***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: Summary Our r and omized controlled trial in prematurely menopausal breast cancer survivors showed that impact + resistance training prevented increases in percentage of body fat compared with controls and also improved BMD at the hip and prevented BMD loss at the spine among exercise-trained women who were menopausal for > 1 year . Introduction Cancer treatment-related menopause worsens bone health and body composition in breast cancer survivors ( BCS ) . We investigated whether impact + resistance training could improve bone mineral density ( BMD ) , reduce bone turnover , build muscle , and decrease fat mass in BCS with premature menopause . Methods We conducted a r and omized controlled trial in 71 BCS ( mean age , 46.5 years ) within 5 years of treatment-related menopause . Women were r and omly assigned to one of two groups : ( 1 ) impact + resistance training ( prevent osteoporosis with impact + resistance ( POWIR ) ) or ( 2 ) exercise placebo ( FLEX ) 3 × /week for 1 year . Outcomes were hip and spine BMD ( in grams per square centimeter ) and body composition ( percent body fat ( % BF ) and lean and fat mass ( in kilograms ) ) by DXA and bone turnover markers ( serum osteocalcin ( in nanograms per milliliter ) and urinary deoxypryrodinoline ( in nanomoles per milliliter ) . Results There were no significant group × time interactions for bone outcomes when using an intent-to-treat approach on the full sample . In analyses restricted to BCS who were menopausal for ≥1 year , POWIR increased BMD at the hip and slowed BMD loss at the spine compared with FLEX ( femoral neck — POWIR , 0.004 ± 0.093 g/cm2 vs. FLEX , −0.010 ± 0.089 g/cm2 ; p < 0.01 ; spine — POWIR , −0.003 ± 0.114 g/cm2 vs. FLEX , −0.020 ± 0.110 g/cm2 ; p = 0.03 ) . POWIR prevented increases in % BF ( POWIR , 0.01 % vs. FLEX , 1.3 % ; p < 0.04 ) . Women with attendance to POWIR at ≥64 % had better improvements in % BF than women attending less often ( p < 0.03 ) . Conclusion Impact + resistance training may effectively combat bone loss and worsening body composition from premature menopause in BCS 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 We present the 5-year results of the effect of adjuvant chemotherapy on bone mineral density ( BMD ) and the efficacy of clodronate in the prevention of bone loss in 73 premenopausal women with primary breast cancer . All patients were treated with cyclophosphamide , methotrexate , 5-fluorouracil ( CMF ) chemotherapy . The patients were r and omised to oral clodronate 1600 mg daily for 3 years or to a control group . At 5 years , patients were divided into those with preserved menstruation and those with amenorrhoea . Changes in BMD correlated significantly with the menstrual function after chemotherapy . The change in the lumbar spine BMD at 3 and 5 years were + 0.6 and -1.3 % in the menstruating group and -7.5 and -10.4 % in the amenorrhoeic group ( P=0.0001 and 0.0001 , respectively ) , and in femoral neck + 1.7 and -0.3 % , and -3.5 and -5.8 % ( P=0.002 and P=0.001 , respectively ) . Three-year clodronate treatment significantly reduced the bone loss in the lumbar spine -3.0 % compared with controls -7.4 % at three years ( P=0.003 ) , but no significant difference was found in the femoral neck : -1.7 % versus -2.8 % , respectively ( P=0.86 ) . These differences between the study groups were still seen at 5 years : in the lumbar spine -5.8 % versus -9.7 % ( P=0.008 ) and femoral neck -3.5 % versus -5.1 % ( P=0.91 ) . In conclusion , chemotherapy-induced ovarian failure in premenopausal women caused a temporary accelerated bone loss of the lumbar spine . Adjuvant clodronate treatment significantly reduced this bone loss . Two years after the termination of treatment , the bone loss was still significantly less in the clodronate group compared with the control group Summary Because treatment for breast cancer may adversely affect skeletal metabolism , we investigated vertebral fracture risk in women with non-metastatic breast cancer . The prevalence of vertebral fracture was similar in women at the time of first diagnosis to that in an age-matched sample of the general population . The incidence of vertebral fracture , however , was nearly five times greater than normal in women from the time of first diagnosis [ odds ratio ( OR ) , 4.7 ; 95 % confidence interval ( 95 % CI ) , 2.3–9.9 ] , and 20-fold higher in women with soft-tissue metastases without evidence of skeletal metastases ( OR , 22.7 ; 95 % CI , 9.1–57.1 ) . We conclude that vertebral fracture risk is markedly increased in women with breast cancer Purpose This study aim ed to determine whether the Physical Activity and Lymphedema ( PAL ) trial weight training program for breast cancer survivors at risk of or with breast cancer-related lymphedema provided skeletal benefits . Methods Of the 295 participants in the r and omized controlled PAL trial , 258 ( weight training ; N = 128 ; control , N = 130 ) had complete measures of bone mineral density ( BMD ( in grams per square centimeter ) ) of the proximal femur and lumbar spine and were also categorized by T scores . Women in the weight training group performed slowly progressive weight training 2 days/week for 12 months compared to women in the control group who maintained their usual physical activities . Results There were no significant differences in the rate of BMD change at any skeletal site between weight training and control groups , regardless of menopausal status . Distribution of bone health categories was not significantly different between groups at baseline , but