***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: IMPORTANCE Cardiorespiratory fitness ( CRF ) as assessed by formalized incremental exercise testing is an independent predictor of numerous chronic diseases , but its association with incident cancer or survival following a diagnosis of cancer has received little attention . OBJECTIVE To assess the association between midlife CRF and incident cancer and survival following a cancer diagnosis . DESIGN , SETTING , AND PARTICIPANTS This was a prospect i ve , observational cohort study conducted at a preventive medicine clinic . The study included 13 949 community-dwelling men who had a baseline fitness examination . All men completed a comprehensive medical examination , a cardiovascular risk factor assessment , and incremental treadmill exercise test to evaluate CRF . We used age- and sex-specific distribution of treadmill duration from the overall Cooper Center Longitudinal Study population to define fitness groups as those with low ( lowest 20 % ) , moderate ( middle 40 % ) , and high ( upper 40 % ) CRF groups . The adjusted multivariable model included age , examination year , body mass index , smoking , total cholesterol level , systolic blood pressure , diabetes mellitus , and fasting glucose level .  Cardiorespiratory fitness levels were assessed between 1971 and 2009 , and incident lung , prostate , and colorectal cancer using Medicare Parts A and B cl aims data from 1999 to 2009 ; the analysis was conducted in 2014 . MAIN OUTCOMES AND MEASURES The main outcomes were ( 1 ) incident prostate , lung , and colorectal cancer and ( 2 ) all-cause mortality and cause-specific mortality among men who developed cancer at Medicare age ( ≥65 years ) . RESULTS Compared with men with low CRF , the adjusted hazard ratios ( HRs ) for incident lung , colorectal , and prostate cancers among men with high CRF were 0.45 ( 95 % CI , 0.29 - 0.68 ) , 0.56 ( 95 % CI , 0.36 - 0.87 ) , and 1.22 ( 95 % CI , 1.02 - 1.46 ) , respectively . Among those diagnosed as having cancer at Medicare age , high CRF in midlife was associated with an adjusted 32 % ( HR , 0.68 ; 95 % CI , 0.47 - 0.98 ) risk reduction in all cancer-related deaths and a 68 % reduction in cardiovascular disease mortality following a cancer diagnosis ( HR , 0.32 ; 95 % CI , 0.16 - 0.64 ) compared with men with low CRF in midlife . CONCLUSIONS AND RELEVANCE There is an inverse association between midlife CRF and incident lung and colorectal cancer but not prostate cancer . High midlife CRF is associated with lower risk of cause-specific mortality in those diagnosed as having cancer at Medicare age Purpose Physical , nutritional and quality -of-life compromises are known sequelae of oesophageal cancer ( OC ) treatment . Inflammation and oxidative stress may be relevant to adverse consequences . Multimodal rehabilitation involving exercise and diet prescription may attenuate some of the negative consequences and optimise survivorship , and this was assessed in this feasibility study in OC patients at least 1 year post-oesophagectomy . Methods The 12-week programme included supervised and home-based exercise , dietetic counselling to ensure energy balance and multidisciplinary education . Baseline and post-intervention assessment s examined aerobic fitness , physical activity and body composition . Serum interleukin (IL)-1β , tumour necrosis factor (TNF)-α , IL-6 and IL-8 were measured via multiplex arrays . Lactate secretion , lipid peroxidation ( 4-HNE ) and oxidative stress ( 8-iso-PGF2α ) were measured by enzyme-linked immunosorbent assay ( ELISA ) . Results Twelve patients ( mean ( SD ) age 64(1.29 ) years ) participated . IL-8 reduced significantly from pre- to post-intervention ( percentage change −11.25 % ( 95 % CI −20.98 to −1.51 % ) , p = 0.03 ) , and there was a non-significant trend towards lower expression patterns of other inflammatory mediators . At baseline , inflammatory status correlated inversely with sedentary behaviour ( IL-6 rho = −0.74 , IL-8 rho = −0.59 , TNF-α rho = −0.69 ; p < 0.05 ) . While energy metabolism did not change , post-intervention lactate concentration correlated strongly and inversely with aerobic fitness ( rho = −0.68 , p = 0.02 ) . Body composition was maintained throughout the intervention . Conclusions Results suggest that multimodal rehabilitation following OC treatment reduced inflammatory status without compromising body composition . Findings