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 To investigate whether the impact of postdiagnosis exercise on  breast cancer outcomes  in women diagnosed with early-stage breast cancer differs on the basis of tumor clinicopathologic and molecular features . Using a prospect i ve design , 6,211 patients with early-stage breast cancer from two large population -based cohort studies were studied . Age-adjusted and multivariable Cox regression models were performed to determine the relationship between exercise exposure ( total MET-hours/week ) and recurrence and breast cancer-related death for : ( i ) all patients ( " unselected " cohort ) , and on the basis of ( ii ) classic clinicopathologic features , ( iii ) clinical subtypes , ( iv ) PAM50-based molecular intrinsic subtypes , and ( v ) individual PAM50 target genes . After a median follow-up of 7.2 years , in the unselected cohort ( n = 6,211 ) increasing exercise exposure was not associated with a reduction in the risk of recurrence ( adjusted Ptrend = 0.60 ) or breast cancer-related death ( adjusted Ptrend = 0.39 ) . On the basis of clinicopathologic features , an exercise-associated reduction in breast cancer-related death was apparent for tumors < 2 cm [ HR , 0.50 ; 95 % confidence interval ( CI ) , 0.34 - 0.72 ] , well/moderately differentiated tumors ( HR , 0.63 ; 95 % CI , 0.43 - 0.91 ) , and ER-positive tumors ( HR , 0.72 ; 95 % CI , 0.53 - 0.97 ) . Stratification by clinical subtype indicated that the ER(+)/PR(+)/HER2(-)/low- grade clinical subtype was preferentially responsive to exercise ( recurrence : adjusted HR , 0.63 ; 95 % CI , 0.45 - 0.88 ; breast cancer-related death : adjusted HR , 0.57 ; 95 % CI , 0.37 - 0.86 ) . The impact of exercise on cancer outcomes appears to differ as a function of pathologic and molecular features in early-stage breast cancer . Cancer Res ; 76(18 ) ; 5415 - 22 . © 2016 AACR Background : The possible benefit of lifetime physical activity ( PA ) in reducing prostate cancer incidence and mortality is unclear . Methods : A prospect i ve cohort of 45 887 men aged 45–79 years was followed up from January 1998 to December 2007 for prostate cancer incidence ( n=2735 ) and to December 2006 for its subtypes and for fatal ( n=190 ) prostate cancer . Results : We observed an inverse association between lifetime ( average of age 30 and 50 years , and baseline age ) total PA levels and prostate cancer risk . Multivariate-adjusted incidence in the top quartile of lifetime total PA  decreased by 16 % ( 95 % confidence interval (CI)=2–27 % ) compared with that in the bottom quartile . We also observed an inverse association between average lifetime work or occupational activity and walking or bicycling duration and prostate cancer risk . Compared with men who mostly sit during their main work or occupation , men who sit half of the time experienced a 20 % lower risk ( 95 % CI=7–31 % ) . The rate ratio linearly decreased by 7 % ( 95 % CI=1–12 % ) for total , 8 % ( 95 % CI=0–16 % ) for localised and 12 % ( 95 % CI=2–20 % ) for advanced prostate cancer for every 30 min per day increment of lifetime walking or bicycling in the range of 30 to 120 min per day . Conclusions : Our results suggest that not sitting for most of the time during work or occupational activity and walking or bicycling more than 30 min per day during adult life is associated with reduced incidence of prostate cancer Objective To evaluate the impact of combinations of lifestyle factors on  mortality in middle aged women . Design Prospect i ve cohort study . Setting Nurses ’ health study , United States . Participants 77 782 women aged 34 to 59 years and free from cardiovascular disease and cancer in 1980 . Main outcome measure Relative risk of mortality during 24 years of follow-up in relation to five lifestyle factors ( cigarette smoking , being overweight , taking little moderate to vigorous physical activity , no light to moderate alcohol intake , and low diet quality score ) . Results 8882 deaths were documented , including 1790 from cardiovascular disease and 4527 from cancer . Each lifestyle factor independently and significantly predicted mortality . Relative risks for five compared with zero lifestyle risk factors were 3.26 ( 95 % confidence interval 2.45 to 4.34 ) for cancer mortality , 8.17 ( 4.96 to 13.47 ) for cardiovascular mortality , and 4.31 ( 3.51 to 5.31 ) for all cause mortality . A