became different at 12 months ( p < 0.03 ) among postmenopausal women due to an increase in the percentage of controls who became osteopenic ( 35 to 44 % ) compared to stable bone health in weight lifters . Conclusions The PAL weight training program that increased muscle strength without exacerbating or causing lymphedema among breast cancer survivors was not as efficacious at improving skeletal health . The skeletal loads produced from the PAL program may be insufficient to notably shift BMD , but may have a subtle osteogenic effect . Implication s for cancer survivorsThe safety and efficacy of rigorous weight training programs for improving skeletal health in women at risk for or with breast cancer-related lymphedema remain to be determined In this 12-month RCT , we examined whether aerobic impact exercise training ( 3x/week ) could facilitate breast cancer survivors ' recovery by enhancing their bone structural strength , physical performance and body composition . After the adjuvant chemo- and / or radiotherapy , 86 patients were r and omly assigned into the training or control group . Structural bone traits were assessed with pQCT at the tibia and with DXA at the femoral neck . Agility ( figure-8 running ) , jump force and power ( force platform ) , grip strength and cardiovascular fitness ( 2-km walk test ) were also assessed . Training effects on outcome variables were estimated by two-way factorial ANCOVA using the study group and menopausal status as fixed factors . Bone structural strength was better maintained among the trainees . At the femoral neck , there was a small but significant 2 % training effect in the bone mass distribution ( p=0.05 ) . At the tibial diaphysis , slight 1 % to 2 % training effects ( p=0.03 ) in total cross-sectional area and bone structural strength were observed ( p=0.03 ) among the postmenopausal trainees . Also , 3 % to 4 % training effects were observed in the figure-8 running time ( p=0.03 ) and grip strength ( p=0.01 ) . In conclusion , vigorous aerobic impact exercise training has potential to maintain bone structural strength and improve physical performance among breast cancer survivors Summary This study examined whether 24 months of weight training exercises enhanced the effectiveness of risedronate , calcium , and vitamin D in maintaining or improving bone mineral density ( BMD ) in 223 postmenopausal breast cancer survivors . Subjects who were ≥50 % adherent to exercise had no improvement in BMD but were less likely to lose BMD . Introduction This study examined whether ( 1 ) postmenopausal breast cancer survivors ( BCS ) with bone loss taking 24 months of risedronate , calcium , and vitamin D had increased bone mineral density ( BMD ) at the total hip , femoral neck , L1-L4 spine , total radius and 33 % radius , and decreased bone turnover ; ( 2 ) subjects who also participated in strength/weight training ( ST ) exercises had greater increases in BMD and greater decreases in bone turnover ; and ( 3 ) subjects who also exercised were more likely to preserve ( at least maintain ) BMD . Methods Postmenopausal BCS ( 223 ) were r and omly assigned to exercise plus medication or medication only groups . Both groups received 24 months of 1,200 mg of calcium and 400 IU of vitamin D daily and 35 mg of risedronate weekly , and the exercise group additionally had ST exercises twice weekly . Results After 24 months , women who took medications without exercising had significant improvements in BMD at the total hip ( + 1.81 % ) and spine ( + 2.85 % ) and significant decreases in Alkphase B ( −8.7 % ) and serum NTx ( −16.7 % ) . Women who also exercised had additional increases in BMD at the femoral neck ( + 0.29 % ) , total hip ( + 0.34 % ) , spine ( + 0.23 % ) , total radius ( + 0.30 % ) , and additional decreases in Alkphase B ( −2.4 % ) and Serum NTx ( −6.5 % ) . Additional changes in BMD and bone turnover with exercise were not significant . Subjects who were ≥50 % adherent to exercise were less likely to lose BMD at the total hip ( chi-square [ 1 ] = 4.66 , p = 0.03 ) and femoral neck ( chi-square [ 1 ] = 4.63 , p = 0.03 ) . ConclusionS trength/weight training exercises may prevent loss of BMD in postmenopausal BCS at risk for bone loss Targeted exercise training could reduce risk factors for fracture and obesity-related diseases that increase from breast cancer treatment , but has not been sufficiently tested . We hypothesized that progressive , moderate-intensity resistance + impact training would increase or maintain hip and spine bone mass , lean mass and fat mass and reduce bone turnover compared to controls who participated in a low-intensity , non-weight bearing stretching program . We conducted a r and omized , controlled trial in 106 women with early stage breast cancer who were > 1 year post-radiation and /or chemotherapy , ≥50 years of age at diagnosis and postmenopausal , free from osteoporosis and medications for bone loss , resistance and impact exercise naïve , and cleared to exercise by a physician . Women were r and omly assigned to participate in 1 year of thrice-weekly progressive , moderate-intensity resistance + impact ( jump ) exercise or in a similar frequency and length control program of progressive , low-intensity stretching . Primary endpoints were bone mineral density ( BMD ; g/cm2 ) of the hip and spine and whole body bone-free lean and fat mass ( kg ) determined by DXA and biomarkers of bone turnover — serum osteocalcin ( ng/ml 
    Output:
    
Implication s for cancer survivorsExercise alone may not be sufficient to prevent bone loss in post-menopausal women at high risk of osteoporosis .