human
***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: Background Patients with acute leukemia experience a substantial symptom burden and are at risk of developing infections throughout the course of repeated cycles of intensive chemotherapy . Physical activity in recent years has been a strategy for rehabilitation in cancer patients to remedy disease and treatment related symptoms and side effects . To date , there are no clinical practice exercise guidelines for patients with acute leukemia undergoing induction and consolidation chemotherapy . A r and omized controlled trial is needed to determine if patients with acute leukemia can benefit by a structured and supervised counseling and exercise program . Methods / design This paper presents the study protocol : Patient Activation through Counseling and Exercise – Acute Leukemia ( PACE-AL ) trial , a two center , r and omized controlled trial of 70 patients with acute leukemia ( 35 patients / study arm ) following induction chemotherapy in the outpatient setting . Eligible patients will be r and omized to usual care or to the 12 week exercise and counseling program .  The intervention includes 3 hours + 30 minutes per week of supervised and structured aerobic training ( moderate to high intensity 70 - 80 % ) on an ergometer cycle , strength exercises using h and weights and relaxation exercise . Individual health counseling sessions include a self directed home walk program with a step counter . The primary endpoint is functional performance/exercise capacity ( 6 minute walk distance ) . The secondary endpoints are submaximal VO2 max test , sit to st and and bicep curl test , physical activity levels , patient reported outcomes ( quality of life , anxiety and depression , symptom prevalence , intensity and interference ) . Evaluation of clinical outcomes will be explored including incidence of infection , hospitalization days , body mass index , time to recurrence and survival . Qualitative exploration of patients ’ health behavior and experiences . Discussion PACE-AL will provide evidence of the effect of exercise and health promotion counseling on functional and physical capacity , the symptom burden and quality of life in patients with acute leukemia during out patient management . The results will inform clinical practice exercise guidelines and rehabilitation programs for patients undergoing treatment for acute leukemia . Optimizing the treatment and care pathway may ease the transition for patients from illness to the resumption of everyday activities . Trial registration Clinical Trials.gov Identifier : NCT01404520 OBJECTIVES  Quality of Life Question naire Core 30 ( QLQ-C30 ) and Functional Assessment of Cancer Therapy-General ( FACT-G ) are widely used cancer-specific health-related  quality of life  ( HRQOL  ) question naires . We aim ed to compare their responsiveness with clinical ly important effects and statistical efficiency to detect such effects . STUDY DESIGN AND SETTING Secondary analysis of QLQ-C30 and FACT-G data from a r and omized controlled trial of Medical Qigong ( n = 162 heterogeneous cancer patients ) .  Difference in responsiveness ( DR ) and relative efficiency ( RE ) were calculated for five domains . RESULTS FACT-G total score was more efficient than QLQ-C30 global scale for detecting change within the intervention arm [ RE = 0.31 ( 0.083 , 0.69 ) ] and comparing change between trial arms [ RE = 0.17 ( 0.009 , 0.58 ) ] . In the social domain , the QLQ-C30 scale was more responsive [ DR = 0.28 ( 0.024 , 0.54 ) ] and more efficient within arm only [ RE = 5.25 ( 1.21 , 232.26 ) ] . In the physical , functional/role , and emotional domains , neither question naire was more responsive or efficient . CONCLUSION FACT-G would require about one-third the sample of QLQ-C30 to detect a given change in overall HRQOL , whereas in the social domain , it would require five times the sample size . FACT-G won advantage in overall HRQOL by reduced " noise " ( smaller st and ard deviation achieved by summing across 27 items ) , whereas QLQ-C30 won advantage in the social domain via a larger " signal " ( achieved through well-targeted item content ) Research suggests that stress‐reduction programs tailored to the cancer setting help patients cope with the effects of treatment and improve their quality of life .  