***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: Purpose The purpose of this study is to test the efficacy of the Survivor Health and Resilience Education Program intervention — a manualized , behavioral intervention focusing on bone health behaviors among adolescent survivors of childhood cancer . Methods Participants were 75 teens aged 11–21 years , one or more years post-treatment , and currently cancer-free . Teens were r and omized to a group-based intervention focusing on bone health or a wait-list control .  Bone health behaviors were assessed at baseline and 1-month post-intervention . Results Controlling for baseline outcome measures and theoretical predictors , milk consumption frequency ( p = 0.03 ) , past month calcium supplementation ( p < 0.001 ) , days in the past month with calcium supplementation ( p < 0.001 ) , and dietary calcium intake ( p = 0.04 ) were significantly greater at 1-month follow-up among intervention participants compared with control participants . Conclusions The intervention had a significant short-term impact on self-reported bone health behaviors among adolescent survivors of childhood cancer . Research examining long-term intervention effectiveness is warranted Background While research on exercise interventions during anticancer treatment is well-established in adults , only very few studies exist in children . However , pediatric patients experience great limitations to being physically active , and appropriate interventions are desired . ProcedureThe present study aim ed at investigating the effects of individualized exercise interventions during inpatient stays on pediatric patients with a malignant bone tumor . The parameter of interest was  physical activity ( PA ) . Patients ’ PA during home stays was assessed 6 weeks as well as 3 , 6 , 12 , and 18 months post-surgery . Patients were distinguished into an intervention  group and a  control group . All patients received endoprosthetic replacement of the affected bone in the same institution . Results A constant increase in all PA parameters was observed during follow-up . Exercise interventions were possible and appeared worthwhile . The intervention group showed better PA results at all measurements ; however , no significant differences between groups were found . Furthermore , differences decreased especially after the cessation of the intervention . General problems in reaching appropriate power and compliance were observed . Conclusions Individualized exercise interventions in pediatric bone tumor patients are possible and appear to be beneficial . Such interventions should be implemented in adjuvant care ; however , future research is needed to underst and more about the effects of different interventions Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more BACKGROUND The risk for cardiovascular disease ( CVD ) is increased in long-term survivors of childhood acute lymphoblastic leukemia ( ALL ) .  Chemotherapy may have direct toxic effects on vascular endothelium , potentially increasing the significance of endothelial dysfunction in the development of CVD in ALL survivors . Endothelial structure and function can be measured with carotid intima media thickness ( IMT ) and brachial flow mediated dilation ( FMD ) . IMT and FMD are intermediate markers of CVD . We studied endothelial function and the effects of an exercise program on vascular endothelium in long-term survivors of childhood ALL . PROCEDURE Twenty-one 16 - 30 year old long-term survivors of ALL ( age at diagnosis ≤16 years ) and 21 healthy controls were studied at baseline , and 17 of the ALL survivors participated in a 16 week home-based exercise program . IMT and FMD were studied before and after the exercise program . RESULTS At baseline , the ALL survivors had impaired overall FMD response ( FMDauc , P = 0.02 ) . FMDmax(% ) was 22 % lower ( P = 0.06 ) and FMD at 40 seconds 44 % lower ( P = 0.01 ) compared to healthy controls . After the exercise program , FMD at 40 seconds ( P < 0.01 ) and IMT ( P = 0.02 ) improved . The mean overall FMD response increased by 25 % after the exercise program , but this change was not statistically significant ( P = 0.27 ) . CONCLUSIONS Our results show that the excess burden of CVD morbidity in this population may possibly be alleviated by simple means . The importance of physical activity on the health of childhood ALL survivors should be emphasized . Longer , controlled studies are needed to confirm our findings The aim was to evaluate the effects of additional exercises during inpatient stays on bone mass in pediatric bone tumor patients . 