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 The Exercise Intensity Trial ( EXcITe ) is a r and omized trial to compare the efficacy of supervised moderate-intensity aerobic training to moderate to high-intensity aerobic training , relative to attention control , on aerobic capacity , physiologic mechanisms , patient-reported outcomes , and biomarkers in women with operable breast cancer following the completion of definitive adjuvant therapy . Methods / Design Using a single-center , r and omized design , 174 postmenopausal women ( 58 patients / study arm ) with histologically confirmed , operable breast cancer presenting to Duke University Medical Center ( DUMC ) will be enrolled in this trial following completion of primary therapy ( including surgery , radiation therapy , and chemotherapy ) . After baseline assessment s , eligible participants will be r and omized to one of two supervised aerobic training interventions ( moderate-intensity or moderate/high-intensity aerobic training ) or an attention-control group ( progressive stretching ) . The aerobic training interventions will include 150 mins.wk-1 of supervised treadmill walking per week at an intensity of 60%-70 % ( moderate-intensity ) or 60 % to 100 % ( moderate to high-intensity ) of the individually determined peak oxygen consumption ( VO2peak ) between 20 - 45 minutes/session for 16 weeks . The progressive stretching program will be consistent with the exercise interventions in terms of program length ( 16 weeks ) , social interaction ( participants will receive one-on-one instruction ) , and duration ( 20 - 45 mins/session ) . The primary study endpoint is VO2peak , as measured by an incremental cardiopulmonary exercise test . Secondary endpoints include physiologic determinants that govern VO2peak , patient-reported outcomes , and biomarkers associated with breast cancer recurrence/mortality . All endpoints will be assessed at baseline and after the intervention ( 16 weeks ) . Discussion EXCITE is design ed to investigate the intensity of aerobic training required to induce optimal improvements in VO2peak and other pertinent outcomes in women who have completed definitive adjuvant therapy for operable breast cancer . Overall , this trial will inform and refine exercise guidelines to optimize recovery in breast and other cancer survivors following the completion of primary cytotoxic therapy . Trial Registration Goals of workOur aim was to compare the effects of l and versus water multimodal exercise programs on body composition and breast cancer-specific quality of life in breast cancer survivors . Patients and methods Ninety-eight breast cancer survivors were assigned to three groups : control , l and exercise , and water exercise . Both exercise groups participated in an 8-week multimodal program . Adiposity was measured by anthropometry ( body mass index , waist circumference ) and bioelectrical impedance ( body fat and muscle lean body mass ) . Incidence of clinical ly significant secondary lymphedema was also assessed . Finally , specific quality of life was assessed using the European Organization for Research and Treatment of Cancer Quality of Life BR-23.Main Results Using ANCOVA , significant group × time interactions for body fat percentage ( F = 3.376 ; P = 0.011 ) and lean body mass ( F = 3.566 ; P = 0.008 ) were found . Breast cancer survivors in the l and exercise group exhibited a greater decrease in percentage of body fat than those in the water exercise ( P < 0.001 ) and control ( P = 0.002 ) groups . The ANCOVA revealed a significant group × time interaction for waist circumference ( F = 4.553 ; P = 0.002 ) : breast cancer survivors in the control group showed a greater waist circumference when compared to water ( P = 0.003 ) and l and ( P < 0.001 ) exercise groups . A significant group × time interaction was also found for breast symptoms ( F = 9.048 ; P < 0.001 ) : participants in the water exercise group experienced a greater decrease of breast symptoms than those in the l and exercise ( P < 0.01 ) and control ( P < 0.05 ) groups . Conclusion L and exercise produced a greater decrease in body fat and an increase in lean body mass , whereas water exercise was better for improving breast symptoms 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 Recovering from cancer treatment can be a difficult experience , both physically and psychologically . This paper describes a r and omized controlled trial that evaluates the effects of exercise therapy upon quality of life in 120 women who have had breast cancer . To facilitate behaviour change , exercise counselling is also included as an integral component in the exercise therapy intervention .  