.41 and 4.1 - 3.1 , respectively . In contrast , in the LE group LPS-stimulated cytokines and antagonists did not significantly change during exercise . Circulating cytokines and antagonists remained unchanged in both groups . In providing quantitative data in patients with curatively-treated colorectal cancer , we demonstrated that a short-term rehabilitation program with moderate exercise leads to a decreased LPS-induced antagonist response with a shift to a more pro-inflammatory state ( decreased antagonist/cytokine ratio ) . Whether this change of the phasic immune response to moderate exercise may be clinical ly beneficial ( decreased rates of infection , relapses and /or second tumours ) is possible , but has to be investigated in long-term studies This pilot study examined the efficacy of two home-based exercise programs on alleviating fatigue and improving functional capacity in breast cancer survivors . Participants were r and omly assigned into one of three groups : aerobic exercise ( AE ) , resistance exercise ( RE ) , or usual care control ( CON ) . After receiving individualized instruction and training , participants assigned to the AE and RE groups were asked to perform the prescribed exercise(s ) 3 times per week for 12 weeks at home . Both groups were instructed to keep their perceived exercise intensity in the " fairly light " to " somewhat hard " range using the Borg Perceived Exertion Scale . All participants completed the revised Piper Fatigue Scale ( PFS ) and the 6-minute walk test ( 6MWT ) at baseline and 12-week post-exercise program . Analysis of pre- and post-training data revealed a significant reduction in fatigue levels on the PFS among participants in the AE group ( Z=2.521 , one-tailed P=0.006 ) , and a significant improvement in the distance of the 6MWT for the RE group ( Z=2.366 , one-tailed P=0.009 ) at the end of 12-week study period . No significant changes in fatigue or functional status were observed in the CON group . Findings provide preliminary support for RE as a viable strategy for improving functional capacity in breast cancer survivors , while AE may be more effective in attenuating cancer-related fatigue . Incorporating RE training for future research may help advance the growing body of knowledge in symptom management for breast cancer survivors Evidence -based practice involves the use of evidence from systematic review s and r and omised controlled trials , but the extent of this evidence in physiotherapy has not previously been surveyed . The aim of this survey is to describe the quantity and quality of r and omised controlled trials and the quantity of systematic review s relevant to physiotherapy . The Physiotherapy Evidence Data base ( PEDro ) was search ed . The quality of trials was assessed with the PEDro scale . The search identified a total of 2,376 r and omised controlled trials and 332 systematic review s. The first trial was published in 1955 and the first review was published in 1982 . Since that time , the number of trials and review s has grown exponentially . The mean PEDro quality score has increased from 2.8 in trials published between 1955 and 1959 to 5.0 for trials published between 1995 and 1999 . There is a substantial body of evidence about the effects of physiotherapy . However , there remains scope for improvements in the quality of the conduct and reporting of clinical trials Few r and omized controlled trials have examined the effects of combined aerobic and resistance training in breast cancer survivors soon after completing adjuvant therapy . Breast cancer survivors ( N = 58 ) within 2 years of completing adjuvant therapy were r and omly assigned to an immediate exercise group ( IEG ; n = 29 ) or a delayed exercise group ( DEG ; n = 29 ) . The IEG completed 12 weeks of supervised aerobic and resistance exercise , three times per week . The DEG completed the program during the next 12 weeks . Participants completed patient-rated outcomes at baseline , 6 , 12 , 18 and 24 weeks . The primary endpoint was overall quality of life ( QoL ) measured by the Functional Assessment of Cancer Therapy-Breast scale . Secondary endpoints were fatigue , social physique anxiety , and physical fitness . Follow-up data was obtained on 97 % of participants and exercise adherence was 61.3 % . Repeated measures analyses of variance revealed a significant group by time interaction for overall QoL ( P < 0.001 ) . Specifically , QoL increased in the IEG from baseline to 12 weeks by 20.8 points compared to a decrease in the DEG of 5.3 points ( mean group difference = 26.1 ; 95 % CI = 18.3–32.7 ; P < 0.001 ) . From 12 to 24 weeks , QoL increased in the DEG by 29.5 points compared to an increase of 6.5 points in the IEG ( mean group difference = 23.0 ; 95 % CI = 16.3–29.1 ; P < 0.001 ) . Similar results were obtained for the secondary endpoints . Combined aerobic and resistance exercise soon after the completion of breast cancer therapy produces large and rapid improvements in health-related outcomes PURPOSE Self-directed and supervised exercise were compared with usual care in a clinical trial design ed to evaluate the effect of structured exercise on physical functioning and other dimensions of health-related quality of life in women with stages I and II breast cancer . PATIENTS AND METHODS One hundred twenty-three women with stages I and II breast cancer completed baseline evaluations of generic and disease- and site-specific health-related quality of life , aerobic capacity , and body weight . Participants were r and omly allocated to one of three intervention groups : usual care ( control group ) , self-directed exercise , or supervised exercise .  