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: Physical activity is associated with improved breast cancer survival , but the underlying mechanisms , possibly including modification of the inflammatory state , are not well understood . We analyzed changes in interleukin (IL)-6 , C-reactive protein ( CRP ) , and TNF-α in a r and omized controlled trial of exercise in postmenopausal breast cancer survivors . Seventy-five women , recruited through the Yale-New Haven Hospital Tumor Registry , were r and omized to either a six-month aerobic exercise intervention or usual care . Correlations were calculated between baseline cytokines , adiposity , and physical activity measures . Generalized linear models were used to assess the effect of exercise  on IL-6 , CRP , and TNF-α . At baseline , IL-6 and CRP were positively correlated with body fat and body mass index ( BMI ) and were inversely correlated with daily pedometer steps ( P < 0.001 ) . We found no significant effect of exercise  on changes in inflammatory marker concentrations between women r and omized to exercise versus usual care , though secondary analyses revealed a significant reduction in IL-6 among exercisers who reached 80 % of the intervention goal compared with those who did not . Future studies should examine the effect of different types and doses of exercise and weight loss on inflammatory markers in large-scale trials of women diagnosed with breast cancer . Cancer Prev Res ; 6(2 ) ; 109–18 . © 2012 AACR To evaluate the efficacy and economic efficiency of a multimedia , multimodal physical activity program for women undergoing adjuvant therapy following surgery for breast cancer . We conducted a r and omized trial with concurrent incremental cost-effectiveness analysis and blinded baseline , 3 , 6 and 12-month follow-up assessment s amongst women undergoing adjuvant therapy following surgery for breast cancer ( n = 89 ) . The intervention was a multimedia , multimodal exercise program comprising strength , balance and endurance training elements . The control was sham flexibility and relaxation program delivered using similar material s. The primary outcome was health-related quality of life ( EQ-5D & VAS , EORTC C30 , BR23 ) . Economic outcomes included direct health care costs and productivity gains and losses . Participants in the intervention group demonstrated greater improvement in health-related quality of life between baseline and the 3-month assessment [ mean ( sd ) EQ-5D VAS ( 0–100 ) baseline : 72.6 ( 15.6 ) , 3 month : 80.6 ( 11.6 ) ] when compared to control group participants [ baseline : 77.5 ( 13.5 ) , 3 month : 74.1 ( 20.6 ) , P = 0.006 ] and also improved more in terms of physical function [ mean ( sd ) EORTC C30 physical function scale intervention ( 0–100 ) baseline : 84.9 ( 14.8 ) , 3 month : 86.9 ( 10.7 ) , control baseline : 91.3 ( 9.6 ) , 3 month : 86.7 ( 14.9 ) , P = 0.02 ] . These improvements were not sustained beyond this point . Upper limb volumes were also lower amongst intervention group participants . However , there was low probability that the intervention would be both less costly and more effective than the control condition ( range probability = 0.05–50.02 % depending on approach ) . Provision of multimodal exercise programs will improve the short-term health of women undergoing adjuvant therapy for breast cancer but are of question able economic efficiency 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 Abstract Objective Exercise interventions benefit cancer patients . However , only low numbers of patients adhere to these interventions . This review aim ed to identify predictors of exercise intervention adherence in patients with cancer , during and after multimodality cancer treatment . Methods A literature search was performed using electronic data bases ( PubMed , Embase , and Cochrane ) to identify relevant papers published before February 1 , 2017 . Papers reporting r and omized controlled trials , conducted in adult cancer patients who participated in an exercise intervention during and /or after multimodality cancer treatment  , and providing outcome of factors predicting exercise adherence were included . Papers were assessed for method ological quality by using the Physiotherapy Evidence Data base scale . Results The search identified 720 potentially relevant papers , of which 15 fulfilled the eligibility criteria . In these 15 studies , 2279 patients were included and 1383 of these patients were r and omized to an exercise intervention .  