Yoga , an ancient Eastern science , incorporates stress‐reduction techniques that include regulated breathing , visual imagery , and meditation as well as various postures . The authors examined the effects of the  Tibetan yoga ( TY ) practice s of Tsa lung and Trul khor , which incorporate  controlled breathing and visualization , mindfulness techniques  , and low‐impact postures  in patients with lymphoma This study examined the effect of an integrated yoga programme on chemotherapy-related nausea and emesis in early operable breast cancer out patients . Sixty-two subjects were r and omly allocated to receive yoga ( n = 28 ) or supportive therapy intervention ( n = 34 ) during the course of their chemotherapy . Both groups had similar socio-demographic and medical characteristics . Intervention consisted of both supervised and home practice of yoga sessions lasting for 60 min daily , while the control group received supportive therapy and coping preparation during their hospital visits over a complete course of chemotherapy . The primary outcome measure was the Morrow Assessment of Nausea and Emesis ( MANE ) assessed after the fourth cycle of chemotherapy . Secondary outcomes included measures for anxiety , depression , quality of life , distressful symptoms and treatment-related toxicity assessed before and during the course of chemotherapy . Following yoga , there was a significant decrease in post-chemotherapy-induced nausea frequency ( P = 0.01 ) and nausea intensity ( P = 0.01 ) , and intensity of anticipatory nausea ( P = 0.01 ) and anticipatory vomiting ( P = 0.05 ) as compared with the control group . There was a significant positive correlation between MANE scores and anxiety , depression and distressful symptoms . In conclusion , the results suggest a possible use for stress reduction interventions such as yoga in complementing conventional antiemetics to manage chemotherapy-related nausea and emesis BACKGROUND Adolescents with irritable bowel syndrome ( IBS ) frequently experience interference with everyday activities . Mind-body approaches such as yoga have been recommended as interventions for patients with IBS . Despite promising results among adult sample s , there have been limited studies exploring the efficacy of yoga with pediatric patients . OBJECTIVE To conduct a preliminary r and omized study of yoga as treatment for adolescents with IBS . METHODS Twenty-five adolescents aged 11 to 18 years with IBS were r and omly assigned to either a yoga or wait list control group . Before the intervention , both groups completed question naires assessing gastrointestinal symptoms , pain , functional disability , coping , anxiety and depression . The yoga intervention consisted of a 1 h instructional session , demonstration and practice , followed by four weeks of daily home practice guided by a video . After four weeks , adolescents repeated the baseline question naires . The wait list control group then received the yoga intervention and four weeks later completed an additional set of question naires . RESULTS Adolescents in the yoga group reported lower levels of functional disability , less use of emotion-focused avoidance and lower anxiety following the intervention than adolescents in the control group . When the pre- and postintervention data for the two groups were combined , adolescents had significantly lower scores for gastrointestinal symptoms and emotion-focused avoidance following the yoga intervention . Adolescents found the yoga to be helpful and indicated they would continue to use it to manage their IBS . CONCLUSIONS Yoga holds promise as an intervention for adolescents with IBS OBJECTIVES This study compares the effects of an integrated yoga program with brief supportive therapy in breast cancer out patients undergoing adjuvant radiotherapy at a cancer centre . METHODS Eighty-eight stage II and III breast cancer out patients were r and omly assigned to receive yoga ( n = 44 ) or brief supportive therapy ( n = 44 ) prior to their radiotherapy treatment . Intervention consisted of yoga sessions lasting 60 min daily while the control group was imparted supportive therapy once in 10 days . Assessment s included European Organization for Research in the Treatment of Cancer- Quality of Life ( EORTCQoL C30 ) functional scales and Positive and Negative Affect Schedule ( PANAS ) . Assessment s were done at baseline and after 6 weeks of radiotherapy treatment . RESULTS An intention to treat GLM repeated measures ANOVA showed significant difference across groups over time for positive affect , negative affect and emotional function and social function . There was significant improvement in positive affect ( ES = 0.59 , p = 0.007 , 95%CI 1.25 to 7.8 ) , emotional function ( ES = 0.71 , p = 0.001 , 95%CI 6.45 to 25.33 ) and cognitive function ( ES = 0.48 , p = 0.03 , 95%CI 1.2 to 18.5 ) , and decrease in negative affect ( ES = 0.84 , p<0.001 , 95%CI -13.4 to -4.4 ) in the yoga group as compared to controls . There was a significant positive correlation between positive affect with role function , social function and global quality of life . There was a significant negative correlation between negative affect with physical function , role function , emotional function and social function . CONCLUSION The results suggest a possible role for yoga to improve quality of life and affect in breast cancer out patients PURPOSE / OBJECTIVES To determine the effect of aerobic and strength resistance training and epoetin alfa ( EPO ) therapy on transfusions , stem cell collection s , transplantation recovery , and multiple myeloma treatment response . DESIGN R and omized clinical trial . SETTING A myeloma research and therapy center in the south central United States . SAMPLE 135 patients with multiple myeloma , 120 evaluable . METHODS R and om assignment to exercise or usual care groups . All patients received EPO based on an algorithm . Aerobic capacity , using the six-minute walk test , was assessed prior to induction chemotherapy , prior to stem cell mobilization , and following stem cell collection for all patients and before and after transplantation for patients continuing in the study . Data analysis included analysis of variance to compare other outcome variables by groups . MAIN RESEARCH VARIABLES Number of red blood cell and platelet transfusions during transplantation , number of attempts at and total number of days of stem cell collection , time to recovery after transplantation , and response to intensive therapy for multiple myeloma . FINDINGS Recovery and treatment response were not significantly different between groups after transplantation . The exercise group had significantly fewer red blood cell transfusions and fewer attempts at stem cell collection . Serious adverse events were similar in each group . CONCLUSIONS Exercise with prophylactic EPO therapy reduces the number of RBC transfusions and attempts at stem cell collection for patients receiving intensive treatment for multiple myeloma . IMPLICATION S FOR NURSING Exercise is safe and has many physiologic benefits for patients receiving multiple myeloma treatment BACKGROUND Physical activity provides a number of physical and psychological benefits to cancer survivors , including lessening the impact of detrimental cancer-related symptoms and treatment side-effects ( e.g. fatigue , nausea ) , and improving overall well-being and quality of life . The purpose of the present pilot study was to examine the physical and psychological benefits afforded by a 7-week yoga program for cancer survivors . METHOD Eligible participants ( per-screened with PAR-Q/PAR-MED-X ) were r and omly assigned to either the  intervention ( n=20 ) or control group ( n=18 ) . All participants completed pre- and post-testing assessment s immediately before and after the yoga program , respectively . RESULTS The yoga program participants ( M age=51.18 ( 10.33 ) ; 92 % female ) included primarily breast cancer survivors , on average 55.95 ( 54.39 ) months post-diagnosis . Significant differences between the intervention and the control group at post-intervention were seen only in psychosocial ( i.e. global quality of life , emotional function , and diarrhea ) variables ( all p 's < 0.05 ) . There were also trends for group differences , in the hypothesized directions , for the psychosocial variables of emotional irritability , gastrointestinal symptoms , cognitive disorganization , mood disturbance , tension , depression , and confusion ( all p 's < 0.10 ) . Finally , there were also significant improvements in both the program participants and the controls from pre- to post-intervention on a number of physical fitness variables . CONCLUSIONS These initial findings suggest that yoga has significant potential and should be further explored as a beneficial physical activity option for cancer survivors . Future research might attempt to include a broader range of participants ( e.g. other types of cancer diagnoses , male subjects ) , a larger sample size , and a longer program duration in an RCT Background Little is known about the metabolic and heart rate responses to a typical hatha yoga session . The purpose s of this study were 1 ) to determine whether a typical yoga practice using various postures meets the current recommendations for levels of physical activity required to improve and maintain health and cardiovascular fitness ; 2 ) to determine the reliability of metabolic costs of yoga across sessions ; 3 ) to compare the metabolic costs of yoga practice to those of treadmill walking . Methods In this observational study , 20 intermediate-to-advanced level yoga practitioners , age 31.4 ± 8.3 years , performed an exercise routine inside a human respiratory chamber ( indirect calorimeter ) while wearing heart rate monitors . The exercise routine consisted of 30 minutes of sitting , 56 minutes of beginner-level hatha yoga administered by video , and 10 minutes of treadmill walking at 3.2 and 4.8 kph each . Me 
    Output:
    