total of 28 % ( 25 % to 31 % ) of deaths during follow-up could be attributed to smoking and 55 % ( 47 % to 62 % ) to the combination of smoking , being overweight , lack of physical activity , and a low diet quality . Additionally considering alcohol intake did not substantially change this estimate . Conclusions These results indicate that adherence to lifestyle guidelines is associated with markedly lower  mortality in middle aged women . Both efforts to eradicate cigarette smoking and those to stimulate regular physical activity and a healthy diet should be intensified OBJECTIVE To investigate the association between physical activity ( PA ) and risk of mortality in a large middle-aged cohort stratified by inflammatory status . PATIENTS AND METHODS A total of 336,560 individuals ( mean age , 39.7 years ; 58 % male ) who underwent comprehensive health screenings were enrolled in this prospect i ve cohort study . They were grouped according to self-reported PA level using a question naire : no regular PA with a sedentary lifestyle , regular but insufficient PA ( below the guidelines ) , sufficient PA ( concordant with the guidelines ) , and health-enhancing PA . Inflammation was assessed via high-sensitivity C-reactive protein ( hsCRP ) level . Study end points were all-cause , cardiovascular-related , and cancer-related mortality . RESULTS During the 1,976,882 person-years of follow-up ( median follow-up duration , 6.17 years ) , 2062 deaths occurred . Compared with a sedentary lifestyle , the hazard ratios ( 95 % CIs ) on the multivariable Cox proportional hazards regression analyses for all-cause mortality by PA level were 0.95 ( 0.84 - 1.07 ) , 0.85 ( 0.72 - 0.99 ) , and 0.75 ( 0.60 - 0.93 ) ( P for trend=.003 ) , and those for cardiovascular- and cancer-related mortality were 0.95 , 0.80 , and 0.55 ( P for trend=.05 ) and 0.82 , 0.83 , and 0.78 ( P for trend=.01 ) , respectively . Compared with participants with low hsCRP levels and any regular PA , those with high hsCRP levels and no regular PA had a significantly higher risk of mortality ( 1.59 [ 1.38 - 1.84 ] ) . CONCLUSION Higher PA levels were associated with a dose-dependent reduced risk of cardiovascular-related , cancer-related , and all-cause mortality . Individuals with high hsCRP levels and no regular PA had the highest risk of mortality Background : Several empirical investigations have attempted to characterize the effect of physical activity on cancer mortality , but these investigations have rarely focused on patients with advanced breast cancer . Objective : The current study examined the hypothesis that greater physical activity is associated with longer survival among women with advanced breast cancer . Methods : We conducted a secondary data analysis of a prospect i ve study of 103 patients with stage IV ( n = 100 ) or locally recurrent ( n = 3 ) breast cancer involved in a group psychotherapy trial .  Physical activity  was assessed at baseline using the Seven-Day Physical Activity Recall question naire , and patients were followed until April 1 , 2016 , at which time 93 of 103 had died . Results : Greater  physical activity  level at baseline was significantly associated with longer subsequent survival time in a Cox proportional hazards model ( hazard ratio [ HR ] , 0.90 ; 95 % confidence interval [ CI ] , 0.84–0.97 ; P < .01 ) . Engaging in 1 additional hour per day of moderate activity reduced the hazard of subsequent mortality by 23 % ( HR , 0.77 ; 95 % CI , 0.65–0.92 ; P < .01 ) . These results remained significant even after controlling for demographic , medical , cancer , depression , and cortisol variables ( HR , 0.91 ; 95 % CI , 0.84–0.99 ; P < .05 ) . Conclusions : Women with advanced breast cancer who engaged in physical activity for 1 or more hours per day at baseline had an increased likelihood of survival compared with those who exercised less than 1 hour per day . Implication s for Practice : Nurses should consider recommending moderate physical activity for women with advanced breast cancer . R and omized trials of physical activity interventions for this population are needed OBJECTIVE While low physical activity and high body mass index ( BMI ) have been associated with higher endometrial cancer incidence , no previous studies have evaluated the association between physical activity and survival after endometrial cancer diagnosis , and studies on BMI and survival