During cancer treatment , the factors predicting exercise adherence were as follows : location of the rehabilitation center , extensive exercise history , high motivation for exercise , and fewer exercise limitations . After cancer treatment , factors that predicted adherence were as follows : less extensive surgery , low alcohol consumption , high previous exercise adherence , family support , feedback by trainers , and knowledge and skills of exercise . Method ological quality of the included papers was rated “ high ” . Conclusions The most prominent predictors of  adherence to exercise interventions were location of the rehabilitation center , extensive exercise history , high motivation for exercise , and fewer exercise limitations . To increase the number of cancer patients who will benefit , these results should be considered into the development and implementation of future exercise interventions Background We previously reported that a physical activity ( PA ) behavior change intervention based on the theory of planned behavior ( TPB ) increased PA and quality of life in breast cancer survivors . Purpose To examine the effects of our interventions on TPB variables and to determine if PA at 12 weeks follow-up was mediated by TPB variables at 4 weeks . Methods Breast cancer survivors ( N = 377 ) were r and omly assigned to receive either a st and ard public health recommendation for PA ( SR group ) , a step pedometer alone , or one of two TPB-based behavior change interventions consisting of print material s ( alone or combined with a step pedometer ) . For the purpose of this study , we compared the two TPB-based intervention groups ( INT group ) to the SR group . Results Compared to the SR group , the INT group reported more favorable changes in instrumental attitude ( mean difference = 0.13 ; 95 % CI = −0.01 to 0.23 ; d = 0.19 ; p = 0.077 ) , intention ( mean difference = 0.33 ; 95 % CI = 0.10 to 0.56 ; d = 0.33 ; p = 0.006 ) , and planning ( mean difference = 0.39 ; 95 % CI = 0.04 to 0.73 ; d = 0.26 ; p = 0.027 ) . Mediation analyses indicated that both planning and intention partially mediated the effects of the intervention on PA at 12 weeks . Conclusions Our TPB-based behavior change intervention result ed in small improvements in the TPB constructs that partially mediated the effects of our intervention on PA behavior . Additional research with the TPB is warranted AIMS AND OBJECTIVES To explore factors influencing exercise adherence  among women with breast cancer while following an exercise programme .  BACKGROUND Earlier research shows that women with breast cancer decrease physical activity following the cancer diagnosis and that adhering to exercise interventions can be a challenge . Research is needed to identify motivational factors and barriers for exercise adherence among women during treatment for breast cancer . DESIGN This was a qualitative study to explore patient 's perceptions of the challenges to exercise adherence during a r and omised , controlled trial . METHODS Twenty-seven women with early-stage breast cancer were purposively sample d for focus group interviews during 2011 - 2012 from their participation in the exercise intervention group during 2010 - 2012 . Five focus groups were performed , and data analysis was completed using the systematic text condensation method . RESULTS During the focus group study , five main themes were identified , which described factors participants perceived to influence their adherence to exercise during chemotherapy : ' side effects of breast cancer treatment as a barrier to exercise ' , ' restoring and maintaining normality in daily life motivates exercise ' , ' other valued activities compete with exercise ' , ' constructive support enhances exercise ' and ' positive beliefs about efficacy and outcomes motivate exercise ' . CONCLUSION Adherence to exercise in women with breast cancer is challenged by internal and external conditions and may be improved by attention to the impact of treatment side effects and by supporting patient self-efficacy towards changing health behaviour . RELEVANCE TO CLINICAL PRACTICE Nurses should be aware that exercise adherence could be a challenge among women with breast cancer . They should help identify obstacles to exercise for women and ways to overcome them , as well as support them in their beliefs that they are capable of changing their health behaviour We describe adherence to a three group r and omised controlled trial that involved aerobic exercise therapy  ( N=34 ) and exercise-placebo intervention  ( N=36 ) or usual care  ( N=38 ) in women treated for breast cancer . We also investigated relationships between routes of trial recruitment , socio-economic characteristics , health behaviours , cancer treatment regimen(s ) and subsequent adherence to the interventions . Women who had completed breast cancer treatment 12 - 36 months previously were r and omised to one of the groups . The