agent
***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: Background Patients with acute leukemia experience a substantial symptom burden and are at risk of developing infections throughout the course of repeated cycles of intensive chemotherapy . Physical activity in recent years has been a strategy for rehabilitation in cancer patients to remedy disease and treatment related symptoms and side effects . To date , there are no clinical practice exercise guidelines for patients with acute leukemia undergoing induction and consolidation chemotherapy . A r and omized controlled trial is needed to determine if patients with acute leukemia can benefit by a structured and supervised counseling and exercise program . Methods / design This paper presents the study protocol : Patient Activation through Counseling and Exercise – Acute Leukemia ( PACE-AL ) trial , a two center , r and omized controlled trial of 70 patients with acute leukemia ( 35 patients / study arm ) following induction chemotherapy in the outpatient setting . Eligible patients will be r and omized to usual care or to the 12 week exercise and counseling program .  The intervention includes 3 hours + 30 minutes per week of supervised and structured aerobic training ( moderate to high intensity 70 - 80 % ) on an ergometer cycle , strength exercises using h and weights and relaxation exercise . Individual health counseling sessions include a self directed home walk program with a step counter . The primary endpoint is functional performance/exercise capacity ( 6 minute walk distance ) . The secondary endpoints are submaximal VO2 max test , sit to st and and bicep curl test , physical activity levels , patient reported outcomes ( quality of life , anxiety and depression , symptom prevalence , intensity and interference ) . Evaluation of clinical outcomes will be explored including incidence of infection , hospitalization days , body mass index , time to recurrence and survival . Qualitative exploration of patients ’ health behavior and experiences . Discussion PACE-AL will provide evidence of the effect of exercise and health promotion counseling on functional and physical capacity , the symptom burden and quality of life in patients with acute leukemia during out patient management . The results will inform clinical practice exercise guidelines and rehabilitation programs for patients undergoing treatment for acute leukemia . Optimizing the treatment and care pathway may ease the transition for patients from illness to the resumption of everyday activities . Trial registration Clinical Trials.gov Identifier : NCT01404520 OBJECTIVES  Quality of Life Question naire Core 30 ( QLQ-C30 ) and Functional Assessment of Cancer Therapy-General ( FACT-G ) are widely used cancer-specific health-related  quality of life  ( HRQOL  ) question naires . We aim ed to compare their responsiveness with clinical ly important effects and statistical efficiency to detect such effects . STUDY DESIGN AND SETTING Secondary analysis of QLQ-C30 and FACT-G data from a r and omized controlled trial of Medical Qigong ( n = 162 heterogeneous cancer patients ) .  Difference in responsiveness ( DR ) and relative efficiency ( RE ) were calculated for five domains . RESULTS FACT-G total score was more efficient than QLQ-C30 global scale for detecting change within the intervention arm [ RE = 0.31 ( 0.083 , 0.69 ) ] and comparing change between trial arms [ RE = 0.17 ( 0.009 , 0.58 ) ] . In the social domain , the QLQ-C30 scale was more responsive [ DR = 0.28 ( 0.024 , 0.54 ) ] and more efficient within arm only [ RE = 5.25 ( 1.21 , 232.26 ) ] . In the physical , functional/role , and emotional domains , neither question naire was more responsive or efficient . CONCLUSION FACT-G would require about one-third the sample of QLQ-C30 to detect a given change in overall HRQOL , whereas in the social domain , it would require five times the sample size . FACT-G won advantage in overall HRQOL by reduced " noise " ( smaller st and ard deviation achieved by summing across 27 items ) , whereas QLQ-C30 won advantage in the social domain via a larger " signal " ( achieved through well-targeted item content ) Research suggests that stress‐reduction programs tailored to the cancer setting help patients cope with the effects of treatment and improve their quality of life .  