Participants are r and omized to one of three groups : exercise therapy , body conditioning ( placebo control ) or a normal care control group .  The supervised exercise therapy and body conditioning sessions take place 3 times per week for 8 weeks . Outcome measures include quality of life , physical self-perceptions , depression , satisfaction with life , exercise behaviour , aerobic capacity and percentage body fat . All outcomes are assessed at baseline , 4 weeks during the intervention and at the end of the 8-week intervention . Follow-up assessment s of outcomes take place at 3 and 6 months post-intervention . As the number of women surviving breast cancer is increasing and cancer treatment is linked to reduced quality of life , it is critical to evaluate treatments that improve the quality of life of this population or hasten recovery following treatment Few r and omized controlled trials have examined the effects of combined aerobic and resistance training in breast cancer survivors soon after completing adjuvant therapy . Breast cancer survivors ( N = 58 ) within 2 years of completing adjuvant therapy were r and omly assigned to an immediate exercise group ( IEG ; n = 29 ) or a delayed exercise group ( DEG ; n = 29 ) . The IEG completed 12 weeks of supervised aerobic and resistance exercise , three times per week . The DEG completed the program during the next 12 weeks . Participants completed patient-rated outcomes at baseline , 6 , 12 , 18 and 24 weeks . The primary endpoint was overall quality of life ( QoL ) measured by the Functional Assessment of Cancer Therapy-Breast scale . Secondary endpoints were fatigue , social physique anxiety , and physical fitness . Follow-up data was obtained on 97 % of participants and exercise adherence was 61.3 % . Repeated measures analyses of variance revealed a significant group by time interaction for overall QoL ( P < 0.001 ) . Specifically , QoL increased in the IEG from baseline to 12 weeks by 20.8 points compared to a decrease in the DEG of 5.3 points ( mean group difference = 26.1 ; 95 % CI = 18.3–32.7 ; P < 0.001 ) . From 12 to 24 weeks , QoL increased in the DEG by 29.5 points compared to an increase of 6.5 points in the IEG ( mean group difference = 23.0 ; 95 % CI = 16.3–29.1 ; P < 0.001 ) . Similar results were obtained for the secondary endpoints . Combined aerobic and resistance exercise soon after the completion of breast cancer therapy produces large and rapid improvements in health-related outcomes PURPOSE To determine the effects of breast cancer-specific print material s and step pedometers on  physical activity ( PA ) and quality of life ( QoL ) in breast cancer survivors . PATIENTS AND METHODS Breast cancer survivors ( N = 377 ) were r and omly assigned to receive one of the following : a st and ard public health recommendation for PA , previously developed breast cancer-specific PA print material s , a step pedometer , or a combination of breast cancer-specific print material s and step pedometers . The primary outcome was self-reported moderate/vigorous PA minutes per week . Secondary outcomes were QoL ( Functional Assessment of Cancer Therapy-Breast ) , fatigue , self-reported brisk walking , and objective step counts . Assessment s were conducted at baseline and postintervention ( 12 weeks ) . RESULTS Attrition was 10.3 % ( 39 of 377 ) . On the basis of linear mixed-model analyses , PA increased by 30 minutes/week in the st and ard recommendation group compared with 70 minutes/week in the print material group ( mean difference , 39 minutes/week ; 95 % CI = -10 to 89 ; d = 0.25 ; P = .117 ) , 89 minutes/week in the pedometer group ( mean difference , 59 minutes/week ; 95 % CI , 11 to 108 ; d = 0.38 ; P = .017 ) , and 87 minutes/week in the combined group ( mean difference , 57 minutes/week ; 95 % CI , 8 to 106 ; d = 0.37 ; P = .022 ) . For brisk walking minutes/week , all three intervention groups reported significantly greater