have not been performed in a prospect i ve cohort . METHODS We examined pre-diagnosis BMI and moderate- to vigorous-intensity physical activity in relation to overall and disease-specific survival among 983 postmenopausal women who were diagnosed with endometrial cancer in the Women 's Health Initiative Observational Study and Clinical Trials . RESULTS Over a median 5.2 ( max 14.1 ) years from diagnosis to death or end of follow-up , 163 total deaths were observed , 66 of which were due to endometrial cancer . We observed a higher all-cause mortality hazard ratio ( HR ) = 1.85 ( 95 % CI 1.19 - 2.88 ) comparing women with a BMI ≥ 35 kg/m(2 ) to women with BMI < 25 kg/m(2 ) . For endometrial cancer-specific mortality the HR = 2.23 ( 95 % CI 1.09 - 4.54 ) comparing extreme BMI categories . To examine histologic subtypes we analyzed type I endometrial tumors separately and found an HR = 1.20 ( 95 % CI 1.07 - 1.35 ) associated with all-cause mortality for each 5-unit change in BMI . Moderate- to vigorous-intensity physical activity was not associated with all-cause or endometrial cancer-specific mortality . CONCLUSIONS Pre-diagnosis BMI , but not physical activity , was associated with survival among women with endometrial cancer . Future studies should investigate mechanisms and timing of BMI onset to better underst and the burden of disease attributable to BMI OBJECTIVE To examine the independent associations of leisure-time aerobic physical activity ( PA ) and resistance exercise ( RE ) on  all-cause mortality in cancer survivors . PATIENTS AND METHODS Patients included 2863 male and female cancer survivors , aged 18 to 81 years , who received a preventive medical examination between April 8 , 1987 , and December 27 , 2002 , while enrolled in the Aerobics Center Longitudinal Study in Dallas , Texas .  Physical activity and RE were assessed by self-report at the baseline medical examination . Cox proportional hazards regression analysis was performed to determine the independent associations of PA and RE with all-cause mortality in participants who had a history of cancer . RESULTS Physical activity in cancer survivors was not associated with a lower risk of all-cause 
    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 To investigate whether the impact of postdiagnosis exercise on  breast cancer outcomes  in women diagnosed with early-stage breast cancer differs on the basis of tumor clinicopathologic and molecular features . Using a prospect i ve design , 6,211 patients with early-stage breast cancer from two large population -based cohort studies were studied . Age-adjusted and multivariable Cox regression models were performed to determine the relationship between exercise exposure ( total MET-hours/week ) and recurrence and breast cancer-related death for : ( i ) all patients ( " unselected " cohort ) , and on the basis of ( ii ) classic clinicopathologic features , ( iii ) clinical subtypes , ( iv ) PAM50-based molecular intrinsic subtypes , and ( v ) individual PAM50 target genes . After a median follow-up of 7.2 years , in the unselected cohort ( n = 6,211 ) increasing exercise exposure was not associated with a reduction in the risk of recurrence ( adjusted Ptrend = 0.60 ) or breast cancer-related death ( adjusted Ptrend = 0.39 ) . On the basis of clinicopathologic features , an exercise-associated reduction in breast cancer-related death was apparent for tumors < 2 cm [ HR , 0.50 ; 95 % confidence interval ( CI ) , 0.34 - 0.72 ] , well/moderately differentiated tumors ( HR , 0.63 ; 95 % CI , 0.43 - 0.91 ) , and ER-positive tumors ( HR , 0.72 ; 95 % CI , 0.53 - 0.97 ) . Stratification by clinical subtype indicated that the ER(+)/PR(+)/HER2(-)/low- grade clinical subtype was preferentially responsive to exercise ( recurrence : adjusted HR , 0.63 ; 95 % CI , 0.45 - 0.88 ; breast cancer-related death : adjusted HR , 0.57 ; 95 % CI , 0.37 - 0.86 ) . The impact of exercise on cancer outcomes appears to differ as a function of pathologic and molecular features in early-stage breast cancer . Cancer Res ; 76(18 ) ; 5415 - 22 . © 2016 AACR Background : The possible benefit of lifetime physical activity ( PA ) in reducing prostate cancer incidence and mortality is unclear . Methods : A prospect i ve cohort of 45 887 men aged 45–79 years was followed up from January 1998 to December 2007 for prostate cancer incidence ( n=2735 ) and to December 2006 