***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 
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    Input: Background Cancer cachexia is a syndrome of progressive weight loss . Non-small cell lung cancer patients experience a high incidence of cachexia of 61 % . Research into methods to combat cancer cachexia in various tumour sites has recently progressed to the combination of agents . The combination of the anti-cachectic agent Eicosapentaenoic acid ( EPA ) and the cyclo-oxygenase-2 ( COX-2 ) inhibitor celecoxib has been tested in a small study with some benefit . The use of progressive resistance training ( PRT ) followed by the oral ingestion of essential amino acids ( EAA ) , have shown to be anabolic on skeletal muscle and acceptable in older adults and other cancer groups . The aim of this feasibility study is to evaluate whether a multi-targeted approach encompassing a resistance training and nutritional supplementation element is acceptable for lung cancer patients experiencing cancer cachexia .  Methods / Design Auckl and 's Cancer Cachexia evaluating Resistance Training ( ACCeRT ) is an open label , prospect i ve , r and omised controlled feasibility study with two parallel arms . All patients will be treated with EPA and the COX-2 inhibitor celecoxib on an outpatient basis at the study site . In the experimental group patients will participate in PRT twice a week , followed by the ingestion of essential amino acids high in leucine .  A total of 21 patients are planned to be enrolled . Patients will be r and omised using 1:2 ratio with 7 patients enrolled into the control arm , and 14 patients into the treatment arm . The primary endpoint is the acceptability of the above multi-targeted approach , determined by an acceptability question naire . Discussion To our knowledge ACCeRT offers for the first time the opportunity to investigate the effect of stimulating the anabolic skeletal muscle pathway with the use of PRT along with EAA alongside the combination of EPA and celecoxib in this population .Trial registration Netherl and s Trial Register ( NTR ) : PURPOSE / OBJECTIVES To test the effects of aerobic and resistance exercise on changes in bone mineral density ( BMD ) in women newly diagnosed with stage I-III breast cancer receiving chemotherapy . DESIGN R and omized clinical trial . SETTING Two National Cancer Institute- design ated cancer centers in metropolitan areas . SAMPLE 66 women with stage I-III breast cancer beginning adjuvant chemotherapy .  METHODS Participants were r and omized to aerobic or resistance exercise and usual care . At the beginning of chemotherapy and at six months , patients completed exercise testing and BMD assessment of the lumbar spine by dual energy x-ray absorptionetry . MAIN RESEARCH VARIABLES BMD , aerobic capacity , and muscle strength . FINDINGS The average decline in BMD was -6.23 % for usual care , -4.92 % for resistance exercise , and -0.76 % for aerobic exercise . Aerobic exercise preserved BMD significantly better compared to usual care . Premenopausal women demonstrated significantly greater declines in BMD than postmenopausal women .  Aerobic capacity increased by almost 25 % for women in the aerobic exercise group and 4 % for resistance exercise . Participants in the usual care group showed a 10 % decline in aerobic capacity . CONCLUSIONS The data suggest that weight-bearing aerobic exercise attenuates declines in BMD and that aerobic and resistance exercise improve aerobic capacity and muscle strength at a time when women generally show marked declines in functional ability . IMPLICATION S FOR NURSING Exercise may prevent or at least minimize bone loss observed during chemotherapy and may prevent or delay the long-term effects of osteoporosis OBJECTIVE To compare the effects of resistance and cardiovascular exercise on functional mobility in individuals with advanced cancer . DESIGN Prospect i ve , 2-group pretest-posttest pilot study with r and omization to either resistance or cardiovascular exercise mode . SETTING Comprehensive community cancer center and a hospital-based fitness facility . PARTICIPANTS Volunteer sample of individuals ( N=66 ; 30 men ; 36 women ; mean age , 62y ) with advanced cancer recruited through the cancer center , palliative care service , rehabilitation department , and a local hospice . INTERVENTIONS Ten weeks of individualized resistance or cardiovascular exercise , prescribed and monitored by oncology-trained exercise personnel . MAIN OUTCOME MEASURES Functional mobility was assessed using the Short Physical Performance Battery ( SPPB ) ; self-reported pain and fatigue were assessed secondarily using visual analog scales . Data were analyzed using a split plot 2 × 2 analysis of variance ( α=.05 ) . RESULTS Fifty-two patients ( 78.8 % ) completed the study : 23 ( 67.7 % ) of 34 patients in the resistance arm and 29 ( 90.6 % ) of 32 patients in the cardiovascular arm . No participant withdrew because of study adverse events . Ten-week outcomes ( n=52 ) included a significant increase in SPPB total score ( P<.001 ) , increase in gait speed ( P=.001 ) , and reduction in fatigue ( P=.05 ) . Although cardiovascular exercise participants had a modestly greater improvement in SPPB total score  than resistance training participants ( F1,49=4.21 , P=.045 ) , the difference was not confirmed in a subsequent intention-to-treat analysis ( N=66 ) . CONCLUSIONS Individuals with advanced cancer appear to benefit from exercise for improving functional mobility . Neither resistance nor cardiovascular exercise appeared to have a strong differential effect on outcome BACKGROUND Physical exercise can improve cancer patients ' functioning and reduce their symptom levels . A r and omized , controlled trial was launched to test the hypothesis that physical exercise reduces fatigue and improves physical performance in cancer patients with advanced and incurable disease . METHODS Cancer patients ( n = 231 ) with a life expectancy ≤2 years were r and omized to a physical exercise group ( PEG , n = 121 ) or a control usual care group ( UCG , n = 110 ) . The PEG exercised under supervision 60 minutes twice a week for 8 weeks . Assessment s were performed before and after the intervention . The primary outcome was physical fatigue ( PF ) measured by the Fatigue Question naire . Physical performance was a secondary outcome measured by the Shuttle Walk Test ( SWT ) and h and grip strength ( HGS ) test . Analyses were performed after multiple imputations for missing data . The trial is registered with Clinical Trials.gov ( identifier , NCT00397774 ) . FINDINGS Thirty-six percent of the PEG were lost to follow-up compared with 23 % of the UCG , primarily as a result of disease progression . Seventy-eight PEG and 85 UCG patients completed the intervention . Analyses showed no significant between-group effects in PF . However , clinical ly and statistically significant between-group effects were found for the SWT and HGS test . INTERPRETATION Fatigue was not reduced but physical performance ( SWT and HGS test ) was significantly improved after 8 weeks of physical exercise . Physical exercise might therefore be a suitable approach for maintaining physical capacity in cancer patients with incurable and advanced disease Summary The ability of combined step aerobic- and circuit-training to prevent bone loss after breast cancer treatments was related to skeletal site and patients ’ menopausal status . Among premenopausal breast cancer survivors , a 12-month exercise intervention completely prevented bone loss at the femoral neck , whereas no exercise effect was seen at lumbar spine or at neither site in postmenopausal women . Introduction The primary objective of this r and omised clinical trial was to determine the preventive effect of supervised weight-bearing jumping exercises and circuit training on bone loss among breast cancer patients . Methods Of 573 breast cancer survivors aged 35–68 years r and omly allocated into  exercise  or  control group after adjuvant treatments , 498 ( 87 % ) were included in the final analysis . The 12-month exercise intervention comprised weekly supervised step aerobic- and circuit-exercises and similar home training . Bone mineral density ( BMD ) at lumbar spine and femoral neck were measured by dual-energy X-ray absorptiometry . Physical performance was assessed by 2-km walking and figure-8 running tests , and the amount of physical activity was estimated in metabolic equivalent-hours/week . Results In premenopausal women  , bone loss at the femoral neck was prevented by exercise , the mean BMD changes being −0.2 % among the trainees vs. −1.4 % among the controls ( p = 0.01 ) . Lumbar bone loss could not be prevented ( −1.9 % vs. −2.2 % ) . In postmenopausal women , no significant exercise-effect on BMD was found either at the lumbar spine ( −1.6 % vs. −2.1 % ) or femoral neck ( −1.1 % vs. −1.1 % ) . Conclusions This 12-month aerobic jumping and circuit training intervention completely prevented femoral neck bone loss in premenopausal breast cancer patients , whereas no effect on BMD was seen in postmenopausal women BACKGROUND AND OBJECTIVE A phase III r and omised study