***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: Introduction Lymphedema is a potentially debilitating condition that occurs among breast cancer survivors . This study examines the incidence of self-reported lymphedema , timing of lymphedema onset , and associations between sociodemographic , clinical and lifestyle factors and lymphedema risk across racial-ethnic groups using data from a multicenter , multiethnic prospect i ve cohort study of breast cancer survivors , the Health , Eating , Activity and Lifestyle Study . Methods A total of 666 women diagnosed with breast cancer staged as in situ , localized or regional disease at ages 35 to 64 years were recruited through the Surveillance , Epidemiology , and End Results registries in New Mexico ( non-Hispanic white and Hispanic white ) , Los Angeles County ( black ) , and Western Washington ( non-Hispanic white ) and followed for a median of 10.2 years . We evaluated  sociodemographic factors , breast cancer- and treatment-related factors , comorbidities , body mass index ( BMI ) , hormonal factors , and lifestyle factors in relation to self-reported lymphedema by fitting Cox proportional hazards models , estimating hazard ratios ( HR ) and 95 % confidence intervals ( CI ) . Results Over the follow-up period , 190 women ( 29 % ) reported lymphedema .  The median time from breast cancer diagnosis to onset of lymphedema was 10.5 months ( range : 0.5 to 134.9 months ) . Factors independently associated with lymphedema were total/modified radical mastectomy  ( versus partial/less than total mastectomy ; HR = 1.37 , 95 % CI : 1.01 to 1.85 ) ,  chemotherapy  ( versus no chemotherapy ; HR = 1.48 , 95 % CI : 1.09 to 2.02 ) , no lymph nodes removed ( versus ≥10 lymph nodes removed ; HR = 0.17 , 95 % CI : 0.08 to 0.33 ) , pre-diagnostic BMI ≥30 kg/m2 ( versus BMI < 25 kg/m2 ; HR = 1.59 , 95 % CI : 1.09 to 2.31 ) , and hypertension ( versus no hypertension ; HR = 1.49 , 95 % CI : 1.06 to 2.10 ) . After adjusting for demographics and breast cancer- and treatment-related factors , no significant difference in lymphedema risk was observed across racial/ethnic groups . Analyses stratified by race/ethnicity showed that hypertension and chemotherapy were lymphedema risk factors only for black women . Conclusions Breast cancer patients who have undergone extensive surgery or extensive lymph node dissection , or who have a higher BMI should be closely monitored for detection and treatment of lymphedema . Further studies are needed to underst and the roles of chemotherapy and hypertension in the development of lymphedema Goals of workOur aim was to compare the effects of l and versus water multimodal exercise programs on body composition and breast cancer-specific quality of life in breast cancer survivors . Patients and methods Ninety-eight breast cancer survivors were assigned to three groups : control , l and exercise , and water exercise . Both exercise groups participated in an 8-week multimodal program . Adiposity was measured by anthropometry ( body mass index , waist circumference ) and bioelectrical impedance ( body fat and muscle lean body mass ) . Incidence of clinical ly significant secondary lymphedema was also assessed . Finally , specific quality of life was assessed using the European Organization for Research and Treatment of Cancer Quality of Life BR-23.Main Results Using ANCOVA , significant group × time interactions for body fat percentage ( F = 3.376 ; P = 0.011 ) and lean body mass ( F = 3.566 ; P = 0.008 ) were found . Breast cancer survivors in the l and exercise group exhibited a greater decrease in percentage of body fat than those in the water exercise ( P < 0.001 ) and control ( P = 0.002 ) groups . The ANCOVA revealed a significant group × time interaction for waist circumference ( F = 4.553 ; P = 0.002 ) : breast cancer survivors in the control group showed a greater waist circumference when compared to water ( P = 0.003 ) and l and ( P < 0.001 ) exercise groups . A significant group × time interaction was also found for breast symptoms ( F = 9.048 ; P < 0.001 ) : participants in the water exercise group experienced a greater decrease of breast symptoms than those in the l and exercise ( P < 0.01 ) and control ( P < 0.05 ) groups . Conclusion L and exercise produced a greater decrease in body fat and an increase in lean body mass , whereas water exercise was better for improving breast symptoms Objective The aim of this study was to evaluate the feasibility and effect of a water-based exercise program on lymphedema status and shoulder range of motion among women with breast cancer – related