Quality of life , aerobic capacity , and body weight measures were repeated at 26 weeks . The primary outcome was the change in the Short Form-36 physical functioning scale between baseline and 26 weeks . RESULTS Physical functioning in the control group decreased by 4.1 points , whereas it increased by 5.7 points and 2.2 points in the self-directed and supervised exercise groups , respectively ( P = .04 ) . Post hoc analysis showed a moderately large ( and clinical ly important ) difference between the self-directed and control groups ( 9.8 points ; P = .01 ) and a more modest difference between the supervised and control groups ( 6.3 points ; P = .09 ) . No significant differences between groups were observed for changes in quality of life scores . In a secondary analysis of participants stratified by type of adjuvant therapy , supervised exercise improved aerobic capacity ( + 3.5 mL/kg/min ; P = .01 ) and reduced body weight ( -4.8 kg ; P < .05 ) compared with usual care only in participants not receiving chemotherapy . CONCLUSION Physical exercise can blunt some of the negative side effects of breast cancer treatment , including reduced physical functioning .  Self-directed exercise is an effective way to improve physical functioning compared with usual care . In participants not receiving chemotherapy  , supervised exercise may increase aerobic capacity and reduce body weight compared with usual care The objective was to determine the effects of exercise training on changes in blood immune function in postmenopausal breast cancer survivors . Fifty-three postmenopausal breast cancer survivors were r and omly assigned to an exercise ( n=25 ) or control group ( n=28 ) . The exercise group trained on cycle ergometers three times per week for 15 wk . The control group did not train . The primary end point was change in natural killer cell cytotoxic activity in isolated peripheral blood mononuclear cells . Secondary end points were changes in st and ard hematological variables , whole blood neutrophil function , the phenotypes of isolated mononuclear cells , estimations of unstimulated and phytohemaglutinin-stimulated mononuclear cell function ( rate of [3H]thymidine uptake ) , and the production of proinflammatory [ interleukin (IL)-1alpha , tumor necrosis factor-alpha , IL-6 ] and anti-inflammatory cytokines ( IL-4 , IL-10 , transforming growth factor-beta1 ) . Statistical tests were two-sided ( alpha < 0.05 ) . Fifty-two participants completed the trial . Intention-to-treat analyses , which included the baseline value as a covariate , showed significant differences between groups for change in percent specific lysis of a target natural killer cell at all five effector-to-target ratios ( adjusted mean between-group change over all 5 effector-to-target ratios = + 6.34 % ; P < 0.05 for all comparisons ) , the lytic activity per cell ( adjusted mean between-group change = -2.72 lytic units ; P=0.035 ) , and unstimulated [3H]thymidine uptake by peripheral blood lymphocytes ( adjusted mean between-group change = + 218 per dpm x 10(6 ) cells ; P = 0.007 ) . There were no significant differences between groups for change in any other end point . Exercise training increased natural killer cell cytotoxic activity and unstimulated [3H]thymidine uptake by peripheral blood lymphocytes in postmenopausal breast cancer survivors Introduction Older breast cancer survivors ( BCS ) report more falls and functional limitations than women with no cancer history .  Exercise training could reduce risk factors for future falls and disability . Methods We conducted a r and omized , controlled trial in 106 early-stage , postmenopausal BCS who were ≥50 years old at diagnosis and post-treatment . Women were r and omly assigned to a 1-year resistance + impact exercise program or a stretching placebo program . Endpoints were one repetition maximum bench press and leg press strength , timed five chair st and s , 4 m usual walk speed , timed stance tests , h and grip strength , self-report physical function , and fatigue . We also examined the influence of age , adjuvant hormone therapy use , and exercise adherence on study outcomes . Results Women in the resistance + impact training program significantly improved maximal leg ( p < 0 .02 ) and bench ( p < 0 .02 ) press strength compared to the stretching group . Women who attended 50 % or more of prescribed resistance training sessions had significantly better changes in maximal strength measures compared to less adherent women . Conclusions Resistance + impact exercise is superior to stretching at improving maximal muscle strength and exercise adherence contributes to the degree of improvement . Implication s for cancer survivorsOlder BCS can safely engage in resistance exercise that improves lower and upper body strength , thereby reducing a risk factor for falls and future disability . However , the ability of resistance training to shift other indices of fall and disability risk , i.e. , balance and function , is unclear . Strategies to promote adherence to resistance training could lead to greater improvements in strength Objectives To determine functional and psychological benefits of a 12 week supervised group exercise programme during treatment for early stage breast cancer , with six month follow-up . Design Pragmatic r and omised controlled prospect i ve open trial . Setting Three National Health Service oncology clinics in Scotl and and community exercise facilities . Participants 203 women entered the study ; 177 completed the six month follow-up . Interventions Supervised 12 week group exercise programme in addition to usual care , compared with usual care . Main outcome measures Functional assessment of cancer therapy ( FACT ) question naire , Beck depression inventory , positive and negative affect scale , body mass index , seven day recall of physical activity , 12 minute walk test , and assessment of shoulder mobility . Results Mixed effects models with adjustment for baseline values , study site , treatment at baseline , and age gave intervention effect estimates ( intervention minus control ) at 12 weeks of 129 ( 95 % 
    Output:
    
Meta-regression analysis revealed that exercise volume parameters are closely related with the effect estimates on CRF .
Conclusions Supervised exercise  reduces CRF and must be implemented in breast cancer rehabilitation setting s. High-volume exercises are safe and effective in improving CRF and overall quality of life in women with breast cancer .