intervention groups attended an exercise facility three times per week for eight weeks . A total of 77 % of the aerobic exercise therapy and 88.9 % of the exercise-placebo groups attended at least 70 % of prescribed sessions . The percentage of women achieving 30min of aerobic exercise per session steadily increased during the intervention but many women were not able to achieve this goal . Routes of trial recruitment , socio-economic characteristics , health behaviours and cancer treatment regimen(s ) were not related to intervention . Exercise therapy participants were able to comply with the progressive nature of the aerobic exercise intervention , although some women were not able to achieve 30min of aerobic exercise per session by intervention completion . Research is still required to tease out all the potential determinants of exercise in this population Purpose This study evaluated the effectiveness of a self-managed home-based moderate intensity walking intervention on psychosocial health outcomes among breast cancer patients undergoing chemotherapy . Methods The r and omised controlled trial compared a self-managed , home-based walking intervention to usual care alone among breast cancer patients receiving chemotherapy . Outcome measures included changes in self-report measures of anxiety , depression , fatigue , self-esteem , mood and physical activity .  Fifty participants were r and omised to either the intervention group ( n = 25 ) , who received 12 weeks of moderate intensity walking , or the control group ( n = 25 ) mid-way through chemotherapy . Participants in the intervention group were provided with a pedometer and were asked to set goals and keep weekly diaries outlining the duration , intensity and exertion of their walking .  Levels of psychosocial functioning and physical activity were assessed pre- and post-intervention in both groups . Results The intervention had positive effects on fatigue ( F = 5.77 , p = 0.02 ) , self-esteem ( F = 8.93 , p ≤ 0.001 ) , mood ( F = 4.73 , p = 0.03 ) and levels of physical activity ( x2 = 17.15 , p = 0.0011 ) but not anxiety ( F = 0.90 , p = 0.35 ) and depression ( F = 0.26 , p = 0.60 ) as assessed using the HADS . We found an 80 % adherence rate to completing the 12-week intervention and recording weekly logs . Conclusion This self-managed , home-based intervention was benef 
    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: Physical activity is associated with improved breast cancer survival , but the underlying mechanisms , possibly including modification of the inflammatory state , are not well understood . We analyzed changes in interleukin (IL)-6 , C-reactive protein ( CRP ) , and TNF-α in a r and omized controlled trial of exercise in postmenopausal breast cancer survivors . Seventy-five women , recruited through the Yale-New Haven Hospital Tumor Registry , were r and omized to either a six-month aerobic exercise intervention or usual care . Correlations were calculated between baseline cytokines , adiposity , and physical activity measures . Generalized linear models were used to assess the effect of exercise  on IL-6 , CRP , and TNF-α . At baseline , IL-6 and CRP were positively correlated with body fat and body mass index ( BMI ) and were inversely correlated with daily pedometer steps ( P < 0.001 ) . We found no significant effect of exercise  on changes in inflammatory marker concentrations between women r and omized to exercise versus usual care , though secondary analyses revealed a significant reduction in IL-6 among exercisers who reached 80 % of the intervention goal compared with those who did not . Future studies should examine the effect of different types and doses of exercise and weight loss on inflammatory markers in large-scale trials of women diagnosed with breast cancer . Cancer Prev Res ; 6(2 ) ; 109–18 . © 2012 AACR To evaluate the efficacy and economic efficiency of a multimedia , multimodal physical activity program for women undergoing adjuvant therapy following surgery for breast cancer . We conducted a r and omized trial with concurrent incremental cost-effectiveness analysis and blinded baseline , 3 , 6 and 12-month follow-up assessment s amongst women undergoing adjuvant therapy following surgery for breast cancer ( n = 89 ) . The intervention was a multimedia , multimodal exercise program comprising strength , balance and endurance training elements . The control was sham flexibility and relaxation program delivered using similar material s. The primary outcome was health-related quality of life ( EQ-5D & VAS , EORTC C30 , BR23 ) . Economic outcomes included direct health care costs and productivity gains and losses . Participants in the intervention group demonstrated greater