increases than the st and ard recommendation group . The combined group also reported significantly improved QoL ( mean difference , 5.8 ; 95 % CI , 2.0 to 9.6 ; d = 0.33 ; P = .003 ) and reduced fatigue ( mean difference , 2.3 ; 95 % CI , 0.0 to 4.7 ; d = 0.25 ; P = .052 ) compared with the st and ard recommendation group . CONCLUSION Breast cancer-specific PA print material s and pedometers may be effective strategies for increasing PA and QoL in breast cancer survivors . A combined approach appears to be optimal . CLINICAL TRIAL REGISTRATION Clinical Trials.gov Identifier Excess body weight at diagnosis and weight gain after breast cancer are associated with poorer long-term prognosis . This study investigated the effects of a lifestyle intervention on body weight and other health outcomes influencing long-term prognosis in overweight women ( BMI > 25.0 kg/m2 ) recovering from early-stage ( stage I – III ) breast cancer . A total of 90 women treated 3–18 months previously were r and omly allocated to a 6-month exercise and hypocaloric healthy eating program ( n = 47 , aged 55.6 ± 10.2 year ) or  control group ( n = 43 , aged 55.9 ± 8.9 year ) . Women in the intervention group received three supervised exercise sessions per week and individualized dietary advice , supplemented by weekly nutrition seminars . Body weight , waist circumference , waist/hip ratio [ WHR ] , cardiorespiratory fitness , blood biomarkers associated with breast cancer recurrence and cardiovascular disease risk , and quality of life ( FACT-B ) were assessed at baseline and 6 months . Three-day diet diaries were used to assess macronutrient and energy intakes . A moderate reduction in body weight in the intervention group ( median difference from baseline of −1.09 kg ; IQR −0.15 to −2.90 kg ; p = 0.07 ) was accompanied by significant reductions in waist circumference ( p < 0.001 ) , WHR ( p = 0.005 ) , total ( p = 0.021 ) and saturated fat ( p = 0.006 ) intakes , leptin ( p = 0.005 ) , total cholesterol ( p = 0.046 ) , and resting diastolic blood pressure ( p = 0.03 ) . Cardiopulmonary fitness ( p < 0.001 ) and FACT-B quality of life ( p = 0.004 ) also 
    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 The Exercise Intensity Trial ( EXcITe ) is a r and omized trial to compare the efficacy of supervised moderate-intensity aerobic training to moderate to high-intensity aerobic training , relative to attention control , on aerobic capacity , physiologic mechanisms , patient-reported outcomes , and biomarkers in women with operable breast cancer following the completion of definitive adjuvant therapy . Methods / Design Using a single-center , r and omized design , 174 postmenopausal women ( 58 patients / study arm ) with histologically confirmed , operable breast cancer presenting to Duke University Medical Center ( DUMC ) will be enrolled in this trial following completion of primary therapy ( including surgery , radiation therapy , and chemotherapy ) . After baseline assessment s , eligible participants will be r and omized to one of two supervised aerobic training interventions ( moderate-intensity or moderate/high-intensity aerobic training ) or an attention-control group ( progressive stretching ) . The aerobic training interventions will include 150 mins.wk-1 of supervised treadmill walking per week at an intensity of 60%-70 % ( moderate-intensity ) or 60 % to 100 % ( moderate to high-intensity ) of the individually determined peak oxygen consumption ( VO2peak ) between 20 - 45 minutes/session for 16 weeks . The progressive stretching program will be consistent with the exercise interventions in terms of program length ( 16 weeks ) , social interaction ( participants will receive one-on-one instruction ) , and duration ( 20 - 45 mins/session ) . The primary study endpoint is VO2peak , as measured by an incremental cardiopulmonary exercise test . Secondary endpoints include physiologic determinants that govern VO2peak , patient-reported outcomes , and biomarkers associated with breast cancer recurrence/mortality . All endpoints will be assessed at baseline and after the intervention ( 16 weeks ) . Discussion EXCITE is design ed to investigate the intensity of aerobic training required to induce optimal improvements in VO2peak and other pertinent outcomes in women who have completed