lymphedema . Design This was a single-blinded , r and omized controlled pilot trial . Twenty-nine eligible breast cancer survivors ( median , 10 yrs after surgery ) with arm lymphedema ( median , 21 % interlimb difference ) were included and r and omized into the intervention ( n = 15 ) or control ( n = 14 ) group . Twenty-five participants completed the study . The intervention was at least twice-weekly water-based exercise for 8 wks , initially supervised but performed independently during the study period . Outcomes of interest were feasibility as measured by retention and adherence ; lymphedema status as measured by optoelectronic perometry , bioimpedance spectroscopy , and tissue dielectric constant ; and shoulder range of motion as measured by goniometer . Results Four participants were not measured at postintervention and were not included in the analysis ( retention ) . Four participants in the intervention group did not perform the minimum water-based exercise criteria set ( adherence ) . No effect was found on lymphedema status . Compared with the control group , median range of motion change for flexion was 6 ( 1–10 ) degrees ( P < 0.001 ) and 6 ( 0–15.5 ) degrees ( P = 0.07 ) for external rotation . A clinical ly relevant increase in the intervention group was found for 36 % in flexion ( P ⩽ 0.05 ) and 57 % in external rotation ( P ⩽ 0.05 ) compared with controls . Conclusions This study shows that water-based exercise is feasible for breast cancer survivors with arm lymphedema and that shoulder range of motion can be improved years after cancer treatment has been completed The aim of this study was to determine whether an exercise program , commencing 4–6 weeks post-operatively , reduces upper limb impairments in women treated for early breast cancer . Women ( n = 160 ) were r and omized to either an 8-week exercise program ( n = 81 ) or to a control group ( n = 79 ) following stratification for axillary surgery . The exercise program comprised a weekly session and home program of passive stretching and progressive resistance training for shoulder muscles . The control group attended fortnightly assessment s but no exercises were provided . The primary outcome was self-reported arm symptoms derived from the EORTC breast cancer-specific question naire ( BR23 ) , scored out of 100 with a low score indicative of fewer symptoms . The secondary outcomes included physical measures of shoulder range of motion , strength , and swelling ( i.e. , lymphedema ) . Women were assessed immediately following the intervention and at 6 months post-intervention . The change in symptoms from baseline was not significantly different between groups immediately following the intervention or at 6 m post-intervention . The between group difference immediately following the intervention was 4 ( 95 % CI −1 to 9 ) and 6 months post-intervention was 4 ( −2 to 10 ) . However , the change in range of motion for flexion and abduction was significantly greater in the exercise group immediately following the intervention , as was change in shoulder abductor strength . In conclusion , a supervised exercise program provided some , albeit small , additional benefit at 6 months post-intervention to women who had been provided with written information and reminders to use their arm . Both the groups reported few impairments including swelling immediately following the intervention and 6 months post-intervention . Notably , resistance training in the post-operative period did not precipitate lymphedema BACKGROUND Weight lifting has generally been proscribed for women with breast-cancer-related lymphedema , preventing them from obtaining the well-established health benefits of weight lifting , including increases in bone density . METHODS We performed a r and omized , controlled trial of twice-weekly progressive weight lifting involving 141 breast-cancer survivors with stable lymphedema of the arm . The primary outcome was the change in arm and h and swelling at 1 year , as measured through displaced water volume of the affected and unaffected limbs . Secondary outcomes included the incidence of exacerbations of lymphedema , number and severity of lymphedema symptoms , and muscle strength . Participants were required to wear a well-fitted compression garment while weight lifting . RESULTS The proportion of women who had an increase of 5 % or more in limb swelling was similar in the weight-lifting group ( 11 % ) and the control group ( 12 % ) ( cumulative incidence ratio , 1.00 ; 95 % confidence interval , 0.88 to 1.13 ) . As compared with the control group , the weight-lifting