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: OBJECTIVE To examine upper limb physical function and adverse effects after axillary lymph node dissection ( ALND ) and sentinel lymph node biopsy ( SLNB ) in patients with breast cancer to identify impairments that can inform rehabilitation strategies . DESIGN Prospect i ve longitudinal cohort . Upper limb measurements were studied preoperatively and 2.5 years after breast cancer treatment . SETTING Hospital setting . PARTICIPANTS Two groups of patients with early-stage primary breast cancer ( N=391 ) : the ALND surgery group ( mean age , 55±10y ) and the SLNB group ( mean age , 57±10y ) . INTERVENTIONS Not applicable . MAIN OUTCOME MEASURES Arm lymphedema ( ≥10 % increased arm volume relative to control arm volume ) , grip strength ( in kilograms ) , shoulder mobility , pain intensity during isometric shoulder abduction ( on a 100-mm visual analog scale ) , and body mass index ( kg/m(2 ) ) . Parametric/nonparametric tests were used for hypothesized changes and differences , and regression analysis was used for confounding factors . RESULTS We observed more adverse effects in women treated with ALND than with SLNB after 2.5 years ( P<.05 ) : arm lymphedema ( 17 % vs 3 % ) , grip strength reduction ( 12 % vs 2 % ) , and shoulder abduction-provoked pain ( increase of 6 % vs decrease of 50 % ) . The adverse effects were similar for affected and control upper limbs for all outcomes except arm lymphedema , which occurred only on the affected side . CONCLUSIONS Adverse effects in both affected and control/unaffected upper limb were observed after 2.5-year follow-up in both ALND and SLNB groups , but a higher prevalence was observed in the ALND group . Thus , women going through ALND surgery may benefit from further postoperative physical therapy , including resistance and strength exercise , focusing on pain management Background : This r and omized controlled trial assessed the safety and effects of twice-weekly weight training among recent breast cancer survivors . Outcomes included body size and biomarkers hypothesized to link exercise and breast cancer risk . Methods : A convenience sample of 85 recent survivors was r and omized into immediate and delayed treatment groups . The immediate group trained from months 0 to 12 ; the delayed treatment group served as a no exercise parallel comparison group from months 0 to 6 and trained from months 7 to 12 . Measures at baseline , 6 and 12 months included body weight , height , body fat , lean mass , body fat % , and waist circumference , as well as fasting glucose , insulin , insulin resistance , insulin-like growth factor-I ( IGF-I ) , IGF-II , and IGF-binding protein-1 , IGFBP-2 , and IGFBP-3 . Injury reporting was st and ardized . Results : The intervention result ed in significant increases in lean mass ( 0.88 versus 0.02 kg , P < 0.01 ) , as well as significant decreases in body fat % ( −1.15 % versus 0.23 % , P = 0.03 ) and IGF-II ( −6.23 versus 28.28 ng/mL , P = 0.02 ) comparing immediate with delayed treatment from baseline to 6 months . Within-person changes experienced by delayed treatment group participants during training versus no training were similar . Only one participant experienced a study related injury that prevented continued participation . Conclusion : Twice-weekly weight training is a safe exercise program for recent breast cancer survivors that may result in increased muscle mass , as well as decreased body fat % and IGF-II . The implication s of these results on cancer recurrence or survival may become more evident with longer exercise intervention trials among breast cancer survivors 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 . Introduction Older breast cancer survivors ( BCS ) report more falls and functional limitations than women with no cancer history .  Exercise training could reduce risk factors for future falls and disability . Methods We conducted a r and omized , controlled trial in 106 early-stage , postmenopausal BCS who were ≥50 years old at diagnosis and post-treatment . Women were r and omly assigned to a 1-year resistance + impact exercise program or a stretching placebo program . Endpoints were one repetition maximum bench press and leg press strength , timed five chair st and s , 4 m usual walk speed , timed stance tests , h and grip strength , self-report physical function , and fatigue . We also examined the influence of age , adjuvant hormone therapy use , and exercise adherence on study outcomes . Results Women in the resistance + impact training program significantly improved maximal leg ( p < 0 .02 ) and bench ( p < 0 .02 ) press strength compared to the stretching group . Women who attended 50 % or more of prescribed resistance training sessions had significantly better changes in maximal strength measures compared to less adherent women . Conclusions Resistance + impact exercise is superior to stretching at improving maximal muscle strength and