improvement in health-related quality of life between baseline and the 3-month assessment [ mean ( sd ) EQ-5D VAS ( 0–100 ) baseline : 72.6 ( 15.6 ) , 3 month : 80.6 ( 11.6 ) ] when compared to control group participants [ baseline : 77.5 ( 13.5 ) , 3 month : 74.1 ( 20.6 ) , P = 0.006 ] and also improved more in terms of physical function [ mean ( sd ) EORTC C30 physical function scale intervention ( 0–100 ) baseline : 84.9 ( 14.8 ) , 3 month : 86.9 ( 10.7 ) , control baseline : 91.3 ( 9.6 ) , 3 month : 86.7 ( 14.9 ) , P = 0.02 ] . These improvements were not sustained beyond this point . Upper limb volumes were also lower amongst intervention group participants . However , there was low probability that the intervention would be both less costly and more effective than the control condition ( range probability = 0.05–50.02 % depending on approach ) . Provision of multimodal exercise programs will improve the short-term health of women undergoing adjuvant therapy for breast cancer but are of question able economic efficiency 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 Abstract Objective Exercise interventions benefit cancer patients . However , only low numbers of patients adhere to these interventions . This review aim ed to identify predictors of exercise intervention adherence in patients with cancer , during and after multimodality cancer treatment . Methods A literature search was performed using electronic data bases ( PubMed , Embase , and Cochrane ) to identify relevant papers published before February 1 , 2017 . Papers reporting r and omized controlled trials , conducted in adult cancer patients who participated in an exercise intervention during and /or after multimodality cancer treatment  , and providing outcome of factors predicting exercise adherence were included . Papers were assessed for method ological quality by using the Physiotherapy Evidence Data base scale . Results The search identified 720 potentially relevant papers , of which 15 fulfilled the eligibility criteria . In these 15 studies , 2279 patients were included and 1383 of these patients were r and omized to an exercise intervention .  During cancer treatment , the factors predicting exercise adherence were as follows : location of the rehabilitation center , extensive exercise history , high motivation for exercise , and fewer exercise limitations . After cancer treatment , factors that predicted adherence were as follows : less extensive surgery , low alcohol consumption , high previous exercise adherence , family support , feedback by trainers , and knowledge and skills of exercise . Method ological quality of the included papers was rated “ high ” . Conclusions The most prominent predictors of  adherence to exercise interventions were location of the rehabilitation center , extensive exercise history , high motivation for exercise , and fewer exercise limitations . To increase the number of cancer patients who will benefit , these results should be considered into the development and implementation of future exercise interventions Background We previously reported that a physical activity ( PA ) behavior change intervention based on the theory of planned behavior ( TPB ) increased PA and quality of life in breast cancer survivors . Purpose To examine the effects of our interventions on TPB variables and to determine if PA at 12 weeks follow-up was mediated by TPB variables at 4 weeks . Methods Breast cancer survivors ( N = 377 ) were r and omly assigned to receive either a st and ard public health recommendation for PA ( SR group ) , a step pedometer alone , or one of two TPB-based behavior change interventions consisting of print material s ( alone or combined with a step pedometer ) . For the purpose of this study , we compared the two TPB-based intervention groups ( INT group ) to the SR group . Results Compared to the SR group , the INT group reported more favorable changes in instrumental attitude ( mean difference = 0.13 ; 95 % CI = −0.01 to 0.23 ; d = 0.19 ; p = 0.077 ) , intention ( mean difference = 0.33 ; 95 % CI = 0.10 to 0.56 ; d = 0.33 ; p = 0.006 ) , and planning ( mean difference = 0.39 ; 95 % CI = 0.04 to 0.73 ; d = 0.26 ; p = 0.027 ) . Mediation analyses indicated that both planning and intention partially mediated the effects of the intervention on PA at 12 weeks . Conclusions Our TPB-based behavior change intervention result ed in small improvements in the TPB constructs that partially mediated the effects of our intervention on PA behavior . Additional research with the TPB is warranted AIMS AND OBJECTIVES To explore factors influencing exercise adherence  among women with breast cancer while following an exercise programme .  