21 patients were non-r and omly allocated either to the  exercise group ( n = 10 ) or the control group ( n = 11 ) . DXA of the lumbar spine , the non-affected femur and both calcanei was performed after completion of neoadjuvant chemotherapy ( baseline ) , as well as 6 and 12 months after baseline . Bone mineral content ( BMC ) , bone mineral density ( BMD ) and height-corrected lumbar spine Z-scores were determined . Group changes after 6 and 12 months were compared by covariance analyses . Additionally ,  daily physical activities ( PA )  were assessed by means of accelerometry . After adjusting for initial age , height and weight , mean reductions in lumbar spine and femoral BMC were lower in the exercise group ( not significant ) . Effect sizes during the observational period for lumbar spine and femur BMC were generally small ( partial η² = 0.03 ) . The exercise group demonstrated substantially higher PA levels in terms of gait cycles per day , per hour and moderate PA ( activities above 40 gait cycles per minute ) . Additional exercises for bone tumor patients are feasible during hospitalization . Though the intervention did not influence BMC , it appeared beneficial regarding PA promotion with respect to volume and intensity OBJECTIVE The Social Ecological Model ( SEM ) has been used to describe the aetiology of childhood obesity and to develop a framework for prevention . The current paper applies the SEM to data collected at multiple levels , representing different layers of the SEM , and examines the unique and relative contribution of each layer to children 's weight status . DESIGN Cross-sectional survey of r and omly selected households with children living in low-income diverse communities . SETTING A telephone survey conducted in 2009 - 2010 collected information on parental perceptions of their neighbourhoods , and household , parent and child demographic characteristics . Parents provided measured height and weight data for their children .  Geocoded data were used to calculate proximity of a child 's residence to food and physical activity outlets . SUBJECTS Analysis based on 560 children whose parents participated in the survey and provided measured heights and weights . RESULTS Multiple logistic regression models were estimated to determine the joint contribution of elements within each layer of the SEM as well as the relative contribution of each layer . Layers of the SEM representing parental perceptions of their neighbourhoods , parent demographics and neighbourhood characteristics made the strongest contributions to predicting whether a child was overweight or obese . Layers of the SEM representing food and physical activity environments made smaller , but still significant , contributions to predicting children 's weight status . CONCLUSIONS The approach used herein supports using the SEM for predicting child weight status and uncovers some of the most promising domains and strategies for childhood obesity prevention that can be used for design ing interventions PURPOSE The purpose of this controlled trial was to assess the effect of an approximately 3-wk intrahospital exercise intervention performed during inpatient hospitalization for pediatric allogeneic hematopoietic stem cell transplant ( HSCT ) on ( i ) immune cell recovery and ( ii ) body composition . METHODS Immune ( i.e. , blood counts of leukocytes , monocytes , lymphocytes , and lymphocyte sub population s ) and anthropometric variables ( i.e. , body mass , body mass index , and estimated fat-free mass ) were measured before and after ( + 15 and 30 d ) HSCT . Seven children ( 5 boys and 2 girls ; age ( mean + /- SD ) = 8 + /- 4 yr ) with high-risk cancer performed an individualized training program ( aerobic + resistance exercises ) in their isolated hospital rooms . We also assessed a control group ( n = 13 ; 9 boys and 4 girls ; age = 7 + /- 3 yr ) with similar medical conditions and following the same transplant protocol . RESULTS In both groups , the dendritic cell count decreased from pre-HSCT to + 15 d post-HSCT and thereafter ( up to + 30 d ) remained stabile ; however , the posttransplant decrease was more abrupt in the control group than that in the intervention group ( -87 % vs -63 % , respectively , from pre-HSCT to + 15 d ) . The rest of the immune cell parameters measured showed a similar response from pre-HSCT to post-HSCT in both groups . We found a significant effect of the interaction group x time for all anthropometric variables ( weight , body mass index , body fat , and fat-free mass ) , indicating an increase over the hospitalization period only in the intervention group , for example , body mass