Intervention programs and exercise details
shoulder girdle, ®, fatigue, pain
ADVERSE EVENTS, PROGRESSION
The intervention program for both groups was a supervised multi-modal workout. The exercise plan for both groups is provided as supplementary material (Online Resource The strength exercises were divided into two categories: upper extremity (UE) and lower extremity (LE). To avoid under- or overstrain, the participants were required to perform a minimum of three and a maximum of five exercises of each category. The strength exercises were:UE: seated rowing, chest press, butterfly reverse, lat. pulldown, straight arm-pulldownLE: leg extension, back extension, abductor, leg curls, leg pressFor each exercise, two sets of 15 repetitions were trained with a 30-s rest between sets. Exercise intensity was determined by the patient’s ability. The goal was to achieve a moderate to vigorous level, corresponding to perceived exertion of 13–15 on the Borg scale. Progression was achieved by increasing the initial weight. All participants were instructed to gradually increase the weight by a maximum of one level per session. All strength exercises were performed on MILON® Premium Med devices, with one exception: straight arm-pulldowns were conducted using a cable machine. Unlike conventional devices, Milon® devices are electronically controlled and require an additional retraction weight to be moved during the eccentric movement. Due to chip card control, all Milon® devices adjust individually to the user after initialization (ergonomic and weight settings). The chip card was also used to record training progression and document the devices used in every session.In addition, a balance board (Posturomed®) was used for exercises as part of the training. The participants had to keep their balance for 10–20 s while standing on one leg. The device can be set to three levels of difficulty (1–3), where 1 means “rather easy” and 3 means “rather difficult.” This exercise had to be performed twice to three times with each leg. At the end of each training session, all participants had to use a ball (Blackroll®), Duoball (Blackroll®) or fascia stick to stimulate the muscles and fascia of the shoulder girdle. Some studies confirm the positive correlation between the use of muscle rollers and improved body mobility and increased range of motion [Participants of the intervention group also completed mobility training, which comprised mobility exercises for the torso and shoulder girdle on five different devices (FIVE ®). They are provided as supplementary material (Online Resource All exercises were performed individually and supervised by at least one qualified sport therapist who provided corrections and instructions. Adherence to exercise was monitored and documented by the supervising sport therapist. There were no adverse events reported during the intervention period, except for a general state of fatigue in both groups and stretching pain during the flexibility exercises in the intervention group. Subjects in both groups were requested to follow only the exercises assigned to their group and to not make any changes in their exercise behavior during the study period. However, in accordance with a holistic approach to therapy, the participants also attended further complementary therapy programs (pilates, water aerobics, disease-specific group training, Nordic walking) and counseling services (return-to-work and nutritional counseling).