was carried out to establish the most effective and safest treatment to improve the primary endpoints of cancer cachexia : lean body mass ( LBM ) , resting energy expenditure ( REE ) , fatigue ; and relevant secondary endpoints : appetite , quality of life , grip strength , Glasgow Prognostic Score ( GPS ) and proinflammatory cytokines . PATIENTS Three hundred and thirty-two assessable patients with cancer-related anorexia/cachexia syndrome ( CACS ) were r and omly assigned to one of five arms of treatment : 1 - -medroxyprogesterone 500 mg/d or megestrol acetate 320 mg/d ; 2 - -oral supplementation with eicosapentaenoic acid ( EPA ) ; 3 - -L-carnitine 4 g/d ; 4 - -thalidomide 200 mg/d ; 5 - -a combination of the above . Treatment duration : 4 months . RESULTS Analysis of variance showed a significant difference between the treatment arms . A post hoc analysis showed the superiority of arm 5 over the others for all primary endpoints . An analysis of changes from baseline showed that LBM ( by dual-energy X-ray absorptiometry and by L3 computed tomography ) significantly increased in arm 5 . REE decreased significantly and fatigue improved significantly in arm 5 . Appetite increased significantly in arm 5 . IL-6 decreased significantly in arm 5 and 4 . GPS significantly decreased in arms 5 , 4 and 3 . Total daily physical activity showed that total energy and active energy expenditure increased significantly in arm 5 . Eastern Cooperative Oncology group-Performance Status ( ECOG-PS ) significantly decreased in arms 5 , 4 and 3 . Toxicity was substantially negligible , comparable between treatment arms . CONCLUSIONS The most effective treatment for all three primary efficacy endpoints as well as secondary endpoints appetite , IL-6 , GPS and ECOG PS was the combination regimen that included all selected agents During " nondamaging " exercise , skeletal muscle markedly releases interleukin (IL)-6 , and it has been suggested that one biological role of this phenomenon is to inhibit the production of tumor necrosis factor (TNF)- alpha , which is known to cause pathogenesis such as insulin resistance and atherosclerosis . To test this hypothesis , we performed three experiments in which eight healthy males either rested ( CON ) , rode a bicycle for 3 h ( EX ) , or were infused with recombinant human IL-6 ( rhIL-6 ) for 3 h while they rested . After 2.5 h , the volunteers received a bolus of Escherichia coli lipopolysaccharide endotoxin ( 0.06 ng/kg ) i.v . to induce low- grade inflammation . In CON , plasma TNF-alpha increased significantly in response to endotoxin . In contrast , during EX , which result ed in elevated IL-6 , and rhIL-6 , the endotoxin-induced increase in TNF-alpha was totally attenuated . In conclusion , physical exercise and rhIL-6 infusion at physiological concentrations inhibit endotoxin-induced TNF-alpha production in humans . Hence , these data provide the first experimental evidence that physical activity mediates antiinflammatory activity and suggest that the mechanism include IL-6 , which is produced by and released from exercising muscles Given the negative effects of a breast cancer diagnosis and its treatments on body weight and bone mass , we investigated the effects of a 6-month r and omized controlled aerobic exercise intervention vs. usual care on body composition in breast cancer survivors . Secondary aims were to examine the effects stratified by important prognostic and physiologic variables . Seventy-five physically inactive postmenopausal breast cancer survivors were recruited through the Yale-New Haven Hospital Tumor Registry and r and omly assigned to an exercise ( n = 37 ) or usual care ( n = 38 ) group . The exercise group participated in 150 min/week of supervised gym- and home-based moderate-intensity aerobic exercise . The usual care group was instructed to maintain their current physical activity level . Body composition was assessed at baseline and 6-months through dual-energy X-ray absorptiometry ( DXA ) by one radiologist blinded to the intervention group of the participants . On an average , exercisers increased moderate-intensity aerobic exercise by 129 min/week over and above baseline levels compared with 45 min/week among usual care participants ( P < 0.001 ) . Exercisers experienced decreases in percent body fat ( P = 0.0022 ) and increases in lean mass ( P = 0.047 ) compared with increases in body fat and decreases in lean mass in usual care participants . B 
    Output:
    
There is insufficient evidence to determine the safety and effectiveness of exercise  for patients with cancer cachexia .