will be further examined in a larger r and omised controlled trial Purpose Preoperative chemo(radio)therapy for oesophageal cancer ( OC ) may have an attritional impact on body composition and functional status , impacting postoperative outcome . Physical decline with skeletal muscle loss has not been previously characterised in OC and may be amenable to physical rehabilitation . This study characterises skeletal muscle mass and physical performance from diagnosis to post-neoadjuvant therapy in patients undergoing preoperative chemo(radio)therapy for OC . Methods Measures of body composition ( axial computerised tomography ) , muscle strength ( h and grip ) , functional capacity ( walking distance ) , anthropometry ( weight , height and waist circumference ) , physical activity , quality -of-life and nutritional status were captured prospect ively . Sarcopenia status was defined as pre-sarcopenic ( low muscle mass only ) , sarcopenic ( low muscle mass and low muscle strength or function ) or severely sarcopenic ( low muscle mass and low muscle strength and low muscle function ) . Results Twenty-eight participants were studied at both time points ( mean age 62.86 ± 8.18 years , n = 23 male ) . Lean body mass reduced by 4.9 ( 95 % confidence interval 3.2 to 6.7 ) kg and mean grip strength reduced by 4.3 ( 2.5 to 6.1 ) kg from pre- to post-neoadjuvant therapy . Quality -of-life scores capturing gastrointestinal symptoms improved . Measures of anthropometry , walking distance , physical activity and nutritional status did not change . There was an increase in sarcopenic status from diagnosis ( pre-sarcopenic n = 2 ) to post-treatment ( pre-sarcopenic n = 5 , severely sarcopenic n = 1 ) . Conclusions Despite maintenance of body weight , functional capacity and activity habits , participants experience declines in muscle mass and strength . Interventions involving exercise and /or nutritional support to build muscle mass and strength during preoperative therapy , even in patients who are functioning normally , are warranted Objectives Poor cardiorespiratory fitness ( CRF ) is associated with  death from cancer .  If follow-up time is short , this association may be confounded by sub clinical disease already present at the time of CRF assessment . This study investigates the association between CRF and death from cancer and any cause with 42 years and 44 years of follow-up , respectively . Setting , participants and main outcome measures Middle-aged , employed and cancer-free Danish men from the prospect i ve Copenhagen Male Study , enrolled in 1970–1971 , were included .  CRF ( maximal oxygen consumption ( VO2max ) )  was estimated using a bicycle ergometer test and analysed in multivariable Cox models including conventional risk factors , social class and self-reported physical activity .  Death from cancer and all-cause mortality was assessed using Danish national registers . Follow-up was 100 % complete . Results In total , 5131 men were included , mean ( SD ) age 48.8 ( 5.4 ) years . During 44 years of follow-up , 4486 subjects died  ( 87.4 % ) , 1527 ( 29.8 % ) from cancer . In multivariable models , CRF was highly significantly inversely associated with death from cancer and all-cause mortality ( ( HR ( 95 % CI ) ) 0.83 ( 0.77 to 0.90 ) and 0.89 ( 0.85 to 0.93 ) per 10 mL/kg/min increase in estimated VO2max , respectively ) . A similar association was seen across specific cancer groups , except death from prostate cancer ( 1.00 ( 0.82 to 1.2 ) ; p=0.97 ; n=231 ) . The associations between CRF and outcomes remained essentially unchanged after excluding subjects dying within 10 years ( n=377 ) and 20 years ( n=1276 ) of inclusion . Conclusions CRF is highly significantly inversely associated with death from cancer and all-cause mortality . The associations are robust for exclusion of subjects dying within 20 years of study inclusion , thereby suggesting a minimal influence of reverse causation CONTEXT Although several studies have examined peri-operative nutritional supplementation in patients undergoing pancreaticoduodenectomy all provided support at various timepoints with a variety of protocol s. OBJECTIVE This study undertakes a detailed nutritional and anthropometric assessment of patients due to undergo pancreaticoduodenectomy with particular reference to pre-operative nutritional status and peri-operative outcome . PATIENTS Twenty-six patients undergoing pancreaticoduodenectomy .  