***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: Physical activity is associated with improved breast cancer survival , but the underlying mechanisms , possibly including modification of the inflammatory state , are not well understood . We analyzed changes in interleukin (IL)-6 , C-reactive protein ( CRP ) , and TNF-α in a r and omized controlled trial of exercise in postmenopausal breast cancer survivors . Seventy-five women , recruited through the Yale-New Haven Hospital Tumor Registry , were r and omized to either a six-month aerobic exercise intervention or usual care . Correlations were calculated between baseline cytokines , adiposity , and physical activity measures . Generalized linear models were used to assess the effect of exercise  on IL-6 , CRP , and TNF-α . At baseline , IL-6 and CRP were positively correlated with body fat and body mass index ( BMI ) and were inversely correlated with daily pedometer steps ( P < 0.001 ) . We found no significant effect of exercise  on changes in inflammatory marker concentrations between women r and omized to exercise versus usual care , though secondary analyses revealed a significant reduction in IL-6 among exercisers who reached 80 % of the intervention goal compared with those who did not . Future studies should examine the effect of different types and doses of exercise and weight loss on inflammatory markers in large-scale trials of women diagnosed with breast cancer . Cancer Prev Res ; 6(2 ) ; 109–18 . © 2012 AACR A continuing challenge in weight loss treatment is attaining maintenance of weight loss . The goal of this study was to develop a counseling method that would assist African American breast cancer survivors with weight loss maintenance . In this pilot study , 31 obese breast cancer survivors were recruited .  Individualized , dietitian-led counseling by telephone and free Weight Watchers coupons were provided to all participants for 18 months . At the 6-month time point , women were r and omized to receive spirituality counseling or not in addition to the st and ard program . The spirituality counseling was delivered via telephone using an 8-step framework . Subjects were asked to utilize  daily meditation or prayer , daily readings  , and the recording of thoughts in a journal . Mean weight loss from baseline to 6 months was a modest 2.0 % of baseline weight . From 6 to 18 months , there was no further weight change in the spirituality arm and a gain of 0.7 % in the dietitian-only arm . Despite little effect on weight loss , it did appear that spirituality counseling positively affected spiritual well-being ( FACIT-Sp ) scores and dietary quality . The spirituality counseling framework therefore may be further refined and useful for other health promotion studies with African American population OBJECTIVE The purpose of this analysis was to examine the correlates of the physical and psychosocial domains of quality of life ( QOL ) in a cohort of breast cancer survivors participating in a weight loss intervention trial . METHODS Correlates of QOL and psychosocial functioning were examined in 692 overweight or obese breast cancer survivors at entry into a weight loss trial .  QOL was explored with three measures :  Short-form 36 ( SF-36 ) , Impact of Cancer scale ( IOC ) , and the Breast Cancer Prevention Trial ( BCPT ) symptom scales .  Available data included information on weight and physical activity , as well as demographic and medical characteristics . Multivariate analyses were used to identify associations adjusted for other characteristics . RESULTS In multivariate analysis , younger age was associated with higher negative impact scores ( p < 0.0001 ) . Hispanic , African-American , and Asian women had higher positive IOC impact scores compared with White non-Hispanic women ( p < 0.01 ) . Increased number of comorbidities was associated with lower physical and mental QOL scores ( p < 0.01 ) . Body mass index was not independently associated with QOL measures . Physical activity was directly associated with physical and mental QOL and IOC positive impact , and inversely related to IOC negative impact and Breast Cancer Prevention Trial symptom scales . CONCLUSIONS Quality -of-life measures in breast cancer survivors are differentially associated with demographic and other characteristics . When adjusted for these characteristics , degree of adiposity among overweight or obese women does not appear to be independently associated with QOL . Among overweight or obese breast cancer survivors , higher level of physical activity is associated with higher QOL across various scales and dimensions Abstract Minority recruitment to cancer trials is low and there are limited data on minority adherence to lifestyle modification interventions . We examined factors related to recruitment and adherence to a pilot weight loss intervention among Hispanic and black breast cancer survivors . Participants completed a detailed screening interview to assess barriers to enrollment . An index was created to assess adherence at 6 months . 