increased from 32.9 + /- 18.7 kg pre-HSCT to 35.4 + /- 18.6 kg at + 30 d in the intervention group versus a decrease from 30.2 + /- 16.6 to 29.3 + /- 6.3 kg in the control group . CONCLUSION Our findings support the feasibility of exercise training interventions during hospitalization , including immunocompromised children & NA ; This r and omized , controlled experimental study was carried out to determine the effects of an exercise program on both physical parameters and the quality of life of children with acute lymphoblastic leukemia ( ALL ) . A total of 41 children with ALL ( 20 trial and 21 control cases ) at two university hospitals were accepted into the study . Due to the demise of one of the children in the trial group , the study was completed with 19 trial and 21 control patients , a total of 40 children and their parents .  Regular and systematic exercise regimens implemented by children with ALL have result ed in improved testing results , enhanced physical performance , and better laboratory results compared with a control group and to children 's scores before the initiation of such a program BACKGROUND Children surviving acute lymphoblastic leukemia ( ALL ) are at increased risk for overweight and obesity over that of the general population . Whether a generic or tailored approach to weight management is needed for cancer survivors has yet to be tested . PROCEDURE Thirty-eight youth 8 - 18 years with BMI ≥ 85 % who had survived ALL were recruited for a r and omized clinical trial evaluating a weight management intervention ( WMI ) tailored for childhood ALL survivors ( Fit4Life ) . Fit4Life recipients received a 4-month web , phone , and text message-delivered WMI tailored for cancer survivorship . Controls received a general WMI delivered via phone and mail . Assessment s were performed at baseline and 4 months . Outcome data were analyzed according to assigned treatment condition over time . RESULTS Most ( 80 % , ( 70 % , 100 % ) [ median ( IQR ) ] ) of the assigned curriculum was received by Fit4Life participants as compared to 50 % ( 40 % , 65 % ) among controls . Fit4Life recipients ≥ 14 years demonstrated less weight gain ( P = 0.05 ) and increased moderate-to-vigorous physical activity ( P < 0.01 ) while all Fit4Life recipients reported reduced negative mood ( P < 0.05 ) over time as compared to control counterparts . CONCLUSIONS We demonstrated acceptable feasibility of a WMI tailored for overweight and obese children surviving ALL utilizing a multimodal technology approach . Improved weight , weight-related behavior , and psychological outcomes were demonstrated among Fit4Life intervention as compared to youth receiving a generic WMI . Data from this pilot trial may be used to design a larger trial to determine whether youth of all ages also can derive a benefit from a cancer survivor-tailored WMI and whether short-term outcomes translate into improved long-term outcomes for childhood ALL survivors Ruiz , JR , Fleck , SJ , Vingren , JL , Ramírez , M , Madero , L , Fragala , MS , Kraemer , WJ , and Lucia , A. Preliminary findings of a 4-month intrahospital exercise training intervention on IGFs and IGFBPs in children with leukemia . 24(5 ) : 1292 - 1297 , 2010-The aim of this study was to determine the effect of a 16-week intrahospital supervised , conditioning program including both resistance and aerobic type training on insulin-like growth factors 1 and 2 ( IGF-1 , IGF-2 ) , several IGF-binding proteins ( IGFBPs ) , and growth hormone ( GH ) in children receiving treatment against acute lymphoblastic leukemia ( ALL ) . We also analyzed the effects of a 20-week detraining period on these hormones . Seven children ( 3 girls and 4 boys ) aged 4 - 7 years in the maintenance phase of treatment against ALL performed 3 training sessions per week for 16 weeks of resistance ( 1 set of 8 - 15 repetitions of 11 exercises ) and aerobic training ( 30 minutes at ≥50 % heart rate max ) followed by 20 weeks of detraining where no structured exercise program was performed . Levels of IFG-1 and IFG-2 did not significantly change after the intervention period or after the detraining phase . Likewise , levels of GH , IGFBP-2 , and IGFBP-3 remained stable pre and posttraining and after the detraining period . IGFBP-1 levels significantly decreased after training ( −43.8 % , p = 0.014 ) , whereas there 
    Output:
    
The studies that included direct parental involvement showed positive outcomes on a variety of measures suggesting that increasing parental involvement in interventions for CCS may be one way to promote long-term lifestyle changes for pediatric cancer patients .