exercise adherence contributes to the degree of improvement . Implication s for cancer survivorsOlder BCS can safely engage in resistance exercise that improves lower and upper body strength , thereby reducing a risk factor for falls and future disability . However , the ability of resistance training to shift other indices of fall and disability risk , i.e. , balance and function , is unclear . Strategies to promote adherence to resistance training could lead to greater improvements in strength 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 Lymphopenia is frequent in advanced cancers and predicts the toxicity of chemotherapy . Its effect on relapse and survival is uncertain . Its prognostic value for survival was analyzed in three data bases of previously reported prospect i ve multicenter studies : ( a )  FEC chemotherapy in metastatic breast carcinoma ; ( b )  CYVADIC in advanced soft tissue sarcoma ( European Organization for Research and Treatment of Cancer-Soft Tissue and Bone Sarcoma Group 62791 ) ; and ( c ) prospect i ve , consecutive phase III studies of aggressive diffuse large-cell non-Hodgkin 's lymphomas conducted at Centre Léon Bérard between 1987 and 1993 . Univariate and multivariate analyses of prognostic factors for survival were performed . The incidence of lymphopenia of < 1,000/microL before treatment was constant among the series : 25 % , 24 % , and 27 % , respectively . Lymphopenia was significantly more frequent ( P < 0.05 ) in metastatic breast cancer patients with performance status ( PS ) of > 1 , non-Hodgkin 's lymphoma patients with international prognostic index ( IPI ) of > 0 , and advanced soft tissue sarcoma and metastatic breast cancer patients with bone metastases . Inunivariate analysis , lymphopenia of < 1,000/microL significantly correlated to overall survival in patients with metastatic breast cancer ( median , 10 versus 14 mo ; P < 0.0001 ) , advanced soft tissue sarcoma ( median , 5 versus 10 months ; P < 0.01 ) , and non-Hodgkin lymphoma ( median , 11 versus 94 months ; P < 0.0001 ) . In multivariate analysis ( Cox model ) , lymphopenia was an independent prognostic factor for overall survival in metastatic breast cancer [ RR ( relative risk ) , 1.8 ; 95 % CI ( confidence interval ) , 1.3 - 2.4 ] along with liver metastases and PS ; in advanced soft tissue sarcoma ( RR , 1.46 ; 95 % CI , 1.0 - 2.1 ) along with liver metastases , lung metastases , and PS ; and in non-Hodgkin 's lymphoma ( RR , 1 
    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: OBJECTIVE To examine upper limb physical function and adverse effects after axillary lymph node dissection ( ALND ) and sentinel lymph node biopsy ( SLNB ) in patients with breast cancer to identify impairments that can inform rehabilitation strategies . DESIGN Prospect i ve longitudinal cohort . Upper limb measurements were studied preoperatively and 2.5 years after breast cancer treatment . SETTING Hospital setting . PARTICIPANTS Two groups of patients with early-stage primary breast cancer ( N=391 ) : the ALND surgery group ( mean age , 55±10y ) and the SLNB group ( mean age , 57±10y ) . INTERVENTIONS Not applicable . MAIN OUTCOME MEASURES Arm lymphedema ( ≥10 % increased arm volume relative to control arm volume ) , grip strength ( in kilograms ) , shoulder mobility , pain intensity during isometric shoulder abduction ( on a 100-mm visual analog scale ) , and body mass index ( kg/m(2 ) ) . Parametric/nonparametric tests were used for hypothesized changes and differences , and regression analysis was used for confounding factors . RESULTS We observed more adverse effects in women treated with ALND than with SLNB after 2.5 years ( P<.05 ) : arm lymphedema ( 17 % vs 3 % ) , grip strength reduction ( 12 % vs 2 % ) , and shoulder abduction-provoked pain ( increase of 6 % vs decrease of 50 % ) . The adverse effects were similar for affected and control upper limbs for all outcomes except arm lymphedema , which occurred only on the affected side . CONCLUSIONS Adverse effects in both affected and control/unaffected upper limb were observed after 2.5-year follow-up in both ALND and SLNB groups , but a higher prevalence was observed in the ALND group . Thus , women going through ALND surgery may benefit from further postoperative physical therapy , including resistance and strength exercise , focusing on pain management Background : This r and omized controlled trial assessed the safety and effects of twice-weekly weight training among recent breast cancer survivors . Outcomes included body size and biomarkers hypothesized to link exercise and breast cancer risk . Methods : A convenience sample of 85 recent survivors was r and omized into immediate and delayed treatment groups . The immediate group trained from months 0 to 12 ; the delayed treatment group served as a no exercise parallel comparison group from months 0 to 6 and trained from months 7 to 12 . Measures at baseline , 6 and 12 months included body weight , height , body fat , lean mass , body fat % , and waist circumference , as well as fasting glucose , insulin , insulin resistance , insulin-like growth factor-I ( IGF-I ) , IGF-II , and IGF-binding protein-1 , IGFBP-2 , and IGFBP-3 . Injury reporting was st and ardized . Results : The intervention result ed in significant increases in lean mass ( 0.88 versus 0.02 kg , P < 0.01 ) , as well as significant decreases in body fat % ( −1.15 % versus 0.23 % , P = 0.03 ) and IGF-II ( −6.23 versus 28.28 ng/mL , P = 0.02 ) comparing immediate with delayed treatment from baseline to 6 months . Within-person changes experienced by delayed treatment group participants during training versus no training were similar . Only one participant experienced a study related injury that prevented continued participation . Conclusion : Twice-weekly weight training is a safe exercise program for recent breast cancer survivors that may result in increased muscle mass , as well as decreased body fat % and IGF-II . The implication s of these results on cancer recurrence or survival may become more evident with longer exercise intervention trials among breast cancer survivors 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 . Introduction Older breast cancer survivors ( BCS ) report more falls and functional limitations than women with no cancer history .  Exercise training could reduce risk factors for future falls and disability . Methods We conducted a r and omized , controlled trial in 106 early-stage , postmenopausal BCS who were ≥50 years old at diagnosis and post-treatment . Women were r and omly assigned to a 1-year resistance + impact exercise program or a stretching placebo program . Endpoints were one repetition maximum bench press and leg press strength , timed five chair st and s , 4 m usual walk speed , timed stance tests , h and grip strength , self-report physical function , and fatigue . We also examined the influence of age , adjuvant hormone therapy use , and exercise adherence on study outcomes . Results Women in the resistance + impact training program significantly improved maximal leg ( p < 0 .02 ) and bench ( p < 0 .02 ) press strength compared to the stretching group . Women who attended 50 % or more of prescribed resistance training sessions had significantly better changes in maximal strength measures compared to less adherent women . Conclusions Resistance + impact exercise is superior to stretching at improving maximal muscle strength and exercise adherence contributes to the degree of improvement . Implication s for cancer survivorsOlder BCS can safely engage in resistance exercise that improves lower and upper body strength , thereby reducing a risk factor for falls and future disability . However , the ability of resistance training to shift other indices of fall and disability risk , i.e. , balance and function , is unclear . Strategies to promote adherence to resistance training could lead to greater improvements in strength 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 Lymphopenia is frequent in advanced cancers and predicts the toxicity of chemotherapy . Its effect on relapse and survival is uncertain . Its prognostic value for survival was analyzed in three data bases of previously reported prospect i ve multicenter studies : ( a )  FEC chemotherapy in metastatic breast carcinoma ; ( b )  CYVADIC in advanced soft tissue sarcoma ( European Organization for Research and Treatment of Cancer-Soft Tissue and Bone Sarcoma Group 62791 ) ; and ( c ) prospect i ve , consecutive phase III studies of aggressive diffuse large-cell non-Hodgkin 's lymphomas conducted at Centre Léon Bérard between 1987 and 1993 . Univariate and multivariate analyses of prognostic factors for survival were performed . The incidence of lymphopenia of < 1,000/microL before treatment was constant among the series : 25 % , 24 % , and 27 % , respectively . Lymphopenia was significantly more frequent ( P < 0.05 ) in metastatic breast cancer patients with performance status ( PS ) of > 1 , non-Hodgkin 's lymphoma patients with international prognostic index ( IPI ) of > 0 , and advanced soft tissue sarcoma and metastatic breast cancer patients with bone metastases . Inunivariate analysis , lymphopenia of < 1,000/microL significantly correlated to overall survival in patients with metastatic breast cancer ( median , 10 versus 14 mo ; P < 0.0001 ) , advanced soft tissue sarcoma ( median , 5 versus 10 months ; P < 0.01 ) , and non-Hodgkin lymphoma ( median , 11 versus 94 months ; P < 0.0001 ) . In multivariate analysis ( Cox model ) , lymphopenia was an independent prognostic factor for overall survival in metastatic breast cancer [ RR ( relative risk ) , 1.8 ; 95 % CI ( confidence interval ) , 1.3 - 2.4 ] along with liver metastases and PS ; in advanced soft tissue sarcoma ( RR , 1.46 ; 95 % CI , 1.0 - 2.1 ) along with liver metastases , lung metastases , and PS ; and in non-Hodgkin 's lymphoma ( RR , 1 
    Output:
    