112 potentially eligible women were identified ; 66 consented and completed a screening interview . After screening , 9 were ineligible ; 15 opted to not enroll ; and 42 were r and omized . Among eligible women , earlier stage at diagnosis , treatment type , and negative beliefs related to exercise and diet after diagnosis were negatively associated with study enrollment ( P < 0.05 ) . Self-reported barriers to adherence included fatigue , family responsibilities , illness , work , transportation , and negative perceptions of exercise and diet . Results from this study emphasize the need to adapt recruitment and adherence strategies to address these factors OBJECTIVE Physical inactivity is a modifiable risk factor for breast cancer .  Physical activity interventions that can be delivered through the Internet have the potential to increase participant reach . The efficacy of an Internet-based physical activity intervention was tested in a sample of women at an elevated risk for breast cancer . METHOD A total of 55 women with at least 1 first-degree relative with breast cancer ( but no personal history of breast cancer ) were r and omized to a 3-month theoretically grounded Internet-based physical activity intervention or an active control arm . Minutes of moderate to vigorous physical activity , psychosocial mediators of physical activity adoption and maintenance , as well as worry and perceived risk of developing breast cancer were assessed at baseline , 3-month , and 5-month follow up . RESULTS Participants were on average 46.2 ( SD = 11.4 ) years old with a body mass index of 27.3 ( SD = 4.8 ) kg/m2 . The intervention arm significantly increased minutes of moderate to vigorous physical activity compared to the active control arm at 3 months ( 213 vs. 129 min/week ) and 5 months ( 208 vs. 119 min/week ; both ps < .001 ) . Regression models indicated that participants in the intervention had significantly higher self-efficacy for physical activity at 3 months ( p < .01 ) and borderline significantly higher self-efficacy at 5 months ( p = .05 ) . Baseline breast cancer worry and perceived risk were not associated with physical activity . CONCLUSION Findings from this study suggest that an Internet-based physical activity intervention may substantially increase physical activity in women with a family history of breast cancer OBJECTIVE Obesity is associated with poorer breast cancer outcomes and losing weight postdiagnosis may improve survival . As Hispanic and black women have poorer breast cancer prognosis than non-Hispanic whites diagnosed at similar age and stage , and have higher rates of obesity , effective weight loss strategies are needed . We piloted a r and omized , waitlist-controlled , crossover study to examine the effects and feasibility of the commercial Curves weight loss program among Hispanic , African American and Afro-Caribbean breast cancer survivors . DESIGN AND METHODS Women with stage 0-IIIa breast cancer ≥ 6 months posttreatment , sedentary , and BMI ≥ 25 kg/m(2 ) were r and omized to the immediate arm ( IA ) : 6 months of the Curves program followed by 6 months of observation ; or the waitlist control arm ( WCA ) : 6 months of observation followed by 6 months of the Curves program . The Curves program uses a 30-min exercise circuit and a high-vegetable/low-fat/calorie-restricted diet . RESULTS A total of 42 women enrolled ( 79 % Hispanic , 21 % black ) , mean age 51 ( range 32 - 69 ) and mean BMI 33.2(± 5.9 ) kg/m(2 ) ; 91 % were retained at month 12 . At month 6 , women in the IA lost an average 3.3 % ( ± 3.5 % ) of body weight ( range : 1.7 % gain to 10.6 % loss ) , as compared with 1.8 % ( ± 2.9 % ) weight loss in the WCA ( P = 0.04 ) . At month 12 , on average women in the IA regained some but not all of the weight lost during the first 6 months ( P = 0.02 ) . CONCLUSIONS Minority breast cancer survivors were recruited and retained in a weight loss study . Six months of the Curves program result ed in moderate weight loss , but weight loss was not maintained postintervention . Future interventions should identify methods to increase uptake and maintenance of weight loss behaviors Purpose . To examine associations of intervention dose with behavior change outcomes in a telephone counseling intervention for physical activity and dietary change .  