definitive adjuvant therapy for operable breast cancer . Overall , this trial will inform and refine exercise guidelines to optimize recovery in breast and other cancer survivors following the completion of primary cytotoxic therapy . Trial Registration Goals of workOur aim was to compare the effects of l and versus water multimodal exercise programs on body composition and breast cancer-specific quality of life in breast cancer survivors . Patients and methods Ninety-eight breast cancer survivors were assigned to three groups : control , l and exercise , and water exercise . Both exercise groups participated in an 8-week multimodal program . Adiposity was measured by anthropometry ( body mass index , waist circumference ) and bioelectrical impedance ( body fat and muscle lean body mass ) . Incidence of clinical ly significant secondary lymphedema was also assessed . Finally , specific quality of life was assessed using the European Organization for Research and Treatment of Cancer Quality of Life BR-23.Main Results Using ANCOVA , significant group × time interactions for body fat percentage ( F = 3.376 ; P = 0.011 ) and lean body mass ( F = 3.566 ; P = 0.008 ) were found . Breast cancer survivors in the l and exercise group exhibited a greater decrease in percentage of body fat than those in the water exercise ( P < 0.001 ) and control ( P = 0.002 ) groups . The ANCOVA revealed a significant group × time interaction for waist circumference ( F = 4.553 ; P = 0.002 ) : breast cancer survivors in the control group showed a greater waist circumference when compared to water ( P = 0.003 ) and l and ( P < 0.001 ) exercise groups . A significant group × time interaction was also found for breast symptoms ( F = 9.048 ; P < 0.001 ) : participants in the water exercise group experienced a greater decrease of breast symptoms than those in the l and exercise ( P < 0.01 ) and control ( P < 0.05 ) groups . Conclusion L and exercise produced a greater decrease in body fat and an increase in lean body mass , whereas water exercise was better for improving breast symptoms 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 Recovering from cancer treatment can be a difficult experience , both physically and psychologically . This paper describes a r and omized controlled trial that evaluates the effects of exercise therapy upon quality of life in 120 women who have had breast cancer . To facilitate behaviour change , exercise counselling is also included as an integral component in the exercise therapy intervention .  Participants are r and omized to one of three groups : exercise therapy , body conditioning ( placebo control ) or a normal care control group .  The supervised exercise therapy and body conditioning sessions take place 3 times per week for 8 weeks . Outcome measures include quality of life , physical self-perceptions , depression , satisfaction with life , exercise behaviour , aerobic capacity and percentage body fat . All outcomes are assessed at baseline , 4 weeks during the intervention and at the end of the 8-week intervention . Follow-up assessment s of outcomes take place at 3 and 6 months post-intervention . As the number of women surviving breast cancer is increasing and cancer treatment is linked to reduced quality of life , it is critical to evaluate treatments that improve the quality of life of this population or hasten recovery following treatment Few r and omized controlled trials have examined the effects of combined aerobic and resistance training in breast cancer survivors soon after completing adjuvant therapy . Breast cancer survivors ( N = 58 ) within 2 years of completing adjuvant therapy were r and omly assigned to an immediate exercise group ( IEG ; n = 29 ) or a delayed exercise group ( DEG ; n = 29 ) . The IEG completed 12 weeks of supervised aerobic and resistance exercise , three times per week . The DEG completed the program during the next 12 weeks . Participants completed patient-rated outcomes at baseline , 6 , 12 , 18 and 24 weeks . The primary endpoint was overall quality of life ( QoL ) measured by the Functional Assessment of Cancer Therapy-Breast scale . Secondary endpoints were fatigue , social physique anxiety , and physical fitness . Follow-up data was obtained on 97 % of participants and exercise adherence was 61.3 % . Repeated