Yoga , an ancient Eastern science , incorporates stress‐reduction techniques that include regulated breathing , visual imagery , and meditation as well as various postures . The authors examined the effects of the  Tibetan yoga ( TY ) practice s of Tsa lung and Trul khor , which incorporate  controlled breathing and visualization , mindfulness techniques  , and low‐impact postures  in patients with lymphoma This study examined the effect of an integrated yoga programme on chemotherapy-related nausea and emesis in early operable breast cancer out patients . Sixty-two subjects were r and omly allocated to receive yoga ( n = 28 ) or supportive therapy intervention ( n = 34 ) during the course of their chemotherapy . Both groups had similar socio-demographic and medical characteristics . Intervention consisted of both supervised and home practice of yoga sessions lasting for 60 min daily , while the control group received supportive therapy and coping preparation during their hospital visits over a complete course of chemotherapy . The primary outcome measure was the Morrow Assessment of Nausea and Emesis ( MANE ) assessed after the fourth cycle of chemotherapy . Secondary outcomes included measures for anxiety , depression , quality of life , distressful symptoms and treatment-related toxicity assessed before and during the course of chemotherapy . Following yoga , there was a significant decrease in post-chemotherapy-induced nausea frequency ( P = 0.01 ) and nausea intensity ( P = 0.01 ) , and intensity of anticipatory nausea ( P = 0.01 ) and anticipatory vomiting ( P = 0.05 ) as compared with the control group . There was a significant positive correlation between MANE scores and anxiety , depression and distressful symptoms . In conclusion , the results suggest a possible use for stress reduction interventions such as yoga in complementing conventional antiemetics to manage chemotherapy-related nausea and emesis BACKGROUND Adolescents with irritable bowel syndrome ( IBS ) frequently experience interference with everyday activities . Mind-body approaches such as yoga have been recommended as interventions for patients with IBS . Despite promising results among adult sample s , there have been limited studies exploring the efficacy of yoga with pediatric patients . OBJECTIVE To conduct a preliminary r and omized study of yoga as treatment for adolescents with IBS . METHODS Twenty-five adolescents aged 11 to 18 years with IBS were r and omly assigned to either a yoga or wait list control group . Before the intervention , both groups completed question naires assessing gastrointestinal symptoms , pain , functional disability , coping , anxiety and depression . The yoga intervention consisted of a 1 h instructional session , demonstration and practice , followed by four weeks of daily home practice guided by a video . After four weeks , adolescents repeated the baseline question naires . The wait list control group then received the yoga intervention and four weeks later completed an additional set of question naires . RESULTS Adolescents in the yoga group reported lower levels of functional disability , less use of emotion-focused avoidance and lower anxiety following the intervention than adolescents in the control group . When the pre- and postintervention data for the two groups were combined , adolescents had significantly lower scores for gastrointestinal symptoms and emotion-focused avoidance following the yoga intervention . Adolescents found the yoga to be helpful and indicated they would continue to use it to manage their IBS . CONCLUSIONS Yoga holds promise as an intervention for adolescents with IBS OBJECTIVES This study compares the effects of an integrated yoga program with brief supportive therapy in breast cancer out patients undergoing adjuvant radiotherapy at a cancer centre . METHODS Eighty-eight stage II and III breast cancer out patients were r and omly assigned to receive yoga ( n = 44 ) or brief supportive therapy ( n = 44 ) prior to their radiotherapy treatment . Intervention consisted of yoga sessions lasting 60 min daily while the control group was imparted supportive therapy once in 10 days . Assessment s included European Organization for Research in the Treatment of Cancer- Quality of Life ( EORTCQoL C30 ) functional scales and Positive and Negative Affect Schedule ( PANAS ) . Assessment s were done at baseline and after 6 weeks of radiotherapy treatment . RESULTS An intention to treat GLM repeated measures ANOVA showed significant difference across groups over time for positive affect , negative affect and emotional function and social function . There was significant improvement in positive affect ( ES = 0.59 , p = 0.007 , 95%CI 1.25 to 7.8 ) , emotional function ( ES = 0.71 , p = 0.001 , 95%CI 6.45 to 25.33 ) and cognitive function ( ES = 0.48 , p = 0.03 , 95%CI 1.2 to 18.5 ) , and decrease in negative affect ( ES = 0.84 , p<0.001 , 95%CI -13.4 to -4.4 ) in the yoga group as compared to controls . There was a significant positive correlation between positive affect with role function , social function and global quality of life . There was a significant negative correlation between negative affect with physical function , role function , emotional function and social function . CONCLUSION The results suggest a possible role for yoga to improve quality of life and affect in breast cancer out patients PURPOSE / OBJECTIVES To determine the effect of aerobic and strength resistance training and epoetin alfa ( EPO ) therapy on transfusions , stem cell collection s , transplantation recovery , and multiple myeloma treatment response . DESIGN R and omized clinical trial . SETTING A myeloma research and therapy center in the south central United States . SAMPLE 135 patients with multiple myeloma , 120 evaluable . METHODS R and om assignment to exercise or usual care groups . All patients received EPO based on an algorithm . Aerobic capacity , using the six-minute walk test , was assessed prior to induction chemotherapy , prior to stem cell mobilization , and following stem cell collection for all patients and before and after transplantation for patients continuing in the study . Data analysis included analysis of variance to compare other outcome variables by groups . MAIN RESEARCH VARIABLES Number of red blood cell and platelet transfusions during transplantation , number of attempts at and total number of days of stem cell collection , time to recovery after transplantation , and response to intensive therapy for multiple myeloma . FINDINGS Recovery and treatment response were not significantly different between groups after transplantation . The exercise group had significantly fewer red blood cell transfusions and fewer attempts at stem cell collection . Serious adverse events were similar in each group . CONCLUSIONS Exercise with prophylactic EPO therapy reduces the number of RBC transfusions and attempts at stem cell collection for patients receiving intensive treatment for multiple myeloma . IMPLICATION S FOR NURSING Exercise is safe and has many physiologic benefits for patients receiving multiple myeloma treatment BACKGROUND Physical activity provides a number of physical and psychological benefits to cancer survivors , including lessening the impact of detrimental cancer-related symptoms and treatment side-effects ( e.g. fatigue , nausea ) , and improving overall well-being and quality of life . The purpose of the present pilot study was to examine the physical and psychological benefits afforded by a 7-week yoga program for cancer survivors . METHOD Eligible participants ( per-screened with PAR-Q/PAR-MED-X ) were r and omly assigned to either the  intervention ( n=20 ) or control group ( n=18 ) . All participants completed pre- and post-testing assessment s immediately before and after the yoga program , respectively . RESULTS The yoga program participants ( M age=51.18 ( 10.33 ) ; 92 % female ) included primarily breast cancer survivors , on average 55.95 ( 54.39 ) months post-diagnosis . Significant differences between the intervention and the control group at post-intervention were seen only in psychosocial ( i.e. global quality of life , emotional function , and diarrhea ) variables ( all p 's < 0.05 ) . There were also trends for group differences , in the hypothesized directions , for the psychosocial variables of emotional irritability , gastrointestinal symptoms , cognitive disorganization , mood disturbance , tension , depression , and confusion ( all p 's < 0.10 ) . Finally , there were also significant improvements in both the program participants and the controls from pre- to post-intervention on a number of physical fitness variables . CONCLUSIONS These initial findings suggest that yoga has significant potential and should be further explored as a beneficial physical activity option for cancer survivors . Future research might attempt to include a broader range of participants ( e.g. other types of cancer diagnoses , male subjects ) , a larger sample size , and a longer program duration in an RCT Background Little is known about the metabolic and heart rate responses to a typical hatha yoga session . The purpose s of this study were 1 ) to determine whether a typical yoga practice using various postures meets the current recommendations for levels of physical activity required to improve and maintain health and cardiovascular fitness ; 2 ) to determine the reliability of metabolic costs of yoga across sessions ; 3 ) to compare the metabolic costs of yoga practice to those of treadmill walking . Methods In this observational study , 20 intermediate-to-advanced level yoga practitioners , age 31.4 ± 8.3 years , performed an exercise routine inside a human respiratory chamber ( indirect calorimeter ) while wearing heart rate monitors . The exercise routine consisted of 30 minutes of sitting , 56 minutes of beginner-level hatha yoga administered by video , and 10 minutes of treadmill walking at 3.2 and 4.8 kph each . Me 
    Output:
    