Design . Secondary analysis of intervention participants from a cluster-r and omized controlled trial . Setting . Primary care practice s in a disadvantaged community in Queensl and , Australia . Subjects . Adult patients with type 2 diabetes or hypertension . Intervention . Patients ( n = 228 ) received telephone counseling  over a 12-month period . The initiation phase ( 1–4 months ) consisted of up to 10 weekly or fortnightly calls ; the maintenance-enhancement phase ( 5–12 months ) consisted of up to eight monthly calls . Measures . Intervention dose was defined as the number of calls completed in total and during each phase and was categorized into tertiles .  Diet and physical activity  were measured using vali date d self-report instruments . Analysis . Multivariate analyses of call completion and change in health behaviors . Results . Those completing a high number of calls were more likely to be female , white , older than 60 years , retired , and earning less than an average weekly Australian wage . Relative to low call completion , high completion during the maintenance-enhancement phase was associated with significantly greater ( least squares mean [ SE ] ) behavioral improvement for the following : total fat intake as percentage of calories ( –3.58 % [ .74 % ] ) , saturated fat intake ( –2.51 % [ .51 % ] ) , fiber intake ( 4.23 [ 1.20 ] g ) , and moderate-to-vigorous physical activity ( 187.82 [ 44.78 ] minutes ) . Conclusion . Interventions of longer duration may be required to influence complex behaviors such as physical activity and fat and fiber intake . ( Am J Health Promot 2011;25[4]:257–263 . Background Cancer of the uterine corpus is the most common gynecologic malignancy and the fourth most common cancer in U.S. women . There is a racial disparity in the survival from endometrial cancer and this may be addressed by culturally-tailored lifestyle interventions to help African American ( AA ) endometrial cancer survivors lose weight or maintain a healthy weight . Objective The overall purpose of this pilot study is to develop and evaluate a culturally-tailored lifestyle intervention to help AA uterine cancer survivors reduce their risk of cancer recurrence and improve their quality of life through healthy eating , physical activity , and weight management . While many interventions have been evaluated to assist cancer survivors through diet and physical activity , few have focused on AA women with a uterine cancer diagnosis . Methods Community-engaged research principles are being followed . This study was developed with input from the Augusta University ( AU ) College of Nursing Community Advisory Board ( CAB ) and the Division of Gynecologic Oncology at the Georgia Cancer Center at AU . Weekly sessions throughout a 12-week intervention will include physical activity and lectures on improving nutritional status . The pre/post-test design includes baseline and 6-month follow-up , where participants will complete a question naire that assesses knowledge and attitudes about physical activity , nutrition , uterine cancer , social support , and quality of life . Conclusions From this pilot study , we will learn more about the feasibility and integration of healthy lifestyle interventions in this patient population , and the results can provide an opportunity for a larger-scale , multi-center study with a r and omized controlled design CONTEXT Physical activity has been shown to decrease the incidence of breast cancer , but the effect on recurrence or survival after a breast cancer diagnosis is not known . OBJECTIVE To determine whether physical activity among women with breast cancer decreases their risk of death from  breast cancer  compared with more sedentary women . DESIGN , SETTING , AND PARTICIPANTS Prospect i ve observational study based on responses from 2987 female registered nurses in the Nurses ' Health Study who were diagnosed with stage I , II , or III breast cancer between 1984 and 1998 and who were followed up until death or June 2002 , whichever came first . MAIN OUTCOME MEASURE Breast cancer mortality risk according to  physical activity  category ( <3 , 3 - 8.9 , 9 - 14.9 , 15 - 23.9 , or > or = 24 metabolic equivalent task [ MET ] hours per week ) . RESULTS Compared with women who engaged in less than 3 MET-hours per week of physical activity , the adjusted relative risk ( RR ) of death from breast cancer was 0.80 ( 95 % confidence interval [ CI ] , 0.60 - 1.06 ) for 3 to 8.9 MET-hours per week ; 0.50 ( 95 % CI , 0.31 - 0.82 ) for 9 to 14. 
    Output:
    
The most common reported barriers among the target population were fatigue , lack of social support , weather , illness/health issues , cost , time constraints , living too far away , and inability/unwillingness to obtain physician clearance , whereas the most common facilitators were faith , other health concerns , and social support .