***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 our study was to evaluate the effect of cognitive behavioral therapy ( CBT ) , physical exercise ( PE ) , and of these two interventions combined ( CBT/PE ) on menopausal symptoms ( primary outcome ) , body image , sexual functioning , psychological well-being , and health-related quality of life ( secondary outcomes ) in patients with breast cancer experiencing treatment-induced menopause . PATIENTS AND METHODS Patients with breast cancer reporting treatment-induced menopausal symptoms ( N=422 ) were r and omly assigned to CBT ( n=109 ) , PE ( n=104 ) , CBT/PE ( n=106 ) , or to a waiting list control group ( n=103 ) . Self-report question naires were completed at baseline , 12 weeks , and 6 months . Multilevel procedures were used to compare the intervention groups with the control group over time . RESULTS Compared with the control group , the intervention groups had a significant decrease in levels of endocrine symptoms ( Functional Assessment of Cancer Therapy-Endocrine Symptoms ; P<.001 ; effect size , 0.31 - 0.52 ) and urinary symptoms ( Bristol Female Lower Urinary Tract Symptoms Question naire ; P=.002 ; effect size , 0.29 - 0.33 ) , and they showed an improvement in physical functioning ( 36-Item Short Form Health Survey physical functioning subscale ; P=.002 ; effect size , 0.37 - 0.46 ) . The groups that included CBT also showed a significant decrease in the perceived burden of hot flashes and night sweats ( problem rating scale of the Hot Flush Rating Scale ; P<.001 ; effect size , 0.39 - 0.56 ) and an increase in sexual activity ( Sexual Activity Question naire habit subscale ; P=.027 ; effect size , 0.65 ) . Most of these effects were observed at both the 12-week and 6-month follow-ups . CONCLUSION CBT and PE can have salutary effects on endocrine symptoms and , to a lesser degree , on sexuality and physical functioning of patients with breast cancer experiencing treatment-induced menopause . Future work is needed to improve the design and the planning of these interventions to improve program adherence Sexual dysfunction is present the most important problem among menopausal women and thus counseling may have a major role for improving menopausal sexual state in this population . We aim ed to assess effects of counseling on sexual function of menopause women and their spouses . An interventional trial study was performed on 120 consecutive Iranian couples ( menopause women and their spouses ) who were resident in Hamadan , Iran in 2015 . The subjects were r and omly assigned to  receive counseling service ( n = 60 ) or did not receive this service ( n = 60 ) . Couples were asked to complete a st and ardized vali date d question naire assessing sexual function and behaviors . The frequency of sexual intercourse was considerably increased following first and second counseling sessions compared with the time before counseling in former group , while sexually state was remained unchanged in those who not received these counseling . Furthermore , dyspareunia in interventional women with counseling was significantly reduced after the first and second counseling , whereas this complaint was not significantly removed in the control group within the study period . Also , unsuccessful intercourse was significantly decreased in men who received counseling sessions , while this parameter was remained unchanged in other men . In addition , talking with the partner about sexually and Satisfaction degree of wife ’s love was significantly improved in both men and women in interventional groups compared with the control groups . Active and structured counseling effectively improve sexual functions and behaviors in menopausal women and their spouses Although a large number of studies report the impact of daily exercise on many aspects of women 's health , none of them address the relationship between Pilates exercise and sexual function prospect ively . The aim of this study was to assess the effect of Pilates exercise on sexual function in healthy young women using a vali date d question naire . In total , 34 premenopausal healthy Turkish women aged between 20 and 50 years who had regular menstrual cycles and sexual relationships were included in the study . Women were asked to complete Beck Depression Inventory ( BDI ) and Female Sexual Function Index ( FSFI ) question naires . Question naires were completed before and after 12 weeks of Pilates exercise . Primary endpoints were changes in total and individual domain scores on the FSFI and BDI . After the 12-week Pilates  intervention , BDI scores were decreased and all domains of the FSFI were significantly improved with mean ± SD total FSFI scores increasing from 25.9 ± 7.4 to 