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 Research suggests that physical activity is associated with improved breast cancer survival , yet no studies have examined the association between post-diagnosis changes in physical activity and breast cancer outcomes . The aim of this study was to determine whether baseline activity and 1-year change in activity are associated with breast cancer events or mortality . Methods A total of 2,361 post-treatment breast cancer survivors ( Stage I – III ) enrolled in a r and omized controlled trial of dietary change completed physical activity measures  at baseline and one year .  Physical activity variables ( total , moderate – vigorous , and adherence to guidelines )  were calculated for each time point . Median follow-up was 7.1 years . Outcomes were invasive breast cancer events and all-cause mortality . Results Those who were most active at baseline had a 53 % lower mortality risk compared to the least active women ( HR = 0.47 ; 95 % CI : 0.26 , 0.84 ; p = .01 ) . Adherence to activity guidelines was associated with a 35 % lower mortality risk ( HR = 0.65 , 95 % CI : 0.47 , 0.91 ; p < .01 ) . Neither baseline nor 1-year change in activity was associated with additional breast cancer events . Conclusions Higher baseline ( post-treatment ) physical activity was associated with improved survival . However , change in activity over the following year was not associated with outcomes . These data suggest that long-term physical activity levels are important for breast cancer prognosis OBJECTIVE To examine the changes from a combined exercise intervention after radical prostatectomy ( RP ) in elderly patients with prostate cancer , because r and omized controlled trials addressing exercise intervention after RP have been lacking . METHODS From May 2009 to May 2010 , all patients who underwent laparoscopic RP were assessed for eligibility . A total of 66 patients were r and omized to an exercise or a control group . The exercise group received a combined exercise intervention ( resistance , flexibility , and Kegel exercises ) twice a week for 12 weeks , and the control group received only Kegel exercises . The primary outcome was physical function , and the secondary outcomes were continence status and quality of life after the exercise intervention . RESULTS A total of 49 patients completed follow-up to the end of study . After the 12-week exercise intervention , except for grip strength , all physical functions were better in the exercise group than in the control group . The 24-hour pad test results ( 12.2 g in the exercise group , 46.2 g in the control group ) and continence rate ( 73.1 % in exercise group , 43.5 % in the control group ) recovered more promptly in the exercise group . On a question naire study using the International Consultation on Incontinence question naire , Beck Depression Inventory , and Medical Outcomes Study 36-item short-form health survey , only the exercise group showed improvement at the last follow-up visit . CONCLUSION A 12-week combined exercise intervention after RP results in improvement of physical function , continence rate , and quality of life . These results could help with prompt recovery of daily activities Purpose : Physical activity in colon cancer survivors has been associated with lower cancer recurrences and improved survival . Whether molecular features of the tumor portend more or less likelihood for benefit from exercise is unknown . Experimental Design : Using two large prospect i ve cohort studies with physical activity assessment s after colon cancer diagnosis , we examined expression of fatty acid synthase , p53 , p21 , and p27 and mutational status of K-ras and phosphatidylinositol 3-kinase(PI3KCA ) . We calculated hazard ratios ( HR ) of colon cancer – specific mortality , adjusted for tumor and patient characteristics , and tested for molecular interactions with exercise . Results : In a cohort of 484 men and women with stage I to III colon cancer , patients who engaged in at least 18 metabolic equivalent task (MET)–hours per week after diagnosis had an adjusted HR for colon cancer – specific mortality of 0.64 [ 95 % confidence interval ( 95 % CI ) , 0.33 - 1.23 ] and for overall mortality of 0.60 ( 95 % CI , 0.41 - 0.86 ) . A statistically significant interaction was detected based on p27 expression ( P = 0.03 ) . For tumors with loss of p27 ( n = 195 ) , physical activity of ≥18 MET-hours/week led to a HR for colon cancer mortality of 1.40 ( 95 % CI , 0.41 - 4.72 ) , compared with those with < 18 MET-hours/week . However , for tumors with expression of p27 ( n = 251 ) , the adjusted HR was 0.33 ( 95 % CI , 0.12 - 0.85 ) . Molecular status of fatty acid synthase , K-ras , p53 , p21 , and PI3KCA did not influence the association  between exercise and colon cancer – specific or overall mortality . Conclusion : The benefit of physical activity on outcomes in patients with stage I to III colon cancer may be influenced by p27 status . Further studies are warranted to confirm these findings . ( Clin Cancer Res 2009;15(18):5931–6 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 Vigorous activity after diagnosis was recently reported to be inversely associated with prostate cancer-specific mortality . However , men with metastatic disease may decrease their activity due to their disease ; thus , a causal interpretation is uncertain . We therefore prospect ively examined  vigorous activity and brisk walking  after diagnosis in relation to risk of prostate cancer progression , an outcome less susceptible to reverse causation , among 1,455 men diagnosed with clinical ly localized prostate cancer . Cox proportional hazards regression was used to examine  vigorous activity , nonvigorous activity , walking duration , and walking pace  after diagnosis and risk of prostate cancer progression . We observed 117 events ( 45 biochemical recurrences , 66 secondary treatments , 3 bone metastases , 3 prostate cancer deaths ) during 2,750 person-years .  Walking  accounted for nearly half of all activity . Men who walked briskly for 3 h/wk or more had a 57 % lower rate of progression than men who walked at an easy pace for less than 3 h/wk ( HR = 0.43 ; 95 % CI : 0.21 - 0.91 ; P = 0.03 ) . Walking pace was associated with decreased risk of progression independent of duration ( HR brisk vs. easy pace = 0.52 ; 95 % CI : 0.29 - 0.91 ; P(trend ) = 0.01 ) . Few men engaged in vigorous activity , but there was a suggestive inverse association ( HR ≥3 h/wk vs. none = 0.63 ; 95 % CI : 0.32 - 1.23 ; P(trend ) = 0.17 ) . Walking duration and total nonvigorous activity were not associated with risk of progression independent of pace or vigorous activity , respectively . Brisk walking  after diagnosis may inhibit or delay prostate cancer progression among men diagnosed with clinical ly localized prostate cancer 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 Exercise has been reported to decrease cancer-related fatigue  and to increase quality of life ( QoL ) in various breast cancer ( BC ) population s. However , studies investigating exercise during radiotherapy or resistance training are scarce . We conducted a r and omized , controlled trial ( BEST study ) to assess the efficacy of 12-week resistance training on fatigue beyond possible psychosocial effects of a group-based intervention . PATIENTS AND METHODS One hundred sixty patients with BC stage 0-III were r and omly assigned to a 12-week progressive resistance training ( 2 times/week ) or a 12-week relaxation control ( RC , 2 times/week ) . Both interventions were group-based . The primary end point fatigue was assessed with a 20-item multidimensional question naire , QoL with EORTC question naires . Statistical analyses were based on analysis of covariance models for the individual changes from baseline to week 13 . RESULTS Adherence to the intervention program as well as the completion rate ( 97 % ) for the primary outcome variable fatigue was high . In intention-to-treat analyses for the N = 155 patients , significant between-group mean differences ( MD ) favoring the exercise group ( EX ) were observed for general fatigue ( P = 0.044 ) , especially for the subscale physical fatigue [ MD = -0.8 ; 95 % confidence interval -1.5 to -0.2 , P = 0.013 ] , but not for affective ( P = 0.91 ) or cognitive fatigue ( P = 0.65 ) . For QoL , significantly larger improvements regarding the role function ( P = 0.035 ) and pain ( P = 0.040 ) were noted among exercisers compared with RCs . Future perspective improved significantly stronger in the RC group compared with the EX group ( P = 0.047 ) . CONCLUSIONS The 12-week resistance training program was a safe , feasible and efficacious strategy to improve cancer-related fatigue and components of QoL  in BC patients during adjuvant radiotherapy . As exercise was compared with another group-based intervention , results indicate that resistance training effects on fatigue and QoL go beyond psychosocial benefits , and that the clinical ly relevant overall benefit of resistance exercise compared with usual care can be assumed to be higher . TRIAL REGISTRATION Clinical Trials.gov NCT01468766 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 