group had greater improvements in self-reported severity of lymphedema symptoms ( P=0.03 ) and upper- and lower-body strength ( P<0.001 for both comparisons ) and a lower incidence of lymphedema exacerbations as assessed by a certified lymphedema specialist ( 14 % vs. 29 % , P=0.04 ) . There were no serious adverse events related to the intervention . CONCLUSIONS In breast-cancer survivors with lymphedema , slowly progressive weight lifting had no significant effect on limb swelling and result ed in a decreased incidence of exacerbations of lymphedema , reduced symptoms , and increased strength . ( Clinical Trials.gov number , NCT00194363 . Background This study was to investigate the effects of complex exercise on shoulder range of motion and pain for women with breast cancer-related lymphedema . Methods 69 women participated in this study and then they were r and omly allocated to complex exercise group ( n = 35 ) or the conventional decongestive therapy group ( n = 34 ) . All subjects received 8 sessions for 4 weeks . To identify the effects on shoulder range of motion and pain , goniometer and visual analog scale were used , respectively . The outcome measurements were performed before and after the 4 week intervention . Results After 4 weeks , complex exercise group had greater improvements in shoulder range of motion and pain compared with the conventional decongestive therapy group ( p < 0.05 ) . Conclusion These results suggest that complex exercise is beneficial to improve shoulder range of motion as well as pain of the women with breast cancer-related lymphedema .  Complex exercise would be useful to improve shoulder range of motion and pain of the women with breast cancer-related lymphedema Background We aim ed to evaluate the effect of an 8-week yoga intervention on the shoulder and spinal actions of women with breast cancer-related arm lymphoedema . Method A r and omised controlled pilot trial . The intervention group ( n = 12 ) completed eight weeks of daily yoga sessions while the control group ( n = 11 ) continued with best current care including information on compression sleeves , skin care , risks of temperature variations and recommended safe use of affected arm . Lumbo-pelvic posture , range of motion ( ROM ) in the shoulder and spine , and strength in shoulder and pectoral major and minor , and serratus anterior were taken at baseline , week 8 and after a 4-week follow-up . Outcome assessors were blinded to allocation . Results At week eight the intervention group had an improvement in lumbo-pelvic posture , as indicated by a reduction in pelvic obliquity compared to the control group ( mean difference = −8.39 ° , 95 % CI : −15.64 to −1.13 ° , p = 0.023 ) . A secondary finding was that strength in shoulder abduction significantly increased following the yoga intervention in both the affected ( 9.5 kg ; CI : 0.34 to 18.66 , p = 0.042 ) and non-affected arm ( 11.58 kg ; CI : 0.25 to 22.91 ; p = 0.045 ) . There were no significant between group changes in any ROM measures as a result of the yoga intervention . Conclusion This pilot study demonstrates that participation in yoga may provide benefits for posture and strength in women with Breast Cancer Related Lymphoedema . The improvements may be attributed to the focus of yoga on overall postural and functional movement patterns . Further trials with longer intervention that follow this methodology are warranted . Trial registration The Australian New Zeal and Clinical Trials Registry ACTRN12611000202965 Exercise for Health was a r and omized , controlled trial design ed to evaluate two modes of delivering ( face-to-face [ FtF ] and over-the-telephone [ Tel ] ) an 8-month translational exercise intervention , commencing 6-weeks post-breast cancer surgery ( PS ) . Outcomes included quality of life ( QoL ) , function ( fitness and upper body ) and treatment-related side effects ( fatigue , lymphoedema , body mass index , menopausal symptoms , anxiety , depression and pain ) . Generalised estimating equation modelling determined time ( baseline [ 5 weeks PS ] , mid-intervention [ 6 months PS ] , post-intervention [ 12 
    Output:
    
Results have indicated aerobic exercise , resistance exercise , stretching , yoga , qigong , and pilates can be safe and effective in the management of symptoms for those with , or at risk for , BCRL .
Conclusion Several forms of exercise appear to be safe interventions for clinicians to use when treating this population and offer benefits such as improved quality of life , strength , body mass index , and mental health and decreased pain and lymphatic swelling .