BACKGROUND Earlier research shows that women with breast cancer decrease physical activity following the cancer diagnosis and that adhering to exercise interventions can be a challenge . Research is needed to identify motivational factors and barriers for exercise adherence among women during treatment for breast cancer . DESIGN This was a qualitative study to explore patient 's perceptions of the challenges to exercise adherence during a r and omised , controlled trial . METHODS Twenty-seven women with early-stage breast cancer were purposively sample d for focus group interviews during 2011 - 2012 from their participation in the exercise intervention group during 2010 - 2012 . Five focus groups were performed , and data analysis was completed using the systematic text condensation method . RESULTS During the focus group study , five main themes were identified , which described factors participants perceived to influence their adherence to exercise during chemotherapy : ' side effects of breast cancer treatment as a barrier to exercise ' , ' restoring and maintaining normality in daily life motivates exercise ' , ' other valued activities compete with exercise ' , ' constructive support enhances exercise ' and ' positive beliefs about efficacy and outcomes motivate exercise ' . CONCLUSION Adherence to exercise in women with breast cancer is challenged by internal and external conditions and may be improved by attention to the impact of treatment side effects and by supporting patient self-efficacy towards changing health behaviour . RELEVANCE TO CLINICAL PRACTICE Nurses should be aware that exercise adherence could be a challenge among women with breast cancer . They should help identify obstacles to exercise for women and ways to overcome them , as well as support them in their beliefs that they are capable of changing their health behaviour We describe adherence to a three group r and omised controlled trial that involved aerobic exercise therapy  ( N=34 ) and exercise-placebo intervention  ( N=36 ) or usual care  ( N=38 ) in women treated for breast cancer . We also investigated relationships between routes of trial recruitment , socio-economic characteristics , health behaviours , cancer treatment regimen(s ) and subsequent adherence to the interventions . Women who had completed breast cancer treatment 12 - 36 months previously were r and omised to one of the groups . The intervention groups attended an exercise facility three times per week for eight weeks . A total of 77 % of the aerobic exercise therapy and 88.9 % of the exercise-placebo groups attended at least 70 % of prescribed sessions . The percentage of women achieving 30min of aerobic exercise per session steadily increased during the intervention but many women were not able to achieve this goal . Routes of trial recruitment , socio-economic characteristics , health behaviours and cancer treatment regimen(s ) were not related to intervention . Exercise therapy participants were able to comply with the progressive nature of the aerobic exercise intervention , although some women were not able to achieve 30min of aerobic exercise per session by intervention completion . Research is still required to tease out all the potential determinants of exercise in this population Purpose This study evaluated the effectiveness of a self-managed home-based moderate intensity walking intervention on psychosocial health outcomes among breast cancer patients undergoing chemotherapy . Methods The r and omised controlled trial compared a self-managed , home-based walking intervention to usual care alone among breast cancer patients receiving chemotherapy . Outcome measures included changes in self-report measures of anxiety , depression , fatigue , self-esteem , mood and physical activity .  Fifty participants were r and omised to either the intervention group ( n = 25 ) , who received 12 weeks of moderate intensity walking , or the control group ( n = 25 ) mid-way through chemotherapy . Participants in the intervention group were provided with a pedometer and were asked to set goals and keep weekly diaries outlining the duration , intensity and exertion of their walking .  Levels of psychosocial functioning and physical activity were assessed pre- and post-intervention in both groups . Results The intervention had positive effects on fatigue ( F = 5.77 , p = 0.02 ) , self-esteem ( F = 8.93 , p ≤ 0.001 ) , mood ( F = 4.73 , p = 0.03 ) and levels of physical activity ( x2 = 17.15 , p = 0.0011 ) but not anxiety ( F = 0.90 , p = 0.35 ) and depression ( F = 0.26 , p = 0.60 ) as assessed using the HADS . We found an 80 % adherence rate to completing the 12-week intervention and recording weekly logs . Conclusion This self-managed , home-based intervention was benef 
    Output:
    