    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 Research suggests that physical activity is associated with improved breast cancer survival , yet no studies have examined the association between post-diagnosis changes in physical activity and breast cancer outcomes . The aim of this study was to determine whether baseline activity and 1-year change in activity are associated with breast cancer events or mortality . Methods A total of 2,361 post-treatment breast cancer survivors ( Stage I – III ) enrolled in a r and omized controlled trial of dietary change completed physical activity measures  at baseline and one year .  Physical activity variables ( total , moderate – vigorous , and adherence to guidelines )  were calculated for each time point . Median follow-up was 7.1 years . Outcomes were invasive breast cancer events and all-cause mortality . Results Those who were most active at baseline had a 53 % lower mortality risk compared to the least active women ( HR = 0.47 ; 95 % CI : 0.26 , 0.84 ; p = .01 ) . Adherence to activity guidelines was associated with a 35 % lower mortality risk ( HR = 0.65 , 95 % CI : 0.47 , 0.91 ; p < .01 ) . Neither baseline nor 1-year change in activity was associated with additional breast cancer events . Conclusions Higher baseline ( post-treatment ) physical activity was associated with improved survival . However , change in activity over the following year was not associated with outcomes . These data suggest that long-term physical activity levels are important for breast cancer prognosis OBJECTIVE To examine the changes from a combined exercise intervention after radical prostatectomy ( RP ) in elderly patients with prostate cancer , because r and omized controlled trials addressing exercise intervention after RP have been lacking . METHODS From May 2009 to May 2010 , all patients who underwent laparoscopic RP were assessed for eligibility . A total of 66 patients were r and omized to an exercise or a control group . The exercise group received a combined exercise intervention ( resistance , flexibility , and Kegel exercises ) twice a week for 12 weeks , and the control group received only Kegel exercises . The primary outcome was physical function , and the secondary outcomes were continence status and quality of life after the exercise intervention . RESULTS A total of 49 patients completed follow-up to the end of study . After the 12-week exercise intervention , except for grip strength , all physical functions were better in the exercise group than in the control group . The 24-hour pad test results ( 12.2 g in the exercise group , 46.2 g in the control group ) and continence rate ( 73.1 % in exercise group , 43.5 % in the control group ) recovered more promptly in the exercise group . On a question naire study using the International Consultation on Incontinence question naire , Beck Depression Inventory , and Medical Outcomes Study 36-item short-form health survey , only the exercise group showed improvement at the last follow-up visit . CONCLUSION A 12-week combined exercise intervention after RP results in improvement of physical function , continence rate , and quality of life . These results could help with prompt recovery of daily activities Purpose : Physical activity in colon cancer survivors has been associated with lower cancer recurrences and improved survival . Whether molecular features of the tumor portend more or less likelihood for benefit from exercise is unknown . Experimental Design : Using two large prospect i ve cohort studies with physical activity assessment s after colon cancer diagnosis , we examined expression of fatty acid synthase , p53 , p21 , and p27 and mutational status of K-ras and phosphatidylinositol 3-kinase(PI3KCA ) . We calculated hazard ratios ( HR ) of colon cancer – specific mortality , adjusted for tumor and patient characteristics , and tested for molecular interactions with exercise . Results : In a cohort of 484 men and women with stage I to III colon cancer , patients who engaged in at least 18 metabolic equivalent task (MET)–hours per week after diagnosis had an adjusted HR for colon cancer – specific mortality of 0.64 [ 95 % confidence interval ( 95 % CI ) , 0.33 - 1.23 ] and for overall mortality of 0.60 ( 95 % CI , 0.41 - 0.86 ) . A statistically significant interaction was detected based on p27 expression ( P = 0.03 ) . For tumors with loss of p27 ( n = 195 ) , physical activity of ≥18 MET-hours/week led to a HR for colon cancer mortality of 1.40 ( 95 % CI , 0.41 - 4.72 ) , compared with those with < 18 MET-hours/week . However , for tumors with expression of p27 ( n = 251 ) , the adjusted HR was 0.33 ( 95 % CI , 0.12 - 0.85 ) . Molecular status of fatty acid synthase , K-ras , p53 , p21 , and PI3KCA did not influence the association  between exercise and colon cancer – specific or overall mortality . Conclusion : The benefit of physical activity on outcomes in patients with stage I to III colon cancer may be influenced by p27 status . Further studies are warranted to confirm these findings . ( Clin Cancer Res 2009;15(18):5931–6 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 Vigorous activity after diagnosis was recently reported to be inversely associated with prostate cancer-specific mortality . However , men with metastatic disease may decrease their activity due to their disease ; thus , a causal interpretation is uncertain . We therefore prospect ively examined  vigorous activity and brisk walking  after diagnosis in relation to risk of prostate cancer progression , an outcome less susceptible to reverse causation , among 1,455 men diagnosed with clinical ly localized prostate cancer . Cox proportional hazards regression was used to examine  vigorous activity , nonvigorous activity , walking duration , and walking pace  after diagnosis and risk of prostate cancer progression . We observed 117 events ( 45 biochemical recurrences , 66 secondary treatments , 3 bone metastases , 3 prostate cancer deaths ) during 2,750 person-years .  Walking  accounted for nearly half of all activity . Men who walked briskly for 3 h/wk or more had a 57 % lower rate of progression than men who walked at an easy pace for less than 3 h/wk ( HR = 0.43 ; 95 % CI : 0.21 - 0.91 ; P = 0.03 ) . Walking pace was associated with decreased risk of progression independent of duration ( HR brisk vs. easy pace = 0.52 ; 95 % CI : 0.29 - 0.91 ; P(trend ) = 0.01 ) . Few men engaged in vigorous activity , but there was a suggestive inverse association ( HR ≥3 h/wk vs. none = 0.63 ; 95 % CI : 0.32 - 1.23 ; P(trend ) = 0.17 ) . Walking duration and total nonvigorous activity were not associated with risk of progression independent of pace or vigorous activity , respectively . Brisk walking  after diagnosis may inhibit or delay prostate cancer progression among men diagnosed with clinical ly localized prostate cancer 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 Exercise has been reported to decrease cancer-related fatigue  and to increase quality of life ( QoL ) in various breast cancer ( BC ) population s. However , studies investigating exercise during radiotherapy or resistance training are scarce . We conducted a r and omized , controlled trial ( BEST study ) to assess the efficacy of 12-week resistance training on fatigue beyond possible psychosocial effects of a group-based intervention . PATIENTS AND METHODS One hundred sixty patients with BC stage 0-III were r and omly assigned to a 12-week progressive resistance training ( 2 times/week ) or a 12-week relaxation control ( RC , 2 times/week ) . Both interventions were group-based . The primary end point fatigue was assessed with a 20-item multidimensional question naire , QoL with EORTC question naires . Statistical analyses were based on analysis of covariance models for the individual changes from baseline to week 13 . RESULTS Adherence to the intervention program as well as the completion rate ( 97 % ) for the primary outcome variable fatigue was high . In intention-to-treat analyses for the N = 155 patients , significant between-group mean differences ( MD ) favoring the exercise group ( EX ) were observed for general fatigue ( P = 0.044 ) , especially for the subscale physical fatigue [ MD = -0.8 ; 95 % confidence interval -1.5 to -0.2 , P = 0.013 ] , but not for affective ( P = 0.91 ) or cognitive fatigue ( P = 0.65 ) . For QoL , significantly larger improvements regarding the role function ( P = 0.035 ) and pain ( P = 0.040 ) were noted among exercisers compared with RCs . Future perspective improved significantly stronger in the RC group compared with the EX group ( P = 0.047 ) . CONCLUSIONS The 12-week resistance training program was a safe , feasible and efficacious strategy to improve cancer-related fatigue and components of QoL  in BC patients during adjuvant radiotherapy . As exercise was compared with another group-based intervention , results indicate that resistance training effects on fatigue and QoL go beyond psychosocial benefits , and that the clinical ly relevant overall benefit of resistance exercise compared with usual care can be assumed to be higher . TRIAL REGISTRATION Clinical Trials.gov NCT01468766 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 
    Output:
    