SETTING A regional hepatobiliary service . MAIN OUTCOME MEASURES Nutritional , anthropometric and clinical course details . DESIGN Data were collected prospect ively . RESULTS There was no significant change in any anthropometric index from baseline to immediately prior to surgery . However , there was a significant fall in BMI comparing baseline measurements to observations at time of discharge from hospital ( P<0.001 ) . There was , in addition , a significant difference between baseline and BMI at 3 months ( P<0.001 ) . Similar trends were observed in mid-arm circumference , triceps skin fold thickness and h and -grip . There was no in-hospital or 3-month post-operative mortality in this series . CONCLUSION Nutritional and anthropometric indices remain stable from the time of index admission to operation . However , there is a drastic and sustained reduction in nutritional indices in the post-operative period with this deficiency being sustained at 3-months after operation BACKGROUND Preserving functional walking capacity and nutritional status is important for patients with esophageal cancer , but no effective intervention is available , particularly during active treatment . METHODS This pilot r and omized controlled trial tested the effects of a walk- and -eat intervention for patients with esophageal cancer undergoing neoadjuvant chemoradiotherapy . Participants with locally advanced esophageal cancer stage IIB or higher ( n = 59 ) were r and omly assigned to receive the walk- and -eat intervention ( n = 30 ; nurse-supervised walking three times per week and weekly nutritional advice ) or usual care ( n = 29 ; control group ) during 4 - 5 weeks of chemoradiotherapy . Primary endpoints were changes in distance on the 6-minute walk test , h and -grip strength , lean muscle mass , and body weight between initiation and completion of intervention . RESULTS Participants ( mean age : 59.6 years ) were mostly male ( 92.9 % ) with squamous cell carcinoma ( 96.4 % ) . During chemoradiotherapy , participants who received the walk- and -eat intervention had 100-m less decline than controls in walk distance ( adjusted p = .012 ) , 3-kg less decrease in h and -grip strength ( adjusted p = .002 ) , and 2.7-kg less reduction in body weight ( adjusted p < .001 ) , regardless of age . The intervention group also had significantly lower rates of need for intravenous nutritional support and wheelchair use . CONCLUSION The nurse-led walk- and -eat intervention is feasible and effective to preserve functional walking capacity and nutritional status for patients with esophageal cancer undergoing neoadjuvant chemoradiotherapy Non-r and omised studies of the effects of interventions are critical to many areas of healthcare evaluation , but their results may be biased . It is therefore important to underst and and appraise their strengths and weaknesses . We developed ROBINS-I ( “ Risk Of Bias In Non-r and omised Studies - of Interventions ” ) , a new tool for evaluating risk of bias in estimates of the comparative effectiveness ( harm or benefit ) of interventions from studies that did not use r and omisation  to allocate units ( individuals or clusters of individuals ) to comparison groups . The tool will be particularly useful to those undertaking systematic review s that include non-r and omised studies OBJECTIVE Despite the potential for nutritional deficits in patients undergoing pancreaticoduodenectomy or Whipple procedure  , long-term assessment of nutritional status has largely been ignored . This study assessed nutritional status of 24 Whipple patients compared with matched post-cholecystectomy controls . METHODS Clinical assessment was by subjective global assessment , body composition was assessed by bioelectric impedance analysis and functional assessment was by respiratory muscle strength and skeletal muscle function performed by electrical stimulation of the ulnar nerve of the wrist and h and -grip dynamometry . RESULTS Whipple patients studied 4.6+/-0.7 years since surgery and controls ( 4.8+/-0.7 years since surgery ) were all judged clinical ly to be in a good nutritional state . Compared with controls , Whipple patients had significantly lower body weight ( Whipple 
    Output:
    
The relationship between physical function and pancreatic/liver cancer resection outcome remains unclear , although anaerobic threshold appears the strongest predictor of postoperative outcomes .