measures analyses of variance revealed a significant group by time interaction for overall QoL ( P < 0.001 ) . Specifically , QoL increased in the IEG from baseline to 12 weeks by 20.8 points compared to a decrease in the DEG of 5.3 points ( mean group difference = 26.1 ; 95 % CI = 18.3–32.7 ; P < 0.001 ) . From 12 to 24 weeks , QoL increased in the DEG by 29.5 points compared to an increase of 6.5 points in the IEG ( mean group difference = 23.0 ; 95 % CI = 16.3–29.1 ; P < 0.001 ) . Similar results were obtained for the secondary endpoints . Combined aerobic and resistance exercise soon after the completion of breast cancer therapy produces large and rapid improvements in health-related outcomes PURPOSE To determine the effects of breast cancer-specific print material s and step pedometers on  physical activity ( PA ) and quality of life ( QoL ) in breast cancer survivors . PATIENTS AND METHODS Breast cancer survivors ( N = 377 ) were r and omly assigned to receive one of the following : a st and ard public health recommendation for PA , previously developed breast cancer-specific PA print material s , a step pedometer , or a combination of breast cancer-specific print material s and step pedometers . The primary outcome was self-reported moderate/vigorous PA minutes per week . Secondary outcomes were QoL ( Functional Assessment of Cancer Therapy-Breast ) , fatigue , self-reported brisk walking , and objective step counts . Assessment s were conducted at baseline and postintervention ( 12 weeks ) . RESULTS Attrition was 10.3 % ( 39 of 377 ) . On the basis of linear mixed-model analyses , PA increased by 30 minutes/week in the st and ard recommendation group compared with 70 minutes/week in the print material group ( mean difference , 39 minutes/week ; 95 % CI = -10 to 89 ; d = 0.25 ; P = .117 ) , 89 minutes/week in the pedometer group ( mean difference , 59 minutes/week ; 95 % CI , 11 to 108 ; d = 0.38 ; P = .017 ) , and 87 minutes/week in the combined group ( mean difference , 57 minutes/week ; 95 % CI , 8 to 106 ; d = 0.37 ; P = .022 ) . For brisk walking minutes/week , all three intervention groups reported significantly greater increases than the st and ard recommendation group . The combined group also reported significantly improved QoL ( mean difference , 5.8 ; 95 % CI , 2.0 to 9.6 ; d = 0.33 ; P = .003 ) and reduced fatigue ( mean difference , 2.3 ; 95 % CI , 0.0 to 4.7 ; d = 0.25 ; P = .052 ) compared with the st and ard recommendation group . CONCLUSION Breast cancer-specific PA print material s and pedometers may be effective strategies for increasing PA and QoL in breast cancer survivors . A combined approach appears to be optimal . CLINICAL TRIAL REGISTRATION Clinical Trials.gov Identifier Excess body weight at diagnosis and weight gain after breast cancer are associated with poorer long-term prognosis . This study investigated the effects of a lifestyle intervention on body weight and other health outcomes influencing long-term prognosis in overweight women ( BMI > 25.0 kg/m2 ) recovering from early-stage ( stage I – III ) breast cancer . A total of 90 women treated 3–18 months previously were r and omly allocated to a 6-month exercise and hypocaloric healthy eating program ( n = 47 , aged 55.6 ± 10.2 year ) or  control group ( n = 43 , aged 55.9 ± 8.9 year ) . Women in the intervention group received three supervised exercise sessions per week and individualized dietary advice , supplemented by weekly nutrition seminars . Body weight , waist circumference , waist/hip ratio [ WHR ] , cardiorespiratory fitness , blood biomarkers associated with breast cancer recurrence and cardiovascular disease risk , and quality of life ( FACT-B ) were assessed at baseline and 6 months . Three-day diet diaries were used to assess macronutrient and energy intakes . A moderate reduction in body weight in the intervention group ( median difference from baseline of −1.09 kg ; IQR −0.15 to −2.90 kg ; p = 0.07 ) was accompanied by significant reductions in waist circumference ( p < 0.001 ) , WHR ( p = 0.005 ) , total ( p = 0.021 ) and saturated fat ( p = 0.006 ) intakes , leptin ( p = 0.005 ) , total cholesterol ( p = 0.046 ) , and resting diastolic blood pressure ( p = 0.03 ) . Cardiopulmonary fitness ( p < 0.001 ) and FACT-B quality of life ( p = 0.004 ) also 
    Output:
    