4.2. Module Selection and Exercise Preferences
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The evaluation of module selection at baseline showed the highest interest in module 2 followed by module 1. However, the strong influence of the COVID-19 pandemic and the comprehensive restrictions have had a high impact on module selections. Since module 3 could not be offered during the majority of the study period, no clear statement can be made about the actual interest in the in-person exercise program. Nevertheless, the hypothetical question about module interest under COVID-19-free circumstances showed very high interest in M3. At the same time, study participants showed high interest in both online modules (M1 and M2). After 12 weeks, more YAs participated in the individual home-based program M2 than the fixed group-based program M1. The most named reasons for choosing M2 was the flexibility in terms of time and individual training programming, whereas M1 was chosen because of the fixed training date and being motivated by others.Further, the module changes at T1 highlighted interesting findings. Less than half of the participants changed their initial module. The amendment or replacement of modules were related to different reasons such as increasing the physical activity, interest in other modules or the wish to receive more individual advice by exercise trainers. Interestingly, despite the possibility to amend the initial module, no increase in PA could be determined between T1 and T2. Overall, comparing the two online modules, M1 (supervised, group-based online exercise program) was less popular than M2 (home-based individual training via app). Around 60% of those who chose M1 at baseline decided to amend or replace that module after 6 weeks. Compared to M2, only around 30% wanted to replace or amend that module. All in all, only around 20% of the YAs took part in two different modules during the 12-week intervention. Adams and colleagues outlined in their study with 533 AYA that the majority of patients preferred home-based (79%) and online (47%), but less hospital-based (25%) programs. Further, a significant higher proportion of AYA preferred individually supervised programs (82%) rather than group-based programs (63%). Interestingly, most AYA preferred to exercise ≥30 min on ≥3 days per week [Our analysis highlights that exercise preferences of YAs are highly individual and diverse. First of all, the demography of patient characteristics showed the high variety of different diagnosis, treatment status, employment status, family situations and physical activity levels among YAs. At the same time, the given reasons for choosing a module or for not choosing a module were very diverse, some were even contradictory (e.g., flexibility in terms of time vs. fixed training dates). The subgroup analysis in which patient characteristics of the three different module groups were examined, brought only little insights. A significant correlation between treatment status and module selection was found. YAs undergoing acute therapy seem to prefer supervised training; however, due to the little sample size, non-randomization and limitations in the context of COVID-19 pandemic, we cannot conclude any clear statement about which exercise program fits the individual treatment status. Further, neither employment status nor physical activity level, distress or social media usage behavior seemed to have a definite influence on module selection. We therefore conclude that in order to be able to respond to different needs of YAs, a wide range of exercise programs must be created.