for its subtypes and for fatal ( n=190 ) prostate cancer . Results : We observed an inverse association between lifetime ( average of age 30 and 50 years , and baseline age ) total PA levels and prostate cancer risk . Multivariate-adjusted incidence in the top quartile of lifetime total PA  decreased by 16 % ( 95 % confidence interval (CI)=2–27 % ) compared with that in the bottom quartile . We also observed an inverse association between average lifetime work or occupational activity and walking or bicycling duration and prostate cancer risk . Compared with men who mostly sit during their main work or occupation , men who sit half of the time experienced a 20 % lower risk ( 95 % CI=7–31 % ) . The rate ratio linearly decreased by 7 % ( 95 % CI=1–12 % ) for total , 8 % ( 95 % CI=0–16 % ) for localised and 12 % ( 95 % CI=2–20 % ) for advanced prostate cancer for every 30 min per day increment of lifetime walking or bicycling in the range of 30 to 120 min per day . Conclusions : Our results suggest that not sitting for most of the time during work or occupational activity and walking or bicycling more than 30 min per day during adult life is associated with reduced incidence of prostate cancer Objective To evaluate the impact of combinations of lifestyle factors on  mortality in middle aged women . Design Prospect i ve cohort study . Setting Nurses ’ health study , United States . Participants 77 782 women aged 34 to 59 years and free from cardiovascular disease and cancer in 1980 . Main outcome measure Relative risk of mortality during 24 years of follow-up in relation to five lifestyle factors ( cigarette smoking , being overweight , taking little moderate to vigorous physical activity , no light to moderate alcohol intake , and low diet quality score ) . Results 8882 deaths were documented , including 1790 from cardiovascular disease and 4527 from cancer . Each lifestyle factor independently and significantly predicted mortality . Relative risks for five compared with zero lifestyle risk factors were 3.26 ( 95 % confidence interval 2.45 to 4.34 ) for cancer mortality , 8.17 ( 4.96 to 13.47 ) for cardiovascular mortality , and 4.31 ( 3.51 to 5.31 ) for all cause mortality . A total of 28 % ( 25 % to 31 % ) of deaths during follow-up could be attributed to smoking and 55 % ( 47 % to 62 % ) to the combination of smoking , being overweight , lack of physical activity , and a low diet quality . Additionally considering alcohol intake did not substantially change this estimate . Conclusions These results indicate that adherence to lifestyle guidelines is associated with markedly lower  mortality in middle aged women . Both efforts to eradicate cigarette smoking and those to stimulate regular physical activity and a healthy diet should be intensified OBJECTIVE To investigate the association between physical activity ( PA ) and risk of mortality in a large middle-aged cohort stratified by inflammatory status . PATIENTS AND METHODS A total of 336,560 individuals ( mean age , 39.7 years ; 58 % male ) who underwent comprehensive health screenings were enrolled in this prospect i ve cohort study . They were grouped according to self-reported PA level using a question naire : no regular PA with a sedentary lifestyle , regular but insufficient PA ( below the guidelines ) , sufficient PA ( concordant with the guidelines ) , and health-enhancing PA . Inflammation was assessed via high-sensitivity C-reactive protein ( hsCRP ) level . Study end points were all-cause , cardiovascular-related , and cancer-related mortality . RESULTS During the 1,976,882 person-years of follow-up ( median follow-up duration , 6.17 years ) , 2062 deaths occurred . Compared with a sedentary lifestyle , the hazard ratios ( 95 % CIs ) on the multivariable Cox proportional hazards regression analyses for all-cause mortality by PA level were 0.95 ( 0.84 - 1.07 ) , 0.85 ( 0.72 - 0.99 ) , and 0.75 ( 0.60 - 0.93 ) ( P for trend=.003 ) , and those for cardiovascular- and cancer-related mortality were 0.95 , 0.80 , and 0.55 ( P for trend=.05 ) and 0.82 , 0.83 , and 0.78 ( P for trend=.01 ) , respectively . Compared with participants with low hsCRP levels and any regular PA , those with high hsCRP levels and no regular PA had a significantly higher risk of mortality ( 1.59 [ 1.38 - 1.84 ] ) . CONCLUSION Higher PA levels were associated with a dose-dependent reduced risk of cardiovascular-related , cancer-related , and all-cause mortality . Individuals with high hsCRP levels and no regular PA had the highest risk of mortality Background : Several empirical investigations have attempted to characterize the effect of physical activity on cancer mortality , but these investigations have rarely focused on patients with advanced breast cancer . Objective : The current study examined the hypothesis that greater physical activity is associated with longer survival among women with advanced breast cancer . Methods : We conducted a secondary data analysis of a prospect i ve study of 103 patients with stage IV ( n = 100 ) or locally recurrent ( n = 3 ) breast cancer involved in a group psychotherapy trial .  Physical activity  was assessed at baseline using the Seven-Day Physical Activity Recall question naire , and patients were followed until April 1 , 2016 , at which time 93 of 103 had died . Results : Greater  physical activity  level at baseline was significantly associated with longer subsequent survival time in a Cox proportional hazards model ( hazard ratio [ HR ] , 0.90 ; 95 % confidence interval [ CI ] , 0.84–0.97 ; P < .01 ) . Engaging in 1 additional hour per day of moderate activity reduced the hazard of subsequent mortality by 23 % ( HR , 0.77 ; 95 % CI , 0.65–0.92 ; P < .01 ) . These results remained significant even after controlling for demographic , medical , cancer , depression , and cortisol variables ( HR , 0.91 ; 95 % CI , 0.84–0.99 ; P < .05 ) . Conclusions : Women with advanced breast cancer who engaged in physical activity for 1 or more hours per day at baseline had an increased likelihood of survival compared with those who exercised less than 1 hour per day . Implication s for Practice : Nurses should consider recommending moderate physical activity for women with advanced breast cancer . R and omized trials of physical activity interventions for this population are needed OBJECTIVE While low physical activity and high body mass index ( BMI ) have been associated with higher endometrial cancer incidence , no previous studies have evaluated the association between physical activity and survival after endometrial cancer diagnosis , and studies on BMI and survival have not been performed in a prospect i ve cohort . METHODS We examined pre-diagnosis BMI and moderate- to vigorous-intensity physical activity in relation to overall and disease-specific survival among 983 postmenopausal women who were diagnosed with endometrial cancer in the Women 's Health Initiative Observational Study and Clinical Trials . RESULTS Over a median 5.2 ( max 14.1 ) years from diagnosis to death or end of follow-up , 163 total deaths were observed , 66 of which were due to endometrial cancer . We observed a higher all-cause mortality hazard ratio ( HR ) = 1.85 ( 95 % CI 1.19 - 2.88 ) comparing women with a BMI ≥ 35 kg/m(2 ) to women with BMI < 25 kg/m(2 ) . For endometrial cancer-specific mortality the HR = 2.23 ( 95 % CI 1.09 - 4.54 ) comparing extreme BMI categories . To examine histologic subtypes we analyzed type I endometrial tumors separately and found an HR = 1.20 ( 95 % CI 1.07 - 1.35 ) associated with all-cause mortality for each 5-unit change in BMI . Moderate- to vigorous-intensity physical activity was not associated with all-cause or endometrial cancer-specific mortality . CONCLUSIONS Pre-diagnosis BMI , but not physical activity , was associated with survival among women with endometrial cancer . Future studies should investigate mechanisms and timing of BMI onset to better underst and the burden of disease attributable to BMI OBJECTIVE To examine the independent associations of leisure-time aerobic physical activity ( PA ) and resistance exercise ( RE ) on  all-cause mortality in cancer survivors . PATIENTS AND METHODS Patients included 2863 male and female cancer survivors , aged 18 to 81 years , who received a preventive medical examination between April 8 , 1987 , and December 27 , 2002 , while enrolled in the Aerobics Center Longitudinal Study in Dallas , Texas .  Physical activity and RE were assessed by self-report at the baseline medical examination . Cox proportional hazards regression analysis was performed to determine the independent associations of PA and RE with all-cause mortality in participants who had a history of cancer . RESULTS Physical activity in cancer survivors was not associated with a lower risk of all-cause 
    Output:
    