32.2 ± 3.6 ( p < .0001 ) . This is the first prospect i ve study that quantifies the improvement in sexual function of healthy women after a 12-week Pilates program . Our findings suggest that Pilates may improve sexual function in healthy women . However , further studies with a larger sample size are needed in this field OBJECTIVE To examine the effects of " Rusie Dutton " on health and quality of life in menopausal women . METHOD Menopausal women ( aged 45 - 59 ) were recruited and r and omly allocated to 2 groups . Rusie Dutton group ( n = 24 ) practice d Rusie Dutton conducted by Wat Pho Thai Traditional Massage School for 13 weeks . The  control group ( n = 26 ) was assigned to a waiting list and received no intervention .  BW , BMI , restingHR , BP , flexibility , VO2max , and MENQOL including vasomotor , physical , psychosocial and sexual domains were measured at the beginning and the end . A paired- sample t-test and independent sample t-test were used for statistical analysis . RESULTS Significant improvement was found in all variables within group ( p < .05 ) in Rusie Dutton group , and a significant difference between groups was found ( p < .05 ) in all variables except BW and BMI . Therefore , it is concluded that the traditional Thai exercise Rusie Dutton can promote health related physical fitness and QOL in menopausal women BACKGROUND Moderate-to-vigorous-intensity physical activity is recommended to maintain and improve health , but the mortality benefits of light activity and risk for sedentary time remain uncertain . OBJECTIVES Using accelerometer-based measures , we 1 ) described the mortality dose-response for sedentary time and light- and moderate-to-vigorous-intensity activity using restricted cubic splines , and 2 ) estimated the mortality benefits associated with replacing sedentary time with physical activity , accounting for total activity . DESIGN US adults ( n = 4840 ) from NHANES ( 2003 - 2006 ) wore an accelerometer for ≤7 d and were followed prospect ively for mortality . Proportional hazards models were used to estimate adjusted HRs and 95 % CIs for mortality associations with time spent sedentary and in light- and moderate-to-vigorous-intensity physical activity . Splines were used to graphically present behavior-mortality relation . Isotemporal models estimated replacement associations for sedentary time , and separate models were fit for low- ( < 5.8 h total activity/d ) and high-active participants to account for nonlinear associations . RESULTS Over a mean of 6.6 y , 700 deaths occurred . Compared with less-sedentary adults ( 6 sedentary h/d ) , those who spent 10 sedentary h/d had 29 % greater risk ( HR : 1.29 ; 95 % CI : 1.1 , 1.5 ) . Compared with those who did less light activity ( 3 h/d ) , those who did 5 h of light activity/d had 23 % lower risk ( HR : 0.77 ; 95 % CI : 0.6 , 1.0 ) . There was no association with mortality for sedentary time or light or moderate-to-vigorous activity in highly active adults . In less-active adults , replacing 1 h of sedentary time with either light- or moderate-to-vigorous-intensity activity was associated with 18 % and 42 % lower mortality , respectively . CONCLUSIONS Health promotion efforts for physical activity have mostly focused on moderate-to-vigorous activity . However , our findings derived from accelerometer-based measurements suggest that increasing light-intensity activity and reducing sedentary time are also important , particularly for inactive adults 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 Objective : The relationship between vulvovaginal atrophy and female sexual dysfunction is unclear . We investigated this association among sexually active postmenopausal women . Design : The Menopause Epidemiology Study is a cross-sectional , population -based study of women 40 to 65 years old in the United States chosen from a source population selected by r and om digit dialing and probability sampling . We focused on sexually active postmenopausal women ( N = 1,480 ) for our analyses . Vulvovaginal atrophy was defined as one or more of the following : vaginal dryness , itching , irritation ; pain on urination ; or pain or bleeding on intercourse . The Arizona Sexual Experience Survey was used to define female sexual dysfunction . Sexual dysfunction subtypes for desire , arousal , and orgasm difficulties were individually scored . We evaluated demographic , behavioral , reproductive history , and medication covariates for effect modification and confounding . Multivariate logistic regression was used to assess the relationship between vulvovaginal atrophy and female sexual dysfunction . Results : The prevalence of vulvovaginal atrophy ( 57 % ) and female sexual dysfunction ( 55 % ) was high . Women with female sexual dysfunction were 3.84 times more likely to have vulvovaginal atrophy than women without female sexual dysfunction ( 95 % CI : 2.99 - 4.94 ) . Hot flashes modified the association between vulvovaginal atrophy and desire difficulty . Educational level modified the association between vulvovaginal atrophy and arousal difficulty . Parity modified the association between vulvovaginal atrophy and orgasm difficulty . Conclusions : This large population -based study provides evidence of an association between vulvovaginal atrophy and overall female sexual dysfunction and its subtypes . Therapies aim ing to reduce symptoms of one condition may also relieve symptoms of the other Objective . This study was design ed to determine the effects of different short-term exercise programs on menopausal symptoms , psychological health , and quality of life in postmenopausal women . Material and Methods . Forty-two women were chosen from volunteering postmenopausal women presenting to the Department of Obstetrics and Gynecology of Bayındır Hospital between March and December 2009 . The women aged 45–60 years and experiencing menopause naturally were included in the study . They were r and omly divided into aerobic ( n = 18 ) and resistance ( n = 18 ) exercise groups . The women exercised 3 days per week for 8 weeks under the supervision of a physiotherapist . Aerobic exercise training was performed through a bicycle ergometer . Before and after the training , lipid profiles were measured and menopausal symptoms , psychological health , depression , and the quality of life were assessed through question naires . Results . In both exercise groups , no significant changes in lipid profiles were observed . In the resistance exercise group , excluding the urogenital complaints , there were significant improvements in all subscales of Menopausal Rating Scale ( MRS ) . In the resistance exercise group , excluding the phobic anxiety , there were significant improvements in all subscales of The Symptom Checklist . Depression levels significantly decreased in both groups . Improvements were observed in all subscales of menopause-specific quality of life question naire in both groups except for sexual symptoms . Conclusion . Resistance exercise and aerobic exercise were found to have a positive impact on menopausal symptoms , psychological health , depression , and quality of life Objectives The purpose of this study was to evaluate the quality of life ( QOL ) in postmenopausal members and non-members of the elderly support association in Borujen city , Iran . Methods This study was a cross-sectional descriptive study being applied to the participants were postmenopausal women of over 55 years . Thus , 40 postmenopausal members of the elderly support association of Borujen city and 40 non-members were r and omly selected . The  36 item short-form health survey ( SF-36 )  , with the 4 psychological , social , physical-movement , and environmental domains , was completed . Data were analyzed using SPSS software . Results The mean total score of QOL of member of the association was significantly greater than non-members . Student 's t-test showed a significant relationship between QOL and membership of the association ( P < 0.05 ) . One-way analysis of variance ( ANOVA ) showed that the mean QOL of postmenopausal women , according to membership and marital status ( P < 0.01 ) , housing ( P < 0.01 ) , and underlying disease ( P < 0.01 ) , was statistically significant . Conclusions According to the results , supportive measures , such as increasing the participation of the elderly in public life through proper preparations to join them and membership in peer groups such as support associations and non-governmental organizations ( NGOs ) can be greatly effective in improving QOL . The results showed that the QOL of the participants was at a moderate level and membership in support associations for the elderly was effected on the QOL in postmenopausal women . Moreover , considering the importance of the elderly in the community Background : Exercise and supplementation with isoflavones are therapies used to prevent and treat climacteric symptoms . Aim : To verify the effects of 10 weeks of combined aerobic and resistance training and isoflavone supplementation on climacteric symptoms 
    Output:
    
The most commonly recommended training programs are based on exercising pelvic floor muscles , as they seem to have the largest impact on sexual function .
Mind – body disciplines also helped in managing menopausal symptoms .
However , as far as the most traditional programs were concerned , aerobic exercises showed inconsistent results and resistance training did not seem to convey any benefits .