2.3. YOUEX Exercise Intervention Modules
Cancer, cancer, Tumor, cancer-
CANCER, DISEASE, TUMOR, CANCER
Patients who fulfilled the inclusion criteria and provided informed consent received a comprehensive exercise consultation via phone or in person at the exercise department of the National Center of Tumor Disease (NCT), Heidelberg, or the department of sports medicine at Charité—Universitätsmedizin, Berlin. In the first consultation, study coordinators collected information about the cancer diagnosis and therapy, cancer- and cancer-treatment-related side effects, medical history, past and current physical activity levels and patient’s preferences to exercise. Further, they explained to the participants that they were free to choose one of three different exercise programs. The different modules were developed in exchange with the German Foundation for Young Adults with Cancer. Based on a survey that was carried out by the foundation and asked young adults for their wishes regarding different exercise options, the following three modules were developed:Module 1 (M1): supervised, group-based, online exercise program once a weekModule 2 (M2): unsupervised, individual home-based training with an online-training app at least once per weekModule 3 (M3): participation in a supervised, in-person exercise program close to place of residence at least once per weekAt baseline (T0), patients choose one of the three exercise modules. The selected module had to be followed obligatory for the first six weeks. After 6 weeks (T1), the initial module could be replaced or amended by another study module. This or these selected module(s) had to be followed for another six weeks. The same procedure was repeated after 12 weeks (T2) of the exercise intervention. The main intervention ended after 12 weeks (T2). Thereafter, participants could voluntarily maintain one or up to three modules for another unsupervised 12-week time period. The follow-up ended at the 24-week time point (T3).The supervised M1 took place once per week at a fixed, pre-scheduled time, via an online video conference platform. The training sessions lasted 60 min. They always started with a general 10 min warm-up, followed by a 40 to 45 min workout with specific exercises and finished with a 5 to 10 min stretching or relaxation part. The main workout focused on a different aspect of exercise each week (e.g., resistance training for lower extremities, sensorimotor training, home-based endurance training). The aim was for the YAs to learn exercises that they could do independently at home. For participants starting with M1, the study coordinator further recommended independent physical activity, such as walking or cycling, 1–2 times per week or to maintain the current volume of PA. Exercise recommendations for M2 were personalized and included primarily a combination of endurance and resistance training, 2–3 times a week, depending on the patient’s needs. Endurance training should be performed with moderate intensity for at least 30 min duration (or less, if the patient needed to adopt the exercise recommendations due to their current health status). The type of endurance exercise (e.g., walking, cycling, swimming) was chosen according to the individual interest of the patient. Resistance training consisted of various strength exercises for the large muscle groups (at least two each for lower and upper extremities and two for trunk muscles) and was aimed to improve muscular strength. Additional types of exercise (e.g., sensorimotor training) were added if therapy-related side effects were present. If necessary, exercise trainers conducted one introductory training session as a video conference to check for exercise techniques and answer any individual questions. Thereafter, M2 was executed as application-guided home-based intervention. M3 was executed in a certified exercise facility of the network OnkoAktiv and supervised by special qualified exercise trainers. The weekly recommendation was to participate in a personalized in-person exercise program 1–2 per week plus independent physical activity (or to maintain the current level of PA). Evolution of the training load was recommended in each of the three modules if this was possible for the patients.Due to the differences in the three modules regarding frequency and content, the overall exercise recommendations in all study modules were guided by the present exercise guidelines of the ACSM, aiming to reach at least 150 min of moderate PA per week plus two strength-training sessions per week [